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163 Cards in this Set

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What provides collateral circulation around a celiac trunk thrombosis/blockage?
Right and Left Pancreaticduodenal arteries
PCOS is associated with which aneurysms?
Berry aneurysms
Lungs collapsed or distended alveoli with fibrin-rich hyaline membranes following surgery
ARDS (Diffuse Alveolar Damage)
Causes of ARDS
Septic shock, trauma, uremia, gastric aspiration, inhalation of chemical irritants, oxygen toxicity, Mycoplasma infection, and SARS
Rubbery, well-encapsulated, freely movable mass in breast of a 20 yo woman
Fibroadenoma (benign mass found in women younger than 25)
Aortic diastolic murmur, "water-hammer" pulse, wide pulse pressure
Aortic valve insufficiency (usually caused by tertiary syphilis), usually accompanied by aneurysm of the ascending aorta
Temporal arteritis
Jaw pain, headache, and elevated ESR
Hypertrophic Cardiomyopathy
Auto dom, usually involves ventiruclar septum which protrudes and blocks left ventricular outflow tract
Most common cause of death in the first few hours after an MI
When do the first morphological myocardial changes and serum myocardial marker proteins appear?
Often delayed for several hours after MI (CK-MB and cTN-I elevated at about 6 hours and peak at 10-15 hrs)
When after an MI (in terms of time) is one most likely to have cardiac rupture -> hemipericardium and tamponade?
Days 4-10 after MI
Aschoff bodies
found in heart as part of Rheumatic Fever
Reversible changes with necrosis
fatty change, cell blebs, myelin figures, swelling of cell or organelles
Irreversible changes with necrosis
Nuclear pyknosis, karryohexis, karyolysis
Malignant HTN
severe HTN, left ventricular hypertrophy/failure, papilledema, and renal dysfunction (renal arteriolar lesion of malignant nephrosclerosis and necrotizing glomerular lesion -> "flea-bitten" kidney with petechial hemorrhages on the kidney surface
progressive somnolence -> metabolic acidosis (low bicard with AG), coma, and dehydration, often with prerenal azotemia
Diabetic ketoacidosis
Expect increased serum and urine glucose and ketones
Fat embolism
occurs 2-3 days after fracture and can have CNS and respiratory effects (due to pulmonary microvessels leaking fluid -> ARDS) - THROMBOCYTOPENIA WITH PETECHIAL HEMORRHAGES is common
Congenital pyloric stenosis
obstruction of gastric outlet due to hypertrophy of pyloric muscularis, often perceived as palpable mass (more common in boys) - PRINCIPLE CLINICAL FEATURE = projectile vomitting during first two weeks of life
Watery Diarrhea, Hypokalemia, Achlorhydria (WDHA syndrome, also called Verner-Morrison syndrome)
Endocrine disorders causing hyperglycemia
Cushing syndrome, acromegaly, hyperthyroidism
Weakeness, weight loss, and anorexia, with hypotension and hyperpigmentation of skin, lips, and buccal mucosa
Addison's disease
Aniline dyes (ex. beta-napthylamine) associated with which cancer?
Transitional cell carcinoma of the bladder
Aflatoxin B1
Diethylstillbesterol (exposure in utero)
Clear cell carcinoma of the vagina
Ionizing radiation
Leukemias, breast cancer, and thyroid maligancies
What is the most important factor in pathogenesis of endometrial carcinoma?
