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Uworld > Test 48: Pathology > Flashcards

Test 48: Pathology Flashcards

1
Q

The 2 most important factors in osteoclast differentiation to osteoclasts include

A

M-CSF: macrophage colony-stimulating factor

RANK-L: receptor for activated nuclear factor kappa B ligand

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2
Q

Interaction of RANK-L with RANK is blocked by what

A

osteoprotegerin (OPG)

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3
Q

Bone turnover is regulated by what ratio

A

OPG to RANK-L

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4
Q

Estrogen role on bone

A
  • inducing production of OPG by osteoblasts and stromal cells
  • decrease RANK on osteoclast precursor
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5
Q

drug used in postmenopausal osteoprosis

A

Denosumab

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6
Q

Skin rash, photosensitivity, arthralgia and renal disease in young women suggests

A

SLE

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7
Q

Name 3 antibodies in SLE

A
  1. antinuclear abs (ANA)
  2. anti-double stranded DNA (anti-dsDNA) abs : specific
  3. Anti-Smith abs : specific
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8
Q

Abs found in primary biliary cirrhosis

A

antimitochondiral abs

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9
Q

Liver mass with increased alpha-fetoprotein has what

A

hepatocellular carcinoma

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10
Q

which hepatitis can increase risk for hepatocellular carcinoma

A

B and C

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11
Q

how does HBV invade liver

A
  • integration of viral DNA into genome of host hepatocytes

- tiggers neoplastic changes

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12
Q

14 yr old boy: minimally raised yellow spots on inner surface of abdominal aorta? what is this

A

fatty streaks

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13
Q

What is in fatty streaks

A

collection of lipid-laden macrophages ( foam cells)

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14
Q

HPV produce what viral proteins?

A

E6 and E7

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15
Q

What do E6 and E7 inhibit

A

E6: p53
E7: Rb
- inhibit cell cycle regulation

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16
Q

clinical feature of acute adrenal insufficiency ( adrenal crisis)

A

-hypotension/shock

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17
Q

treatment for acute adrenal insufficiency ( adrenal crisis)

A
  • hydrocortisone or dexamethasone immediate

- fluid resuscitation

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18
Q

Patient has severe hypotension, skin hyper pigmentation, weight loss, hypothyroidism puts her at risk of other autoimmune endocrinopathies, has what

A

primary adrenal insufficiency

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19
Q

Mini-Mental Sate Examination MMSE does not test what? what can be used instead

A

executive function

- can be tested with clock drawing

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20
Q

patient must have what to demonstrate dementia

A
  1. impairment across several cognitive domains

2. functional impairment in activities of daily living

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21
Q

test for concentration

A

reciting months of year backwards

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22
Q

test for comprehension

A

following multistep commands

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23
Q

cerebellar vermis controls what? via?

A

axial/truncal posture coordination

- via medial descending motor system

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24
Q

acute lesions in cerebellar vermis would present as

A

-truncal and gait ataxia

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25
Q

Lesions in corticospinal tracts in cerebral subcortical white matter and brainstem cause

A

hemiparesis

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26
Q

lesions to the lower cerebellum vermis and flocculonodular lobe cause what

A
  • vertigo/nystagmus
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27
Q

live biopsy shows, extensive lymphocyte infiltration and granulomatous destruction of interlobular bile ducts. what is this

A

primary biliary cirrhosis

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28
Q

What gets destroyed in primary biliary cirrhosis

A

-intrahepatic interlobular bile ducts

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29
Q

clinical features of primary biliary cirhhosis

A
  • fatigue and pruritus ( first symptoms)
  • Cholestasis
  • xanthelasma
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30
Q

Fever, abdominal pain an jaundice in homeless man suggests

A

acute viral hepatitis

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31
Q

Fatigue and high alkaline phosphatase in a man with a long history of UC, suggests

A

primary sclerosing cholangitis

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32
Q

fever and prolonged episode of severe right upper abdominal pain after fatty mean ingestion in middle-aged, obese women suggests

A

acute cholecystitis

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33
Q

Weight loss, abdominal discomfort, jaundice and epigastric mass in older women suggests

A

pancreatitc cancer

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34
Q

What can cause functional heart murmurs in the absence of fixed valve lesion

A

acute hemodynamic changes

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35
Q

Dilatation of the left ventricle in response to increased preload can have what valve impact

