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Ashly Benson: Path III Final > Past Test Tidbits > Flashcards

Flashcards in Past Test Tidbits Deck (185)
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1

What is the MC non cardiac symptom of an MI?

Dyspnea

2

Which EKG wave is most indicative of an MI?

Q wave will be wider and deeper

3

What labs reflect an MI?

Elevated WBC
Elevated LDH
Elevated Cardiac Enzymes: Creatine phosphokinase (MB band), Troponin (esp. I and T)

4

Does a fatty streak impair the lumen size?

No

5

What is the MC cause of an Myocardia Ischemia?

Reduction in coronary blood flow due to atherosclerotic coronary arterial obstruction.

6

What is a unique feature of unstable angina?

Pain occurs at rest (may awake in the night with pain)

7

What is the MC cause of an MI?

Plaque rupture: pathology comes from interior of the plaque being exposed

8

What is pericarditis and what are the sequelae of pericarditis following an MI?

Inflammation of the pericardium; No serious consequences or sequelae

9

What is cardiac tamponade?

Pericardial effusion in which fluid, pus, blood clots and gas accumulate in the pericardium resulting in compression of the heart

10

What is fibrinous pericarditis known as?

Bread and butter pericarditis.

11

What presumed auto-immune form of pericarditis occurs weeks to months after injury to the heart/pericardium?

Dressler's syndrome

12

What layers does an aortic dissection occur in?

Occurs through the medial tissue layer of the aorta (between internal and medial layer)

13

Marfan's syndrome results in abnormal collage/connective tissue due to abnormal production of what? Individuals w/Marfan's tend to have what heart problem?

Abnormal fibrillin-1 protein
Aneurysms localized to the aorta

14

What deficiency can lead to all sx of a Marfan's pt w/o actually having Marfan's?

Copper deficiency

15

What are heart failure cells?

Hemosiderin(oxidized iron) containing macrophages in the alveoli. (Brown color)

16

Cor Pulmonale is heart failure that occurs as a result of what?

Pulmonary disease: emphysema, chronic bronchitis, PE, Pulmonary HTN

17

What is the MC causes of non-ischemic dilated cardiomyopathy in the US?

Chronic alcoholism

18

What condition presents with variations in myocyte size, myocyte vacuolation, loss of myofibril material and/or fibrosis?

Dilated Cardiomyopathy

19

What are the MC causes of restrictive cardiomyopathy (infiltration of abnormal tissue that results in impaired ventricular wall motion: contraction and relaxation)?

Amyloidosis and Hemochromatosis

20

What are the MC organisms that cause community-acquired endocarditis?

Staph Aureus (30-50%; Non-MRSA)
Strep Viridans (10-35%)

21

What organism cases most noscomial endocarditis?

Staph Aureus (60-80% MRSA)

22

Does infectious endocarditis always present with fever?

No. Can often present as afebrile

23

In subacute endocarditis, vegetations frequently embolize. How does this present clinically?

Microemboli reach the skin in the form of petechiae in the mouth, under the tongue, in the finger nail beds (splinter hemorrhages) or in the retina (Roth's spots)

24

What are the major risk factors for endocarditis?

Artificial valves
Immunocompromised patients
IV drug users
Alcoholics
Pt w/indwelling catheters
Pt w/vascular grafts

25

What is the MC organism associated w/endocarditis of native valves?

Strep Viridens (alpha hemolytic Strep)

26

What is the MC endocarditis organism associated with alcoholics?

Anaerobes and oral cavity bugs

27

What is the MC endocarditis organism associated w/ IV drug users?

Staph Aureus

28

What is the MC endocarditis organism associated w/ prosthetic valves?

Staph Epidermitis

29

If Strep Bovis is found on culture from the blood what is test is indicated?

Colonoscopy to rule out colon cancer

30

Endocarditis of SLE is referred to as what?

Libman-Sacks endocarditis

31

Culture negative endocarditis points toward what?

