test #13 4.1 Flashcards Preview

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Flashcards in test #13 4.1 Deck (160):
1

pleuritic pain 2-4 days post-MI

pleuritic (changes w/ cough & swallowing, radiating to neck). fibrinous or serofibrinous early-onset pericarditis. 10-20% fever. rxn to transmural necrosis. short-lived, rx: aspirin

2

pericarditis vs. myocardial ischemia pain

pericarditis: pleuritic & sharp, changes w/ cough. MI: constant, substernal, crushing

3

dressler's syndrome

diffuse pericardial inflammation (& lung pleura) due to autoimmune reaction to necrotic tissue. 1 wk-months post MI (fewer than 4%). fever, pleuritis, leukocytosis, pericardial friction rub, chest radiograph evidence of new pericardial / pleural effusions. autoimmune polyserositis. rx: aspirin, NSAID, glucocorticoids

4

viral pericarditis usu follows..

upper respiratory infection.

5

3 major symptoms of klinefelter 47 XXY

(1) primary testicular failure: (hyalinization and fibrosis of seminiferous tubules) ---> subsequent lack of testosterone.
(2) eunuchoid body habitus: due to testosterone deficiency: tall w/ gynecomastia. lack body hair.
(3) cognitive symptoms: mild retardation, but mostly normal.

6

arachnodactyl, scoliosis, and aortic root dilation

Marfan. inherited defect of extracellular matrix protein: fibrillin

7

short stature, hypotonia, obesity.

prader-willi. microdeletion on chromosome 15 (inherited from fatheR). mental retardation.

8

exact direction of translocation in CML. karyotype.

t(9,22). fusion gene on shortened 22. BCR gene on 22 to ABL gene on 9. karyotype: long 9

9

kartagener syndrome

autosomal recessive mutation in gene coding for dynein. male infertility, recurrent sinusitis, bronchiectasis. situs inversus.

10

karyotype analysis of fragile X syndrome

karyotype of cells cultured in folate-deficient medium, discontinuity of staining on the long-arm of X chromosome.

11

chromosome of sickle cell anemia

chromosome 11

12

1 gram of hemoglobin holds how much oxygen?

1.34ml oxygen / 100ml blood

13

PaO2 100 = how much oxygen dissolved?

0.3ml oxygen dissolved / 100ml blood

14

cyanide intoxication leads to what blood gas finding

inhibition of cytochrome C, failure of electron transport chain & aerobic metabolism. SaO2 of venous blood INCREASES (oxygen cannot unload)

15

what 3 factors affect total oxygen content of blood

(1) hemoglobin concentration (2) oxygen saturation of hemoglobin (SaO2) (3) partial pressure of xygen dissolved in blood (PaO2)

16

SCID presentation

bacterial (i.e. recurrent otitis media), viral (bronchiolitis), and fungal (candidiasis) w/ poor growth & thymic hypoplasia (absent thymic shadow).

17

absent thymic shadow can mean.. (2)

SCID or DiGeorge (very uncommon)

18

Bruton's agammaglobulinemia

X-linked, boys, 6 months after passive immunity passes. BTK gene. insufficient production of mature B cells

19

common variable immunodeficiency

defect in B cell maturation. many causes.

20

Ab abnormalities w/ Wiskot-Aldrich

low to normal IgG and IgM. increased IgE and IgA

21

4 basic payment methods (most contracts between health insurance plans & physicians)

capitation, fee-for-service, discounted fee-for-service, salary

22

capitation

paid fixed amount per enrollee (not per service). fixed budget aloocated: incentives to contain costs. motivated to catch illness early (preventative care) so less tests needed as patient ages.

23

fee-for-service

paid fixed amount for every service & diagnostic test. face little financial risk, enticed to increase visits per patient and services per visit.

24

discounted fee-for-service

similar to FFS, but are reimbursed a discounted price. physician will be more conservative when ordering tests / providing services

25

salary

fixed amount, pay not tied to service or enrollee. no financial risk. no financial incentive to change treatment patterns.

26

HMO (health maintenance organization insurance plans) tend to use... Preferred provider organization insurance plans tend to use.. (payment plans)

HMO: capacitation. PPO: FFS or discounted FFS

27

latency in epidemiological studies

time elapsed from exposure to clinically apparent disease. short: infectious disease. long: heart disease/cancer.

or, exposure to risk modifiers occur significant time before effect on disease process. or must occur continuously over extended period before disease outcome is affected.

