Flashcards in 3/23 GI and Renal Deck (104):
Hemophagocytic lymphohistocytosis (HLH)
AR defect in perforin-related genes or linked to EBV infection.
Over active immune system attacks bone marrow, liver and brain in little kids
see macrophages engulfing RBCs
Signs and symp of Diffuse liver injury with no signs of cirrhosis
Steatosis, acute inflammatory infiltrate
accumulation of eosinophilic material in hepatocytes
During thoracentesis why insert needle on the lower margin of the intercostal space
To avoid stabbing the intercostal a, n, v
Mutation in Duchenne muscular dystrophy
X linked FRAMESHIFT
(out of frame)
dystrophin gene (usually anchors muscle fibers to extra cellular matrix
Mutation in Becker muscular dystrophy
x-linked NON frameshift (in-frame deletions)
Myotonia, muscle wasting, cataracts, testicular atrophy, frontal balding
Myotonic type 1
MY Tonia My testicles, My toupee, My ticker (arrhythmias)
Drugs that cause malignant hyperthermia
Sevoflurane, Desflurane, isoflurane, succinylcholine
IV drug user with leukopenia, diffuse powdery interstitial infiltrates and + Methenamine silver stain
Tx for pneumocystis jirovecii
MOA: Block folate synthesis at pteridine and PABA nucleotide formation
Forehead lesion with palisading nuclei
Basal cell carcinoma
What does basal cell carcinoma look like
Pink, pearly nodules with telangiectasis, rolled borders and central crusting
SE of haloperidol
Acute dystonia (first several hrs)
Akinesia (first several days)
Tardive dyskinesia (mo)
Acute respiratory acidosis
normal or slightly elevated HCO3 (
inheritance of classical galactosemia
inheritance of lesch-Nyhan
X linked recessive disorders
Be Wise, Fool's GOLD Heeds Silly HOpe
Duchenne (and Becker)
Hemophilia A and B
Ornithine transcarbamylase def
Where is the majority of water reabsorbed in the kidneys?
(depending loop-20%; DT and CD 20%)
Where is K+ reabsorbed?
66% in the PT
25-30% thick ascending loop
where is K+ levels regulated?
Alpha intercalated cells of the collecting tubules
Depletion of K+ stimulates alpha intercalated cells to reads K+
Increased K load stimulated principal cells to secrete K+
Who gets IgA nephropathy?
children (hence-schonlein purpura)
Episodic hematuria with RBC casts
Triad and cause of HSU
Triad: anemia, Thrombocytopenia, acute renal failure
Due to micro thrombi forming on damaged endothelium
With GI illness
Thrombocytopenia thrombotic purpura-HUS
A thrombotic microangiopathy
Fever, neuro symptoms, renal failure, anemia, thrombocytopenia w/ GI illness
Normal PT and aPTT
Thrombotic microangiopathy syndromes
TTP-HUS and DIC
Put activation in arterioles and caps
diffuse microvascular thrombosis (brain, kid, heart)
microangiopathic hemolytic anemia with schistocytes
What is the most important poor prognostic factor for PSGN?
Increased age of onset
Also pre-existing kidney disease
Eosinophilic glassy casts
(or chronic pyelonephritis but they resemble thyroid tissue)
Cause of acute interstitial nephritis
Penicillin, NSAIDs, PPI, sulfonamides, diuretics
See eosinophils in pee, fever, rash, acute renal failure
Gross painless hematuria in an older adult
Urinary tract cancer (urothelial or RCC)
Renal cell carcinoma histology
Clear cells--> filled with glycogen and lipids
Lipid peroxidation associated with...
inflammation, atherosclerosis and tumorigenesis
how is PAH secreted?
Carrier protein mediated process so it can be saturated at high blood concentrations
membranous nephropathy, flank pain, gross hematuria, right-sided varicocele, elevated lactate dehydrogenase
Renal vein thrombosis
What does a isolated right-sided varicocele indicate?
IVC occlusion by a malignant tumor or thrombus
Inherited--> only a problem if give heparin (increased PTT)
Acquired--> renal failure/nephrotic syndrome--> antithrombin loss in urine--> decreased inhibition of factors IIa and Xa
Risk factor for calcium kidney stones?
