-microbody - peroxisome + glycoxysome FA brk fats to sugar -CD3- extracellular immunoglobulin domain on TCR - MHC - HLA genes class

I - one alpha and 2 beta /all nucleated / Tcells ; interact with CD8-----cell mediated class II - one alpha and one beta/ present on - Bcell /dendritic cell/ macrophage [APCs] ; interact with CD4 --------humoral -CD8 - perforins-apoptosis - glucocorticoids- granulation tissue - Healing primary - quickn easy secondary - granulation | ulceration of epithelial surface tertiarty - cicatrizatoin - more scars - anti- teratogens - mitomycin,dactinomycin,puromucin - SEPSIS Systemic Inflammatory Response Syndrome (SIRS)

caused by S.aureus / Klebsiella / E.coli and LPS from gm -ve bacteria lipid storage disease only Fabry - x-linked recessive all others are autosomal recessive

- chelating agents - chelating agents, such as 2,3-dimercapto-1-propanesulfonic acid (DMPS) and alpha lipoic acid (ALA) - ceruloplasmin - is an anti-oxidant.Fe-cu enzyme [ hosts most of body Cu] deficiency causes Menkes / Wilson diseases - silicosis - egg shell calcification - POMC - precrusser for ACTH and MSH - Levels of lactate dehydrogenase (LDH)[5] or a Rivalta test can be used to distinguish transudate from exudate. - epitheloid - activated macrophages during granulomatous inflammation - cytokines IL INF TNF CSF [ bone marrow regulators] Naive T cell fate -

- IL12 --- TH0 --- TH1 ---INFgamma/IL2/TNFbeta [ cyctotoxic] - IL4 --- TH0 ---TH2 ---IL4,5,6,13 and TGFbeta [humoral] -TGF b - secreted by Bcell Th1 These participate in cell-mediated immunity. They are essential for controlling such intracellular pathogens as viruses and certain bacteria, e.g., Listeria and Mycobacterium tuberculosis (the bacillus that causes tb). They provide cytokine-mediated "help" to cytotoxic T lymphocytes perhaps the body's most potent weapon against intracellular pathogens. Th2 These provide help for B cells and are essential for the production of IgE antibodies and perhaps assist in the production of other classes as well. Antibodies are needed to controlextracellular pathogens (which unlike intracellular parasites are exposed to antibodies in blood and other body fluids). - defensin -cystein rich /anti bac/vira/mycotic - secreted by PMN for destruction - Lysosome contains lysozyme - cleaves peptidoglycan defensin - circular peptides-- forms channels in bacteria hydrolytic enzymes lactoferrin - chelates iron macrophage - appear in transition between acute and chronic inflammation basophil,mast - secrete histamine - acute inflammation vascular - BMP [basophil, monocyte,platelet] cellular - PMN macrophage - transition - arg - NO - tryptophan - serotonin [ 5HT ] ----------------------- IMMUNOLOGY ----------------------Rx for anaphylactic shock consious patient - IM epi 0.3mg uncounsious patient - IV epi 0.1mg antihistamines + corticosteroids will further reduce symptoms humoral immunity protects from encapsulated bugs **Some Killers Have Pretty Nice Capsules, . {Encapsulated} Strep Pneumo Klebsiella

Haemophilus Psuedomonas N.meningitidis Crytoccocus -extravasation steps [leaking of leukocytes] rolling - E-selectin - enhace loose binding activation- IL8 --> c5a --> integrin [LAD CD18 on integrin deficiency] arrest and adhesion - Integrin + IgCAM - tight binding trans-endothelial migration opsonin - IgG - c3b complement - IgM- most and IgG - some liver/normal in serum/not Ig/arond 20 plasma proteins note what properdin does --

also see http://upload.wikimedia.org/wikipedia/commons/6/68/Complement_system.jpg

complement fixation - wasserman - syphillis Immunoflorosence - tissue sections and cell suspension RIA - quantitative method for Ag or haptens ELISA - Ag/Ab in patient specimens arachidonic acid pathway

Blood disorders arteriosclerosis hyperplastic - fibrinoid | malig | onion skin hyaline - in DM | thck BM Monckeberg's arteriosclerosis,also - medial calcific sclerosis,vessel hardening, calcium deposits in t.media | not severe toxic accumalation : ccl4 - liver Hg - renal necrosis and GI ulceration Cn - oxphos / bitter almond smell Bi - NVD + nephro and neuro toxicity Pl - RBC stippling | hand n foot drop | abdominal pain schillng test - for B12 absorption coombs test direct coombs - Ab or complements bound to RBC + antihuman globulin- coombs reagent indirect coombs - unbound patient serum eg.pregnacy / transfusion [ recepient serum + donor blood + coombs reagent]

vit k dependant - 2,7,9,10

PT - I, II, V, VII, and X extrinsic PTT I, II, V, VIII, IX, X, XI, & XII. intrinsic bleeding time - platelet plug formation time leukemics have thrombocytopenia cirrhosics have hypoprothrombinemia PC - cell wall- peptidoglycan penicillins and ceph AT MCdonalds - ribosome disruption AT - 30s - aminoglycosides and tetracycline MC - 50s - macrolides and clindamycin [psue colitis] sulfonamides - folic acid syn inhinbitor chloramphenicol and tetracyclines are broad spectrum

