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Langerhans cells are located in the stratum spinosum.

Stratum corneum (corneocytes sloughing off = a process called desquamation, make

s up 95% of your house dust)
Stratum lucidum
Stratum granulosum (Lamellar granules and keratinohyaline granules).
Stratum spinosum (thick, strength, contains langerhans cells. These keratinocyte
s are attached to each other with desmosomes.)
Stratum basale = (attached to basement membranes by hemidesmosomes).
Basal layer cells include stem and progenitor cells. Stem cells -> progenitor ce
lls -> spinous cell -> granular cell -> corneocytes. Journey of progenitor to co
rneocytes takes 4-6 weeks in humans.
Ki67 = marker of
granuloma annulare vs tinea corporis vs erythema marginatum vs erythema chronicu
m migrans
hla-b5701 abacavir hypersensitivity
hla-b5801 allopurinol hypersensitivity
----after this class, eat last bit of chicken and go to the gym. you appearance is i
mportant. go on, get more chicken
i don't just cut people off after the end of something. because i'm polite. beca
use i'm civil.
joey's behavior is uncivil, not mine. my messages are cordial, polite and even c
harming. so i've done nothing wrong. if we see each other, it's my role to be qu
izzical, yet openminded.
however, this is not something i'll just "forget". i am not in the wrong here.
--------On another note: exercise makes you happy.
Get down to the 3rd floor study room more often - sure it's not perfect, but it'
s great on weekday afternoons. You can go back up and do some pushups and pullup
s (to complete your 'day 1' workout)
I'll need to go up in about 40 minutes (at 4:45) anyway, to get my charger.
So right now, what am I to do?
---------Clearly, I don't understand the infectious arthropathies yet.
It's amazing how much more happy and relaxed I feel right now compared to before
A G-2 is a great pen to have around because it's not bad (if 0.38) and because i
t reminds you how much better Hi Tec C is by comparison.

-----So I'm going to learn those infectious arthropathies and do my PBL lookup - and
that's it. I'll call it a day after that. Tomorrow
Anyway, I think Jennifer is good at finding the right thing to say at the right
moment. She's been life-toughened.
And I'm proud that I've come far since first year - and I am going to keep movin
g forward.
------I want some kougin aman (WF) and some more of those bars. Aside from that, I can
happily subsist on home food. I also want to do PM yoga before sleeping tonight
Perhaps it would be best to do this before sleep so I am super sleepy at the end
of the day.
------Arm wrestling - Dr. Goljan. It's a "y chromosome" thing.
Goodpasture Syndrome
Slow acetylators display more immunogenic (unmodified) drug on DC surfaces. This
can be genetic tendency or an acquired one (liver disease). Neonates are natura
lly slow acetylators, however an underdeveloped immune system may balance this o
ut (SJS in neonates is actually quite rare). This leads to increased CD4+ and CD
8+ T-cell activation. NKG2C (also known as CD94) on CD8+ cells is like a less sp
ecific version of NKG2D which we learned about in
I am going to take care of (some) business today:
1. PBL lookup
2. Find and download Goljan audio. THAT is the next thing to listen to, after "I
n Cold Blood". I'm going to organize it nicely, and download one block at a time
. I'd suggest listening to everything a couple of times. Try to put it all onto
the old iPod touch and bring it everywhere.
3. I am going to go to Whole Foods and pick me up some more of those delicious b
ars and Kougin Aman - probably while the rice is cooking.
4. Talk to Sarah about a ride Friday.
This weekend, I am going to:
1. Workout
2. Lunch with Rahul
3. Study Lab Medicine - nephrotic/nephritic, etc. Go through the 2 exams.
4. Do QBank questions for rheum and derm.
5. Create a Workout calendar and a USMLE study calendar for the following week.
Working out makes you happy and calm, and nothing gets done without a calendar.

