Flashcards in Past Test Tidbits Deck (185)
What is the MC non cardiac symptom of an MI?
Which EKG wave is most indicative of an MI?
Q wave will be wider and deeper
What labs reflect an MI?
Elevated Cardiac Enzymes: Creatine phosphokinase (MB band), Troponin (esp. I and T)
Does a fatty streak impair the lumen size?
What is the MC cause of an Myocardia Ischemia?
Reduction in coronary blood flow due to atherosclerotic coronary arterial obstruction.
What is a unique feature of unstable angina?
Pain occurs at rest (may awake in the night with pain)
What is the MC cause of an MI?
Plaque rupture: pathology comes from interior of the plaque being exposed
What is pericarditis and what are the sequelae of pericarditis following an MI?
Inflammation of the pericardium; No serious consequences or sequelae
What is cardiac tamponade?
Pericardial effusion in which fluid, pus, blood clots and gas accumulate in the pericardium resulting in compression of the heart
What is fibrinous pericarditis known as?
Bread and butter pericarditis.
What presumed auto-immune form of pericarditis occurs weeks to months after injury to the heart/pericardium?
What layers does an aortic dissection occur in?
Occurs through the medial tissue layer of the aorta (between internal and medial layer)
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
What deficiency can lead to all sx of a Marfan's pt w/o actually having Marfan's?
What are heart failure cells?
Hemosiderin(oxidized iron) containing macrophages in the alveoli. (Brown color)
Cor Pulmonale is heart failure that occurs as a result of what?
Pulmonary disease: emphysema, chronic bronchitis, PE, Pulmonary HTN
What is the MC causes of non-ischemic dilated cardiomyopathy in the US?
What condition presents with variations in myocyte size, myocyte vacuolation, loss of myofibril material and/or fibrosis?
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
What are the MC organisms that cause community-acquired endocarditis?
Staph Aureus (30-50%; Non-MRSA)
Strep Viridans (10-35%)
What organism cases most noscomial endocarditis?
Staph Aureus (60-80% MRSA)
Does infectious endocarditis always present with fever?
No. Can often present as afebrile
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)
What are the major risk factors for endocarditis?
IV drug users
Pt w/indwelling catheters
Pt w/vascular grafts
What is the MC organism associated w/endocarditis of native valves?
Strep Viridens (alpha hemolytic Strep)
What is the MC endocarditis organism associated with alcoholics?
Anaerobes and oral cavity bugs
What is the MC endocarditis organism associated w/ IV drug users?
What is the MC endocarditis organism associated w/ prosthetic valves?
If Strep Bovis is found on culture from the blood what is test is indicated?
Colonoscopy to rule out colon cancer
Endocarditis of SLE is referred to as what?
Culture negative endocarditis points toward what?
Endocarditis of an inflammatory disorder.
What is the MC cause of valvular disease in the world?
What is the pathological name for MVP?
RF develops following pharyngitis with what organism?
Group A beta-hemolytic Streptococcus
What is the lab test for Group A Strep?
Elevated or rising streptococcal antibody titer: antistrepotolysin O or ASO titer
Post-strep acute RF is likely due to an autoimmune response caused by ????
Anti-streptococcal M protein antibodies that cross react with cardiac myosin
Aschoff bodies are found in individuals with what disease?
Fully developed they are granulomatous
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
Hemorrhagic Pericardial Effusion is most likely due to:
Trauma, cancer, TB infections (Caseious pericarditis)
Hemorrhagic pericarditis makes you think of what disease processes?
TB, tumor, bacterial infection, bleeding disorders (Von Willebrand), trauma
MC benign heart tumor
MC malignant heart tumor
What is the MC metastasis to the heart?
What is the MC pediatric tumor of the heart?
What tumor features cells that are polygonal or have an elongated cell shape, mononuclear or multinucleate w/finely vacuolated eosinophilic cytoplasm?
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
Achalasia has what histological picture?
Lymphocytic infiltration of Auerbach's plexus
Which esophageal motility disorder presents with coordinated but excessive contractions?
Nutcracker esophagus (painful w/no pathologic abnormality)
How does corkscrew esophagus present?
Uncoordinated contractions within several segments of the esophagus simultaneously (painful w/no pathological abnormality).
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.
What is Boerhaave's syndrome?
A full thickness tear or rupture of the esophageal wall.
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.
Nearly 2/3rds of benign esophageal tumors are ____________?
Granular cell tumors (benign) arise from what cell?
Where does squamous cell cancer present in the esophagus?
Upper 2/3rds of esophagus
What cancer presents in the lower portion of the esophagus?
Adenocarcinoma: arises from glandular cells at the junctions on of the esophagus and stomach
Which form of esophageal cancer is MC?