-- oxphos in bact @plasma membrane -- elec donors are nitrate, sulfate, sulfur

Osteophytes [bony spurs] on the fingers or toes are known as Heberden's nodes (if on the DIP joint) or Bouchard's nodes (if on the PIP joints). H - Distal interphalangeal B - Proximal interphalangeal FD -

Many patients have lesions localized in only one bone (monostotic fibrous dysplasia), affecting 7080%.

Others have them in many bones (polyostotic fibrous dysplasia).

In 3% of cases, people suffering from fibrous dysplasia also have endocrine diseases and skin pigmentation; the three together constitute McCune-Albright syndrome. These endocrine diseases include precocious (early) puberty, often occurring as early as 6 years old. Osteochondrosis avascular necrosis of bone | degeneration followed by reosification in growing children , each site has its disease name Femur head - Legg-calve-perthes disease Tibial tuberosity - Osgood-schlatter disease Intervertebral jt = Scheurermann disease Tarsal navicular bobe - Kohler disease metatarsal head - Freiberg infarction Pagets - Paramyxo ? teeth widely placed | osteosarcoma predisposed | anemia | high alk.phosphatase |normal levels of calcium and phosphorus, enlargement of the skull, and an increased incidence of osteogenic sarcoma | high hydoxyproline - indicating osteoclastic activity| mosaic

von recklinghausens - hyperparathyroidism ; aka Osteitis fibrosa cystica - hyperparathyroidism high serum alk. phosphatase and serum calcium | low serum phosphorous condensing osteitis - bone production

- becks triad -- c.tamponade - most severe of pericarditis decreased BP | muffled hrt sound | Distended neck veins amphotericin B- kidney toxicity Plummer-Vinson syndrome (PVS), also called Paterson-Brown-Kelly syndrome or sideropenic dysphagia presents as a triad of dysphagia (due to esophageal webs), glossitis, and iron deficiency anemia.[1] glossitis iron deficiency anemia, pernicious anemia and other B-vitamin deficiencies, oral lichen planus, erythema multiforme, aphthous ulcer, pemphigus vulgaris, syphilis, irritants like tobacco etc....

Trichinosis, a disease caused by flatworms, does not usually produce oral lesions. TAILS causes of microcytic anemia thalasemia , anemia of chronic , Iron def , Lead poisoning , sideroblastic anemia behcet ocular/oral/genital/skin

-- it is vasculitis | veins

metastatic prostate - acid phosphatase increase villous adenoma - GI cancer most common cause asbestosis - cancer silocosis - severe form of pnumoconiosis

secondary hypertension causes CHAPS CHAPS: Cushing's syndrome [hypercortisolism] Hyperaldosteronism [aka Conn's syndrome]

Aorta coarctation Phaeochromocytoma Stenosis of renal arteries Note: only 5% of hypertension cases are secondary, rest are primary. -Common proven chemical carcinogens include benzpyrene, benzene, aniline dyes, and asbestos

macrolides are the ******mycins azithro - 500mg orally | 15g/kg - children periapical abcess Rx cross allergenicity - allergy to both clans of meds eg - penicilin and cefalosporins [10%] Clindamycin - macrolide/lincosamide has no CA with penicillins --------------CF[cystic Fibrosis]- white | 28yrs | exocrine | ch 7q | bronchiectasis ,meconium ileus | CFTR Von Hippel Lindau - ch3 | hemangiomas | cysts and ademomas Marfans - Fibrillin gene | CT disorder | spider finger | aorta - DAAnueurism | distended mitral valve| lens dislocation von hippel Lindau - hemangiomas of retina and cerebellum | also abcesses and cyst of kidney,liver,pancreas and adrenals bullous | IgG against basement memb| blisters | hemidesmosomes |inflammation | subepidermal

vulgaris | desmosomes | acantholysis [TZANK cell ]| transudate | oral lesion - first site | infection prone alcoholism - lung abcess | klebsiella ** COPD ** chronic bronchitis | squamous metaplasia | hyperplasia of bron. submucosal glands & smooth muschle hypertrophy | blue bloaters -reid index - [glandular layer thickness : bronchial wall thickness ] is increased -asthma - mucus with curshmann spirals,esinophils,charcot leyden crystals | cox inhibitors | vagal stimlaton | type 1 HS -emphysema = alveolar sac damage | labored breathing| no sputum| decreased alpha-1 antitrypsin| pink puffers -bronchiectasis - dilation of bronchi or bronchioles [ from CF[mostly] | sputum] Atelectasis - collapse of alveoli -pneumonia - crackles on auscultation | hypoxia | infiltrate on chest xray lobar - strep.pnuem broncho -patchy | intra alveolar exudate atypical - interstitial | children | mycoplasma,RSV,adenovirus erythrogen toxin - scarlet M prot - antiphagocytic streptokinase - fibrin streptolysin - rbc and wbc lysis endotoxin - LPS - complement via properdin pathway | non specific |pyrogenicity N.meningitidis - capsule | vaccine | resp entry | maltose N.gonorrhea - genital | no capsule/vaccine | b-lactamase nisseria - theyer martin stain neuraminidase - v.cholerae and shigella - affects NANA of int. mucosa acid fast | murein | intracellular - mycobacterium | Niacin producing ! alkaliphiles - Nitrobacter and s.pnumonea acidophiles - thiobacillus x-linked recessive-

