Test 46: Pathology Flashcards Preview

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Flashcards in Test 46: Pathology Deck (111):
1

Hepatits B virus infection can produce one of three syndromes

1. acute hepatitis with complete resolution (most common)
2. chronic hepatitis ( with or without cirrhosis and increase risk of hepatocellular carcinoma)
3. fulminant hepatitis with liver necrosis

2

PE for lead poisoning

blue "lead lines" at junction of teeth and gingival

3

diagnostic finding on peripheral blood smear for lead poisoning

basophilic stippling on background of hypo chromic microcytic anemia

4

what does lead inhibit

ferrochelatase and ALA dehydratase

5

What is Mesothelioma

rare malignant neoplasm arising from mesothelial cells, which line body cavities

6

exposure to what is the primary risk factor for mesothelioma

asbestos
- mining and industrial applications

7

histo for mesothelioma

1. long slender microvilli
2. abundant tonofilaments

8

Difference between adenocarcinoma and mesothelioma

adenocarcinoma: short and plump microvilli

9

Meningioma is derived from what

meningothelial cells of arachnoid

10

symptoms of Meningioma

often asymptomatic
- seizures or focal neurologic signs

11

histo for Meningioma

- Spindle cells arranged in whorled pattern
- psammoma bodies (eosinophilic laminar structures)

12

location of meningiomas

cerebral convexities in adults

13

46 yr old women: persistent diarrhea, weight loss, abdominal pain, diarrhea improves with fasting. Endoscopy shows post bulbar duodenal and jejunal ulcers

Zollinger-Ellison syndrome

14

What causes Zollinger-Ellison syndrome

- gastrin-secreting neuroendocrine tumor ( gastrinomas)
- located in small intestines or pancreas

15

role of gastrin? can cause

stimulate gastric acid production
- peptic ulcer that can be located beyond the duodenal bulb
- diarrhea b/c pancreatic intestinal enzymes inactivated by gastronome

16

Zollinger-Ellison patients should get tested to rule out

multiple endocrine neoplasia type 1

17

pathophysiology of thrombocitic thrombocytopenia purpura

- decrease or deficiency of ADAMTS13

18

role of ADAMST13

normally cleaves vRF multimers into smaller monomers for depredation

19

patient with new-onset neurologic symptoms, anemia with schistocytes, thrombocytopenia, and acute kidney injury has

thrombotic thrombocytopenia purport TTP

20

disseminated intravascular coagulation results from

abnormal activation of coagulation cascade

21

What is acute calculous cholecystitis

acute inflammation of gallbladder initiated by gallstone obstruction of cystic duct

22

Persistent gallbladder outflow obstruction promotes what

hydrolysis of luminal lecithins to lysolecithins , disrupts protective mucus layer
- exposed to bile salts releasing prostaglandin
- inflammation causes hypo motility
- ischemia
- bacteria invade injured and necrotic gallbladder wall

23

Klinefelter syndrome

47 XXY

24

in Klinefelter what is damaged in males

Leydig cells resulting in low testosterone
- excess gonadoptropins
- increase estrogen

