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Step 1 > Pathology > Flashcards

Pathology Flashcards

1
Q

Stained in blue (by hematoxylin)

A

Nucleic acids and calcium salts:
NBC!!

Nuclei and Nucleoli
mRNA in the cytoplasm
Bacteria
Calcium

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2
Q

Stained in pink (by eosin)

A

Pink proteins!

Cytoplasm
Collagen
Fibrin
Red blood cells
Thyroid colloid
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3
Q

Vitamin A deficiency generates:

A 
Night blindness
Squamous metaplasia (keratomalacia in the conjuntiva)
Immune deficiency
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4
Q

Vitamin D deficiency generates:

A

Rickets and osteomalacia

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5
Q

Vitamin K deficiency generates:

A

Bleeding diathesis

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6
Q

Vitamin B12 deficiency generates:

A

Megaloblastic anemia

Neuropathy (Subacute Combined Degeneration: Spinocerebellar, Corticospinal, Dorsal column)

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7
Q

Folate deficiency generates:

A

Megaloblastic anemia

Neural cord defects

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8
Q

Vitamin B3 or niacin deficiency generates:

A

Pellagra:
diarrhea
dermatitis
dementia

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9
Q

Biliary track obstruction is signaled by:

A

Alkaline phosphatase

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10
Q

What is Barrett esophagus?

A

A metaplasic change of the esophageal epithelium from squamous to columnar (globet cells are dx of Barrett)

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11
Q

Russel bodies are:

A

Intra cytoplasmic accumulations of immunoglobulins

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12
Q

Collagen type I is found in:

A

Skin
BONE (1)
Tendons
Most organs

It is the most common form, is strong

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13
Q

Collagen type II is found in:

A

Cartilage, CarTWOlage (2)
Vitreous humor
Nucleus pulposus

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14
Q

Collagen type III is found in:

A 
Blood vessels
Granulation tissue
Embryonic tissue
Uterus
Keloid
It is pliable, in tissues that need to change shape
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15
Q

Collagen type IV is found in:

A

Basement membranes. Heparan sulfate is what gives the basement mb it’s negative charge (Ab against it on Goodpasture sd. hematuria+hemoptysis)
Lens of the eye

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16
Q

Warfarin therapy is monitored with:

A

Prothrombin time (extrinsic pathway)

The short one for the strange

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17
Q

Heparin therapy is monitored with:

A

Partial thromboplastin time (intrinsic pathway)

The long one for our own

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18
Q

Prothrombin time tests:

A

The extrinsic pathway

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19
Q

Partial thromboplastin time tests:

A

The intrinsic pathway

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20
Q

Thrombin time tests:

A

Fibrinogen levels

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21
Q

Fibrin degradation products test:

A

Fibrinolytic system

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22
Q

Albinism is due to a deficiency of the enzyme:

A

Tyrosinase (needed to convert tyrosine, an aromatic aa, and DOPA to melanin). This is the most common form and it is autosomal recessive

Other forms affect the tyrosine transporter and neural crest migration

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23
Q

The triplets that repeats in Fragile X syndrome is:

A

CGG

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24
Q

The triplets that repeats in Huntington disease is:

A

CAG
Caudate
↓ Ach and GABA
↑ DA

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25
Q

In Prader-Willi the microdeletion is on:

A

The paternal chromosome 15

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26
Q

In Angelman the microdeletion is on:

A

The maternal chromosome 15

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27
Q

Type I hypersensitivity is mediated by and it’s also called:

A

IgE

Also called anaphylactic type

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28
Q

Type II hypersensitivity is mediated by and it’s also called:

A

IgG or IgM

Also called antibody-mediated hypersensitivity

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29
Q

Type III hypersensitivity is mediated by and it’s also called:

A

Antibody-antigen immune complexes

Also called immune complex disease

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30
Q

Type IV hypersensitivity is mediated by and it’s also called:

A

Sensitized T lymphocytes

Also called cell-mediated type or delayed type

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31
Q

Function of P53:

A

Prevents cell with damaged DNA to progress from G1 to S-phase

If DNA is damaged upregulates either repair enzymes or BAX to break Bcl2 and promote apoptosis

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32
Q

Function of Rb:

A

Prevents progression from G1 to S-phase

Holds E2F transcription factor, releases it when it is phosphorylated by the cyclinD/CDK4 complex, when E2F is released cell can go to S-phase

Rb PHOSPHORYLATION means cell cycle PROGRESSION; the inactive form is the phosphorylated in which Rb cannot halt progression

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33
Q

Name 6 important tumor suppressor genes:

A 
P53 (17p): p21 activator
Rb (13q): E2F inhibitor
VHL (3p): hypoxia-induced factor 1a inhibitor
APC (5q): β-catenin regulator
DCC and DPC (18q)
NF-1 (17q): ras supressor!
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34
Q

Cyanide and CO toxicity mechanism:

A

Cyanide (bitter almonds)
CO (cherry red)

Both bind mitochondrial Fe in cytochrome oxidase a/a3; cynide binds Fe3+ and CO binds Fe2+; avoid e- to move to O2

On top CO binds Hb and causes left shift in Hb’s curve

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35
Q

Cocaine mechanism of action:

A

Prevents dopamine, serotonin and norepinephrine uptake into presynaptic neurons

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36
Q

Auerbach plexus refers to ____ ganglia

A

Myenteric

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37
Q

Meissner plexus refers to ____ ganglia

A

Submucosal

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38
Q

The autoimmune reaction involved in diabetes type 1 pathogenesis is:

A

Type IV hypersensitivity

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39
Q

To assess the coagulopathy due to liver disease we use:

A

The prothrombin time

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40
Q

In hepatitis B serology,

HBsAg
HBeAg and
HBV-DNA

Are positive in:

A

Acute and chronic infection

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41
Q

In hepatitis B serology,

HBcAb

Is positive in:

A

Acute (IgM) and chronic (IgG) infection
Window period (IgM); the one that is not up yet is the HBsAb IgG
Acute battle

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42
Q

In hepatitis B serology,

HBcAb IgG

Is positive in:

A

Prior infection and chronic infection
You don’t have IgG in acute; IgG means chronic or passed! Victory but you have had an acute battle!

Chronic active: high liver enzymes
Chronic persistent: asymptomatic, nr labs

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43
Q

In hepatitis B serology,

HBsAb IgG

Is positive in:

A

Prior infection and immunization; victory

HBsAb IgG binds to circulating virus preventing viral entry into hepatocyte (this is the mechanism of the vaccine)

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44
Q

Döhle bodies are? and basophilic stippling?

A

Döhle bodies: aggregates of RER and ribosomes in WBC seen in leukemoid reaction, myelodysplasia, burns

Basophilic stippling: ribosomes precipitated in RBC seen in sideroblastic anemia and thalassemias

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45
Q

Reed-Sternberg cells are:

A

Diagnostic of Hodgkin lymphoma

Have a bilobed nucleus with prominent large inclusion-like nucleolus in each lobe

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46
Q

Lacunar cells are:

A

Characteristic from Nodular sclerosis (most common subtype of Hodgkin lymphoma)

Have a clear space surrounding the malignant tumor cells

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47
Q

The tumor marker for seminoma is:

A

Placental alkaline phosphatase (PLAP) and β-HCG

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48
Q

Chvostek sing is:

A

Twitching of ipsilateral facial muscles after tapping the muscles (neuromuscular excitability)

Occurs in hypoparathyroidism
Is indicative of hypocalcemia

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49
Q

Trousseau sign is:

A

Muscular contractions after inflating the sphygmomanometer cuff above systolic blood pressure for several minutes (neuromuscular excitability)

Occurs in hypoparathyroidism
Is indicative of hypocalcemia

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50
Q

Secondary gout can be caused by:

A 
Leukemia (excessive WBC cell breakdown) and myeloproliferative diseases (P vera; excessive RBC cell breakdown)
Tumor lysis syndrome
Lesch-Nyhan syndrome
Von Gierke
Chronic kidney disease
Thiazide/loops use
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51
Q

Pseudogout in a patient younger than 50 should raise suspicions about:

A 
Hemochromatosis 
Hyperparathyroidism
Hypophosphatemia (low P)
Hypomagnesemia (low Mg)
Join trauma

4Hs

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52
Q

Marker on cytotoxic T lymphocytes

A

CD8

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53
Q

The mesonephric or Wolffian duct evolves to form:

A

SEED: Seminal vesicles, Epididymis, Ejaculatory ducts, Ductus deferens and ureter (male internal structures except the prostate). Men are wolfs

In the female forms the Gartner duct; also forms the distal part of female and males forms the trigone of the bladder

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54
Q

Poison ivy and poison oak contact lead to:

A

Hypersensitivity type IV, cell-mediated type or delayed type

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55
Q

Side effect of bleomycin:

A

Pulmonary fibrosis

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56
Q

Cyclosporine and tacrolimus side effect:

A

Nephrotoxicity

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57
Q

Cyclosporine and tacrolimus mechanism of action:

A

Inhibit calcineurin-mediated transcription of IL-2 gene and therefore reduce T-cell activation

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58
Q

Risk factors for pigment gallstones:

A

Cirrhosis
Hemolytic anemias
Liver fluke infection (Clonorchis sinensis)

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59
Q

p-ANCAs are elevated in:

A

Microscopic polyangiitis
Churg-Strauss sd.
Ulcerative colitis

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60
Q

Rb tumor suppressor gene is in and is associated with:

A

Chromosome 13q

Associated with retinoblastoma and osteosarcoma

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61
Q

Whooping cough is the hallmark of:

A

Pertussis infection

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62
Q

Typical heart sound in mitral stenosis:

A

Low-pitched, rumbling diastolic murmur

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63
Q

Enzymes missing (2) in panacinar emphysema:

A

1) Alpha-1 antitrypsin, coded by the gene SERPINA1
Codominant, normal genotype is PiMM and the homozygous for illness genotype is PiZZ
Because alpha-1 antitrypsin can lead to cirrhosis it can present with bleeding due to ↑PT

2) Elastine

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64
Q

Histological findings in asthma:

A

Curschmann’s spirals (mucus)

Charcot leyden crystals (granules in eosinophils made of eosinophilic major basic protein)

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65
Q

Treatment of patent ductus arteriosus:

A 
O2
Indomethacin (PGs inhibitor)
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66
Q

Cause of primary pulmonary hypertension:

A

Inactivating mutation in BMPR2

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67
Q

Where does the transitional cell ca. occur?

A

On the bladder

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68
Q

CREST sd. Manifestations:

A 
Calcinosis (Ca deposits in the skin)
Raynaud’s (cold/stress induced vasospasm)
Esophageal dysfunction
Sclerodactyly (atrophy of hand’s skin)
Telangiestasias
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69
Q

Kartagener syndrome is characterized by:

A

Immotile cilia due to dynein arms defect

Situs inversus
Chronic sinusitis
Bronchiectasis (airway enlargement)
Infertility

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70
Q

Most frequent bacteria in aspiration pneumonia:

A

Anaerobic: peptostreptococcus, bacteroides, prevotella, fusobacterium

Aerobic: streptococcus

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71
Q

The most important inmune effectors in TB are:

A

CD4 T lymphocytes and macrophages

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72
Q

Example of a serine protease inhibitor:

A

Alpha-1 antitrypsin

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73
Q

The a wave of the jugular venous pulse is caused by:

A

Atrial contraction

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74
Q

The c wave of the jugular venous pulse is caused by:

A

The RV contraction and the closed tricuspid valve bulging into the RA

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75
Q

The x descent of the jugular venous pulse is caused by:

A

Atrial relaXation

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76
Q

The v wave of the jugular venous pulse is caused by:

A

Increase of pressure in the RA because of the filling of RA with a closed tricuspid valve

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77
Q

The y descent of the jugular venous pulse is caused by:

A

Decrease pressure in the RA because the tricuspid valve opens and blood goes to the RV

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78
Q

Histological pattern that predisposes to thoracic vs abdominal aortic aneurysms and dissection:

A

Thoracic: cystic medial degeneration, with myxomatous degeneration of the media layer in large arteries

Abdominal: atherosclerosis

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79
Q

Illnesses in MEN1 or Wermer sd:

A

Pituitary tumors
Parathyroid tumors
Pancreatic endocrine tumors
Kidney stones and stomach ulcers

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80
Q

Illnesses in MEN2A or Sipple sd:

A

Medullary thyroid ca.
Pheochromocytoma (VMA)
Parathyroid hyperplasia

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81
Q

Illnesses in MEN 2B sd:

A

Medullary thyroid ca.
Pheochromocytoma (VMA)
Mucosal neuromas
Marfanoid habitus

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82
Q

The only functional parameters increased on the air trapping pattern of COPD are:

What parameter can be normal?

A

TLC (might be normal initially)
RV
RV/TLC
FRC

FVC can be decreased or nr
Expiratory reserve vol. is decreased

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83
Q

ST elevation or Q waves in avL and lead I indicate:

A

Left circumflex A occlusion (lateral MI)

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84
Q

ST elevation or Q waves in V5 and V6 indicate:

A

Left circumflex A occlusion (lateral MI)

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85
Q

ST elevation or Q waves in V1-V4 indicate:

A

LAD occlusion (anterior MI)

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86
Q

ST elevation or Q waves in V3-V4 indicate:

A

Distal LAD occlusion (anteroapical MI)

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87
Q

ST elevation or Q waves in V1-V6, I and avL indicate:

A

Left main coronary A occlusion

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88
Q

ST elevation or Q waves in leads II, III and avF indicate:

A

Right coronary A occlusion (inferior MI)

The RCA lesion and inferior MI can affect either the RV to the LV because it gives 3 branches:
PDA: causes inferior heart MI
Marginal: causes RV MI leading to hypotension
Atrial branch

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89
Q

Clothing factors involved, diagnostic coagulation time and treatment for intrinsic pathway problem:

A

12, 11, 9 and 8
PTT
HEParin

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90
Q

Clothing factors involved, diagnostic coagulation time and treatment for extrinsic pathway problem:

A

7
PT
Warfarin, cumidin

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91
Q

Examples of tumors that contain psammoma bodies:

A 
Mesothelioma
Meningioma 
Papillary thyroid ca.
Papillary serous ovary/endometrial ca. (psammoma indicates high grade in serous cystosarcoma)
Prolactinoma and somatostatinoma
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92
Q

Isoniazid therapy leads to deficiency of which vit? And which symptoms?

A 
Vit B6, pyridoxine
Sideroblastic microcytic anemia
Chelosis, stomatitis 
Peripheral neuropathy 
Convulsions
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93
Q

Permanent tissues, 3 types and main characteristic:

A

Cardiac and skeletal m. and nerves

Don’t have stem cells so cannot make new cells so cannot undergo hyperplasia. They undergo hypertrophy only.

