Past Test Tidbits Flashcards
(185 cards)
1
Q
What is the MC non cardiac symptom of an MI?
A
Dyspnea
2
Q
Which EKG wave is most indicative of an MI?
A
Q wave will be wider and deeper
3
Q
What labs reflect an MI?
A
Elevated WBC
Elevated LDH
Elevated Cardiac Enzymes: Creatine phosphokinase (MB band), Troponin (esp. I and T)
4
Q
Does a fatty streak impair the lumen size?
A
No
5
Q
What is the MC cause of an Myocardia Ischemia?
A
Reduction in coronary blood flow due to atherosclerotic coronary arterial obstruction.
6
Q
What is a unique feature of unstable angina?
A
Pain occurs at rest (may awake in the night with pain)
7
Q
What is the MC cause of an MI?
A
Plaque rupture: pathology comes from interior of the plaque being exposed
8
Q
What is pericarditis and what are the sequelae of pericarditis following an MI?
A
Inflammation of the pericardium; No serious consequences or sequelae
9
Q
What is cardiac tamponade?
A
Pericardial effusion in which fluid, pus, blood clots and gas accumulate in the pericardium resulting in compression of the heart
10
Q
What is fibrinous pericarditis known as?
A
Bread and butter pericarditis.
11
Q
What presumed auto-immune form of pericarditis occurs weeks to months after injury to the heart/pericardium?
A
Dressler’s syndrome
12
Q
What layers does an aortic dissection occur in?
A
Occurs through the medial tissue layer of the aorta (between internal and medial layer)
13
Q
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?
A
Abnormal fibrillin-1 protein
Aneurysms localized to the aorta
14
Q
What deficiency can lead to all sx of a Marfan’s pt w/o actually having Marfan’s?
A
Copper deficiency
15
Q
What are heart failure cells?
A
Hemosiderin(oxidized iron) containing macrophages in the alveoli. (Brown color)
16
Q
Cor Pulmonale is heart failure that occurs as a result of what?
A
Pulmonary disease: emphysema, chronic bronchitis, PE, Pulmonary HTN
17
Q
What is the MC causes of non-ischemic dilated cardiomyopathy in the US?
A
Chronic alcoholism
18
Q
What condition presents with variations in myocyte size, myocyte vacuolation, loss of myofibril material and/or fibrosis?
A
Dilated Cardiomyopathy
19
Q
What are the MC causes of restrictive cardiomyopathy (infiltration of abnormal tissue that results in impaired ventricular wall motion: contraction and relaxation)?
A
Amyloidosis and Hemochromatosis
20
Q
What are the MC organisms that cause community-acquired endocarditis?
A
Staph Aureus (30-50%; Non-MRSA) Strep Viridans (10-35%)
21
Q
What organism cases most noscomial endocarditis?
A
Staph Aureus (60-80% MRSA)
22
Q
Does infectious endocarditis always present with fever?
A
No. Can often present as afebrile
23
Q
In subacute endocarditis, vegetations frequently embolize. How does this present clinically?
A
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
Q
What are the major risk factors for endocarditis?
A
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
