Pathology Flashcards
(209 cards)
1
Q
Interstitial lung disease: NSIP PATTERN + interstitial fibrosis + concentric arterial thickening?
A
Scleroderma lung
2
Q
NSIP PATTERN lung disease?
A
Scleroderma lung
3
Q
EARLY Mediators of scleroderma lung are?
A
IL-8
TNF
4
Q
LATE mediator of scleroderma lung?
A
TGF beta
5
Q
All the mediators of scleroderma lung
A
IL-8 TNF alpha MIF1 alpha RANTES TGF beta
6
Q
Radiographic distribution of scleroderma lung?
A
BASES
Posterior + periphery
GROUND GLASS–> reticular pattern
7
Q
Fibrosis favoring bases + posterior and periphery?
A
Scleroderma lung
8
Q
What types of cells are seen in NSIP pattern lung disease?
A
Scleroderma lung–> Lymphocytes + macrophages + fibroblasts
9
Q
Causes concentric thickening + fibrosis of small Pulmonary arteries–> Pul HTN –> cor pulmonale. what is the associated antibody?
A
Scleroderma–> Anti-centeromere
10
Q
Systemic signs of Scleroderma lung (NSIP pattern)?
A
Dyspnea
Dry cough
VELCRO crackles @ bases
11
Q
Anti-DNA topoisomerase antibodies?
A
Systemic sclerosis
12
Q
Tx for scleroderma lung?
A
Cyclophosphamide
NOT steroids
13
Q
MCC of death in pt with Anti-Scl70 antibodies?
A
Systemic sclerosis–> NSIP pattern lung disease
14
Q
Pleuropulmonary disease associated with LUPUS?
A
PLEURITIS NSIP Vascular disease Shrinking LUNG Acute Lupus pneumonitis
15
Q
MC pleuropulmonary involvement in Lupus?
A
Pleuritis–> fibrinous
+ small pleural effusion
16
Q
NSIP Pattern lung disease?
A
Scleroderma
17
Q
NSIP lung disease?
A
LUPUS
18
Q
Thromboembolic disease from anti-phospholipid antibodies?
A
LUPUS anticoagulant
19
Q
Disease causing either UIP or NSIP pattern in significant and likely similar proportions?
A
RA
20
Q
Pleuropulmonary disease in RA pt MC involves what?
A
Bronchioles
Pleura
21
Q
Interstitial fibrosis consisting of Temporal heterogeneity + Severe @ periphery and Lower Lobes?
A
UIP pattern–> RA
22
Q
RA with rheumatoid nodules in lung + pneumoconiosis?
A
Caplan syndrome
23
Q
Follicular bronchiolitis is associated with what AI disease?
A
RA
24
Q
More common in RA + obstructive PFTs + Sjogrens + DOES not respond to Steroids?
A
Obliterative Bronchiolitis
25
More common in RA + acute onset of fever and alveolar infiltrates + responds to Steroids?
Organizing pneumonia
26
Rim of palasading histiocytes + basophilic debris surrounded by fibrosis, lymphocytes, macrophages, and multinucleate Giant cells?
Rheumatoid nodule
27
MCC of death in RA pts?
Respiratory failure from fibrosis
28
What is the most unpredictable serious AE of methotrexate?
Pneumonitis
29
Causes restrictive pattern LD + organizing Pneumonia + NSIP?
Polymyositis/ Dermatomyositis
30
NSIP in lower lobes with LOTS of submucosal secretions and RELENTLESS DRY cough?
Sjogren syndrome
31
NSIP with LYMPHOID follicles (germinal centers) and bronchiolocentric?
Sjogren syndrom NSIP
32
NSIP with LOTS of lymphocyte + macrophages + multi nucleated giant cells?
Sjogrens syndrome
33
CELLULAR NSIP?
Sjogren--> excess lymphocyte infiltrates
34
What Ai disease is associated with HIGHER risk for lymphomas?
Sjogren syndrome
35
Mediastinal LAD + pleural effusion + Lung nodularity + dry mouth?
Lymphoma in Sjogrens patient
36
Autoimmune interstitial pneumonias are usually?
```
Chronic
Velcro crackles + dyspnea
BASAL, posterior, Peripheral
Restrictive PFTs
Decreased DLCO
```
37
Acute lung disease in a rheumatology patient is more likely?
Infectious
38
Subacute or chronic dyspnea in rheumatology patient is more likely?
Manifestation of rheumatological disease
39
Nodular lung disease in Rheumatology patient is more likely?
