M2 Pathology Cardio_Renal

Front 1

What is the difference between STEMI and non-STEMI?

Back 1

transmural versus subendocardial ischemia

Front 2

What are the 2 MCCs of stable angina? What layer does it typically affect?

Back 2

athersclerosis of coronaries and LVH
subendocardium

Front 3

What is the pathogenesis of unstable angina?

Back 3

severe disease w/ clot on pre-existing ruptured plaque

Front 4

What does you never do to a patient with unstable angina?

Back 4

stress test

Front 5

What does the EKG show for Prinzmetal's angina?

Back 5

ST elevation due to the vasospasm of coronary arteries --> entire heart is affected

Front 6

What is chronic ischemic heart disease?

Back 6

Progressive CHF from long term ischemic damage to heart muscle
heart tissue is replaced w/ noncontractile scar tissue

Front 7

What are causes of MI?

Back 7

atherosclerosis (MCC), embolism, vasculitis, and cocaine

Front 8

How does plaque vulnerabilities affect MIs?

Back 8

soft versus thick fibrous cap affects acute thrombus formation

Front 9

What occurs cellularly after plaque rupture?
What are attracted by the inflammation?

Back 9

platelet agregation --> thrombus formation -> flow blockage & vasoconstriction (thromboxane A2 from platelets)
inflammation --> monocytes, metalloproteinases, and free radicals

Front 10

What typically causes a transmural (Q-wave) infarct versus a subendocardial (Non-Q wave) infarct?

Back 10

Quality of collaterals

Front 11

When are wavy fibers and contraction bands visible post MI?

Back 11

30 min - 2 hrs

Front 12

When does coagulation necrosis set in?

Back 12

8-24 hrs

Front 13

When does granulation tissue being to scar?

Back 13

1-7 weeks

Front 14

What marker of inflammation non-specifically asses risk of MI?

Back 14

C-reactive protein

Front 15

What are the clinical signs of MI?

Back 15

sever retrosternal pain, referred pain to left arm, shoulder, jaw, or epigastrium, diaphoresis, anxiety, SOB

Front 16

What is the fastest enzyme marker of MI?

Back 16

myoglobin

Front 17

What is the enzyme marker that is best for re-infarct dx?

Back 17

CK-MB

Front 18

What is the best enzyme marker for MI, both sensitive and specific?

Back 18

Tn

Front 19

What enzyme marker is characterized by a flip in isoenzyme 2 (normally higher) and 1 (higher post MI) levels?

Back 19

LDH

Front 20

What is the MCC of death post MI?

Back 20

cardiac arrythmias (Ventricular fibrillation)

Front 21

When does post MI CHF with cardiogenic shock set in?

Back 21

1st day

Front 22

Why does rupture occur post MI? What is the result of ventricle rupture, papillary muscle rupture, and intraventricular septum rupture?

Back 22

weak granulation tissue replaces infarcted myocardium

cardiac tamponade
mitral insufficiency
L -> R shunt

Front 23

When does fibrinous pericarditis set in post MI? What are the clinical signs?

Back 23

1-7 days. Chest pain relieved by leaning forward. Friciton rub hear on ausculation.

Front 24

What are the late complications of MI?

Back 24

Mural thrombus --> embolization, ventricular aneurysm (4-8 weaks), autoimmune pericarditits (Dressler's syndrome 6-8 wks)

Front 25

What is a jet lesion?

Back 25

high velocity stream emerging from stenotic lesion --> dilatation distal to stenosis

Front 26

What is the presentation of Coarctation of the aorta?

Back 26

increased pressure proximal to the narrowing
1. high BP in upper extremities
2. dilation of aortic valve --> regurg
3. increased risk of berry aneurysm

decreased pressure dista to narrowing
1. low BP in lower extremities
2. leg claudication
2. low RBF --> RAAS --> HTN

development of intercostal collaterals --> rib notching on XR

Front 27

What type of shunt creates late cyanosis and Eisenmenger's syndrome?

