Pathology

• Usually due to inferior MI, rarely goes into 3rd degree block
• Tx w/ Atropine or Isoproterenol

BBB association. Often goes to 3rd degree AV block. Usually due to anterior MI

atrial depol

LA contraction

Ventricular repol

• Eosinophilic bands of necrotic myocytes
• Early signs of MI

• Acute bacterial endocarditis
• Nontender, erythematous lesions of palms and soles

• Subacute bacterial endocarditis
• Tender lesions of fingers and toes

• Wet Beri Beri heart. Dilated (congestive) cardiomyopathy due to chronic alcoholic consumption
• Dry Beri Beri = peripheral neuropathy
• Wernicke-Korsakoff = ataxia, confusion, confabulation, memory loss

Associated w/ MI: Dressler's

Associated w/ nonbacterial; viral (coxsackie) infection; immunologic reaction

Pericarditis association

Associated w/ TB or neoplasm

• AKA infiltrative cardiomyopathy that stiffens the heart
• Due to amyloidosis in the elderly
• Also seen in schaumann & asteroid bodies in young (<25 yo)

JC Virus (papovaviurs = dsDNA, naked icosahedral capsid)

• Increase Pc (more seeps out)
• Decreased oncotic pressure (less reabsorbed)
• increased permeability
• Block lymphatic drainage

• Commonly see liver cysts & Berry aneurysms along w/ kidney cysts. Hematuria & HTN also present
• 3 cysts in each Kidney w/ + family hx conforms dx

Petechial hemorrhages are seen on kidney surfaces = Flea - Bitten surface = young black men

hematuria; RBC casts; HTN

Proteinuria; Hypoalbuminemia; Edema

Minimal change (lipid nephrosis) disease

• Acute post-streptococcal GN (due to beta HGA Strep)
• Anti streptolysin O

• Rapidly progressive GN -- nephritic syndrome
• Associated w/ mult system disease or post-strep/post infectious glomerular nephritis

• Alport's syndrome. X linked
• Renal disease w/ deafness and ocular abnormalities

• Can be secondary to complement deficiency; chronic infectious CCL
• See tram tracking

C3 & IgG deposits

• Only C3 deposits
• AKA dense deposit disease

IgM & C3 deposits

• Seen in atypical pneumonia
• It is IgM Ab w/ specificity for I Ag on adult RBC

TB in lymph nodes

Nasal Polyps - Rhinitis - bronchoconstriction

Hemosiderin (pigment w/ Fe^3-) covered macrophages that have been phagocytised

Ulnar nerve pain & Horner's syndrome

• Make up primary of triglycerides
• Most commonly due to alcoholism which commonly leads to hepatic cirrhosis
• Associated w/ CCl₄^-

• Failure of cellular Na pump
• Seen in fatty degeneration of the liver an in Hydropic (Vaculoar) degeneration of the liver

• severe form of cloudy swelling
• seen w/ hypokalemia induced by vomiting/diarrhea

• Rapid enzymatic break down of lipids
• Seen commonly in brain and spinal cord (CNS) injuries
• Seen in suppurative infections = pus formation

• Result of sudden ischemia
• Seen in organs w/ end arteries limited collateral circulation = heart, lung, kidney, slpeen

• Combo of both coagulation & liquefaction necrosis
• Seen w/ TB and Histoplasma capsulatum infection

• Seen in walls of small arteries
• Associated w/ malignant hypertension, polyarterties nodosa, immune metidated vasculitis

• Result of lipase actions liberated from pancreatic enzymes
• Seen w/ acute pancreatitis = saponification results

Most commonly thrombus from LE vein

• From a vein of LE, a pregnant uterus, in congestive HF, bed ridden pt
• As a complication in a pt w/ pancreatic CA due to increased blood coagulability

• Embolus logged in bifurcation of pulmonary trunks
• Increased RV strain = RV & RA dilate = Acute cor pulmonale

• R to L shunt allows venous emboli to enter arterial circulation
• Patent ovale foramen or ASD

• Collection of macrophages w/o caseation
• Seen w/ Sarcoidosis (non-caseating): syphilis, Brucellosis and Leprotic infection

Spreading infection due to streptococcus

In cases of metastatic carcinoid, tx w/ Methysergide (5HT antagonist)

• Hepatocarcinoma
• Neural tube defects

Carcinoembryonic Antigen = elevated in colon ca

Retoblastoma

Wilms tumor of the kidney

associated w/ angiosarcoma of liver

• Contains dioxin
• Implicated as a cause of Hodgkin's, non-Hodgkin's and soft tissue sarcomas

