Test 41: Pathology Flashcards
(161 cards)
1
Q
16-yr old boy confusion, fatigue, abdominal pain, excessive thirst, and polyuria.
Urine dipstick: positive for glucose and ketones
What does he have
A
diabetic ketoacidosis
2
Q
Diabetic ketoacidosis commonly affects patients with what type of diabetes
A
Type 1 diabetes mellitus
3
Q
What happens in type I diabetes
A
autoimmune response against pancreatic beta cells
- destruction of beta cells through cell-mediated immunity
4
Q
insulitis
A
infiltration of islets by inflammatory cells
5
Q
Insulin resistance accompanied by relative insulin deficiency is main cause of what
A
type 2 diabetes mellitus
6
Q
Cystinuria
A
hereditary defect in renal PCT and intestinal amino acid transporter
7
Q
cystinuria prevents absorption of what
A
COLA cystine ornithine lysine arginine
8
Q
how does cystinuria impact intestines and kidney
A
intestine: do not develop deficiency, aa absorbed in sufficient quantities as oligopeptides
kidney: formation of cystine kidney stones (ornithine, lysine and arginine soluble in urine)
9
Q
What are risk factors for cysteine precipitation
A
- low urine pH
- presence of preexisting crystal nidus and urine supersaturation
10
Q
aortic dissection is a well-known complication of what disease
A
Marfan syndrome
11
Q
how is cystinuria inherited
A
autosomal recessive
12
Q
What hormones cannot be synthesized in congenital adrenal hyperplasia caused by 21-hydroxlase deficiency
A
aldosterone and cortisol
13
Q
What hormone and over synthesized in 21-hydroxylase deficiency and why?
A
adrenal androgens
- low cortisol level increases ACTH, since aldosterone and cortisol not made, increase androgen
- increase 17-hydroxyprogesterone
14
Q
clinical manifestations of 21-hydroxylase
A
female: virillization
made: normal genitalia
Both: salt-wasting, hypoglycemia,
15
Q
1 week old boy: vomiting, poor feeding, dehydrated, hypotensive, hyperkalemia, hyponatremia. What does he have
A
21-hydroxylase deficiency
16
Q
What is the strongest risk factor for cervical dysplasia and carcinoma
A
infection with human papillomarvirus (HPV) type 16 or 18
- need immune system to fight off
17
Q
27 yr old man: muscle weakness, high blood pressure, very low plasma renin activity? what does he have
A
primary hyperaldosteronism
18
Q
What causes primary hyperaldosteronism
A
- increase secretion of mineralocorticoids from bilateral nodular hyperplasia of adrenal zona glomerulosa
- aldosterone-producing adrenal adenoma (Conn syndrome)
19
Q
What causes muscle weakness in hyeraldosteronism
A
hypokalemia
20
Q
Why is there no edema in hyperaldosteronism
A
aldosterone escape
- increase renal blood flow and release of atrial natriuretic peptide –> increase sodium excretion
21
Q
where does pheochromocytoma occur
A
- chromatin cells of adrenal medulla or extra-adrenal sympathetic chain
22
Q
Kimmelsteil-Wilson nodules are diagnostic for what
A
nodular glomerulosclerosis
23
Q
Characterize Kimmelsteil-Wilson
A
- peripheral mesangium
- ovoid or spherical
24
Q
What is the most common cause of nodular glomerulosclerosis
A
Diabetic nephropathy
25
What is nodular glomerulosclerosis
- glomerular basement membrane thickening
| - increased mesangial matrix deposition
26
nodular glomerulosclerosis leads to what
nephrotic syndrome to renal failure
27
minimal change disease on electron microscopy
podocyte foot process effacement
28
Minimal change disease can occur secondary to what
allergic reaction due to pollen/dust, insect stings, or immunization
29
Hep C is associated with what kidney problem
membranoproliferative glomerulonephritis
30
Focal segmental glomerulosclerosis can develop secondary to what
HIV
heroin
severe obesity
31
in poststreptococal glomerulonephritis, light microscopy shows
diffuse glomerular hypercellularity
32
What happens in amniotic fluid embolism
fetal squamous cells in maternal pulmonary arteries
33
Hallmark of respiratory distress syndrome
hyaline membranes living alveolar ducts
34
Where is a common lung location for aspiration pneumonia
lower lobe of right lung
35
Common sings for amniotic fluid embolism
hypoxia
hypotensive shock
DIC
36
3week-old male: projectile non-bilious vomiting after every meal, prominent peristalsis in epigastrium, olive-sized mass on deep palpation of right upper abdomen?
