Path Ii Final

Front 1

Causes of chronic blood loss?

Back 1

Menstraution, pregnancy, GI bleeding

Front 2

Microcytic hypochromic anemia? (3)

Back 2

1. Chronic blood loss
2. Fe deficiency anemia
3. Beta thalassemia minor

Front 3

Characteristics of hemolytic anemias? (4)

Back 3

1. Increase RBC destruction
2. Retention of RBC products (hemosiderosis)
3. Hypercellularity of BM (Increased EPO)
4. Extramedullary hematopoeisis

Front 4

Hemolytic Anemias (6)

Back 4

1. Hereditary spherocytosis
2. Sickle cell anemia
3. Thalassemias
4. G6PD Deficiency
5. Immunohemolytic anemia
6. Erythroblastosis Fetalis

Front 5

Anemias of diminished erythropoiesis? (30

Back 5

1. Iron deficiency anemia
2. Megaloblastic anemias (Folate & Vit B12 deficiency)
3. Aplastic anemia

Front 6

Inherited anemias? (4)

Back 6

1. Hereditary spherocytosis- Dominant
2. Sickle cell- Codominant
3. Thalassemias- Codominant
4. G6PD Deficiency- X chromosome?

Front 7

Severe decrease in neutrophils w/ WBC total <1000

Back 7

Agranulocytosis

Front 8

Infectious mononucleosis caused by?

Back 8

EBV (Herpes)

Front 9

Infectious mono is what type of disease?

Back 9

Reactive leukocytosis (Increase WBC count)

Front 10

Positive heterophile reaction is diagnostic for what disease?

Back 10

Infectious mono

Front 11

Site of origin of lymphomas?

Back 11

Lymph nodes, spleen, lymphoid organs

Front 12

Proliferation of what cell type in lymphomas?

Back 12

Lymphocytes, histocytes

Front 13

Non-Hodgkin Lymphoma usually start in which tissue & what cell origin?

Back 13

Non-Hodgkin Lymphoma = Lymph nodes & B cell origin

Front 14

Starry-sky pattern seen in?

Back 14

Burkitt Lymphoma (NHL)
*Most rapidly growing cancer
*Head & neck cancer

Front 15

Reed-Sternberg cell (owl eyes) is diagnostic for which disease?

Back 15

Hodgkin Lymphoma

Front 16

Most common Hodgkin lymphoma?

Back 16

Nodular sclerosis
*Commen in women
*Best prognosis of hodgkin lymphomas

Front 17

Site of origin of leukemias? & Cell types?

Back 17

Leukemia
Site of origin= Bone marrow
Cells= hematopoietic stem cells (granulocytes, lymphocytes)

Front 18

What is the most common leukemia?

Back 18

Acute lymphoblastic leukemia
(Precursor B-cell Lymphoblastic Leukemia)

Front 19

Philadelphia crhomosome seen in pts w/ what disease?

Back 19

Chronic Myelogenous Leukemia

Front 20

Clinical Manifestations of acute leukemias?

Back 20

1. Anemia (pancytopenia- low RBC & WBC)
2. Infections (Leukopenia)
3. Bleeding problems (thrombocytopenia)

Front 21

Most common plasma cell dyscrasia?

Back 21

Multiple myeloma

Front 22

Punched out lesions radiographically?

Back 22

Multiple myeloma

Front 23

Bence-Jones proteins (abnormal Ab spilled in urine)

Back 23

Multiple myeloma

Front 24

Scurvy is an example of a disease that causes bleeding disorder due to?

Back 24

Increased fragility of blood vessels --> NOT a problem w/ platelets or coagulation

Front 25

Dcreased number of platelets?

Back 25

Thrombocytopenia (< 100,000)
*Spontaneous & excessive bleeding
*Prolonged bleeding time
*NORMAL coagulation times

Front 26

What is immune thrombocytopenia purpura?

Back 26

Autoimmune disease w/ IgG anti-platelet Abs

Front 27

DELAYED onset of beeding is characteristic of which disease?

Back 27

VW Disease
*Dominant
*Prolonged PTT time, normal coagulation

Front 28

Spontaneous bleeding is characteristic of which type of bleeding disorder?

Back 28

Platelet deficiency or dysfunction

Front 29

MASSIVE HEMORRHAGE due to trauma/surgery & ABSENCE OF SPONTANEOUS bleeding?

Back 29

Hemophilia
*X-linked recessive
*Prolonged partial thromboplastin time

Front 30

What is the mechanism of Coumadin?

Back 30

INDIRECT acting anticoagulant
*Competitvely INHIBITS VIT K
* Decreased synthesis of II, VII, IX & X
*Prolonged PT test
*Don't treat > 3.5 INR

Front 31

Mechanism of Aspirin?

Back 31

IRREVERSIBLY binds platelets
*INHIBITS synthesis of TXA2

Front 32

Mechanism of Ibuprofen?

Back 32

REVERSIBLY binds platelets
(Inhibts syntehsis of TXA2)

Front 33

Which analgesic is often prescribed because it is not associated w/ bleeding problems?

Back 33

Acetominophen

Front 34

Ranking of acquired risk factors for atherosclerosis? (4)

Back 34

1. Hyperlipidemia
2. Hypertension
3. Smoking
4. Diabetes

Front 35

Sites of predilection of atherosclerosis (6)

Back 35

1. Lower abdominal aorta
2. Coronary arteries
3. Popliteal arteries
4. Descending thoracic aorta
5. Internal carotid arteries
6. Circle of willis

Front 36

Vasculitis syndromes w/ head & neck manifestations? (3)

Back 36

1. Wegener granulomatosis
2. Giant cell arteritis
3. Kawasaki disease
NOT:
-Polyarteritis nodosa
-Thromboangitis obliterans

Front 37

Classic triad of ???
NECROSIS of:
1. Upper &/or lower resp tract
2. Small arteries & veins
3. Glomerulonephritis

Back 37

Wegener granulomatosis
*c-ANCA
*granulomatous inflammation

Front 38

Disease seen in young men smokers w/ hypersensitivity rxn to cig smoke producing severe pain in extremities w/ gangrene?

Back 38

Thromboangitis obliterans

Front 39

Congenital aneurysm due to developmental weakness of vessel wall?

Back 39

Berry aneurysm-- Circle of willis

Front 40

Atherosclerotic aneurysm occurs where?

Back 40

Abdominal aorta

Front 41

Tree barking of intima of aorta occurs in?

Back 41

Syphilitic aneurysm (thoracic aorta)
Tertiary syphillis

Front 42

Most important contributing factor to aortic dissection?

Back 42

Hypertension --> tear in intima due to blunt trauma (Thoracic aorta)

Front 43

Systemic hypertension is defined as?

Back 43

BP > 140/90

Front 44

Formula... BP =?

Back 44

Blood pressure =
Cardiac output x Peripherial resistance

Front 45

Hyaline arteriolosclerosis & hyperplastic arteriolosclerosis go w/ which clinic pattern of hypertension?

Back 45

Hyaline -- Benign hypertension
Hyperplastic -- Malignant hypertension

Front 46

Masses of endothelial lined vascular channels filled w/ blood?

Back 46

hemiangiomas
(hamartomas --> developmental)

Front 47

Kaposi sarcoma is associated w/ which HHV?

Back 47

HHV 8

Front 48

Loss of lung volume due to inadequate expansion of air spaces? (4)

Back 48

Atelectasis
1. Resorption- obstruction
2. Compression-accumulations cause collapse
3. Microatelectasis- Never inflated
4. Contraction-fibrosis

Front 49

What are the obstructive lung diseases? (4)

Back 49

Limitation of airflow to due increased resistance
1. Asthma-
COPD
2. Emphysema
3. Chronic bronchitis
4. Bronchiectasis

Front 50

What are the restrictive lung diseases? (1)

Back 50

Reduced expansion & total lung capacity
1. Sarcoidosis

Front 51

Extrinsic vs. Intrinsic asthma

Back 51

EXTRINSIC- IgE type I hypersensitivity
-2 yrs
-Other allergic rxns
-Positive family history
-Less severe
INTRINSIC-Triggering stimuli
-Defect in autonomic reg (non-immune)
-Adult
-More persistent & severe

Front 52

Most common form of COPD?

Back 52

Emphysema & chronic bronchitis together "blue bloaters"

Front 53

Barrel chest, dyspnea, hyperventilation & prolonged expiration?

Back 53

Pink puffer-- pure emphysema

Front 54

Cough w/ purlent sputum, less dyspnea, less hyperventilation, hypoxia, cyanosis?

Back 54

Blue bloater- chronic bronchitis & emphysema

Front 55

Persistent productive cough w/ sputum for 3 consecutive months in 2 consecutive years?

Back 55

Chronic bronchitis

Front 56

Mucus plugs are found in which lung diseases? (4)

Back 56

1. Chronic bronchitis
2. Cystic fibrosis
3. Asthma
4. Bronchiectasis
NOT EMPHYSEMA

Front 57

Potato nodes seen on chest x-rays (hilar & paratracheal nodes in head & neck) in which disease?

Back 57

Sarcoidosis
(head & neck- dry mouth)

Front 58

Which organisms cause lobar pneumonia? (2)

Back 58

1. Strep- Most common
2. Klebsiella

Front 59

Which organisms are associated w/ nosocomial infection of pneumonia?

Back 59

1. Staph
2. Pseudomonas

Front 60

Most common cause of primary atypical pneumonia?

Back 60

1. Mycoplasma (children & young adults)
2. RSV (infants)

Front 61

Ghon focus is pathognomonic for which disease?

Back 61

Primary TB
*Asymptomatic

Front 62

Which percentae of people get secondary TB?

Back 62

5%

Front 63

Develops when microorganisms spread through pulonary drainage into systemic circulation?

Back 63

Systemic miliary TB

Front 64

Low grade fever, night sweats & weight loss associated w/?

Back 64

Secondary TB

Front 65

Most common bronchiogenic carcinoma?

Back 65

Adenocarcinoma
*Women >40
*Non-smokers
*Best prognosis

Front 66

Which bronchiogenic carcionma is most likely to produce ectopic homrones?

Back 66

Small cell carcinoma
(All bronchiogenic carcinomas can produce ectopic hormones but small cell is MOST likely)

Front 67

Worst prognosis of all lung cancers?

Back 67

Malignant mesothelomia (asbestos exposure)

Front 68

Worst prognosis of bronchogenic carcinomas?

Back 68

Small cell carcinoma

Front 69

Elevated BUN & creatinine?

Back 69

Azotemia

Front 70

Azotemia (always present), edema/dehydration, metabolic acidosis, hyperkalemia, hypocalcemia, Decreased renin & EPO, N/V/A, fibrinous preicarditis, uremic encephalopathy all associated w?

Back 70

Uremia

Front 71

Defining characteristics of nephrotic syndrome (4)

Back 71

1. Massive proteinuria
2. Hypoalbuminemia
3. Generalized edema
4. Hyperlipidemia & hyperlipiduria

Front 72

Defining characterstics of nephritic syndrome? (3)

Back 72

1. Hematuria
2. Oliguria & azotemia
3. Hypertension

Front 73

Acute proliferative glomerulonephritis is associated with previous infection w/?

Back 73

Strep

Front 74

Most common form of end stage renal disease?

Back 74

Chronic glomerulonephritis

Front 75

Most common way to get acute pyelonephritis? (inflammation of kidney & renal pelvis)

Back 75

Asceding infection of E. coli

Front 76

Most common cause of chronic pyelonephritis?

Back 76

Reflux nephropathy-- congenital vesicoureteral incompetence

Front 77

Most common cause of acute renal failure?

Back 77

Acute tubular necrosis

Front 78

Autosomal dominant polycystic kidney disease found in?

Back 78

Adults--

Front 79

Autosomal recessive polycystic kidney disease found in?

Back 79

Kids (congenital)-- poor prognosis

Front 80

Mechanism of urolithiasis?

Back 80

Supersaturation of urine (ost commonly calcium oxalate) causing PAIN, hematuria

Front 81

Dilation of renal pelvis & calyces w/ atrophy of parenchyma caused by obstruction of urine outflow?

Back 81

Hydronephrosis

Front 82

Most common causes of hydronephrosis

Back 82

1. Nodular hyperplasia of prostate
2. Kidney stones

Front 83

Most common tumor of kidney parenchyma?