Goljan Audio
FA 2015 (you should make a full pass through it - phaps using the cards - before
you hit the 6 week study period)
Goljan notes
3 Qbanks + will probably get UWorld biostats.
If you can get through the above resources, and use them efficiently, you will b
e set for step one.
Q banks are for solidifying material after you have learned it. That's why it's
so important to learn the material properly!
------Fine touch, epidermis = Meissner corpuscle
Pressure, dermis = Pacinian
Reticular dermis from the back has much more collagen than others.
Von Giesen stain = stains fibroblasts (or is it the collagen?)
Solar elastosis = that beautiful pink collagen is lost. The epidermis is thin, t
he dermis is fried (With destruction of collagin).
Pregnant women = telogen effluvia. Hair in telogen phase falls out.
Holocrine secretion = sebaceous glands and meibomian glands of eyelid.
ACrosyringium = duct growing through the skin.
Actinic keratosis that spares the acrosyringium is NOT SCC.
Eccrine glands next to apocrrine sweat glands (bigger, more jagged lining - part
of the cell pinches off into the lumen itself).
Meisser = light touch
Pacinian = pressure sensation
Merocrine = eccrine = exocytosis only (most sweat glands are eccrine sweat gland
Apocrine = pinched off part of the Mammary gland, and in apocrine sweat glands (
axilla, areola, ear canal, perianal)
Holocrine = the whole cell (sebaceous glands of skin and meibomian glands of eye
Acanthosis = thickening of the epidermis = parallel acanthosis = psoriasiform ac
--------------Pemphigus vulgaris = anti-desmogleins = cells in the stratum spinosum of the epi
dermis become acantholytic (lysis of the epidermis) = flaccid blisters
Bullous pemphigoid = the blister is very tense because the entire epidermis is a
bove the fluid, allowing it to push better against the
Inflammation in the subcutaeneous fat = septal granuloma formation = panniculiti
s = which can manifest as erythema nodosum.

--------------Make the diagnoses of acral melanoma (from cornified epithelium alone)


Case 2: Pemphigus Vulgaris
needs assessment sounds really important and cool
-------------ultrasound survey
got her into trouble
US for entertainment, others get 2 weeks of training and they are trained to do
RDMS license
should have come in w rdms or paramedic license
osteogenesis imperfecta = kept the pictures
chiari vs dandy-walker
next time i go to facebook it will be for putting on "in cold blood". and until
then i'm going to listen to "art of tidying up" by konmari. of course i won't bu
y it, as i already have it. only diff is - delete ICB, but leave KonMari on phon
on a tired day i just wanna read, eat and sleep. not talk to anyone. but this is
the good tired. the tired of waking up early and going to the gym :)
--------If someone says "you complete me", RUN. they should be complete on their own.
--------KonMari will be a lovely break after the intensity of ICB. lol
Also, what is Crohn's disease, anyway?
----Writing by hand, and then making powerpoint etc, is such a great way to learn.
That was so productive! Keep doing things this way. In a trance.
Maybe the book after 'Tidying' is 'Breakfast at Tiffany's", actually. And then t
o watch the movie! Be elegant in spite of weirdness, like Audrey Hepburn.

--------this weekend: think about (1) NIH poster presentation (2) SIGN UP FOR USMLE. SIG

I guess I now have

Breakfast at Tiff's
Pippi Longstocking

But above all, it's Goljan audio. Incorporate that into the study plan somehow.
^^ This syndrome is called "delaying the inevitable". It's very funny in your re
ading habits, but not nearly so amusing in terms of USMLE prep. It is OCTOBER. I
t's high time you started making passes through your QBanks (find that
Recall, this weekend you'll make exercise and USMLE calendars.
Today: make USMLE and exercise calendars TODAY.
And you want to finish that "TAL" episode while eating 2 fruit, drinking water,
generally healing self from this heat. Dinner will be sticky rice and yogurt, pe
rhaps with an apple.
--------------Focus should always be on avoiding injury.
Make sure Abhi accompanies you tomorrow - you don't know these exercises yet, an
d you want to avoid injury.

