General patho 0422Q

Question 1

what is a common complication of aspiration PNA?

Answer 1

LUNG ABSCESS

caused by anaerobic bacteria of gingivodental sulcus (fusobacterium, peptostreptococcus, bacteroides)

Question 2

who gets aspiration PNA?

Answer 2

pts with impaired consciousness OR decreased ability to swallow (alcoholics, chronically ill, demented)

Question 3

what sx are seen with lung abscess?

Answer 3

cough with copious foul-smelling sputum.

fever, malaise, weight loss, clubbing, leukocytosis.

Question 4

where do lung abscesses most often develop?

Answer 4

RIGHT lung bc right bronchus is straighter

Question 5

where does gastric cancer commonly met to?

Answer 5

1. left supraclavicular sentinel node (Virchows node)
2. periumbilical region (SQ mass - Sister Mary Joseph nodule)
3. ovary (Krukenberg tumor)

Question 6

Krukenberg tumor

Answer 6

mucin-producing signet ring cells in ovarian stroma.

common type of metastatic ovarian cancer.

Question 7

where do systemic emboli arise from?

Answer 7

left atrium or left ventricle

ex: LA clot, LV clot, valvular vegetation, aortic atherosclerotic plaque

Question 8

what simultaneous clinical features point to emboli?

Answer 8

stroke, intestinal/foot ischemia, renal infarction

Question 9

what gene mutation is involved in hemochromatosis?

Answer 9

HFE protein (chromo 6) - unregulated iron uptake by transferrin/iron complex endocytosis (high Fe GI absorption)

Question 10

what are the more serious complications of hemochromatosis?

Answer 10

liver cirrhosis, HCC

Question 11

what does positive babinski sign indicate?

Answer 11

[extension/dorsiflexion of toes with plantar stroking]

UMN lesion (other signs include hyperreflexia, muscle weakness/paralysis, and spasticity)

Question 12

what is the straight leg raise test?

Answer 12

leg held straight while raised off exam table - pain indicates sciatic nerve root (L4-S3) irritation. intervertebral disc herniation causing sciatica.

Question 13

kaposi sarcoma affects?

Answer 13

skin but can have extracutaneous spread to LUNGS and GI TRACT

Question 14

what is the most important RF for development of intimal tears leading to aortic dissection?

Answer 14

hypertension

less commonly, cystic medial degeneration of marfan

Question 15

what are major RFs for atherosclerosis predisposing to aortic aneurysm?

Answer 15

smoking, diabetes, hypercholesterolemia

Question 16

what is the schilling test?

Answer 16

give pt oral radiolabeled vit B12 followed by IM injection of unlabeled B12 – measure urinary excretion of radioactive B12 – normal excretion indicates dietary deficiency while decreased excretion indicates intestinal problem (pernicious anemia or malabsorption)

Question 17

sx of carcinoid syndrome (metastatic to liver)

Answer 17

1. vasomotor instability: cutaneous flushing, dizziness
2. GI: secretory diarrhea, crampy pain
3. bronchoconstriction: dyspnea with wheezing
4. right sided valvular heart disease (tricuspid, pulmo)

Question 18

how does phosphatidylcholine affect cholesterol?

Answer 18

phospholipid that makes chol soluble - high levels (along with high levels of bile acid) help decrease risk for gallstones

Question 19

complications of adult-type coarctation of aorta

Answer 19

HTN-associated: LV failure, ruptured dissecting aortic aneurysm, intracranial hemorrhage (increased incidence of congenital berry aneurysm)

Question 20

causes of spontaneous intracranial hemorrhage in young adults

Answer 20

1. AV malformations
2. ruptured cerebral aneuryms
3. sympathomimetic drugs (cocaine)

Question 21

what change is seen with congenital pyloric stenosis?

Answer 21

hypertrophy of pyloric muscularis mucosa (palpable olive-sized mass)

Question 22

how does desmopressin acetate (DDAVP) treat mild-moderate hemophilia A and vW disease?

Answer 22

synthetic vasopressin analog that release factor VIII and vWf from endothelial cells

Question 23

what is Virchows triad?

