Path shelf - deck 1 Flashcards by Desiree Nieves

Profound diarrhea, unicellular acid fast creating oocytes. Infectious cysts can be passed in watery stool

Cryptosporidum / HIV, IC

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Transmitted via spores, DKA predisposes to infection. Hyphae are non-septated with 90’ degree angle branching. Can cause black eschar and necrosis of nasal cavity/eyes with neuro defects -> death.

Murcor – Rhizopus

DM, IC

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Strawberry cervix, cervicitis – burning, itching, malodorous with yellow/green discharge. Diagnosed via wet mount showing motile trophozoits – Treatment Metronidazole

Trichomonas

Sexually Transmitted

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Psuedohyphae at 25C, germ at 37C (opp of mold in the cold, yeast in the heat), Catalase +; increased susceptibility in CGD, Diaper rash, inhaler for corticosteroids, KOH prep oral candida, AIDs defining illness MAX CD4 100 -

Candida

IC, CGD, HIV, DM

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ssDNA, naked virus (smallest virus). Transmitted via respiratory droplets causing “slap cheek” or 5th disease – starts on face and moves down. Adults – joint pain, arthritis, soreness. En Utero baby can cause hydrops fetalis.

Sickle cell patient can cause aplastic anemia due to shut down of BM.
Thalassemia B Major: Aplastic crisis
Spherocytosis: Can cause aplastic crisis

Parvo B19

Sickle Cell, Hydrops

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Spirocytes – can cause lyme disease, erlichosis, bubesiosis. Do not gram stain. Wright/Giemsa used for diagnosis.
Stage 1: Target lesions with Bulls eye rash – chronic migrains, fever, papule -bite
Stage 2: Heart block – myocaridits, bilateral bells palsy
Stage 3: Joint pain, arthritis, migratory arthritis, meningitis, encephalopathy
Treatment: Doxycycline (stage 1), Ceftriaxone

Borrelia Burgdorferi

Tick Exposure

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Coughing, macrophages with intracellular oval bodies. Histoplasma much smaller than RBCs. Can cause granulomas which look similar to TB – have calcification of hilar lymph nodes. IC can cause hepatosplenomegaly. KOH used for diagnosis .With nucleus = histoplasma (without = coccid)

Histoplasma

Bird/Bat droppings
IC

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Severe hemorrhagic colitis by O157 H7 most commonly from undercooked beef. Symptoms: bloody diarrhea. Does not ferment sorbitol. Shiga like toxin can cause hemolytic uremic syndrome which damages endothelial cells of capillaries and glomerulus -> Thrombocytopenia and platelet clumps

EHEC

Raw Hamburger

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Cysts of giardia (flagellated) from feces in unfiltered water – bloating, flactulence, and foul smelling diarrhea (steatorrhea). Deficiency in DEAK due to this. Treatment: Metronidazole

Giardia Travels/Campers unfiltered water

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Grows green colonies - Induces M cells in peyers patcheert6 s to phagocytose them and escape. Then use host actin cytoskeleton to create a tail and propel itself from one another. Damages tissues to release cytokines that will watery -> bloody diarrhea. Leads to Hemolytic uremic syndrome in children <10 y/o with acute renal damage and schistocytes. Treatment: Macrolide/Fluoroquinolone.

Shigella

Fecal/Oral

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Gram – non-lactose fermenter, motile, H2S positive with black colonies. Undercooked chicken -> inflammatory diarrhea.
Typhi: Typhoid Mary – Harbored in gallbladder, stayed longer in stool with antibiotic use. #1 cause of osteomyelitis

Salmonella Raw chicken OR
Human Source
Osteomyelitis Sickle cell

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Ammonium magnesium phosphate stone – Ammonia urease + which makes staghorn calculi to struvite stones causing pain and kidney stones. Symptoms: fishy odor, UTI, pain. H2S +

Proteus

Staghorn Kidney

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Attracts neutrophils along with IL-8, C5a

LTB4 Chemotaxis

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Underdeveloped 3/4th pharyngeal pouch - Thymic hypoplasia, recurrent infection and hypocalcemia due to decreased parathyroid. LOW T cells.