Back 83

Renal cell carcinoma

Front 84

Malignant parenchymal tumor in kidneys of kids

Back 84

Wilms tumor- good prognosis

Front 85

Most common tumor of urinary collecting system?

Back 85

Transitional cell carcinoma

Front 86

#1 contributing factor for transitional cell carcinoma?

Back 86

Smoking
(renal carcinoma too)

Front 87

Defect in diaphragm allowing stomach to pouch through?

Back 87

Hiatal hernia

Front 88

Failure of cardiac sphinter to relax causing functional obstruction?

Back 88

Achalasia

Front 89

Dilated & tortous veins in lower esophagus which are caused by portal hypertension leading to massive hematemsis on rupture?

Back 89

Esophageal varices

Front 90

Replacement of normal stratified squamous epithelium of distal esophagus by metaplastic columnar epithelium w/ goblet cells?

Back 90

Barrett esophagus (long standing GERD)

Front 91

Most common esophageal carcinoma?

Back 91

Adenocarcinoma

Front 92

Risk factors for adenocarcinoma of esophagus?

Back 92

GERD & Barret esophagus
Distal 1/3

Front 93

Risk factors for squamous cell carcinoma of esophagus? (5)

Back 93

1. Slowed passage of food
2. Tobacco/alcohol
3. Plummer-vinson syndrome
4. Nitrosamines in diet
5. Vitamin & mineral deficiencies
Middle 1/3

Front 94

Major causes of chronic gastritis? (2)

Back 94

1. H. pylori
2. Pernicious anemia

Front 95

Morphology of chronic gastritis? (3)

Back 95

1. Chronic inflammation
2. Mucosal atrophy
3. Intestinal metaplasia

Front 96

Where does peptic ulcer disease most commonly occur?

Back 96

First part of duodenum

Front 97

Causes of intestinal type of gastric carcinoma?

Back 97

Diets- nitrates, smoked, pickled, salty foods
Chronic gastritis- H pylori, pernicious anemia

Front 98

Types of malabsorption syndromes?

Back 98

1. Defective intraluminal digestion-CF, bile obstruction
2. Primary mucosal cell abnormalities- lactose intolerance
3. Reduced SA- celiac disease, short gut, Chrohn disease
4. Infection- Tropical sprue & whipple disease

Front 99

Immunologic rxn to gluten causing flattening of villi and loss of surface area for absoprtion?

Back 99

Celiac disease

Front 100

Ectopic hormone production of which neoplasm of small intestine?

Back 100

Carcinoid tumor

Front 101

Segmental involvement w/ skip lesions and ruber hose consistency of bowel is seen in which disease?

Back 101

Crohn disease

Front 102

Which inflammatory bowel disease has greater risk of GI cancer?

Back 102

Ulcerative colitis

Front 103

Signs & Symptoms of inflammtory bowel diseasses?

Back 103

Crohn disease- Recurrent diarrhea w/ pain, malabsorption
Ulcerative colitis- Bloody mucoid diarrhea & pain releived by defecation

Front 104

Differences between Crohn disease & ulcerative colitis?

Back 104

ABSENT IN ULCERATIVE COLITIS:
*Granulomas
*No skip lesions
*rarely extend below submucosa
*Little fibrosis (rubber hose)
*No mucosal thickening
GREATER RISK OF GI CANCER in ULCERATIVE COLITIS

Front 105

Most likely place to see diverticulum in GI?

Back 105

Colon

Front 106

Risk factors of colorectal carcinoma? (3)

Back 106

1. Diet- fatty, low vitamins, refined carbs
2. Adenomatous polyps- risk is proportional to number of polyps
3. NSAIDS reduce risk

Front 107

Earliest sign of colorectal carcinoma?

Back 107

Occult blood in stool (iron def anemia as result)

Front 108

Which form of biliruibin is lipid soluble, toxic, tightly bound to albumin & cannot be excreted in urine?

Back 108

Unconjugated bilirubin

Front 109

Hemolytic anemias, Gilbert syndrome, Crigler Najjar, physiologic jaundice of newborn all have elevated levels of which form of bilirubin?

Back 109

Unconjugated

Front 110

Clinical findings of liver failure (6)

Back 110

1. Jaundice
2. Fetor hepaticus
3. Hypogonadism, gynecomastia, palmar erythema, spider angiomas
4. Coagulopathy
5. Weight loss, muscle wasting
6. Peripheral edema
7. Increase risk of multiorgan failure

Front 111

Lab findings of liver failure? (6)

Back 111

1. Elevated bilirubin
2. Hyperestrogenemia
3. Decrease coag factors
4. Hypoglycemia & hypolipidemia
5. Hypoalbuminemia
6. Hyperammoneia

Front 112

Late findings of liver failure? (2)

Back 112

-Hepatic encephalogy (toxins to brain)
-Hepatorenal syndrome (renal failure)

Front 113

Causes of cirrhosis? (7)
Ranked order

Back 113

1. Alcoholic liver disease
2. Hepatitis
3. Biliary disease
4. Hemochromatosis
5. Wilsin disease
6. alpha1-antritrypsin def
7. Cryptogenic cirrhosis-unknown

Front 114

Most commmon cause of portal hypertension/

Back 114

Cirrhosis

Front 115

Clinical manifestations of portal hypertension? (6)

Back 115

1. Ascities
2. Hemorroids
3. Esophageal varicies
4. caput medusae
5. Splenomegaly
6. hepatic encephalopathy

Front 116

Greatest new cases of hep a year?

Back 116

Hep B , C, A

Front 117

Greatest rate of asymptomatic infection of hep?

Back 117

Hep C, B A

Front 118

Highest rate of chronic infection of hep?

Back 118

Hep C, B (NOT A)

Front 119

Highest total of chronically infected people w/ hep?

Back 119

Hep C, B

Front 120

Longest & shortest incubation periods of hep?

Back 120

Long- B, short- A

Front 121

+ IgG anti HAV?

Back 121

Past exposure or infection of Hep A --> Long term immunity

Front 122

Pt w/ acute hep B will test + for?

Back 122

IgM anti-HBc

HBsAg

Front 123

Past infection of Hep B is indicated by +?

Back 123

IgG anti-HBs

High titers confer immunity
Persists for life

Front 124

+ IgG anti-HBs would indicate?

Back 124

Pt who had hep B

Front 125

First detectable Ag in Hep B?

Back 125

HBsAg

Front 126

First detectable Ab in Hep B?

Back 126

IgM anti-HBc

Front 127

High titers of which Ab confer immunity in hep B?

Back 127

IgG-anti-HBs

Front 128

+ anti-HCV?

Back 128

Past infection of Hep C

Need to do further testing to see if it is current infection or carrier

Front 129

3 patterns of alcoholic liver disease?

Back 129

1. Hepatic steatosis- reversible, asymptomatic
2. Alcoholic hepatitis- acute, binge drinking, Mallory bodies
3. Cirrhosis -Irreversible

Front 130

Most common disease w/ inborn error of metabolism?

Back 130

Gilbert syndrome
*Def f glucuronyl transferase
*More yellow than sick
*Hemolytic anemia

Front 131

Kernicterus is found in which inborn errror of metabolism?

Back 131

Type I Crigler Najar

Front 132

Reye syndrome characterized by fatty change in liver & encephalopathy due to?

Back 132

Aspirin follwing virus --> NO JAUNDICE

Front 133

Metastic tumors are most common malignancy in which organ systems?

Back 133

1. Lungs
2. Liver
3. Bone

Front 134

Most commmon primary carcinoma of liver?

Back 134

Hepatocellular carcinoma

Front 135

3 contributing factors to hepatocellular carcinoma?

Back 135

1. Cirrhosis
2. Hep B & C
3. Aflatoxin B

Front 136

alpha-fetoprotein is used to screen for which disease?

Back 136

Hepatocellular carcinoma

Front 137

Risk factor for calcium bilirubinate choleliths?

Back 137

Hemolytic anemia

Front 138

Major cause of acute cholecystitis?

Back 138

Infection (enteric bacteria)

Front 139

Major cause of chronic cholecystitis?

Back 139

Chemical injury by supersaturated bile

Front 140

Major contributing conditions for acute pancreatitis?

Back 140

Alcoholism & gallstones

Front 141

Elevated serum amylase & lipase?

Back 141

Acute pancreatitis

Front 142

Carcinoma of pancreas

Back 142

Smokers, poor prognosis 2%

Head of pancreas = most common

Pain is first symptom but not until advanced stage

Front 143

Ranked order of risk factors for breast carcinoma? (Highest to lowest) (5)

Back 143

1. Lobular carcinoma in situ
2. Proliferative disease w/ atypical hyperplasia
3. First degree relative, Nulliparious, First birth after 35
4. Menopause >55
5. Menarche <12

Front 144

Most common type of breast cancer?

Back 144

Infiltrating ductal carcinoma

Front 145

Best prognosis of breast cancer?
Worst?

Back 145

BEST: Ductal carcinoma in situ, Best invasive-medullary carcinoma
WORST: Paget disease of breast

Front 146

Shift in androgens to dihydrotesterone in men in > 40s will cause?

Back 146

Nodular hyperplasia of prostate

Front 147

Signs & symptoms of NHP/BPH?

Back 147

1. Hesitancy
2. Interuption
3. Incomplete voiding of bladder

Front 148

Risk factors for testicular cancers?

Back 148

1. Cryptorchidism
2. Klifefelter
3. First degree relative
4. Contralateral testis

Front 149

Testicular cancer that is most common & has best prognosis?

Back 149

Seminoma

Front 150

Most common tumor of adult women?

Back 150

Leiomyomas

Front 151

Most common cancer of female genital?

Back 151

Endometrial carcinoma

Front 152

Risk factors of endometrial carcinoma?

Back 152

Increased unopposed estrogen
Obesity, infertility, diabetes, hypertension
Endometrial hyperplasia

Front 153

Worst prognosis cancer of female genitals?

Back 153

Ovarian cancer
Serous type-most common

Front 154

Precursor for chorocarcinoma in females?

Back 154

Hydatidiform mole

Front 155

Anterior pit disturbances are most commonly due to?

Back 155

Functional pit adenoma

Front 156

Gigantism is an excess of which hormone? (produced by which organ? Age of onset?

Back 156

Excess GH from ant pit
Kids-Before skeletal growth complete

Front 157

Acromegaly excess of which hormone? form which organ? Age?

Back 157

Excess GH from ant pit
Adults-after growth is complete
-Continued elongation of mand
-Can also have had gigantism

Front 158

Hypothyroidism, hypogonadism, adrenal insufficiency, poor tissue maintenance (men), amenorrhea & inferfitility (women) is?

Back 158

Panyhypopituitarism
-Sheehan syndrome
-Empty sella syndrome

Front 159

Diabetes insipidus is deficiency of which homrone?
What are signs & symptoms? (3)

Back 159

DEFICIENCY of ADH
-Polyuria
-Polydipsia
-Dehydration/electrolyte imbalance

Front 160

Most common disease to cause thyrotoxicosis?

Back 160

Graves disease

Front 161

Signs & symptoms of thyrotoxicosis?

Back 161

INcreased metabolic rate:
-Heat intolerance, warm sweaty
-weight loss
-Nervous, emotional, tremors, weak
-Tachycardia, dyspnea, palapitations
-Diarrhea

Front 162

Mental retardation, growth retardation, delayed tooth eruption present in infants & young children?

Back 162

Cretinism (low thyroid hormone)

Front 163

cool, rough, doughy skin along w/ decreased metabolic rate & slowed speech & movement is found in which endocrine disease state?

Back 163

Myxedema

Front 164

Gland looks more like LN than thyroid tissue?

Back 164

Hashimoto thyroiditis

Front 165

All pts have early euthryoid --> SOME thyrotoxicosis & ALL have hypothyroidism?

Back 165

Hashimoto thyroiditis

Front 166

Diseases which may have thyrotoxicosis? (5)

Back 166

1. Hashimoto thyroiditis?
2. Subacute granulomatous thyroiditis?
3. Subacute lymphocytic thyroiditis (Y)
4. Graves disease(Y)
5. Toxic multinodular goiter (Y)

Front 167

Diseases w/ permanent myxedema? (4)

Back 167

1. Hashimoto (permanent)
2. Subacute granulomatous thyroiditis (some)
3. Subacute lymphocytic thyroiditis (some permanent)
4. Simple colloid goiter (some)

Front 168

Most common thyroid adenoma?

