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1

Causes of dilated cardiomyopathy?

ABCCCD
Alcohol; Beriberi; Coxsackie; Cocaine; Chagas; Doxorubicin; also hemochromatosis

2

Restrictive cardiomyopathy with endomyocardial fibrosis with a prominent eosinophilic infilitrate?

Lofflers syndrome

3

Vasculitis due to IgA deposition following upper respiratory tract infection?

Henoch Schonlein-- see fibrinoid necrosis

4

Destruction of helminths?

Major basic protein released by eosinophils

5

CD4<50

Pneumocystis-- TMP SMX
Toxoplasma-- TMP SMX
Avium-- Azithromycin

6

Treatment of histoplasma? (commonly seen in HIV patient from endemic area with CD4 under 150)

Itraconazole

7

Copper arsenic and gold antidote?

Penicillinamase

8

Erosions are in?

Mucosa only

9

Collaterals
a) superior epigastric to? aka internal thoracic or mammary
b) Sup pancreaticodudodenal
c) Middle colic
d) Superior rectal

a) inf epigastric (external iliac)
b) inf pancreaticodudoenal (SMA)
c) middle colic to left colic
d) superior rectal to middle and inferior rectal i.e. IMA to internal iliac

10

Rectum above pectinate drains into?
Below pectinate drains into?

Above inferior mesenteric vein-- adenocarcinoma
Below internal iliac vein-- squamous

11

Zone in liver commonly affected by viral hepatitis?

zone 1

12

Zone in liver first affected by ischemia?

zone 3-- most sensitive to toxic injury

13

Two AA that are potent stimulators of gastrin?

Phenylalanine and tryptophan

14

Motilin receptor agonist used to stimulate intestinal peristalssis/

Erythromycin

15

How does gastrin increase acid secretion?

Through ECL cells-->histamine release (rather than acting directly on the parietal cells themselves)

16

ACh-->M3 activation-->?

Gq-->phospholipase C-- IP3/Ca-->H/K atapase

17

only.....are absorbed by enterocytes?

Monosaccharides

18

What are bile acids conjugated to to make them water soluble?

Taurine and glycine

19

Malignant tumor with mucinous and squamous components of parotid gland-- involves what nerve?

Mucoepidermoid carcinoma-- involves facial nerve

20

ingestion of cleaning products associated with?

esophageal strictures

21

Esophageal squamous cell carcinoma?

Areas of keratinization in well differentiated tumor

22

65 yo male Pt. presents with steatorrhea, pain in joints, confusion

Whipples-- PAS positive-- foamy macrophages in LAMINA PROPRIA

23

3 key features of celic?

Intraepithelial CD8 T cells in lamina propria!
Cryp hyperplasia
Villous atrophy--- see loss of villi on histology

24

Abetalipoproteinemia have RBCs associated with?

Thorny projections called acanthocytes

Cannot aborb essential fatty acids--- mutation in microsomal triglyceride transfer protein-- MTP

25

Pernicious anemia affects with part of stomach?
H pylori affects which part of stomach?

Anemia Body
Bacterium Antrum

26

Histology of Hpylori gastritis?

Intraepithelial neutrophils
subepithelial plasma cells

27

Gastric adenocarcinoma often presents with?

Acanthosis nigricans

28

Diffuse adenocarcinoma associated with?

Signet ring cellss

29

Hpylori virulence?

Flagella; adehsins; urease; CagA

30

Rupture of posterior wall of duodenum--?

bleeding form gastrodudodenal

31

ulcer perforations are more common....?
Ulcer hemorrhages are more common...?

1) perforationsa re more common anteriorly
2) Hemorrhages are more common posteriorly

32

String sign on barium swallow?

Crohn's disease

33

Crohns is Th?
UC is Th?

crohns th1
UC th2

34

Friable mucosal pseudopolyps with freely hanging mesentery?

Ulcerative colitis

35

Cause of appendicitis in children? adults?

Children? lymphoid hyperplasia
Adults? Fecalith

36

Difference between Meckels and omphaloesenteric cyst?

Meckels is PERSISTENT vitelline duct
Omphalomesenteric cyst is cystic dilation of vitelline duct

37

Child presents with painless rectal bleeding-- what should you always suspect?

Meckels-- persistence of vitelline duct-- diagnose with pertechnate study

38

What does sessile mean?

Fixed in one place

39

Apple core lesion on barium swallow?

Colorectal cancer

40

Most common area of colorectal cancer?

Rectosigmoid then Ascending then descending

41

CEA tumor marker?

Good for monitoring recurrent of CRC; not for screening

42

Describe transition from normal colon to carcinoma

Loss of APC then KRAS mutation then Loss of p53

Remember: KRAS is an activating mutation!

43

Carcinoid tumors are derived from? what do you see on hisotlogy? may cause depletion of?

neuroendocrine cells--

See Dense core bodies--

Carcinoid tumors uses tryptophan to make 5HT-- tryptophan is also used for niacin so may ahve niacin deficiency

44

Stimulates fibrosis?
Induces vascular remodeling and stimulates fibroblast growth factor for collagen synthesis

1--TGF beta stimulates fibrosis

2-- PDGF induces vascular remodeling

45

Child comes in with hypoglycemia; hepatomegaly and fatty liver-- what is MOA of causative agent?

