Gold Path

Gold Path

•Mobitz I

–Usually due to inferior MI. Rarely goes into

3rd degree block.– Txt w/ Atropine or

Isoproterenol.

•Mobitz II

–BBB association. Often goes to 3rd degree AV block.

Usually due to anterior MI.

•a wave

•LA contraction

•Wavy fibers

•Eosinophilic bands of necrotic myocytes. Early sign of MI.

•Serous Pericarditis

–Associated w/ nonbacterial; viral

(Coxsackie) infection; immunologic reaction.

•Hemorrhagic Pericarditis

•Associated w/ TB or neoplasm

•Restrictive Cardiomyopathy

– Aka infiltrative cardiomyopathy that stiffens the heart

– Due to amyloidosis in the elderly

– Due to , also see schaumann & asteroid bodies in young (<25

yoa).

•Crescentic GN

–Rapidly progressive GN - nephritic syndrome– Associated w/ multi system disease or post-

strep/post infectious glomerular nephritis

•Membranoproliferative GN

–Can be secondary to complement

deficiency; chronic infections; CLL

– See tram tracking

•Type I MembranoProliferative

GN deposits

•C3 & IgG deposits

•Type II MembranoProliferative

GN deposits

–Only C3 deposits– Aka Dense deposit

disease

•Focal segmental glomerulosclerosis

deposits

• IgM & C3 deposits

•Cold agglutinins

–Seen in atypical pneumonia

– It is IgM Ab with specificity for I Ag on

adult RBCs

•Scrofula

•TB in the lymph nodes

•Aspirin-Asthma Triad

•Nasal polyps •- Rhinitis

•- bronchoconstriction

•Cloudy swelling

– Failure of cellular Na pump

– Seen in Fatty degeneration of the liver and in

Hydropic (Vacuolar) degeneration of the liver

•Hydropic degeneration

–Severe form of cloudy swelling– Seen with

hypokalemia induced by vomitting/diarrhea

•Retinoblastoma

•Chromosome 13

•Wilms tumor of the kidney

•Chromosome 11p

•Agent Orange

– Contains dioxin– Implicated as a cause of

Hodgkin;s disease, non-Hodgkin’s lymphoma &

soft tissue sarcomas

•Ochronosis

– Alkaptonuria– Error in tyrosine metabolism due to

Homogentisic acid (oxidizes tyrosine)

– Involving intervertebral disks = Ankylosing Spondilitis = Poker spine

– See dark urine; dark coloration of sclera, tendons, cartilage

•Warthin-Finkeledy cells

–Reticuloendothelial giant cells on tonsils, lymph nodes, spleen– Seen with Rubeola

(measles) due to paramyxovirus

•Subacute Bacterial Endocarditis

• Hemolytic Streptococci (S.

viridans) = usually in pt w/ pre-existing heart

problem

•Acute Bacterial Endocarditis

–Staph aureus, Hemolytic

Streptococci, E. coli– Common among drug

addicts & diabetics

•Mitral Insufficiency

•Ruptured papillary muscle

•Left Anterior Descending branch

– Branch of the Left Coronary artery

– Highest frequency of thrombotic occlusion

– MI = anterior wall of the LV, especially in apical part of

interventricular septum

•Left Circumflex branch

–Branch of the Left Coronary artery

– Occlusion = MI of posterior/lateral wall

of the LV

•Bronchopneumonia

–Lobular (rather than lobar)– Due to Staph aureus; Pseudomonas aeruginosa;

Klebsiella; E. coli– Abscess formation is

common

•Lobar pneumonia

– Due to Strep. Pneumoniae infection (5% due to Klebsiella)

– Red Hepatization: days 1-3 of the pneumonia

– Gray Hepatization: days 3-8 of untreated pneumonia

– Complicaitons: pleural effusion; atelectasia; fibrinous pleuritis; empyema;

fibrinous pericarditis; otitis media

•Panlobular Emphysema

•1 - antitrypsin deficiency, causing elastase Increased =

Increased compliance in the lung

•Farmer’s Lung

•Due to Micropolyspora faeni

(thermophilic actinomycetes)

•Bagassosis

–Due to M. vulgaris (actinomycetes)

– Inhalation of sugar cane dust

•Silo-Filler’s Lung

•Due to Nitrogen dioxide from nitrates

in corn

•Scirrhous Carcinoma

•Infiltrating Duct Carcinoma w/ fibrosis - most common type of breast carcinoma

•Hofbauer Cells

•Lipid laden macrophages seen in

villi of Erythroblastosis

Fetalis

•IgA deficiency

–Pt has recurrent infections & diarrhea w/ Increased

respiratory tract allergy & autoimmune diseases

– If given blood w/ IgA = develop severe, fatal anaphylaxis reaction

•LDH1 & LDH2

•Myocardium. LDH1 higher than LDH2 =

Myocardial Infarction

•LDH3

•Lung tissue

•LDH4 & LDH5

•Liver cells

•Keratomalacia

•Severe Vit A deficiency. See Bitot’s spots in the eyes = gray plaques = thickened, keratinized