Back 168

Follicular thyorid adenoma

Front 169

Which cancer of thyroid is strongly linked to previous head &neck irradiation?

Back 169

papillary carcinoma of thyroid

Front 170

Ectopic hormone production? 3

Back 170

1. Small cell carcinoma of lung
2. Carcionoid tumor of small intestine
3. Medullary carcinoma of thyroid

Front 171

Primary parahyperthyroidism

Back 171

HYPERCALCEMIA
moans, groans, stones, bones

Front 172

Seondary parathyroidism

Back 172

Bones & stones

Front 173

What causes cushing syndrome & sign/symptoms?

Back 173

EXCESS CORTISOL
-truncal obesity
-moon facies
-HYPERtension
-muscle weakness
-hirsutism, amenorrhea, mental disturbance

Front 174

Addison disease

Back 174

chronic def of cortisol (autoimmune)--> hypotension & hypoglycemia, bronzing of gingiva

Front 175

Acute adrenocortical insufficiency

Back 175

Sudden & severe def of cortisol
Waterhouse-Friderischen- meningococcal septicemia

Front 176

Phlemochrocytoma signs and symptoms are due to?

Back 176

Norepi & epi

Front 177

Highly malignant neoplasm in kids derived from sympathetics?

Back 177

Neuroblastoma

Front 178

What is the limiting factor to RBC replacement in chronic blood loss?

Back 178

Depletion of Fe
-Chronic blood loss results in Fe deficiency pattern

Front 179

Lab results of Fe deficiency anemia typically present as?

Decreased Hb, MCV

Back 179

Microcytic hypochromic

Front 180

Anemias due to shortened survival of RBC that may be inherited or acquired

Back 180

Hemolytic anemias

Front 181

Plummer vinson syndrome typically presents w/ what 3 features?

Back 181

1. Atrophic glossitis
2. Hypochromic microcytic anemia
3. Esophageal webs

Front 182

Ratio of packed RBCs to total blood volume is known as?

Back 182

Hematocrit

Front 183

What are the characteristics of ALL hemolytic anemias? (3)

Back 183

1. Increased RBC destruction
2. Accumulation of Hb degredation products
3. Elevated EPO (hypercellularity of BM)

Front 184

What defect is present in HEREDITARY SPHEROCYTOSIS?

Back 184

Defiency of spectrin molecules (protein that forms skeleton of RBC)

-Spheroidal, less deformable --> vulnerable to sequestration in spleen

Front 185

Normal HbA is replaced by what in pts w/ sickle cell disease?

Back 185

HbS
-Substiution of Val for Glu at 6th position in beta chain

Front 186

What are the major problems of sickle cell disease due to?

Back 186

Low O2--> Increased blood viscosity & stasis or occlusion in microvasculature --> Ischemic damage --> painful vaso-occlusive crisis

Front 187

How many genes are responsible for making alpha & beta globins?

Back 187

2 genes for 2 alpha globin
1 gene for 2 beta globin

Front 188

What is the defect of beta thalassemia?

Back 188

-Splicing variation of mRNA --> non-production or reduced production of beta-globin
PRECIPITATION OF ALPHA CHAINS

Front 189

Hereditary spherocytosis presents with what lab findings?

Back 189

Hyperchromic microcytic

Front 190

Beta-thalassemia presents with what lab findings?

Back 190

Hypochromic microcytic

Front 191

What causes alpha-thalassemia?

Back 191

Gene deletion of 1-4 genes coding for alpha
-Excessive gamma (barts Hb) or beta (HbH)

Front 192

Which form of alpha-thalassemia is asymptomatic & has no RBC abnormality?

Back 192

Silent carrier state- 1 alpha gene deletion

Front 193

Which form of alpha-thalassemia is similar to beta thalassemia minor- generally healthy w/ microcytosis?

Back 193

2 gene deletion (Alpha thalassemia trait)

Front 194

Severe form of alpha thalassemia in which beta chains associate in groups of 4 producing HbH- damages RBC membrane & triggers hemolysis?

Back 194

Three gene deletion (HbH disease)

Front 195

Which form of alpha thalassemia is lethal in utero or shortly after birth unless detected & forms groups of 4 gamma chains called Hb Barts?

Back 195

Hydrops fetalis- 4 gene deletion

Front 196

Enzyme abnormalities of hexose monophosphate shunt or glutathione metabolism resulting in an inability to protect RBC from oxidative injury?

Back 196

Glucose-6-Phosphate DH deficiency

Front 197

What type of anemia is caused by presence of Ab that are directed against RBC membranes (normal or altered)

Back 197

Immunohemolytic anemia

Front 198

What test is used to diagnose presence of anti-RBC Ab?

Back 198

Coombs (agglutination) test (not pathognomonic)

Front 199

Warm type of immunohemolytic anemia is characterized by which Ab?

Back 199

IgG at 37

Front 200

Cold type of immunohemolytic anemia is characterized by which Ab?

Back 200

IgM below 30

Front 201

Most common cause of hemolytic anemia in the world?

Back 201

Malaria

Front 202

What is most important cause of Fe deficiency anemia in western world?

Back 202

Chronic blood loss

Front 203

What are the features common to all types of megloblastic anemias? (3)

Back 203

1. Enlargement of erythroid precursors --> megaloblasts --> macrocytes
2. Enlargement of granulocytic precursors --> hypersegmented neutrophils
3. Hyperchromic

Front 204

What are the lab findings of megloblastic anemias?

Back 204

Hyperchromic microcytic

Front 205

What clinical manifesttions are present w/ pernicious anemia? (4)

Back 205

1. Gastric atrophy
2. Achlorhydria
3. Demylination of peripheral nerves/spinal cord
4. Atrophic glossitis

Front 206

Type of anemia that is characterized by fatty replacement of hematopoietic marrow, usually associated w/ pancytopenia

Back 206

Aplastic anemia

Front 207

Increased concentration of RBC usually associated w/ increased Hb level

Back 207

Polycythemia

Front 208

Normal Hb for male & female?

Back 208

Male 13- 17
Female 12-15

Front 209

Normal % hematocrit for male & female?

Back 209

Male 39-49

Female 33-43

Front 210

Normal MCV (mean cell volume) for adults?

Back 210

76-100

Front 211

Normal WBC count?

Back 211

4.8 - 10.8 x 10^3

Front 212

Normal % of segmented neutrophils?

Back 212

29-60

Front 213

Normal % of lymphocytes?

Back 213

25-31

Front 214

Normal % of monocytes?

Back 214

2-6

Front 215

Normal % of eosinophils?

Back 215

0-5%

Front 216

Normal % of basophils?

Back 216

0-2

Front 217

Reduction in number of WBC?

Back 217

Leukopenia
-Neutropenia
-Lymphopenia
-Agranulocytosis (sever neutropenia)

Front 218

2 diseases of reactive leukocytosis w/ lymphadenopathy?

Back 218

1. Mono
2. Cat scratch disease

Front 219

Do lymphomas metastasize?

Back 219

Lymphomas do NOT metastasize --
They are multifocal (WBC are already mobile)

Front 220

Which morphological features of Non-Hodgkins lymphoma indicate a better prognosis? (3)

Back 220

1. Nodular growth > follicular
2. Small cells > large cells
3. Cleaved cells > noncleaved nuclei

Front 221

Most common type of Non-hodgkin lymphoma?

Back 221

1. Diffuse large cell lymphoma
2. Follicular lymphoma
3. Small cell lymphocytic lymphoma
4. Mantle cell lymphoma
5. Burkitt lymphoma

Front 222

Most --> Least common Hodginks lymphomas? (4)

Back 222

1. Nodular sclerosis
2. Mixed cellularity
3. Lymphocyte-predominance
4. Lymphocyte-depletion

Front 223

Which type of Hodgkin lymphoma is most often seen in adolescents or young women?

Back 223

Nodular sclerosis

Front 224

Which type of Hodgkin lymphoma is most often seen in young men under 35?

Back 224

Lymphocyte-predominance

Front 225

Best --> Worst prognosis of Hodgkin lymphomas (4)

Back 225

1. Nodular sclerosis
2. Lymphocyte predominance
3. Mixed cellularity
4. Lymphocyte depletion

Front 226

What are the types of Acute leukemias?

Back 226

1. Precursor B cell lymphoblastic leukemia (Acute lymphoblastic leukemia)
2. Acute myelogenous leukemia

Front 227

What is the one characteristic shared w/ chronic leukemias?

Back 227

-Most are associated w/ relatively indolent course - slow progression
-Mature cell profile

Front 228

What is a "blast crisis"?

Back 228

Pt treated & goes into remission
-Comes out of remission w/ a profile resembling an acute leukemia w/ immautre blasts

Front 229

What are the types of chronic leukemias & myeloproliferative disorders?

Back 229

1. Chronic myelogenous leukemia
2. Chronic lymphocytic leukemia
3. Hairy cell leukemia
4. Polycythemia vera
5. Myeloid metaplasia w/ myelofibrosis

Front 230

what is the most indolent of all the leukemias?

Back 230

Chronic lymphocytic leukemia

Front 231

What leukemia has a strong overlap w/ small lymphocytic lymphoma?

Back 231

Chronic lymphocytic leukemia

Front 232

What type of leukemia occurs in older men, involves BM, liver & spleen & has cells w/ hair-like proections?

Back 232

Hairy cell leukemia

Front 233

What disease leads to an absolute increased in red cell mass that causes increased viscosity, stasis, thromboiss & infarcts-- most often spleen heart & liver?

Back 233

Polycythemia vera

Front 234

What disease has proliferation primarily in spleen & bone marrow becomes hypocellular & fibrotic?

Back 234

Myeloid metaplasia w/ myelofibrosis

Front 235

What disease is best regarded as hybrid between small lymphocytic lymphoma & multiple myeloma-- B cells produce immunoglobins but don't look like plasma cells

Back 235

Waldenstrom Macroglobulinemia

Front 236

What are the plasma cell dyscrasias? (4)

Back 236

1. Multiple myeloma
2. Localized plasmacytoma
3. Waldenstrom macroglobulinemia
4. Heavy chain disease

Front 237

Normal platelet count?

Back 237

150 - 450 x 10^3

Front 238

Normal prothrombin time?
What does PT test? (3)

Back 238

Normal = 10-13 seconds
EXTRINSIC & COMMON Coagulation pathways:
1. Factor V, VII & X
2. Prothrombin
3. Fibrinogen

Front 239

Normal INR range ?
What is INR?

Back 239

Normal = 0.8-1.2
Standardized PT test

Front 240

Normal partial thromboplastin time?
What does PTT test? (3)

Back 240

Normal = 23-40 seconds
INTRINSIC & COMMON coagulation pathways:
1. Factor V, VIII, IX, X, XI, XII
2. Prothrombin
3. Fibrinogen

Front 241

Thrombocytopenia is characterized by? (3)

Back 241

1. Spontaneous & excessive bleeding (petechiae & purpura)
2. Prolonged bleeding time
3. Normal coagulation times

Front 242

Rare disease due to deficiency of ADATS13 (vWF metalloprotease) which allows high weight vWF to promote platelet aggregation w/ microthrombi & hemolytic anemia?

Back 242

Thrombotic Thrombocytopenia Purpura

Front 243

What is the most common disease of coagulation problems due to Factor VIII?

Back 243

von Willebrand disease

Front 244

What is the most common inherited disorder to cause serious bleeding?

Back 244

Hemophilia A

Front 245

What is the mechanism of Heparin?

Back 245

DIRECT acting anticoagulant
-Accelerates inactivation of thrombin by binding antithrombin III
-Blocks conversion of prothrombin to thrombin

Front 246

Vitamin K is required to synthesize which factors?

Back 246

Factors II, VIII, IX & X

Front 247

All protein coagulation factors are made in the liver EXCEPT?

Back 247

Part of Factor VIII complex= von Willebrand factor
-synthesized by endothelial cells in body

Front 248

General term for patterns of disease w/ thickening & inelasticity of of arteries

Back 248

Arteriosclerosis

Front 249

Calcifications in tunica media of medium sized muscular arteries in individuals over 50 that does NOT usually cause clinical disease?