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94
Q

Budd-Chiari sd. definition and main causes:

A

Hepatic vein thrombosis that leads to liver infraction

Main cause is polycythemia vera, hepatocell ca, QT, lupus-anticoagulant

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95
Q

Sings of CO poisoning:

A

Early sing is headache, cherry-red skin

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96
Q

Sings and treatment of methemoglobinemia:

A

Cyanosis with chocolate-color blood

Methylene blue to reduce Fe

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97
Q

Mechanics underlying hemochromatosis and Wilson’s disease:

A

Free radical generation by Fe and Cu

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98
Q

Conditions where you get systemic amyloidosis:

A

Multiple myeloma (1ry, AL amyloid)

Chronic inflammation as autoimmune diseases, malignancy and Familial Mediterranean fever (2ry, AA amyloid)

Dialysis-related (β2 microglobulin -also helps follow MM-)

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99
Q

Conditions where you get localized amyloidosis:

A

Senile cardiac amyloidosis (transthyretin :) )

Familial amyloid cardiomyopathy (mutated transthyretin :( 👨🏿)

DM 2 (amylin)

Alzheimer’s (A β amyloid)

Medullary thyroid ca. (calcitonin)

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100
Q

DD of noncaseating granulomas:

A 
Foreign material (breast implants)
Sarcoidosis 
Beryllium 
Crohn 
Cat scratch disease
Schistosoma (bladder)
Syphilis
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101
Q

DD of caseating granulomas and further testing:

A

TB, tested with acid fast bacillus (AFB) stain

Fungi, tested with Grocott methenamine silver (GMS) stain

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102
Q

DiGeorge sd. is caused by a microdeletion in:

A

22q11

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103
Q

Collagen change in scaring and cofactor needed:

A

Collagen type III (pliable) changes to type I (hard) by collagenase that needs Zinc

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104
Q

Ca. related to EBV:

A

Nasopharyngeal ca.
Burkitt lymphoma
CNS lymphoma

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105
Q

Ca. related to HHV-8:

A

Kaposi sarcoma

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106
Q

Ca. related to HTLV-1:

A

Adult T-cell leukemia/lymphoma

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107
Q

Which tumor is associated with KIT mutation?

A

Gastrointestinal stromal tumor (GIST)
Acral melanoma
Systemic mastocytosis (↑ histamine, flushing, hypotension, pruritus, urticaria, ↑ gastric acid)
(Also seminoma and AML)

Is a tyrosine kinase, can be treated with imatinib as CML!

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108
Q

Where do you see t(9,22) and what gets mutated?

A

ABL (a signal transducer) gets mutated and this is seen in CML and some adult ALL

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109
Q

Where do you see t(8,14) and what gets mutated?

A

C-myc (Congo); a nuclear regulator that gets mutated in Burkitts lymphoma

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110
Q

Where do you see t(11,14) and what gets mutated? What is the histology?

A 
Cyclin D1 (a cell cycle regulator that allows G1–>S) gets mutated and this is seen in mantle cell lymphoma 
Histology: expansion of the region immediately adjacent to the follicle
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111
Q

What is the cause of thrombotic thrombocytopenic purpura?

A

Decrease in ADAMTS13 (autoantibodies)

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112
Q

What is a classic cause of hemolytic uremic sd?

A

E. coli O157:H7 dysentery in children that eat undercooked beef (generates a verotoxin)

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113
Q

Specific test and treatment for von Willebrand disease:

A

Abnormal ristocetin test
Acute tto/prophylaxis with desmopressin (ADH analog just binds V2, no vasoconstriction) that increases vWF and factor 8 release from Weibel-Palade bodies (also helps in hemophilia A). Tachyphylaxis due to depletion of endothelial stores

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114
Q

What test do you use to measure coagulation on liver failure? why?

A

PT

The liver makes coagulation factors, also vit. K activation by epoxide reductase takes place in the liver

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115
Q

Vit K function:

A

Gamma carboxylate and activate factors 2, 7, 9, X, C and S

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116
Q

Function of epoxide reductase of the liver and how is blocked:

A

Activate Vit K, blocked by warfarin (=coumidin)

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117
Q

Best screening test for DIC:

A

Elevated D-dimer (also characterized by low fibrinogen)

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118
Q

Causes of DIC:

A 
Leaking of amniotic fluid on mother’s blood (amniotic fluid has tissue thromboplastin, tissue factor)
Sepsis
Adenoca.
Acute promyelocytic leukemia 
Rattlesnake venom
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119
Q

Common presentation and cause of death in sickle cell anemia:

A

Presentation is dactylitis 👶🏿
Death for infection with encapsulated (s.pneumoniae or h. influenzae) 👶🏿 and acute chest sd. (vasooclusion in lung vessels after pneumonia) 👨🏿

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120
Q

JAK2 kinase mutation is associated with:

A

Polycythemia vera
Essential thrombocytopenia
Myelofibrosis

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121
Q

What is the most frequent cause of Budd Chiari sd?

A

Polycythemia vera (can also be caused by hepatocellular ca.)

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122
Q

Which tumor can secretes EPO? What are the side effects of EPO?

A

Renal cell ca.

SE: polycythemia, thromboembolism, hypertension, ↑GFR (bc ↑ glomerular capillary oncotic pressure)

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123
Q

Where do you see t(14,18) and what gets translocated?

A

Bcl2 is overexpressed and it inhibits apoptosis of B cells

Follicular lymphoma

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124
Q

Serum marker, type of hypersensitivity and micro associated with Polyarteritis Nodosa:

A

HBsAg, hepatitis B surface antigen
Type 3 hypersensitivity, immune-complex mediated inflammation of the medium-size arteries
Micro: fibrinoid necrosis; different stages of transmural necrotizing inflammation (amorphic eosinophilic materia in blood vessels)

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125
Q

Distribution, Ab and tto. of Wegener Granulomatosis:

A

WeCener:
Distribution: Nasopharynx, lungs (nodules/cavitation) and kidneys, fatigue, weight loss…
Ab: C-ANCA
Micro: necrotizing vasculitis with granulomas
tto: Cyclophosphamide

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126
Q

What kind of nephropathy do you get on Henoch-Schönlein Purpura?

A

IgA nephropathy causing nephritic syndrome (normally after GI/upper respiratory infection on young)

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127
Q

When do the different fibrinous (bread and butter) pericarditis happen after MI? How are they called?

A

Postinfarction fibrinous pericarditis: 1-3 days after an MI (neutrophils phase) only if transmural

Autoinmune pericarditis=Dressler sd that happens weeks after due to an autoimmune phenomenon also causes fibrinous pericarditis

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128
Q

What does direct Coombs asks?

A

Are there RBCs bound to this Ab? Done on baby or patient at risk

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129
Q

What does indirect Coombs asks?

A

Does the patient has Abs in his/her serum?

Done on mom

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130
Q

VSD is associated with:

A

Fetal alcohol sd.

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131
Q

Ostium primum type ASD is associated with:

A

Down sd.

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132
Q

Name 2 important associations of patent ductus arteriosus:

A

Associated with congenital rubella

May lead to lower extremity cyanosis later in life

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133
Q

Transposition of the great vessels is associated with:

A

Gestational maternal diabetes

PREgestational diabetes with bad control on the 1st trimester is associated with sacral agenesis and hypertrophic heart

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134
Q

Name 2 important associations of infantile coartation of the Aorta:

A

Associated with Turner sd.

Has a PDA and causes lower extremity cyanosis at birth

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135
Q

Name 2 important associations of adult coartation of the Aorta:

A

Associated with bicuspid aortic valve

Causes notching of ribs on x-ray

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136
Q

What is the most common cause of nephrotic sd. in african-american and hispanics?

A

Focal segmental glomerulonephritis/sclerosis because they have lipoprotein L1 allele

Also in sickle, heroin, AIDS (collapsing glomerular form, bad) or of they have less kidney

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137
Q

What is the most common cause of nephrotic sd. in children?

A

Minimal change disease

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138
Q

Which is the most common primary cardiac tumor in children? What is associated with?

A

Rhabdomyoma, associated with tuberous sclerosis

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139
Q

Viruses associated and distribution of laryngeal papilloma:

A

HPV 6 and 11, low risk of ca.

Single in adults multiple in children

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140
Q

Gene deficiency in paroxysmal nocturnal hemoglobinuria and consequences:

A

Acquired defect in myeloid stem cell’s PIGA gene that synthesizes glycophosphatidylinositol so complement inhibitors (CD55=DAF and CD59=MIRL cannot anchor)

Complement break down RBCs: low haptoglobin

Can develop iron deficiency, aplastic anemia!! and 10% will develop AML

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141
Q

What is the screening test for adequate surfactant production?

A

Lecithin (phosphatidylcholine)/ sphingomyelin ratio

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142
Q

Name two very mutagenic carcinogens of tobacco:

A

Polycyclic aromatic hydrocarbons
Arsenic
2-Naphthylamine

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143
Q

Findings in Plummer-Vison sd:

A

Severe iron deficiency anemia
Esophageal web
Beefy-red tongue (glossitis)
Increased risk of squamous ca. of the esophagus

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144
Q

What is the most common inherited cause of hypercoagulability? What is the mutation that causes it? What is the pathophysiology?

A

Factor V Leiden
A506G
Mutated factor 5 that cannot be inactivated by proteins C and S so thrombosis

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145
Q

Celiac disease pathophysiology, most prominent location and associations:

A

T cells against DEAMINATED gliadin damage small bowel villi
Most prominent in duodenum
Some celiacs are IgA deficient
Complications: small bowel ca. T!!! cell lymphoma

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146
Q

Right upper quadrant pain that radiates to the right scapula is indicator of:

A

Acute cholecystitis

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147
Q

Presentation of Dubin-Johnson sd:

A

Asymptomatic but liver is dark because of epi metabolites accumulation in lysosomes

(same but nr liver in Rotor sd.)

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148
Q

Principles for serologic markers in Hepatitis B:

A

Surface antigen (HBsAG) indicates infection
IgM against the core (HBcAB IgM) indicates acute battle
IgG against the surface (HBsAB IgG) indicates victory
Envelope antigen (HBeAG) indicates infectivity

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149
Q

Anti mitochondrial Ab indicates:

A

Primary biliary cirrhosis

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150
Q

Primary sclerosing cholangitis is associated with:

A

Ulcerative colitis; both can have a positive p-ANCA

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151
Q

Risk factors of hepatocellular ca:

A

Chronic hepatitis (80%) cirrhosis and aflatoxins form Aspergillus

Aspergillus grows in grains stored for a long time and aflatoxins induce p53 mutations

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152
Q

What are the antibodies against in myasthenia gravis:

A

Nicotinic Ach receptors on the postsynaptic plate

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153
Q

What are the antibodies against in Lambert-Eaton:

A

Voltage-gated Ca ch. on the presynaptic plate

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154
Q

What mediates inmune response in myasthenia gravis and what condition is associated with it?

A

T cells

Associated with thymomas or thymic hyperplasia

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155
Q

Hallmark cell in acute interstitial nephritis? Causes?

A

Eosinophils (maybe present in urine as WBC casts ± sterile pyuria) fever, RASH, proteinuria and hematuria

Causes; 5Ps: NSAIDs (pain), penicillin (cephalosporins, sulfa drugs), ppi’s, diuretics (pee), rifamPin

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156
Q

Minimal change disease is associated with which other conditions? And population?

A

Hodgkin lymphoma

Children 👦

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157
Q

Focal segmental glomerulosclerosis is associated with which other conditions? And population?

A

HIV
Heroin use
Sickle cell anemia

Hispanics👨🏽and African Americans👨🏿

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158
Q

Membranous nephropathy is associated with which other conditions? And population?

A

Lupus
Hepatitis B or C
Solid tumors
NSAIDs and penicillamine

Caucasian adults👨🏻

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159
Q

Membranoproliferative glomerulonephritis is associated with which other conditions? And population?

A

Type I: HVC; subENDOthelial deposits
Type II: C3 nephritic factor; intramembranous deposits
Both: Tram tracks (basement mb splitting)

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160
Q

H. Pylori colonization of the antrum tends to cause:

A

Duodenal ulcers

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161
Q

How do you differentiate Goodpasture and WeCener sd?

A

Both have hematuria and hemoptysis
Goodpasture has lineal IF
WeCener has sinus symptoms, negative IF and c-ANCA

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162
Q

How do you differentiate microscopic polyangiitis and Chung-Strauss sd?

A

Both have negative IF and p-ANCA

Chung Strauss has granulomatous inflammation, eosinophilia and asthma

Microscopic polyangiitis does not have granulomas, asthma (DD w Chung-Strauss) or nasopharyngeal involvement (DD w WeCener)

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163
Q

Presentation of Alport sd:

A

Hematuria, hearing loss and ocular disturbances in a family (X-linked dominant)

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164
Q

Ammonium magnesium phosphate kidney stones are associated with:

A

Struvite stones: Urease + infections as Proteus, Klebsiella and ureaplasma urealyticum
Result in staghorn 🦌 coffins-like prisms calculi, in adults 👨 that promote UTIs
Urine smells like ammonia, ammonia makes basic pH so Mg and P precipitate with the ammonia

tto: percutaneous nephrolithotomy

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165
Q

Staghorn 🦌 calculi in children 👦 indicates:

A

Cystine stones due to cystinuria (defect in cystine reabsorption)

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166
Q

Dialysis in shrunken end-stage kidney failure leads to:

A

Cysts that increase the risk of renal cell ca.

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167
Q

Paraneoplastic sd. that can be seen in renal cell ca. can secrete:

A

EPO: polycythemia
Renin: HT
PTHrP: hypercalcemia and SHORT QT (PTH causes SHORT QT)
ACTH: Cushing sd.
Gonadotropins: feminitation
IL: leukemoid reaction, eosinophilia, AA amyloid

In general paraneoplastic sd are rare

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168
Q

Tumor suppressor gene lost in renal cell ca:

A

VHL

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169
Q

VIPoma presentation:

A

WDHA sd: watery diarrhea, hypokalemia and achlorhydia

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170
Q

What do high risk HPV viruses produce to make them high risk?

A

E6 and E7 proteins that destroy p53 (that ↓ transcription of p21) and Rb respectively

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171
Q

What’s the name of endometriosis of the myometrium?

A

Ademyosis

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172
Q

What is the most important predictor of progression to ca. in endometrial hyperplasia?

A

Cellular atypia

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173
Q

BRCA mutation carriers are at increased risk of:

A 
BRCA1:
Breast ca.
Ovarian serous ca.
Fallopian tuve serous ca.
Prostate
Often elect to have mastectomy+salpingo-oophorectomy

BRCA2:
Breast in both sexes
Pancreatic ca.

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174
Q

What is Meigs sd. and what type of tumor indicates?

A

Pleural effusion + ascitis + fibroma of the ovary

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175
Q

Treatment for achalasia:

A

Botulinium toxin injection on the LES

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176
Q

Smoking is a risk factor of which ca?

A 
Oro pharyngeal ca.
Squamous ca. of the esophagus 
Lung ca.
Renal cell ca.
Urothelial ca. (bladder)

Cervix ca.
Pancreatic ca.

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177
Q

What is the most common testicular tumor in children?

A

Yolk sac tumor

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178
Q

Describe the paraneoplastic sd. of choriocarcinoma:

A

Syncytiotrophoblasts secrete beta-hCG and the alpha-subunit of hCG is similar to FSH, LH and TSH so patients can have gynecomastia or hyperthyroidism

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179
Q

What can happen to an embryonal ca. (of the testicle) after Chemotherapy?

A

It can differentiate into another type of germ cell tumor as teratoma

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180
Q

Which HLA is associated with Hashimoto thyroiditis? which disease is associated with?

A

HLA-DR5

NON-Hodgkin lymphoma

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181
Q

Familial autosomal dominant form of pseudohypoparathyroidism is due to? And associated with?

A

Due to a defect of Gs protein

Associated with short stature and short 4th and 5th digits

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182
Q

What benign lesions can present as mammographic calcifications?

A 
Fibrocystic changes (sclerosing adenosis)
Fat necrosis
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183
Q

What mutation is present in some familiar cases of amyotrophic lateral sclerosis?

A

Zinc-cooper superoxide dismutase mutation

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184
Q

What gene is mutated in Friedreich ataxia and what problem causes?