• Schistosoma haematobium = urinary bladder ca
• S. mansoni = Colon ca
• Aspergillus flavus = poteint hepatocarcinogen

• Alkaptonuria
• Error in tyrosine metabolism due to Homogentisic acid (oxidizes tyrosine)
• Involving intervertebral disk = Ankylosing Spondilitis = Poker Spine
• Seen dark urine, dark coloration of sclera, tendons, cartilage

• Acid fast inclusion bodies
• Increase urinary coproprophyrin
• Anemia: microcytic / hypochromic
• Stippling of basophils
• Gingival line & lead line in bones - xray
• Mental retardation

Massive pulmonary edema w/ frothy fluid from nostrils

Small head, small eyes, funnel chest, ASD, mental deficiency and hirstuism

M. kanasasii & M. avium intracellulare

Liquified TB lesions similar to pyogenic abscess but lacking acute infection

• Farmers infection
• Lumpy jaw (from chewing grain) & PID (IUD), but most common is due to saprophyticus

Saddle nose, Saber shin, Hutchinson's teeth, nerve deafness, interstitial keratitis

• Reticuloendothelial giant cells on tonsils, lymph nodes, spleen
• Seen with Rubeloa (measles) due to paramyxovirus

Tapeworm infection causing megaloblactic anemia by consuming large amount of B12 in the host

alpha-hemolytic streptococci (S. viridans) usually in pt w/ pre-existing heart problem

• Staph aureus, beta-hemolytic streptococci, E. coli
• Common among drug addicts and diabetics

Ruptured papillary muscle

• Branch of the left coronary artery
• highest frequency of thrombotic occlusion
• MI = anterior wall of LV, especially in apical part of intraventricular septum

• Branch of Left Coronary Artery
• Occlusion = MI of posterior/lateral wall of the LV

• False aneurysm: it is splitting of the media of the aorta
• Usually accompanied w/ long history of severe hypertension, also seen w/ familial hyperlipidemia, atherosclerotic disease, Marfan's collagen disease
• Zones of medial necrosis +/- slit-like cysts = Medial Cystic Necrosis of Erdheim

Right ventricular strain, associated w/ right ventricular hypertrophy

Sudden right ventricular strain due to a massive pulmonary embolism

• Lobular (rather than lobar)
• Due to Staph aureus; Pseudomonas aeruginosa; Klebsiella; E.coli
• Abscess formation is common

• Due to Strep. pneumoniae infection (5%due to Klebsiella)
• Red Hepatization: days 1-3 of pneumonia
• Grey Hepatizaiton: days 3-8 of untreated pneumonia
• Complications: pleural effusion; atelectasia; fibrinous pleuritis; empyema; fibrinous pericarditis; otitis media

• Permanent dilation of bronchi - predisposed by chronic sinusitis and post nasal drip
• Supparation association
• Lower lobe > than upper lobe involvement

Found w/ Mycoplasma pneumoniae

Alpha 1 - antitrypsin deficiency, causing elastase increase = increase compliance in lung

Associated w/ Emphysema = "Bleb" = outpouching - If it ruptures causes Pneumothorax

Due to Micropolyspora faeni (thermophilic actinomycetes)

• Due to M. vulgaris (actinomycetes)
• Inhalation of sugar cane dust

Due to Nitrogen dioxide from nitrates in corn

• Sex-linked chronic hemolytic anemia w/o challenge or after eating fava beans
• Heinz Bodies appear in RBC's

Sickle Cell Anemia

• Lytic lesions of flat bones ("salt and pepper lesions") = vertebrae, ribs, skull; Hypercalcemia; Bence-Jones protein casts
• Weakness; weight loss; recurrent infection; proteinuria; anemia; increased proliferation of plasma cells in BM plasma cell dx
• Serum M protein spike - most often of IgG or IgA
• Hypercalcemia (increased bone destruction)

• Malignant neoplasm of lymph nodes causing puritis; fever = looks like an acute infection
• Reed Sternberg cells

• Immune complex disease of Ag-Ab complexes on blood vessel wall
• Half of the immune complexes have Hepatitis B Ag
• Can see fever; abdominal pain; decreased weight; HTN; muscle aches

• Celiac disease due to a gluten-induced enteropathy = small intestine villi are blunted
• High titers of anti-gliadin Abs & increased IgA levels

• Crohn's Disease
• Association w/ Arthritis; Uveitis; Erythema Nodosum

Intestinal Lipodystrophy = malabsorption syndrome

Neural crest cells from which carcinoids arise = of the Bronchi, GIT, Pancreas

• Inflammatory disease of the colon w/ increased colon CA incidence
• Crypt abscess in the crypts of Lieberkuhn
• Pseudopolyps when ulcers deep
• Not transmural involvement