A

functional mitral regurgitation

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36
Q

Holosystolic murmur over cardiac apex

A

mitral regurgitation

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37
Q

S3 gallop sound indicates

A

increased left ventricular filling rate during mid diastole

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38
Q

27 yr old male: infertility, bilateral gynecomastia, small firm testes. lower extremities are abnormally long

A

Klinefelter

47XXY

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39
Q

inhibit levels in Klinefelter

A

decreased because sertoli cell damage

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40
Q

Decreased LH, normal FSH, and evaluated testosterone in setting of low sperm count suggests

A

exogenous testosterone use

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41
Q

Normal LH and testosterone, elevated FSH, and a low spurn count suggests

A

cryptorchidism

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42
Q

D-xylose is what type of molecule

A

monosaccharide

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43
Q

what type of molecules are readily absorbed in GI tract

A

monosaccharides

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44
Q

If there is multi system invovlement and a biopsy shows transmural inflammation of the arterial wall with fibrinoid necrosis. what is ti

A

Polyarteritis nodosa

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45
Q

Polyarteritis nods greatest predisposing factor is what

A

Hep B

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46
Q

Most common vasculitis associated with antibiotic use

A

microscopic polyangiitis

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47
Q

Vasculitis linked to asthma is

A

Churg-Strauss syndrome

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48
Q

crescent formation on light microscopy is diagnostic of what renal disease

A

rapidly progressive (crescent) glomerulonephritis

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49
Q

What are 3 different abs in rapidly progressive glomerulonephritis

A
  1. antiglomerular basment membrane abs
  2. immune complex
  3. Pauce-Immune
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50
Q

Pauce-Immune in rapidly progressive glomerulonephritis have what in kidney and serum

A
  • no immunoglobulin or complement deposits in basement membrane of kidney
  • antineutrophil cytoplasmic abs (ANCA) in their serum
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51
Q

What do UVA wavelengths do to the skin

A

penetrate deeper into skin and cause photo aging

- decreased collagen fibril production `

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52
Q

how does photoaging present on skin

A
  • thinning of epidermis

- increase cross linking of collagen, with deposition of collagen breakdown products

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53
Q

what is the most likely responsible for patien’ts wrinkles

A
  • collagen fibril production

- elastin degration also occurs but not most likely

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54
Q

Most common primary cerebral neoplasm in adults

A

glioblastoma

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55
Q

location of glioblastoma

A

cerebral hemispheres

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56
Q

Grossly what does Glioblastoma look like

A

necrosis and hemorrhage

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57
Q

“butterfly glioma” is seen in what

A

Glioblastoma, when cerebral hemisphere cross midline

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58
Q

symptoms of low back pain and morning stiffness in young man. HLA-B2, Fusion of sacroiliac joints

A

akylosing spondylitis

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59
Q

enthesitis

A

pain, tenderness, and swelling at sites of tendon insertion into bone

60
Q

complications from ankylosing spondylitis

A
  1. Respiratory: limit chest wall expansion, hypoventilation
  2. Cardiovascular: ascending atrocities lead to dilation of aoritic ring and aortic insufficiency
  3. Eye: anterior uveitis
61
Q

Why wouldn’t peak expiration flow be a good measurement used in ankylosing spondylitis

A
  • PEF is determined from airway resistance and abdominal wall muscular function
  • Ankylosing spondylitis interrupts costovertebral and coststernal junction
62
Q

At what event is dysplasia no longer considered reversible

A

dysplastic cells breached the basement membrane

63
Q

Another name for high-grade dysplasia

A

carcinoma in situ

64
Q

Clinical clue for degenerative osteroarheritis

A

relieved with rest

65
Q

clinical clue for radiculopathy ( disc herniation)

A
  • radiates to leg

- positive straight leg raise test

66
Q

clinical clue for spondyloarthropathy

A

relieved with excercise

67
Q

clinical clue for vertebral osteomyelitis

A

Recent infection

IV drug use

68
Q

advanced age, pain that is worse at night , and persistent and progressive pain not relieved with position changes or analgesics suggests

A

spinal metastases

69
Q

55 yr old women: fatigue, bradycardia, weight gain, constipation and slowed relaxation of deep tendon reflexes suggest