Digeorge Syndrome:

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XLR Male – LOW T cells. Deficiency of CD43 on T lymphocytes and platelets causing eczema, thrombocytopenia – petechiae, recurrent bacterial infections. Increased risk for pneumococcal infections. T cell depletion.

Wiscott Aldrish Syndrome:

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6 months old male – recurrent pyogenic bacteria. B cells don’t mature. No ab in the blood. Absent germinal centers due to no plasma cells. Increased infection with Strep, staph, giardia, enteroviruses.

X-Linked Agammaglobulinemia or Brutons:

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boy or girl with low levels of B cells. Increased risk of autoimmune diseases – Increased risk for giardia infection.

Common Variable Immunodeficiency:

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Most common. Most patients are asymptomatic. Involve GI, urinary, and respiratory. BLOOD transfusions -> anaphylactic reaction

Isolated IgA deficiency:

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Defect in humeral/T cell immunity – Hypoplasia of LN and thymus – Risk of bacterial, fungal, and viral infection. NEED A BM TRANSPLANT for survival. 50% have X linked inheritance.

Severe Combined Immunodeficiency:

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Mutation of CD40/L leading to low signals and no differentiation – Low to no IL-4/IL-5. Low IgA, IgG, IgE – recurrent pyrogenic infections at mucosal sites

Hyper-IgM Syndrome:

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Increased risk of Neisseria infection

C5-9 Deficiency:

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Hereditary angioedema (periorbital edema)

C1 inhibitor deficiency

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AIRE mutation – failure of central tolerance. Autoimmunity to endocrine glands. Hypoparathyroidism, adrenal failure, chronic candida infections of skin and oral mucosa

Autoimmune Polyendocrine Syndrome

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(ALPS) Mutation FAS/L – breakdown in peripheral tolerance. Self reactive lymphocytes -> Cytopenia, lymphadenopathy, hepatosplenomegaly. Can progress to lymphoma

Autoimmune Lymphoproliferative Syndrome

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Mutated FOXP3. Thyroiditis, type I DM, Diarrhea, eczema

IPEX

* Increased vascular permeability, pain, vasodilation, bronchoconstriction * Mediators of pain: Bradykinin, PGE2

Bradykinin – Pain

IL-6 Secreted by Mo. Important mediator of fever and acute phase response. Is capable of crossing BBB and initiating PGE2 causing activation in hypothalamus. Increased production of No in the bone marrow.

IL-6

• Produced by many different lymphocytes in the body. Found in epithelial cells causing increased diapedesis at site of need. Can cause fever and activation of hypothalamus. Also can cause increased sensitivity to pain, vasodilation, and hypotension. Seen most often in shock.

IL-1, TNFa

Transmembrane protein of Toll-like receptor family – activation of NFkB and inflammatory cytokine production for activation of the immune system. It is well known for recognizing lipopolysaccharide of gram – bacteria. LPS bind CD14. Causing binding of TLR4-MD2 protein -> dimerization. LPS recognition causes conformational change of TLR4 receptors results in recruitment of intracellular domains. Causes release of pro-inflammatory cytokine signaling -> IL-1, TNF, IL6.