A

GAA repeat in Frataxin gene essential for mitochondrial iron regulation
Causes free radical damage

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185
Q

Cell present on CSF of bacterial meningitis:

A

Neutrophils

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186
Q

Cell present on CSF of viral/fungal meningitis:

A

Lymphocytes

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187
Q

Histological hallmark of Parkinson disease:

A

Lewy bodies: alpha-synuclein inclusions in eosinophils

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188
Q

What is the cause of achondroplasia?

A

Autosomal dominant activating!! mutation on fibroblast GF receptor 3 (FGFR3) leading to decreased chondrocyte proliferation so there is not endochondal ossification in long bones

All that are alive are heterozygous

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189
Q

What is one cause of osteoPETRosis? Consequences and treatment?

A

Carbonic anhydrase II mutation

There is not acidic environment to break up bone so: poor osteoclasts function

There is no way to get rid of acid on the renal tubule so: renal tubular acidosis

Tto: bone marrow transplant because osteoclasts derive form monocytes

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190
Q

Levels of Ca, P, PTH and AP in osteoporosis:

A

All normal

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191
Q

What are the complications of Paget disease of the bone?

A

High output heart failure (bc of AV shunts in bone)
Osteosarcoma
Myelophthisic anemia (or myelophthisis) ~ myelofibrosis

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192
Q

How do you differentiate osteoid osteoma from osteoblastoma?

A

Osteoid osteoma is in long bones and pain responds to aspirin

Osteoblastoma is >2cm, happens in vertebrae and pain doesn’t decrease with aspirin

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193
Q

Where in the bone does osteomyelitis happens?

A

EPIphysis: adults 👨
Metaphysis: kids 👦
Epi es un adulto con la Meta de gustar a niños

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194
Q

Where do you see t(11,22)?

A

On Ewing sarcoma

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195
Q

Main laboratory finding in rheumatoid arthritis:

A

Rheumatoid factor: IgM against the Fc portion of IgG. Indicates disease activity and tissue damage but just in 80%

Alpha-cyclin citrullinated peptide antibodies (alpha-CCP): in 95%

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196
Q

Inflammatory complications of rheumatoid arthritis and cause:

A

Due to inmune phase reactants:

Secondary amyloidosis: SAA generates AA that deposits

Anemia of chronic disease: hepcidin blocks the ability to use Fe stored in macrophages

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197
Q

What should you do on a patient that presents with dermatomyositis?

A

Exclude underlying ca. especially gastric ca.

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198
Q

How do you differentiate lupus and dermatomyositis?

A

Both have malar rash and positive ANA
Lupus has positive dsDNA antibody
Dermatomyositis has anti-Jo-1 antibody

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199
Q

How do you differentiate dermatomyositis and polymyositis?

A

In Dermatomyositis you get Perimysial inflammation and CD4+ infiltration

Polymyositis Endomysial inflammation, vascular involvement, CD8+ infiltration and sarcolemmal MHCI overexpression

DP vs PE (2Ps cannot go together)

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200
Q

What is the hallmark and cause of Duchenne and Becker disease?

A

Hallmark: REPLACEMENT of muscle by adipose and connective tissue
In Duchenne you have dystrophin deletion and in Becker dystrophin mutation so Duchenne is more severe

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201
Q

Which ulcers are associated with malignancy?

A

Gastric ulcers can turn into INTESTINAL gastric ca. or MALT lymphoma (not in diffuse)

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202
Q

In acute onset shortness of breath + tachypnea (respirations above ~20/min) you should think about:

A

Pulmonary embolism

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203
Q

Which two pathologies are associated with acanthosis nigricans?

A

Insulin resistance

Gastric ca.

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204
Q

What is Leser-Trélat sd?

A

Sudden onset multiple seborrheic keratoses

Think about underlying ca. (especially GI tract)

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205
Q

Risk factors of squamous cell ca:

A 
UVB light exposure (sun, albinism, xeroderma)
Immunosuppressive therapy 
Arsenic 
Scar from burn 
Draining sinus tract
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206
Q

Which is the most important px factor predicting metastasis in melanoma?

A

Breslow thickness: deep of extension

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207
Q

Pie in the sky indicates a lesion of:

A 
Temporal lobe 
Lingual gyrus (external)
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208
Q

Pie on the floor indicates a lesion of:

A 
Parietal lobe
Cuneus gyrus (internal)
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209
Q

What is the most common trisomy in miscarriages?

A

16 trisomy (also triploidy) they are never carried to term

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210
Q

What is the cause of polycythemia vera? What is the treatment?

A

Mutation of the proto-oncogene JAK2

Hydroxyurea and ruxolitinib (JAKl/2 inhibitor)

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211
Q

What is the mutation and what ca. are more frequent in VHL?

A

3 letter illness!
Mutation 3p, autosomal dominant
VHL normally suppresses hypoxia inducible factor HIF1α! is no VHL ↑VEGF

Renal cell ca. (often bilateral)
Hemangioblastoma!! in retina cerebellum…
Polycythemia tumors make EPO
Pheochromocytoma (VMA)
Angiomatosis
Benign CYSTS!!! in the liver, pancreas (serous cystoadenoma) and kidney

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212
Q

Which illnesses do we treat with octreotide?

A 
Carcinoid tumor 
VIPoma 
Glucagonoma
Acromegaly 
Esophageal variceal bleeding
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213
Q

Cancers that metastasize to bone:

A 
Breast 
Lung
Thyroid 
Renal cell ca.
Prostate
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214
Q

Where can pathological increased of 1α-hydroxylase and hypercalcemia can be seen? What is the mechanism?

A

Any granulomatous condition:
Sarcoidosis
TB
Hodgkin lymphoma

Activated T-lymphocytes secrete γ-interferons which increase the expression of 1α-hydroxylase!!!

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215
Q

What generates cold agglutinins?

A

Mycoplasma and mononucleosis!!
Hep C
Wäldestrom macroglobulinemia
CLL

Intravascular coagulation in extremities by IgM

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216
Q

What generates warm agglutinins?

A

Lupus
Drugs: alpha-methyldopa, penicillins
CLL

Extravascular coagulation by IgG

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217
Q

Glomerulonephritis with subEPIthelial deposits:

A

Acute poststreptococcal

Membranous

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218
Q

Glomerulonephritis with subENDOthelial deposits:

A 
Diffuse proliferative (type 4 lupus)
MPGN type 1
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219
Q

Glomerulonephritis with mesangial deposits:

A

Berger IgA
Amyloidosis
Nodular sclerosis in DM (mesangial expansion)
Class 2 lupus (mesangial expansion)

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220
Q

Glomerulonephritis with C3 deposits and other deposits associated:

A 
Acute poststreptococcal (IgG, IgM)
Diffuse proliferative (type 4 lupus) (IgG)
MPGN type 2
Focal segmental (IgM,C1)
Membranous (IgG)

Just acute poststreptococcal and focal segmental have IgM and focal segmental has C1

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221
Q

What are the 4 mechanisms of the body to get rid of free radicals?

A

Antioxidants vit A,C,E
Superoxide dismutase (for superoxide)
Glutathione peroxidase (for hydroxyl, especially in RBSs needs HMP shunt)
Catalase (for hydrogen peroxidase)

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222
Q

Tumors that can secrete EPO and cause hypercoagulability:

A 
Renal cell ca.
Hemangioblastoma 
Pheochromocytoma (VMA)
Hepatocellular ca.
Leiomyoma

DD. With P. Vera where EPO will be low

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223
Q

What is the most common site of ectopic pregnancy?

A

Ampulla of the fallopian tube

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224
Q

Rectal involvement in inflammatory bowel disease:

A

The rectum is always involved in ulcerative colitis and never in Crohn (regional enteritis)

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225
Q

Where do you see WBC casts?

A

Acute interstitial nephritis (eosinophils)
Acute pyelonephritis
Transplant rejection

Be careful, you can see some WBCs in urine in other etiologies but not casts!

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226
Q

Main characteristics of pemphigus:

A 
Ab against desmosomes (desmoglein 3 -a cadherin-) that connect epithelial cells to one another
Intraepidermal blisters (achantolysis)
Blisters start in the mouth
Break, + Nikolsky
Fatal
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227
Q

Main characteristics of pemphigoid:

A

Ab (BPAg1 and 2) against hemidesmosomes (dystonin) that connect epithelial cells to the basement membrane, sub epidermal linear complement deposits
Separation of epithelium and basal lamina, subepidermal blisters
Don’t break, - Nikolsky

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228
Q

Melanoma stain markers and main gain of function mutation (protoncogene):

A

Melanocyte markers: S-100+ (neural crest) HMB45+ (melanoma marker) and MART-1+

V600E (alters Braf and can be treated with vemurafenib; also in pilocytic astrocytoma, langerhans histiocytosis and papillary thyroid ca.)

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229
Q

Tumors with fried eggs appearance in histology:

A

Seminoma and dysgeminoma
Renal cell ca.
Oligodendroglioma

They are described as clear cells or cells with clear cytoplasm together with clear cell adenoca. of the vagina

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230
Q

Illnesses with high AFP (alpha-fetoprotein):

A

AFP is made by liver and yolk sac in fetus
Yolk sac tumor
Hepatocelular ca.
Embryonal ca. when mixed (men)
Ataxia-telangiectasia
Pregnancy (high in neural tube defect low in trisomies)

Different form placental alkaline phosphatase in seminoma

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231
Q

What is Fanconi anemia?

A

Autosomal recessive disease due to lack homologous DNA interestrand crosslink repair that leads to aplastic anemia due to bone marrow failure

Presentation: short stature, no thumb!!! increase malignancy as AML and myelodysplastic sd.

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232
Q

Which marker goes up first on MI?

A

Myoglobin, goes up first in MI

Bur it is not specific at all, also goes up in skeletal muscle breakdown causing renal failure

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233
Q

MI makes:

A

Best: Troponis T and I and CK-MB!!!

Most specific and sensitive: Troponins I and T (cTnI and cTnT)

Good for reinfartion: CK-MB (MB fraction of creatinine phosphokinase for muscle -MM for skeletal MB for brain-)

1st to go up: myoglobin; tiny, goes up fast but non specific, also goes up in skeletal muscle breakdown

Others: AST!! (liver and muscle) LDH (goes up 1 day after MI and stays up for 6 days; LDH increases when any cell dies; indicates rapidly growing tumor)

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234
Q

What is invasive carcinoma vs carcinoma in situ?

A

Carcinoma in situ: dysplasia expanding trough all the epithelium with intact basement. In cervix is asymptomatic

Invasive carcinoma: invasion of the basement membrane! using metalloporteinases (cell-cell contact lost by E-cadherin inactivation). In cervix you get symptoms as malodorous discharge and coital bleeding

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235
Q

Vessel lesions associated with hypertension:

A

Fibromuscular dysplasia: string of beads in the renal artery. Cause of secondary hypertension due to renal artery stenosis. Can also involve the carotid, vertebral, mesenteric… Types: perimedial, medial, medial+aneurisms (most common)

Hyaline arteriOLOsclerosis: pink thick vessel due to protein leakage in the endothelium in benign hypertension (in the good kidney of renal A. stenosis) and diabetes

Hyperplastic arteriOLOsclerosis: onion skinning with fibrinoid necrosis and smooth m. proliferation consequence of malignant hypertension, acute renal failure with flea bitten appearance

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236
Q

Mutations and treatments that address them in melanoma:

A

Gain, protoncogene: ckit (acral; imatinib), nras, BRAF v600e (-serine/threonine kinase- vemurafenib, dabrafenib)

Loss, tumor suppressor: pten, CDKN2a (p16 and p14 lost so the cell goes from G1 to S)

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237
Q

Clinical picture of Peutz-Jeghers:

A 
Hyperpigmented freckels
Harmatomas (intussusception)
GI cancer (colon, pancreas, stomach, breast, ovary, lung...)
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238
Q

Most of the polysaccharide is secreted in the lung by:

A

Globet cells

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239
Q

Renal papillary necrosis presentation and causes:

A

Acute renal failure with painless gross HEMATURIA+PROTEINURIA +- renal colic PAIN

Causes: Sickle, acute pyelonephritis, NSAIDs (analgesics) and DM=SAAD

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240
Q

Periportal hepatic fibrosis is found in and characteristics of the affected area:

A

Zone 1. Has the postal tract (hepatic A. portal V. and bile duct) that brings stuff from the GI so:
Viral hepatitis (affected first)
Ingested toxins: cocaine, phosphorus

Makes glucose

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241
Q

Panlobular lymphocytic infiltration with spots with apoptotic hepatocytes that look round and pink called councilman bodies is found in:

A

Acute viral hepatitis; in acute hepatitis you get:

  • inflammation of both lobules and portal tracts
  • spotty necrosis
  • ballooning degeneration (swelling)
  • councilman bodies (eosinophilic)
  • mononuclear cells

Vs chronic hepatitis where you get inflammation predominantly in the portal tracts, infiltration of lymphocytes, plasma cells, and macrophages.

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242
Q

Nodular regeneration is found in:

A

Cirrhosis

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243
Q

Hepatic centrilobular necrosis is found in and characteristics of the affected area:

A

Zone 3. Contains P450 enzymes, has the hepatic V. that takes stuff out of the liver so:
Ischemia
Metabolic toxins: alcohol, acetaminophen, halothane, rifampin, CCl4. They become toxic after they are metabolized
Congestion and hemorrhage in CHF (nugmet liver)

Breaks down glucose

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244
Q

Hepatic lymphocytic infiltration and destruction of small intrahepatic bile ducts is found in:

A

Primary biliary cholangitis

Graft-versus-host disease

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245
Q

Wedge-shaped areas of hemorrhagic!! necrosis can happen in:

A

Pulmonary emboli

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246
Q

What cleans particles on alveoli, bronchi and nose? What is the size of the particles cleared?

A

*Nanoparicles less than 0.1μm go into the pulmonary capillaries

Alveoli, macrophages: clean particles smaller than 3μm

Bronchi, mucociliary escalator: clean particles bigger than 3μm

Nose, nasal vibrissae/shallowing: clean particles bigger than 10μm

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247
Q

Clean particles on bronchi and bronchioles:

A

Ciliated epithelial cells

248
Q

Ground-glass hepatocytes are found in:

A

Chronic hepatitis B

Hepatocytes with granular eosinophilic cytoplasm

249
Q

Mallory bodies are found in:

A

Hepatic steatosis; they are cytoskeletal intermediate filaments formed when hepatocytes degenerate

250
Q

Macrovesicular steatosis and lymphoid aggregates in the portal track are found in:

A

Chronic hepatitis C

251
Q

Pale-pink hepatocytes are found in:

A

Chronic hepatitis B

252
Q

Hemosiderin-laden macrophages are characteristic of:

A

Pulmonary edema due to left heart failure

253
Q

What is used to destroy the cytoskeleton?

A

The ubiquitin-proteasome!! degradation pathway (irreversible!)

(defects in ubiquitin-proteasome system have been implicated in Parkinson)

254
Q

Epithelium change in Barrett esophagus:

A

From nonkeratinized STRATIFIED squamous to non-ciliated columnar with globet cells (mucin-producing)

255
Q

What type of cellular adaptation is cervical intraepithelial neoplasia?

A

Dyplasia

256
Q

Sings of reversible cell injury:

A

Key is cellular swelling that leads to:

Loss of microvilli, chromatin clumping, blebbing and decrease protein synthesis by the swelling RER

257
Q

Sings of irreversible cell injury:

A

Key is membrane damage that leads to:
Cellular enzymes in blood (hepatic enz, troponin), loss of inner mitochondrial mb so no e- transport chain, cytochrome c leak so apoptosis and lysosomal enz in cytosol

Nuclear pyknosis (condensation), karyorrhexis (fragmentation) and karyolysis (fading)

258
Q

Phases of loss of the nucleus:

A

Pyknosis (condensation), then karyorrehxis (fragmentation) and then karyolysis (dissolution)

259
Q

Where can red infarction happen?