Back 249

Mokeberg Medial Calcific Sclerosis

Front 250

Arteriosclerosis of small arteries & arterioles most often associated w/ hypertension & diabetes mellitus

Back 250

Arteriolosclerosis

Front 251

Formation of intimal fibrofatty plaques (artheromas) that cause:
-Vascular narrowing
-Degenerative changes

Back 251

Atherosclerosis

Front 252

Intense spasm of local small arteries & arterioles in response to cold or emotions in healthy young womeh which cause pallor & pain

Back 252

Primary Raynaud Phenomenon

Front 253

Episodic arterial insufficiency secondary to another disease process that cause pain & pallor of digits & frequent, sever episodes usually after 30 yrs

Back 253

Secondary Raynaud Phenomenon

Front 254

Inflammation of wall of artery or vein that have necrotizing changes

Back 254

Vasculitis syndrome

Front 255

Classic example of vasculitis syndrome?
-Kidney, heart, liver, GI
-Necrotizing inflammation of medium-small arteries

Back 255

Polyarteritis Nodosa

Front 256

Wegener granulomatosis is positive for which auto-Ab in 95% of pts?

Back 256

c-ANCA

Front 257

T-cell mediated response to an Ag that causes granulomatous inflammation in larger arteries of head?

Back 257

Giant cell arteritis (Temporal arteritis, cranial arteritis)
-Significant predilection for temporal arteries & terminal branches of ophthalmic arteries

Front 258

Which disease is often an acute febrile illness of infants/young kids that features vasculitis of coronary arteries that may lead to thrombosis & MI. Oral lesions can be present.

Back 258

Kawasaki Disease

Front 259

Abnormal dilation of an artery or vein?

Back 259

Aneurysm

Front 260

Blood enters wall of an artery forming a hematoma between layers of arterial wall, often aneurysmal

Back 260

Dissection

Front 261

Hypertension is an important risk factor for? (4)

Back 261

1. Coronary heart disease
2. Cerebrovascular accident
3. CHF
4. Renal failure

Front 262

What is the most common type of hypertension by etiology?

Back 262

Essential hypertension

Front 263

Which is the most common type of hypertension by clinical course?

Back 263

Benign hypertension
-Fairly stable & compatible w/ long life

Front 264

Homogenous pink hyaline thickening of arterior walls & narrowing of vascular lumen represents which type of arteriolosclerosis?

Back 264

Hyaline arteriolosclerosis

Front 265

Onion skin concentric laminated thickening of arterior walls narrowing lumen represents which type of arteriolosclerosis?

Back 265

Hyperplastic arteriolosclerosis

Front 266

Most common type of lymphedema?

Back 266

Secondary lymphedema

Front 267

What are the 3 types of primary lyphedema?

Back 267

1. Simple congenital
2. Milroy disease
3. Lymphedema pracoex

Front 268

What is the most common type of primary lymphedema?

Back 268

Lymphedema praecox

Front 269

Which types of primary lymphedema are congenital & which are familial? (3)

Back 269

1. Simple congenital- CONGENITAL
2. Milroy disease- CONGENITAL & FAMILIAL
3. Lymphedema praecox- FAMILIAL

Front 270

Reactive lesion that appears to be an aberration of healing following trauma/irritation- formed of granulation tissue, often w/ surface ulceration- very vascular & bleeds easily?

Back 270

Pyogenic granuloma

Front 271

Focal red lesions created by abnormal dilation & branching of preexisting small arteries/arterioles about a central core

Back 271

Spider telangiectasias

Front 272

In forward heart failure there is problem with?

Which 2 causes of Left-sided CHF are forward failure?

Back 272

FORWARD = decreased cardiac output (problem w/ heart muscle/contractility)
1. Ischemic heart disease
2. Primary myocardial disease

Front 273

In backward heart failure there is problem with?

What 2 causes of Left-sided CHF are backward failure?

Back 273

BACKWARD = increased work load, pressure load or blood volume
1. Hypertension
2. Valvular disease

Front 274

Clinical manifestations of Left-sided CHF? (5)

Back 274

1. Dyspnea
2. Orthopnea
3. Paroxysmal nocturnal dyspnea
4. Cough
5. Cyanosis (advanced)

Front 275

MOST --> LEAST common causes of Left-sided CHF? (4)

Back 275

1. ISCHEMIC HEART DISEASE
2. Hypertension
3. Valvular disease
4. Cardiomyopathy/myocarditis

Front 276

MOST --> LEAST common causes of Right-sided CHF? (4)

Back 276

1. LEFT SIDED CHF
2. Valvular disease
3. Congenital L-to-R shunts
4. Intrinsic lung disease (cor pulmonale)
5. Cardiomyopathy/myocariditis

Front 277

what are the 4 patterns of ischemic heart disease (coronary heart disease)?

Back 277

1. Angina pectoris
2. MI
3. Sudden cardiac death
4. Chronic ischemic heart disease

Front 278

Which ischemic heart disease (coronary heart disease) is most common?

Back 278

Chronic ischemic heart disease

Front 279

Pathogenesis of all 4 patterns of ischemic heart disease?

Back 279

Severe coronary atherosclerosis

Front 280

Critical stenosis is what % obstructed?

Fixed stenosis at what % causes symptoms?

Back 280

Critical = 70%

Fixed = 90% --> symptoms

Front 281

What is the most common pattern of angina?

Back 281

Typical (Stable) Angina

Front 282

Ischemia due to stenosing atherosclerosis compounded with increased myocardial demand (triggered by exertion/emotional stress)

Back 282

Stable (typical) angina

Front 283

Vaspospasm which may be superimposed of fixed stenosis- attacks may appear at rest & are relieved by vasodilators

Back 283

Prinzmetal angina

Front 284

Attacks forewarm of imminent dange of a subsequent acute MI

Back 284

Unstable angina

Front 285

What are the 2 types of MIs & which is more common?

Back 285

1. TRANSMURAL (full thickness of ventricular wall)--MORE COMMON
2. SUBENDOTHELIAL (inner 1/3-1/2 thickness of wall)

Front 286

What is most common precipitating factor to MI?

Back 286

Thrombosis superimposed on coronary atherosclerosis

Front 287

Most common coronary artery involved in MI?

Back 287

Left anterior descending coronary artery

Front 288

Irreversible cell injury in the case of MI occurs in what time frame?

Back 288

20-40 mins

Front 289

Lesion is maximally soft & weak during what time frame?

Back 289

7-10 days

Front 290

What type of complications arise from MI? (5)

Back 290

1. Arrythmias (early)
2. Cardiogenic shock (early)
3. Rupture of wall, septum or papillary muscle (early)
4. Embolism of mural thrombus (early)
5. Left sided CHF (late)

Front 291

Unexpected death from cardiac causes w/ in 1 hr of onset of acute symptoms

Back 291

Sudden cardiac death

Front 292

The ultimate mechanism of death in SCD is almost always due to?

Back 292

Lethal arrythmia (asystole, ventricular fibrillation)

Front 293

Form of heart disease that appears insidiously in older pts who develop ECG changes & CHF

Back 293

Chronic ischemic heart disease

Front 294

Minimal anatomic criteria for diagnosis of hypertensive heart disease?

Back 294

1. Left ventricular hypertrophy w/ NO other changes

Front 295

Right ventricular hypertrophy secondary to pulmonary hypertension-- w/o ventircular dilation

Back 295

Cor pulmonale

Front 296

Gross morphologic changes of heart in CHF?

Back 296

Left-sided CHF
-Left ventricular hypertrophy & dilation

Right-sided CHF
-R & L ventricular hypertrophy w/ R & L dilation

Front 297

Most common clinical sign of congenital heart defect?

Back 297

Heart murmur

Front 298

What are examples of L-to-R shunts?
What are the clinical signs of L-to-R shunts?

Back 298

1. Ventricular septal defect
2. Atrial septal defect
3. Patent ductus arteriosis
-Acyanotic (normal) at first
-Late cyanosis due to R. heart pressure overload & reversal of flow

Front 299

What are examples of R-to-L shunts & what are their clinical signs?

Back 299

1. Tetraology of Fallot
2. Transposition of Great Vessels
-Cyanosis
-Allow for paradoxical emboli

Front 300

What are examples of congenital heart diseases w/ obstruction to flow w/ NO cyanosis?

Back 300

1. Coarctation of the Aorta
2. Aortic stenosis
3. Pulmonic stenosis

Front 301

What is the most common congenital heart defect?

Back 301

Ventricular septal defect

Front 302

What are the 4 components of tetratology of fallot?

Back 302

1. Ventricular septal defect
2. Detraxposed aorta that overides VSD
3. Pulmonic stenosis (obstruction of R. ventricular outflow)
4. R. ventricular hypertrophy

Front 303

What is the problem in transposition of the great vessels?

Back 303

Reversed positon of pulmonary artery & aorta

Front 304

What may give the patient more time before treating transposition of the great vessels?

Back 304

Patent ductus arteriosis

Front 305

Constriction or narrowing of the aorta is known as?
Which form is more severe?

Back 305

Coarctation of the Aorta
-Preductal form occurs proximal to ductus arteriosis --> fatal
-Postductal form occurs distal to ductus arteriosis--> asymptomatic

Front 306

Fusion of commissures of heart valve leaflets w/ fibrosis & calcification

Back 306

Calcific aortic stenosis

Front 307

Most common acquired cardiac valve disease in US?

Back 307

Mitral valve prolapse
-Valve leaflets prolapse & balloon backward toward L atrium during systole

Front 308

What protein on the surface of strep evokes Ab that are cross-reactive w/ human epitopes on heart?

Back 308

M protein

Front 309

What is the pathognomonic lesion of rheumatic fever?

Back 309

Aschoff body

Front 310

Fibrinous "bread & butter" pericarditis is common in which disease?

Back 310

Rheumatic heart disease

Front 311

Are microorganisms found in vegetations on heart valves in rheumatic heart disease & infective endocarditis?

Back 311

Rheumatic heart disease- vegetations w/o microorganisms

Infective endocarditis- vegetations w/ microorganisms

Front 312

Ab that are diagnostic to rheumatic fever? (2)

Back 312

1. Antistreptolysin O
2. Antistreptokinase

Front 313

What is the single most likely indicator of heart valve replacement?

Back 313

Rheumatic heart disease

Front 314

Infective endocardititis requires which 3 factors ?

Back 314

1. Microorganisms
2. In circulating blood
3. Susceptible host

Front 315

50-60% of cases of infective endocarditis are caused by?
Which form of IE do they cause?

Back 315

Strains of alpha-Strep (including strep viridans)
SUBACUTE BACTERIAL ENDOCARDITIS

Front 316

10-20% of infective endocarditis cases are caused by?
Which form of IE do they cause?

Back 316

S. aureus
ACUTE INFECTIVE ENDOCARDITIS

Front 317

What factors increase risk of infective endocarditis? (6)

Back 317

1. Rhematic heart disease
2. Congenital heart defects
3. Mitral valve prolapse w/ regurgitation
4. SLE
5. Artificial heart valves
6. IV drug abuse

Front 318

What clinical manifestations are common to both subacute & acute endocarditis? (2)

Back 318

1. Changing heart murmur
2. Enlarged spleen

Front 319

Prophylaxis for IE is recommended for? (4)

Back 319

1. Prosthetic heart valve
2. Previous IE
3. Congenital heart disease
-Unrepaired cyanotic shunt (R-to-L)
-Repaired defect w/ prostehtic material during 1st 6 months
-Repaired w/ residual defects near prosthetic device
4. Cardiac transplant who develop valvulopathy

Front 320

Procedures that do NOT require prophylaxis? (6)

Back 320

1. Injections
2. X-rays
3. Placement of RPD or ortho appliance or brackets
4. Adjustment of ortho appliance
5. Shedding of primary teeth
6. Bleeding from trauma to lips or oral mucosa

Front 321

Myocardial inflammation sufficient to cause clinical manifestations commonly due to infections, immune-mediate reactions ?

Back 321

Myocarditis

Front 322

Non-inflammatory myocardial disease that is not attributable to pressure or volume overload?

Back 322

Cardiomyopathy

Front 323

The hallmark of obstructive lung diseases is?

Back 323

Decreased expiratory flow rate
-Anatomic airway narrowing
-Loss of elastic recoil

Front 324

What are the pathogenic mediators in extrinsic asthma? (3)

Back 324

1. LTC4, LTD4, LTE4- bronchoconstriction & mucin production
2. PGD2- bronchonstriciton & vasodilation
3. LTB4-recruit eosinophils & neutrophils

Front 325

Histologic morphology of asthma? (4)

Back 325

1. Mucous plugs in bronchi
2. Inflammation w/ edema, hyperemia & inflammatory cells
3. Mucous gland hyperplasia
4. Hypertrophy & hyperplasia of bronchial SM

Front 326

3 types of emphysema?

