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Uworld > test47: pathology > Flashcards

test47: pathology Flashcards

1
Q

child with serologic tests showing autoantibodies that react with tissue transglutaminase has?

A

Celiac disease

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2
Q

Celiac disease patients react to what? where does it come from

A

gliadin, product of gluten

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3
Q

What part the digestive tract does celiac disease hit

A

duodenum and jejunum

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4
Q

hydrogen breath tests for

A

lactose intolerance

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5
Q

Rectal suction biopsy is gold standard in diagnosing what

A

Hirschsprung disease or congenital aganglionic megacolon

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6
Q

Terminal ileum biospy is performed for what disease

A

Crohn disease

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7
Q

periodic acid-Schiff stain (PAS) stains for what

A

glycogen

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8
Q

PAS can be used to diagnose what

A

Whipple disease ( tropheryma whipple)

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9
Q

alkaline phosphatase is an enzyme marker of what

A

osteoblasts

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10
Q

pathophysiology for pemphigus vulgaris

A
  • autoantibodies against desmosomes ( desmoglzins 1 and 3)

- disrupt intraepithelial cleavage

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11
Q

Nikolsky sign

A

new blisters may form with gentle traction or rubbing

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12
Q

Asboe-Hansen sign

A

bullae spread laterally when pressure is applied on top

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13
Q

Lowest pH of nephron is found where

A

distal tubules and collecting ducts

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14
Q

what precipitates uric acid crystals

A

low pH

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15
Q

what is tumor lysis syndrome

A

lysis of tumor cells cause intracellular ions, K, phosphorous and uric acid to join serum

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16
Q

prevention of tumor lysis

A

hydration and urine alkalinization

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17
Q

54 man: history of Hep C. vomiting red blood, abdominal distention, gynecomastia, repetitive flickering motion of hands, what causes altered mental status

A

increase load of nitrogenous substances absorbed by the gut

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18
Q

liver disease and Bun value and why

A

Decreased BUN b/c ammonia is not efficiently converted to urea.

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19
Q

Grave disease

A

hyperthyroidism

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20
Q

treatment for graves

A

radioactive iodine

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21
Q

how is iodine taken up into thyroid

A
  • against concentration gradient via sodium-iodide symporter

- also transports perchlorate and pertechnetate

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22
Q

What exercises strengthen pelvic floor muscles and can improve symptoms of stress urinary incontinence

A

Kegel exercise

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23
Q

Levator ani and coccygeus

A

pelvic floor muscles

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24
Q

what can cause stress incontinence

A

increase intra-abdominal pressure

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25
Q

sciatica ( siatic nerve compression) presents hoq

A

low back pain radiating down on one side of the hip to the leg, without urinary incontinence

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26
Q

how do uremic toxins in blood impact platelets? causes? txt?

A
  • qualitative platelet disorder
  • prolonged bleeding time
  • dialysis
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27
Q

patient with excessive bleeding around catheter exit site to start dialysis what what PT, PTT, platelet count, and bleeding time

A

everything normal except bleeding time is increased

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28
Q

abnormal myelocyte precursors contain what in cell

A

aurer rod: coarse rod shaped intracytoplasmic granules

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29
Q

myelocyte precursor cells are founding what

A

acute myelogenous leukemia

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30
Q

What is the M3 variant for AML

A

acute promyelocytic leukemia

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31
Q

translocation for acute promyelocytic leukemia

A

t (15;17)

17: retinoid acid receptor alpha
15: promyelocytic leukemia

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32
Q

t(8:14)

A

Burkitt lymphoma

8: c-myc
14: Ig heavy chain

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33
Q

t(11;14)

A

mantle cell lymphoma

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34
Q

older women with intermittent abdominal pain and cholesterol-containing mass lodged at ileocecal valve has what