A

Lung or testicle

260
Q

Only organ that doesn’t get coagulative necrosis when blood supply is cut:

A

Brain (gets liquefactive due to microglia)

261
Q

When can get fibrinoid necrosis a 30 y.o. woman?

A

This is hyperplastic arteriOLOsclerosis (onion skinning with fibrinoid necrosis and smooth m. proliferation) consequence of malignant hypertension, as in the placenta of preeclampsia; can also happen in vasculitis

262
Q

What does mediate apoptosis and what activates it?

A

Caspases
Activated by:
Lack of Bcl2 and cytochrome c leak (intrinsic mitochondrial)
FAS death receptors (thymus) and TNF receptors (extrinsic)
Cytotoxic CD8+ trough perforines and granzyme

263
Q

Organ most commonly affected by systemic amyloidosis and consequence:

A

Kidney, nephrotic sd.

264
Q

What is the defining characteristic of a granuloma?

A

Epitheloid histiocystes (they are macrophages with abundant pale pale cytoplasm) CD14+

265
Q

Where are the stem cells of the small and large bowel?

A

On the crypts

266
Q

Where are the stem cells of the skin?

A

On the basal layer

267
Q

Which are the stem cells of the bone marrow and what is their marker?

A

The hematopoietic stem cells, CD34+

268
Q

Which are the stem cells of the lung?

A

Type II pneumocytes; they can proliferate in response to injury but they have a low rate of proliferation in normal conditions

269
Q

Vimentin and keratin are markers of which type of tumors and how do they spread?

A

Vimentin: mesenchimal (endothelium, fibroblasts, chondroblasts, vascular smooth muscle) tumors, SARCOMA; spread HEMATOGENOUSLY (so they go to the lungs!! besides GI sarcomas that go to the liver)

Ketatin, cytokeratin: epithelial tumors, CARCINOMA; spread by LYMPHATICS (but renal, hepatocell, follicular thyroid and chorioca.)

270
Q

Desmin is a marker of:

A

Muscle tumors (design helps the interactions between the sarcolemma and the Z disk), rhabdomyosarcoma

271
Q

GFAP is a marker of:

A

Neuroglial tumors

272
Q

Chromogranin and neuron-specific enolase are markers of:

A

Neuroendocrine cell tumors: small cell ca. of the lung, carcinoid tumors, neuroblastoma, pheochromocytoma, VIPoma…

Can form rosettes

273
Q

S-100 is a marker of:

A 
Neural crest tumors:
Melanoma
Schwannoma 
Neurofibroma
Astrocytoma

Neural tumors

Langerhans cell histiocytosis

274
Q

What do the Weiner-Palade bodies of the endothelial cells secrete?

A

W: von Willebrand factor (for platelet-endothelium adhesion)
P: P-selectine (for neutrophil rolling)

275
Q

Thromboxane A2 derives from:

A

Platelet cyclooxygenase 1 (not 2, that is why celecoxib is prothrombotic)

276
Q

Endothelial mechanisms to protect from thrombosis:

A

Blocks underlying collagen
Produces PGI2, NO, heparin-like molecules (that increase antithrombin 3), tissue plasminogen activator and thrombomodulin

277
Q

What does the amniotic fluid contain that makes it thrombogenic?

A

Tissue thromboplastine/ factor; you can have tissue thromboplastine leaking into the circulation and DIC without amniotic fluid embolus.

Amniotic fluid emboli will go to the lungs, they are venous and will cause hypotension and cariogenic shock. Micro: fetal squamous cells in the pulmonary vasculature

278
Q

Where is iron absorbed?

A

In the duodenal enterocytes by ferroportin

279
Q

What is the most sensitive cell to radiation (what is it’s mechanism?)? and QT?

A

RT: Lymphocytes and other rapidly dividing cells (by DNA double strand breaks! and free radicals). Fixed by NONhomologous recombination

QT: Granulogytes (neutropenia). Treat with filgrastim or sargramostim

280
Q

Characteristic of immature neutrophils (left shift):

A

Have less Fc (CD16) receptors

281
Q

Specific marker for ALL:

A

Lymphoblasts have TdT (terminal deoxynucleotidyl transferase) on their nucleus (a DNA polymerase)

282
Q

Which acute leukemia infiltrates the gums?

A

Acute monocytic leukemia (M5 AML)

283
Q

Translocations associated with B-ALL:

A

t(12,21) good px 👶. Kids like palindromes

t(9,22) bad px 👨. Philadelphia typic in CML brings bad px to ALL

284
Q

Specific marker for AML:

A 
Positive staining for myeloperoxidase 
Auer rods (myeloperoxidase aggregates)
285
Q

Type, translocation, defect and treatment of acute promyelocytic leukemia:

A 
Type of AML
t(15,17)
Disrupts the retinoic acid receptor
The promyelocytes contain Auer rods that predispose to DIC
Tto with all-trans-retinoic acid
286
Q

Characteristic e- microscopy finding in langerhans cell hystiocytosis:

A

Birbeck or tennis racket granules

287
Q

In which vessel wall layer does atherosclerosis happens?

A

Intima

288
Q

In which pathologies do you get hyaline arteriolosclerosis?

A

In benign hypertension and diabetes
Looks very pink in histology

Hyaline is gentle fibrinoid is malignant

289
Q

In which pathologies do you get hyperplastic arteriolosclerosis?

A

Just in malignant hypertension

Then can lead to fibrinoid necrosis seen in malignant HT and vasculitis (polyarteritis nodosa)

Hyaline is gentle fibrinoid is malignant

290
Q

Small cell ca. can express:

A 
Neuron-specific enolase 
Chromogranin
Synaptophysin
Neural cell adhesion molecule (NCAM)
Neurofilaments
Rosettes
Uniform round nuclei
291
Q

Where is the juxtaglomerular apparatus?

A

In the tunica media of the afferent arteriole

292
Q

What is affected on Kartagener sd?

A

The dynein arm of cilia, needed for ciliary movement

293
Q

What is the histological hallmark of pulmonary hypertension?

A

Plexiform lesions in long lasting disease

294
Q

What is the histological hallmark of respiratory distress sd?

A

Hyaline membranes and fluid in the alveolar space

295
Q

Signet ring cells are a sing of:

A

Diffuse gastric ca. that infiltrates the gastric wall leading to linitis plastica

296
Q

What do the Mallory bodies contain? Where do you see them? What markers will be high?

A

Damaged intermediate filaments within hepatocytes
Alcoholic hepatitis

Aspartate aminotransferase: AST (AST/ALT ratio is high); can increase in MI
Gamma-glutamyl transpeptidase: GGT (biliary disease)
Mean corpuscular volume: MCV

297
Q

Histological changes seen in Reye sd:

A

Microvesicular steatosis with fat vacuoles on hepatocytes

CNS edema

298
Q

Histological hallmark of diabetic nephropathy:

A

Kimmelstiel-Wilson nodules in the mesangium

299
Q

Which cells produce EPO?

A

Renal interstitial peritubular fibroblasts so there is anemia in chronic renal failure
EPO is secreted in IPFs

300
Q

The most common variant of renal cell ca. originates from:

A

Clear cell type, it originates from the epithelium of the proximal renal tubules! It’s always them!!!

Renal cell ca comes form the proximal convoluted tubule
Renal oncocytoma comes from the collecting duct

301
Q

Where are the stem cells of the endometrium?

A

On the basalis (they regenerate the functionalis every cycle)

302
Q

Multiple white whorled masses on an asymptomatic premenopausal woman indicates:

A

Leiomyoma

303
Q

When we find immature tissue on a teratoma what is the most common type?
And if we find somatic malignancy?

A

1) Skin turns malignant causing squamous cell ca. of the skin, normally malignization comes form skin tissue
2) Neural ectoderm can turn malignant causing gliomas

304
Q

What type of characteristic inclusions do Leydig cells have?

A

Reinke crystals

305
Q

Mutation that leads progression form normal tissue to adenomatous polyp:

A

APC Ch5q (loss); polyp has 5 letters

306
Q

Mutation that leads to increase size of the adenoma:

A

K-ras (gain)

KRAS mutation is associated with colorectal ca. and non-small cell lung ca.

307
Q

Mutation that leads to malignant transformation of a polyp:

A

TP53 Ch17p (loss)

308
Q

Histology of prostatic ca:

A

Small invasive glands with PROMINENT NUCLEOLI

309
Q

Where are the beta cells of the pancreas?

A

In the center of the islet of Langerhans

310
Q

Name a metaplastic change that doesn’t increase the risk for ca:

A

Apocrine metaplasia in fibrocystic breast change.

Metaplasia almost always is associated with increased risk for ca.

311
Q

Histological characteristic of breast lobular ca. in situ and invasive lobular ca.

A

Dyscohesive single-file pattern due to lack of E-cadherin

312
Q

What is the histological hallmark of rheumatoid arthritis and which HLA is associated with it?

A

Synovitis leading to formation of a pannus (granulation tissue)
HLA-DR4

313
Q

What is the major site of synthesis of steroid hormones, TG and phospholipids?

A

Smooth endoplasmic reticulum; contains for example 21-hydroxylase

314
Q

What is the major site of detoxification of drugs and poisons?

A

Smooth endoplasmic reticulum

315
Q

Which ovarian tumor gives you Meigs sd?

A

Hydrothorax and ascites due to ovarian FIBROMA

316
Q

CA tumor markers:

A

CA 15-3: breast ca!! 3 on it’s side looks like breast
CA 19-9: pancreas
CA 125: ovarian ca. (papillary/serous epithelial cystadenoca.) and uterine ca! 25 look like uterus and ovary

317
Q

DD of CIS of the penis:

A

Bowen disease: white plaque in the shaft
Erythroplasia of Queyrat: red plaque in the tip
Bowenoid papulosis: multiple red papules on the shaft (not sure if malignant)

318
Q

Difference between cryoprecipitate and FFP:

A 
Cryoprecipitate just contains:
Fibrinogen
Factor 8 and 13
VonWillebrand
Fibronectin

FFP contains all

319
Q

Characteristics of dysplastic nevus syndrome:

A

Autosomal dominant
Loss of function mutations in the CDKN2A gene in chromosome 9
Unusual nevi and multiple melanomas
Also pancreatic ca.

320
Q

What does right and left dominance mean?

A 
Right dominance (70%): the right coronary gives the posterior descending
Left dominance (10%): the left circumflex gives the posterior descending

The left circumflex normally irrigates the side of the LV

321
Q

Acute tubular necrosis presentation and causes:

A

Acute renal failure with oliguria and granular muddy casts

Causes: ischemia, ahminoglycosides (‘mycins’), lead, cisplatin, ethylene glycol (antifreeze), contrast, myoglobin, hemoglobin

322
Q

What does ca. in situ mean?

A

Takes over the whole epithelium but does not penetrate the basement membrane!

323
Q

Types of UV light and how are they blocked?

A

Aging, phototoxicity: UVA, blocked by avobenzone and zinc oxide
Sun: UVB, most important cause of sunburn, blocked by PABA in current sunscreen, zinc oxide and you can apply petrolatum (vaseline) to the lips as a barrier

324
Q

Which metabolic processes happen in zones 1 and 3 of the liver?

A

Zone 1: makes glucose (gluconeogenesis, glycogen breakdown, FA oxidation)
Zone 3: breaks down glucose (glycolysis, glycogen synthesis, lipogenesis)

325
Q

Atypical MI presentation:

A

Jaw/epigastric pain

Most common in females

326
Q

Where are calcitonin and PTH secreted from?

A

Parafollicullar C cells of the thyroid: calcitonin (lowers Ca)
Chief cells of the parathyroid: PTH (increases Ca)

327
Q

Causes of renal diffuse cortical necrosis:

A

DIC (due to a combination of vasospasm and DIC)

328
Q

Difference between ephelides and lentigines:

A

Ephelides: freckles, pecas; increase granules of melanin
Lentigines: lunar; increase in number of melanocytes

329
Q

Ca. associated with BCL-2 mutation and treatment:

A

CLL
Follicular lymphoma
Breast (good px)

tto: venetoclax

330
Q

Tuberous sclerosis presentation:

A 
HARMATOMASSS:
Harmatomas in cns, skin and lung
Adenoma sebaceoum
Rhabdomyoma of the heart, benign 
Mitral regurgitation
Ash-leaf (fluorescent with UVA, Wood's lamp)
TSC1-harmatin (Ch9) TSC2-tuberin (Ch16)  that inactivate mTOR
autosomal dOminant
Mental retardation
Angiomyolipona of the kidney (vessel+muscle+lipid)
Seizures from cortical tubers
Subungual fibromas
Shagreen
SEGA: subependymal astrocytoma
331
Q

Neurofibromatosis type 1 presentation:

A 
Cafe au lait
Lisch nodules (iris harmatomas)
Neurofibromas on the skin
Optic gliomas and Pilocytic astrocytoma
Pheochromocytomas (VMA) and Wilms
Scoliosis
Mental retardation and seizures
Ch17
332
Q

Neurofibromatosis type 2 presentation:

A 
Bilateral schwannomas
Meningiomas
Ependymomas
Cataracts
Ch22
333
Q

Sturge-Weber syndrome presentation:

A

SSTURGGE:
Sporadic, nonhereditary!!! 0% prob of giving it to your kid
Stain in face (nevus flammeus)
Tram track calcifications in opposing gyri (leptomeningeal angiomatosis)
Unilateral
mental Retardation
Glaucoma (congenital can give leukocoria)
activating mutation of GNAQ gene
Epilepsy
Pheochromocytoma (VMA)

334
Q

Von Hippel-Lindau presentation:

A 
Renal cell ca.
Pheochromocytomas (VMA) FEO!
Hemangioblastomas in retina, cerebellum... EPO
Cysts!! in the liver, pancreas...
Angiomatosis
Ch 3p

3 letter illness!
Mutation 3p, autosomal dominant
VHL normally suppresses hypoxia inducible factor HIF! is no VHL ↑VEGF

335
Q

Which illnesses affect the globing gene?

A

Beta globin
Beta thalassemia: point mutation in the noncoding intron deleting/decreasing gene
Sickle cell anemia: point mutation at position 6 of the exon that changes Glutp(p) to Val(n) making HbS
HbC disease:point mutation at position 6 of the exon that changes Glut(p) to Lys(p) making HbC

Alpha globin
Alpha thalassemia: gene deletion forming HbH (–/-α excess β) or Barts Hb (–/– 4: excess γ)

336
Q

Osler-Weber-Rendu presentation:

A

Hereditary hemorrhagic telangiectasia
Autosomal dominant
Telangiectasias: epistaxis, GI bleeding, hematuria, AV malformations

337
Q

DD of abdominal mass in kids:

A

Wilms: doesn’t cross
From nephroblast (embryonic kidney)
WT1 mutation Ch 11
Micro: triphasic with tubules, sheets and stroma
± hypertension (renin secretion), hematuria ±:
WARG: WT1 is associated with anhiridia, genitourinary malformation, retardation. PAX6 next to WT1 is important for iris formation, contiguous gene deletion
Denys-Drash: WT1 is associated with Difusse mesangial sclerosis (nephrOtic) and Dysgenesis of gonads
Beckwith-Wiedemann: WT2 is associated w macroglossia, hemihyperplasia, low sugar and high insulin because over expression of ILGF2, omphalocele, hepatoblastoma

Neuroblastoma: crosses and calcifies
From neural crest (adrenal medulla± hypertension)
Micro: Homer pseudorosettes
Can cause blueberry-muffin baby!
M-YCN! mutation (poor px)
High homovanillic acid
338
Q

In which chromosomes are WT1 and WT2?