To add A BDF Glamour,add 3 HILO Ret Whisky!! A lports syndrome B ecker's muscular dystrophy D uckens muscular dystrophy F abry disease G lucose 6 pho dehydogenase defe H aemophilia H ypo hidrotic epidermal dysplasia H unters disease I ncontinenta pigmenti R ett syndrome-Happy puppet syndrome W hiscott-Aldrich syndrome. eczema-thrombocytopenia-immunodeficiency syndrome infectious Mononucleosis - (a) atypical lymphocytes; (b) lymphocytic leukocytosis; (c) a positive heterophile test. Heart failure cells or siderophages are hemosiderin-containing macrophages in the alveoli. The main causes are left heart failure and chronic pulmonary edema. Hodgkins - lymphocyte rich | reed sternberg | non malig Non-Hodgkins NHL - mixed cells.. B cell most | no reed sterberg | malignant | HTLV1 | Burkitt - NHL | lymph nodes spared | B celll lymphoma | close to B ALL | Burkitt - B ALL diffuse lymphocytic lymphoma - CLL mycosis fungoides - pautrier microabcess | NHL | T cell tumor | skin lesion - erythema eczema multiple myeloma CRAB calcium | renal failure | anemia | bone lesion | punched out histology hemophilia a - factor 8 - male b - factor 9 - female c - factor 11 -rosenthal syndrome.. less bleading Rheumatic fever: Jones criteria Major criteria: CANCER: Carditis Arthritis Nodules Chorea Erythema Rheumatic anamnesis Minor criteria: CAFE PAL: CRP increased

Arthralgia Fever Elevated ESR Prolonged PR interval Anamnesis of rheumatism Leucocytosis

Libman sac - SLE endocarditis DiGeorge syndrome.. CATCH-22 -congenital heart disease -Abnormal facies -Thymic aplasia -Cleft palate -Hypocalcemia -22q deletion TORCH - teratogenic toxoplasmosis - CNS and seizures- uncooked meat and cat feces other agents rubella CMV

HSV histiocytosis - mandible | high histiocytes | asymptonatic | mobile teeth and periodontitis | 30s male von willibrand disease - qualitative platelet disease | f-VIII dependant | aut dom

last min review [from questions purely - I got them wrong and needed to review] female - more increase in lung cancer gluteraldehyde - broadest anti-microbial activity pannus - Rh.arthritis pacreatic cancer - poorest prognosis typhoid - asymptomatic carrier hazard ethelene oxide - inactivates bacterial DNA streptomycin - oto and nephro toxicity skin graft rejection - cell mediated c1,c3- complement activaiton hemolytic anemia - unconjugated bilirubin, kernicterus, and elevated urine urobilinogen. rhabdomyosarcoma - skeletal muscle infulenza - amantidine perinicous anemia - gastric carcinoma histoplasmosis - RE cells | lungs Cervicofacial actinomycosis-contamination of a trauma or surgical site with endogenous organism penicilin - gm +ve Lung, breast, prostate, kidney, thyroid cancers and multiple myeloma often spread to the bone NOT tongue actinic keratosis - precancerous toxoids - toxin + formaldehyde !! Trichophyton - skin fungi amyloid - protein | stuck with CT stroma amyloidosis - lead to ty II DM [amyloid in islets] salk - killed | sabin - live gonorrhea - ophthalmia neonatorum emphysema - polycythemia bacterial cystitis [urinary bladder inflammation] - Escherichia and Proteus affalotoxin | liver cancer ofloxacin - not topical AB p.intermedia - sex steroid induced gingivitis- watch in teens ANA - immune diseases [ anti nuclear antibody] erethema multiforme - penicillin / sulpha allergy subgingival plaque - gm - | supra - gm +

ceroid - hepatocellular injury - pigment chvostek and trousseau - low serum cal - hypoPTH | tetany chvostek - low cal and mg - alchoholics and drugs [aminoglycosides and diuretics Magnesium is a cofactor for Adenylate Cyclase. 2% gluteraldehyde - denatures DNA and prot picorna - Hep A klebsiella - alchoholics

HIV genes env - glycoproteins pol - 3 enzymes gag - core proteins aspirin + viral disease -- reyes syndrome