A

gallstone ileus

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35
Q

how does gallstone ileum erode insetting lumen

A

cholecystoenteric fistula

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36
Q

what are signs of small bowel obstruction

A

abdominal distension
tenderness
high-pitched bowel sounds

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37
Q

pneumobilia? causes

A

air in biliary tree,

caused by fistula between gallbladder and GI tract

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38
Q

What is the main cause of acute cholecystitis

A

gallstone obstruction of cystic duct

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39
Q

what is the preferred initial imaging test for diagnosis of acute cholecystitis

A

ultrasound: wall thickening, pericholecystic fluid

- when not conclusive: nuclear medicine hepatobiliary scanning

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40
Q

explain hepatobiliary scan

A

radio tracer give IV

  • taken up by hepatocytes
  • excreted in bile
  • gallbladder not visualized
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41
Q

pt with cardiogenic shock and evidence of watershed necrosis likely suffered from

A

hypoxic-ischemic encephalopathy

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42
Q

what part of the brain are most vulnerable to ischemic injury

A

pyramidal cells of hippocampus and purkinje cells of cerebellum

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43
Q

where is watershed zones of brain

A
  • located at borders between areas perfused by anterior, middle, and posterior cerebral arteries
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44
Q

how do cortical watershed infarcts typically appear

A

bilateral wedge-shaped strips of necrosis over cerebral convexity, parallel and adjacent to longitudinal cerebral fissure

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45
Q

daytime somnloence, non restorative sleep and elevated blood pressure in the setting of underlying obesity, morning headaches suggest?

A

obstructive sleep apnea

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46
Q

complications of obstructive sleep apnea

A
  • pulmonary hypertension, right heart failure, arrhythmias
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47
Q

abdominal pain and pancreatic calcifications suggest

A

chronic pancreatitis

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48
Q

low hemoglobin and elevated mean corpuscular volume is what type of anemia

A

macrocytic anemia

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49
Q

most common cause of chronic pancreatitis

A

ethanol

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50
Q

Folic acid synthesis what in RBC

A

thymidine

purine and pyrimidine bases

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51
Q

pancreatic insufficiency is associated with what vitrine

A

B12 deficiency

- pancreatic enzymes cleave R factor of B12, allowing binding to intrinsic factor

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52
Q

Libman-Sacks endocarditis occurs in who

A

Systemic lupus erythematosus

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53
Q

what is libeman-sacks endocarditis

A

small cardiac valvular vegetations on either side of value

- fibrotic valve thickening and deformity

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54
Q

68 caucsasion male: chewing difficulty, persistent headaches, tenderness over patient’s temples

A

giant cell arteritis

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55
Q

Takayasu arteritis and giant cell arteritis have what in common

A

granulomatous inflammation of media of artery

56
Q

aortic and pulmonary stenosis have what type of murmor

A

crescendo-decrescendo systolic murmur

57
Q

what causes multiple endocrine neoplasia type 1

A

mutation in MEN1 gene

58
Q

what tumors are in MEN1

A

parathyroid
pancreas
pituitary

59
Q

initial manifestation of MEN1

A

renal stones

60
Q

43 yr old man: neck surgery, recurrent renal stones, bitemporal visual field defects. what other organ should be checked

A

pancreas

- MEN

61
Q

is BRCA1/2 a tumor suppressor gene or proto-oncogene

A

tumor suppressor gene

62
Q

role of BRCA1/2

A

DNA repair gene

- repair of double-stranded DNA breaks

63
Q

why does gynecomastia occur in liver cirrhosis

A
  • increase adrenal production of androstenedione –> estrone –> estradiol
  • estradiol induces sex hormone-binding globulin production in liver, uterus and testes
  • decrease free testosterone/estrogen ratio
  • increase free estrogen
64
Q

Spider angiomata

A

subcutaneous vascular lesions consisting of central arteriole surrounded by many small vessels that blanch on compression