Back 326

1. Centriacinar (Centrilobular)
2. Panacinar (Panlobular)
3. Distal Acinar (Paraseptal)

Front 327

which pattern of emphysema is most severe & has strongest association w/ smoking?

Back 327

Centriacinar (Centrilobular)

Front 328

Why type of emphysema occurs in alpha-1-antitrypsin deficiency?

Back 328

Panacinar (Panlobular)

Front 329

What is the pathogenesis of emphysema? (2)

Back 329

1. Increased elastase activity
2. Decreased alpha-1-antitrypsin activity (protease inhibitor)
UNCHECKED DESTRUCTION OF ELASTIC TISSUE
-This imbalance is greatly increased by smoking

Front 330

Major source of elastase (a protease)?

Back 330

Neutrophils

Front 331

What are the 4 forms of chronic bronchitis?

Back 331

1. Simple chronic bronchitis
2. Chronic mucopurulent bronchitis
3. Chronic asthmatic bronchitis
4. Chronic obstructive bronchitis

Front 332

Permanent dilation of bronchi & bronchioles due to destruction of muscle & elastic supporting tissue resulting from or associated w/ chronic necrotizing infections?

Back 332

Bronchiectasis

Front 333

Which conditions most commonly predispose to bronchiectasis? (3)

Back 333

1. Necrotizing/suppurative pneumonia
2. Bronchial obstruction
3. Congenital/hereditary conditions

Front 334

Multisystem disease of unknown cause w/ non-caseating granulomas-- mechanism involves type IV hypersensitivy rxn

Back 334

Sarcoidosis

Front 335

What are the major target sites of sarcoidosis? (4) Ranked

Back 335

1. Lymph nodes (potato nodes)
2. Spleen
3. Eyes, lacrimal & salivary glands
4. Lungs, lung & skin/mucous membranes

Front 336

Preferred term for acute pneumonias caused by bacteria?

Back 336

Pneumonia

Front 337

Preferred term for acute "atypical" pnuemonias which involve interstitum?

Back 337

Pneumonitis

Front 338

Which pattern of acute bacterial pneumonia has patchy consolidation of more tahn one lobe w/ purulent exudate?

Back 338

Bronchopneumonia

Front 339

What are the 4 stages of Lobar pneumonia & features of each?

Back 339

1. CONGESTION- heavy, red, subcrepitant
2. RED HEPATIZATION- exudate, firm, red & airless
3.GREY HEPATIZATION- fibrin & degenerating WBC, gray brown dry
4. RESOLUTION- exudate digested & return to normal

Front 340

What is the most important risk factor for TB?

Back 340

HIV

Front 341

What are risk groups for TB? (3)

Back 341

1. New immigrants 55%
2. HIV
3. Extreme poverty, crowding

Front 342

What are the pathways of progression of secondary TB? (6)

Back 342

1. Progressive pulmonary TB
2. Miliary pulmonary
3. Endobronchial, endotracheal & laryngeal
4. Systemic miliary
5. Isolated organ
6. Intestinal

Front 343

Most common form of cancer in lung?

Back 343

Metastic tumors

Front 344

What are the 4 types of bronchiogenic carcinomas? BEST --> WORST PROGNOSIS

Back 344

1. Adenocarcinoma
2. Squamous cell carcinoma
3. Large cell carcinoma
4. Small (OAT) cell carcinoma

Front 345

What is the most common lung tumor in males & has strong association w/ smoking & squamous metaplasia?

Back 345

Squamous cell carcinoma

Front 346

Tumor confined to larynx causes what major symptom?

Back 346

Persistent hoarseness

Front 347

Most common mechanism of glomerular diseases? (3)

Back 347

Ab-mediated pathways
1. Circulating immune complex nephritis (Type III hypersensitivity rxn)
2. Immune complex nephritis in-situ
3. Cytotoxic Ab

Front 348

Primary glomerular diseases that present as NEPHROTIC syndrome? (4)

Back 348

1. Lipoid Nephrosis
2. Membranous glomerulonephritis
3. Focal segmental glomerulosclerosis
4. Membranoproliferative glomerulonephritis

Front 349

What is the pathogenesis of NEPHROTIC syndrome diseases?

Back 349

Derangement of capillary basement membrane leading to increased permeability of plasma proteins

Front 350

Glomerular diseases that present as NEPHRITIC syndrome? (4)

Back 350

1. Acute proliferative glomerulonephritis (acute poststrep GN, postinfectious GN)
2. Rapdily progressive GN (crescentic GN)
3. IgA Nephropathy (Berger disease)

Front 351

What is the pathogenesis of NEPHRITIC syndrome diseases?

Back 351

Proliferation of cells w/ in glomeruli accompained by leukocytic infiltrate

Front 352

Which disease is characterized by rapid & progressive loss of renal function, sever oliguria & death from renal failure within weeks-months?

Back 352

Rapidly progressive (Cresenctic) GN
(nephritic syndrome)

Front 353

What is the pathogenic hallmark of Berger disease?

Back 353

IgA in mesangium (IgA Neprhopathy)

Front 354

Types of drug-induced interstital nephritis? (2)

Back 354

1. Acute Drug-Induced Interstital Nephritis
2. Analgesic Nephropathy

Front 355

Which drug-induced nephritis disease is caused by adverse hypersensitivy reaction to drugs that onset about 15 days after & has fever, rash & hematuria?

Back 355

Acute-drug induced interstitial nephritis

Front 356

Which drug induced nephritis is often caused by consumption of large quanitities of analgesics?

Back 356

Analgesic Nephropathy

Front 357

Majority of cases of autosomal dominant (adult) polycystic kidney disease have which defective gene?

Back 357

90% APKD-1 at chromosome 16p
10% APKD-2 at chromosome 4

Front 358

What are serious complications of autosomal dominant polycystic kidney disease? (4)

Back 358

1. Hypertension
2. UTI
3. Progress to renal failure --> need transplant

Front 359

Major symptom associated w/ hydronephrosis?

Back 359

Altered quantity of urine output

Front 360

What is the classic triad of signs & symptoms of renal cell carcinoma?

Back 360

1. Painless hematuria
2. Dull flank pain
3. Longstanding fever

Front 361

3rd most common organ cancer of children under ten?

Back 361

Wilms tumor

Front 362

Defining characteristics of Wilms tumor?

Back 362

1. Primitive/abortive glomeruli w/ poorly formed Bowman's space
2. Abortive tubules
3. Spindle cell stroma

Front 363

Risk factors of transitional cell carcinoma? (5)

Back 363

1. Betal-napthylamine
2. Smoking
3. Chronici cystitis
4. Schistomsomiasis
5. Cyclophosamide

Front 364

Most common site for transitional cell carcinoma & best prognosis?

Back 364

1. Bladder = most common & best prognosis
2. Renal pelvis
3. Ureter = least common & worst prognosis

Front 365

Longitudinal tears in esophageal mucosa that are caused by severe vomiting & is common in chronic alcoholics?

Back 365

Esophageal lacerations (Mallory-Weiss syndrome)

Front 366

Most common type of gastric carcinoma?

Back 366

Diffuse type- risk factors unknown
More aggressive w/ poor prognosis

Front 367

Most common & most innocuous anomaly of small intestine?

Back 367

Meckel diverticulum
-Congenital
-Distal ileum

Front 368

Membranous abdominal wall that balloons out & contains abdominal viscera

Back 368

Omphalocele

Front 369

Which type of malabsorption syndrome is associated w/ increased risk of intestinal lymphoma?

Back 369

Celiac disease

Front 370

Bowel obstruction can be caused by? (4)

Back 370

1. Herniation
2. Adhesions (scar tissue)
3. Intussusception (telescoping)
4. Volvulus (kinks)

Front 371

Most common cancer of small intestines?

Back 371

Adenocarcinoma

Front 372

What is the etiology of Idiopathic inflammtory bowel diseases?

Back 372

1. Genetic predisposition
-Ulcerative colitis - HLA-DR2
-Crohn disease - HLA-DR1, Dqw5
2. Dysregulation of T-cell responses
3. Microbial factors

Front 373

Congenital functional obstruction of bowel because peristalsis stops due to lack of Meissner's & Auerbach's plexus?

Back 373

Hirschsprung disease (Congenital megagolin)

Front 374

Most common type of colon polyps?

Back 374

Non-neoplastic polyps:
1. Hyperplastic (more common)
2. Juveline (hamartomas)

Front 375

Most common morphological type of adenomatous polyp?

Back 375

Tubular
next: tubular villous
last: Villous

Front 376

Familial polyposis syndromes (4)

Back 376

1. Familial adenomatous polyposis
2. Gardner syndrome
3. Peutz-Jehger syndrome
4. Cowden syndrome

Front 377

What is Gardner syndrome? (4)

Back 377

1. Multiple osteomas
2. Impacted & supernumerary teeth
3. Multiple epidermoid or sebaceous cysts
4. Multiple adenomatous polyps
INCREASED RISK OF ADENOCARCINOMA OF COLON

Front 378

Which familail polyposis syndromes have head & neck manifestations? (3)

Back 378

1. Gardner syndrome
2. Peutz-Jehgers syndrome
3. Cowden syndrome

Front 379

What type of pain is present in acute appendicitis?

Back 379

Rebound pain-- hurts worse when pressure is relieved if pushed on
Right lower quadrant

Front 380

Which form of bilirubin is water soluble, loosely bound to albumin & is excreted into bile & eliminated into feces, excess excreted in urine?

Back 380

Conjugated bilirubin

Front 381

What does direct bilirubin measure?

Back 381

Conjugated bilirubin
Normal = 0.3 mg/dL

Front 382

What does total bilirubin measure?

Back 382

Conjugated + unconjugated bilirubin
Normal = 1.3 mg/dL

Front 383

What are the 3 most common causes of jaundice?

Back 383

1. Hemolytic anemias (unconjugated)
2. Hepatitis (conjugated & unconjugated)
3. Obstruction of bile outflow (conjugated)

Front 384

Most common cause of jaundice in newborn?

Back 384

Physiologic jaundice of newborn
-Impaired conjugation of bilirubin

Front 385

Most common cause of extrahepatic biliary obstruction?

Back 385

Gallstones

Front 386

3 Morphologic alterations that cause liver failure?

Back 386

1. Chronic liver disease- most common
2. Massive liver necrosis
3. Hepatic dysfunction w/o over necrosis

Front 387

Defining characteristics of cirhrosis? (3)

Back 387

1. Bridging fibrous septae
2. Nodules of regenerated parencyma
3. Disruption of entire liver architecture

Front 388

+ IgM-anti HAV?

Back 388

Acute hep A

Front 389

What Ag indicates that a person is a carrier of Hep B?

Back 389

HBs Ag = carrier of Hep B

Front 390

27 nm icosahedral capsid w/ ssRNA, Picornavirus?

Back 390

Hepatitis A

Front 391

"serum hepatitis" or "long incubation hepatitis"

Back 391

Hep B

Front 392

What are the clinic forms of Hep B? (4)

Back 392

1. Acute
2. Crhonic
3. Fulminant
4. Asymptomatic carrier

Front 393

What are complications of Hep B? (3)

Back 393

1. Fulminant hepatitis leading to death (rare)
2. Chronic disease --> cirrhosis
3. Chronic disease w/ increased risk for hepatocellular cancer

Front 394

Which Ab heralds the onset of recovery of Hep B?

Back 394

Anti-Hbe

Front 395

42 nm enveloped dsDNA hepadnavirus (Dane particle)

Back 395

Hep B

Front 396

30-60 nm enveloped ssRNA Flavivirus

Back 396

Hep C

Front 397

35 nm enveloped ssRNA replication defective virus that must be surrounded by ____ in order to replicate?

Back 397

Must have co-infection of HBV
Need HBsAg in order to replicate

Forms both IgM & IgG anti HDV Ab

Front 398

32-34 nm unenveloped ssRNA virus of Calicivirdae family
Water borne & transmitted through enterir routes
Short incubation 2-8 weeks

Back 398

Hep E

Front 399

Which forms of Hep do NOT cause chronic hepatitis?

Back 399

Hep A & E

Front 400

Mallory bodies are often seen in what disease?