28

idiopathic hirsuitism. rx: (3)

(1) increased conversion of testosterone to DHT (5-alpha-reductase) or (2) increased sensitivity of hair follicles to DHT. rx: spironolactone, flutamide (testosterone receptor antagonist), finasteride (5-alpha-reductase inhibitor)

29

spironolactone on hirtsuitism

anti-adrogenic properties. block androgen receptors at hair follicles & decreases testosterone production.

30

flutamide

testosterone receptor antagonist

31

clomiphene? rx?

antiestrogen. inteferes w/ negative feedback of estrogens on hypothalamus and pituitary. increases GnRH. rx: infertility w/ anovulation

32

mitotaine? rx?

adrenocortiolytic. rx: adrenocortical carcinoma.

33

medroxyprogesterone? rx?

Depo Provera. progesterone only contraceptive (intramuscular injection once every 12 wks)

34

mifepristone? rx?

RU-486. synthetic steroid w/ anti-progestin & anti-glucocorticoid effect. abortifacient.

35

danazol? rx?

synthetic androgen used to treat endometriosis & hereditary andioedema.

36

where is vitamin E obtained from? deficiency? results in?

widely available in regular diet. deficiency is unusual: fat malabsorption, abetalipoproteinemia. low birth weight infants. deficiency -- subacute combined degeneration of dorsal column & spinocerebellar tract

37

vitamin E deficiency mimics..

freidrich's ataxia (ataxia, dysarthria, loss of position & vibration sense)

38

clinical presentation of acute intermittent porphyria

acute abdominal pain, peripheral neuropathy, hyponatremia

39

PSGN on light microscope? lab findings? EM?

hypercellular (leukocyte, endothelial, mesangian cell proliferation) glomerular.

lab: elevated titers of anti-streptococcal antibodies (anti-streptolysin O, anti-DNase B, anti-cationic proteinase). low C3. cryoglobulins.

EM: subepithelial humps

40

lab finding w/ drug-induced interstitial nephritis (tubulointerstitial nephritis)

high serum EOSINOPHILIA. offenders: beta-lactam antibiotics, NSAIDs, diuretics, anticonvulsants. nephritis. hypersensitivity.

41

early embryonic development, body veins divided into 3 main groups.. what is the fate of these groups?

(1) vitelline -- become veins of portal system (2) umbilical -- degenerate (3) cardinal -- veins of systemic circulation

42

site of superior vena cava

right, posterolateral to ascending aorta. anterior to right pulmonary artery. below level of carina.

43

truncus arteriosus gives rise to..

aorta and pulmonary artery

44

embryological origin of descending aorta

fusion of embryonic left and right dorsal aortas

45

pupillary light reflex pathway

SENSORY: retina --> optic nerve --> bilateral pretectal nucleus in superior colliculus --> ipsilateral & contralateral edingerwestphal nuclei (decussating fibers traverse posterior commissure)

MOTOR: parasympathetic preganglionic fibers in Edinger-Westphal --> travel w/ oculomotor n. to ciliary ganglion --> synapse onto postganglionic neurons --> project fibers to sphincter of iris.

46

main contributor to nitrate effect in patients w/ stable angina?

reduced preload --> reduced left ventricular volume.

also have modest dilatory effect on coronary arterioles & decrease afterload, but less impt.

47

5 major symptoms caused by invasion of pancoast tumors

(1) invasion of parietal pleura, vertebrae, superior ribs: SHOULDER PAIN. (2) invasion of brachial plexus: weakness & paraesthesia of ARM , particular inferior trunk. (3) HORNER (superior cervical ganglion sympathetics) (4) SVC syndrome (5) invasion of recurrent laryngeal n (HOARSENESS

48

isoniazid mechanism

decrease synthesis of mycolic acid in cell wall. bacterial catalase-peroxidase needed (encoded by KatG) to convert to active metabolite.

49

ethambutol mechanism

decrease carbohydrate polymerization of cell wall (block arabinosyltransferase)

50

pyrazinamide mechanism

unknown, acidify intracellular environment (pyrazinoic acid) effective in acidic lysosomes

51

what feature of mycobacteria makes them acid fast?

mycolic acids in cell wall

52

mycolic acids are essential for what 2 things in mycobacterium?

