Flashcards in Barone Deck (131):
1
Micro vs macro cirrhosis of liver
3mm
alcohol is MCC of micro
2
UC
toxic megacolon -> sepsis -> death
continuous lesions
pseudopolyps (healing regions)
3
UC histo
superficial inflammation
crypt abscesses
4
UC markers
HLAB27
pANCA
anti-myeloperoxidase
5
Chrons
transumural inflammation -> strictures - string sign
skip lesions- cobblestone
creeping fat
6
Chrons histo
transmurral granulomatous inflammation
7
markers
NOD2
ASCA
Anti-saccharomyces cerevisiae Ab (brewers yeast - corona)
8
purple cyto
neutros
bacteria
Ca
9
pink cyto
proteins
10
cardiac myocytes
intercalated discs w/gap jnxs made up of kinexins
looks like little circles in a big cirle
11
Hemochromatosis
increased Fe
mutation in HFE
C282Y (Cys-> tyr)
12
what is toxic about Fe and Cu
Fenton Rx
tuns H202 -> OH radical
13
Tx for hemochromatosis
phlebotomy
chelation:
1st line- deferasirox (PO)
2nd line- deferoxamine (IV)
14
Tx for excess Cu
depencilimin
pennies are made of Cu
15
Prussian blue stain
Fe
16
congo red stain
amyloid
17
acid fast aka
kineyou
siehl-nelson
Fite
18
acid fast stain
TB
MAI
weak- nocardia
19
PAS stain
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
20
AML-M6
red cell form
googly elmo
erythroid leukemia
stains PAS
21
herpes viruses
all DNA
all double stranded (except parvo)
encapsulated by nuclear membrane like HPs invisibility cloak -> herpes is forever!
22
rabies infectious process
binds AChRs
Dynin retrograde transport
23
cyclophosphamide
Nitrogen mustard via p450 -> alkylates DNA -> kills cells
build up of acroline
24
acroline
hemorrhagic cystitis and transitional cell carcinoma
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