Back 27

Left to right. It take a while for increased pulmonary pressure to develop and cause cyanosis

Front 28

What is the disease associated with infantile coarctation of the aorta

Back 28

Turner's

Front 29

What type of VSD is a serious problem?

Back 29

Membraneous (muscular can spontaneously close)

Front 30

What are the associated diseases with VSD and the murmur?

Back 30

cri du chat, Edward's, Patau
harsh holosystolic murmur along the left sternal border

Front 31

What is the MC ASD? What are the associated diseases w/ ASD? What is the murmur?

Back 31

patent foramen ovale
fetal alcohol syndrome, Down Syndrome
fixed split S2

Front 32

What is the associated disease w/ PDA? What is the murmur? What hormones close and open PDA?

Back 32

congenital rubella
machine-like murmur
PGE2 opens, Indomethacin closes

Front 33

What are the 4 qualities of Tetrology of Fallot? What are the protective shunts?

Back 33

1. VSD
2. Overriding aorta
3. Pulmonary valve stenosis
4. Right ventricular hypertrophy

ASD or PDA allows blood to reach lungs

Front 34

What are Tet spells?

Back 34

sudden increase in hypoxemia/cyanosis
squatting a lot (increasing SVR to reverse R --> L shunt)
blood forces back into pulmonary artery for oxygenation

Front 35

what is congenitally corrected transpostion of the great vessels? What kinds of CHf do they get?

Back 35

systemic -> RA -> LV -> pulmonary artery -> lungs -> pulmonary veins -> LA -> RV -> aorta -> systemic

R CHF

Front 36

What shunts do you need for tricuspid atresia? What ventricle is hypoplastic?

Back 36

ASD or VSD to shunt blood left. PDA to get blood to lungs.

Left

Front 37

What is truncus arteriosus?

Back 37

Truncus arteriosus fails to divide into pulmonary artery and aorta --> complete mixing at both great vessels.

Front 38

What is total anomalous pulmonary venous return?

Back 38

Pulmonary veins empty oxygenated blood into right atrium --> no blood to systemic
require shunts for survival

Front 39

What is rhabdomyoma? What is the disease association?

Back 39

MC primary tumor of heart in children
tuberous sclerosis

Front 40

What is cardiac myxoma?

Back 40

Benign adult tumor of endocardium in left atrium -(symptomatic)-> block mitral valve
Presentation: dyspnea, syncope, SD
diastolic murmur at apex

Front 41

What is ball valve thrombus?

Back 41

large ball-like thrombus that appears in LEFT ATRIUM
Presentation: dyspnea, syncope, emoblization of thrombus, diastolic murmur at apex

Front 42

What are the causes of fibrinous pericarditis?

Back 42

MC= coxsackie, collagen vascular disease (SLE) post-MI, uremia, metastatic tumor

Front 43

What are the causes and presentation of pericardial tamponade?

Back 43

Post-MI rupture, aortic dissection, trauma
Beck's triad:
hypotension w/ pulsus paradoxus (drop in systolic BP during inspiration)
JVD (kussmauls' sign)
Muffled heart sounds

Front 44

What are the causes of constrictive pericarditis? What is the presentation?

Back 44

TB, post cardiac surgery
pericardial knock

Front 45

What are the causes of dilated cardiomyopathy?

Back 45

undiagnosed viral myocarditis, alcohol (thiamine deficiency - wet beriberi), chemo drugs, radiation, idiopathic

Front 46

How do you distinguish hypertrophic cardiomyopathy from aortic stenosis?

Back 46

valsalva increases murmur because increased preload decreases the obstruction -> increasing outflow

Front 47

What are causes of restrictive cardiomyopathy?

Back 47

amyloidosis, hemochromotosis

Front 48

What is causes the difference in age of presentation for calcific aortic stenosis?

Back 48

in occurs in young people due to a bicuspid valve or due to chronic rheumatic fever.

Front 49

What is the presentation of calcific aortic stenosis?