• Women exposed to DES (Diethylstilbesterol) in utero before the 18th week of pregnancy
• Some develop clear cell adenocarcinoma of cervix and vagina

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

Lipid laden macrophages seen in villi of Erythroblastosis Fetalis

Retroletal Fibroplasia = cause of blindness in premies due to high O2 concentrations

• Pt has recurrent infections & diarrhea w/ increased respiratory tract allergy & autoimmune disease
• If given blood w/ IgA = develop severe, fatal anaphylaxis reaction

Dry eyes & dry mouth, arthritis, increased risk for B cell lymphoma. HLA-DR3 frequent. Autoimmune disease

• Rheumatoid arthritis, SLE, or systemic sclerosis association
• RA association shows HLA-DR4

Myocardium. LDH1 higher than LDH2 = MI

Lung tissue

Liver cells

Severe vit A deficiency. See Bitot's spots in eyes = grey plaques = thickened, keratinized ET

• Suspending RBCs in low O2 content solution
• Can detect Hemoglobin S, which sickles in low O2

• Can be due to HUS or TTP
• See helmet cells

Stain for Burkitt's lymphoma

• Due to EBV infection
• If Mono is treated w/ Amphicillin, thinking that it is strep pharyngitis, a rash will occur

Burkitt's lymphoma = c-myc oncogene overexpression

CML = c-abl/bcr gene formation = Philadelphia translocation

• Letter Siwe syndrome; Hand Schuller Christian Disease; Eosinophilic Granuloma
• Birbeck granules are present = tennis racket shape

• Alkaline phosphate increased/normal compared to CML = low to absent
• Anemia; splenomegaly; platelets > 1 million = extensive extra-medullary hematopoiesis

NH Lymphoma = bcl2 proto-oncogene over-expression seen w/ Small Cleaved Cell (Follicular) Lymphoma)

IgA Focal GN = Berger's disease; SLE; PAN; Schonlein-Henoch purpura (anaphylactoid purpura)

Focal (segmental) GN; Membranous GN; Lipoid (minimal change); Membranoproliferative GN; Hep B; Syphilis; Penicillamine

• Infection is associated w/ Squamous cell CA of the bladder (most common Bladder CA is transitional cell type)
• Associated w/ portal HTN due to intrahepatic obstruction

PID is usually due to N. Gonorrhoeae, but if unresponsive to penicillin think of Bacteroides species

• Severe increase in ICP w/ downward displacement of cerebellar tonsils into Foramen Magnum causing a compression on the brainstem w/ hemorrhaging into the pons and midbrain
• Nearly always associated w/ death due to damage to the vital centers in these areas

Predilection for lenticulostriate arteries = putamen & internal capsule hemorrhage

MI w/ Mural Thrombi; Atrial Fib Thrombi - Marantic thrombi; L-sided Bacterial Endocarditis; paradoxical emboli of septal defect

• Tabes Dorsalis = decreased joint position sensation, decreased pain sensation, ataxia, Argyl Robertson pupil
• Syphilitic meningitis
• Paretic neurosyphilis

Cri di Chat: mental retardation; small head; wide set eyes; low set ears; cat like cry

Patau's: small head & eyes; cleft lip & palate; many fingers

• Abs to I blood group Ag. mediated by IgM Abs
• Complication of EBV of Mycoplasma pneumoniae infections

Associated w/ lymphoid neoplasms. See agglutination & hemolysis in tissues exposed to cold IgM Abs

Hereditary Spherocytosis

• Small Lymphocytic: low grade B cell lymphoma of elderly. Related to CLL
• Small Cleaved cell (Follicular): low grade B cell lymphoma of the elderly. T(14:18) bcl-2 oncogene
• Large cell
• Lymphoblastic: high grade T cell lymphoma of kids progressing to T-ALL
• Small Non Cleaved = Burkitt's: high grade B cell lymphoma. EBV infection, Starry sky histo appearance. T(8:14) c-myc proto-oncogene. Related to B-ALL

Benign laryngeal polyps associated w/ smoking & overuse of the voice

Associated w/ blebs (large subpleural bullae) that can rupture and cause pneumothorax

Obstructed due to bronchogenic carcinoma. Causing swollen face & cyanosis

Associated to oral cancer

Antibodies to parietal cells; pernicious anemia; autoimmune disease

Associated with Helicobacter (Campylobacter) pylori infection. 90% duodenal ulcer

• Autoimmune origin; middle aged women; anti-mitochondiral Abs
• Jaundice; itching; hypercholesterolemia (can see cutaneous xanthomas)