Endocarditis of an inflammatory disorder.

32

What is the MC cause of valvular disease in the world?

RF

33

What is the pathological name for MVP?

Myxomatous degeneration

34

RF develops following pharyngitis with what organism?

Group A beta-hemolytic Streptococcus

35

What is the lab test for Group A Strep?

Elevated or rising streptococcal antibody titer: antistrepotolysin O or ASO titer

36

Post-strep acute RF is likely due to an autoimmune response caused by ????

Anti-streptococcal M protein antibodies that cross react with cardiac myosin

37

Aschoff bodies are found in individuals with what disease?

RF
Fully developed they are granulomatous

38

Aschoff bodies (pathologic features)

Inflammatory lesions found in various tissues, but distinctive within the heart. Foci of enlarged cells surrounded by lymphocytes and plasma cells

39

Hemorrhagic Pericardial Effusion is most likely due to:

Trauma, cancer, TB infections (Caseious pericarditis)

40

Hemorrhagic pericarditis makes you think of what disease processes?

TB, tumor, bacterial infection, bleeding disorders (Von Willebrand), trauma

41

MC benign heart tumor

Atrial myxoma

42

MC malignant heart tumor

Angiosarcoma

43

What is the MC metastasis to the heart?

Melanoma

44

What is the MC pediatric tumor of the heart?

Rhabdomyoma

45

What tumor features cells that are polygonal or have an elongated cell shape, mononuclear or multinucleate w/finely vacuolated eosinophilic cytoplasm?

Atrial Myoxoma

46

Achalasia is the result of what? And it has what distinct anatomical picture found on Xray?

Inability to relax the lower esophageal sphincter.
Beak like appearance

47

Achalasia has what histological picture?

Lymphocytic infiltration of Auerbach's plexus

48

Which esophageal motility disorder presents with coordinated but excessive contractions?

Nutcracker esophagus (painful w/no pathologic abnormality)

49

How does corkscrew esophagus present?

Uncoordinated contractions within several segments of the esophagus simultaneously (painful w/no pathological abnormality).

50

What is Mallory-Weiss syndrome and what layers does it affect?

Bleeding from tears in the mucosa and submucosa (not the muscular layer) at the junction of the stomach and esophagus.

51

What is Boerhaave's syndrome?

A full thickness tear or rupture of the esophageal wall.

52

What is the histological change associated with Barrett's esophagus?

Cells at the lower end of the esophagus transform from normal squamous epithelium to columnar epithelium.

53

Nearly 2/3rds of benign esophageal tumors are ____________?

Leiomyomas

54

Granular cell tumors (benign) arise from what cell?

Schwann cells

55

Where does squamous cell cancer present in the esophagus?

Upper 2/3rds of esophagus

56

What cancer presents in the lower portion of the esophagus?

Adenocarcinoma: arises from glandular cells at the junctions on of the esophagus and stomach

57

Which form of esophageal cancer is MC?

Primary squamous cell (90-95%)

58

What are common findings on hx regarding esophageal SCC and Adenocarcinoma?

SCC: hx of tobacco and alcohol consumption
Adenocarcinoma: hx of GERD, obesity and Barrett's

59

What are the key histological signs of malignancy?

Variable nuclear size, staining and shape; increased mitotic figures; higher nucleus to cytoplasm ratio

60

Deficiency of what enzyme increases risk for developing SCC?

ALDH2 (ADH and ALDH are the two major enzymes in the chemical pathway of alcohol metabolism)

61

What stomach pathology has the highest association with H. Pylori infections?

Duodenal peptic ulceration (H. Pylori in 85% of duodenal ulcers)

62

What is the appearance of malignant ulcers?

Irregular, heaped overhanging margins w/a nodular and irregular mass that may be ulcerated and protrude into the lumen of the stomach.

63

What is the 2nd MC cause of duodenal ulcers?