Estrogen stimulation (estrogen therapy or estrogen secreting tumors); obesity (and associated DM and HTN) can also contribute via estrogen synthesis in adipocytes
Arsenic exposure
Carcinomas of the lung and skin with hepatic hemangiosarcoma
BRCA mutations
Breast and ovarian cancer
Risk factor for colon cancer
Diet low in fiber and high in fat
Cancers associated with asbestos exposure
Mesothelioma, brochongenic carcinoma
Decreased volume of amniotic fluid due to lack of fetal urine (renal agenesis) -> distorted facies and pulmonary hypoplasia (called the Potter progression)
Von Hippel Lindau disease
AD with multiple vascular tumors, multiple cysts of liver, kidney, and pancreas (renal cysts have malignant potential and retinal and CNS hemgioblastoma and pheochromocytomas are common)
Defect in sphingomyelinase
Niemann-Pick disease
Whipple Disease
periodic acid Schiff positive Macs within affected organs (infection is from Tropheryma whippeli) - can be treated, but un-Tx -> progresses to death
GI disorder characterized morphologically by superficial mucosal erosions with overlying necrotic, loosley adherent mucosal debris
PMC (C. diff.) - organisms remain intaluminally but secrete an enterotoxin
Clear vaculosed in liver that displace nuclei to the periphery is characteristic of?
Steatosis (fatty change), can also be water or glycogen accumulation (though less likely)
Wilson's disease - neurological findings
deposition of copper in lenticular nuclei
Courvoisier sign
Palpable gallbladder with adenocarcinoma of the pancreas
Protein-calorie malnutrition
Kwashiokor - cannot make apolipoproteins causing heaptic fatty change
Total-calorie malnutrition
Marasmus - more severe than kwashiokor
General lower abdominal pain, bloody stool, signs of acute inflammation in older patients usually
Menetrier's Disease
giant hypertrophic gastritis, extremely large gastric rugae, severe loss of plasma proteins from altered mucosa, and increased risk of stomach cancer
Alcoholic hepatitis
fatty change, focal liver cell necrosis, neutrophil infiltrates, and intracytoplasmic hyaline inclusions (Mallory bodies); clinically present as low-grade fever, jaundice, hepatomegaly, leukocytosis, and abnormal LFTs
Megaloblastic anemia
Macrocytic red cells (increased MCV) and normochromic (normal MCHC)
Increased MCHC (hyperchromic)
Hereditary spherocytosis
Causes of hypochromic erythrocytes
Iron deficiency anemia, anemia of chronic disease, and thalaseemias
vWF disease
Defect in vWF -> defective platelt adhesion -> prolonged bleeding time and APTT also prolonged due to secondary deficiency in Factor VII which circulates/stabilized by vWF
Hematological maligancy associated with Down's
Acute lymphoblastic leukemia
Fever and skin rash with numerous small petechial hemorrhages (predominantly lower extremities), platelet count reduced, total white count increased), blood smear and BM aspirate show large # of undiff. blast cells (CD10+)
Acute lymphoblastic leukemia (associated with Down Syndrome)
Mild anemia, blood smear with hypochromia and microcytosis
Likely beta-thalassemia
How do you tell beta-thalassemia from other causes of hypochromia and microcytosis?
Hemaglobin A2 (also characteristic CBC with decreased MCV and only moderately reduced Hb and Hct) - compare this to Fe def which has decreased serum Fe, TIBC increased, and storage iron depleted as given by decreased serum ferritin and absent BM hemosiderin AND anemia of chronic disease where usually an obvious disease is present and there is decreased TIBC
Lymphocyte depletion variant of Hodgkin lymphoma
few lymphocytes, numerous Reed-Sternberg cells, and extensive necrosis and fibrosis (usually present late and has worst prognosis and is common in HIV+)
What type of jaundice is associated with hemolytics anemia?