Back 49

Systolic outflow obstruction
LVH
exertional angina
syncope
high risk of cardiac arrythmia (disorganized fivers and less blood flow to heart)

Front 50

What are the risk factors for mitral valve prolapse?

Back 50

women, Marfan's, Ehlers-Danlos

Front 51

What is the pathogenesis of mitral valve prolapse?

Back 51

myxomatous degeneration of mitral vavle leaflets --> excess dermatan sulfate cause mucoid ground substance accumulation

Front 52

What is the murmur heard with mitral valve prolapse?

Back 52

click-murmur

Front 53

What prophylaxis should be done for mitral valve prolapse?

Back 53

SBE antibiotics

Front 54

What valve is normally involved in IV drug users?

Back 54

tricuspid > aortic

Front 55

What are the 3 microembolisms seen in endocarditits?

Back 55

splinter hemorrhages, Janeway lesions, Osler nodes

Front 56

What presents with fever changing cardiac murmurs, splenomegaly, and immunocomplex vasculitis (Roth spots)?

Back 56

endocarditis

Front 57

What happens when an eligible candidate is without an examination?

Back 57

the examination booklet will be "split" and shared between the two candidates (designated “A” and “B”).

Front 58

What causes myocarditits?

Back 58

Coxsackie, Chaga's, Lyme disease, rheumatic fever, drug reaction

Front 59

What is arteriosclerosis? What 3 diseases does it encompass?

Back 59

thickening and loss of elasticity of arterial walls
atherosclerosis, arteriolosclerosis, and medial calcific sclerosis

Front 60

What are the steps of intimal hyperplasia post-injury?

Back 60

recruitment of SM to intima --> proliferate --> scarring

Front 61

What is the mechanism of atherosclerosis?

Back 61

Chronic endothelial injury --> cell response --> fattty streak --> macrophages and platelets adhere --> cytokines --> SM hyperplasia --> foam cell formation --> SMCs release cytokines tht produce extracellular matrix

Front 62

What composes a fibrous plaque?

Back 62

SMCs, foam cells, ECM, calcium

Front 63

What are important lab values in atherosclerosis?

Back 63

C-reactive protein, lipid panel, angiogram (segmental vs diffuse disease)

Front 64

What is intimal fibrosis (aka hypertensive arteriolosclerosis)?

Back 64

slow buildup of fibrous tissue in intima w/o lipid deposition, associated w/ aging & accelerated w/ HTN

Front 65

What is hyaline arteriolar sclerosis?

Back 65

Slow build-up of protein (extracellular basement membrane material), associated w/ DM, HTN, post-radiation

Front 66

What is hyperplastic arteriolar sclerosis?

Back 66

Onion skin proliferation of SMC with narrowing of vessel lumen, can result in necrotizing arteriolitis & fibrinoid necrosis of arteries. Associated with malignant HTN

Front 67

What is arteriolosclerosis?

Back 67

Diseases of small unnamed arteries/arterioles; especially affects kidneys (RAAS)

Front 68

What is Monckeberg's medial calcific sclerosis?

Back 68

calcification of media of medium sized arteries
Not a disease, common in elderly, no stenosis or change in wall strength

Front 69

What is the clinical presentation of congenital berry aneurysm? What are the complications?

Back 69

subarachnoid hemorrhage
death or post-rupture spasm of arteries ca cause strokes?

Front 70

How does syphilis lead to an aneurysm? What is the clinical presentation? What is the gross/histological presentation?

Back 70

endarteritis obliterans
aortic regurgitation, cough/rough voice (recurrent laryngeal nerve)
"tree bark" with plasma cells

Front 71

Where doe abdominal aortic aneurysms occur? What is the ruptured AAA triad?

Back 71

below renal arteries where the aorta lacks vasa vasorum
sudden flank pain, hypotension, palpable pulsatile mass

Front 72

What is the risk factors for aortic dissection?