25

PE for Klinefelter syndrome

- low testosterone
- tall
- gynecomastia
- learning and social difficulties

26

what can cause concentric hypertrophy

- long standing hypertension
- aortic stenosis
-- all increase LV afterload

27

What are 3 type of glial cells

1. astrocytes
2. Oligodendrocytes
3. microglia

28

function of astrocyte

tissue repaire
- proliferate cite of injury: astrocytosis

29

gliosis

proliferation of astrocytes in an area of neuron degeneration

30

What happens to shrunken and deeply eosinophilic neurons of CNS

cell death, phagocytized by microglia

31

Aspirin is a mainstay treatment for what disease

Kawasaki

32

how is the liver impacted in Reye syndrome

microvesicular steatosis of hepatocytes without inflammation and cerebral edema

33

what is NF-kB

transcription factors
- role in immune response to infection and inflammation

34

what inhibits NF-kB

IkB kinase

35

how is IkB kinase degraded

ubiquitination

36

Activated protein C inactivates what

factors Va and VIIIa

37

clinical manifestations of factor V leiden include 3 things

1. deep vein thrombosis
2. cerebral vein thrombosis
3. recurrent pregnancy

38

Most common cause of factor V leiden

- inherited hypergoagulabilty in Caucasian

39

patient with distal duodenal ulcer and high-normal gastrin levels have what

Zollinger-Ellison syndrome

40

ulcers found beyond duodenal bulb suggests what syndrome

Zollinger-Ellison

41

Secretin is released from where

duodenum

42

Action of Secretin

-increase pancreatic bicarb secretion
- inhibit gastrin

43

exogenous secretin stimualtes what

gastrin release from gastronomes

44

Diabetic CN III mononeuropathy presents

1. acute onset diplopia
2. "down and out" position
3. ptosis

45

what causes diabetic mononeuropathy

ischemic nerve damage, usually CN III

46

why is pupillary size and reactivity normal in diabetic CN III mononeuropathy

autonomic component for pupillary contraction and accommodation is located in the peripheral aspect of nerve. central is what gets damaged

47

Patient with abdominal pain/distension, bloody diarrhea, fever and signs of shock in setting of untreated ulcerative colitis like has? diagnostic imaging

toxic megacolon
- abdominal X-ray to se colonic dilation

48

what diagnostic studies are contraindicated in toxic megacolon

1. barium contrast
2. colonoscopy

49

Gastric biopsy specimen are taken for direct diagnosis for what

H. pylori infection

50

Urease impact on urea

convert urea to carbon dioxide and ammonia
- causes pH increase

51

C-anca is found in what type of patients

- granulomatosis with polyangiitis (wegener's)

52

What three things are involved in granulomatous vasculitis

1 pulmonary symptoms
2. upper respriatory tract
3. renal disease

53

Granulomatosis with polyangiitis ( wegener's) causes what to the kidney

progressive crescentic glomerulonephritis typ 3

54

Role of Prostacyclin in vessels

1. inhibits platelet aggregation and adhesion to endothelium
2. vasodialtes
3. increases permeability

55

Protein C needs what vitamin

vitamin K

56

pt. early onset asthma, wrist drop, increase eosinophils in blood, antibodies against neutrophil myeloperoxidase, rhino sinusitis

eosinophilic granulomatosis with polyangiitis

57

antibodies against neutrophil myeloperoxisdase is what test

p-ANCA

58

Another name for Eosinophilic granulomatosis with polyangiitis

Churg-Strauss

59

Irreversible cell injury in brain leads to

liquefactive necrosis

60

ECG changes in anterior V1-V3 and lateral (I, aVL) chest leads.

ECG: ST-segment elevation in lead I, aVL and V1-3 with deep Q-wave development over next several hours mean?

-transmural infarct of anterolateral left ventricle
- obstructive thrombus superimposed on a ruptured atherosclerotic coronary artery plaque

61

Overlying skin retraction on breast such as dimpling involves what structure

suspensory ligament ( cooper ligament)

62

Most common location of invasive breast carcinoma

upper outer quadrant

63

what expresses CD31

PECAM1
platelet endothelial cell adhesion molecule

64

What is liver angiosarcoma

rare malignant vascular endothelial cell neoplasm associated with carcinogen exposure
arsenic and polyvinyl chloride

65

Most common type of lung cancer in the US

Adenocarcinoma in situ ( bronchioalveolar carcinoma)

66

Adenocarcinoma in situ of lung is located where and characterize it

- periphery of lung
- growth along intact alveolar septa

67

histo for adenocarcinoma in situ of lung

well-differentiated, dysplastic columnar cells

68

clinical manifestation of adenocarcinoma in situ of lung

- bronchorrhea --> watery sputum

69

What is medullary thyroid cancer

tumors of parafollicular calcitonin-secreting C-cells

70

mutation in medullary thyroid cancer

RET proto-oncogene

71

role of RET proto-oncogene

codes membrane bound tyrosine kinase receptor

72

Myeloblast nuclei have what? what does it stain for?