Aspirin metabolites decrease beta oxidation by reversible inhibition of mitochondrial enzymes--REYES SYNDROME

46

Pathology of alcoholic hepatitis?

Swollen and necrotic hepatocytes with neutrophilic infiltration-- mallory bodies are intracytoplasmic eosinophilic inclusions

47

Pathology of alcoholic cirrhosis?

Sclerosis around central vein (zone III)

48

Liver mass associated with oral contraceptive use?

Hepatic ADENoma

49

Misfolded gene product proteins aggregated in hepatocellular ER?

alpha 1 antitrypsan

This causes cirrhosis with PAS positive globules in liver

50

Hemochromatosis is associated with HLA...?

HLA3

51

Black gallstones? Brown?

Hemolysis
Brown= infection

52

MUMPs can cause acute pancreatitis

freebie

53

Complication of acute pancreatitis?

Pancreatic pseudocyst lined by GRANULATION tissue which can rupture and hemorrhage

54

Redness and tenderness on palpation of extremities

Migratory thrombophlebitis-- Trousseaus syndrome-- pancreatic carcinoma

55

Southwestern blot detects?

DNA binding protein

56

Path of primary biliary cirrhosis

lymphocytic infiltration and granulomatous destruction of intralobular ducts

57

DDx for xanthelesama?

Primary biliary cirrhosis and hypercholesterolemia

58

99mTc pertechtanate ?

Detects gastric mucosa

59

Colonic diverticula?

outpouchings of mucosa and submucosa

60

most common type of colonic polyp?

hyperplastic polyp-- serrated appearance

61

Two bugs that cause biliary tract infection?

Ascaris-- roundworm
Clonorchis-- endemic to china, korea, and vietnam-- also increased risk for cholangiocarcinoma

62

HEV infection?

In pregnant women associated with fulminant hepatitis and massive hepatic necrosis

63

Pathology of viral hepatitis?

Inflammation of lobules and portal tracts characterized by apoptosis of hepatocytes

64

Fibrosis in cirrhosis is mediated by?

TGF beta from stellate cells

65

Thick mucoid capsule?

Klebsiella

66

Legionella is best visualized by?

silver stain

67

IgM against RBCs causing cold hemolytic anemia?

Mycoplasma pneumonia

68

Causes pneumonia; does not require arthropod vector (survives as highly resistant endospores and does not produce a skin rash

Coxiella-- things that distinguish it from other rickettsia

69

Where does mutant A1AT accumulate?

Misfolded protein accumulates in endoplasmic reticulum of hepatocytes-- PAS positive globules in hepatocytes

70

What is the cause of the hypoxemia in emphysema?

DESTRUCTION OF CAPILLARIES IN ALVEOLAR SAC

71

WHAT IS CAUSE OF HYPOXEMIA IN EMPHYSEMA

DESTRUCTION OF CAPILLARIES IN ALVEOLAR SACS

72

Path of asthma?

1) epithelial desquamation
2) smooth muscle hypertrophy
3) mucous plugging
4) BM thickening
5) NO destruction of alveoli or fibrosis

73

Charcot leyden crystals?

Eosinophils derived crystals seen in asthma

74

Antimetabolite that causes photosensitivity?

5FU

75

idiopathic pulmonary fibrosis mediated by?

tgf beta

76

honeycomb lung

pulmonary fibrosis

77

joint pain; coal worker; fibrosis of lungs

Caplan syndrome= RA plus diffuse fibrosis-- results in carbon laden macrophages that are not clinically significant

78

egg shell calcifications

silicosis-- increased risk for TB

79

lung cancer derived from neuroendocrine cells?

small cell-- may produce ADH or ACTH or cause eaton lambert

80

lung cancer that may produce PTHrP

squamous cell

81

adenocarcinomas are found?

peripherally

82

Columnar cells that grow along preexisting bronchioles and alveoli-- type of lung cancer

Bronchioalveolar carcinoma-- may present with pneumonia like consolidation on imaging

ON HISTOLOGY LOTS OF DARK PINK (NO CELLULARITY) WITH CONNECTING TALL COLUMNAR CELLS

83

Polyp like mass in bronchus?

Carcinoid-- chromogranin positive

84

granulomatous vasculitis?

temporal arteritis

85

Young adult; melena with abdominal pain; skin lesions; hypertension; confusion

Polyarteritis nodosa-- spares the LUNGS; associated with Hep B surface antigen

86

String of pearls appearance on imaging; fibrinoid necrosis; vasculitis

Polyarteritis nodosa

87

45 yo man sinusitis and ulcer in nasopharynx, coughing up blood; hematuria

Wegeners; rapidly progressive glomerulonephritis causes the hematuria

88

What is the difference between wegeners and microscopic polyangitis

microscopic polyangitis does not have granulomas OR nasopharyngeal involvement

89

Churg strauss particularly affects?