---------------------Anyway, there was a whole host of things to resolve:

- Exercise strategy
- USMLE study strategy (you have to make time, in accordance with your daily pla
ns - and it has to be a smart, logical sort of plan.)
search "heme" this weekend and learn the "lab medicine" stuff. learn normal lab
- lookup all that stuff i've been curious about to my heart's content: fanconi a
nemia, wilson disease, sarcoid,
Lambert-Eaton myasthenic

You want a particular brand of comfortable warmth.

And it's always fun talking to Amy and Daniella. :)
Halloween is a time for friends, it's a time for serving little kids. It's not a
time to go on a date.
I mean, I definitely spent more time on this calendar-making than I would have l
iked. But nothing gets done without a calendar, and it's better for me to spend
this time now than later. And I would have been unproductive otherwise, anyway.
Now, if I can just
(1) Do my self-assigned lookups (curiosity things)
(2) Somehow put the Goljan audio onto my iPhone
I will be happy. For tonight.
Remember, studying this weekend will probably involve plenty of Goljan Rapid Rev
iew and Pathoma. Read closely, annotate them, .
So basically: pay attention in class, take handwritten notes, and then review us
ing these other resources. I find lecture attendance is usually useful because I
don't ever get around to podcasting otherwise.
6pm: get home, do 10min yoga and take the Week 2 ARDD quiz. Depending on timing,
can review quiz after dinner (notes in spiral notebook).
PM: Make sure you brush your teeth well. Dentist's appointment tomorrow. Fall as
leep to Pippy Longstockings, a happy medium between Grey's anatomy or Goljan aud
AM: 60 minutes yogaglo, Pushup app and Ab Ripper X - all before dentist's appoin
9am: Dentist's appointment, talk about any cavities, about plaque formation on b
acks of teeth and increased sensitivity on certain teeth. Talk about removal of
wisdom teeth/crowding concerns - what a reasonable timeline would be.
11am: Do Pathoma (find the appropriate sections, then do them - it may be an art
AM: 10x Shady hill (ideally with Goljan audio)
I am a big fan of mantras, of repetitive tasks. Meditation in its simplest form.
<3 <3
"Beats another night of defensive reading. You've done it since we were kids - e
very time the world gets disappointing, you disappear into a book." <= THIS IS S

obviously i knew getting Goljan audio onto my phone was NOT going to be easy. Ho
wever, I also know it's the only way, practically speaking, that I'll get throug
h it all. So I need it.
Therefore, my struggles tonight - organizing my study strategy, my exercise stra
tegy, my Goljan audio - all of it, as far as I'm concerned - is worth it. First,
I downloaded the audio. Then, I renamed and organized it. I even got it into iT
unes. So why won't it copy?
Again, this is something you want to be wrestling with NOW...not your 6 week stu
dy period.
also play gout racer/microbe invader this weekend.
Collagenomas can be seen in TS. Adenoma sebaceusm
-----blue = mongolian spots
red lesion on nose = nevus ___
sturge weber = big port wine stain involving at least V1 (isolated V2 and V3 not
at risk). So the white kid with the V2 distributionis not to worry!
Hemangioma can obscure vision. Segmental hemangioma (follows a
PHACES syndrome associated with posterior fossa malformation (cerebellum), heman
gioma, arterial anomalies (aorta), coarctation of aorta, eye abnormalaties.
Propranolol can treat this well!
Tuberous sclerosis complex is well-treated with sirolimus!
Tortuous arteries suggests PHACES. These kids are at high risk of stroke. PRophy
lactic aspirin.
-Cutaeneous mastocytosis (benign) +Derier's sign. (really?)
Check serum tryptase to make sure there isn't systemic mastocytosis which can su
----Juvenile xanthogranuloma, benign, consists of histiocytes that disappear over ti
me. Check for ocular xanthogranuloma (glaucoma, light sensitivity), refer to opt
ho IF there are many or large lesions.
Pilotrichoma = calcifying epithelioma of Malhebe (they become rock-hard as they
come to the surface).
Gardner syndrome = associated with pilomatrichoma.
Neither pyogenoma nor granuloma - it's a red proliferation of blood vessells. So
metimes seen within hemangiomas or port wines stains.
Psoriasis = not itchy
--staph scalded skin syndrome
Finger = herpetic whitlow