Back 72

cystic medial degeneration, HTN, prgenancy, Marfan's, and Ehlers Danlos

Front 73

What is the clinical presentation of aortic dissection?

Back 73

acute retrosternal pain, aortic regurgitation, widened mediastinum and double barrel aorta

Front 74

What are the complications of aortic dissection?

Back 74

cardiac tamponade, blockage of aortic artery branches

Front 75

Where does temporal (Giant Cell) Arteritis occur? What does it look like histologically? What is the clinical presentation? What is the associated disease?

Back 75

superficial temporal and opthalmic arteries
segmental inflammation with granulomas
jaw claudication --> blindness (untreated)
elevated ESR
Dx: biopsy
treatment: prednisone
Associated: polymyalgia rheumatic

Front 76

Where does Takayasu Arteritis normally occur? What is the histological appearance? What is the clinical presentation?

Back 76

aortic arch vessels and major branches (coronary, carotids, branches to arms)
histology: granulomatous innflammation with giant cells
loss of pulse in upper extremities, pulses in lower are intact.
Seen typically in Jieun and Angela.
May cause coronary artery occlusion.

Front 77

Where does Polyarteritis nodosa occur? What is the pathology? What is the presentation?

Back 77

coronary, renal, mesenteric artieries and spares the pulmonary arteries
Transmural inflammation
ichemia of above arteries with HBsAg.

Front 78

Where does Kawasaki's disease strike? What is the pathology and clinical presentation?

Back 78

coronary artery
neutrophil inflammation
acute febrile illness
desquamating rash, cherry red tongue, abnormal EKG, LAD
Common in 6mo -5 yrs Asian males
Corticosteroids are CI due to coronary artery rupture risk

Front 79

What is Wegener's granulomatosis?

Back 79

upper respiratory tracts, lungs, kidneys
necrotizing vasculitis w/ granulomas
Traid: cough, hemoptusis, and hematuria
sinusitis, penumonia, glomerulonephritis
associated w/ c-ANCA

Front 80

What is microscopic polyangitis?

Back 80

small vessels in skin, also lung, brain, GI.
fibrinoid necrosis, lots of PMNs
palpable purpura, associate with hypersensivity to drugs, infection, immune disease
associated with p-ANCA

Front 81

Thromboangiitis obliternas (Beurger's disease)

Back 81

vessels leading to digits especially tibial and radial arteries
inflammation, thrombosis, grossly manifest as gangrene
ischemic/gangrene fingers. SMOKERS

Front 82

What is the presentation of Raynaud's? What are the disease association?

Back 82

white -> blue -> red
SLE, scleroderma, CREST, Beurger's, cryoglobulinemia

Front 83

What causes varicose veins and what are risk factors? What are complications?

Back 83

loss of competency in leg vein valves --> pooling
obesity, pregnancy, smoking, prolonged standing
stasis changes in skin including pigmentation and ulcers

Front 84

What are the hemangiomas seen in children and adults? What are they?

Back 84

strawberry vs cherry
benign vascular tumors

Front 85

What is a being, pedunculated vascular tumor that bleeds easily? It is associated with estrogen and seen in gingival of pregnant women?

Back 85

pyrogenic granuloma

Front 86

What causes Kaposi's sarcoma?

Back 86

HHV8, seen in AIDS

Front 87

What is angiosarcoma? What is the color?

Back 87

aggressive vascular malignancy seen as brown-red growth

Front 88

What is the difference in protein between nephritic and nephrotic syndrome?

Back 88

3.5g/24 hrs

Front 89

What casts are normal?

Back 89

squamous and hyaline

Front 90

What urinalysis findings indicate cystitis versus pyelonephritis?

Back 90

WBC vs casts

Front 91

What is the BUN:CR of prerenal, renal, and postrenal azotemia?

Back 91

> 15
<15
>15, then <15

Front 92

At what percent of GFR are there clincal signs, renal insufficiency, renal failure, and endstage renal disease?

Back 92

50, 20-50, <25, <5

Front 93

What are the symptoms of uremia, buildup of wastes in renal failure?

