Random Flashcards
1
Q
Causes of dilated cardiomyopathy?
A
ABCCCD
Alcohol; Beriberi; Coxsackie; Cocaine; Chagas; Doxorubicin; also hemochromatosis
2
Q
Restrictive cardiomyopathy with endomyocardial fibrosis with a prominent eosinophilic infilitrate?
A
Lofflers syndrome
3
Q
Vasculitis due to IgA deposition following upper respiratory tract infection?
A
Henoch Schonlein– see fibrinoid necrosis
4
Q
Destruction of helminths?
A
Major basic protein released by eosinophils
5
Q
CD4<50
A
Pneumocystis– TMP SMX
Toxoplasma– TMP SMX
Avium– Azithromycin
6
Q
Treatment of histoplasma? (commonly seen in HIV patient from endemic area with CD4 under 150)
A
Itraconazole
7
Q
Copper arsenic and gold antidote?
A
Penicillinamase
8
Q
Erosions are in?
A
Mucosa only
9
Q
Collaterals
a) superior epigastric to? aka internal thoracic or mammary
b) Sup pancreaticodudodenal
c) Middle colic
d) Superior rectal
A
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
Q
Rectum above pectinate drains into?
Below pectinate drains into?
A
Above inferior mesenteric vein– adenocarcinoma
Below internal iliac vein– squamous
11
Q
Zone in liver commonly affected by viral hepatitis?
A
zone 1
12
Q
Zone in liver first affected by ischemia?
A
zone 3– most sensitive to toxic injury
13
Q
Two AA that are potent stimulators of gastrin?
A
Phenylalanine and tryptophan
14
Q
Motilin receptor agonist used to stimulate intestinal peristalssis/
A
Erythromycin
15
Q
How does gastrin increase acid secretion?
A
Through ECL cells–>histamine release (rather than acting directly on the parietal cells themselves)
16
Q
ACh–>M3 activation–>?
A
Gq–>phospholipase C– IP3/Ca–>H/K atapase
17
Q
only…..are absorbed by enterocytes?
A
Monosaccharides
18
Q
What are bile acids conjugated to to make them water soluble?
A
Taurine and glycine
19
Q
Malignant tumor with mucinous and squamous components of parotid gland– involves what nerve?
A
Mucoepidermoid carcinoma– involves facial nerve
20
Q
ingestion of cleaning products associated with?
A
esophageal strictures
21
Q
Esophageal squamous cell carcinoma?
A
Areas of keratinization in well differentiated tumor
22
Q
65 yo male Pt. presents with steatorrhea, pain in joints, confusion
A
Whipples– PAS positive– foamy macrophages in LAMINA PROPRIA
23
Q
3 key features of celic?
A
Intraepithelial CD8 T cells in lamina propria!
Cryp hyperplasia
Villous atrophy— see loss of villi on histology
24
Q
Abetalipoproteinemia have RBCs associated with?
A
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