Infectious or malignant
40
Insidious onset of painful fingertips with cold, swelling and itching of hands, generalized weakness and joint aches?
Systemic sclerosis
41
Farmer insidious onset of difficulty getting up, combing his hair, scaly knee lesions, purplish eyelid discoloration, pruritic rash from neck to chest?
Dermatomyositis
42
Network-pattern purplish discoloration of skin due to dilation of blood vessels?
Livedo reticularis
43
MCC of fungal vasculitis?
Aspergillus
44
MCC of bacterial vasculitis?
Pseudomonas
45
MCC of viral vasculitis?
CMV
46
Segmental, Transmural, Granulomatous with MN giant cells centering around/ destroying Internal ELsastic lamina?
Temporal Arteritis
47
Headache, tender artery, Visual disturbance, Jaw claudication?
Temporal Arteritis
48
Transmural arteritis narrowing lumen with prominent Granuloma?
Temporal arteritis
49
Giant cells eating Internal elastic lamina, cell proliferation and lymphocytic biopsy
Temporal arteritis
50
Segmental, transmural, necrotizing, Loosely Granulomatous with MN giant cells, Medial loss of elastic fibers (Thinning)?
Takayasu arteritis
51
Arteritis involving Aorta often causing Dissection?
Takayasu arteritis
52
Segmental, transmural, NODULAR arteritis?
Polyarteritis nodosa
53
Fibrinoid necrosis with PMNs acutely, and PREdominant @ branch points?
PAN
54
Branch points + Fibrinoid necrosis?
PAN
55
Late phase of PAN has what characteristics
```
HOMOGENOUS lesions
Inflammation
Fibroblasts
scarring
aneurysms
```
56
Lesions at different phases caused by Hepatitis B?
PAN
57
Vasculitis associated with Livedo Reticularis?
PAN
58
Fibrinoid necrosis + PMN infiltrates?
Acute phase PAN
59
Endothelial necrosis with PMNs, Lymphocytes, Wall necrosis, Child, Thrombosis?
Kawasaki disease
60
Tx of Kawasaki disease?
Aspirin
| IV ig
61
Kawasaki disease usually involves what arteries?
Coronary arteries
62
Necrotizing granulomatous vasculitis of Arteries + veins in URT + LUNGS + KIDNEYS?
Wagerer's--> Granulomatosis with Polyangiitis
63
"Geographic" areas of necrosis with debris and Palisaded Histiocytes?
Wegener's
64
c-ANCA?
ANCA-PR3--> Wegener's
65
Mucosal ulcers + necrotizing vasculitis?
Wegener's
66
Asthma + Eosinophilia + Vasculitis?
Churg-Strauss syndrome (Allergic granulomatosis with polyangiitis)
67
Segmental transmural inflammation without Necrosis, + thrombosis, + granulomas, + giant cells?
Buerger Disease
68
Vasculitis causing gangrene or autoamputaion of fingertips?
Buerger disease
69
Capillary and post capillary venule infiltration by PMNs causing Leukocyoclasia (NUCLEAR DUST)?
Hypersensitivity Angiitis
70
Leukocytoclastic angiitis + lymphocytes + Homogenous lesions?
Hypersensitivity Angiiitis--> Late phase
71
Child post URTi, skin lesions, joint pain, Abdominal discomfort, and Renal damage+ IgA deposition?
Henoch- Schoenlein Purpura
72
MCC of Hypersensitivity angiitis in adults?
Drugs
73
Most common joint issue in ER?
```
Ankle
Wrist
Knee
Hip
Shoulder
Elbow
```
74
Necrotizing muscle infection with sudden onset of severe pain @ trauma site, Bronzing of skin followed by red purple discoloration?
Clostridial myonecrosis (Gas gangrene)
75
Post trauma with TENDER skin and Bullae formation?
Clostridial myonecrosis
76
Clostridium perfringens VF: alpha toxin + hemolytic toxin + phospholipase + sphingomyelinase DO WHAT?
Platelet aggregation
PMN adherence to endothelium
NEGATIVE INOTROPE
inhibits Cardiac pump function
77
What causes rapid irreversible decline in muscle blood flow and ischemic necrosis due to formation of occlusive intravascular masses of activated platelets(GP 2b/3a). leukocytes, and fibrin?
Alpha toxin of Clostridial
78
Post trauma + RE-perfusion + tender but normal appearing skin + Pain with movement?
Compartment syndrome
79
Pain with passive muscle stretch, Tense firm wood-like compartment, Diminished sensation, muscle weakness?