Back 93

dehydration, metabolic acidosis, GI bleeding, HTN (salt retention), uremic pericarditis, CHF& PE (secondary to pericarditis), hematopoietic abnormalities [normocytic anemia, platelet dysfunction], bone pain and fracture [loss of Ca and rise in phosphate], neurological (ammonia), and skin changes.

Front 94

What causes granular appearance in kidney EM?

Back 94

immune complex deposition

Front 95

What do the following terms mean in glomerulopathy: proliferative, membranous, and membranoproliferative?

Back 95

> 100 nuclei
thick GBM,
both of the above

Front 96

Which syndome is associated with hypercholesterolemia and anasarca?

Back 96

nephrotic

Front 97

What nephritis follows group A strep infection and results in immune complex deposition and coke colored urine?

Back 97

acute diffuse proliferative glomerulonephritis

Front 98

What are the labs associated with acute diffuse proliferative glomerulonephritis?

Back 98

elevated ASO titer, decrease in complement due to strep infection

Front 99

What are possible causes to idiopathic membranous glomerulonephritis?

Back 99

SLE, lung carcinoma, bee stings, malaria, syphilis, hep B, gold or penicillamine therapy

Front 100

What is the glomerulonephritis associated with spike-dome deposits in EM?

Back 100

idiopathic membranous glomerulonephritis

Front 101

What are the typical labs for SLE?

Back 101

positive ANA, antibody to dsDNA, smith Antigen

Front 102

What glomerulonephritis is characterized by subendothelial deposits with wire looping on EM?

Back 102

diffuse proliferative glomerulonephritis in SLE

Front 103

What nephropathy is characterized by episodic bouts of hematuria that occur shortly after URI, GI, or UTI, may overlap w/ Henoch-Schonlein Purpura?

Back 103

IgA Nephropathy (Berger's disease)

Front 104

What nephropathy has IgA staining on mesangial areas?

Back 104

IgA Nephropathy

Front 105

What diseases are characterized by hemoptysis w/ ARF? What lab results differentiate them?

Back 105

Goodpastures (anti-GBM, linear immunofluorescence)
Wegener's (C-ANCA)

Front 106

What nephropathy has LM crescent in Bowman's space?

Back 106

RPG Rapidly Progressing Glomerulonephritis

Front 107

What disease involves T cell cytokines damaging podocytes allowing albumin to escape (selective proteinuria)?

Back 107

Minimal Change Disease

Front 108

What is the Tx for minimal change disease?

Back 108

steroids, good response w/ children

Front 109

What is the disease association w/ Minimal Change?

Back 109

immunizations, respiratory infection, atopic, Hodgkin's

Front 110

What nephropathy is associated w/ HIV, IV drugs, and recur after kidney transplants sometimes?

Back 110

Focal Segmental Glomerulonephritis

Front 111

What disease is mostly nephrotic with either Hep or C3 nephritic factor? There is a dense, highly proliferative mesangium and Tram tracking in EM?

Back 111

Membranoproliferative glomerulonephritis?

Front 112

What is the first sign of diabetic nephropathy? What basement membranes are affected?

Back 112

microalbuminuria
glomeruli and arterioles (hyalin thickening or arteriolosclerosis)

Front 113

Whatare the two forms of diabetic glomerulopathy?

Back 113

diffuse and nodular

Front 114

What nephrotic syndrome presents with congo red stain and apple green birefringence?

Back 114

amyloidosis

Front 115

What is the mechanism of childhood hemolytic uremic syndrome? What is the typical source of E. coli O157:H7?

Back 115

shiga-like toxin --> DIC and endothelial damage --> fibrin build up --> clogs and cuts up RBCs

raw hamburger and petting zoos

Front 116

What is seen on imaging with childhood hemolytic uremic syndrome?

Back 116

shistocytes and fibrin deposits in glomerulus with clogged vessels

Front 117

What are the 2 sources of bacteria in acute pyelonephritis? What are predisposing factors?