• Increase pancreatic enzymes = fat necrosis; sapponification = hypocalcemia; increase serum amylase
• Severe epigastric ab pain; prostration; radiation to the back

Chronic pancreatitis

No embryo, Paternal derivation only, 46 XX

Embryo. 2 or more sprems fertilized 1 ovum: triploidy/tetraploidy occurs

• Hypoplastic Goiter nodules that do not take up radio active iodine.
• [Opposite hot and do take up iodine]

• Mammotrophs = Prolactin
• Somatotrophs = GH

• Thyrotrophs = TSH
• Gonadotrophs = LH
• Corticotrophs = ACTH & FSH

• Small / focal aa occlusions. Purely motor or sensory
• Sensory: lesion of thalamus
• Motor: lesion of internal capsule

• decrease glucose
• increase protein, neutrophils and pressure

• Normal glucose; +/- increased protein
• increased lymphocytes

Osteoporosis: Albers-Schonbred Disease = in-spite of increased bone density, many fractures = decreased osteoclasts

Involved in Chemotaxins (for Neutrophils)

Involved in Opsonization (and IgG)

C3a and C5a (mediate Histamine release from Basophils & Mast cells)

• Vasoconstriction: TxA2; LTC₄; LTD₄; LTE₄; PAF
• Vasodilation: PGI₂; PGD₂; PGE₂; PGF_2a; Bradykinin; PAF
• Increased Vascular Permeability: Hist; 5HT; PGD₂; PGE₂; PGF_2a; LTC₄; LTD₄; LTE₄; Bradykinin; PAF

ADP; Thrombin; TxA2; collagen; Epi; PAF

Prostacyclin (PGI₂)

F XII (Hangman); aPTT

F VII: PT

Aterial thrombi = pale red colored (dark red is venous thrombi)

post mortem clots

• Margination
• Pavementing
• Adhesion
• Chemotaxis
• Phagocytosis
• Intracellular microbial killing

Specific gravity <1.012 - low protein

Specific gravity >1.020 - high protein

• Lysosomal storage disease
• alpha L Iduronidase - Heparan/ Dermatan Sulfate accumulation

• Deficiency of Galactose 1 Phosphate Uridyl Transferase.
• Increase Galactose 1 Phosphate

• Deficiency: Phenylalanine Hydroxylase. Increase phenyalanine & degradation products
• Mousy body odor

• 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

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

• Hunter's Syndrome (L-Iduronosulfate Sulfatase deficiency, increased Heparan/Dermatan Sulfate)
• Fabry's Disease (alpha Galactoside 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)
• G6 Phosphatase deficiency (G6PDH deficiency, increased Ceremide Trihexoside)
• Duchenne's Muscular Dystrophy (Dystrophin deficiency, increased Ceremide Trihexoside)

• Type I (anaphylactic): IgE mediated, Ex: hay fever, allergic asthma; hives
• Type II (Cytotoxic): warm Ab autoimmune hemolytic anemia; hemolytic transfusion reactions; Erythroblastosis Fetalis; Grave's Disease; Goodpastures
• Type III (Immune Complex): Insoluble complement bound to aggreates of Ab-Ag complexes. Ex: Serum sickness, arthrus reaction, polyartheritis nodosa, SLE, Immune complex mediated glomerular disease
• Type IV (Delayed = cell mediated immunity): delayed hypersensitivity, involves memory cells. Ex: Tuberculin reaction, contact dermatitis, tumor cell killing, virally infected cell killing

• Hyperacute Rejection: occurs w/in min of transplant Ab mediated
• Acute Rejection: occurs w/in days to months of transplant. Lymphocytes and macrophages. Only rejection type that can be treated w/ therapy
• Chronic Rejection: occurs months to years after transplant. Ab mediates vascular damage

Sarcoma, exception - renal cell Ca: early venous invasion

Carcinoma, exception renal cell CA: early venous invasion

Seen w/ Aspergillus. Increased risk for hepatocellular CA

Incomplete fusion of maxillary prominence w/ median nasal prominence

Incomplete fusion of lateral palatine process w/ each other and medial nasal prominence and medial palatine prominence

Pituitary tumor - usually calcified

Involved in vision relay

Involved in hearing relay

• Glandular: 5-17 weeks
• Canalicular: 13-25 weeks
• Terminal Sac: 24 weeks to birth
• Alveolar period: birth to 8yo

21-22 days

Mouth --> common bile duct - supplied by celiac artery

Duodenum, just below common bile duct --> splenic flexure of the colon supplied by superior mesenteric artery