65
Q

hyperestrinism from liver failure causes what in patient

A
  • spider angiomata

- testicular atrophy with decreased body hair

66
Q

what type of lymphocytic proliferation is strong evidence of malignancy

A

monoclonal

67
Q

what causes benign lymph node enlargement? what type of proliferation

A
  • antigenic stimulation

- polyclonal proliferation

68
Q

Platelet count for DIC

A

decrease

69
Q

bleeding time for DIC

A

increase

70
Q

PT time for DIC

A

increased

71
Q

PTT time for DIC

A

increase

72
Q

AT what lab values should DIC be suspected

A
  • increase PT and PTT
  • platelet and fibrinogen decrease
  • D-dimer elevated in DIC ( fibrine degradation products)
73
Q

Bleeding in DIC compare with TTP-HUS

A

DIC: bleeds

TTP-HUS: do not bleed

74
Q

PT and PTT compare DIC and TTP-HUS

A

DIC: prolonged PT and PTT

TTP-HUS: normal PT and PTT

75
Q

fibrinogen levels compare DIC and TTP-HUS

A

DIC: fibrinogen and increased FDP

TTP- HUS: normal

76
Q

What cells are involved with granulomatous inflammation with caseous necrosis

A

macrophages, multi nucleated giant cells, CD4T lymphocytes

77
Q

clinical manifestations of carcinoid syndrome

A

flushing
watery diarrhea
bronchospasms

78
Q

lab diagnosis for carcinoid syndrome that has metastasized

A

increase urinary excretion 5-HIAA

79
Q

vasoactive substances secreted by localized intestinal carried tumor, what happens to it

A

metabolized by liver, no carcinoid syndrome

80
Q

Patient with painful enlargement of thyroid gland has typical feature of what

A

subacute granulomatous thyroiditis

81
Q

Subacute granulomatous thyroiditis usually follows what health problem

A

viral illness

82
Q

histo for granulomatous thryroiditis

A

first, neutrophilic infiltrate with microabscess formation

then, multinucleated giant cells

83
Q

decreased breath sounds, increased chest anteroposterior diameter, and decreased diaphragmatic excursion

A

COPD

84
Q

TLC and FVC in restrictive lung disease

A

decreased due to reduced lung expansion

85
Q

FEV1/FVC ratio in COPD

A

decreased

86
Q

Sharp chest pain that radiates to the left shoulder suggests

A

acute pericarditis

87
Q

sharp chest pain that radiates to left shoulder, with facial rash and proteinuria suggests

A

SLE lupus

88
Q

what type of inflammation is seen in SLE

A

serosal inflammation: manifests as pleuritis and pericarditis

89
Q

What increases pericarditis pain

A

inspiration

90
Q

what relieves pericarditis pain

A

sitting up and leaning forward

91
Q

What is a syndrome associated with congenital long QT syndrome

A

Jervell and Lange-Nielson syndrome

- autosomal recessive

92
Q

what is Jervell and Lange-Nielson syndrome

A

sensorineural deafness

93
Q

Acute promyelocytic leukemia is what translocation

A

t(15;17)

17: retinoid acid receptor alpha

94
Q

because of the translocation of 15;17 what goes wrong

A

abnormal receptor

95
Q

how do you treat acute promyelocytic leukemia

A

all-trans-retinoid acid

vitamin A derviative

96
Q

translocation for chronic myeloid leukemia

A

9;22

97
Q

histo for burkitt lymphoma

A

“starry sky”

98
Q

MOA of Warfarin

A
  • inhibition of vitamin K-dependent gamma-carboxylation of clotting factors II, VII, IX, X, protein C and S
99
Q

role of protein C and S? compare

A

anticoagulant effects

C- shorter half-fe

100
Q

how does warfarin-induced skin necrosis come about? solution

A
  • protein C reduced ( short half life)
  • II, IX, and X continue to have procoagulant effects
  • give with heparin
101
Q

MOA of metyrapone stimulation test

A
  • blocks cortisol synthesis by inhibiting 11-Beta-hydroxylase
  • if ACTH is working, increase 11-deoxycorticosterone
102
Q

role of 11-beta-hydroxylatse

A

converts 11-deoxycortisol to cortisol

zona fasciculata

103
Q

who metabolizes 11-deoxycortisol? what does it turn into

A

liver

17-hydroxycorticosteroids

104
Q

impaired driving in low light conditions ( “night blindness”) and thickened, dry skin ( hyperkeratosis) suggests