Back 117

lower UT or hematogenously
catheters, instrumentation, stasis, vesicourethral reflux, infection, pregnancy, diabetes

Front 118

What organisms are typical in acute pyelonephritis? what is seen in urinalysis?

Back 118

E. coli, proteus, and klebsiella

WBC casts

Front 119

What causes chronic pyelonephritis? What imaging technique is used for dx?

Back 119

repeated reflux or chronic obstruction --> parenchymal scarring
IV pyelogram

Front 120

What is the MCC of tubular interstitial nephritis?

Back 120

drug induced inflaqmmation Penicillin, NSAIDS, Sulfas

Front 121

What is the presentation of tubular interstitial nephritis?

Back 121

fever, pruritis, eosinophilia, azotemia, oliguria

Front 122

What presents with focal/segmental tubular necrosis? What shows up in labs?

Back 122

ischemic ATN
renal tubular cell casts

Front 123

What presents with damage to early proximal tubule from aminoglycosides, radiocontrast agents or heavy metals?

Back 123

Toxic ATN

Front 124

What is the difference in presentation between benign and malignant nephrosclerosis?

Back 124

hyaline arterioslcerosis and hyperplastic arteriolosclerosis

Front 125

What is the presentation of adult polycystic kidney disease? Where else are cysts? What are the associated diseases?

Back 125

bilateral cysts from birth --> age 40 HTN/ renal failure
cysts are often in liver and pancreas
associated: HTN, berry aneurysms, renal cell carcinoma

Front 126

What is the presentation of juvenile polycystic kidney disease?

Back 126

autosomal recessive, cysts large at birth. In liver --> hepatic fibrosis and portal HTN. associated w/ Potter's sequence.

Front 127

What are simple benign retention cysts?

Back 127

Benign incidentally found cysts. Do not remove = chance of infection

Front 128

What are cortical adenoma?

Back 128

benign proliferation of epithelial cells

Front 129

What is the presentation in renal cell carcinoma? What are major complications?

Back 129

triad: flank pain, hematuria, palpable flank mass
invasion of renal vein, metastasis to lung/bone, paraneoplastic syndrome

Front 130

What is an angiomyolipoma?

Back 130

benign tumor of vessels, smooth muscle, and fat.

Front 131

What is the presenation of Wilm's Tumor?

Back 131

under 10, Chromosome 11, UNILATERAL abdominal mass, HTN, and mricoscopic hematuria

Front 132

What are the causes of hydronephrosis?

Back 132

congenital obstructions, urinary calculi, BPH, tumors, inflammation, pregnancy, and spinal cord damage

Front 133

What are staghorn or struvite stones made of?

Back 133

ammonia, magnesium, phosphate

Front 134

What stones are translUcent on X-ray and associated with gout?

Back 134

uric acid stones

Front 135

What diseases always presents with always presents with dysuria (urgency, frequency, irritation, obstruction); acute disease also has fevers/chills & chronic disease has low back or pelvic pain?

Back 135

prostatitis

Front 136

What presents with enlarged, tender, boggy prostate?

Back 136

prostatits

Front 137

What are risk factors for BPH?

Back 137

age, ↑testosterone

Front 138

What will likely present with both obstructive and irritative symptoms and a rubbery prostate?

Back 138

BPH

Front 139

What are complications of BPH?

Back 139

o Compression of urethra --> postrenal azotemia, bladder hypertrophy, diverticuli
o Urinary retention and stasis --> increased risk of UTI/stones

Front 140

What is the treatment of BPH?

Back 140

o Finasteride (5α-reductase inhibitor): inhibits peripheral conversion of T to DHT
o α-blockers: helps to relax bladder spincter and urethra
o Transurethral resection of prostate (TURP)

Front 141

Metastasis via Obturator lymph nodes, then spine via Batson’s venous plexus

Back 141

Adenocarcinoma of prostate

Front 142

OsteoBLASTIC lesions (vs osteoLYTIC lesions in metastatic breast/lung)

Back 142

adenocarcinoma of prostate

Front 143

What is the DRE with adenocarcinoma of prostate cancer?