NSAID use

64

Which ulceration is more concerning, anterior or posterior?

Posterior wall perforation b/c gastroduodenal artery lies posterior to the 1st part of the duodenum. Digestive enzymes can also cover the pancreas

65

What disease presents with this triad: gastric acid hyper secretion, severe peptic ulceration, non-beta cell islet tumor of the pancreas?

Zollinger-Ellison syndrome

66

What does a gastrinoma do and what disease is it associated with?

Release excessive amounts of gastrin leading to increased stomach acid production. Zollinger-Ellison syndrome

67

What disease results in hypertrophy of the gastric mucosa and why?

Zollinger-Ellison syndrome: due to hypergastrinemia

68

What disease presents with enlarged gastric mucosal folds?

Menetrier's disease: increased mucus leading to gland atrophy in the stomach and hypochloridria

69

Menetrier's disease in childhood is most often noted after what infections?

CMV or H. pylori

70

Adult form of Menetrier's is found in pts who over-express what protein?

TGF-a

71

What disease process is characterized by chronic inflammation of the gastric mucosa w/loss of gastric glandular cells and replacement by intestinal-type epithelium, pyloric-type glands and fibrous tissues?

Atrophic gastritis

72

Atrophic gastritis can lead to what deficiency?

B12 deficiency (dependent on intrinsic factor) and megaloblastic anemia. Potential malabsorption of other nutrients that require an acidic environment.

73

The presence of what in the serum is indicative of Autoimmune metaplastic atrophic gastritis (AMAG)?

Serum antibodies to parietal cells and to intrinsic factor

74

Autoimmune metaplastic atrophic gastritis (AMAG) can present as a pt with hives, rashes and diarrhea. Why?

Hypochlorhydria = G Cell hyperplasia = Hypergastrinemia = trophic effect on ECL cells

ECL cells are responsible for histamine secretion (hives rashes) and can produce neurotransmitters=serotonin excess (diarrhea)

75

Gastric adenocarcinoma presents with what cell pattern?

Signet ring cell pattern where cells are filled with mucin vacuoles that push the nucleus to one side. Signet cells = aggressive tumor

76

What disease is known as leather bottle stomach?

Linitis plastica (rare gastric cancer)

77

How does a carcinoid tumor present histologically?

"Endocrine pattern" nests of cells separated by thin-walled vessels with less than 2 mitoses/10 HPF.
Uniformity of cells and nuclei
Normal nuclear/cytoplasmic ratio
Small nucleoli

78

Hirshsprung's disease aka congenital a ganglionic megacolon is cause by what?

Failure of neural crest cells to migrate completely during fetal development of the intestine

79

Hirshsprung's disease is associated with what cellular landmark?

Involvement with Auerbach plexus

80

What is an intestinal volvulus?

Complete twisting of a loop of intestine around its mesenteric attachment site.

81

The elderly population is prone to have volvulus' in what portion of the colon?.

Sigmoid

82

What is the difference between a volvulus and an intussception?

Intussusception is migration of one part of the intestine into another (usually proximal bowel moving into the distal bowel). Volvulus is a twisting of the bowel.

83

What forms from a remnant of the vitelline duct and is the most frequent malformation of the GI tract?

Meckle's diverticulum

84

Where is Meckel's diverticulum usually located?

Distal ileum, w/in 2 feet of the ileocecal valve.

85

What is the difference between a true diverticula and a false diverticula?

True: involves all layers including the muscular propria and adventitia

False: involves only the submucosa and mucosa

86

What is the microscopic difference between Crohn's and UC?

Crohn's: affects the whole bowel wall (transmural)

UC: restricted to the mucosa

87

Which is granulomatous, Crohn's or UC?

Crohn's

88

A crypt abscess is characteristic in what GI pathology?

UC

89

Which GI pathology has an increased risk for development of adenocarcinoma?

UC

90

What is the MC cause of viral enteritis?