Primary squamous cell (90-95%)
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
What are the key histological signs of malignancy?
Variable nuclear size, staining and shape; increased mitotic figures; higher nucleus to cytoplasm ratio
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)
What stomach pathology has the highest association with H. Pylori infections?
Duodenal peptic ulceration (H. Pylori in 85% of duodenal ulcers)
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.
What is the 2nd MC cause of duodenal ulcers?
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
What disease presents with this triad: gastric acid hyper secretion, severe peptic ulceration, non-beta cell islet tumor of the pancreas?
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
What disease results in hypertrophy of the gastric mucosa and why?
Zollinger-Ellison syndrome: due to hypergastrinemia
What disease presents with enlarged gastric mucosal folds?
Menetrier's disease: increased mucus leading to gland atrophy in the stomach and hypochloridria
Menetrier's disease in childhood is most often noted after what infections?
CMV or H. pylori
Adult form of Menetrier's is found in pts who over-express what protein?
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 can lead to what deficiency?
B12 deficiency (dependent on intrinsic factor) and megaloblastic anemia. Potential malabsorption of other nutrients that require an acidic environment.
The presence of what in the serum is indicative of Autoimmune metaplastic atrophic gastritis (AMAG)?
Serum antibodies to parietal cells and to intrinsic factor
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)
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
What disease is known as leather bottle stomach?
Linitis plastica (rare gastric cancer)
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
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
Hirshsprung's disease is associated with what cellular landmark?
Involvement with Auerbach plexus
What is an intestinal volvulus?
Complete twisting of a loop of intestine around its mesenteric attachment site.
The elderly population is prone to have volvulus' in what portion of the colon?.
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.
What forms from a remnant of the vitelline duct and is the most frequent malformation of the GI tract?
Where is Meckel's diverticulum usually located?
Distal ileum, w/in 2 feet of the ileocecal valve.
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
What is the microscopic difference between Crohn's and UC?
Crohn's: affects the whole bowel wall (transmural)
UC: restricted to the mucosa
Which is granulomatous, Crohn's or UC?
A crypt abscess is characteristic in what GI pathology?
Which GI pathology has an increased risk for development of adenocarcinoma?
What is the MC cause of viral enteritis?
What is the MC cause of severe diarrhea among infants and young children?
What is the MC cause of bloody diarrhea in the US?
What organism is associated w/picnic food poisoning?
What organism is associated with contaminated Chinese food?
What organism is associated with contaminated saltwater crabs and shrimp?
Vibrio (Cholera and non-Cholera)
What organism is associated with improperly prepared home canned goods?
What organism is responsible for the most food borne deaths in the US?
What is the most common area of the bowel affected by necrotizing enterocolitis?
Antibiotic-associated diarrhea (AAD) is often caused by what organism?
Pseudomembranous colitis caused by Clostridium diff
What is the standard for testing for C.diff?
Stool testing for the presence of C.diff toxins
What population is most affected by ischemic colitis?
What presents histologically with elongated spindle cells containing cigar-shaped nuclei?
What is characterized by mucocutaneous pigmentation and benign GI harmartomas?
What is the histological appearance of Peutz-Jeghers syndrome?
frond-like appearance with stromal/smooth muscle core covered by acinar glands and normal mucosa
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)
Where are carcinoid tumors of the bowel most commonly found?
What GI tumor usually secrets excessive amounts of serotonin?
Carcinoid tumors arising from neuroendocrine cells
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?
What is the MC type of polyp found in the GI?
Hyperplastic polyp (increased # of glands and greater # of cells)
What type of polyp is found with Juvenile Polyposis Syndrome?
Non-neoplastic harmartomatous, self-limiting and benign
What is gardner's syndrome?
The combination of polyposis, osteomas, fibromas and sebaceous cysts
What polyp syndrome that starts out benign can often have malignant transformation into colon cancer?
Familial Adenomatous Polyposis
What is galactorrhea?
Presence of milk in a non breast feeding woman or man.
What are the jobs of the luminal epithelial cells of lobules and terminal ducts?
Luminal epithelium: produce milk
Myoepithelial: assist in milk ejection during lactation and maintain normal structure and function of lobule
MC area to find a breast mass?
Upper outer quadrant
What are Montgomery tubercles?
Sebaceous glands on the areola that function in lubrication of the nipple (increase in number and size during pregnancy)
breast tissue, nipple and aureola are absent
mammary gland tissue is absent, but nipple and aureola remain
glandular tissue is present but nipple and areola are absent (one or both)
Cause of inverted nipple
Fibrous bands of tissue that tether the nipple in an inverted position (90% bilateral)
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
Milky d/c of galactorrhea is associated with what?
