Review Pathophysiology - II

[Intro: 90 BPM. A smooth, echoing Rhodes piano plays a jazzy minor chord progression. A crisp hip-hop beat drops in with a heavy kick and a sharp snap. The R&B Singer hums a smooth melody to set the nocturnal vibe before the Rapper slides onto the beat.] [Block 1: The Rapper delivers the infectious diseases with a slow, deliberate pocket. The R&B Singer provides lush background harmonies.] Hemolytic-uremic syndrome Shiga/Shiga-like toxins inactivate 60S ribosome so increase cytokines (snap) NEXT Gas gangrene Alpha toxin (a phospholipase/lecithinase) degrades phospholipids so myonecrosis, crepitus (snap) NEXT Diphtheria Exotoxin inhibits protein synthesis via ADP-ribosylation of EF-2 M tuberculosis Cord factor activates macrophages (promoting granuloma formation), induces release of TNF-α; sulfatides (surface glycolipids) inhibit phagolysosomal fusion (snap) NEXT Tuberculoid leprosy T helper 1 immune response, mild Lepromatous leprosy T helper 2 response, can be lethal (snap) NEXT Chlamydiae resistance to β-lactam it Lacks of classic peptidoglycan (snap) NEXT Rabies Binds to ACh receptors so retrograde transport (dynein) (snap) NEXT [Block 2: The synth bass slides down an octave, making the groove deeper and heavier. The Rapper speeds up her flow slightly to ride the hi-hats.] Persistent truncus arteriosus no aorticopulmonary septum D-transposition of great arteries Failure of the aorticopulmonary septum to spiral (snap) NEXT "Tet spells" Crying increases RV outflow obstruction (snap) NEXT Thoracic aortic aneurysm Cystic medial degeneration; associated with tertiary syphilis (snap) NEXT Death within 0-24 hours post-MI Ventricular arrhythmia (snap) NEXT Death or shock within 3–14 days post-MI Macrophage-mediated ruptures; papillary muscle (2–7 days), interventricular septum (3–5 days), free wall (5–14 days) (snap) NEXT Hypertrophic obstructive cardiomyopathy death due to arrhythmia, Syncope and dyspnea due to systolic anterior motion of mitral valve so outflow obstruction (snap) NEXT [Block 3: The beat strips back slightly, focusing on the heavy kick drum. The R&B Singer smoothly croons "MECHANISM" in the background before the Rapper delivers the GI and endocrine lines.] Vascular disease in diabetes Nonenzymatic glycation of proteins; small vessel hyaline arteriolosclerosis; large vessel atherosclerosis (snap) NEXT Diabetic ketoacidosis (Singer) MECHANISM increase in lipolysis so increase ketogenesis (snap) NEXT Duodenal atresia, Recanalization failure (snap) NEXT Jejunal/ileal atresia (Singer) MECHANISM Disruption of vessels (most commonly SMA) so ischemic necrosis (snap) NEXT Superior mesenteric artery syndrome compression of transverse portion of duodenum by SMA and aorta (snap) NEXT In achalasia, Degeneration of inhibitory neurons (snap) NEXT Barrett esophagus MEANS metaplasia of nonkeratinized stratified squamous epithelium to intestinal, nonciliated columnar with goblet cells (snap) NEXT Hirschsprung (Singer) MECHANISM RET mutation so failure of neural crest migration (snap) NEXT Fibrosis in cirrhosis Occurs via stellate cell production of ECM (snap) NEXT [Block 4: A shimmering synthesizer arpeggio fades into the mix. The Rapper gets breathless and intimate, spitting the hepatic and hematologic defects while the Singer harmonizes beautifully.] Reye syndrome (Singer) MECHANISM Aspirin decrease β-oxidation (snap) NEXT Wilson disease (Singer) MECHANISM Mutated ATP7B, so increase in serum ceruloplasmin, and copper in tissues and urine (snap) NEXT Hemochromatosis HFE mutation so decrease hepcidin, (snap) NEXT Lead inhibits ferrochelatase and ALA dehydratase so decrease heme synthesis, increase RBC protoporphyrin (snap) NEXT G6PD defect so decrease NADPH so decrease reduced glutathione (snap) NEXT Sickle cell anemia; acidosis precipitate sickling so anemia, vaso-occlusive disease (snap) NEXT [Block 5: The final verse. The Rhodes piano swells with lush, complex jazz chords. The Rapper and Singer go back-and-forth, blending rap and melody perfectly to close out the bleeding disorders.] Bernard-Soulier decrease GpIb (snap) NEXT Glanzmann thrombasthenia decrease GpIIb/IIIa (snap) NEXT TTP, decrease in ADAMTS13 decreases the degradation of vWF so microthrombi (snap) NEXT Heparin-induced thrombocytopenia Type 1; within 2 days, so mild, transient drop in platelets; not clinically significant Type 2: in 5–10 days so IgG antibodies activates platelets so thrombosis (snap) NEXT [Outro: The beat drops away, leaving only the smooth Rhodes piano. The Rapper speaks the final line like an intimate, spoken-word sign-off.] Warfarin-induced skin/tissue necrosis due to rapid decrease in protein C [Ending: The R&B Singer hits a high, floating falsetto note that echoes out into the night. A single, final snap. Total silence.]