Brachial Plexus

Just a quick explanation in case it's not clear on the image. I also recommend going through the motions with your hand. It helps! :3

Distal lesions will affect the lumbricals, so the fingers cannot extend.
Proximal lesions will affect the flexors, so the hand cannot make a fist.

A distal lesion of the ulnar nerve will cause the patient to have difficulty uncurling the 4th and 5th digit, but the 2nd and 3rd digit can. A proximal lesion to the medial nerve will cause the patient to have difficulty curling the 2nd and 3rd digit, but the 4th and 5th can. Both will end up looking like the Pope blessing.

A proximal lesion to the ulnar nerve will cause the patient to have difficulty curling the last two digits while a distal lesion to the median nerve will cause the patient difficulty uncurling the 2nd and 3rd digit. Both will end up looking like the OK gesture.

Review Questions

A patient presents to his PCP with a 3 day history of fever, chest pain, and cough. He informs you that he recently went on a trip exploring caves in the midwest. The chronic form of this condition will lead to granulomas and cavitations in the upper lobes of the lungs. What do you expect to find upon histology?
A) pilot's wheel shaped fungus
B) thick walled cells showing broad based budding
C) acid fast bacteria
D) macrophages filled with many yeast-like cells
E) pleural cells showing a biphasic pattern (epithelioid cells and sarcomatoid cells)

A 50yo female with a history of asthma presents to the clinic complaining of white spots in her mouth. She explains that the spots started appearing ever since she started using Fluticasone. She is worried that this may be cancer, but you find that the spots can be scraped off. What does this organism do at 37 degrees Celsius?
A) forms yeast cells
B) unable to grow
C) cause pseudomembranes in the colon
D) leads to changes in vaginal pH
E) forms germ tubes

A 15yo male presents to the clinic with dyspnea. His IgE levels are elevated and CXR reveals bilateral migrating infiltrates. If we were to examine the organism under microscope, we'd see V-shaped branching. The patient has a condition that predisposes him to this condition. What mutation causes this condition?
A) VHL gene chromosome 3
B) COL4A5 gene X chromosome
C) CTFR gene chromosome 7
D) SERPINA1 gene chromosome 14
E) WT1 gene chromosome 11

Paraneoplastic Syndromes

Lung Cancer
1. Small Cell Carcinoma

• SIADH - excess ADH --> hyponatremia
• Cushing Syndrome - excess ACTH
• Lambert-Eaton - antibodies against presynaptic Ca2+ channels --> prevents release of Ach

2. Squamous Cell Carcinoma

• Hypercalcemia - PTHrP, "stones, bones, groans, psychiatric overtones"

Kidney Cancer
1. Renal Cell Carcinoma

• Cushing Syndrome - excess ACTH
• Polycythemia - excess EPO
• HTN - excess renin
• Hypercalcemia - PTHrP, "stones, bones, groans, psychiatric overtones"

Henoch-Schönlein Purpura

HSP is an autoimmune disease that causes vasculitis. It causes blood vessels to leak red blood cells, leading to a bruise-like rash on the arms, legs, and buttocks. The rash is more likely to appear on areas subjected to more pressure. Other symptoms of HSP include abdominal pain and join pain.

Now since our class is having renal pathology on our upcoming exam, we also need to know that HSP can cause nephritic syndrome, specifically IgA nephropathy.

Renal Pathology

Renal Pathology

Here is the complete powerpoint of the following renal pathologies:

• glomerulonephritis
• acute renal failure
• renal cystic disease
• chronic renal disease
• UTIs
• renal tumors
• nephrolithiasis
• incontinence

Notes are from lecture, Pathoma, and First Aid! Anything not high yield is noted in the comments section, so you can use this for the exam and then for board prep. Hope this helps! ^.^

Glomerulonephritis and Acute Renal Failure

Renal Pathology
Many thanks to my awesome study group, Danny, and Jack!

UTIs

Notes from lecture! ^.^ And remember that E. coli gets in via P pili and gal-gal receptors!