Increased prolactin levels (pituitary adenoma, hypothyroidism or endocrine anovulatory syndrome)
inflammation of the parenchyma of the mammary gland, usually occurs in lactating women (puerperal)
What is mastitis called when it occurs in non-lactating women?
Does infection play a major role in mastitis?
NO, but if it is infections it is usually due to Staph aureus or Strep epidermitis
What is peri-ductal mastitis associated with?
90% of pts. w/peri-ductal mattes are smokers
Peri-ductal mastitis microscopic
Keratinizing squamous epithelium in the duct system of the nipple. Chronic granulomatous inflammatory response noted
dilation of the sub-areolar ducts, MC in the 5ht/6th decades of life in multiparous women, MC unilateral
Ectasia clinical presentation
Breast pain, palpable poorly defined areolar or peri-areolar mass, thick secretions from nipple
What is a common sequel of ectasia?
Nipple inversion (30-40%)
dilated lactiferous ducts filled w/granular debris, lipid laden macrophages, lymphocytes, plasma cells
Early: foamy macrophages beneath luminal duct epithelium
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
MC breast disorder
Fibrocystic breast disease
Fibrocystic breast disease microscopy
fibrosis (dense collagen fibers), sclerosing ductal epithelial proliferation, adenosis (full of glands) and apocrine metaplasia
MC cause of fat necrosis on breast?
Trauma or subsequent to surgery
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
Clinical appearance of fat necrosis
Painless breast mass noted to show overlying skin thickening and tissue retraction
Fat necrosis on Mammography
central radiolucent area of fat w/increased density and/or calcifications on fat periphery
Fat necrosis histology
Irregular fatty spaces surrounded by foamy histiocytes and multinucleate giant cells
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
Lymphocytic mastopathy population
Women w/type 1 DM and women w/AI thyroiditis
uncommon and characterized by the presence of granulomas formed by epitheliod cells and giant cells.
Etiology: TB, sarcoidosis, Wegner's granulomatosis
Granulomatous breast dx causes
TB very rare but can happen, use PCR to dx
Mycobacterial or fungal infection common in immunocompromised pts
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
marked cytoplasmic vacuolization
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
Intraductal papilloma microscopy
myoepithelial cells and multilayered ductal cells that are flattened and nuclei of cells appear next to the luminal surface
BC risk factors
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
Common denominator in BC risk factors
Endogenous estrogen stimulation
What percentage of women carrying a mutated BRCA1 gene will develop BCA?
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
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
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
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
3 types of BCA
Paget's disease (generally only involves the nipple and areola)
MC BCA type
80% are infiltrating ductal carcinoma
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
Lobular carcinoma: 2nd MC
Associated w/high risk for multiple loci in affected breast and increased risk for both breasts to be involved
Lobular carcinoma microscopic
Small homogenous cells that invade the stroma seen in "single file pattern"
What is the significance of signet rings?
Worse prognosis, aggressive CA
nipple and areolar area, often associated w/an underlying in-situ or invasive carcinoma
clinical: eczematous changes overlying the nipple and areola
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)
Inflammatory breast cancer IBC
Appears as a markedly inflamed appearance of the affected breast, very aggressive w/o palpable lump
1st appearance of atherosclerosis
Fatty streaks w/foam cells which can become fibrous plaques if they advance
HTN 2ndary cause
Renal artery stenosis
Aneurysm in circle of willis
CHF cells contain
MC cause of Myocarditis
Strep throat histological association w/RF and multinucleate cells
Small regular vegetations found to be sterile but a hx of lupus
MC valvular lesion
MC non MVP lesion
Smooth tumor that pops in and out of the R atrium
Infectious agents of cholecystitis
E. coli, Klebsiella, Pseudomonas, B. fragilis, Enterococcus
Acute cholecystitis histologically
extensive ulceration of mucosa, hemorrhage, edema and transmural infiltrate of neutrophils and mononuclear inflammatory cells
What percentage of cholesterol do pigment stones contain?
How is choleserolosis characterized?
Abnormal deposition of cholesterol and triglyceride filled macrophages in the lamina propria which lifts the superficial epithelium
Chronic cholecystitis has pockets in the wall of the gallbladder. What are those called?
Ascending cholangitis shows what on microscopy?
Onion skin-like appearance, making it distinguishable from PSC
MC gallbladder CA
Intestinal type adenocarcinoma contains goblet cells
Women and men get acute pancreatitis for different reasons. What are they?
W: gall stones
What is different about a pseudocyst?
It has no epithelial lining
What is the histological appearance of a pseudo papillary tumor?
Uniformly shaped and sized nuclei and slightly eosinophilic staining cytoplasm
What is the appearance of a serous cyst adenoma of the pancreas?
Lined by ciliated cuboidal epithelium
Associated w/Von Hippel-Lindau syndrome