Back 400

Alcoholic hepatitis-- Mallory bodies
*Intracellular accumulation of keratin intermediate filaments & other proteins; eosinophilic inclusion bodies

Front 401

Most innocuous type of inborn error of metabolism- "more yellow than sick"?

Back 401

Gilbert syndrome

Front 402

Most common need for pediatric liver transplant?

Back 402

Biliary atresia

Front 403

Both Gilbert syndrome & Crigler-Najjar syndrome feature defiency of which enzyme?

Back 403

Gluconyl Transferase --> Unconjugated bilirubin

1. Gilbert- mild def.
2. Type I CN- complete lack
3. Type II -severe def.

Front 404

Reye syndrome is characterized by which 2 changes?

Back 404

1. Fatty change in liver
2. Encephalopathy

Front 405

Budd-Chairi syndrome?

Back 405

Hepatic vein thrombosis
-Engorged w/ blood & no new blood can enter --> Ischemia

Front 406

Cholangitis is most commonly caused by?

Back 406

Cholangitits = inflammation of bile ducts
-Bacterial infection - Most commonly: E coli & other gram (-) enterics

Front 407

Liver abscesses are most commonly seen as a complication of?

Back 407

Acute ascending cholangitits

Front 408

Severe steady right upper quadrant abdominal pain usually due to?

Back 408

Acute cholecystitis (inflammation of gallbladder)

Front 409

Cardinal manifestation of acute pancreatitis?

Back 409

Mid abdominal pain

Front 410

Pathogenesis of acute pancreatitis & resulting features? (3)

Back 410

Activation of trypsinogen
Autodigestion resulting in:
1. Hemorrhage from vessel necrosis
2. Fat necrosis
3. INflammation

Front 411

Beta islet cell tumors cause?

Back 411

Hyperinsulinism
-Benign insulinoma
-Cause hypoglycemia

Front 412

Zollinger-Ellsion syndrome is a tumor of _________ that secretes _______ & manifests w/ ______?

Back 412

Functional islet cell tumor
-Gastrinoma- secretes GASTRIN
-Causes peptic ulcers
-Most are malignant

Front 413

Normal fasting blood glucose range?
What level is diagnostic for diabetes?

Back 413

Normal = 62-110
Diagnostic for DM = > 126

Front 414

Which test is mostly used for gestational diabetes?

Back 414

Glucose tolerance test (Glucose challenge)
> 200 2 hrs after challege

Front 415

Hemoglobin A1C test measures?
Normal results?

Back 415

Glycosylated hemoglobin
-Reflects average blood glucose levels over past 3 months
Normal = 5%
Desired in DM = <6%
Acceptable in DM = < 7%

Front 416

Major manifestations of Type I DM? (5)

Back 416

1. Polyuria
2. Polydipsia
3. Polyphagia
4. Weight loss/weakness
5. Ketoacidosis

Front 417

Etiology of Type I DM?

Back 417

Severe or total lack of insulin caused by reduction in beta cell mass

Front 418

Genetic susceptibility of type I DM is located on which chromosome?

Back 418

Chromosome 6 --> codes for HLA-D antigens of MHC

Front 419

Pathogenesis of Type I DM?

Back 419

1. Genetic
2. Autoimmune- T cell mediated destroys islet cells
3. Environmental factor triggers autimmune reaction (viruses)

Front 420

Clinical signs & symptoms of Type II DM? (5)

Back 420

1. Polyuria
2. Polydipsia
3. Polyphagia
4. Obesity
5. Weight loss/weakness (late signs)

Front 421

Genetic influences are more important in type I or II DM?

Back 421

Type II- unknown factors but MORE important than type I (HLA Ag)

Front 422

Complications of DM? (5)

Back 422

1. Diabetic nephropathy
2. Ischemic heart disease (MI or stroke)
3. Peripheral neuropathy
3. Diabetic retinopathy (eventually blindnes)
4. Gangrene of extremities
5. Increased susceptibility to infection

Front 423

Most common breast disorder?

Back 423

Fibrocystic changes

Front 424

Most common type of fibrocystic change in breast?

Back 424

Nonproliferative fibrocystic changes-
Cysts & Fibrosis
-Multifocal & bilateral

Front 425

Types of proliferative fibrocystic changes in breasts? (2)

Back 425

1. Epithelial hyperplasia
2. Sclerosing adenosis

Front 426

Epithelial hyperplasia of breast may have proliferation of ductal or lobule epithelium-- What if atypia is present?

Back 426

Epithelial hyperplasia w/ atypia increases risk of developing carcinoma

Front 427

Fibrocystic change that produces Hard rubbery mass, usually unilateral, in upper outer quadrant which is histologically similar to invasive carcinoma of breast?

Back 427

Sclerosing adenosis
*Very slight risk to progression of carcinoma

Front 428

Minimal or NO increased risk of breast carcinoma? (4)

Back 428

1. Fibrosis
2. Cystic changes
3. Appocrine metaplasia
4. Mild epithelial hyperplasia

Front 429

Slightly increased risk of breast carcinoma? (1.5-2x) (3)

Back 429

1. Moderate-florid epithelial hyperplasia
2. Ductal papillomatosis
3. Sclerosing adenosis

Front 430

Significantly Increased risk of breast carcinoma? (5x) (1)

Back 430

1. Atyppical epithelial hyperplasia

Front 431

Most common benign tumor of female breast?

Back 431

Fibroadenoma
-Young women (20s)
-Increased estrogen
-Solitary, firm, freely moveable nodule
-Excellent prognosis

Front 432

Rapidly growing, massive solitary breast mass w/ benign ductal epithelium & malignant tissue stroma but has excellent prognosis becausethey are localized?

Back 432

Cytosarcoma phyllodes

Smaller benign phyllodes tumor = Giant Fibroadenoma

Front 433

Most common location of breast tumors (bengin/malignant)

Back 433

Upper outer quadrant

Front 434

Infilitrating types of breast carcinoma arising in ducts? (4)

Back 434

1. Infiltrating ductal carcinoma
2. Medullary carcinoma
3. Colloid (mucinous) carcinoma
4. Paget disease of breast

Front 435

Nodular hyperplasia of prostate involves which zone of prostate gland? Prostate carcinoma?

Back 435

Central zone surrounding urethra
-Glandular & stromal hyperplasia

Adenocarcinoma of prostate = peripheral zone

Front 436

Most common cancer in males?

Back 436

Carcinoma of prostate
(Adenocarcinoma)

Front 437

Carcinoma of prostate metastasizes where first?

Back 437

Local lymph nodes (lumbar vertebrae)

Front 438

Testicular neoplasms are more commonly derived from which cells?

Back 438

95% germ cells- malignant
5% interstitial cells- benign

Front 439

Most common mixed histological pattern of testicular cancer?

Back 439

Teratoma & embryonal carcinoma

Front 440

Most common testicular tumor in boys under 3 yrs?

Back 440

Yolk sac tumors
(occurs only in mixed tumors of adults)

Front 441

Most common type of ovarian tumor?

Back 441

Surface germinal epithelium tumors
-Serous type
-60% benign

Front 442

Most common germ cell tumor in women?

Back 442

teratoma

Front 443

Abnormal fertilzating causing failure of embryo to develop & proliferation of hydropic chorionic villi?

Back 443

Hydatidiform mole

Front 444

A "complete" hydatidiform mole contains?

Back 444

Empty egg fertilzed by 2 sperm- diploid
No fetal parts

Front 445

A "partial" hydatidiform mole contains?

Back 445

Normal egg w/ 2 sperm - triploid
Some fetal parts

Front 446

3 sites of choriocarcinoma?

Back 446

1. Placenta
2. Ovaries
3. Testes

Front 447

Malignant uterine neoplasmderived from trophoblastic cells

Back 447

Chorocarcinoma
-50% follow hydatidiform moles
-20% arise after abortion/miscarriage

Front 448

Hyperpituitarism is most often due to which 3 tumors?

Back 448

Functioning pituitary adenoma
1. Prolactin cell adenoma
2. ACTH adenoma
3. Gonadotroph cell adenoma

Front 449

Tumor arising from vestiges of craniopharyngeal duct that commonly occurs in kids/adolescents & closely resembes ameloblastoma & causes hypopituitarism

Back 449

Craniopharyngioma

Front 450

Examples of extrasellar lesions that may cause hypopituitarism? (4)

Back 450

1. Craniopharyngioma
2. Meningioma
3. Gliomas
3. Germ cell tumors

Front 451

GH defiency in childhood that presents as grwoth retardation w/ proportional body segments?

Back 451

Pituitary dwarfism

Front 452

Infarction & necrosis of pituitary that often occurs post-partum & first slgn may be mother's inability to feed baby due to hypopituitarism?

Back 452

Sheehan Syndrome

Front 453

Gradual destruction of pituitary that disappears leaving a nubbin of fibrious tissue

Back 453

Empty sell syndrome

Front 454

Syndrome of inappropriate ADH secretion has what clinical signs & symptoms? (3)

Back 454

1. Hypertension (increased blood volume)
2. Hemodilution
3. Relative hypoatremia

Front 455

What must be avoided in pts with signs of thyrotoxicosis?

Back 455

Epinephrine

Front 456

Lab results of hyperthyroidism?

Back 456

1. Elevated T4 & T3
2. Elevated radioactive idione uptake
3. Decreased TSH

Front 457

Increased T4, T3 & TSH would indicate problem with?

Back 457

Hypothalamus or pituitary gland

Front 458

Causes of crenitism? (4)

Back 458

1. Autoimmune- AutoAb from hypothyroid mom
2. Exogenous goitrogens
3. Iodidine deficiency
4. Hereditary biosynthetic defects

Front 459

What disorders present w/ myxedema? (4)

Back 459

1. Surgical removal of thyroid gland (due to Graves disease-most common)
2. Radiation ablation
3. Hashimoto thyroiditis
4. Primary autoimmune disease

Front 460

Lab findings of pts w/ hypothyroidism? (2)

Back 460

1. Low T4 & T3
2. Elevated TSH (compensatory)

Front 461

Most common form of thyroiditis?

Back 461

Hashimoto thyroiditis

Front 462

Pathogenesis of hashimoto thyroiditis?

Back 462

1. Autoimmune- auto Ab
2. Genetic- HLA-DR5
-INcreased frequency of other autoimmune diseases: pernicious anemia, RA, SLE, Type I DM

Front 463

Subacute granulomatous thyroiditis (Quervain thyroiditis) etiology?

Back 463

Viral origin - upper respiratiory infection, Mumps, measles, influenza

Front 464

Which thyroid disease may present with granulomatous inflammation?

Back 464

Subacute granulomatous thyroiditis (Quervain thyroiditis)

Front 465

Thyroid levels in subacute granulomatous thyroiditis (Quervain thyroiditis)?

Back 465

May have thyrotoxicosis (hyperthyroidism)

Resolves to become euthyroid
SOME develop transient hypothyroidism

Front 466

Thyroid levels in subacute lymphocytic thyroiditis?

Back 466

Initial thyrotoxicosis (hyperthyroidism)

Euthyroid within months
SOME hypothyroid

Front 467

Pathogenesis of Graves disease? (2)

Back 467

1. Autoimmune- Auto Ab
2. Genetic- HLA-DR3

Front 468

Classic triad of signs of Graves disease?

Back 468

1. Thyrotoxicosis
2. Bug eyes (infiltrative ophthalmopathy)
3. Subcutaneous edema

Front 469

Lab findings of Graves disease? (2)

Back 469

1. Increased T4 & T3
2. INcrease RAIU

Front 470

Simple colloid goiter typically has what type of thyroid levels?

Back 470

Usually euthyroid
MAY be hypothyroid (myxedema)

Front 471

Multinodular goiter typically has what type of thyroid levels?

Back 471

Often euthyroid
May develop thyrotoxicosis in longstanding cases = Toxic Multinodular goiter

Front 472

Which type of thyroid tumor is very difficult to distinguish from papillary thyroid carcinoma?

Back 472

Papillary thyroid adenoma

Front 473

Most common type of thyroid carcinoma?

Back 473

Papillary carcinoma of thyroid

Front 474

Which type of carcinoma arises from parafollicular C cells of neurosecretory origin?

Back 474

Medullary carcinoma of thyroid

Front 475

Most common --> least common thyroid carcinomas? Well or poorly differientated?