A

11p (world trade center 11S)

In Willms and also in mesothelioma!

339
Q

In which chromosome is TP53?

A

17p

340
Q

In which chromosomes are BRCA1 and BRCA2?

A

BRCA1: 17q
BRCA2: 13q

341
Q

In which chromosomes are APC and DCC?

A

APC: 5q
DCC: 18q

342
Q

In which chromosome is VHL?

A

3p

343
Q

In which chromosome is RB1?

A

13q

344
Q

Why the combination of alcohol and acetaminophen can predispose to hepatic necrosis?

A

Chronic alcohol is a P450 inducer so high P450 activity converts acetaminophen to N-acetyl-p-benzoquinone that depletes glutathione

345
Q

Which pathologies give you a dry tap?

A

Myelofibrosis (different than myelodysplastic that is pre-leukemia and hypercellular)
Hairy cell leukemia
Aplastic anemia (idiopathic, fanconi anemia, QT, bezene, carbamazepine, EBV, hepatitis, different than B19 that causes mostly aplastic crisis just anemia)

In all those normally get pancytopenia
Aplastic anemia will not have splenomegaly

346
Q

Plasmin functions:

A

Breaks down fibrin cloths
Breaks down fibrinogen
Destroys coagulation factors
Blocks platelet aggregation

347
Q

What can cause a disorders of fibrinolysis and how can be treated?

A

Urokinase released after prostatectomy, it activates plasmin
Cirrhosis, α2-antiplasmin is missing so plasmin is not destroyed
Gives you a presentation similar to DIC bc plasmin destroys coagulation factors so ↑PT, PTT and bleeding but nr platelet count and D-dimer (bc the coagulation cascade is not activated so thrombin and therefore fibrin are not formed)
tto: aminocaproic acid

348
Q

Mechanism of heparin-induced thrombocytopenia:

A

Heparin makes a complex with platelet factor 4 and the body makes IgG against this complex so it ends up destroying the platelets

349
Q

Definitive treatment for preeclampsia? How is the urine?

A

Delivery

Renal fx: oliguria, increased specific gravity, yes protein no blood in urine, high serum Cr (that should be low in normal pregnant)

350
Q

Illnesses that cause hyper coagulable state:

A

Protein C and S deficiency, autosomal dominant, do not give warfarin because high risk of skin thrombosis

Factor 5 Leiden mutation, cannot be inactivated by proteins C and S

Prothrombin 20210A point mutation, increases prothrombin gene expression

AT3 deficiency, PTT does not increase with nr dose heparin but yes at high dose

Estrogens increase production of clothing factors

351
Q 
Genes associated with: 
Neuroblastoma
Burkit
Lung small cell
Wilms
CML
Melanoma
Breast
Medullary thyroid
A 
N-MYC: Neuroblastoma
C-MYC: Burkit (Congo)
L-MYC: Lung small cell (all L,N and C)
WT1: Wilms tumor, nephroblastoma, also mesothelioma!
ABL: CML
CDK4: melanoma
Erb2: breast
RET: medullary thyroid and MEN2s
352
Q

Complications of uremia:

A 
Platelet dysfunction (due to complement inhibition)
Anemia
Acute gastritis
Pericarditis
Heart disease
Encephalopathy with asterixis
Deposition of urea crystals on the skin
High ANION GAP metabolic acidosis
353
Q 
Translocations associated with:
Edwing
Follicular thyroid
Synovial sarcoma
Leiomyosarcoma
Alveolar rhabdomyosarcoma
Clear cell sarcoma
A 
t(11,22) FLI1-EWSR1 CD99+ MIC1+: Edwing
t(2,3) PAX8-PPARγ: follicular thyroid
t(X,18): Synovial sarcoma
del(1p): leiomyosarcoma
t(2,13): alveolar rhabdomyosarcoma
t(12,22): Clear cell sarcoma; similar to melanoma
354
Q

Which tumors most likely cause pseudomyxoma peritonei?

A

1) mucinous adenocarcinoma of the appendix 2) mucinous cystadenocarcinoma (adnexal mass indicates bad px, kills because adhesions)

Cavity tumors tend to spread through seeding: on top of 1) and 2) serous endometrial ca., and gallbladder ca. can seed

355
Q

Which tumors present desmoplasia? What is its function?

A

Invasive ductal ca. of the breast
Pancreatic ca.
Helps the tumor to grow, gives blood supply and can protect form QT

356
Q

Where can you find pseudostratified columnar epithelium?

A

Nasal cavity, trachea, bronchi

Epididymis

357
Q

Which component of Hb is low in each of the microcytic anemias?

A

Hemoglobin=Heme + Globin (↓ in thalasemia)

Heme=Fe (↓ in iron deficiency/chronic disease) + protoporphyrin (↓ in sideroblastic)

358
Q

Parietal cell characteristics:

A

Have Proton pumps, make acid
Pink (Chief are blue)
Destroyed in Pernicious anemia
Prodruce IF!!!

359
Q

Labs differences between intra and extravascular hemolysis:

A

Extravascular: RBCs eaten by spleen
Jaundice (↑ unconjugated bilirubin)
Bilirubin gallstones

Intravascular: RBCs broken in blood vessels
Hb in blood and urine
Hemosiderinuria (tubular cells with iron fall off a few days later)
↓ Free haptoglobin

360
Q

In which two anemias do you see high mean corpuscular hemoglobin concentration?

A

Spherocytosis and autoinmune anemia; in both there are spehrocytes that keep loosing their membrane so Hb gets more concentrated

361
Q

Which cell adaptation leads to splenomegaly in extravascular hemolysis? and in infections?

A

Extravascular hemolysis, spherocytosis: Work hypertrophy!!

Infections and autoimmune: Reticuloendotelial (white pulp) hyperplasia

362
Q

Name 4 causes of obstructive shock:

A 
Physical obstruction to the great vessels:
Cardiac tamponade
Constrictive pericarditis
Pulmonary embolism
Tension pneumothorax
363
Q

Name 4 causes of distributive shock:

A

Sepsis (septic)
CNS injury (neurogenic)
Anaphylactic
Endocrine, acute pancreatitis

364
Q

When do you get skin necrosis after warfarin?

A

When you have protein C and S deficiency, protein C has a very short half life

The low protein C and S will stop inhibiting factor 5 and 8 so factors 5 and 8 activity will increase causing a hypercoagulable state

365
Q

Urinary sample markers of pheochromocytoma vs carcinoid tumor:

A

Pheochromocytoma: makes epi, NE and DA so in urine you see homovanillic and vanillylmandelic acid

Carcinoid: makes 5HT so in urine you see 5-hydroxyindoleacetic acid

366
Q

In which illnesses can you see excessive platelets?

A

Essential thrombocytopenia

Iron deficiency anemia

367
Q

Risk factors for bladder ca:

A

Squamous: S. Haematobium, long term Foley catheter, stones, chronic cystitis

Transitional: tobacco, aromatic amine, naphthylamine, dyes, cyclophosphamide, phenacetin, radiation, rubber, plastics, textiles, leather

Adeno: urachal remnant (bladder dom), extrophy, cystitis glandularis

368
Q

Which are the different lymph node regions, which cells contain and when do they expand?

A

Cortex, follicular (B): early HIV (follicular dendritic cells are a reservoir for HIV), rheumatoid arthritis
Paracortex (T): virus, mono
Medullary sinus (histiocytes=macrophages!!): ca. drainage, TB

369
Q

Which papillary m. is most commonly ruptured?

A

Posteromedial m. particularly in inferior MI. causing mitral regurgitation and therefore pulmonary edema
If you see a posterior MI think papillary m. rupture!!

It has single blood supply form the posterior descending A.

370
Q

Presentation, macro, histological hallmark and marker of seminoma and dysgerminoma:

A

Most common in 15-35 yo

PainLESS firm homogeneous testicular enlargement, lobulated (dysgerminoma is a common cause of ovarian ca. in pregnant)

Large polygonal clear cells (with watery large cytoplasm) forming lobules + fried egg (membranes and central nucleus)

Placental alkaline phosphatase and β-HCG (seminoma) lactate dehydrogenase (dysgerminoma)

371
Q

Presentation, macro, histological hallmark and marker of yolk sac (endodermal sinus or INFANTILE embryonal ca.) tumor:

A

Most common in prepuberal children

Yellow mucinous mass

Endodermal sinus formation with Schiller-Duval bodies (glomeruloid structures lined by germ cells) and hyaline droplets

α fetoprotein (± α1 antitrypsin)

372
Q

Presentation, macro, histological hallmark and marker of embryonal ca:

A

Painful mass in 20-30 yo, rare and metastasizes fast

Hemorrhagic mass with necrosis, commonly mixed

Glandular/papillary normally mixed with other tumors

hCG (+ α fetoprotein when mixed)

373
Q

What is Beck’s triad of cardiac tamponade?

A

Hypotension
JVD
Muffled heart sounds

374
Q

Where do you see schistocytes?

A

TTP and HUS
DIC
HELLP sd
Traumatic hemolysis: valve prothesis

375
Q

Where do you see target cells?

A 
HALT:
Hb C disease
Asplenia (so also in sickle after autoinfarction)
Liver disease
Thalassemia

They are due to a high area/vol

376
Q

DD of the different types of lichen:

A

All are itchy
Lichen planus: Flat purple lesion with wickham striae. Sawtooth infiltrate and thickening of the granulosum, hypergranulosis + lymphocytes at the dermoepidermal junction. Associated to Hep C. Risk of ca.

Lichen sclerous: White plaque (leukoplakia) with purple border. THINing of the epidermis that leads to erosions. Postmenopausal. Risk of ca.

Lichen simplex: THICK skin patch with enhanced margins form scratching. Leather- like hyperplasia of the squamous epithelium. No risk of ca.

Tto: Corticoids

377
Q

What are the fibrocystic changes associated with ↑ risk of breast ca:

A

Sclerosing adenosis with epithelial hyperplasia/atypia

378
Q

Illnesses with high CEA (carcinoembryonic antigen):

A

Adenocarcinomas: colon, stomach, breast, lung, medullary thyroid
Bad px is very high

379
Q

What are the markers for Red-Sternberg cells? What is the only subtype without Red-Sternberg cells?

A

CD15 (granulocyte marker)
CD30

The only subtype without is lymphocyte predominant that had popcorn cells are CD20 and CD45

380
Q

What is the illness associated with mutation in GNAS?

A

Intraductal papillary pancreatic ca

Malignant tumors in general

381
Q

Proximal and distal esophagus are formed by which type of m?

A

Proximal: striated m. affected in dermatomyositis

Distal and LES: smooth m.

382
Q

What are atypical lymphocytes pathognomonic from?

A

Mononucleosis (not lymphoma!)

Atypical lymphocytes on peripheral blood smear

383
Q

Which kind of patients get squamous cell ca. of the head and neck? what is the histology?

A

Old man who smokes, drinks and has rotten teeth (if it presents with hoarseness is probably on the vocal cords)
A raising RF is HPV!!

Histology: irregular foci of keratinization (keratin pearls), intracellular bridges, eosinophilic pink cytoplasm

384
Q

Where do the proteins accumulate in centriacinar emphysema PiZ?

A

In the endoplasmic reticulum of hepatocytes forming pass + granules

385
Q

Where does idiomatic pulmonary fibrosis starts and what mediates it?

A

Starts in the subpleural region

TGF-beta mediated

386
Q

Name one endothelial tumor marker:

A

CD31, PEcam-1 for diaPEdesis

Is only on vessels and neutrophils so you will know the tumor is vascular, for example an agiosarcoma

387
Q

Syndromes associated with hepatoblastoma:

A

Beckwith-wiedemann sd
Familial adenomatous polyposis
Glycogen storage diseases

388
Q

Syndromes associated with mitral valve prolapse:

A

Women and fame:

Young female
Klinefelter (increased risk of breast ca.)

FAME:
Fragile X
ADPKD
Marfan
Ehler Danlos
389
Q

Protective and RF of breast, ovarian (epithelial) and endometrium ca:

A

🙁 unopposed estrogen/more cycles: no babies, first baby old, early menarche and late menopause, ovarian dysfunction (anovulatory cycles), fat, DM, postmenopausal hormonal therapy

🙂 progesterone added to estrogens (actually the risk of breast ca. is ↑ even if progesterone is added to estrogen)/less cycles: combination contraceptives, babies, breastfeeding, exercise, tubal ligation for ovarian

390
Q

What is a Rokitansky-Aschoff sinus?

A

Hernitation of the gallbladder mucosa into the muscular wall seen on chronic cholecystitis

391
Q

Causal agents of viral hepatitis:

A

Hepatitis virus, EBV and CMV

392
Q

What is the alcoholic metabolite that causes alcoholic hepatitis? why does it elevate AST more than ALT?

A

Acetaldehyde mediates the damage, it is a mitochondrial poison and AST is in the mitochondria

393
Q

Illness that cause dilated vs hypertrophic cardiomyopathy:

A

Dilated:
Carnitine deficiency (MCAT)
Duchenne Muscular Dystrophy

Hypertrophic:
Pompe
Friedreich ataxia

394
Q

Causes of avascular necrosis of the femoral head:

A 
Legg-Calve-Perthes disease
Gaucher
Sickle cell anemia (is DD for Gaucher disease)
Corticoid use
Alcoholism
395
Q

Which infection is associated with porphyria cutanea tarda?

A

Hepatitis C

396
Q

Risk factors of both types of esophageal ca:

A 
Squamous upper 2/3:
alcohol
hot liquids
caustics
strictures
smoking, achalasia

Adenoca. lower 1/3:
GERD (barret, obesity, nitroglycerin, coffee, chocolate, mint, hiatal hernia)
processed meats
smoking, achalasia

397
Q

What is the most common RF for Ca stones in adults? Which other 2 RF exist?

A

Idiopathic hypercalciURIA; Calcium in plasma remains normal (paradoxically, people with moderately high Ca in the diet have lower risk of calcium-oxalate stones bc ca binds oxalate in the gut so less oxalate gets absorbed)
HyperoxalURIA
HYPOcitratURIA (potassium-citrate is prevention of recurrent calcium stones)

398
Q

How long after fertilization does the β-HCG become detectable in serum? and in urine?

A

8 days in serum

14 days in urine

399
Q

What should you suspect if you see enterovirus or giardiasis on a kid?

A

Burton agammaglobulinemia, no B cells in blood

400
Q

Markers of ALL-B:

A

TdT (terminal deoxynucleotidyl transferase)
CD10
CD19, Negative CD20 (cannot use rituximab)

401
Q

Markers of ALL-T:

A

TdT (terminal deoxynucleotidyl transferase)

CD2-8

402
Q

Markers of hairy cell leukemia:

A

CD11c
CD25
BRAF

CD103
CD19, 20

403
Q

Markers of CLL:

A

CD5
CD23
No CD10!

CD19, 20

404
Q

Markers of Langerhans cell histiocytosis:

A

CD1a
CD11c
BRAF
S-100

405
Q

Markers of mantle cell lymphoma:

A

CD5
No CD23!

CD19, 20

406
Q

Markers of Hodgkin lymphoma:

A

CD15
CD30
All except lymphocyte predominant

407
Q

Markers of lymphocyte predominant lymphoma:

A

Popcorn cells:
CD20
CD45
No CD15, 30!

408
Q

Stains for fibrosis:

A

Trichrome

Reticulin

409
Q

What can stain with PAS?