Unconjugated hyperbilirubinemia, not excreted into the urine (acholuric), Hb is markedly decreased with hemolytic anemia and there is marrow erythroid hyperplasia (often manifest as reticulocytosis)
Angnogenic (idiopathic) myeloid metaplasia - pathology
Extensive non-neoplastic myelofibrosis and extramedullary hematopoiesis causing splenomegaly. Results in tear drop shaped erythrocytes, scattered nucleated cells and granulocyte precursor cells (on peripheral smear). Bone marrow has proliferation of fibrous tissue (myelofibrosis)
Agnogenic (idiopathic) myeloid metaplasia - clinical characteristics
Anemia, splenomegaly, fatiguability, weight loss, and weakness
Megaloblastic erythroid hyperplasia (megaloblastic anemia)
Vit. B12 deficiency - Pernicious anemia, strict vegetarians, and surgically induced blind loops that cause bacterial overgrowth with high avidity for B12 (cobalamin)
Hypochromic microcytic anemia
Iron deficiency anemia (secondary to chronic blood loss) such as hookworm infection (vs. fish tapeworm which cases megaloblastic anemia), anemia of chronic disease (though that is normally normochromic and normocytic)
Diffuse demineralization, "punched out" lesions, anemia, hypergammaglobulinemia, proteinuria, and NORMAL serum AP
Multiple Myeloma
reduction in spleen size in SCA patient during adulthood due to bouts of splenic infarction and fibrosis that reduce spleen size (children have splenomegaly)
What do mono, CML, hereditary spherocytosis, and agnogenic myeloid metaplasia (idiopathic myelofibrosis) have in common?
All cause splenomegaly (contrast to adults with SCA who have autosplenectomy)
Serum Iron and TIBC in Hereditary Hemachromatosis
Inc. serum Fe, dec. TIBC
Damages liver via free radicals and causes fatty change and necrosis
Appearance of disseminated histoplasmosis (HIV+, hepatosplenomegaly, generalized lymphadenopathy)
Widespread dissemination of macs filled with fungal yeast forms
Metastatic Calcification
Deposition of calcium in in organs and tissues
Glomerulonephritis, pleuritis, and Libman-Sacks endocarditis (vegetations on both sides of the MV or TV)
SLE - also have diffuse interstial pulmonary fibrosis, and ANAs (Abs to Sm antigen, dsDNA, and Ab in a peripheral rim pattern of nuclear immunofluorescence)
What is the difference between C3a and C5a?
C3a and C5a are both anaphlotoxins (causing degranulation of mast cells and basophils), but only C5a is chemotactic for neutrophils
Hemolytic disease of the newborn - which type of hypersensitivity
Type II - reaction of Ab with intrinsic cell surface antigens
Absence of Duffy blood group Ag and G6PD deficiency
Resistant to malaria
What Hepatitis primarily affects pregnant women?
Hepatitis E
What causes subacute scelrosis panencephalitis?
Measles - characterized by progressive motor and mental deterioration, cortical atrophy, loss of white matter, and ventricular enlargement (pathophys: defective measles virus that lacks M component nedded for extracellular spread)
Waterhouse-Friderichsen syndrome
catastrophic complication of meningococcemia with adrenal insufficiency and vascular collapse, hemorrhagic necrosis of adrenal cortex, often associated with DIC
Pleural fluid in bacterial PNA
Exudative NOT transudate, appears cloudy with neutrophils and dec. glucose, inc. protein/specific gravity
Atrophy of muscle has what characteristic cellular change?
Autophagic granules - intracytoplasmic vacules with debris from degraded organelles (prominent in atrophic cells such as skeletal muscle)
Bone pain with elevation of the periosteum of the bone and areas of "sunburst" appearance
Hypertrophic Osteoarthropathy
Clubbing of the fingers and associated periostitis of the distal radius and ulna associated with chronic lung disease, cyanotic heart diease, and other sys. disorders
Complication of Paget's Disease of the bone
Osteosarcoma (1% of cases), bone pain, anterolateral bowing of long bones, and high output cardiac failure
Felty Syndrome
Neutropenia, splenomegaly, and rheumatoid arthritis
von Recklinghausen disease of bone (osteitis fibrosa cystica)
