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Barone Flashcards

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1
Q

Micro vs macro cirrhosis of liver

A

3mm

alcohol is MCC of micro

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2
Q

UC

A

toxic megacolon -> sepsis -> death
continuous lesions
pseudopolyps (healing regions)

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3
Q

UC histo

A

superficial inflammation

crypt abscesses

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4
Q

UC markers

A

HLAB27
pANCA
anti-myeloperoxidase

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5
Q

Chrons

A

transumural inflammation -> strictures - string sign
skip lesions- cobblestone
creeping fat

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6
Q

Chrons histo

A

transmurral granulomatous inflammation

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7
Q

markers

A

NOD2
ASCA
Anti-saccharomyces cerevisiae Ab (brewers yeast - corona)

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8
Q

purple cyto

A

neutros
bacteria
Ca

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9
Q

pink cyto

A

proteins

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10
Q

cardiac myocytes

A

intercalated discs w/gap jnxs made up of kinexins

looks like little circles in a big cirle

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11
Q

Hemochromatosis

A

increased Fe
mutation in HFE
C282Y (Cys-> tyr)

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12
Q

what is toxic about Fe and Cu

A

Fenton Rx

tuns H202 -> OH radical

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13
Q

Tx for hemochromatosis

A

phlebotomy
chelation:
1st line- deferasirox (PO)
2nd line- deferoxamine (IV)

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14
Q

Tx for excess Cu

A

depencilimin

pennies are made of Cu

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15
Q

Prussian blue stain

A

Fe

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16
Q

congo red stain

A

amyloid

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17
Q

acid fast aka

A

kineyou
siehl-nelson
Fite

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18
Q

acid fast stain

A

TB
MAI
weak- nocardia

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19
Q

PAS stain

A 
stains sugar
glycogen storage diseases
glycoproteins (alpha 1 anti-trypsan def)
bacteria (whipples disease)
fungi (silver better)
pagets disease of nipple (mucus stains)
AML-M6
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20
Q

AML-M6

A

red cell form
googly elmo
erythroid leukemia
stains PAS

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21
Q

herpes viruses

A

all DNA
all double stranded (except parvo)
encapsulated by nuclear membrane like HPs invisibility cloak -> herpes is forever!