Compartment syndrome
80
Most ligamentous injuries int the knee present with what?
hemarthroses
81
Straight or cross leg raise test is for?
Lumbar disk herniations
82
Low back pain, bladder dysfunction, fecal incontinence and sexual dysfunction?
Cauda equina syndrome
83
Name four surgical emergencies?
Necrotizing fasciitis
Cauda equina syndrome
Acute loss of arterial supply
Acute compartment syndrome
84
Vast majority of ankle fractures are?
Malleolar --> UNImalleoalar
| NO joint space disruption
85
Colles fracture?
Distal radial metaphysis fracture with "dinner fork" deformity
86
Sudden onset of hip pain, leg shortened + externally rotated?
Hip fractures--> Displaced
87
MCC of back pain?
Herniation of disk
88
Predictors of drug-seeking behavior?
ask for Drug by name
multiple visits for same complaint
suspicious history
symptoms out of proportion with exam
89
Small LEG Trauma--> erythema w.out sharp margins + swelling + warm + shiny + tender+ severe pain?
Necrotizing fasciitis
90
What is normal compartment pressures?
0-8 mmHg
91
Pain in compartment syndrome develop when pressures is @?
20-30 mmHg
*Pressure within 25mmHg of MAP causes compromised Blood flow
92
What pressure might be needed for action in compartment syndrome?
Perfusion pressure (diastolic) of <30mmHg
93
What are the causes of traumatic + spontaneous Clostridial myonecrosis?
Trauma--> C. perfringens
| Spon--> C. septicum
94
Muscle necrosis in Gas gangrene is severe due to?
Absence of PMNs--> Alpha toxin induces PMN margination
95
What is seen in clostridial myonecrosis biopsy?
Muscle necrosis
Box car shaped G+ Rods
NO PMNs
96
Triad of muscle pain, weakness, and Dark urine?
Rhabdomyolysis
97
MCC of Rhabdomyolysis?
```
Trauma
Exertion
Alcohol + Drugs
statins
colchicine
```
98
Elevated CK, myoglobinuria, no hematuria?
Rhabdomyolysis
99
Anti-CCP?
RA
100
Anti-centromere?
CREST syndrome
101
Anti-Jo-1 (anti-synthetase)?
Polymyositis
102
Anti-Topoismerase?
Systemic sclerosis Diffuse
103
Anti-RNA polymerase (Anti- U3 RNP)?
Systemic Sclerosis (RENAL CYSTS)
104
Anti- U1 RNP?
Mixed connective tissue disease
105
Anti-Sm?
LUPUS
106
Anti-dsDNA?
LUPUS
107
ANA?
LUPUS
Sjogren
Rheumatic disease
108
Anti-Ro (SSA)?
Sjogren
Neonatal Lupus
Sub Q lupus
109
Anti-La (SSB)?
Sjogren
neonatal lupus
Sub Q lupus
110
p-ANCA is against?
Myeloperoxidase
111
Anti-myeloperoxidase?
Microscopic polyangiitis
| Churg-Strauss
112
c-ANCA is against?
PR3
113
Anti-PR3?
Granulomatosis with polyangiitis (Wegener's)
114
Neoplastic growths located in the Diaphysis?
Ewing
Chondrosarcoma
Fibrous dysplasia
Endochondroma
115
Neoplastic growths at Epiphysis?
Giant cell tumor
| Chondroblastoma
116
Neoplastic growth at Metaphysis?
Osteosarcoma
Osteochondroma
Osteoid Osteoma
117
McCune Albright syndrome?
Polostotic Fibrous dysplasia
Cafe au lait
Endocrinopathies
118
X-ray showing "moth eaten" + "ground glass" bone?
Fibrous dysplasia
119
<2 yo +Benign medullary Histiocytoma?
Fibrous cortical defect
120
X-ray showing "Scooped out" lesions?
Fibrous cortical defect
| Non ossifying fibroma
121
Spongy bone filled with BLOOD + can Expand rapidly?
Aneurysmal bone cyst
122
Gardener's syndrome?
Familial Colorectal Ployposis + Osteomas
123
20 yo + Painful tibial lesion worsen by ETOH?
Osteoid osteoma--> Relieved by Aspirin
124
Caused by displacement of Growth plate?
Osteochondroma
125
Usually in the medullary cavity of Hands + Feet?
Endochondroma
126
Multiple Endochondromas + soft tissue Hemangiomas?