Norwalk virus

91

What is the MC cause of severe diarrhea among infants and young children?

Rotavirus

92

What is the MC cause of bloody diarrhea in the US?

Campylobacter jejunai

93

What organism is associated w/picnic food poisoning?

Staphylococcus aureus

94

What organism is associated with contaminated Chinese food?

Bacillus cereus

95

What organism is associated with contaminated saltwater crabs and shrimp?

Vibrio (Cholera and non-Cholera)

96

What organism is associated with improperly prepared home canned goods?

Clostridium botulinum

97

What organism is responsible for the most food borne deaths in the US?

Salmonella

98

What is the most common area of the bowel affected by necrotizing enterocolitis?

Ileocecal valve

99

Antibiotic-associated diarrhea (AAD) is often caused by what organism?

Pseudomembranous colitis caused by Clostridium diff

100

What is the standard for testing for C.diff?

Stool testing for the presence of C.diff toxins

101

What population is most affected by ischemic colitis?

Elderly

102

What presents histologically with elongated spindle cells containing cigar-shaped nuclei?

Leiomyoma

103

What is characterized by mucocutaneous pigmentation and benign GI harmartomas?

Peutz-Jeghers syndrome

104

What is the histological appearance of Peutz-Jeghers syndrome?

frond-like appearance with stromal/smooth muscle core covered by acinar glands and normal mucosa

105

Where are adenocarcinomas (MC small bowel malignancy) of the bowel most commonly found?

Duodenum except pts w/Crohn's disease (in the ileum for them)

106

Where are carcinoid tumors of the bowel most commonly found?

Ileum

107

What GI tumor usually secrets excessive amounts of serotonin?

Carcinoid tumors arising from neuroendocrine cells

108

What GI tumors appear histologically w/an endocrine appearance of collections of small round cells containing nuclei that are consistent size and shape surrounded by cytoplasm that stains pink to pale blue?

Carcinoid tumors

109

What is the MC type of polyp found in the GI?

Hyperplastic polyp (increased # of glands and greater # of cells)

110

What type of polyp is found with Juvenile Polyposis Syndrome?

Non-neoplastic harmartomatous, self-limiting and benign

111

What is gardner's syndrome?

The combination of polyposis, osteomas, fibromas and sebaceous cysts

112

What polyp syndrome that starts out benign can often have malignant transformation into colon cancer?

Familial Adenomatous Polyposis

113

What is galactorrhea?

Presence of milk in a non breast feeding woman or man.

114

What are the jobs of the luminal epithelial cells of lobules and terminal ducts?

Myoepithelial cells?

Luminal epithelium: produce milk

Myoepithelial: assist in milk ejection during lactation and maintain normal structure and function of lobule

115

MC area to find a breast mass?

Upper outer quadrant

116

What are Montgomery tubercles?

Sebaceous glands on the areola that function in lubrication of the nipple (increase in number and size during pregnancy)

117

Amastia

breast tissue, nipple and aureola are absent

118

Amazia

mammary gland tissue is absent, but nipple and aureola remain

119

Athelia

glandular tissue is present but nipple and areola are absent (one or both)

120

Cause of inverted nipple

Fibrous bands of tissue that tether the nipple in an inverted position (90% bilateral)

121

Galactorrhea causes:

hormonal dysregulation or medication SE

one of the least common presenting sxs of breast cancer in women who are age 60 and younger assoc w/7% of women 60 yo w/BC

122

Milky d/c of galactorrhea is associated with what?

Increased prolactin levels (pituitary adenoma, hypothyroidism or endocrine anovulatory syndrome)

123

Mastitis

inflammation of the parenchyma of the mammary gland, usually occurs in lactating women (puerperal)

124

What is mastitis called when it occurs in non-lactating women?

non-puerperal mastitis

125

Does infection play a major role in mastitis?