Splenic Flexure --> Butt crack --> supplied by inferior mesenteric artery

Narcolepsy

Ruptured cerebral bridging veins

Ruptured middle meningeal artery "intervals of lucidness" 2nd to Temporal bone fx

alpha: "convicting the innocent" - accepting experimental hypothesis/rejecting null hypothesis

beta: "setting the guilty free" = fail to reject the null hypothesis when it was false

1 - beta (type II error)

• TP/ (TP + FN)
• SNOUT

• TN / (TN + FP)
• SPIN

TP / (TP + FP)

TN / (TN+FN)

ad/bc

DIC

Disorder of thought content

Skip from topic to topic

Denial - Anger - Bargaining - Depression - Acceptance

Meckel's Cartilage - gives rise incus / malleus bones of ear

Reichert's cartilage - gives rise to stapes bone of ear

No pronation

wrist drop - seen w/ humerus fracture

foot drop, no dorsifelxion or eversion of foot

• Goes through superficial inguinal ring
• Medial to inferior epigastric artery
• Seen in older men

• Goes through deep and superficial inguinal ring
• Lateral to inferior epigastric artery
• Sen in young boys - processus vaginalis did not close

• T8 - IVC
• T10 - Esophagus / Vagus
• T12 - Aorta / Thoracic duct/ Azygous vein

• Wild flailing of 1 arm
• Lesion of the sub thalamic nucleus

In golgi

In RER

Internuclear Ophthalmoplegia: medial rectus palsy on lateral gaze; Nystagmus on abducting eye. Seen w/ MS

SCID

Initiation of sleep via 5HT predominance

Alert, Awake; Active mind - also seen in REM, therefore we say "paradoxical sleep"

• Hexokinase
• PhosphoFructo Kinase = rate limiting step
• Pyruvate Kinase
• Pyruvate Dehydrogenase

• PyruvateCarboxy Kinae
• PEPCarboxyKinae
• Fructose 1,6 BiPhosphatase
• Glucose 6 Phosphatase
• ***muscle does not take part in Gluconeogenesis, only takes place in liver, kidney and GI epithelium

• Diarrhea, Dermatitis, Dementia
• Niacin Deficiency (Vit B3 deficiency)
• Hartnup's Disease
• Malignant Carcinoid Syndrome
• INH use

Needed as co-factor for pyruvate DH complex and alpha ketoglutarate DH complex

• Esterification of cholesterol: lecithin cholesterol acetyltransferase
• Lecithin = Phosphatidylcholine, therefore phosphotidylcholine acetyltransferase

• Rate limiting step in cholesterol synthesis
• Changes HMGCoA --> Mevalonate
• (-) by Lovastatin

Leucine & Lysine

Methionine, Threonine, Valine, Arginine, Histadine

Phenylaline, Trytophan, Isoleucine

Feeds FA into the mitochondria for their consumption

• Keeps muscles working anaerobically
• Transfers lactate to the liver to make glucose which is sent back into the muscles for energy use

• Ouabain [(-) K pump]
• Vanadate [(-) phosphorylation]
• Digoxin [increase heart contractility]

• "Citric Acid Is Krebs Starting Substrate For Mitochondrial Oxidation"
• Citrate --> Aconitate --> Isocitrate --> alpha Ketoglutarate --> Succinyl --> Succinate --> Fumarate --> Malate --> OAA

Color vision. Contain Iodopsin = Red-Blue-Green specific pigment. For acuity

Contain Rhodopsin pigment. High sensitivity . Concentrated in the fovea. Night vision

Seen at 3rd week: Ecto, Meso, Endo

at 2nd week: forms the primitive streak, from which Meso & Endo come from. Directly gives rise to Ecto

Post streptococcal infection. Necrotizing arteritis of the caudate, putamen, thalamus

Chlamydia trachomatis types L1, L2, L3 = Lymphogranuloma venereum

• Culture for all Fungi
• ie... Culture Cryptococcus neofromans which is found in pigeon droppings

Fragile X Syndrome: macro-orchidism; long face; large jaw; large everted ears; autism, mental retardation

• Present in Kleinfelters: Male - XXY
• Not present in Turner's Female - XO

• Traube Sign = Pistol shot sound over femoral vessels
• Corrigan pulse = water hammer pulse over carotid artery = aortic regurgitation

Calcinosis; Raynauds; Esophageal; Sclerodactyl; Telangiectasis

• Sporadic: bad T4 phosphorylation or developmental failure of thyroid formation
• Endemic: no Iodine in diet - protruding belly and belly button

• Micronodular pigment cirrhosis
• Bronze diabetics
• Skin pigmentation = due to increased F³⁺deposition