widespread osteolytic lesions, manifests as "brown tumor" of bone, cystic spaces that are lined by osteoclasts with fibrous stromas, caused by primary or secondary hyper-PTH
Part of the male reproductive tract rarely affected by N. gonorrhea
6 mo boy with HTN and large tumor of left adrenal gland, looks like "small round blue cells" with minimal cytoplasm and some cells have pink cytoplasm and nucleoli, VMA in urine is increased
Neuroblastoma, can undergo spontaneous differentiation to benign ganglioneuroma (has N-myc amplification), usually are found peripherally in adrenal medulla
Pick Disease
Symptoms similar to Alzheimer's (confusion, aphasia, etc), but atrophy only involves frontal and temporal lobes rather than diffuse atrophy of AD
Wernicke-Korsakoff's syndrome
Degeneration of mamillary bodies and paramedian masses of gray matter with history of progressive dementia, memory loss, and tendency to fabricate false account of events (Korsakoff psychosis), confusion, ataxic gait, and paralysis of eye movements(Wernicke triad) - caused by ethanol abuse causing thiamine deficiency
Blurring of vision in right eye, paresthesias, and spasticity with oligoclonal band on CSF electrophoresis, demyelination in paraventricular regions (along with optic nerve and brain stem as favored sites)
Crescentric region along in skull (hematoma)
Subdural hematoma (usually of bridging veins that join cerebral vessels to the venous sinuses in the dura)
Lens shaped homogenous density (hematoma)
Epidural hematoma (usually the middle meningeal artery and respects suture lines)
Most frequent source of subarachnoid hemorrhages
Rupture of Berry aneurysm, clinically presents as terrible headache, sever anusea, blood in CSF, diffuse hemorrhage over the surface of the brain on CT
Highly malignant tumor of childhoos that often affects the posterior cranial fossa
Benign tumor of the meninges, external to the brain, second most common primary intracranial neoplasm. Has mass effect and symptoms relate to location of tumor.
Charcot-Buchard aneurysm
Microaneurysms (1mm) arising at the bifurcation of small arteries in the brain parenchyma--occur from long-standing HTN
Arnold Chiari Malformation
downward displacement of cerebllar tonsils and medulla through foramen magnum, results in pressure atrophy of displaced tissue, causes hydrocephalus (blocks outflow tracks), thoracolumbar meningomyelocele
White, hyperkeratotic membranes due to chronic irritation of the mucosa of the mouth (usually benign but may represent dysplasia or carcinoma in situ)
Dystrophic calcification
calcification of previously damaged tissue (marked by amorphous basophilic material) in contrast to metastatic calcification (hypercalcemia, non-damaged tissue) and enzymatic fat necrosis
Causes of granulomatous inflammation
Cat-scratch disease, FB reaction, TB, histoplasmosis
Elevated ESR
Notable in temporal arteritis and Rheumatoid arthritis, also consider Kawasaki's disease
TNF-alpha antibodies can be used to treat?
Chron's Disease, Rheumatoid Arthritis
Prednisone block what?
PLA2 - blocks AA formation (can be used to treat SLE and other inflammatory conditions)
Lead poisoning
Usually children with dark precipitates in gingival margins, radiopaque deposits in epiphyses of bones, and urinary excretion of delata-aminolevulinic acid (delta-ALA), and basophilic stippling of erhythrocytes, peripheral neuropathy
renal end organ unresponsiveness to PTH and shortened 4th and 5th metacarpals and metatarsals, short stature, other skeletal abnormalities (GNAS1 mutation) - clinical findings mimic hypoparathyroidism but PTH is normal or elevated
Linear pattern of glomerular IgG immunofluorescence
Abs to Glomerular BM
Nephrotic syndrome with glomerular IC deposits
Membranous glomerulonephritis
How is Membranous glomerulonephritis distinct from amplyoidosis, diabetic nephropathy, IgA nephropathy, and minimal change disease
Membranous glomerulonephritis is the only associated with IC disease
Pathognomonic feature of acute pyelonephritis
White cell casts
What do red cell casts indicate?