A

hypothyroidism

70
Q

most sensitive marker for hypothyroidism

A

TSH serum

71
Q

24 hour urinary cortisol and dexamethasone suppression test screen for what

A

Cushing’s syndrome

72
Q

TRH stimulates what in the pituitary

A

prolactin

73
Q

Location of Schwannomas

A

Cerebellopontine angle attached to CN VIII

- acoustic neuromas

74
Q

what is gene is involved with Schwannomas

A

NF-2

75
Q

Difference between NF-2 and NF-1

A

NF-2: fewer cutaneous manifestations

- CNS involvement

76
Q

chromosome location for NF-2

A

22

77
Q

chromosome location for NF-1

A

17

78
Q

difference between NF-1 and NF-2 mutation

A

1: neurofibromin dysfunction
2: merlin dysfunction

79
Q

mutation on APC gene on chromosome 5

A

familial adenomatous polyposis syndromes of colon cancer

80
Q

mutation on RB1 on chromosome 13

A

retinoblastoma and osteosarcoma

81
Q

mutation of VHL gene on chromosome 3

A

Von-Hippel-Lindau disease

82
Q

45 yr old women: inability to walk, symmetric myelin layer vacuolization, axonal degeneration

A

vitamin B12 deficiency

83
Q

what tracts are damaged in vit. B12 degeneration

A
  1. dorsal column
  2. lateral corticospinal tracts
  3. axonal degeneration of peripheral nerves
84
Q

damage to dorsal column

A
  • bilateral loss of position and vibration sensation

- gait abnormalities, especially when eyes closed

85
Q

damage to lateral corticospinal tracts

A

upper motor neuron signs

- spastic paresis, hyperreflexia, Babinski sign

86
Q

damage to axonal degeneration of peripheral nerves

A

numbness or parenthesis

87
Q

Myelopathy associated with Vit B12 deficiency is also called

A

subacute combined degeneration

88
Q

Poliomyelitis effects what

A

anterior horns of spinal cord

89
Q

what is tabes dorsalis

A

damage to dorsal columns and dorsal roots of spinal cord

90
Q

p53 is what type of gene

A

tumor suppressor gene

91
Q

bcr-abl is what translocation? codes for? disease?

A

9:22 philadelphia chromsome
codes for tyrsoine kinase
chromic myelogenous leukemia

92
Q

murmur for patent ductus arteriosus

A

-continuous murmur

heard at left infraclavicular region

93
Q

Peptostreptococcus and Fusobacterium in lung means

A

lung abscess

94
Q

Peptostreptococcus and Fusobacterium are normally found where

A

normal mouth flora

95
Q

what are risk factors for oropharyngeal aspiration

A

loss of consciousness or dsyphagia

96
Q

leukemoid reaction

A

over-exuberant WBC response associated with bacterial infection or malignancy

97
Q

what is chronic myelogenous leukemia

A

uncontrolled mature granulocyte production

98
Q

Difference between leukemoid reaction and CML

A
  • CML: decreased alkaline phosphatase
99
Q

Recurrent nephrolithiasis in young patient should raise suspicion for

A

cystinuria

100
Q

pathogenic finding for cystinuria

A

hexagonal-shaped crystals

101
Q

What is diagnostic test for cystinuria

A

sodium cyanide-nitroprusside test

102
Q

What is Eczematous dermatitis

A

group of conditions

- erythematous, papulovesicular weeping lesions

103
Q

what causes acute allergic contact dermatitis

A

Type IV (delayed) hypersensitivity

104
Q

histo for acute eczematous dermatitis

A

-spongiosis: accumulation of edema fluid in intracellular spaces of epidermis

105
Q

What can cause a subarachnoid hermorrhage

A

rupture of saccular ( berry) aneurysm or arteriovenous malformation

106
Q

what can occur a couple of days after subarachnoid hemorrhage? txt?