TLR4

``` collagen Type 1: Type 2: Type 3: Type 4: ```

* Type 1: Bones – most common increased in tensile strength * Type 2: Cartilage * Type 3: Granulation tissue, embryonic tissue, uterus – stretchy material * Type 4: Basement membrane

collagen Scar formation steps

• Scar: Granulation tissue causes increased 1) Fibroblasts (Collagen 3), 2) Capillaries (increased nutrients), 3) Myofibroblasts (contraction of wound making scar smaller). Scar formation Type I collagen -> Type III collagen via collagenase requiring Zinc as a cofactor. Stimulation of collagen formation via FGF/VEGF angiogenesis.

collagen delayed wound healing

infection, vitamin C deficiency, Cu (lysl oxidase) deficiency, Zinc deficiency.

collagen hypertrophic scar

Increase in Type 1 collage.

collagen keloid

usually located behind ear in AA, increased Type 3 collagen

Vasodilation, fever (PGE2), inhibits platelet aggregation – produced by vascular endothelium

• Prostaglandin

Vasodilation – produced by vascular endothelium

• Prostacyclin

Inhibits platelet aggregation, vasoconstriction

• Thromboxane A2

Bronchoconstriction, LTB4 attracts neutrophils

• Leukotrienes

rejection = minutes to hours, type II HSR. No accumulation causing kidney cortex damage – pale infarct.

hyperacute

days – 3-4 months (uncommon years rejection

acute rejection o Cellular: Most common; extensive inflammation with lymphocytes, plasma cells. Responds to steroids. o Humeral: Kidney cortex damage same as hyperacute. DOES NOT respond to steroids.

rejection = 6months – years, atrophy of blood vessel with endothelial cell hyperplasia. Compromise of lumen. SLOW NARROWING – chicken fat like. SLOW rise of BUN/Creatinine.

chronic rejection

Graph tissue is attacking the host (BM transplant >>). Host is going to be immunocompromised. Graph attacks – skin, GI, liver. Liver damage – abdominal pain, jaundice, edema ect. Bilirubin will build up in the liver. Increased AST/ALT with pruritus due to increased bile salts.

graph vs host

• IL-1/TNF from macrophage causes increased COX2 expression leading to increased PGE2 expression. Activation of perivascular cells of the hypothalamus leading to fever

Prostaglandin

Butterfly rash worsens with sunlight, hematuria, HTN, glomerulonephritis, lumpy bumpy pattern on IF, pericarditis, Libman Sacks endocarditis, arthritis whats the autoantibody and disease?

SLE | Anti-DsDNA and Anti-Smith

Isoniazid, Hydralazine, Procainamide | whats the disease related and auto antibody ?

Drug Induced Lupus =Anti-Histone

Proximal weakness of muscles, elevated CK | Disease related and AB?

Polymyositis | Anti-Jo-1

Proximal weakness of muscles, rash, periorbital heliotrope rash (similar to SLE) elevated CK Disease related and AB?

Dermatomyositis Anti-Jo-1

Overlap of all disorders – commonly Joint pain, swelling, Raynaud phenomenon, sclerodactylyl, dry mouth/eyes disease related and AB?

Mixed Connective Tissue Disease | Anti-U1-RNP

Anti-Smooth Muscle, Anti-LKM

Autoimmune Hepatitis

Anti-CCP

Rheumatoid Arthritis

Raynauds, respiratory distress – restrictive lung disease, dysphagia – gastric reflux, kidney involvement malignant HTN, pericarditis with fibrosis, arrhythmia, Sclerodactyl

Scleroderma (diffuse) | Anti-Scl-70

``` C: Calcinosis – Calcium deposits R: Raynauds E: Esophageal dysphagia S: Sclerodactyl T: Telangiectasia – dilation of small blood vessels ```

CREST Scleroderma (limited) Anti-Centromeric Ab

Fibrosis of lacriminal and sweat glands. | Increased risk lymphoma

Sjogrens Anti SS-A/SS-B

ANCA

Autoimmune Vasculitis

``` Chromosomes: C-myc? cyclin D? RB? Ig Heavy chain? p53? ```

``` C-myc? 8 cyclin D? 11 RB? 13 Ig Heavy chain? 14 p53? 18 ```

• IgA deficiency has anti IgA Ab in their serum. Which can cause anaphylactic reaction after blood transfusion. Use washed RBCs to avoid anaphylactic reaction

IgA/ABO Blood Transfusion

• S100+ Tanning bed has highest increased risk, Radial growth -> vertical growth. >>6mm, irregular borders, color changes. Vertical growth important for metastasis. Types melanoma en situ, superficial spreading (radial growth) and lengio maligna have good prognosis. Acral (hands and feet) and nodular have poor prognosis

Melanoma

• Also known as Buerger disease associated with smoking. Necrotizing vasculitis of the digits leading to ulceration, gangrene, and auto-amputation of the digits. Can also present with Raynauds phenomenon.

Thrombosis Obliterans:

• Granulomas with involvement of lung and heart. Often present with asthma, p-ANCA, and eosinophilia.