Back 475

1. Papillary carcinoma (well)
2. Follicular carcinoma (well)
3. Anaplastic carcinoma (poor)
4. Medullary carcinoma (poor)

Front 476

Osteitis fibrosa cystica is found in?

Back 476

Hyperparathyroidism

Front 477

Most common cause of secondary hyperparathyroidism?

Back 477

Advanced renal disease w/ calcuria

Front 478

What are the disease mechanisms of Cushing syndrome? (4)

Back 478

1. Iatrogenic (long term steroid use)
2. Pituitary (excess ACTH)
3. Adrenal (low ACTH high coritisol)
4. Ectopic (ectopic ACTH)

Front 479

Most common mechanism of Cushing syndrome? exogenous & endogenous

Back 479

Iatrogenic (exogenous)
Pituitary (endogenous)

Front 480

Clinical findings of Hyperaldosteronism? (4)

Back 480

1. Hypokalemia (muscle weakness, paralysis & cardiac dysfunction)
2. Hypernaturemia
3. Hypertension
4. Anasarca

Front 481

Neoplasm derived from chromaffin cells of sympathetic nervous system

Back 481

Pheochromocytoma

Front 482

Signs & symptoms of pheochromocytoma? (4)

Back 482

1. Hypertension
2. Tachycardia
3. Anxiety, headaches
4. Diaphoresis

Front 483

Most neuroblastomas arise where?

Back 483

Adrenal medulla

Front 484

Most common extracranial tumor of childhood?

Back 484

Neuroblastoma

Front 485

Neuroblastoma produces catecholamines but does it produce symptoms?

Back 485

NO symptoms due to catecholamines

Front 486

Elevated Urine levels of vanillylmandelic acid & homovanillic acid ?

Back 486

Neuroblastoma

Front 487

Clinical signs & symptoms of Multiple Endocrine Neoplasia Syndrome Type IIB? (3)

Back 487

1. Marfanoid habitus
2. Dolichofacies w/ full lips
3. Multiple neoplasms
-Multiple neuromas of oral & eye
-Medullary carcinoma of thyroid
-Pheochromocytoma

Front 488

Impaired epiphyseal cartilaginous growth resulting in short limbs but normal head & torso

Back 488

Achondroplasia (achondroplastic dwarfism)

Front 489

Abnormalities in type I collagen syntehsis due to multiple gene mutations- fractures & defromitiy, blue sclera & dentinogenesis imperfecta

Back 489

Osteogenesis imperfecta

Front 490

Reduction in bone mass of postmenopausal females (most commonly) due to imbalance of bone resorption/restorating- predisposed to pathologic fractures

Back 490

Osteoporosis

Front 491

Most common sites for fracture of osteoporosis?

Back 491

Vertebral bodies, radius, femoral neck

Front 492

Overproduction of osteoid before epiphyses close in children due to a lack of Vitamin D

Back 492

Rickets

Front 493

Characteristic skeletal lesions caused by excess osteoid in children with Rickets? (6)

Back 493

1. Frontal bossing
2. "Rachitic rosary" & pigeon breast
3. Lumbar lordosis
4. Bowing of legs
5. Pathologic fracture (uncommon)
6. Enamel hypoplasia/delayed eruption possible

Front 494

Lack of mineralization of newly formed bone in adults resulting in soft, weak bones & pathologic fracture due to lack of Vitamin D?

Back 494

Osteomalacia

Front 495

Generalized bone loss & replacement by fibrous tissue
-Radiographic: ground glass
-Brown tumors of hyperparathyroidism
-Pathologic fracture possible

Back 495

Osteitis Fribrosa Cystica
Hyperparathyroidism of bone
Von Recklinghausen disease of bone

Front 496

Combination of osteitis fibrosa cystica & osteomalacia caused by chronic renal failure, complicated by aluminum toxicity

Back 496

Renal osteodystrophy

Front 497

Most common route of infection of pyogenic osteomyelitis?

Back 497

Hematogenous spread

Front 498

Most common organism found in pyogenic osteomyelitis?

Back 498

S. aureus

Front 499

What organism is found in pyogenic osteomyelitis of pts w/ sickle cell disease?

Back 499

Salmonella

Front 500

Islands of dead bone surrounded by bacteria & pus

Back 500

Sequestrum

Front 501

3 stages of disease of Paget disease of bone?

Back 501

1. Initial osteolytic phase
2. Mixed stage of osteolysis & osteogenesis
3. Inactive, burned out sclerotic phase

Front 502

Pathogenesis of paget disease of bone? (2)

Back 502

Maybe viral infection
-Paramyxovirus- measles, RSV

Genetic- Chromosome 18q

Front 503

Bone pain, bone deformity, swelling, increasing hat size, pathologic fractures common, pts over 40

Back 503

Paget disease of bone (Osteitis deformans)

Front 504

Radiographic mixed lesions w/ cotton wool appearance
Histo: Prominent reversal lines

Back 504

Paget disease of bone (Osteitis deformans)

Front 505

Markedly elevated serum alkaline phosphatase is found in which disease?

Back 505

Paget disease of bone (osteitis deformans)

Front 506

Which form of fibrous dysplasia is more common?

Back 506

Monostotic fibrous dysplasia

Front 507

Monostotic fibrous dysplasia vs. Polyostotic fibrous dysplasia

Back 507

MONOSTOTIC:
-One bone
-Adolescents
-Stops when growth complete

POLYOSTOTIC:
-Young children
-Multiple bones
-Can continue into adulthood
-Pathologic fracture possible

Front 508

Polyostotic disease w/ associated endocrinopathy (3)

Back 508

1. Unilateral multiple bone lesions
2. Cafe au lait skin unilateral
3. Precocious sexual development (McCune Albright syndrome)
-Less common: hyperthyroidism, Cushing syndrome, acromegaly

Front 509

Focal areas of disordered maturation of bone leaving loose, whorled fibrous tissue punctuated by haphazard islands & strands of woven bone

Back 509

Fibrous dysplasia

Front 510

MOST --> LEAST common primary sources of metastases to bone (6)

Back 510

1. Prostate
2. Breast
3. Lung
4. Renal
5. Colon
6. Thyroid

Front 511

MOST --> LEAST common sites of metastasis in bone? (4)

Back 511

1. Vertebral column
2. Ribs
3. Skull
4. Pelvis

Front 512

Most metastases appear as radiolucencies due to bone destruction, which 2 may stimulate bone growth & appear as opaque/mixed lesions?

Back 512

1. Breast
2. Prostate

Front 513

Lateral growth of epiphyseal cartilage or remnants of cartilage that present as mushroom-shaped lateraly boney projects
Site: Metaphyseal regions of long bones

Back 513

Osteochondroma

Front 514

Benign tumor of hylaine cartilage that are almost always located interior of bone & are common in small bones of hand & feet

Back 514

Chondroma (outside bone)
Endochondroma (inside bone) --> more common

Front 515

What syndrome has multiple chondromas accompanied by hemangiomas of skin?

Back 515

Maffuci syndrome

Front 516

What syndrome has multiple endochondromas in childhood?

Back 516

Enchondromatosis (Ollier disease)

Front 517

Males, under 20 (5-10 yrs), exquisitely painful bone lesions relieved by aspirin
-Radiographic: bulls eye lesion

Back 517

Osteoid osteoma

Front 518

20-40 yrs
Pain in epiphyses of long bones
-X-ray: Soap bubble appearance
-Histo: indistinguishable from brown tumor of hyperparathyroidism

Back 518

Giant cell tumor

Front 519

Most common primary bone cancer?

Back 519

Osteosarcoma (osteogenic sarcoma)

Front 520

Pathogenesis of osteosarcoma?

Back 520

-Genetic
-RB gene- tumor suppressor gene
-Homozygous deletion of 13q14 where Rb gene is located

Front 521

Predisposing factors to osteosarcoma? (2)

Back 521

1. Paget disease of bone
2. Previous radiation

Front 522

Sunburst pattern is characteristic of?

Back 522

Osteosarcoma

Front 523

Hallmark of osteosarcoma?

Back 523

Direct formation of osteoid or bone by tumor cells

Front 524

Second most common primary cancer of bone?

Back 524

Chondrosarcoma

Front 525

>35 yrs, males
-X-ray: snowstorm densities
-Well differentiated, difficult to distinguish from endochondroma
-Large pleomorphic or bizarre binucleated chondrocytes

Back 525

Chondrosarcoma

Front 526

Children & young adults (10-15 yrs)
Long bones
Local pain, tenderness fever
Rapidly gorwing tumor
-Xray: Onion skin

Back 526

Ewing sarcoma

Front 527

Reciprocal translocation between chromosomes 11 & 22 can be used as a marker for?

Back 527

Ewing sarcoma

Front 528

MOST --> LEAST common MALIGNANCIES occurring in BONE? (6)

Back 528

1. Metastatic
2. Multiple myeloma
3. Osteosarcoma
4. Chondrosarcoma
5. Ewing sarcoma
6. Malignant giant cell tumor

Front 529

Circumscribed flat skin lesion of differing color than normal skin

Back 529

Macule

Front 530

Elevated skin lesion <5mm across

Back 530

Papule

Front 531

Elevated skin lesion more than 5mm across

Back 531

Nodule

Front 532

Mildly elevated skin lesion w/ level surface >5mm across

Back 532

Plaque

Front 533

Fluid-filled raised skin lesion <5mm across

Back 533

Vesicle

Front 534

Fluid filled raised skin lesion >5mm across

Back 534

Bulla

Front 535

Increased thickness of surface keratin layer

Back 535

Hyperkaratosis

Front 536

Pattern of hyperkeratosis characterized by retention of nuclei

Back 536

Parakeratosis

Front 537

Epidermal hyperplasia = thickening of spinous epithelial layer

Back 537

Acanthosis

Front 538

Abnormal keratinization occuring prematurely within individual cells or groups of cells below stratum granulosum

Back 538

Dyskeratosis

Front 539

Loss of intercellular connections resulting in loss of cohesion of keratinocytes

Back 539

Acantholysis

Front 540

Intercellular edema of epidermis

Back 540

Spongiosis

Front 541

Which type of dermatitis is NOT immune mediated?

Back 541

Primary irritant dermatitis
-Repeated trauma (rubbing)/chemical injury

Front 542

Pathogenesis of erythema multiforme?

Back 542

Immune response- hypersensitivity rxn
-Type I (eosinophils)
-Type II (cytotoxic T cells)

Front 543

Most common trigger of erythema multiforme?

Back 543

Infections (Herpes)
Others:
-drugs, malignancies, autoimmune diseases

Front 544

Target lesion is pathognomonic for which disease?

Back 544

Erythema multiforme

Front 545

Internediate form of erythema multiforme?

Back 545

Steven-Johnson syndrome
-Extensive & symptomatic febrile
-Skin & mucosal surfaces inolved
-Self limited but can be life-threatening

Front 546

Severe, life-threatening form of erythema multiforme?

Back 546

Toxic epidermal necrosis

Front 547

Well-demarcated pink & salmon colored plaque covered by loosely adherent silver-white scales

Back 547

Psoriasis

Front 548

+ Autspitz sign indicates which disease?

Back 548

Psiorasis
-Granular cell layer thin or abset so dermal papillae are close to surface --> leave pnpoint bleeding

Front 549

Munro's microbscesses are pathognomonic for which disease?

Back 549

Psoriasis

Front 550

Pathogenesis of lichen planus?

Back 550

Ag in basal cell layer at dermal-epidermal junction --> cell mediated cytotoxic immune response

Front 551

What are the "4 P's" & what disease are they found in?

Back 551

LICHEN PLANUS
1. Pruritis
2. Purple
3. Polygonal
4. Papules

Front 552

Striae of Wickham are found in which disease

Back 552

Lichen planus

Front 553

Classic prototype of systemic autoimmune diseases?

Back 553

Lupus erythematosus

Front 554

Pathogenesis of lupus erythematosus?

Back 554

Antinuclear auto-Ab

Front 555

Pathogenesis of pemphigus vulgaris?

Back 555

Type II hypersensitivity
-Auto Ab (IgG) to desmoglein 1 & 3
-Desmosomes
-Suprabasal (intraepithelial) blister

Front 556

Which disease is most like to produce acantholysis & Tzank cells?

Back 556

Pemphigus vulgaris

Front 557

Pathogenesis of bullous pemphigoid?