(1) proper cell wall structure (2) synthesis of mycobacterial virulence factors (sulfatides, wax D, and cord factor)

53

streptomycin is indicated in the treatment of... (3)

(1) mycobacteria: TB (2) plague: Yersenia pestis (3) tularemia: Francisella tularensis

54

skin findings in sarcoidosis (3)

variety: 1. subcutaneous nodules (erythema nodosum), 2. erythemtous plaques 3. macules that are slightly reddened / scaling

55

liver pathology in sarcoidosis

scattered noncaseating granulomas (75% of cases). affect portal triad far more than lobular parenchyma.

56

fatty (steatosis) change in liver occurs in.. (3)

reversible (1) hypoxic (2) toxic (3) metabolic injury (i.e. protein malnutrition, diabetes, obesity)

57

hepatic centrilobular necrosis can be caused by..

death of hepatocytes immediately surrounding terminal hepatic vein. cause: ischemic injury (right heart failure), drugs, toxins, fulminant hepatitis

58

portal inflammation can be found in

VERY NONSPECIFIC: alcoholic heptatitis, acute/chronic viral hepatitis, secondary biliary cirrhosis due to biliary tract obstruction, primary biliary cirrhosis, sclerosing cholangitis, chronic graft vs. host disease, acute cellular rejection of liver transplant, idiopathic neonatal hepatitis.

59

periportal fibrosis is a common pathologic finding in..

chronic viral hepatitis

60

prolactinomas in men v. women? why?

female: < 10mm (micro). male: >10mm (macro). bc men don't present until it is very large (i.e. no menstrual abnormalities)

61

renal failure and calcium problems...

VITAMIN D synthesis occurs in kidney. low vitamin D, low Ca2++, high PTH

62

which bacteria are capable of producing dextrans using sucrose as a substrate?

s. viridans

63

what is the most likely adherence site for S. viridans?

fibrin & platelets (think: subacute endocarditis, valvular vegetation)

64

role of subendothelial collagen and subendothelial glycosaminoglycans

subendothelial GAGs form subendothelial fibrous cap over the central core of atherosclerotic plaque. can activate platelets

65

antithrombin III inactivates..

thrombin, IX, X, XI, and XII (prevent conversion of fibrinogen to fibrin)

66

golgi tendon organ

sensory receptors located at junction of muscle and tendon. innervated by group Ib sensory axons

67

what does contraction of muscle do to golgi tendon organ? passive stretch?

GTO located in junction between tendon and extrafusal muscle fibers. contraction: increased tension transmitted through the tendon, activates golgi tendon organ (in SERIES w/ extrafusal muscle).

note, passive stretch: no effect, GTO insensitive to changes in muscle length (which affects muscle, not tendon)

68

golgi tendon organ circuit

group IB sensory axon from GTO contact inhibitory interneurons in spinal cord, synapse w/ alpha motor neurons that innervate SAME muscle. NEGATIVE FEEDBACK: regulates & maintains muscle tension. note: too much force on muscle --> GTO inhibit contraction --> SUDDEN MUSCLE RELAXATION (prevents damage)

69

A-delta fibers..

thin, myelinated nerve fibers, free never endings --> temperature and pain

70

muscle spindle aka..

intrafusal muscle fibers

71

muscle spindle / intrafusal muscle fibers

connected in PARALLEL w/ extrafusal fubers. innervated by group Ia and II sensory axons, sensitive to muscle LENGTH. mediate STRETCH reflex (myotactic reflex -- DTR). stretch of muscle, monosynaptic reflex ACTIVATION of alpha-motor neuron, contraction that resists stretch.

72

pacinian corpuscles

rapidly adaptive mechanoreceptors in subcutaneous tissue of skin, mesentery, peritoneum, joint capsule. vibration and pressure. A-beta fibers.

73

ruffini's end organs

slowly adaptive mechanoreceptors in skin, subcutaneous tissue, and joint capsule. pressure. A-beta fibers.

74

monitor and maintenance of muscle length

muscle spindle system (intrafusal)

75

monitor and maintenance of muscle force

golgi tendon organ

76

atrial fibrillation

irregularly irregular, absent P waves w/ irregularly irregular QRS waves. no coordinated atrial contraction

77

palpitations are.. caused by..

subjective sensation/awareness of one's heart beating. any significant acute change in HR, rhythm, or force of ventricular contraction.

78

precipitating factors for isolated atrial fibrillation

(1) binge alcohol consumption (holiday heart syndrome) (2) increased cardiac sympathetic tone (3) pericarditis

79

high QRS voltage in precordial leads suggests..

ventricular hypertrophy. HR is regular.