Idiopathic but maybe:
Increased GI abs
increased mobilization from bone
Decreased renal tubular Ca reabs
Other risks: hyperoxaluria, hyperuricosuria, low urine volume, hypocitraturia
Why patients with calcium stones remain normocalcemic
intact regulation of serum Ca by Vit D and PTH
Associations with renal papillary necrosis
Sickle cell dz and trait
Difficulty starting and maintaining stream of urine + nocturnal enuresis and daytime uncontrolled voiding w/o feeling a full bladder
impaired detrusor contractility or bladder outlet obstruction
can be due to DM neuropathy
Which fluids increase in concentration along the proximal tubule? which decrease?
increase: PAH, creatinine, insulin, urea
Decrease: Bicarb, glucose, aa
primary virulence factor of E. coli causing UTIs
allows adhesion to uroepithelium
Found on chylomicrons and VLDLs--> responsible for up take
NOT on LDL
deficiency--dysbetalipoproteinemia (palmar xanthomas and premature atherosclerosis)
Extrinsic clotting pathway factor
alcoholic who has increased PT and no improvement from K+ supplement
Liver disease: Inability to make VII because of liver cirrhosis
HPV viral protein E6 and E7 roles
E7--inhibits Rb gene
Inactivated flu vaccine effect
inducing neutralizing Ab against HA antigen--> inhibit viral entry into cell by inhibiting HA binding to salivated receptor membranes
Tumor markers for Small cell carcinomas
Neural cell adhesion molecule (CD56)
where does the left temporal hemiretina send visual signal?
Left lateral geniculate body of the thalamus
Secretion via exocytosis
Eccrine sweat glands
Cells secrete via membrane bound vesicles
Cell lysis releases entire content of the cytoplasm and cell membrane
Pure red cell aplasia
marrow failure (rare)
sever hypoplasia of marrow erythroid elements with normal granulopoiesis and thrombopoiesis
associated with thymoma, lymphocytic leukemias, parvovirus B19
what happens to sickle cell pt spleens?
early adult: repeated splenic infarctions--> scaring, fibrosis and atrophy
Infants will get splenic sequestration crisis--> enlarged spleen + Hbg decrease + hypovolemic shock
anemia with high MCV low reticulocyte index
Folate or B12 deficiency
low RI--Not making enough blood
Extramedullary erythropoiesis less likely b/c that would have high RI
Signs and symptoms of biliary track obstruction
dark urine (bilirubinuria)
Hypercholesteremia with xanthomas
steatorrhea + malnutrition
Binds fibrin in thrombus
converts trapped plasminogen to plasmin
Shigella and SL toxin
inactive 60s ribosome--> remove adenine from rRNA
aa needed for purine synthesis
Glutamate, glycine, aspartate
what type of lung disease develops in sarcoidosis
Interstitial lung dz
Pathophys of sarcoidosis
Dysregulation of CD4+ Th
Why hypercalcemia in pts with sarcoid?
increase of 1 alpha hydroxylase mediated vitamin D activation in macrophages--> increased absorption of Ca and phos from the GI tract (down reg PTH)
hyper stabilize polymerized microtubules in M phase so they CANNOT break down
ovarian and breast carcinoma
what to monitor after starting heparin?
aPTT and plt count (risk of Heparin induced thrombocytopenia (HIT))
Causes of calcium oxylate stones
vit C abuse
testing for syphilis
Nonspecific VDRL/RPR-->Cardiolipin testing (found in inner mitochondrial membrane)
osteogenesis imperfect leads to
problem forming collagen triple helix
Where are class II MHC
On antigen presenting cells
normal looking female with little sexual hair and no uterus
Androgen insensitivity syndrome (46 XY)
primary amenorrhea in a female with fully developed secondary sexual characteristics, short vagina and underdeveloped uterus
Mullerian aplasia (46, XX)
defective development or congenital absence of uterus
Infertility in primary ciliary dyskinesia vs. CF
Primary ciliary dyskinesia-->immotile spermatozoa (situs inversus)
CF--> absent vas deferens bilaterally (azoospermia)
what decreases a pts risk of ovarian neoplasm?