NO, but if it is infections it is usually due to Staph aureus or Strep epidermitis

126

What is peri-ductal mastitis associated with?

90% of pts. w/peri-ductal mattes are smokers

127

Peri-ductal mastitis microscopic

Keratinizing squamous epithelium in the duct system of the nipple. Chronic granulomatous inflammatory response noted

128

Ectasia

dilation of the sub-areolar ducts, MC in the 5ht/6th decades of life in multiparous women, MC unilateral

129

Ectasia clinical presentation

Breast pain, palpable poorly defined areolar or peri-areolar mass, thick secretions from nipple

130

What is a common sequel of ectasia?

Nipple inversion (30-40%)

131

Ectasia microscopic

dilated lactiferous ducts filled w/granular debris, lipid laden macrophages, lymphocytes, plasma cells

Early: foamy macrophages beneath luminal duct epithelium

132

Fibrocystic breast disease

Fibrous tissue and cobblestone texture in breasts; lumps are smooth with defined edges and free moving; MC in upper outer sections of breast

133

MC breast disorder

Fibrocystic breast disease

134

Fibrocystic breast disease microscopy

fibrosis (dense collagen fibers), sclerosing ductal epithelial proliferation, adenosis (full of glands) and apocrine metaplasia

135

MC cause of fat necrosis on breast?

Trauma or subsequent to surgery

136

How does fat necrosis occur?

Rupture of adipocytes and hemorrhage from broken blood vessels in traumatized area. Fat undergoes lipolysis and is converted to fatty acids and glycerol leading to fibroblastic proliferation and increased vascularization

137

Clinical appearance of fat necrosis

Painless breast mass noted to show overlying skin thickening and tissue retraction

138

Fat necrosis on Mammography

central radiolucent area of fat w/increased density and/or calcifications on fat periphery

139

Fat necrosis histology

Irregular fatty spaces surrounded by foamy histiocytes and multinucleate giant cells

140

Lymphocytic mastopathy

Single hard mass or multiple hard masses made up of collagenized stroma surrounding atrophic ducts and lobules

Micro: dense stromal fibrosis and peri-ductal lymphocytic infiltration

141

Lymphocytic mastopathy population

Women w/type 1 DM and women w/AI thyroiditis

142

Granulomatous mastopathy

uncommon and characterized by the presence of granulomas formed by epitheliod cells and giant cells.

Etiology: TB, sarcoidosis, Wegner's granulomatosis

143

Granulomatous breast dx causes

TB very rare but can happen, use PCR to dx

Mycobacterial or fungal infection common in immunocompromised pts

144

MC benign tumor of the breast

Fibroadenoma: well circumscribed mass w/prominent fibrotic capsule

Microscopy: hyperplasia of intraductal epithelial cells but no abnormality in nuclear size and nucleus/cytoplasm ratio

145

Lactating adenoma

marked cytoplasmic vacuolization

146

Papillomas

Solitary Ductal Papilloma (SDP)
Multiple Intraductal Papilloma (MP)

SDP: originate in the large ducts and is located centrally beneath the nipple

MP located int eh terminal ducts at the periphery of the breast

147

Intraductal papilloma microscopy

myoepithelial cells and multilayered ductal cells that are flattened and nuclei of cells appear next to the luminal surface

148

BC risk factors

Female/advanced age
Hx of CA
Family hx of BCA in sister or mother
EtOH intake >2/day
High premenopausal blood insulin like growth factor (IGF)-1
High post-menopausal blood estrogen

149

Common denominator in BC risk factors

Endogenous estrogen stimulation

150

What percentage of women carrying a mutated BRCA1 gene will develop BCA?

50-85%

151

BCA in the US

1/8 women will develop BCA
1/35 will die of BCA
MC cause of cancer in women
2nd MC cause of cancer death in women

152

What does ER-positive mean?