congenital pyloric stenosis
37
congenital pyloric stenosis arises secondary to what problem
hypertrophy of pyloric muscular mucosae
38
Free wall rupture of the heart is a catastrophic mechanical complication of what
transmural MI
39
when does Free wall rupture of the heart typically occur? what does it look like
first 5-14 days after MI
| - slit-like tear
40
Abrupt rupture of left ventricle leads to what
cardiac tamponade --> profound shock
41
What is the most common cause of sudden cardiac death within the first 48-72 hours after an MI
ventricular arrhythmias
42
What is pulses paradoxus
exaggerated drop ( less than 10 mmHg) in systolic blood pressure during inspiration
43
how is pulses paradoxus calculated
- diference in systolic pressure at which Korotokoff sounds are first audible during expiration AND pressure when Korotkoff sounds are heard throughout all phases of respiration
44
how does inspiration impact blood vessels
increase systemic venous retune
45
impair expansion into pericardial space of heart, increased right ventricular volume with inspiration leads to what
bowing of inter ventricular septum toward left ventricle
46
Pulsus paradoxus is seen in what conditions
cardiac tamponade, asthma, obstructuve sleep apnea, pericarditis, croup
47
Patient presents with dyspnea, tachypnea, prolonged expiration, bilateral wheezing
obstructive pulmonary disease
48
What is acute obstructive pulmonary disease treated with
beta-adrenergic agonists
49
MOA for beta-adrenergic agonists
Gs protein
- adenylyl cyclase
- increase cCAMP
50
role of Cromolyn sodium
inhibits mast cell degranulation and release of histamine and leukotrienes
51
acute synovitis is best evaluated with what
diagnostic arthrocentesis and synovial fluid analysis
| - fluid sent for crystal analysis, cell count, gram stain/culture
52
patient with well-demarcated, scaly erythematous plaques involving extensor surfaces of extremities has features of what
psoriasis
53
Additional complications of psoriasis
- arthritis
- nail changes: yellow-brown discoloration, pitting
- inflammatory disorder of eye: uveitis
54
What characterizes dermatitis herpetiformis
- erythematous prussic papules, vesicles, and bull on extensor surfaces, upper back, and buttocks.
55
Dermatiti herpetiformis is associated with what
celiac disease and IgA antibodies against gliadin
56
What causes Gaucher disease
autosomal recessive
- beta-glucocerebrosidase deficiency
- accumulation of glucocerebroside and glycolipid component of leukocyte and erythrocyte membranes
57
Describe Gaucher cells
-lipid-laden macrophages
| "wrinkled tissue paper"
58
symptoms of gaucher
- abdominal dissension due to hepatosplenomegaly
| - fatigue due to pancytopenia
59
Clinical presentation for Hodgkin lymphoma
- nontender lymphadenopathy
| - B symptoms ( fevers, night sweats, weight loss)
60
What age group does Hodgkin lymphoma attack
bimodal
| 20's then 60's
61
in lymph node biopsy, what distinguishes Hodgkin Lymphoma
Reed-Sternberg cells
62
Burkitt lymphoma presents a mass where
abdomen, pelvis, or jaw
63
Histo for Burkitt lymphoma
- "starry sky" appearance
| - sheets of lymphocytes with interspersed "tangible Body" macrophages
64
clinical presentation for follicular lymphoma
"waxing and waning" lymphadenopathy
65
2 important causes of megaloblastic anemia
folic acid and B12 deficiency
| - required for DNA synthesis for erythropoiesis
66
Which megaoblastic anemia has neurological dysfunction
B12
67
Treating megaloblastic anemia due to vit B12 deficiency with folate does what
worsens the neurological dysfunction
68
What type of neutrophils are seen in megaloblastic anemia
hypersegmented neutrophils
69
what is MCV value for Vitamin B12 and folic anemias
greater than 110 fL
70
CXR: bilateral and diffuse pattern of small irregular (reticulonodular) opacities that are most pronounced in the lower lobules
pulmonary fibrosis
71
clinical presentation for pulmonary fibrosis
gradual-onset dyspnea
72
PE for pulmonary fibrosis
end-inspiratory crackles
73
Advanced pulmonary fibrosis shows up how on
honeycomb
74
What drug is used for rheumatoid arthritis that can cause interstitial pneumonitis and fibrosis
Methotrexate
75
Atelectasis
diminished air volume in part of lung due to obstruction
| - opaque on CXR
76
Interstitial fibrosis with cystic air space enlargement
idiopathic pulmonary fibrosis
77
What causes honeycomb appearance for pulmonary fibrosis
collapse of alveolar
78
FEV1/FVC ratio for restrictive disease
greater than 80%
79
Most common benign tumor of the breast
Fibroadenoma
80
histo for fibroadenoma
myxoid storm that encircles epithelium-lined glandular and cystic spaces
81
How does estrogen impact fibroadenoma
increases with size with increased estrogen
82
myasthenia gravis
autoantibodies directed against nicotinic acetylcholine receptors on postsynaptic membrane
- complement-mediated damage to postsynaptic membrane
83
clinical presentation for myasthenia gravis
fluctuating weakness worsens over course of day
- extra ocular weakness
- may have thymoma
84
pathophysiology of Lambert-Easton
autoantibodies to presynaptic Ca 2+ channel