A 
Paget in nipple (stains mucus)
Whipple
Diabetes (nodular glomerulosclerosis)
AML: erythroleukemia M6 
Fungi
alpha 1 antitrypsin
Glycogen storage diseases
410
Q

How do free radicals cause damage?

A

Directly damages the DNA causing strand breaks

Generate radioactive oxygen spices

411
Q

Which is the most sensitive and specific marker for pancreatic disease?

A

Amylase: sensitive; goes up fast, also released by salivary glands

Lipase: specific; takes several days to increase but just increases in pancreatic disease

Fecal elastase: decreased in pancreatic insufficiency

412
Q

How do you differentiate between biliary and bone disease if you see high ALP?

A

You need to look at GGT, if it is high is biliary pathology if it is low it is the bone

413
Q

Which illnesses are associated with thymoma?

A

Pure red cell aplasia!!
Good syndrome (low immunoglobulins, immunodeficiency)!!!
Myasthenia gravis

414
Q

DD of beaten appearance (string of beads) in angiogram?

A

Polyarteritis nodosa: everywhere but the lung
Fibromuscular dysplasia: young with renal artery stenosis

Primary sclerosing cholangitis: beaded on ERCP

415
Q

Effects of excess phosphate in chronic kidney disease:

A

↑P causes the release of fibroblast growth factor 23 (FGF-23=Klotho) from the bone which lowers 1,25-vitD (calcitriol) and GI Ca absorption

416
Q

Presentation, macro and histological hallmarks of osteochondroma:

A

Presentation: most frequent, benign, condro part can transform in chondrosarcoma

Macro: bony spike covered by a cartilage cap on the metaphysis (almost tip)

Micro: spike is continuous wit the marrow

417
Q

Presentation, macro and histological hallmarks of chondrosarcoma:

A

Presentation: in adults >50 around the pelvis. *Osteochondromas are a lot more frequent, benign, happen in kids and their condro part can transform in chondrosarcoma

Macro: moth eaten lytic appearance with popcorn-like spiculated calcifications in Rx

Micro: irregular cartilage and calcifications

418
Q

Presentation, macro and histological hallmarks of osteoid osteoma:

A

Presentation: Less than 2cm and pain at night relieved by NSAIDs (vs osteoblastoma that is bigger than 2cm, not relived! and in vertebra). Benign

Macro: on the cortex of the diaphysis (side), Rx radiolucent core of osteoid (dark) surrounded by sclerosis (white)

Micro: woven bone lined by a single layer of ~blasts

419
Q

Presentation, macro and histological hallmarks of giant cell/osteoclatoma:

A

Presentation: benig but locally aggressive and may recur. Female=male

Macro: on the epiphysis!!! (tip) of the knee. Rx soap bubble. Nonsclerotic sharply defined border

Micro: tumor cells with RANK-L (~blasts) and multinucleated giant cells (~clasts)

420
Q

Presentation, macro and histological hallmarks of osteosarcoma/ osteogenic sarcoma:

A

Presentation: Most common malignant. Painful enlarging mass or fracture. Bimodal teenager (retinoblastoma) and old (paget, radiation). Aggressive

Macro: on the metaphysis (almost tip) of the knee. Rx codman triangle (periostial elevation, swelling) or sunburst (litic, tiny fragments of bone)

Micro: plemomorphic cells making osteoid; malignant proliferation of osteoblasts (spindle shaped pink)
Malignant osteoblasts arise form mesenchymal stem cells in the PERIOSTEUM

421
Q

Presentation, macro and histological hallmarks of Ewing sarcoma:

A

Presentation: 2nd most common malignant. Painful and swelling, ±fever, boys, good px

Macro: on the diaphysis of femur, grows inside the narrow and pressures the periosteum that grows on onion skin reaction

Micro: mesenchymal but small blue w Homer-Wright pseudorosettes and glycogen +CD99, +MIC2, t(11;22) EWS-FLI1 for DD with lymphoma and osteomyelitis

422
Q

Causes of macro and micronodular cirrhosis:

A

Macro: viruses, toxins (CCl4, amanita phalloides)
Micro: Reye, hemochromatosis, Wilson’s, alcohol, biliary cholangitis

423
Q

HER2/neu type of gene, type of receptor and gene product, how is it expressed? associated tumors and treatments:

A

Oncogene
Tyrosine kinase receptor of epidermal GF that accelerates cell proliferation (activates Ras and MAPKinases (GTP bound); Epidermal GFs stimulate growth through tyrosine kinases). If + worse px and higher grade and recurrence, 1/3 has metastasized to the brain
Overexpressed by AMPLIFICATION
Breast, gastric and gallbladder ca!!
Trastuzumab (blocks receptor), pertuzumab (block receptor production)

424
Q

RET type of gene, type of receptor and gene product, how is it expressed? and associated tumors:

A

Oncogene
Tyrosine kinase receptor (glial neurotrophic)
Point mutation
Overexpression causes endocrine tumors (MEN2A 2B papillary thyroid ca, pheochromocytoma) knock down causes Hirschsprung

425
Q

RAS type of gene, gene product, how is it expressed? associated tumors and treatments:

A

Oncogene
GTP binding protein, GTPase!!! if mutated GTPase activity is lost and GTP never goes to GDP so there is a constitutive activation
Point mutation
Colon, lung, pancreas

K-RAS: Epidermal GF receptor activates K-RAS downstream. Targets are Cetuximab, panitumumab (only for wild-type K-RAS if K-RAS mutation leading to constitutive activation they will not work)

426
Q

MYC type of gene, gene product, how is it expressed? and associated tumors:

A

Oncogene
Transcription factor
t(8,14)
C: Burkitt; L: little lung ca; N: neuroblastoma

427
Q

VHL type of gene, gene product, how is it expressed? and associated tumors:

A

Tumor suppressor gene, Ch3
Inhibits hypoxia-inducible factor 1a
Mutation (born with 1 mutation in VHLsd or 2 mutations in RCC in old/smoker)
Renal cell ca, hemangioblastoma, pheochromocytoma, cysts

428
Q

WT1,2 type of gene, gene product, how are they expressed? and associated tumors:

A

Tumor suppressor gene, Ch 11
Urogenital development transcription factor
Mutation
Wilms tumor (WARG: Anhiridia+ Retardation+ Genitourinary malformation) Denis-Drash (Diffuse mesangial sclerosis, Disgenic gonads) Beckwith-Wiedemann (macroglosia, some body areas larger, omphalocele, hepatoblastoma)

429
Q

RB type of gene, gene product, how is it expressed? and associated tumors:

A

Tumor suppressor gene, Ch 13
Inhibits E2F, stops the progression G1→S cell cycle
Mutation (born with 1 mutation or 2 mutations)
Retinoblastoma, osteosarcoma

430
Q

TP53 type of gene, chromosome, gene function, how is it expressed? and associated tumors:

A

Tumor suppressor gene, Ch 17
Activates p21, stops the progression G1→S cell cycle
Mutation (born with 1 mutation in Li-Fraumeni or 2 mutations as most cancers progress)
Li-Fraumeni sd: sarcoma, breast, leukemia, adrenal… at young age. Mutated in most ca. progression

431
Q

BRCA1,2 type of gene, gene product, how are they expressed? and associated tumors:

A

Tumor suppressor gene, 1 in Ch 17 2 in Ch13
BRCA1,2 proteins fix strand breaks by homologous recombination (repairing using complementary strand)
Mutation
BRCA 1) Breast, ovarian and fallopian serous BRCA 2) both sexes get breast ca. and pancreatic ca.

432
Q

APC type of gene, gene product, how is it expressed? and associated tumors:

A

Tumor suppressor gene, Ch 5 (5 letters in colon)
Negative regulator of β-catenin or WNT pathway
Mutation (born with 1 mutation in FAP or 2 mutations as colon cancers progresses)
Colon ca

433
Q

NF1,2 type of gene, gene product, how are they expressed? and associated tumors:

A

Tumor suppressor gene, 1 in Ch 17 2 in Ch22
NF1: neurofibromin a Ras GTPase that shuts RAS off
NF2: merlin (schwannomin) stops growth by contact inhibition
Mutation
NF1: neurofibroma, optic glioma and pilocytic astrocytoma, lisch nodules (iris harmatomas), pheochromocytoma
NF2: bilateral schwannoma, meningioma, ependymomas

434
Q

Clinic and how you differentiate alpha thalassemia minor and beta thalassemia minor?

A

Both are normal until anemia when they are in stress, have target cells
Alpha has normal electrophoresis
Beta has aBnormal electrophoresis ↑HbA2(2α2δ) ↑HbF(2α2γ)

435
Q

Sickle trait symptoms:

A

Normally asymptomatic until they go to high altitude

They can get renal medulla ischemia so they will get isosothenuria because they cannot concentrate the urine so pee in bed

436
Q

DD of stroke in young women:

A 
Takayasu
Thrombotic thrombocytopenic purpura
Antiphospholipid syndrome
Fibromuscular dysplasia
AV malformation
437
Q

Uric acid stones look like:

A

Broken glass, barrel shape

438
Q

Cysteine stones look like:

A

Cyst=6; hexagon

439
Q

Ca oxalate stones look like:

A

Envelope, dumbbell

440
Q

Ammonium magnesium phosphate stones look like:

A

Struvite stones: Coffins, prisms

441
Q

Types of papillary tumors and characteristics:

A

Ovarian, bladder, thyroid, renal (MET oncogene expansion, how I met your papi?)
All are bilateral and multifocal

442
Q

Syndromes associated with Wilms tumor:

A

WARG: WT1 is associated with anhiridia, genitourinary malformation, retardation. PAX6 next to WT1 is important for iris formation, contiguous gene deletion

Denys-Drash: WT1 is associated with Difusse mesangial sclerosis (nephrOtic) and Dysgenesis of gonads

Beckwith-Wiedemann: WT2 is associated w macroglossia, hemihyperplasia, low sugar and high insulin because over expression of ILGF2, omphalocele, hepatoblastoma

443
Q

Risk factors of gastritis:

A

Gastritis: lost of folds in stomach;

Chronic:
H. pylori: bug in ANTRUM mucosa surrounded by ammonia, more frequent if smoking, causes duodenal ulcers. Drink radioactive urine and if H.pylori is there, its urease will break it into ammonia and CO2 that will come out into the breath. Silver stain biopsy is gold standard. also fecal antigen testing.
If has Cag A gene expression can cause adenoca. and MALToma

Autoimmune: pernicious anemia B12 deficiency bc antibodies against IF, a type 2 hypersensitivity + lymphocytes kill parietal cells, a type 4 hypersensitivity in BODY AND FUNDUS. Associated with intestinal metaplasia: adenoca.

Acute:
Alcohol
NSAIDs, steroids
QT
H.pylori
Uremia
Shock: curlings
Brain injury: cushings
Zollinger-ellison: a lot of ulcers, thick folds
444
Q

Risk factors of peptic ulcers and intestinal gastric ca:

A

Duodenal:
H.pylori ~100% (smoking)
Blood group O (vs Blood group A RF of gastric ca.)
Zollinger-ellison: a lot of ulcers, thick folds
MEN1
Cirrhosis
COPD

Stomach:
H. pylori ~75% (smoking)
NSAIDs

Intestinal gastric ca:
H. pylori and autoimmune gastritis
Smoking
Nitrosamines
Blood group A
445
Q

What gene mutation, type of lymphocytes and antibodies are associated with Crohn and ulcerative colitis?

A

Crohn: NOD2; UC: HLA-B27
Crohn: Th1; UC: Th2
Crohn: ASCA (anti-saccharomyces cerevisiae ab); UC: P-Anca
Crohn: transmural, granulomas, cobblestone; UC: crypt abscesses, neutrophils in crypt lumina and pseudopolyps

446
Q

What is the most frequent location of carcinoid tumor?

A

Terminal ileum: presents later
Appendix: 2nd most frequent, less aggressive because it causes apendicitis

It can lead to pellagra

447
Q

Which illness has anti mitochondrial and which one antimicrosomal antibodies?

A

Anti mitochondrial is in primary biliary cholangitis

Anti microsomal (anti-thyroid peroxidase) is in Hashimoto

448
Q

Histological difference between chronic hep B and C:

A

B: ground glass cytoplasm bc HBsAg accumulates!!

C: fatty change and lymphoid agreggates!!

449
Q

Inclusions in ALS and in some cases of fronto-temporal dementia:

A

Tar DNA protein 43 (TRP-43)

450
Q

Mutation that indicates lower grade astrocytoma:

A

IDH (isocitrate dehydrogenase) present in grade 2 (fibrillary, oligodendroglioma) and 3 (anaplastic) astrocytomas, indicates that is not glioblastoma or that is a glioblastoma that progressed from a lower grade, they have a better prognosis

451
Q

Mutations related to medulloblastoma:

A

🙂 Wnt (it went well)

😐 sonic the hedgehog

☹️ P53 C-myc

452
Q

Tumors that might have expression of PD-1 receptors for CD8 cells therefore could be treated with pembrolizumab or nivolumab:

A

Melanoma
Renal cell ca.
Non small lung ca.
A small % of breast and colon ca.

453
Q

Tumors associated with loss of tumor suppressor gene PTEN:

A

Prostate
Thyroid
Endometrioid
Glioblastoma

454
Q

Which two tumors can metastasize to the ovary?

A

Krukenberg from diffuse gastric ca. that infiltrates the gastric wall leading to linitis plastica
Lobular breast ca.

455
Q

Histological subtypes of breast ca in order from worse to best:

A

Inflammatory: peu d’orange bc of suspensory Cooper ligs (worse one, is in the lymphatics)
LOObular (does not have HER2/neu)
Ductal (can be associated with Paget, Paget is in situ)

Medullary (host response, good if local but triple - bad if they spread)
Mucinous (clusters of tumor floating in mucin)
Tubular (best, rare, very similar to breast tissue)

456
Q

Subtypes of breast ca depending on receptor status in order from worse to best:

A

Basal-like, myoepithelium cell tumors: triple negative (normally in BRCA1)

Luminal: + E,P receptors -HER2/neu

HER2/neu enriched: ± E,P receptors +HER2/neu

457
Q

Genetic abnormality related to all germ cell tumors?

A

Isochromosome 12p (so you have an extra copy of short arms and deletion of the long arm)

458
Q

Ca. that can be treated with vemurafenib? Why?

A

They have V600E mutation that alters Braf

Melanoma (40-60%)
Pilocytic astrocytoma
Langerhans histiocytosis
Papillary ca. of the thyroid

459
Q

Which mutation is associated with aortic stenosis?

A

NOTCH1

460
Q

Triad of aspirin induced asthma:

A

Asthma and aspirin intolerance
Chronic sinusitis
Nasal polyps

461
Q

Cirrhosis manifestations secondary to high estrogen:

A

Palmar erythema
Spider angiomas
Testicular atrophy
Gynecomastia

462
Q

Unilateral bloody nipple discharge indicates:

A

Do not present with masses, just with bloody nipple discharge

In young, benign (can hide atypia or ductal ca in situ): Intraductal papilloma (it’s vascular stalk twists and bleeds). Micro: epithelial and myoepithelial cells lining a fibrovascular core forming papillae within a duct. Excision

In old, malignant: Ductal carcinoma in situ. Micro: ducts distended by pleomorphic cells with central necrosis that do not penetrate the basement mb. the basal (myoepithelial) layer of the duct is uninvolved

463
Q

Organs that tend to give liver metastasis:

A

Colon»Stomach>Pancreas (Cancer Sometimes Penetrates the liver)

464
Q

What is the second most common cause of lung ca?