tubal ligation, sapling-oophorectomy
what increases a pts risk of ovarian neoplasm?
genetics (BRCA1 or BRCA2, Lynch syndrome)
Marker for ovarian epithelia
Treatment for PCOS
Estrogen receptor modulation (clomiphene)
if not wanting to be pre: estrogen-progestin OCP
Antagonist at estrogen receptors in hypothalamus--> blocking negative feedback
increase LH and FSH production
tx for PCOS
risk of prostatectomy
Erectile dysfunction from damaging the prostatic plexus and cavernous nerves
dysmenorrhea, menorrhagia, uniformly enlarged soft globular uterus
Adenomyosis --> extension of endometrial tissue into uterine myometrium
Tx: GnRH agonist (leuprolide)
The deep inguinal ring is an opening in what?
The superficial inguinal ring is formed by an opening in...
The external oblique muscle aponeurosis (above and medial to pubic tubercle
Causes of polyhydramnios
impaired fetal swallowing: anencephaly, GI obstruction
Increased fetal urination: high fetal CO (alloimmunization, parvovirus, fetomaternal hemorrhage)
47 chromosomes, male, behavioral issues, mild intellectual disability
Klinefelter syndrome (47, XXY)
Primary testicular failure (atrophy)--> increased FSH and LH low T
eunuchoid body shape
post hysterectomy fever and flank pain
Have to ligate the uterine vessels that run in cardinal ligament during hysterectomy
presentation of a sertoli-Leydig ovarian tumor
adnexal mass with amenorrhea and virilization (hirsutitism etc)
increased T from sex-cord tumor
usually young women
Central chemoreceptors response
Respond to pCO2 changes
drop in pCO2-->vasoconstriction--> increasing vascular resistance and decreasing CBF
are the delusions always accompanied by mania or depression?
Yes-->major depressive disorder or bipolar disorder wth psychotic features
no--> Schizoaffective disorder
What is the pathogenesis of TB in the first week?
TB enters lungs and gets gobbled up by Macs where they use sulfatide virulence factor to proliferate inside the mac. Then they lyse the mac and continue the process.
Week 2-4 involved interferon secretion by activated T lymphocytes
Primary polydipsia on a water deprivation test
Serum Na LOW
urine osm after water deprivation: increased
after addition of vasopressin: no additional increase
Where does Hep C get its envelope?
Budding through the plasma membrane of the host cell
where does CMV get its envelope?
Budding through the host cell nuclear membrane
How is metabolic acidosis compensated?
Calculate compensation using winter's formula
if have respiratory acidosis on top of metabolic acidosis-->respiratory failure
Where and what do enhancer sequences bind?
Where: upstream, downstream or w/in transcribed genes
bind to activator proteins
Where are promoter regions?
25-75 bases upstream and initiate transcription
where is a poly A tail found?
on mature mRNA 3' end
In skeletal muscle what is the thin myofilament? What band is it the only part of?
I band (containing the Z line)
In skeletal muscle what is the thick myofilaments? what band is it the only part of?
H band (straddles the M line)
sustained, involuntary muscle contractions
Most common: spasmodic torticollis (cervical dystonia)
second most common: blepharospasm (closure of the eyelids)
sudden brief, sometimes severe (shock-like) muscle contraction
lab findings in lupus
decreased C3, C4 and CH50
post giving birth hypoxia, hypotensive shock and DIC
Amniotic fluid embolism
see fetal squamous cells in pulmonary vasculature
Where does thoracic outlet syndrome occur?
W/in scalene triangle
(anterior + middle scalene+ first rib)
brachial plexus and subclavian artery pass between anterior and middle scalene
Consequences of fibroids (leiomyoma)
reproductive issues (submucosal or intramural)
Prolonged menstrual bleeding
Subserosal can lead to bulk-related symptoms (constipation if posterior down and obstructive urinary if posterior and pushing up)
Pelvic pressure, constipation, normal uterus
Posterior vaginal wall prolapse (rectocele)
Location of osteomyelitis in children
from transient bacteremia
Location and cause of osteomyelitis in adults