Back 143

rock hard

Front 144

What is the result of untreated ureter obstruction? What are intrinsic and extrinsic causes?

Back 144

• If unrelieved, will result in hydronephrosis
• Intrinsic causes: calculi, strictures, tumor masses, blood clots, neurogenic causes
• Extrinsic causes: pregnancy, retroperitoneal fibrosis, endometriosis, tumors

Front 145

What is the presentation for all bladder cancers?

Back 145

painless hematuria

Front 146

What is a benign papillary stalk from a single transitional cell in the bladder?

Back 146

Papilloma

Front 147

What are the risk factors for transitional cell carcinoma (bladder)?

Back 147

smoking, Azo/Aniline dyes, Cyclophosphamide (chemo drug)

Front 148

Which grade expresses ABH antigen and is diploid?

Back 148

transitional cell carcinoma

Front 149

What is a risk factor for Squamous Cell Carcinoma?

Back 149

Schistosoma haematobium infection

Front 150

What is a risk factor for adenocarcinoma?

Back 150

extrophy of bladder

Front 151

What are predisposing factors to acute cystitis? What are the bacteria?

Back 151

o Females (due to short urethra)
o Stasis (BPH in males, neurogenic bladder, etc)
o Catheterization: this is the MC hospital acquired infection

Proteus, Klepsiella, Enterobacteria, Candida, Chlamydia

Front 152

What is the presentation of acute cystitis? What are complications? What makes it hemorrhagic?

Back 152

lower abdominal pain, dysuria (without fever/chills or flank pain)

acute pyelonephritis

SE of cyclophosphamide or cytoxin

Front 153

What is extrophy of the bladder associated with? What is it a risk factor for?

Back 153

epispadias
infection and bladder adenocarcinoma

Front 154

What are hypospadias associated with?

Back 154

inguinal hernias

Front 155

What are the sores associated with syphilis?

Back 155

chancre or condyloma lata

Front 156

What causes Condyloma accuminata?

Back 156

HPV

Front 157

What is Bowen’s disease (carcinoma-in-situ) associated with?

Back 157

HPV

Front 158

What is a Bowenoid papulosis?

Back 158

multiple pigmented reddish-brown lesions; associated with HPV 16
Does not progress to squamous cell carcinoma

Front 159

Penial angiofibroma

Back 159

Benign penile plaques which develop in adolescence and persist

Front 160

Where does Squamous Cell Carcinoma of the penis spread?

Back 160

inguinal and iliac lymph node

Front 161

What is the presentation of testicular torsion?

Back 161

tender & one is higher than the other (vs. epididymitis – equal height)
Loss of cremasteric reflex (tickle the leg)

Front 162

What is hydrocele and how do you dx?

Back 162

accumulation of fluid around the testicle; MCC of scrotal enlargement
• Diagnosis: transillumination or ultrasound to distinguish from blood or mass

Front 163

What is variocele, how does right and left differ?

Back 163

dilated veins (like varicose veins of the scrotum), described as a “bag of worms”
• Left-sided varicocele can occur from obstruction of L renal vein or L gonadal vein
• Right-sided varicocele occurs from obstruction of R gonadal vein only

Front 164

What metastasizes to para-aortic lymph nodes?

Back 164

testicular tumors

Front 165

What do you never do a needle biopsy with?

Back 165

testicular cancers

Front 166

What stromal sex cord tumors make androgens and which make estrogen?

Back 166

Sertoli-Leydig cells: androgens --> masculinization, but usually asymptomatic in males
Granulosa-thecal cells: estrogens --> feminization, gynecomastia in males

Front 167

What germ cell tumor is radiosensitive?

Back 167

seminoma

Front 168

What is a potential downside to lytics post-MI?