Maffuccii syndrome
| Olliers without Hemangiomas
127
Codman triangle on x-ray?
Osteosarcoma
128
Homer-wright rossets?
Ewings sarcoma
129
PNET t(11;22) ?
Ewing sarcoma
130
10-15 yo WHITE male with Long bone tumor. What is on X-ray?
Onion skin periosteum
131
MC metastatic tumors to Bone?
```
Prostate
Breast
Lung
Kidney
Thyroid
```
132
Metastatic bone tumor causing Lots of Bleeding?
Renal cell carcinoma
133
Blastic metastatic bone tumor?
Prostate
134
Non cancerous growth of Dermal Dendritic cells and lesion with central "DIMPLE"?
Dermatofibroma
135
Children associated soft tissue neoplasia?
Rhabdomyosarcoma
136
Clonal cells that are Estrogen sensitive and show "Cigar shaped" nuclei?
Leiomyoma
137
Micro-architectural deterioration + thinning of Trabeculae?
Osteoporosis
138
Risk factors for Osteoporosis?
```
Age
Menopause
Glucocorticoids
Obesity
Diabetes
Alcohol
```
139
Pg of Menopause Osteoporosis?
Decrease estrogen= Increased IL-1 + IL-6 + TNF
| Increase RANKL--> Increase Osteoclast actions
140
Macrophages react to micro-fractures and Hemorrhage?
BROWN TUMOR--> Hyperparathyoidism
141
Increased bone activity with peritrabecular fibrosis and Cystic brown tumors?
Osteitis Fibrosa Cystica--> HPT
142
Cells that sense mechanical stress in bone and regulate Ca++ and Phosphorus?
Osteocytes
143
Mesenchymal becomes cartilage--> Osteoblasts lay down bone on preformed cartilage mold?
Endochondral bone formation
144
Bones without medullary cavities + Misshapen + pancytopenia?
Osteopetrosis
145
Membrane of GRANULATION tissue containing Macs + Osteoclasts + Fibroblasts which destroy Articular Cartilage?
PANNUS ---> RA
146
Fever + chalky white skin deposits?
GOUT
147
OLD + Knee pain + crystals?
Pseudogout
148
What is the process of bone healing (1-7)?
```
CALLUS FORMATION
Clot
Recruitment
Neovascularization
Fibroblast organization
removal of Dead tissue
Osteocyte ingrowth
Osteoclast remodeling
```
149
Bone within Bone or Double bone appearance on X-ray?
Osteonecrosis
150
what is the cellular composition of normal bone marrow?
50% Cellular
| 50% Fat
151
Hematogenous spread to Metaphysis?
Osteomyelitis in Children
152
Saddle nose + Sabre shin?
Congenital Syphilis
153
What types of cells predominate in Acute vs. Chronic Osteomyelitis?
PMNs for BOTH
154
Sinuses + Involucrum + sequestrum?
Osteomyelitis
155
Sinus drainage of osteomyelitis is a risk factor for developing?
SCC
156
Sexual transmission + painful ulcer heals spontaneously?
Primary Syphilis
157
Symmetrical Non Pruritic Rash (SOLES + PALMS)
| Headache + LAD + Arthritis + renal/hepatic dysfunction?
Secondary Syphilis
158
Soft tissue like granuloma + Degeneration of Joints + Loss of proprioception + might be severe with spread to heart or CNS?
Tertiary Syphilis
159
GUMMA?
Soft tissue granuloma of tertiary Syphilis
160
Congenital Syphilis?
Sabre shins
| Saddle nose
161
Segmental Granulomatous inflammation + fibrosis can cause Blindness?
Temporal arteritis
162
ESR > 100 + Headache + Jaw claudication. Tx?
Temporal Arteritis== Corticosteroids
163
Granulomatous inflammation @ Aortic Brach points?
Takayasu arteritis
164
"pulseless Disease" Tx?
Takayasu arteritis == Corticosteroids
165
Necrotizing vasculitis that spare the LUNG?
PAN
166
What disease is associated with PAN?
Hepatitis B
167
Aneurysms + fibrinoid necrosis?
PAN
168
2 yo with Fever, conjunctivitis, palmar/ sole Rash, cervical LAD. What are major complications?
Kawasaki disease
Coronary artery Thrombosis--> MI
Strawberry TONGUE
169
3 yo child with coronary artery vasculitis. Tx?
Aspirin or IVIg
170
Mono clonal cryoglobulin, RF - , associated with Malignancy and causes Hyper viscosity?