Churg Strass Syndrome

Most common vasculitis in children – due to IgA deposits. Symptoms: palpable purpura on buttock and legs s/p URI with hematuria. Often following B19 infection.

Hench Schonlein Purpura

rening/ angiotensin 2

Low blood pressure, stenosis of renal artery, decreased Na delivery to macula densa, increase sympathetic tone -> release of angiotensinogen. Converted to Angiotensin I in the liver. Angiotensin II in the lung by ACE. Angiotensin II causes o Increased aldosterone secretion: Na retention, K+ excretion o Vasoconstriction of efferent arteriole

causes of renal stenosis

Renal Artery Stenosis • Can result in narrowing of the renal artery -> decreased blood flow to the kidney -> HTN. • Causes: o Atherosclerosis: hardening of renal arteries and narrowing with plaque. o Fibromuscular Dysplasia: Females <40, abnormal growth within the wall of the artery. 2’ HTN with abdominal bruit on auscultation.

causes of right sided heart failure?

Right Sided Heart Failure (RSHF) • Causes: Left heart failure (most common), pulmonary HTN, left -> right shunt, chronic lung disease (cor pulmonale) • Symptoms: JVD, painful hepatosplenomegaly, pitting edema or pedal edema

Holosystolic high pitched blowing murmur greatest at apex which radiates what is the murmur and what are some causes?

Mitral Regurgitation Holosystolic Murmur • Causes: Rheumatic fever, Infective endocarditis, LV dilation, papillary muscle rupture after MI o Rheumatic fever: S. Pyrogenes – M proteins against tissues (molecular mimicry). Chronic RF -> M. Stenosis o Subacute infective endocarditis: S. Viridans

Holosystolic, harsh sounding murmur – loudest at the tricuspid area what is the murmur and what are some causes?

VSD | • Most common congenital heart defect. Associated with fetal alcohol syndrome.

• Fever, night sweats, weight loss, new or exacerbated murmur – can cause septic embolism, Janeway lesions – on hands and toes, Ouch ouch osler – painful nodes, anemia of chronic disease

endocarditis

High virulence – large vegetation’s. Most often tricuspid valve. Gram + cocci, coagulase +, ferments mannitol

S. Aureus IVDA

ALWAYS CHECK – with this more likely to have colorectal carcinoma

S. Bovis =Colorectal carcinoma

Gram + cocci, coagulase -, does NOT ferment mannitol

S. Epidermatis Indwelling catheter

Most common overall cause – infects previously damaged valves. Low virulence. Gram + cocci, Coagulase -.