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22
Q

rabies infectious process

A

binds AChRs

Dynin retrograde transport

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23
Q

cyclophosphamide

A

Nitrogen mustard via p450 -> alkylates DNA -> kills cells

build up of acroline

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24
Q

acroline

A

hemorrhagic cystitis and transitional cell carcinoma

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25
how do you prevent hemorrhagic cystitis
mesna should always be given w/cyclophosphamide
26
repetitive catalase + infections in kid
think chronic granulomatous disease
27
troponin
most specific marker of cell death
28
myoglobin
most sensitive marker of cell death
29
amylase
most sensitive marker of pancreatits
30
lypase
most specific marker of pancreatitis
31
how do you know if ALP is elevated d/t liver or bone?
if GGT elevated biliary | if GGT normal bone
32
cytotoxic T cells kill how
FasL binds FasR/CD95 on infected cell -> death domain -> caspase 8 -> caspases 3,6,7
33
p53
G1->S checkpoint by keeping RB hypophosphorylated
34
DNA strand breaks... what happens?
Sensed by ATM -> tell p53 to stop cycle and BRACA to fix it
35
ataxia telangetasia
mutated ATM
36
Lynch syndrome
``` mutated MLH1/MSH2 CEO colon endometrial ovarian ```
37
excision endonuclease repair
sun damage | broken in xeroderma pigmentosa -> skin CA
38
if mutation cannot be fined
increased p53 -> Bax punches holes in outer membrane -> cytochrome C into cyto -> APAF1 -> caspase 9 -> caspase 3
39
BCL2
anti-apoptotic plugs up BAX channels follicular NHL turns on BCL2
40
follicular NHL
``` b cell tumor (B cell markers) 14,18 IgH, BCL2 low grade, divides slowly Px 10yrs chemo or radiation do nothing ```
41
infliximab
Anti TNF
42
rituximab
anti CD20 | check serology for HBV and HBC
43
kid born w/o thymic shadow
DiGeorge SCIDs HIV
44
adult w/thymic shadow
Thymoma MG pure red cell aplasia
45
viral hepatits
councilman bodies
46
concentric left ventricular hypertrophy
HTN | S4 gallop
47
PTEN mutation
chrom 10 prostate follicular thyroid CA endometrial CA
48
serous adenocarcinoma of endometrium
older women usually papillary -> bad bc break off and seed usually in ovary worst ovarian CA present w/adnexal mass w/ascites -> death sentence
49
pagets carcinoma
keratin + | PAS +
50
Melanoma
S100 (so are pheos and schwanomas) | HMB-45
51
Nieman pick
chrom 11 | sphingomyelin -> zebra body lysosomes -> hepatosplenomegaly
52
lipofusion
accumulates in aging heart, brain, liver perioxidized undigestible lipids normal
53
BRAF mutations
nevi and melanoma | RAS pathway
54
type of melanoma
nodular acrolentiginous superficial spreading lentigo
55
nodular melanoma
vertical growth worst Px breslow thickness
56
acrolentiginous
``` flat 2nd worse Px dark skin pts (bob marley) mutations in C-kit (tyrosine kinase) Tx w/imatinib ```
57
superficial spreading
MC | eventually becomes vertical growth and is too late to cure
58
lentigo maligna
``` freckle on steroids hutchinson freckle old face best Px ```
59
psamomma bodies
meningiomas thyroid papillomas papillary serous adeoma in ovaries mesothelioma (shipbuilders)
60
CML
9,22 BCR-ABL TK, so Tx w/imatinib
61
GIST
Tx with imatinib
62
Dx of papillary thyroid CA
orphan annie eyes
63
what chemo drugs are CI in restrictive lung disease
bleomycin | busulfan
64
what antiarrhythmic is CI in restrictive lung dis
amioderone (Class III/K) | can also cause hypo/hyper thyroid and blue skin
65
lymphedema
Tx w/compression | @ risk for lymphangiosarcoma
66
non-pitting edema
myxedema from thyroid | lymphedema
67
nutmeg liver
d/t right sided heart failure Budd-chiari d/t blocked outflow of hepatic v zone III
68
what damages zone I of liver
HTN | viruses
69
palpable purpura
small vessel vasculitis henlock scholein purpura microscopic angiopathic
70
ITP
``` spleen makes Abs against GpIb and/or GpIIb/IIIa on platelets type II hypersensitivity spleen sequestered opsonized platelets NO splenomeglay Healthy young women or kids post viral secondary to SLE, HIV high BT, normal pT/pTT bone marrow lots of megakarycytes ```
71
Tx of ITP
steroids active bleeding -> IV IgG then platelets rituximab (anti CD20) splenectomy (almost everyone eventually)
72
TTP
young female presents w/stroke usually triggered by virus pentad: CNS, fever, low platelets (stuck in brain), anemia, increased BUN/Cr
73
Abs in TPP
ADAMTS13 | usually inactivates vWF
74
other signs of TTP
microangiopathic hemolytic anemia (schytocytes/helmet cells) elevated BT pT/pTT normal (unless in DIC)
75
Tx of TTP
plasma exchange
76
vWD
``` superficial bleeding MC familial bleeding disorder platelet count normal elevated BT pT normal, pTT may be prolonged d/t concurrent factor VIII def + ristocetin (adhesion disorder) ```
77
how do you differentiate vWD from hemophilia
hemophilia normal BT hemophilia males low vWF Ag in vWD
78
Tx of vWD
avoid aspirin | give desmopressin
79
hemophilia A
``` XR missing factor 8 normal pT elevated pTT normal BT normal platelet count Male w/just an increased pTT 5x > then hemophilia B often bleed at circumcision easy bruising at 6mo+ bleeding in joints ```
80
mixing studies
determines whether deficiency or inhibitor