Back 557

Auto Ab (IgG) to hemidesmosome
-Subepidermal vesicle
-Complement activation

Front 558

Positive nikolsky sign ?

Back 558

Bullous pemphigoid
Benign mucous membrane pemphigoid

Front 559

Which bullous disease is common in the oral cavity & rarely involves the skin?

Back 559

Benign Mucous Membrane Pemphigoid

Front 560

Soft flesh colored tag-like tumor w/ small stalk found in middle age or older- one of most common skin lesions

Back 560

Skin tag (Acrocordon, Fibroepithelial polyp)

Front 561

Multiple dark brown sharply defined coin-like plaques found on exposed parts of skin with "stuck on" appearance that may peel of but reutrn?

Back 561

Seborrheic Keratosis
-NO risk of skin cancer

Front 562

White men >50, flesh- colored, dome shaped nodule w/ keratin plug on sun-exposed skin-- Mimics SCC but spontaenously heals

Back 562

Keratoacanthoma

Front 563

Common skin wart

Back 563

Verruca vulgaris

Front 564

Veneral wart?

Back 564

Condyloma accuminata

Front 565

Which benign skin tumor is dysplastic and has the potential to become malignant?

Back 565

Actinic keratosis

Front 566

Most common cancer of vermillion lip (sun exposed sites)?

Back 566

Squamous cell carcinoma

Front 567

Most common skin cancer?

Back 567

Basal cell carcinoma

Front 568

Best prognosis of all skin cancers?

Back 568

Basal cell carcinoma

Front 569

Well demarcated areas of pigment loss due to melanocytes in epidermis?

Back 569

Vitiligo

Front 570

Most common pigmented lesions of childhood due to hyperpigmentation & increased amounts of melanin?

Back 570

Ephilides

Front 571

Congenital or acquired hamartomas of melanocytes that usually develop during childhood or early adulthood?

Back 571

Melanocytic Nevus (pigmented nevus, mole)

Front 572

Junctional nevus is found?

Back 572

Dermal-epidermal junction

Front 573

Compound nevus is found?

Back 573

Upper dermis & dermal-epidermal junction

Front 574

Dermal nevus is found?

Back 574

Upper dermis only

Front 575

Most common site for melanoma of women & men?

Back 575

Women- back & legs
Men- upper back

Front 576

Melanoma does not have capacity to to metastasize in which growth phase?

Back 576

Radial growth phase
-proliferate in epidermal & superficial dermal layers

Front 577

WHich growth phase does melanoma have potential to metastasize?

Back 577

Vertical growth phase
-Proliferates downward into deeper dermal layers

Front 578

Disorders related to mutation of a single gene of large effect

Back 578

Mendelian

Front 579

Diseases arising from chromosomal abberations that are identifiable on a karyote

Back 579

Cytogenic (chromosomal) disorders

Front 580

Triple repeat mutations in mitochondrial genes & genomic imprinting

Back 580

Single-gene disorders w/ atypical patterns of inheritance

Front 581

Single gene mutation causing many phenotypic effects

Back 581

Pleiotropy

Front 582

Single gene mutation at any of several different gene pairs may cause same phenotypic disease.

Back 582

Genetic heterogeneity

Front 583

Most common autosomal dominant disorder?

Back 583

Familial hypercholesterolemia

Front 584

What is the defect of familial hypercholesterolemia?

Back 584

Defect in LDL receptor on hepatocytes

Front 585

What is the mutation in Marfan syndrome?

Back 585

Fibrillin 1
FBN1 on chromosome 15q21

Front 586

Pathogenesis of Marfan syndrome?

Back 586

Defects in fibrillin that cause skeletal problems, & cardiovascular problems:
1. Dissecting aneurysm
2. Floppy heart valve

Front 587

What is the defect in Neurofibromatosis type I?

Back 587

Mutation in NF1 gene (tumor suppressor gene)
-Neurofibromin negatively regulates RAS oncoprotein
-Mutation --> overactivity of RAS resulting in tumors

Front 588

Multiple neurofibromas
Cafe-au-lait spots
Lisch nodules (pigmented hamartomas of iris)
Malignant transformation 3%

Back 588

Neurofibromatosis type I (Von Recklinghausen disease of skin)

Front 589

Most common lethal genetic disease in US?

Back 589

Cystic fibrosis

Front 590

What is the defect of cystic fibrosis?

Back 590

Mutations of CFTR gene at chromosome 7q31.2
-Code for chloride channel proteins
-Defects in transport across epithelial surfaces

Front 591

-Onset: infants & young kids
-Viscous mucous secretions
-Salty sweat
-Recurrent & chronic lung infections (Bronchiectasis & chronic bronchitis)
-Pancreatic insufficiency & malabsorption
-Biliary cirrhosis

Back 591

Cystic fibrosis

Front 592

What is the defect of phenylketonuria?

Back 592

Autosomal recessive
-Severe lack of phenylalanine hydroxylase
-Phe doesn't get converted to Tyr
-Phe accumulates in serum

Front 593

Onset within weeks of birth
Severe mental retardation if not treated, seizure disorder, decreased pigmentation of hair & skin, skin rash

Back 593

Phenylketonuria

Front 594

What is the treatment for Phenylketonuria? (2)

Back 594

1. No Phe in diet 1st 2 yrs of life
2. BH4 (helps break down Phe)

Front 595

Onset within days of birth
-Failure to thrive, vomiting, diarrhea
-Hepatomegaly & jaundice (1 month)
-Cataracts
-Mental retardation w/ in 6-12 months

Back 595

Galactosemia

Front 596

What is the defect of galactosemia?

Back 596

Lack of galactose-1-phosphate uridyl transferase

Front 597

What is the defect of Tay-Sachs disease?

Back 597

Deficiency of hexosaminidase A which causes Gm2 gangliosides to be stored in CNS

Front 598

Severe mental retardation in infancy, blindness & severe neurologic dysfunction, death by 2-3 yrs

Back 598

Tay-Sachs disease

Front 599

Most common type of Niemann-Pick disease?

Back 599

Type A Niemann-Pick disease

Front 600

What causes Niemann-Pick disease?

Back 600

Deficiency of acid sphingomyelinase
-Excess sphingomyelin accumulates in phagocytic cells & neurons

Front 601

Severe deficiency of acid sphingomyelinase
-Severe visceromegaly: spleen, liver, BM, LN, lungs
-Neurologic deterioration
-Death by 3 yrs old

Back 601

Type A Niemann-Pick disease

Front 602

Defiency of acid sphingomyelinase
-hepatomegaly & splenomegaly
-CNS not affected
-Survive into late childhood/early adulthood

Back 602

Type B Niemann-Pick disease

Front 603

"Wrinkle tissue paper" cytoplasm is pathognomonic for which disease?

Back 603

Gaucher disease
-Glucsylceramides accumulate in phagocytic cells to form Gaucher cells

Front 604

What is the defect of Gaucher disease?

Back 604

Deficient activity of glucosylceramidase
-Cleave glucose residue from ceramide
-Glucsylceramides accumulate in phagocytic cells to form Gaucher cells

Front 605

Which variant of Gaucher disease feaures no CNS involvement, is compatible w/ long live & features bone involvement & hepatosplenomegaly?

Back 605

Type I- Most common

Front 606

Which type of Gaucher disease has severe CNS involvement that manifests by 6 months of age?

Back 606

Type II

Front 607

Juveline form of Gaucher disease that involves CNS & viscera-- an Intermediate form?

Back 607

Type III

Front 608

Group of diseases w/ abnormal degredation & accumulation of mucopolysaccharides

Back 608

Mucopolysaccharidoses

Front 609

Major manifestations of hepatic forms of glycogen storage diseases? (2)

Back 609

1. Hepatomegaly
2. Hypoglycemia

Front 610

Major manifestations of myopathic forms of glycogen storage diseases? (2)

Back 610

1. Muscle cramps/weakness
2. Reduced production of lactate

Front 611

Von-Gierke disease results from?

Back 611

Lack of glucose-6-phosphatase

Front 612

McCardle syndrome results from?

Back 612

Reduced muscle phosphorylase

Front 613

Pompe disease results from?

Back 613

Generalized lysosomal glucosidase (acid maltase) defiency

Front 614

Major findings of pompe disease?

Back 614

1. Hepatomegaly
2. Cardiomegaly
3. Skeletal muscle glycogen deposities

Front 615

3 Glycogen storage diseases?

Back 615

1. Von Gierke disease (hepatic)
2. McArdle syndrome (myopathic)
3. Pompe disease (generalized- also lysosomal storage disease)

Front 616

Ehlers-Danlos syndromes are group of syndromes all caused by mutations of?

Back 616

Defects in collagen structure/synthesis

Front 617

Mutation in COL3A1 causes deficient synthesis of?

Back 617

Type II collagen --> vascular type of Ehlers-Danlos syndrome
Autosomal dominant

Front 618

Mutation in COL1A1 & COL1A2 causes defect in?

Back 618

Conversion of procollagen type I to collagen
-Arthrochalasia type EDS
-Autosomal dominant

Front 619

What are internal complications of Ehlers-Danlos syndrome? (4)

Back 619

1. Rupture of large arteries
2. Rupture of colon
3. Rupture of cornea & retinal detachment
4. Diaphragmatic hernia

Front 620

What is the defect in Fragile X syndrome?

Back 620

Mutation in FMR1 gene on Xq27.3
X-linked disorder

Front 621

What percent of females are affected by fragile X syndrome?

Back 621

50% of heterozygous females are affected

Front 622

What percent of males have fragile X syndrome mutation are asymptomatic?

Back 622

20% males are asymptomatic

Front 623

Mental retardation
Long face, large mandible, large everted ears, large testicles

Back 623

Fragile X syndrome

Front 624

Most common cause of familial mental retardation?

Back 624

Fragile X syndrome

Front 625

In chromosome anatomy, what does metacentric mean?

Back 625

p & q arms are equal length

Front 626

In chromosomal anatomy, what is submetacentric?

Back 626

p arm shorter than q arm

Front 627

IN chromosome anatomy what is acrocentric?

Back 627

p arms are very short & have satellites

Front 628

Two or more karyotypic populations of cells in the same individual, occurring more commonly in sex chromosomes

Back 628

Mosaicism

Front 629

When fragments are exchanged between 2 chromosomes & no genetic material is lost?

Back 629

Balanced reciprocal translocation

Front 630

Type of reciprocal translocation that always occurs between 2 acrocentric chromosomes?

Back 630

Robertsonian translocation
(Centric fusion)

Front 631

Centromere divides transversely so that 2 short arms are paired & 2 long arms are paired

Back 631

Isochromosomes

Front 632

Loss of a portion of a chromosome

Back 632

Deletion

Front 633

2 breaks on the same arm of chromosome

Back 633

Para-inversion

Front 634

2 breaks on different arms of chromosome

Back 634

Peri-inversion

Front 635

Deletions occur at both ends of a single chromosome & damaged ends fuse

Back 635

Ring chromosome

Front 636

Most common cytogenic disorder?

Back 636

Trisomy 21

Front 637

Most cases the extra 21 chromosome comes from?

Back 637

Mom

Front 638

Mental retardation
Flat face & epicanthal folds
Horizontal palmar (Simian) crease
Hypotonia
Congenital heart defects
Predisposition to infections & acute myelogenous leukemia

Back 638

Trisomy 21

Front 639

Most common congenital heart defect in trisomy 21?

Back 639

Atrial septal defect

Front 640

Mental retardation
Failure to thrive
Prominent occiput
Low set ears, micrognathia
Hypertonicity, heart defects
Horse-shoe kidney
Rocker bottom feet
Crossed fingers
Die shortly after birth

Back 640

Trisomy 18 (Edwards syndrome)

Front 641

Mental retardation
Microcephaly, micropthalmia
Cleft lip & palate
Rocker bottom feet
Abnormal ears, extensive visceral defects
Polydactyl

Back 641

Trisomy 13 (Patau Syndrome)

Front 642

Male hypogonadism (small testes, sterile, low testosterone)
Gynecomastia
Reduced facial & body hair
Elongated body
Mild decreasted intelligence

Back 642

Klinefelter syndrome

Front 643

Failure to develop secondary sex charactersistics
Short stature, webbed neck & low posterior hairline
Broad (shield) chest
Streak ovaries, primary amenorrhea, infertility
Coarctation of aorta
High arched palate

Back 643

Turnor syndrome