A kid with fifth disease will be fine - by the time they come in,, no longer usu
ally contagious. But ask if they've been around pregnant woman, beware! Because
parvovirus can be bad for pregnant women
Morbiliform rash with koplik spots is measles.
central umbilication = molluscum contagiosum. poxvirus related to smallpox
tinea of the body = annular lesion
(what's granuloma annulare?)
Use iTurnes for the remaining 4.
dark red granulation tissue = JEB, especially around back of neck (glistening, c
lean, lots of capillaries - not much fibrinous material).
rDEB can be treated with BMT.
ebv + penicillin = rash
--------------moving right along my to-do list - one by one:
0. I wanted to eat 2 oranges, cook the salmon with some rice. Dinner will be squ
ash and eggs and more fruit. Post-dinner, be sure to wash and pack tupperwares f
or tomorrow.
1. lookups: sarcoid, Paget's disease, behcet's, churg-strauss, wilson disease, g
oodpasture syndrome, ANCA vasculitis, Crohn's disease, nephrotic vs nephritic (o
ne sheet). Also am curious about Leprosy vs TB again, as well as EBV-associated
problems/cancers, parvovirus, and lyme disease arthropathy, congenital herpes/pa
rvovirus in pregnant women, chikugunya, etc -> the infectious lecture, but using
2. I also wanted to go through this morning's 2 lectures and organize the inform
ation in a semi-intelligent manner in my spiral notebook.
3. the thing that i'm behind on and definitely wanted to skip class to work on:
was my flashcard quota. just going through them is such a treat! realize that it
's something that years ago you would have never had the opportunity to do. it's
active, it's targeted, it's efficient.
Also, I feel like advanced knowledge - like MTB2 and MTB3 - is always helpful fo
r those extra points. Super helpful, actually. :D love it.
----Get lost in the world of audiobooks. They are more fulfilling than TV by far. Th
at said, your studies are also very important and should not be neglected.
1. Pippi Longstockings
also 'the lovely bones' reminds me of 'in cold blood'. actually, the REAL movie
to watch this weekend is "where the wild things are". be outdoors. explore the w
orld. Be a wild child! Be Pippi!.

----------------------------Guess what you can always benefit from? The vitamin ISM. Nephrotic vs nephritic.
Don't be afraid to use Robbin's pathology in a searching manner.
1. What is the difference between the tissue reaction in sarcoidosis and tubercu
losis? Caseating granuloma with epithelioid histocytes. In sarcoid, the granulom
as are typically noncaseating.
2.Name two important disease of granulomatous inflammation in the U.S. (1) Crohn
disease (2) Sarcoidosis.
3. 55 year old white woman can't swallow her beloved Ritz crackers at wine and c
heese parties "witout guzzling wine." If she has high SS-A, what is she at risk
for? Extraglandular disease: synovitis, diffuse pulmonary fibrosis and periphera
l neuropathy. (Unlike Lupus, kidney involvement in Sjorgen's is RARE.) [Again, t
his is why you need multiple textbooks, multiple passes.]
4. Will the salivary gland be enlarged or shrunken in Sjorgen's? Usually enlarge
d due to invasion of B and T lymphocytes.
5. Name the differential diagnosis of Mikulicz syndrome: primary Mikulicz sydrom
e of salivary and lacrimal inflammation is Sjorgen's xerostomia/xerophthalmia. S
econdary Mikulicz syndrome is
6. Why does Knowlton care about sarcoidosis? It's a chief cause of sudden cardia
c arrest in younger people, along with infectious myocarditis and hypertrophic c
ardiomyopathy (due to Troponin T mutation in the rare athlete).
7. What is needed for diagnosis of Sjorgen's? Lip biopsy.
8. Dilated, restrictive cardiomyopathy is both associated with Sarcoid. Adriamyc
in (doxorubicin) toxicity and hemochromatosis both yield dilated cardiomyopathy.
9. What two diseases does sarcoidosis imitate well? Tuberculosis or other mycoba
cterial infection, followed by berylliosis. Sarcoid = granulomas of the lung and
bilateral hilar lymphadenopathy.
10. What is the epidemiology of sarcoidosis? Blacks more than whites (10x), wome
n more than men (2-3x). So the classic case would be a black woman in Louisiana.
Sarcoid is rare (but not nonexistent) among Chinese and Southeast Asians.
11. Name two examples of immune complex-mediated vasculitis. (1) Drugs: penicill
in acts as a hapten to a circulating serum protein and that self protein + Ab fo
rms an immune complex. In other case, streptokinase can itself form one half of
the immune complex (2) Post Hep-B polyarteritis nodosa (30% of polyarteritis nod
12. What is the purpose of ANCA's? ANCA's (antineutrophil cytoplasmic antibodies
) are a group of antibodies that people with vasculitis have. They are directed
against neutrophil parts. High ANCA levels mean more severe disease. Therefore,
you can use them to monitor response to therapy.
13. What is the difference between PR3-ANCA and MPO-ANCA? PR3-ANCA is associated
with polyangitis and infection. MPO-ANCA is associated with micropolyangitis an