Type I cryoglobulin
171
Polyclonal (IgG and IgM), RF + , HEP C/ Sjogren/ SLE associated, causes IC vasculitis?
Type II & III Cryoglobulins
172
Medium, Granulomatous necrotizing vasculitis that affect all organs EXCEPT the LUNGS?
PAN
173
Granulomatous vasculitis that is associated with Smoking. what Abs and ANCAs directed against?
Beurger disease
Abs--> Collagen, Elastin, Laminin, endothelial cells
ANCAs--> MPO . lactoferrin, Elastin
174
Palpable purpura is the classical sign for what?
IC mediated Vasculitis
175
Small/ Skin vessel vasculitis due to drugs or infections?
Hypersensitivity vasculitis
176
Purpura + arthritis + glomerulonephritis + abdominal pain?
Henoch Schonlein purpura
Might be: HS vasculitis
177
Child with non granulomatous vasculitis and lower leg non-blanching purport. What is the Pg?
IgA IC deposition post INFECTION
178
What are cryoglobulins?
Antibodies that ppt from serum in COLD
179
Causes hyper viscosity syndromes?
Type I cryoglobulins (monoclonal)
180
Palpable purpura with ulcers, peripheral neuropathy, Raynauds. Hep C infection. What will lab findings be?
Cryoglobulinemia vasculitis:
RF+
C4 decreased
181
IgM + C3 deposits around arteries?
Cryoglobulinemia vasculitis
182
Granulomatous with thoracic aortic Aneurysms?
Giant cell arteritis
183
Pt with Shoulder + pelvic pain, morning stiffness is most likely to have what type of vasculitis?
Giant cell--> polymyalgia rheumatica
184
Visual disturbances + jaw pain + arthralgia + headache. What is the most significant Lab finding?
HIGHLY elevated ESR
185
Biopsy showing lymphocytes on the internal elastic lamina and adventitia?
EARLY Giant cell arteritis
186
Elastic membrane destroyed by histocytes + plasma cells + fibroblast?
LATE GC arteritis
187
Granulomatous vasculitis of Aorta and branches + asian women?
Takayasu
188
MCC of acquired heart disease in Japan. What are some of the clinical signs and symptoms?
Kawasaki disease
| PALM/ Soles rash + conjunctivitis + strawberry tongue + Myocarditis
189
Myocarditis + strawberry tongue + profound Lymphocytosis. Tx?
Aspirin + IViG
190
Cutaneous vasculitis is associated with what two lab findings?
Hypocomplementemia and Increased ANA
191
IgG and C3 deposition around Dermal blood vessels?
Cutaneous vasculitis
192
Purpuric lesions and DEEP cutaneous ulcer over Malleoli?
Rheumatoid vasculitis
193
Granular IgM and C3 deposition and IC-complement cryoglobulins?
Rheumatoid vasculitis
194
Glomerulonephritis + Pulmonary hemorrhage + neuropathy + skin involvement. what is the confirmatory Lab test?
p-ANCA positive--> Microscopic polyangiitis
195
Focal granulomatous vasculitis with Chronic sinusitis + ulcerations + otitis media + saddle nose . What are the typical organs affected?
ERK--> Wegners
ENT--> ulcers
Respiratory--> hemorrhage
Kidney--> GN
196
Dyspnea, cough, asthma, vasculitis?
Chrug Strauss
197
Eosinophilia + vasculitis. What is the lab test?
p-ANCA +
198
Oral + genital ulcers + arthritis + Middle eastern Man?
Bachet's disease
199
Associated with Hepatitis B?
PAN
200
Causes Neuropathy, renal HTN, pericarditis, NO LUNG or GN what is the skin finding?
PAN--> Livedo Reticularis
201
Thrombosis + aneurysms + fibrinoid necrosis?
PAN
202
Ischemic digital ulcers + splinter hemorrhages?
Beurger disease
203
Plasma + COLD + ppt with serum cold
| precipitate?
Cryopercipitate
204
Serum+ COLD + ppt?
Cryoglobulin
205
Plasma cold ppt w. out serum ppt?
Cryofibrinogen
206
Positive pathergy test, clinical symptoms?
Bechet-> Oral and genital lesions
207
Destructive lesion in Vertebrae + Psoas abscess?
TB osteomyelitis
208
What are the biochemical markers for bone formation?
ALP
Osteocalcin
P1NP
209
What are the biomarkers for bone resorption?
Pyramidine crosslinks
n-teropeptide
CTX1