A

vitamin A deficiency

105
Q

What can cause vitamin A deficiency besides malnutrition

A
  1. biliary obstruction
  2. exocrine pancreatic insufficiency
  3. small-bowel resection
106
Q

Who usually gets granuloma cell tumors of ovary

A

postmenopausal women

107
Q

histo for granuloma cell tumors of ovary

A

Call-Exner bodies: small and cuboidal in shape, grow in cords or sheets, Rosette-like structures

108
Q

gross granuloma cell tumors of ovary

A

lipid content

- yellow color

109
Q

granuloma cell tumor of ovary secrete what and results in

A

estrogen

- endometrial hyperplasia

110
Q

alpha-fetoprotein can be seen in what

A
  • pregnancy
  • hepatocellular carcinoma
  • nonseminomatous testicular carcinoma
  • ovarian carcinoma
111
Q

How do pulmonary emboli typically appear on gross lung

A

multiple wedge-shaped hemorrhagic lesions in periphery of lung

112
Q

Do patients with pulmonary emboli get hemorrhages or ischemic infarction

A

hemorrhages

113
Q

young patient with recent IV drug use and acute presentation with septic shock most likely developed what pulmonary emboli from

A

tricuspid valve endocarditis

114
Q

patient has fatigue, pruritus, hepatomegaly and an elevated alkaline phosphatase suggesting

A

cholestatic liver disease

- secondary to hepatocellular dysfunction

115
Q

Cardiac dilation can result from deficiency in what vitamin

A

thiamine B1

116
Q

timeframe for acute transplant rejection

A

within first 6 months

117
Q

chronic lung transplant can cause what

A

bronciolitis obliterans

118
Q

Who produces Surfactant

A

type II pneumocytes

119
Q

in cells where is surfactant stored and allows transportation to cell surface

A

lamellar bodies

120
Q

describe lamellar bodies

A

organelles containing parallel stacks of membrane lamellae

121
Q

what is the most common type of congenital adrenal hyperplasia

A

21-hydroxylase deficiency

122
Q

11-beta-hydroxilyase deficiency impacts levels of what things

A
  • decreased glucocorticoid synthesis

- increase production of adrenal androgens

123
Q

17 alpha-hydroxylase impairs synthesis of what

A

androgens, estrogens, and cortisol

124
Q

Wallerian degeneration

A

axon is damaged, resulting in axonal degeneration and breakdown of myelin sheath distal to the site of injury

125
Q

six months after an acute subcortical infarct in the left internal capsule, what is seen in brain

A

Myelin debris: persist for year because macrophages must cross BBB
- suppresses axonal growth

astrocytes: glial scars, act as barrier to axon regeneration

126
Q

why does axonal regeneration not occur in CNS

A
  1. persistence of myelin debris
  2. secretion of neuronal inhibitory factors
  3. dense glial scarring
127
Q

esophagus lining

A

nonkeratinazed stratified squamous epithelium

128
Q

epithelium changes in smoking

A

trachea and bronchi: columnar epithelial cells ciliated replaced by stratified squamous epithelial cells

129
Q

What causes familial chylomicronemia syndrome

A
  • lipoprotein lipase (LPL) deficiency
130
Q

what other problems come with hyper chylomicronemia

A
  1. acute pancreatitis
  2. lipemia retinalis
  3. hepatosplenomegaly
131
Q

Schwannomas are what lab test positive

A

S-100

  • also for melanoma
132
Q

Common site of intracranial schwannomas is

A

cerebellopontine angle at CN VIII

133
Q

clinical presentation for Schwannomas

A

tinnitus
vertigo
hearing loss

134
Q

patient has anemia, thrombocytopenia (easing bruising), neutropenia ( recent respiratory infection), reticulocytopenia, normal cell lines on peripheral smear, no splenomegaly

A

aplastic anemia

135
Q

What PE finding is not seen in aplastic anemia

A

splenomegaly

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