Glomerular inflammation
Membranous glomerulonephritis
Thickened glomerular capillary loops on light microscopy, often in young women - associated with nephrotic syndrome and azotemia
Complication of chronic use of phenacetin or its metabolite (acetaminophen) or other NSAIDs and aspirin
Renal papillary necrosis (also diabetes mellitus and phenacetin is associted with transitonal cell carcinoma of the renal pelvis)
Renal changes associated with DIC
Thrombotic obliteration of glomerular capillary lopps typical of DIC (APPT, PT and thrombin time prolonged with decreased platelet count and increased fibrin/fibrinogen degradation products)
Common cause of secondary renal amyloidosis
Rheumatoid arthritis, NOTE: renal amyloidosis is characterized by proteinuria, HTN, edema, and hypoalbuminemia
Diabetic nephropathy
Marked by diffuse or nodular mesangial accumulations of glycosylated BM-like material
Abruptio placenta
Common cause of DIC, involves separation of the placenta from the uterine wall prematurely
Infectious causes of spontaneous abortion
Listeria, Hepatitis E
Rubella congenital defects
PDA, septal defects, deafness, mental retardation (worst if during 1st trimester)
Most common gynecological malignancy
Endometrial carcinoma
Most common type of carcinoma of the bladder
Transitonal cell carcinoma
Affects central lobes (middle and lateral lobes due to periurethral foci), increased free PSA
Prostate carcinoma
Increase total PSA, but not free, palpable nodules, often peripheral
Tuberous Sclerosis Syndrome
AD nodular proliferation of multinucleated atypical astrocytes forming tubers (white nodules in cortex), adenoma sebaceum of the skin, and angiomyolipoma of the kidney, also have seizure and mental retardation
Alpha-1 antitrypsin deficiency
PAN-acinar emphysema, cirhosis (auto rec)
African American woman with bilateral hilar lymphadenopathy and reticular densities in both lung fields
Sarcoidosis - granulomas are non-caseating, often multisystem effects, finding include anergy to tuberculin, hypercalcemia, and polyclonal hypergammaglobunemia
Bronchioalveolar carcinoma
Tumor cells line walls of terminal air spaces
What molecule induces coughing?
Bradykinin (remains disputed)
Centrilobular emphysema
Dilation of the respiratory bronchiles localized to the upper part of the pulmonary lobes
Panacinar emphysema
Dilation of the entire acinus (distributed uniformly) - often due to alpha-1 antitrypsin deficiency -> loss of elasticity
Paraseptal emphysema
Distal part of the acinus (alveoli and alveolar ducts) - associated with large subpleural bullae or blebs
Irregular emphysema
Irregular involvement of the acinus with scaring of the walls of the enlarged air spaces - usually a complication of inflammatory processes
CEA is a marker for what?
Adenocarcinoma of the colon
Benign lesion of children, presenting as orange-red dome shaped papule that has grown
Juvenile Melanoma (Spitz Nevus)
Acanthosis nigricans often reflects what?
Visceral malignancy (stomach, lung, breast, or uterus); migratory venous thrombosis is also associated with visceral malignancies
Actinic keratosis - T/F is a premalignant epidermal lesion
Dysplastic nevus may transform into ….?
Malgnant melanoma
What is xeroderma pigmentosum assciated with?
Increased risk of skin cancer because of failed DNA repair
Grayish pigmentation of the skin on posterior neck and axillae in a 40 yo woman, hyperpigmented areas started out as macules and now are palpable plaques, at times these areas are pruritic
Anthosis nigricans
Which pigmented lesion has the worst prognosis and is likely to metastasize early?
Nodular melanoma
Acanthosis nigricans
Acanthosis and yperpgmentation often involving the flexural areas
Squamous cell carcinoma of the skin
locally invasive, due to exposure to sun, presents as scaling, inducrated, ulcerated nodule, histology chacterized by sheets and islands of neoplastic epidermal cells with keratin pearls, tends to involve lower part of the face
Basal cell carcinoma of the skin
Sun exposed areas, tends to involve upper part of the face, pearly papule overlying telangiectatic vessels, basaloid cells with palisade arrangement of nuclei at periphery
Histology of Medullary Carcinoma
Proliferation of C cells and amyloid stroma that stains for Congo Red (occurs singly or as part of MEN IIa or b)
Hashimoto's thyroiditis is associated with which HLA alleles?