Estrogen receptors over-expressed in 70% of BCA cases = increased ER stimulation = disruption of normal growth cycle and apoptosis and DNA repair

153

BRCA1 and BRCA2 are tumor suppressor genes that are involved in DNA repair. BRCA2 protein binds to regulate RAD51 to fix DNA breaks. What's the problem?

Mutations in BRCA1 and/or BRCA2 cause decreased stability of DNA and result in in gene rearrangements leading to cancer

154

Which proto-oncognee is known to be a genetic risk factor for BCA?

HER2/neu gene (30% of BCA have an amplification or over-expression of its protein)

Associated with increased risk for disease recurrence and worse prognosis

155

3 types of BCA

ductal
lobular
Paget's disease (generally only involves the nipple and areola)

156

MC BCA type

80% are infiltrating ductal carcinoma

157

Infiltrating ductal carcinoma microscopy

Absent or scant stroma, extends through the tissue as cords and nests of neoplastic cells with intervening collagen.

Pleomorphic cells located throughout stroma and collagen deposits

158

Lobular carcinoma: 2nd MC

Associated w/high risk for multiple loci in affected breast and increased risk for both breasts to be involved

159

Lobular carcinoma microscopic

Small homogenous cells that invade the stroma seen in "single file pattern"

160

What is the significance of signet rings?

Worse prognosis, aggressive CA

161

Paget's dx

nipple and areolar area, often associated w/an underlying in-situ or invasive carcinoma

clinical: eczematous changes overlying the nipple and areola

162

Paget's dx histology

Paget cells: large round cells w/pale cytoplasm and pleomorphic nuclei, cells are derived from glandular epithelium (Cell looks like a nipple)

163

Inflammatory breast cancer IBC

Appears as a markedly inflamed appearance of the affected breast, very aggressive w/o palpable lump

164

1st appearance of atherosclerosis

Fatty streaks w/foam cells which can become fibrous plaques if they advance

165

HTN 2ndary cause

Renal artery stenosis

166

Aneurysm in circle of willis

Berry aneurysm

167

CHF cells contain

Hemosiderin

168

MC cause of Myocarditis

Coxacie virus

169

Strep throat histological association w/RF and multinucleate cells

Aschoff bodies

170

Small regular vegetations found to be sterile but a hx of lupus

Libman-Sachs Endocarditis

171

MC valvular lesion

MVP

172

MC non MVP lesion

Aortic stenosis

173

Smooth tumor that pops in and out of the R atrium

Atrial myxoma

174

Infectious agents of cholecystitis

E. coli, Klebsiella, Pseudomonas, B. fragilis, Enterococcus

175

Acute cholecystitis histologically

extensive ulceration of mucosa, hemorrhage, edema and transmural infiltrate of neutrophils and mononuclear inflammatory cells

176

What percentage of cholesterol do pigment stones contain?

20%

177

How is choleserolosis characterized?

Abnormal deposition of cholesterol and triglyceride filled macrophages in the lamina propria which lifts the superficial epithelium

Strawberry gallbladder

178

Chronic cholecystitis has pockets in the wall of the gallbladder. What are those called?

Rokitansky-Anschoff sinuses

179

Ascending cholangitis shows what on microscopy?

Onion skin-like appearance, making it distinguishable from PSC

180

MC gallbladder CA

Adenocarcinoma

Intestinal type adenocarcinoma contains goblet cells

181

Women and men get acute pancreatitis for different reasons. What are they?

W: gall stones
Men: alcohol

182

What is different about a pseudocyst?

It has no epithelial lining

183

What is the histological appearance of a pseudo papillary tumor?

Uniformly shaped and sized nuclei and slightly eosinophilic staining cytoplasm

184

What is the appearance of a serous cyst adenoma of the pancreas?

Honeycombed

Lined by ciliated cuboidal epithelium

Associated w/Von Hippel-Lindau syndrome

185

What is the MC pancreatic CA?

Ductal adenocarcinoma: moderately to poorly differentiated glandular structures