| - proximal muscle weakness improves with use
85
Leading medical cause of death in athletes age less than 35
sudden cardiac death
- hypertrophic cardiomyopathy
- ventricular fibrillaiton or v-tach
86
histo for hypertrophic cardiomyopathy
massive myocyte hypertrophy and myofiber disarray
87
complications resulting from poor blood flow with varicose veins are
- stasis dermatitis
- skin ulcerations
- poor wound healing
- superficial infections
88
Claudication
pain and weakness associated with exertion
89
What is phlegmasia alba dozens? who gets it
- painful white leg "milk leg"
| - consequence of iliofemoral venous thrombosis occurring in permpartum women
90
what characterizes small patent ductus arteriosus
continuous machinelike murmur
91
PDA clinical features
clubbing and cyanosis without blood pressure or pulse discrepancy
92
what is pseudo gout made of
calcium pryophosphate disposition disease
93
where does pseudo gout occur and regular gout
pseudo: joints
gout: first metatarsophalangeal joint
94
What is in synovial fluid for pseudogout
- elevated WBC
- neutrophilic predominance
- Rhomboid-shaped calcium pyrophosphate crystals
95
one of most common constituents of renal calculi
calcium oxalate
96
What is deposited in gout
monosodium urate
97
birefringment for gout and pseudogout
gout: negativiely birefringent
pseudogout: positiviely birefringent
98
Fever, dyspnea, new blowing holosystolic murmur best heard at cardiac apex? what does patient have
mitral regurgitation likely due to infective endocarditis
99
Describe Janeway lesions
nontender, macular, erythematous lesions
| - typically on palms and soles
100
what can cause laneway lesion
septic embolization from valvular vegetarians
| -composed of bacteria, neutrophils, necrotic material, subcutaneous hemorrhage
101
pathogenesis for Osler nodes
immune-complex deposition in skin
102
granuloma serves to do what
wall off offending agent
103
Th1 CD4 + cells secrete what? what does it activate
interferon-gamma
| activates macrophages
104
Marjolin's ulcer
aggressive, ulcerating squamous cell carcinoma that presents in areas of previously traumatized, chronically inflamed, or scarred skin
105
how do keloids form
excessive granulation tissue formation during tissue repair`
106
Ascending paralysis that starts a few weeks after a febrile illness is a typical presentation of what? usually precedes what?
Guillain-Barre syndrome
| - usually precedes upper respiratory or GI infection
107
What happens in guillain-Barre
acute demyelinating disease with autoantibodies cross react with the myelin of spinal roots and peripheral nerves
- "endoneural inflammatory infiltrate" consisting of lymphocytes and macrophages
108
Toxin penetration through the Blood-nerve barrier occurs in what
diphtheria
109
Hyalinization of nerve arterioles is seen in what
diabetes mellitus
110
Polymyositis
inflammatory disease of unknown etiology that affects skeletal muscles
111
Pilocytic astrocytomas and medullublastomas arise where
cerebellum
112
Sheets of primitive cells with many mitotic figures describes what cerebellar tumor
Medulloblastoma
113
most common location of medulloblastoma
cerebellar vermis
114
symptoms for medulloblastoma
- increased intracranial pressure ( morning headache, voting, lethargy)
- cerebellar dysfuction
115
Most common brain neoplasm of childhood
pilocytic astrocytoma
116
histo for pilocytic astrocytoma
astrocytes and Rosenthal fibers
117
histo for ependymoma
rosettes
118
compare prognosis for pilocytic astrocytoma and medulloblastoma
- pilocytic astrocytoma: low-grade tumor, better prognosis
| - medulloblastoma: bad prognosis and poorly differentiated
119
pseudocyst consists of what
granulation tissue and no epithelial lining
120
Glycogen-rich cuboidal epithelium is seen in what pancreas problem
serous pancreatic neoplasm
121
columnar mutinous epithelium is seen in what pancreas problem
mucinous cystic neoplasms of pancreas
122
late phase of an atopic asthma attack involves what
mucosal infiltration by eosinophils, basophils, neutrophils
123
What protein do basophils release
anti-helminthic toxin
| - can damage epithelial and endothelial cells
124
What is Metalloproteinase
zinc-containing enzyme: degrease components of ECM and basement membrane
125
how do tumor cells detach from each other
decrease expression of E-cadherins
126
Most common cause of xanthelasmas
LDL receptor abnormality
127
15 yr old girl: gait instability, mild weakness, "clumsiness" in lower limbs, hold on to rails when walking down stairs due to several recent falls, kyphoscoliosis, pets cavus, joint position and vibration impaired
Fredreich ataxia
128
heat like in frediech ataxia
hypertrophic cardiomyopathy
129
degeneration of spinocerebellar tracts
gait ataxia
130
degeneration of posterior columns and dorsal root ganglia
impaired joint and vibration sense
131
lymphoblast in precursor B-ALL are
TdT +
CD10
CD19
132
lymphoblast in precursor T-ALL are
tDt
CD1a
CD2,3,4,5,7,8
133
What is the most common predisposing condition for infective endocarditis in developed nations? developing nations?