80

prolonged QRS interval..

sign of ventricular dysynchrony or slowed intraventricular impulse conduction (i.e. bundle blood). HR is normal.

81

3 ways PTH increases serum calcium

(1) increasing osteoclastic bone resorption (2) increasing distal tubular Ca2++ resorption (3) increasing formation of 1,25 dihydroxy vitamin D (upregulation of 1-alpha-hydroxylase). impt for GI reabsorption of Ca++

82

how does chronic renal failure affect PTH?

secondary parahyperthyroidism. (1) decrease vitamin D, less Ca2++ resorption in gut (2) poor PO4- excretion, which further stimulates PTH and lowers serum Ca2++

83

primary hyperparathyroidism

high PTH, high Ca2++

84

PTH-independent causes of hyperparathyroidism

(1) humoral hypercalcemia of malignancy (2) vitamin D toxicity (3) excessive injestion of calcium (4) thyrotoxicosis (5) immobilization

85

homeobox gene

highly conserved sequence of DNA (180 nucleotides). typically codes for DNA-binding transcription factors (alter expression of genes involved in morphogenesis.

86

viral bronchitis in a child < 2 years old. rx?

RSV infection. ribavarin (nucleoside analog, inhibits synthesis of guanosine nucleotides) active against RSV and Hep C

87

ribavarin controversy

ribavarin for RSV is controversial for most children, but indicated in infants at risk for disease progression (immunodeficiency, prematurity, cardiopulmonary disease)

88

osteltamavir

sialic acid analogue, inhibitor of influenza A and B viral neuraminidases.

89

ganciclovir differs from acyclovir bc..

gancyclovir is more specific for cytomegalovirus DNA polymerase

90

amantadine

impairs uncoating of influenza A virion after endocytosis

91

IFN-alpha used to treat?

combat hep B and hep C infxn

92

acute obstruction in small airways of infant usu secondary to...

RSV bronchiolitis

93

2 promoter regions in eukaryotic DNA

CAAT box and TATA box. CAAT is 60-80 base upstream 5' end. TATA is 25 bases upstream beginning of coding region. Gene transcription begins when RNA pol II attaches at one promoter site. facilitated by TFs. mutations here alter expression levels.

94

hyperinfection (widespread dissemination of worms in body) w/ strongyloides usu occurs in.. (2)

(1) immunosuppressant (i.e. taking corticosteroids) or (2) HTLV-1 infection. impaired Th2-directed cellular immunity

95

physical sign of stronglyoides infxn?

larva currens (pruitic, erythematous, linear streaks on thighs and buttocks as larva migrate subcutaneously away from perianal region).

96

diagnosis of stronglyoides? rx?

diagnosis: larvae in stool. eggs & adult parasites in intestinal biopsy. rx: ivermectin

97

diagnosis of tapeworms (t. solium, t. saginata, d. latum)

proglottids in stool

98

trophozoites & cysts in stool

giardia lamblia and entamoeba histolytica

99

eggs in stool

schistosomiasis

100

features of nephrotic syndrome

(1) massive proteinuria (>3.5g/day) (2) hypoalbuminemia (<2.5g/dl) (3) generalized edema (4) hyperlipidemia (5) lipiduria. will see increased aldosterone and aldosterone & Na+ & H20 retention due to low intravascular volume

101

protease inhibitor (-navir) side effects

(1) LIPODYSTROPHY -- increased deposition of fat on back & abdomen, decrease adipose on extremities. buffalo hump w/ central obesity & peripheral wasting. (2) HYPERGLYCEMIA -- increased insulin resistance, leads to frank diabetes.
(3) INHIBITION of P-450 -- leading to drug drug intxn

102

rifampin in patients on protease inhibitors (-navirs)? what should be used instead if TB + HIV?

rifampin ramps P450 & gets rid of -navir. use rifabutin instead

103

impt side effects of TMP-SMX

megaloblastic anemia, steven-johnson's syndrome, toxic epidermal necrolysis

104

impt side effects of NRTI (zidovudine)

bone marrow toxicity resulting in anemia (40% of patients)

105

impt side effect of acyclovir

crystalline nephropathy

106

fosacarnet rx? side effects

treatment of CMV infxn in HIV patients. nephrotoxicity, electrolyte disturbances (hypocalcemia, hypomagnesemia, hypokalemia)

107

what drugs increase rise of gallstones (2)?

(1) bile acid binding resins: cholestyramine, colestipol, colesevelam --> block enterohepatic circulation of bile acids, which can increase bile acid production/secretion, which increases cholesterol content of bile (2) fibrates: gemfibrizol, fenofibrate --> increase cholesterol content of bile.