Auer rods that stain for peroxidase

73

Hairy cell leukemia stain for what

TRAP
tartate resistant acid phosphatase

74

When do you see myeloblast in blood smear

acute myelogenous leukemia

75

finding of impaired sperm motility raises concern for what

primary ciliary dyskinesia

76

PE for primary ciliary dyskinesia? Also called

1. chronic sinusitis
2. situs inversus ( received right/left positioning of internal organs)
3. infertility

Kartagener syndrome?

77

Man comes in with immobile sperm due to abnormal tail function also has what problem

persistent bronchial dilation

78

what congenital cardiac anomaly has increase risk for cerebral hemorrhage ( berry aneurysms)

Coarctation of aorta

79

pt has phospholipase A2 receptor with IgG4 antibodies, with peripheral edema and proteinuria. renal disease?

membranous nephropathy

80

what causes renal disease in multiple myeloma

deposition of light chains

81

Shrunken nuclei, detectable Nissle substance, and eosinophilic cystoplasm, what happened to cell

irreversible cell injury

82

red neuron

neuron reacting to acute irreversible damage

83

role of microglia

phagocytize dead neurons

84

Cardiac arrest leads to rapid cessation of cerebral blood flow and causes what to brain

global cerebral ishcemia

85

What is the first area damaged during global cerebral ischemia

hippocampus (pyramidal cells
Second: neocortex and parking cells of cerebellum

86

patient with firm, palpable gallbladder and extensive calcification through out bladder wall has

porcelain gallbladder

87

Radiographic features of porcelain gallbladder

thickened gallbladder wall with rim of patchy calcification

88

Procelain gallbladder is a potential manifestation of what

chronic cholecystitis

89

Procelain gallbladder is associated with an increase risk of what

adenocarcinoma of the gallbladder

90

Acalculous cholecystitis commonly occurs in who

critically ill patients ( those with sepsis, severe burns, trauma, immunosuppression

91

what can cause acalculous cholecystitis

ischemia

92

clinical features of calculus cholecystitis

- fever
- right upper quadrant pain
- leukocytosis

93

58 yr old patient: abrupt-onset severe chest pain radiates to his back, blood pressure higher in left arm than right arm but both high. no ST- segment elevation.

intimal tear--> aortic dissection

94

primary risk factor for aortic dissection

hypertension

95

atherosclerosis predisposes patient to what aorta problem

aortic aneurysm

96

What is Monckeberg sclerosis

calcific deposits in medial layer of muscular arteries

97

Tertiary syphilis can cause what to the heart

obliterative endarteritis of the vasa vasorum
- weakens aortic wall
- predispose to aneurysms

98

34 yr old man: low-grade fever, anorexia/nausea, dark-colored urine, right upper quadrant abdominal tenderness

acute viral hepatitis

99

what is the most common cause of acute viral hepatitis in young adults

Hep A

100

histo for acute viral hepatitis

- hepatocyte necrosis: cellular swelling and cytoplasmic emptying
- monocyte infiltration
- Councilman bodies: hepatocyte apoptosis--> cellular shrinkage and eosinophilia

101

is HAV associated with a increased risk of hepatocellular cancer

no
but B, C and aflatoxin B exposure is

102

Middle-aged adult, presenting with dyspnea on exertion, nodular densities on x-ray, calcified hillier lymph nodes, and birefringent particles on biopsy

Silicosis

103

What is silicosis

inhalation of mineral dusts

104

What is the distinguishing feature of silicosis

- eggshell calcification and birefringent silica particles

105

What is the single most important risk factor for development of intimal tears leading to aortic dissection

hypertension

106

what congenital things can cause aortic dissection

- bicuspid valve
- Marfan

107

Atherosclerosis predisposes aorta to what

aortic aneurysm

108

demyelination of peripheral nerves in response to administration of myelin-like susbtance

Guillain-Barre

109

Beriberi ( thiamine deficiency) can do what do peripheral nerves

demyelination
(no inflammation like Guillain-Barre)

110

What causes Werdnig-Hoffman syndrome

anterior horn cell damage

111

Patients with medically intractable symptoms of Parkinson disease may benefit from high-frequency deep brain stimulation of what area

Globus pallidus or subthalamic nucleus
- inhibit firing of nuclei