d Churg-Strauss.
14. What are ANCA-associated vasculitides also known as "pauci-immune"?
15. Splitting headaches and a temporal artery that is tender to palpation are cl
assic signs of? Giant cell arteritis of the temporal artery, associated with pol
ymyalgia rheumatica. (As such it is the most common vasculitis among white peopl
16. If temporal arteritis is associated with blurry vision, why is that a medica
l emergency? Because it can lead to irreversible blindness.
17. Granulomatous sclerosis of the aortic arch in a 55 year old man is considere
d an atypical presentation of giant cell arteritis, regardless of whether or not
giant cells are present. What is granulomatous sclerosis of the aortic arch in
a 45 year old man called? Takayasu arteritis - the word "granulomatous" is more
commonly associated with this disease. The classic presentation is in the aortic
arch. The initial branches off the aortic arch are the most thickened - this fa
ct is particularly important when considering clinical diagnosis. Typically, the
re are initially nonspecific symptoms such as weight loss, fatigue and fever. An
other word for Takayasu arteritis is "pulseless disease". (Loss of carotid and r
adial pulses, but not foot pulses.)

I feel like it's associated with this block to learn about Ehlers-Danlos syndrom
e and Marfan syndrome, in both Robbins and Pathoma.
This is good. In a way, it's better than strictly sticking to coursework - becau
se it's
Time to ROL the entire vasculitis section. Take sparing notes only.
Later: histopathology of silicosis vs berylliosis.
----> it may be hard, but cover all of these arteritises becasue they are ALL in R
obbin's, they will ALL be on Step 1, and they barely teach them. This is the 25%
of STEP1 stuff we never learn.
finish lookups to your heart's content
eat a salmon. make Tiff's calls.
then go through your flashcard quota for the day. Listen to music, be joyful.
then go to the gym
after gym, review this morning's lectures.
eat dinner. be merry. watch grey's anatomy.
Gabrielle Alpin
Sharon van Etten
Ludovico Eiunadi
Coke Studio
Lim Kim

Zankyou no terror
-----realization: lovely bones is a lot like 'in cold blood'
1. pippi longstockings
2. breakfast at tiffany's
3. The art of tidying.
------i'll buy all the books, 2 credits at a time.
but WAIT. the whole point of yesterday's ordeal is to be doing Goljan all the ti
me - isn't it? I'm better with audiobooks than print books. I can do 11 hrs a we
also. I'm glad I didn't end up going to phantom. Or lab. Or lab medicine. Becaus
e I'm actually working through things, and feel quite calm and relaxed.