108

how do bile acid resins decrease LDL?

hepatic cholesterol is consumed in re-synthesis of bile acids (increases uptake of LDL from circulation)

109

etoposide & podophyllin

targets topoisomerase II. inhibits topoisomerase II's ability to seal the strand break it induces.

110

topoisomerase I vs. topoisomerase II

topo I: single stranded nicks to relieve negative supercoiling. topo II: transient breaks in both DNA strands simultaneously to relieve both positive and negative supercoiling.

111

rx: etoposide. rx: podophyllin

etoposide: testicular cancer and small cell lung cancer. podophyllin: genital warts

112

irinotecan and topotecan..

inhibit topoisomerase I (normally induces single strand breaks in DNA to relieve negative supercoiling during replication

113

bioavailability defined as.. how is it determined?

fraction of administered drug that reaches systemic circulation in a chemically unchanged form. plot plasma drug concentration over time (for a dose) IV and then other route: F = divide AUC of route / AUC of IV. if doses are not equivalent: F= (area under oral curve x IV dose)/(area under IV curve x oral dose)

114

ABPA (allergic bronchopulmonary aspergillosis) can affect...

colonize bronchial mucosa and complicate (1) asthma (5-10%) or (2) cystic fibrosis

115

ABPA causes

high serum IgE, eosinophilia, and IgE plus IgG against Apergillus. intense airway inflammation and mucos plugging w/ exacerbation and remission. repeat exacerbation --> transient pulmonary INFILTRATES and proximal BRONCHIECTASIS.

116

progression of femoral hernias

(1) prone to INCARCERATION [femoral canal is small]: cannot be reduced (2) impaired blood flow for few hrs --> STRANGULATION (ischemia and necrosis)

117

pectineal (cooper's ligament)

thickened part of pectineal fascia. overlies pectineal ridge of the pubic bone. located posteriorly to the femoral canal.

118

where is traversalis fascia found

between transversalis muscle and extraperiotoneal fat.

119

hesselbach's triangle

medial border: rectus muscle shealth. lateral: inguinal ligament. superior: femoral artery & vein

120

round ligament in women homologous to what in men?

spermatic cord in men. in women: leaves pelvis through deep inguinal ring, passes through inguinal canal

121

femoral hernia borders

inferior to inguinal ligament. medial to pubic tubercle. lateral to femoral artery/vein

122

rx for allergic asthma?

1st: LTD4 antagonist (zafirlukast and montelukast). short term relief: inhaled ipratropium --> cholingeric m3 antagonist

123

leukotrienes in lungs

synthesized by mast cells, eosinophils, basophils. causes (1) bronchial constriction and (2) hyperreactivity. (3) promote mucosal edema and (4) mucous hypersecretion

124

uremic platelet dysfunction

qualitative (platelet count, PT, PTT normal). BLEEDING TIMe -- VERY PROLONGED. build up of dialyzable platelet-inhibitory factors (inhibit platelet fxn --> leading to intrinsic platelet defects and impairment of platelet-endothelial interactions.

125

what stabilizes factor VIII in circulation

vWF

126

H. pylori-associated antral gastritis..

decrease in number of somatostatin-producing antral cells (ssn inhibits gastrin release)

127

where does H. pylori live? how?

mucus layer overlying the epithelium of gastric antrum and fundus, as well as any ectopic gastric tissue in duodenum or esophagus. h. pylori does not invade, and IS susceptible to gastric acidity. protected by (1) mucus layer (2) urease production

128

increased acidity from h. pylori specifically associated w/

duodenal ulcer. though h. pylori is also associated w/ gastric adenocarcinoma, gastric ulcer, gastritis, gastric lymphoma (via unclear mechanisms)

129

tetrahydrobiopterin is..

BH4

130

BH4 (tetrahydrobiopterin) is a cofactor for the synthesis of..