Lung and heart; eosinphils in multiple organs; p-ANCA levels correlate with disease activity

90

Purple spot on but and legs; GI pain and bleeding; hematuria; child was sick two weeks ago

IgA nephropathy-- henoch shonlein purpura

91

Describe pathogenesis of arteriosclerosis?

1) Damage to endothelium and lipid leak into intima-->2) lipids are oxidized and then consumed by macrophages via scavenger receptors resulting in foam cells-->3)Inflammation and healing leads to deposition of ECM and proliferation of smooth msucle

92

Describe pathogenesis of arteriosclerosis?

1) Damage to endothelium and lipid leak into intima-->2) lipids are oxidized and then consumed by macrophages via scavenger receptors resulting in foam cells-->3)Inflammation and healing leads to deposition of ECM and proliferation of smooth msucle

93

Intrinsic tyrosine kinase/

Insulin (intrinsic); think growth factors; IGF; PDGF

94

RPF is best estimated using?

PAH

95

hyperplastic arteriolosclerosis is a consequence of?

malignant hypertension

96

hypotension pulsatile mass and flank pain?

abdominal aortic aneurysm

97

EKG shows what on prinzemetal angina?

transumural ischemia===st segment elevation

98

Infarcation of posterior wall caused by block in which artery?

Right coronary artery

99

infarcatino of left circumflex causes?

lateral wall infarction

100

Morphological changes of myocardium at 12 hours? 48 hours; 5 days? 2 weeks? months?

12 hours= coagulative necrosis; dark discoloration-- removes nucleus; at risk for arrhythmia
48 hours= neutrophils-- fibrinous pericarditis may arise (chest pain with friction rub)

5 days= macrophages-- may lead to rupture of ventricular free wall-->cardiac tamponade

2 weeks= red border emerges as granulation tissue enters from edge of infarct-- granulation tissue with plump fibroblasts, collagen, and blod vessels are seen on histology

months= white scar; fibrosis; dressler syndrome, aneurysm mural thrombus

101

6 drugs that cause hyperkalemia?

1) ARBs 2) ACEI 3) Nonselective Beta blockers 4) Cardiac glycosides 5) K sparing diuretics 6) NSAIDs

102

Paradoxical splitting caused by?

Delayed left ventricular ejection

103

Heart findings in marfans?

Cystic medial degeneration of aorta

104

Murmurs that are increased by valsalva or abrupt standing?

Mitral valve prolapse or HCM

105

Mitral valve prolapse and HCM decrease on?

Squatting or passive leg raise

106

Which ions are increased in myocytes when there is no ATP?

Ca and Na

107

Prevents cholesterol reabsorption at small intestine brush border

ezetimibe

108

Gray hepatization ?

degradation of RBCs within the pulmonary exudate

109

Alveolar exudate contains neutrophils, fibrin, and erythrocytes

Red hepatization

110

Gynecomastia and galactorrhea-- lung cancer?

Large cell (large breasts)

111

thrombocytopenia; hypoxemia; neurologic abnormaltities; petechial rash

fat embolus-- platelets coat fat microglobules causing thrombocytopenia

112

Eggshel calcification

silicosis-- may disrupt phagolysosomes and impair macrophages increasing susceptibility to TB

113

Asbestosis affects this part of the lung while silicosis affects this part of the lugn

Silicosis upper
Asbestosis lower

114

initial damage of alveoli in ARDS is dt?

release of neutrophilic substances toxic to alveolar wall, activation of coagulation cascade and oxygen derived free radicals--WHITE OUT ON CHEST XRAY

115

white out on chest xray?

ARDS

116

Difference in physical findings between pleural effusion and atelectasis (bronchial obsturction)?

atelectasis has tracheal deviation (toward side of lesion) while pleural effusion doesn't

117

hemorrhagic pleural effusions and pleural thickening

Mesothelioma-- and see psammoma bodies

118

intraalveolar exudate?

lobar pneumonia

119

treatment of paroxysmal nocturnal hemoglobinuria

eculizumab

120

venous thrombosis; pancytopenia; and hemolytic anemia

PNH

121

Endomyocardial fibrosis with prominent eosinophilic infiltrates and hemochromatosis

Lofflers syndrome

122

White spots on retina surrounded by hemorrhage

roth spots of bacterial endocarditis

123

Drugs/states that cause digoxin toxicity

renal failure; hypokalemia; quinidine

124

class of antiarrhythmics that cause thrombocytopenia?

IA

125

high hcg

Downsyndrome, chorio, dysgerminoma,hydaditiform mole

126

Prevent nephrotoxicity of cisplatin with?

amifostine

127

1 of 2 viruses that infect a cell has a mutation that results in a nonfunctional protein. the nonmutated virus helps out the mutated one by making a functional protein that serves both viruses

Complementation

128

Genome of virus A coated with surface proteins of virus b?

Phenotypic mixing