developed: mitral valve prolapse
developing: rheumatic heart disease
134
During healing process, fibroblast migration and proliferation are controlled by what growth factors
- platelet-derived growth factor (PDGF)
| - transforming growth factor-beta (TGF-beta)
135
how is hypertrophic cardiomyopathy inherited and what happens
autosomal dominant
| - mutations in cardiac sarcomere proteins
136
left ventricular outlaw tract obstruction in heart results in what
- systolic anterior motion of anterior leaflet of mitral valve toward inter ventricular septum
- mitral regurgitation
137
bcl-2 normally inhibits what
cell death cascade
138
Follicular lymphoma has what translocation
t (14;18)
14: heavy-chain Ig
18: bcl-2
139
What is primary biliary cirrhosis
autoimmune destruction of intrahepatic bile ducts and cholestasis
140
who gets primary biliary cirrhosis
middle-aged women
141
first symptom of biliary cirrhosis
pruritus
142
paradoxical emboli
venous thromboembolic that enter systemic arterial circulation via intracardiac or intrapulmonary shunt. (patent foramen oval, atrial petal defect
143
atrial septal defects with left-to-right shunting typically causes what sounds
wide and fixed splitting (no change with respiration) of 2nd heart sound
144
What is diastolic decrescendo murmur
aortic regurgitation
145
systolic ejection murmur that increases with intensity with standing is in who
hypertophic cadriomyopathy
146
1 week old boy: normal till now. Grade II/VI harsh, holosystolic murmur best heard at the left mid to lower sternal border ? what does he have
small ventricular septal defect
147
when do small ventral septal defects show on babies and why
4-10 days after born
| - pulmonary vascular resistance declines, enabling left-to-right shunting
148
clinical presentation of Ebstein Anomaly
- cyanosis
| - heart failure from severe tricuspid regurgitation
149
Atrial septal defects and patent ductus arterioles are what type of heart defects?
non-cyanotic congenital heart disease
150
What is Ebstein anomaly
displacement of malformed tricuspid valve into right ventricle
151
patient with history of rheumatic fever now presenting with exertion dyspnea and diastolic murmur at cardiac apex most likely has what
- mitral stenosis
152
PE for mitral stenosis
1. loud first heart sound S1
2. Early diastolic opening snap
3. low-pitched diastolic rumble
153
Where is mitral valve best heard
cardiac apex
154
The opening snap sound in mitral stenosis is caused by what
sudden opening of mitral valve leaflets when left ventricular pressure falls below he left arterial pressure at beginning of diastole
155
Patient with hypertrophic cardiomyopathy has increased intensity of murmur in what position
```
standing up (Valvsalva)
nitroglycerin administration
- b/c they both decrease preload therefore increase murmur intensity
```
156
Phenylphrine
alpha 1 agonist
157
patient presents with bitemporal hemianopsia and hypogonadism ( erectile dysfunction and decreased libido)
prolactin-secreting pituitary adenoma
| - prolactinoma
158
what negatively regulates prolactin
dopamine from hypothalamus
159
pituitary tumor can give what eye problems
bitemporal hemainopsia
160
Prolactin surpasses what hormone
GnRH
161
What increases prolactin recreation
TRH