(1) tyrosine: precursor of dopa and melanin (2) DOPA (antecedent of catecholamines) (3) 5HT (4) nitric oxide. works w/ dihydrobiopterin reductase, which reduces dihydrobiopterin (BH2) to tetrabiopterin (BH4)

131

how is serotonin made

hydroxylation and decarboxylation of amino acid tryptophan

132

2 possible enzyme deficiencies resulting in phenylketonuria

(1) most common: phenylalanine hydroxylase (2) dihydrobiopterin reductase deficiency

133

formation of GABA

decarboxylation of glutamate via glutamatic acid decarboxylase (GAD)

134

most common congenital abnormality of small intestine

meckel diverticulum. present in 2% of population. incomplete obliteration of omphalomesenteric duct that connects midgut lumen and yolk sac cavity early in life. connected to ileum (2 ft proximal to ileocecal valve)

135

tissue found in meckel diverticulum? most common?

could be gastric, pancreatic, colonic, jejunal, duodenal, endometrial. most common -- GASTRIC. (significant bc epithelium produces acid --> cause ulceration of adjacent tissues & lower GI bleed)

136

most common presentation of Meckel diverticulum

painless melena. could also become inflamed and stimulate clinical presentation of acute appendicitis.

137

ectopy

identification of microscopically and fxnally normal cells/tissues in abnormal location due to embryonic maldevelopment (i.e. meckel's diverticulum)

138

criteria for anorexia nervosa

(1) body weight at least 15% below normal, accompanied by a refusal to maintain body weight at normal levels (2) amenorrhea for 3 months (3) distortion of body image in which individual views self as obese (4) fear of gaining weight or becoming fat despite being underweight. often observe female athlete triad: eating disorder, amenorrhea, osteoperosis

139

two subtypes of anorexia nervosa

(1) restricting subtype (2) binge eating / purging subtype

140

clinical signs of significant vomiting history (i.e. in anorexia nervosa / bulemia)

(1) parotid gland hypertrophy (2) anterior tooth enamel erosion

141

primary biliary cirrhosis

chronic liver disease characterized by autoimmune destruction of intrahepatic bile ducts & cholestasis

142

two enzymes that need B12 as a cofactor

(1) methylmalonyl CoA mutase (methylmalonyl CoA --> succinyl CoA) and (2) methionine synthase

143

B12 deficiency lab values

(1) increase in methylmalonic acid (2) homocysteine

144

elevated levels of serum protoporphyrin in..

(1) iron-deficiency anemia, (2) lead poisoning, (3) erythropoietic protoporphyria

145

anthracyclines are..

daunorubicin, doxorubicin, epirubicin, idarubicin

146

side effect of anthracyclines

severe cardiotoxicity (generation of free radicals). DILATED CARDIOMYOPATHY (cumulative dose dependent)

147

early sign of doxorubin-associated cardiomyopathy (histologically, and symptoms)

swelling of sarcoplasmic reticulum, followed by loss of cardiomyocytes "myofibrillar dropout". same symptoms of biventricular CHF, including dyspnea on exertion, orthopnea, and peripheral edema

148

effective method of preventing doxorubicin cardiomyopathy

dexrazoxane (iron-chelating agent that decreases formation of oxygen free radicals)

149

fructose absorption in GI

GLUT 5, proximal small bowel

150

respiratory epithelium from nose to terminal bronchioles?

ciitated mucosal epithelium. goblet cells give mucous

151

clara cells

(1) secretory constituents of TERMINAL respiratory epithelium -- clara cell secretory protein. also source of some surfactant (2) role in detox of inhaled particles via a cytochrome p450 mechanism

152

absorption of copper in GI system

60% absorbed in STOMACH and DUODENUM

153

pathway of copper upon absorption

stomach/duodenum absorption --> bound to albumin loosely --> liver --> incorporated into an alpha-2-globulin to form CERULOPLASMIN. ceruloplasmin accounts for 90-95% of circulating copper.

154

normal total body copper

50-150 mg

155

copper excretion

senescent ceruloplasmin & remainder of ingested unabsorbed Cu --> bile and extreted in stool. also small amt --> renal tubular secretion

156

3 forms of aspergillus infxn

(1) colonizing (2) hypersensitivity rxn (3) invasive

157

colonizing aspergillosis

occurs in old lung cavities (i.e. from TB, emphysema, sarcoidosis) -- fungus ball. does not invade lung tissue. asymptomatic or cough w/ hemoptysis. chest x-ray: radiopaque structure that shifts when pt changes position

158

hypersensitivity rxn to aspergillus

allergic bronchopulmonary aspergillosis -- wheezing, fever, migratory pulmonary infiltrates

159

invasive aspergillosis

characterized by primary lung involvement (cough, hemoptysis, pleuritic chest pain, fever). can form necrotizing pneumonia and granuloma. hyphae INVADING lung tissue.

160

necrotizing aspergillosis

can occur bc predilection for vasculature --> ischemia