Answer 23

1. endothelial injury
2. venous stasis
3. hypercoag state

predispose to DVT

Question 24

morphology of NSAID-assoc. chronic renal injury

Answer 24

papillary necrosis and chronic interstitial nephritis

Question 25

vWf functions

Answer 25

1. protective carrier for circulating factor VIII | 2. promoter of plt adhesion to injured epith surfaces - bind plt glycoprots to collagen on injured bld vessel wall

Question 26

what is the major cause of mitral regurg?

Answer 26

mitral insuff due to myxomatous degeneration (mitral valve prolapse predisposes to infected vegetations) - native valve bacterial endocarditis (plt and fibrin deposit on valves spontaneously, then microorgs colonize valves during bacteremia)

Question 27

what is the COD in rare but lethal acute rheumatic fever?

Answer 27

heart failure due to severe myocarditis (with MR)

Question 28

when does acute rheumatic fever occur?

Answer 28

10d-6wks after group A strep pharyngitis. | most often age 5-15.

Question 29

how common is the occurrence of acute rheumatic fever and PSGN together?

Answer 29

RARE!

Question 30

what is lacunar infarct most commonly due to?

Answer 30

hypertensive arteriolosclerosis of small penetrating arterioles. involves basal ganglia, pons, internal capsule, or deep white matter of brain. small size < 15 mm

Question 31

what is most affected by ischemic ATN?

Answer 31

tubular epith cells - proximal tubule and thick ascending limb of Henle

Question 32

what is syringomyelia?

Answer 32

formation of cavity (syrinx) in cervical SC - damage to ventral white commissure leads to bilateral loss of P&T. extension of syrinx destroys motor neurons (ventral horns) causing flaccid paralysis, atrophy of intrinsic hand mm, other LMN signs

Question 33

red neuron

Answer 33

neuron responding to irreversible injury. changes evident 12-24hrs after event. cell body shrinks, eosinophilic cytoplasm, pyknosis of nucleus, loss of Nissl substance.

Question 34

how does sickle cell disease affect spleen?

Answer 34

repeated splenic infarctions resulting in splenic atrophy with scarring/fibrosis or asplenia (by young adulthood) - after autosplenectomy, pts are predisposed to infx with encapsulated bact.

Question 35

why are pts with sickle cell or other hemolytic anemias predisposed to folic acid deficiency (and thus, macrocytic change)?

Answer 35

increased RBC turnover

Question 36

what do ECG findings in leads II, III, aVF along with MI sx indicate?

Answer 36

transmural ischemic injury to INFERIOR wall of heart (supplied by posterior descending branch of RCA)

Question 37

how do pts with vWf disease often present?

Answer 37

lifelong hx of gingival bleeding, epistaxis, mucosal bleeding, menorrhagia. occult bleeding may be sufficient to cause iron deficiency anemia.

Question 38

histology of acute viral hepatitis

Answer 38

panlobular lymphocytic infiltrates. ballooning hepatocytes. hepatocyte necrosis. hepatocyte apoptosis (acidophliic councilman bodies).

Question 39

what is the most common hepatic malignancy?

Answer 39

mets from another primary site (breast, lung, colon). more common than HCC.

Question 40

what does a matched V/Q defect mean?

Answer 40

ventilation defect matched by perfusion defect = lung collapse or consolidation

Question 41

why is there an increased incidence of subdural hematoma in elderly indivs after minor trauma?

Answer 41

age-related brain atrophy: distance from skull to brain surf increases, and cortical bridging veins are under more tension/rupture more easily. gradual onset of sx. subtle and variable presentation ("great imitator")

Question 42

what factors predispose to infective endocarditis?

Answer 42

prosthetic heart valves. | prior valvular inflamm, damage, and scarring.

Question 43

what do the vegetations assoc. with bacterial endocarditis represent?

Answer 43

fibrin and plt deposition at site of bact colonization (most common: S.aureus)

Question 44

what is a common cause of acute renal failure in children?

Answer 44

HEMOLYTIC-UREMIC SYNDROME (HUS) - shiga toxin producing E.coli or Shigella dysenteriae. TRIAD: ARF, microangiopathic hemolytic anemia, thrombocytopenia

Question 45

what are signs of hemolysis?

Answer 45

pallor. red urine. etc...