A

Radon (in basements)

Other RF: smoking (cause 90% cases) arsenic, asbestos, chromium, radiation and air pollution)

465
Q

What is a possible screening for lung ca? when can you do it

A

Yearly low dose chest CT

On 30 year-pack history smokers

466
Q

Define cutaneous small vessel vasculitis:

A

Drugs (penicillins, cephalosporins, sulfonamides, phenytoin, allopurinol) or a virus (Hepatitis, HIV) before purple/red raised lesions (palpable purpura)

Micro: inflamed blood vessels with fibrinoid necrosis

467
Q

Common locations where cholesterol emboli lodge:

A

Kidney: acute kidney injury
Foot: blue toe, livedo reticularis
GI: intestinal infarction/ bleeding
CNS: stroke/ amaurosis fugax

Normally happens after dislodgment of atherosclerosis

468
Q

What is Stewart-Treves sd?

A

Angiosarcoma due to chronic lymphedema after radical mastectomy with lymph node dissection
Micro: dermal inflammation with slit-like abnormal vascular spaces
Bad prognosis

469
Q

Interrupted aortic arch and tetralogy of Fallot associated with:

A

Di George sd.

470
Q

Diagnosis of irregular nodule with small lymphocytes and germinal center effacement:

A

Follicular (nodular) lymphoma

It is not large B cell lymphoma until you get sheets of lymphocytes without any clear nodules

471
Q

Hypertensive encephalopathy: cause, symptoms and micro:

A

Cause: malignant hypertension (vs a lacunar infarct is due to chronic HT)
Generalized symptoms as headache, confusion, somnolence, maybe coma, No focality!
Micro: edema, petechial hemorrhages, fibrinoid necrosis

472
Q

Which cells are most affected by ionizing radiation?

A 
Rapidly dividing cells: 
Hematopoietic stem cells
Spermatogonia and oogonia
Basal keratinocytes and hair follicle stem cells
Intestinal crypt cells
473
Q

Which system transforms pro carcinogens in carcinogens?

A

Cytochrome P450= microsomal monooxygenase; present in hepatic microsomes and in ER of most tissues

474
Q

Name medical illnesses that cause erectile dysfunction and premature ejaculation:

A

Erectile dysfunction: nerve function and blood flow problems as diabetes
Premature ejaculation: prostatitis or thyroid disease

475
Q

How do you calculate the gamma gap? Which illness does a high gamma gap indicate?

A

Total protein-Albumin> or =4 indicates multiple myeloma

476
Q

Histology of osteoporosis:

A

Loss of trabecular bone, thinning and perforation with loos of the interconnecting bridges

477
Q

What is the function of c-myc?

A

Transcription activator

478
Q

What is the function of BRCA?

A

DNA repair

479
Q

What is the function of Bcl2?

A

Apoptosis inhibitor

480
Q

What is the function of cyclin D1?

A

Promoter of G1 to S transition

481
Q

What is the function of BCR-ABL?

A

TK upregulator

482
Q

Subarachnoid hemorrhage complications and timing:

A 
COMMUNICATING hydrocephalus (impaired absorption of CSF by ARACHNOID granulations): hours after; dilated ventricles and deteriorating mental status
Spider talk!

Vasospasm: 4-14 days after; presents with acute change in mental status and new focality

483
Q

DD. between abruptio placentae, placenta accreta, placenta previa, vasa previa and uterine rupture:

A

ABRUPTIO placentae: premature separation of the placenta from the uterus. In PREECLAMPSIA, tx, SMOKING…
PAIN, vaginal bleeding and firm uterus

Placenta ACCRETA: abnormal trophoblastic invasion into the myometrium. In previous CESAREAN, multiparty…
POSTPARTUM! vaginal bleeding (vs uterine atony that w respond to uterotonic agents)

Placenta PREVIA: placenta extending over the cervix. In previous CESAREAN, >35, smoker
NO PAIN but yes vaginal bleeding, no fetal distress

VASA previa: fetal vessels extending over the cervix
No pain but yes vaginal bleeding + FETAL BRADYCARDIA

Uterine rupture: rupture of the uterine myometrium and serosa. Prepartum PAIN, vaginal bleeding and fetal parts palpable from abdomen. After previous cesarean

484
Q

Diagnosis of painless otorrhea with conductive hearing loss and pearly mass behind the tympanic membrane:

A

Cholesteatoma (collection of squamous cell derbis)

485
Q

Which pathology is associated with increase β-glucuronidase activity?

A

Brown stones

Colonic bacteria have β-glucuronidase activity!

486
Q

What is the most important predictor of success in rehabilitation?

A

Activity level before the fracture

487
Q

What is the recurrence of schizophrenia in identical twins?

A

50%

488
Q

What is core binding factor α1 (Cbfa1) important for?

A

Osteoblast, it is essential transcription factor in osteoblast differentiation and bone formation
If you see decrease alkaline phosphatase it indication decreased osteoblast function!!

489
Q

What is Felty’s syndrome?

A

Rheumatoid arthritis + Splenomegaly + Neutropenia (repeated infections)

490
Q

What does the retropulsion or pull test indicate?

A

Parkinson or parkinsonism (for example due to antipsychotics)

The retropulsion test evaluates the ability of patients to recover from a backward pull on the shoulders, if patient cannot recover, as in parkinsonism, it indicates postural instability

491
Q

Where do you see target cells and hemoglobin crystals?

A

Hemoglobin C disease

492
Q

Sterile immunocomplex with platelet thrombi vegetations are indicative of:

A

Libman-Sacks endocarditis

Easily dislodged sterile vegetations made of platelets interwoven with fibrin strands and mononuclear cells indicate lupus or mucin-producing tumors

493
Q

Explain the pathophysiology of hepatorrenal sd:

A

Liver failure leads to RAAS activation that causes splanchnic vasodilation + renal vasoconstriction leading to prerenal azotemia
Kidneys will be normal in size and shape

494
Q

Which kind of chronic pyelonephritis is associated with proteus?

A

Xanthogranulomatous pyelonephritis

495
Q

Arteriolar medial hypertrophy and fibrointimal proliferation indicate:

A

Hyaline atherosclerosis (endothelial damage) in hypertensive nephrosclerosis

496
Q

Ulcers beyond the duodenal bulb suggest:

A

Zollinger-Ellison

497
Q

Extension, appearance, mediator and sensation of primary, secondary and tertiary burns:

A

1ry: epidermis; yes blanching and NO blisters; painful
2ry: all epi + some dermis; yes blanching and blisters; painful
3ry: all epi + some dermis; NO blanching and yes blisters; painless

Edema can be because of inflammatory mediators as histamine and bradykinin that contract endothelial cells creating gaps in venules or the gaps can be directly caused by injury

498
Q

What is the rout of metastasis of prostate ca?

A

Batson plexus; from the prostatic venous plexus to the vertebral venous plexus

499
Q

Define labile, stable and permanent cells:

A

Labile: multiply constantly throughout life

Stable: spend most of the time in the quiescent G0 but can be stimulated to enter the cell cycle when needed

Permanent: incapable of regeneration

500
Q

What is the reason why a diabetic gets hypoglycemia after injecting insulin?

A

In DM1 there is an impaired response of glucagon to hypoglycemia! On top, insulin inhibits glucagon release

Alpha cells failure leads to the rapid hypoglycemia

501
Q

Flank pain irradiating to the groin+nausea indicates:

Right upper quadrant pain+nausea indicates:

A

Groin: nephrolithiasis

Right upper: gallstones

502
Q

What are cysts and pseudocysts lined by?

A

True: epithelial cells
Pseudo: granulation tissue (pancreatic pseudocyst after acute pancreatitis)

503
Q

Causes of pure red cell aplasia:

A

Thymoma
CLL, ALL
Parvovirus B19

504
Q

Which bleed is associated with vacuum delivery?

A

Subgaleal hemorrhage, between the periosteum and the galea aponeurosis (outside the skull)

505
Q

What is the function of the gloms bodies under the nails?

A

Thermoregulation

506
Q

Which phase of wound healing do excessive matrix metalloproteinases and actin-containing fibroblasts correspond to?

A

Contracture

507
Q

Which signaling pathway is associated with Dupuytren?

A

Wnt signaling pathway

508
Q

What is the most common cause of temporal epilepsy?

A

Hippocampal sclerosis (astrocytic proliferation, glyosis)

509
Q

What do you think if you see JVD+hepatomegaly?

A

Right heart failure and CENTRILOBULAR ZONE 3 hepatic congestion (nutmeg liver)

510
Q

Name 4 main rickets symptoms:

A

Frontal bossing and rachitic rosary: due to increased proportion of OSTEOID deposition
Pigeon-breast
Leg bowing

511
Q

What needs to be intact for male internal genitalia, external genitalia and inhibition of female internal genitalia in male development?

A

Male internal genitalia: Y chromosome, SRY gene, testes (because they make testosterone) and testosterone→ SRY is missing you will have inside ♀ outside ♀

Male external genitalia: Dihydrotestosterone→ if DHT or 5-alpha reductase are missing you will have inside ♂ outside ♀ (or smaller genitalia)

Inhibition of female internal genitalia: MIF (antimullerian hormone) and intact Sertoli cells in the testes (because they make MIF) → if Sertoli cells don’t work you will have inside ♂ and ♀ outside ♂

512
Q

DD of chromatin negative nuclei on a female:

A

Chromatin negative nuclei= no Barr bodies
Male karyotype: androgen insensitivity
Turner

513
Q

What changes cause binge and chronic drinking in the liver?

A

Binge: fatty change
Chronic: alcoholic hepatitis with cellular swelling

514
Q

Another name for usual interstitial pneumonitis:

A

It is the histological definition of Idiopathic pulmonary fibrosis

515
Q

Pathological changes after CNS stroke/hemorrhage:

A

12-48 Hrs = red neurons

1-3 days = neutrophils (liquefactive necrosis)

3-5 days = macrophages (microglia). They are + CD40, CD11b, CD68, and CD45

1-2 weeks = Reactive gliosis = astrocyte proliferation (liquefactive necrosis + vascular proliferation)

More than 2 weeks = Glial scar, made of astrocytes

516
Q

What is the cause of cataracts in normal patient?

A

Age-related oxidative injury

517
Q

How does IκB interact with NF-κB?

A

IκB binds and inactivates NF-κB in the cytoplasm
Binding of an antigen to a toll-like receptor activates IκB kinase that ubiquitinates IκB
Then, the free NF-κB can go to the nucleus and synthesize inflammatory proteins

518
Q

What is the clinic of middle temporal lobe herniation vs subfalcine herniation:

A

Transtentorial; Temporal/uncal herniation beneath the tentorium cerebelli:
Early: ipsi blown pupil+contralateral hemiparesis
Late: contralateral blown pupil+ipsilateral hemiparesis

SUbfalcine; cingUlate gyrus herniation beneath the fall cerebri: awake+contralateral hemiparesis because compresses the anterior cerebral A. =)

519
Q

Presentation and histology of intraductal papilloma:

A

Bloody nipple discharge (it’s vascular stalk twists and bleeds) on young woman (benign).

Micro: epithelial and myoepithelial cells lining a fibrovascular core forming papillae within a duct

520
Q

DD. between bipolar I, II and cyclothymia:

A

1; just needs 1: mania±depression
2; needs 2: hypomania+depression
Cyclothymic: more than 2 years fluctuating between mild hypomanic and depressive

521
Q

DD. between marrow aspirate in myelofibrosis, myelodysplasia and aplastic anemia:

A

Myelofibrosis: fibrotic marrow with collagen bands and clusters of megakaryocytes
Megakaryocytes secrete TGF-β that stimulates fibroblasts
There is extramedullary hematopoiesis and therefore hepatosplenomegaly and dracrocytes

Myelodysplasia: dysplastic progenitor cells
No hepatosplenomegaly but yes oval macrocytic RBCs and neutrophilis
Can process to AML

Aplastic anemia: hypocellular marrow replaced by adipose cells
Hematopoietic stem cells are destroyed by drugs, radiation, viruses…

All 3 have anemia + leukopenia + thrombocytopenia

522
Q

Hepatic inflammation and necrosis with neutrophilic infiltration is found in:

A

Acetaminophen overdose

523
Q

Joint involvement in Osteoarthritis, Rheumatoid arthritis and Psoriatic arthritis:

A

Osteoarthritis: DIP (heberden), PIP (bouchard); the distal and thumb’s carpometacarpal
Rheumatoid: PIP, metacarpophalangeal and wrist
Psoriatic: DIP

524
Q

What do you think about if you see diarrhea+anemia?

A

Celiac disease; causes iron deficiency anemia because iron is absorbed in the duodenum

525
Q

Which prostatic ca. histology is associated with better response to finasteride?

A

Those with predominance of epithelia hyperplasia

Those with stromal hyperplasia (with collagen/smooth m.) respond worse because finasteride acts on the epithelial components

526
Q

DD. between Right heat failure, Budd-Chiari and Portal vein thrombosis:

A

RHF: liver =( cirrhosis nugmet liver; post-hepatic JVD+

Budd-Chiari is Hepatic vein thrombosis: liver =( cirrhosis nugmet liver; post-hepatic JVD-

Portal vein thrombosis: liver =) pre-hepatic JVD-

In all you have splenomegaly (thrombocytopenia), portal HT, varices, ascitis, edema

527
Q

What is the histology of erythema nodosum?

A

Type 4 hypersensitivity

Panniculitis without vasculitis

528
Q

What is the histology of tophy?

A

Giant cell granulomas surrounding crystal deposition

529
Q

What is the histology of rheumatoid nodules?

A

Palisading histiocytes with central necrosis

530
Q

Which polyps are characterized by sawtooth appearance?

A

Hyperplastic polyps; they are also the most common polyps

531
Q

Which gland makes the majority of mucus secretions? which one the majority of serous secretions?

A

Mucus: sublingual
Serous: parotid

532
Q

What is the histology of valve stenosis due to previous rheumatic fever?

A

Fibrous bridging between thickened, calcified leaflets

533
Q

What is the histology of the area where you get a pap smear from?

A

Transition zone: transition from squamous to columnar epithelial cells; is where metaplasia and dysplasia are more common

534
Q

Which is the earliest change in rheumatoid arthritis?

A

Synovial neovascularization

535
Q

Define subclavian steal sd:

A

Due to subclavian stenosis you get reversed flow form the contralateral vertebral A. to the ipsilateral vertebral to reperfuse the subclavian that is stenotic

536
Q

How does meconium ileus present?

A

Baby that is days old with distal small bowel obstruction of green dehydrated (inspissated) meconium

537
Q

What do engorged alveolar capillaries indicate? and hypertrophy of the pulmonary vascular smooth muscle?

A

Engorged capillaries: indicate increased pulmonary venous pressure normally due to left-sided heart failure

Hypertrophy of the pulmonary vascular smooth muscle: indicate pulmonary arterial hypertension

538
Q

Which is the best predictor factor for atherosclerotic plaque rupture?

A

Instability (better predictor than size) that depends on strength of the fibrous cap; metalloproteinases secreted by macrophages decrease stability by collagen degradation!

539
Q

What is the key way to differentiate Berger’s disease and hemolytic-uremic syndrome? And what is the key way to differentiate ITP and hemolytic-uremic syndrome

A

Both have red urine after a GI infection on a kid

DD with Berger’s: Look at the platelets! in Berger’s they will be normal and in HUS will be low!

DD with ITP: platelets will be low in both but ITP will not have schistocytes on the smear

540
Q

Hystologies of HPV and Molluscum contagiosum lessions:

A

Wart (HPV): epidermal hyperplasia, cells with big nuclei, perinuclear halos and cytoplasmic vacuolization (koilocytosis)

Umbilicated flesh-colored papule (Molluscum contagiosum): cytoplasmic inclusion bodies

541
Q

What is the biggest RF for osteoarthritis?