A

vasospasm

- Nimodipine: calcium channel blocker

107
Q

subarachnoid hemorrhage can occur between what brain layers

A

subarachnoid and pia mater

108
Q

how do females present with 21-hydroxylase deficiency

A

ambitious genitalia at birth

109
Q

treatment of 21-hydroxylase deficiency is targeted at directly suppressing which hormone

A

ACTH

110
Q

costosternal syndrome (costochondritis) pain is characterized how

A

pain that is reproducible with palpation and worsened with movement of changes in position

111
Q

What timing is abnormal in hemophilia A and B

A

PTT time decreased

increase bleeding time

112
Q

degeneration occurs where in frontotemporal demantia

A
  • frontal lobes progresses to temporal lobes
113
Q

symptoms of frontotemporal dementia

A
  • early personality and behavioral changes ( social inappropriateness)
  • altered speech patterns
114
Q

Difference between Alzheimer and frontotemporal dementia

A

alzheimer: impairment involving recent memory

115
Q

caudate atrophy presents in what disease

A

Huntington disease

116
Q

in Alzheimer was the first region to suffer damage

A

hippocampus

117
Q

depletion of dopamine in substantial nigra occur in

A

Parkinsons

118
Q

what explains the complication of strictures and fistulas in Crohn’s disease

A

transmural inflammation

119
Q

malignant hypertension can cause what to vessels

A

hyperplastic arteriolosclerosis

120
Q

histo for hyperplastic arteriolosclerosis

A
  • onion-like concentric thickening of arteriolar walls in renal vasculature
121
Q

Transmural inflammation of arterial wall with fibrinoid necrosis is characteristic of what

A

polyarteritis nodosa

122
Q

Granulomatous inflammation of media characterizes

A

temporal giant cell arteritis

123
Q

lymph node biopsy has noncaseating granulomas, elevated calcium, scattered crackles, nontender cervical lymphadenopathy

A

Sarcoidosis

124
Q

1-alpha-hydroxylase is expressed in what cell? role

A

activated macrophages

  • produced 1,25-dihydroxyvitamin D (activated)
  • creates hypercalcemia
125
Q

PTH levels during sarcoidosis

A

decreased

126
Q

what stains congo red and viewed under polarized light, deposits have apple-green birefringence

A

amyloid

127
Q

Amyloid deposition in Alzheimer can occur where

A 
Brain parenchyma ( neuritic plaques) 
wells of cerebral vessels ( amyloid angiopathy)
128
Q

intracellular eosinophilic inclusions composed of alpha-synuclein

A

Lewy Bodies

Parkinson disease

129
Q

Odynophagia, dysphagia accompanied by fever or burning chest pain. endoscopy shows linear and shallow ulcerations? what is it

A

CMV esophagitis

130
Q

histo for CMV esophagitis

A

enlarged cells with intranuclear inclusions

131
Q

Child with vascular lesions with IgA and C3 deposition

A

Henoch-Schonlein purpura

132
Q

triad for Henoch-Schonlein purpura

A
  1. skin rash
  2. arthralgias
  3. abdominal pain
133
Q

63 yr old male: abdominal pain, mesenteric vein thrombosis, absence of CD 55 on surface of RBC

A

Paroxysmal nocturnal hemoglobinuria

134
Q

What gene is defected is paroxysmal nocturnal hemoglobinuria

A

PIGA gene, synthesizes GPI anchor for dear-accelerating factor (DAF)

135
Q

what goes wrong in paroxysmal nocturnal hemoglobinuria

A

uncontrolled complement-mediated hemolysis

136
Q

Chronic hemolysis with breath down of iron-containing erythrocytes can also lead to what

A

iron deposition in kidney

137
Q

What is given after nuclear accidents to protect the thyroid from radioactive iodine

A

potassium iodide

138
Q

normal intestinal mucosal architecture, enterocytes contain clear or foamy cytoplasm more prominent at tips of villi

A

abetalipoproteinemia

139
Q

what is abetalipoproteinemia

A

caused by impaired formation of apolipoprotein B

140
Q

Abetalipoproteinemia is defective in what gene

A

MTP gene

141
Q

peripheral blood smear for abetalipoproteinemia

A

acanthocytes

142
Q

PE for abetalipoproteineimai

A

neurologic abnormalities

143
Q

What is polycythemia vera

A

uncontrolled erythrocyte production

144
Q

clinical features of polycythemia vera

A
  • aquagenic pruritus
  • facial plethora
  • splenomegaly
145
Q

Polycythemia vera have a mutation in what

A

JAK 2, non-receptor (cytoplasmic) tyrosine kinase associated with erythropoietin receptor

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