81
Tx of hemophilia A
mild bleeding- desmopressin (release factor 8 and vWF) | severe- give 8
82
hemophilia B
``` aka christmas disease/kings disease deficiency in factor 9 prolonged pTT normal count, pT, BT mixing corrects usually severe XR ```
83
hemophilia C
``` factor 11 deficiency very mild bleeding AR increased pTT Tx with factor 11 or FFP ```
84
factor 7 deficiency
normal pTT | abnormal pT
85
vit k deficiency
new borns C. diff rat poison/warfarin overdoese
86
liver disease and bleeding
stops making factors 7 effected first -> pT looks like vit K deficiency
87
warfarin
blocks vit K epoxide reductase knocks out proteind C and S first -> hypercoag -> skin necrosis in those w/protein C deficiency monitor w/pT
88
heparin
activates anti thrombin III (factor 2) also knocks out 12, 10, 9, 10 monitor w/pTT
89
what if you Tx w/heparin and nothing happens
anti thrombin III deficiency
90
which CA most likely to cause DIC
AML M3 (15,17)
91
AML M3
(15,17) PML,RAR Tx/all trans retinoic acid 'sexy young girl (15-17) driving sexy BMW M3, looking for sexy DIC to give her the (auer) rod, but she is in the wrong part of town and can only find ALL TRANS (ATRA) which will only give her the (zinc) finger
92
auer rods
lysosomes -> TF -> coag
93
brutons agammaglobulinemia
``` x-linked BTK (burtons tyrosine kinase) mutations normal until 6mo histo- no germinal centers no gamma bumb IVIG every month ```
94
digeorger
3rd and 4th pharyngeal pouch chacostek and trousous sign no paraCx in nodes TBX1 gene
95
SCIDs
``` IL-7 matures T cells, IL2 activates SCIDS have ILR mutation on T cells X linked never give live vaccine BM transplant ```
96
wiscott-aldrich
``` X-linked TIE: Thrombocytopenia infections eczema death- bleeding, infections, lymphoma IgM low IgA and E high eventually become mentally challenged ```
97
how do you tell TB and MAC appart
TB makes niacin | TB has porin factor and sulfatides
98
what advantage does foscarnet have over gancyclovir?
it does not need to be activated by viral kinase
99
periventricular calcifications
congenital CMV
100
basal ganglia calcification
congenital toxo
101
anti arrythmics
``` No Better Pot then in Cali Na BB K Ca ```
102
when do you shock an arrythmia
decreased BP change in mental status chest pain severe SOB
103
myocarditis w/eos
loefflers endomyocarditis
104
right sided cardiac fibrosis
tricuspid regurg, pulmonic valve stenosis d/t carcinoid syndrome
105
what vit is deficient in carcinoid syndrome
niacin, bc tryptophan used up making serotonin | DO NOT supplement tryptophan (restrict it) and supplement niacin
106
Tx of carcinoid syndrome
surgery | somatostatin analog octreotide (tumor will take it up to ID tumor)
107
tumor in heart that stains S100 and HMB-45
metastatic melanoma
108
tumor in heart that stains cytokeratin (CK) 7
metastatic lung CA
109
tumor in heart that stains CK 2D
metastatic colon CA
110
increased unconjugated/indirect bilirubin
hemolytic anemai physiologic jaundice of newborn gilberts (very common) crigler-najjar
111
crigler-najjar tyep 1
fatal, w/o liver transplant no UGT phenobarbital -> nothing confirm w/genetic testing UGT promoter
112
crigler najjar type 2
too little UGT, phenobarbital -> corrects uncommon UGT coding region
113
increased conjugated/direct bilirubin
dubin-johnson rotors obstructive
114
dubin-johnson
black liver not bilirubin pigment from catecholamine build up cannot transport conjugated bili out of liver
115
rotors
normal color of liver
116
which parasite causes obstructive jaundice
clonorchis sinensis
117
primary biliary cirrhosis
``` granulomas cause obstruction only destroys bile ducts inside liver xanthomas fatigue chirrosis common in SLE, RA AMA abs (mito) ```
118
primary sclerosing cholangitis
``` unknown etiology autoimmune segmental inflammation and fibrosing of bile ducts inside and out of liver males 20-30 70% have UC progresses to cholangiocarcinoma string of beads ```
119
what cells lay down fibrosis in liver?
ITO cells, aka hepatic stellate cell | usually fat and vit A
120
what signals fibrosis
TGF-beta
121
trichome stain
think fibrosis blue-fibrosis red- regenerative nodules
122
how do you Tx esophageal varices
``` ocreotide to decrease portal HTN surgery lactulose to bind proteins and pull them out to prevent hepatic encephalopathy give broad spectrum abx prevent another w/BB ```
123
hepatic encephalopathy
d/t ammonia build up | cannot eat protein
124
HBV
ground glass cytoplasm
125
HCV
fatty change | lymphoid aggregates
126
amebic liver abscess
brown fluid, looks like chocolate | Tx w/metronidasole
127
mallory bodies
swollen hepatocytes w/pink ropey stuff in alcoholic hepatitis
128
wilsons disease
mutated ATP7B Cu accumulates atrophy of lenticular nucleus of basal ganglia doesn't present until 10+ chirrotic liver Cu collects in descemets memebrane-> kayser fleischer rings cogwheel ridgitiy, resting tremor, shuffling gate mis Dx as parkinsons or ASHD
129
Dx of wilsons
ceroplasmin low high urine Cu liver Bx shows Cu
130
what level to horseshoe kidneys get stuck at?
IMA at L3
131
ARPCKD
PKHD1- codes for fibrocystin fatal near birth radiating cysts

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