A

Age

542
Q

Which deficiency do you think about if you see glossitis, brittle nails, dry mouth, tongue papillae atrophy, alopecia or pagophagia?

A

Iron deficiency anemia

543
Q

Which is the most important RF of postpartum endometritis?

A

C-section

544
Q

Which is the most important daily screening for a diabetic?

A

Feet inspection; feet ulcers are due to atherosclerosis

545
Q

Name an important genetic cause of premature osteoporosis

A

Osteogenesis imperfecta

546
Q

What is the pathophysiologic mechanism of achalasia?

A

Inflammation and degeneration of neurons in the esophageal wall

547
Q

Name the HLA associated with psoriasis and the 3 most important histological characteristics:

A

HLA-C
Hyperkeratosis (corner thickening)
Parakeratosis (nuclei retention)
Acantolisis (loss of cohesion between keratinocytes)

548
Q

If you see double vision, dilated pupils and loss of strength you think about:

A

Botulism
Diplopia, Dysarthria, Dysphagia (descending paralysis) and Dispnea

Paralysis is a way to differentiate it form organophosphate poisoning

549
Q

Which type of cell is found in pemphigoid?

A

Eosinophils within sub epidermal blisters

550
Q

Which virus causes hepatocelular ca. earlier hepB or hepC?

A

HepB

Hepatocelular ca. can occur without cirrhosis!

551
Q

Which parameter is common for both obstructive and restrictive disease?

A

Decreased VITAL capacity of FV!!!C

552
Q

What do juxta-articular erosions with overhanging edges and subcortical bone cyst indicate? what is the key mediator? if you see edema, what is the cause?

A

Gout
Neutrophils
Increased vascular permeability

553
Q

Presentation and histology of infiltrative ductal carcinoma:

A

Rock-hard mass + axillary lymph nodes

Anastomosing sheets of pleomorphic cells that invade the stroma

554
Q

Pathologies that release tissue factor causing hypercoagulation:

A

Amniotic fluid emboli

Pancreatic ca.

555
Q

Which cell secretes cytokines and which cell is stimulated by those cytokines in atherosclerosis pathogenesis?

A

Macrophages secrete cytokines and growth factors that recruit vascular smooth m. cells

The vascular smooth muscle cells secrete matrix proteins and make collagen which makes the fibrous cap

556
Q

What is the most important factor determining if a pleural effusion will progress to tamponade?

A

Rate of fluid accumulation

557
Q

Causes of communicating and non-communicating hydrocephalus:

A

Communicating: Decreased CSF absorption by ARACHNOID villi; meningitis and subarachnoid hemorrhage!!!

Non-communicating: Ventricular obstruction; tumor and aqueduct stenosis

Ex-vacuo: alzheimer, schizophrenia

558
Q

Histological findings in pleomorphic adenoma, Warthin tumor and mucoepidermoid carcinoma:

A

Pleomorphic adenoma: benign and most common; multiple cell types, typically epithelial cells in a chondromyxoid stroma

Warthin: benign; germinal centers or follicles and large pink cells called oncocytes

Mucoepidermoid carcinoma: most common malignant; mucinous and squamous components

559
Q

What does leukocytoclastic vasculitis mean?

A

Palpable purpura

560
Q

What is the diagnosis when a patient tells you that he/she cannot talk in public or use public bathrooms?

A

Social anxiety disorder

Different from specific phobia where you are afraid of spiders…

561
Q

What do you think if you see acute epigastric pain that radiates to the back?

A

Acute pancreatitis

562
Q

Which area of the heart do eosinophils invade in Loeffler’s syndrome and what does it cause?

A

The end-myocardial layer causing restrictive cardiomyopathy leading to thrombi

563
Q

From which cells does lung adenocarcinoma come from? Which translocation is associated with?

A

Club cells
t(EML4,ALK) causes an activating mutation of ALK
Also activating mutations in EGFR and KRAS are associated with adenoca.
There is targeted therapy for this mutations

564
Q

What is the cause os the gallbladder stones in Chron’s?

A

Chron’s increases enterohepatic circulation of bilirubin and decreases enterohepatic circulation of bile acids.

The bile acids are not absorbed therefore are conjugated by the colonic bacteria forming bilirubin that is absorbed and makes stones.

Therefore the stones are black (bilirubin and hemolysis)

565
Q

Which part of the kidney is the most damaged in vesicoureteral reflux?

A

The upper and lower poles, where compound papilla are situated

566
Q

What are ferruginous bodies?

A

Macrophages that have phagocytosed and attempted to digest the asbestos fibers

567
Q

What do intercostal retractions, wormian appearance and costochondral thickening indicate?

A

Intercostal retractions and brittle bones, fractures: OI
Wormian appearance: OI
Costochondral thickening= Rachitic rosary, bendy bones: rikets

568
Q

What is the key histologic finding in postinfectious encephalopathy?

A

Perivenous infiltration

MRI: dark nodules on brain

569
Q

Complications of O2 therapy for neonatal respiratory distress sd? and what are the complications of neonatal respiratory distress sd itself?

A

O2 therapy: RIB
R = Retinopathy of prematurity
I = Inraventricular hemorrhage
B = Bronchopulmonary dysplasia

Neonatal respiratory distress sd: ground glass opacities and diffuse atelectasis

570
Q

Describe the key main sites of protein digestion:

A

Stomach: acid and pepsinogen (from chief cells) cut proteins

Duodenum: pancreatic proteases cleave large polypeptides into smaller (dipeptides and tripeptides). Trypsinogen makes trypsin that activates Trypsinogen, Chymotripsiniogen and Procarboxypeptidase

Intestinal mucosa: BRUSH BORDER aminopeptidases break down dipeptides and tripeptides into aa, which can be co-transported with Na+ and H+ into the intestinal cell

571
Q

How do you differentiate between chronic, gestational hypertension, preeclampsia and eclampsia?

A

Chronic HT: HT onset before 20 w
Gestational HT: HT onset after 20 w
Preeclampsia: HT onset after 20 w + proteinuria
Eclampsia: HT onset after 20 w + proteinuria + seizures

572
Q

Which intermediate filaments do Z discs contain?

A

Vimentin and desmin (sarcoma markers)

573
Q

What is a bronchogenic cyst and when does it develop?

A

Cysts that arise on the baby’s lung in utero

They are due to abnormal budding of the foregut and bronchi dilation

574
Q

What are xanthomas made of?

A

Lipoprotein extravasation

575
Q

Effects of testosterone on RBCs:

A

High testosterone causes erythrocytosis

Low testosterone causes anemia

576
Q

Consequences of cryptorchidism:

A

Low sperm count + low inhibin

577
Q

Osteitis fibrosa cystica hallmark:

A

Subperiosteal erosions

578
Q

Why is there pruritus in biliary obstruction and no pruritus in Dubin-Johnson syndrome?

A

Because in biliary obstruction on top of secreting conjugated bilirubin into the blood you also secrete bile salts, which cause the pruritus
In Dubin-Johnson syndrome bile salts are excreted normally

579
Q

Which injuries cause permanent vs transient diabetes insipidus?

A

Permanent: hypothalamus (supraoptic)
Transient: posterior pituitary

580
Q

DD of Biliary colic, Cholecystitis, Choledocholithiasis and Ascending cholangitis:

A

Biliary colic:
Stone on the gallbladder
Pain for less than 6h
tto: ursodiol/ ursodeoxycholic acid

Cholecystitis:
Stone on the cystic duct
Pain for more than 6h + Murphy sign, pericholecystic fluid and ↑ wall thickness
± fever, leukocytosis
NO jaundice no ↑ alkaline phosphatase
tto: cholecystectomy

Choledocholithiasis:
Stone on common bile duct
Less severe pain + JAUNDICE + ↑ alkaline phosphatase
Liver enzymes do not have to be ↑
NO fever, no leukocytosis, no Murphy sign

Ascending cholangitis:
Infection of the biliary tree due to enteric organisms as E.Coli, Klebsiella, clonorchis sinensis
Charcot triad: pain + jaundice + fever
+ leukocytosis + ↑ alkaline phosphatase
Reynolds pentad if progresses to shock: + hypotension + metal status changes
tto: piperacillin+tazobactam then surgery

581
Q

Which area is ablated in flutter?

A

The area between the tricuspid and the IVC

582
Q

What is the cause of MODY?

A

Defect in expression of glucokinase gene

583
Q

What causes milk-alkali syndrome?

A

Taking a lot of antacids

Decrease vit D activation so 24,25-Dihydroxycholecalciferol accumulates

584
Q

What is the key histologic finding in acute rheumatic fever?

A

Aschoff bodies, fibrinoid necrosis with histiocytic infiltrate or myocardial granulomas
Anitschkow cells, mononuclear cardiac histiocytes

585
Q

What is the key distinguishing factor between 5HT syndrome, neuroleptic malignant syndrome and malignant hyperthermia?

A

5HT syndrome: clonus, you are moving a lot → give cyproHEPtadine
Neuroleptic malignant syndrome and malignant hyperthermia: rigidity, you cannot move → give dantrolene

586
Q

What is the key histologic finding in CIN?

A

Expansion of immature basal cells to the epithelial surface

587
Q

If you see a mass in the posterior mediastinum, what should you think?

A

Neurogenic tumor as neurofibroma and schwannoma

588
Q

What is the main polyp type in Peutz Jeghers syndrome?

A

Hamartomas

589
Q

Where are the eye deposits on Wilson’s disease?

A

Cornea!

590
Q

Which type of cerebral edema is associated with brain tumors?

A

Vasogenic edema, due to BBB disruption and vascular leakage

591
Q

Diagnosis on a girl that gets to puberty and starts developing male characteristics:

A

5-alpha reductase deficiency; inside ♂ outside ♀ (or smaller genitalia) but when they get to puberty do not develop menarche and the increase in testosterone makes develop male secondary sexual characteristics

592
Q

What does lead pipe sign on barium enema indicate?

A

Ulcerative colitis

593
Q

Signs of iron deficiency anemia:

A 
Brittle nails
Glossitis
Dry mouth
Tongue papillae atrophy
Alopecia
Pagophagia: compulsive consumption of ice or iced drinks
594
Q

What should you think if you see weakly birefringent needles surrounded by concentric layers of hyalinized collagen in the lung?

A

Silicosis

595
Q

Which growth factor contributes to the migration of smooth m. cells into in atherosclerosis?

A

PDGF by biding to TK receptors

596
Q

How do you differentiate fibroadenoma from phyllodes tumor?

A

Both are benign, solitary, painless and mobile

Fibroadenoma: in younger than 35. + popcorn calcifications in mammography. Micro: benign hyper plastic stroma encapsulating ductal tissue

Phyllodes: older than 35. Micro: leaf-like appearance

597
Q

What does hypotension, bradycardia, respiratory depression and spontaneous bruising of the upper eyelids indicate?

A

Elevated intracranial pressure

598
Q

Which are the key histologic finding in wrinkles?

A

There is less collagen: less synthesis and more degradation
Decreased elatin fiber assembly
Normal or even increased crosslinking

599
Q

Which is the most common type of ovarian mass in young women of reproductive age? And in pregnant? And in complete mole?

A

Non-pregnant ± PCOS: Follicular cyst (cause irregular bleeding). No vascular
Normal in pregnant: Corpeus luteum cyst. Vascular
Complete mole or twins: Theca lutein cyst (bilateral)

600
Q

Which infections is an AIDS patient at risk if his/her CD4 count is below 500/mm3 but greater than 200/mm3?

A

Oral hairy leukoplakia
Oral thrush
HHV-8 infection
Squamous cell carcinoma

601
Q

Which layers of the gut are affected in Hirschsprung disease?

A

SUbmucosa and MUscular Externa of the narrow segment!
SUMUjÉ

The submucosa normally contains the Meissner (submucous) plexus, while the muscularis externa contains the Auerbach (myenteric) plexus

602
Q

How are the stools in lactose intolerance?

A

Acid, low pH

Increase still osmotic gap (unabsorbed lactose increases the gap)

603
Q

What is the histologic hallmark of thromboangiitis obliterans?

A

Segmental thrombosing inflammation with sparing of the internal elastic lamina

604
Q

How do you differentiate duct CIS and invasive clinically and in histology?

A

Non palpable and is detected due to micro calcifications on Rx→ In situ: ducts distended by pleomorphic cells with central necrosis that do not penetrate the basement mb

Firm mass dimpling the skin→ invasive: disorganized nests of glandular cells with surrounding fibrosis

605
Q

How do you differentiate peau d’orange from invasion of the suspensory ligaments in breast ca?

A

Swelling and pitting→ peau d’orange→ Inflammatory: dermal lymphatics by malignant tumor

Retraction and dimpling→ tightening and shortening of the suspensory ligaments (Cooper ligaments)→ invasive lobular: disorganized nests of glandular cells with surrounding fibrosis

606
Q

Phases of pneumonia:

A

1-2 days: Congestion: red, purple→ bacteria
3-4 days: Red hepatization: brown→ ALL; fibrin, bacteria, RBCs and WBCs
7-5: Gray hepatization: gray→ ALL BUT BACTERIA; fibrin, lysed RBCs and WBCs
8 days: Resolution→ macrophages have eaten all

607
Q

What is the main difference between PTH and PTHrP?

A

Unlike PTH, PTHrP does not stimulate the hydroxylation of 25-dihydroxyvitamin D to 1,25-dihydroxyvitamin D

608
Q

Which channels are over expressed in CF?

A

Na ch. in respiratory epithelial cells
CF causes decrease in Cl- in lung secretions. This causes an increase in the activity of Na+ channels so water gets reabsorbed resulting in abnormally thick bronchial secretions

609
Q

Giant pronormoblasts in the bone marrow indicate:

A

Giant pronormoblasts with glassy intranuclear inclusions

Aplastic anemia due to Parvovirus B 19 infection

610
Q

Periostitis of the distal diaphysis of long bones indicates

A

Hypertrophic osteoarthropathy (clubbing), associated with adenocarcinoma of the lung

611
Q

Which extracellular deposition is a marker of acute inflammation? and of chronic inflammation?

A

Acute: fibrin, it is thought to be an important local defense mechanism because it sequesters and walls off bacterial spillage

Chronic: collagen, fibrosis

612
Q

Why is there estrogen excess in cirrhosis?

A

Failure fo the liver to degrade estrogens!!!

Increase peripheral conversion of androgens to estrone by aromatase

613
Q

What is the histologic hallmark of chronic bronchitis?

A

Squamous metaplasia of the pseudostratified columnar epithelium in the bronchi and bronchioles

614
Q

Diagnosis on a girl with complete hypogonadism, streak ovaries and XY genotype?

A

Swyer syndrome, deficient expression of SRY gene

615
Q

DD of Oral hairy leukoplakia, Oral leukoplakia and In-situ oral squamous cell carcinoma:

A

All are white patches that cannot be scraped off

Oral hairy leukoplakia; EBV only in immunocompromised. Only in lateral surfaces of the tongue, hairy or feathery
Micro: marked hyperkeratosis and parakeratosis

Oral leukoplakia; precancerous, in smoker/alcoholic
single or multiple asymptomatic white plaques with granular texture. Any part of the oral cavity can be affected
Micro: marked hyperkeratosis and parakeratosis

In-situ oral squamous cell carcinoma; micro: dysplastic changes extending to the basement membrane

616
Q

What is the most common cause of hepatic abscess?

A

Colangitis, ascending infection from a biliary tract

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