Back 168

reperfusion injury

Front 169

Who doesn't feel pain with MIs?

Back 169

elderly, diabetics. Wilford Brimley

Front 170

When does autoimmune pericarditis occur?

Back 170

6-8 weeks post MI

Front 171

What is the presentation of Rheumatic fever?

Back 171

joints, heart, nodules, erythema marginatum, syndenham's chorea

Front 172

What causes marantic endocarditis?

Back 172

paraneoplastic syndrome from mucin secreting tumors of colon and pancreatic cancer

Front 173

What is libaman-sack's endocarditis caused by?

Back 173

SLE

Front 174

What are complications of atherosclerosis?

Back 174

lumen stenosis, thrombosis, embolizaiton, hemorrhage, ruptured aneurysm

Front 175

22 year old. Facial swelling. Leukocytosis, High cholesterol and ALBUMIN in urine. Nephrotic. Elevated Sed rate.
Light microscope shows normal looking glomerulus and immunofluorescence was negative. EM shows effacement of podocytes.

Back 175

Minimal change disease
Tx: steroids

Front 176

Symptoms within a month. Elevated BUN, leukocytosis, and low creatinine. Oliguria. Leukocyte esterase positive.
RBCs casts.
Linear immunofluoresence.
light microscopy shows crescentic glomerulonephritis

Back 176

Goodpasture's
Tx: plasmapharesis + immunosuppressive drugs

Front 177

Hx: URI. The light microscopy images show first some increase in cells in the mesangial areas and in the second image a segmental lesion in a glomerulus. The immunofluorescent staining with anti-IgA is characteristic for this abnormality.

Back 177

IgA nephropathy (Berger's)

Front 178

"Abnormal test" after rountine exam. The cholesterol is elevated, albumin decreased and the 24 hour urine excretion of protein is 3.8 gms. The light microscopy shows marked diffuse thickening of the capillary loop basement membranes with no increase in cellularity. The immunofluorescent staining with anti-IgG shows a characteristic granular pattern (as opposed to the linear pattern in case 2). The electron microscopy photo shows the dense deposits in the characteristic 'spike-dome' pattern in the sub-epithelial area.

Back 178

Diagnosis: Membranous Glomeropathy, (refer to your notes or book for possible causes)
Tx: steroids/antirejection/ACE-I/statins?

Front 179

This 6 year-old girl was thought to have a gastrointestinal or flu-like illness by the mother which began about 24 hours prior to admission. The mother also though her urine color was "dark or bloody." Her urine output has been sparse. Three other of her school friends were also quite ill. They had all recently gone on a school trip to a petting farm. leukocytosis, increased BUN and creatinine, with obvious oliguria. What little urine which can be examined is bloody. The light microscopy shows a typical thrombotic micro-angiopathy (consumption coagulopathy, microangiopathic anemia, DIC). The lumens of capillary loops as occluded by fibrin thrombi, trapping RBCs and causing their fragmentation (schistocytes). The arteriole near the hilar area is almost completely occluded. The glomerulus will infarct and there will be wide areas of cortical necrosis because of this.

Back 179

Diagnosis: Hemolytic Uremic Syndrome
Tx: supportive care --> transplant probably (fucking heartbreaking)

Front 180

A 61 year old female admitted for impaired renal function. She had recently been bothered by pain in her knees and started taking some ibuprofen. A week before admission, after she had begun the ibuprofen, she noted some pruritis. The day of admission she had vomited several times and noted marked fatigue. She also noted a decrease in urine output.

Back 180

Interstitial Nephritis

Front 181

What are the marker of all of the germ cell tumors?

Back 181

seminoma: hCG (10%)
choriocarcinoma: hCG (all+gynemastia)
yolk sac tumor: Schiller-Duvali (AFP)
embryonal carcinoma (buly w/ hemorrhage and necrosis) hCG and AFP

Front 182

What can cause left variocele?

Back 182

obstruction of left renal or gonadal vein
(compare to right, where gonadal vein comes straight off IVC)