HLA-DR5 and HLA-B5
Malignant versus Benign - based on what?
Clinical behavior, not histology
Episodic headache, palpitation, diaphoresis, HTN and hyperglycemia
Which malignancy is associated with clubbing of the fingers?
Carcinoma of the lung
Marrantic endocarditis is associated with…?
Wasting diseases such as widespread cancer
Small cell lung carcinoma of the lung
Almost always metastatic when diagnosed, not resectable, endodermal origin (like bronchogenic carcinoma), located centrally rather than peripherally, associated with smoking, and paraneoplastic syndromes of SIADH and ACTH
Associated with secretion of PTH-RP
Squamous bronchogenic carcinoma
Abdominal pain radiating through to the back, jaundice, anorexia, and recent weight loss
Suggests bile duct obstruction with carcinoma of the pancreas (also expect migratory thrombophlebitis - Trouseau's sign)
Salivary gland tumors
Most occur in parotid, pleiomorphic adenomas, painless mass anterior to the ear, and often recurs due to incomplete resection (close to facial nerve)
Horner syndrome causes what tumors?
Lung tumors
Calcification within a cystic ovarian tumor in a young woman is characteristic of which ovarian tumor?
Mature teratoma (benign lesion and frequently occuring)
Common childhood tumors
medulloblastoma, acute leukemmia, Wilms tumor, and adrenal neuroblastoma
Glioblastoma Multiforme
most common primary intracranial neoplasm, in late middle-age group, marked anaplasia and pleomorphism with endothelial hyperplasia, areas of necrosis and hemorrhage surrounded by "pseudopalisade arrangement" of tumor cells, poor prognosis
slow growing, cells with large nuclei with halo of cytoplasm (fried egg appearance), origin in cerebral hemispheres, calcifications
usually in the 4th ventricle, form tubules or rosettes with cells encircling vessels or pointing towards central lumer, causes papillary growth that obstruct CSF flow
second most common primary intracranial neoplasm, benign, slow growing tumor, occurs after 30 years of age, arises in arachnoid cells of the meninges and is external to the brain, occurs in convexities and parasagittal regions (falx cerebri, sphenoid ridge, olfactory area, suprasellar region), whorled patters of concentrically arranged spindle cells and psammoma bodies
common childhood malignany, sheets of closely packed cells with scant cutoplasm in rosette or perivascular pseudorosette pattern
Amplification of N-Myc, neuroblastoma of afrenal medulla or sympthetic ganglia
Neurolemmoma (schwannoma)
third most common primary intracranial neoplasm, benign slow growing encapsulated tumor, arises from Schwann cells, localized to 8th CN usually - Antoni A (interlacing bundles, palisading nuclei), Antoni B (looser, less cellular)
solitary or multpiple tumors of peripheral nerves derived from Schwann cells, may be part of NF
Metastatic tumors to the brain
lung, breast, skin, kidney, GI, and thyroid
Kruckenberg tumors
Ovaries are replaced bilaterally by mucin secreting signet-ring cells, often originating from stomach cells
von Recklinghausen NF type 1 and NF-1
multiple benign neurofibromas, café au lait spots, iris hamartomas, increased risk of developing fibrosarcomas (due to mutations in NF-1)
Henoch-Schonlein purpura
IgA IC disease in small vessels, form of hypersensitivity or leukocytoclastic vasculitis (may only involve skin -> palpable purpura or glomeruli, GI tract, lungs or brain)
4 yo with fever, abdominal pain, tenderness, heamturia, and palpable purpuric skin lesions on buttocks and extensor suraces of arms/legs
Henoch-Schonlein purpura
Folate deficiency
Megaloblastic anemia
Bleeding gums, petechiae, easy bruising, and pain in arms/legs - diet of "tea and toast"
Vit. C deficiency - abnormal collagen and osteoid matrix synthesis, causing impair wound healing and fagility of capillaries -> abnormal bleeding, Vit. C maintains reduced state of Fe necessary for absorption and Fe absorption is decreased