Strep. Viridans Subacute: underlying valve disease

Gram + cocci, bile salt tolerant, efflux pump, Lancefield D+

Enterococcus Indwelling catheter

Gram – rods | Negative blood cultures

``` HACEK Hemophilus Acintobacillus. Cardiobacterium Elkenella Kingella ``` Oral Flora

Yeast producing pseudohyphae

Candida Albicans Nosocomial, Indwelling Catheter

Feces from Reduvid bug causing dilated cardiomyopathy, arrthymia, elevated CRP

Typanosoma Cruzi Reduvid bugs – Kissing bug

Vegetation’s on both sides of the valve

Libman Sacks Endocarditis LPS – Lupus

* Symptoms: decreased CO, diastolic dysfunction – unable to fill the heart, Syncope during exercise * Histology: Myofibril disarray

Hypertrophic Cardiomyopathy | • Genetic mutations in the sarcomere proteins (AD) – leading to massive hypertrophy

• Primary tumor of the heart in children/infants associated with tuberous sclerosis usually in the ventricle •

Rhabdomyoma: | • Histology: Striated muscle with mass

• Symptoms: Fever, chills, pleuritic chest pain – expansion of lung, elevated WBCs

Pneumonia • Damage to mucociliary escalator can cause increased risk of pneumonia, mucous plugging. • Symptoms: Fever, chills, pleuritic chest pain – expansion of lung, elevated WBCs • Types: Lobar, Bronchopneumonia (dots) – bacteria; Interstitial (increased lung marking) – Virus • Type II pneumocyte – will help regenerate damaged lung tissue

95% of lobar pneumonia – most common cause of community acquired.

S. Pneumoniae Lobar Pneumonia

Affects malnourished, elderly, alcoholics, DM – gelatinous sputum (thick current red). Thick mucoid capsule. Most commonly complicated by abscess.

Klebsiella Lobar Pneumonia

Most common cause of 2’ pneumonia – often complicated by abscess

S. Aureus Bronchopneumonia

pneumonia Common in COPD

H. Influenza Bronchopneumonia

pneumonia Common in CF

Pseudomonas Bronchopneumonia

pneumonia Common community acquired and COPD exacerbation

Moraxella Bronchopneumonia

pneumonia Common community acquired, COPD exacerbation – transmitted from water source which is an intercellular organism visualized on silver stain

Legionella Bronchopneumonia

pneumonia Most common cause – young adults, military recuits – Complications autoimmune hemolytic anemia IgM

Mycoplasma Interstitial Pneumonia (atypical)

pneumonia HIGH fever Q fever – spores from cattle which causes PNA

Coxiella Burnetii Interstitial Pneumonia (atypical)

pneumonia Common in elderly -> S. Aureus -> bacteria pneumonia

Influenza Interstitial Pneumonia (atypical)

penumonia infants

RSV Interstitial Pneumonia (atypical)

• Painful swallowing, erythema throat, LN, exudate (S. Pyrogenes)

pharyngitis

Painful swallowing, erythema throat, LN, exudate | Gram + cocci, Catalase -, Lancefield A, M Proteins – JONES

S. Pyrogenes Exudate, erythemia, high fever

painful swallowing Most common cause 90% - can present with conjunctivitis – dsDNA linear naked

Adenovirus | No Exudate

painful swallowing PiCoFlaCoCa – ssRNA+ virus naked – respiratory droplets

Picorna CoxA Herpangina - vesicular ulcerations on hands and feet

painful swallowing Lemierre Syndrome – Lungs – systemic emboli – anerobic gram – rod

Fusobacterium Necrophorum Abscess internal Jugular vein

complications of bronchiectasis ?

Secondary amyloidosis – SAA -> AA with deposition of AA amyloid

predisposing factors of Bronchiectasis?

CF, Kartagener Syndrome – Primary ciliary dyskinesia (dynein arm) causing sinus adverus, tumor/foreign body, necrotizing infection, allergic bronchopulmonary aspergillosis, alcoholic, immunodeficiency

mental retardation, coarse facial features, joint stiffness | corneal clouding, growth retardation, death 6-10y/o

Mucopolysacchardoses • Deficiency in different GAGS • Hurlers: AR alpha iduronidase

mental retardation, coarse facial features, joint stiffness | no corneal clouding

Mucopolysacchardoses • Deficiency in different GAGS • Hunters: XLR iduonate 2 sulfatase

Chin, Giant Gonads – Large ears, mental retardation

Fragile X CCG

Chin, Giant Gonads – Large ears, mental retardation

Fragile X -CCG repeat

Loss of motor control, dementia, increased

Huntington’s disease CAG

AD - Gradually worsening muscle loss and weakness, cataracts, intellectual disability, heart conduction problem

Myotonic Dystrophy CTG

5-15 y/o (but can occur 20-30) with progressive loss of coordination and muscle strength -> wheel chair bound. Cardiomegaly, nystagmus, cerebellar dysfunction, slurred speech, DM

Fredrich’s Ataxia GAA

tongue increased in size (macroglossia), HTN, 2nd DM | bitemporal hemianopsia, hypopituitarism, headache

GH Adenoma • Pituitary adenoma – • Children = Gigantism – linear growth of bone due to no closure of bones prior • Adults = Acromegaly • GH decreases glucose uptake into cells – glucose is not taken into cells causing secondary cause of DM • Treatment: Ocreotide – somatostatin analog which blocks the production

Cretism – mental retardation, short stature, coarse facial features, large tongue • Iodine Deficiency, Lithium

Hypothyroidism • Decreased T3/T4 • Children

Path shelf - deck 1 Flashcards

(105 cards)