ET

•Metabisfite Test

–Suspending RBCs in a low O2 content solution

– Can detect Hemoglobin S, which

sickles in low O2

•Microangiopathic Hemolytic Anemia

–Can be due to Hemolyitc Uremic Syndrome &

Thrombotic Thrombocytopenic

Purpura (TTP)– See Helmet cells

•Focal Segmental GN exs

• IgA Focal GN = Berger’s disease; SLE;

PAN; Schonlein-Henoch purpura

(anaphylactoid purpura)

•Nephrotic Syndrome exs

• Focal (Segmental) GN; Membranous GN; Lipoid (Minimal Change) GN; Membranoproliferative GN; Hep B; Syphilis;

Penicillamine

•Hypertensive Hemorrhage

–Predilection for lenticulostriate

arteries = putamen & internal capsule

hemorrhages

•Chronic Cold Agglutinaiton

–Associated w/lymphoid neoplasms. See agglutination &

hemolysis in tissue exposed to cold. IgM Abs

•Acidophils

–Mammotrophs = Prolactin

– Somatotrophs = GH

•Basophils

–Thyrotrophs = TSH– Gonadotrophs = LH– Corticotrophs =

ACTH & FSH

•Vasoconstriction

•TxA2; LTC4; LTD4; LTE4; PAF

•Vasodilation

•PGI2; PGD2; PGE2; PGF2; Bradykinin;

PAF

•Increased Vascular Permeability:

•Hist.; 5HT; PGD2; PGE2; PGF2; LTC4;

LTD4; LTE4; Bradykinin; PAF

•Platelet Aggregation

–ADP; Thrombin; TxA2; collagen;

Epinephrine; PAF

•Platelet Antagonist

•Prostacyclin (PGI2)

•Hurler’s

•Lysosomal storage disease L

Iduronidase - Heparan/Dermatan

Sulfate accumulation

•Galactosemia

•Deficiency of Galactose 1 Phosphate

Uridyl Transferase. Increased Galactose 1

Phosphate

•Autosomal Dominant Diseases

– Adult Poly Cystic Kidney Disease– Familial Hypercholestrolemia Disease– Hereditary Hemorrhagic Telengectasia (Osler-

Weber-Rendu)– Hereditary Spherocytosis

– Huntington’s Disease (chromosome 4p)– Marfan’s Syndrome

– Neurofibromatosis (von Recklinghausen’s)– Tuberous Sclerosis

– Von Hippel Lindau Disease

•Autosomal Recessive Diseases

– Tay-Sachs– Gaucher’s– Niemann-Pick– Hurler’s– Von Gierke’s– Pompe’s– Cori’s– McArdle’s– Galactosemia– PKU– Alcaptonuria

•X Linked Recessive Diseases

– Hunter’s Syndrome (L-Iduronosulfate Sulfatase deficincy, Increased Heparan/Dermatan Sulfate)

– Fabry’s Disease ( Galactosidase A deficiency, Increased Ceremide Trihexoside)

– Classic Hemophilia A (Factor VIII deficiency, F8 Gene on X chromosome is bad, Increased Ceremide

Trihexoside)– Lisch-Nyhan Syndrome (HGPRT deficiency,

Increased Uric acid)– G6Phosphatase deficiency (G6PDH deficiency,

Increased Ceremide trihexoside)– Duchenne’s Muscular Dystrophy (Dystrophin

deficinecy, Increased Ceremide Trihexoside)

•Lung Development

–Glandular: 5-17 fetal weeks– Canalicular 13-25 fetal

weeks– Terminal Sac 24 weeks to

birth–Alveolar period birth-8yoa

•Heart’s 1st Beat

•21-22 days

•Type I Error

•: “Convicting the innocent” - accepting

experimental hypothesis/rejecting

null hypothesis

•Type II Error

•: “Setting the guilty free” - fail to reject the null hypotesis when it

was false

•Power

•1 -

•1st Branchial Arch

•Meckel’s cartillage - gives rise to

incus/malleus bones of ear

•2nd Branchial Arch

–Reichert’s cartillage - gives rise to stapes

bone of ear

•(-) Na+ Pump (ATPase)

–Ouabain [(-) K+ pump]– Vanadate [(-) phosphorylation]

–Digoxin [Increased heart contractility]

•(+) Frei Test

–Chlamydia trachomatis types L1,

L2, L3 = Lymphogranuloma

venereum

•3p

•Von Hippel Lindau, Renal Cell CA

•5p

•Familial adenomatous polyposis, Colon CA

•11p

•Wilm’s tumor

•13q

•Retinoblastoma, Osteosarcoma

•13q

•Breast CA , BRCA-2

•17p

•P53 Most human Cas

•17q

• NF-1 Neurofibromatosis type 1

• BRCA-1 -Breast CA, Ovarian CA•

•18q

•DCC - Colon & Stomach CA

•DPC - Pancreatic CA

•22q

•NF-2 - Neurofibromatosis type 2 = bilateral acoustic neuroma