Pathology

Front 1

Breast enlargement during pregnancy is an example of

Back 1

Hyperplasia

Front 2

What about skeletal muscle enlargement from weight lifting

Back 2

Hypertrophy

Front 3

Atrophy is often marked by the presence of

Back 3

Autophagic granules

Front 4

Metaplasia (eg squamous metaplasia of the bronchi from long-term smoking) is often associated with

Back 4

Chronic irritation

Front 5

Metaplasia can also be associated with

Back 5

Vitamin A deficiency

Front 6

Myeloid metaplasia is aka

Back 6

Extramedullary hematopoiesis

Front 7

____ is the most common cause of hypoxic cell injury

Back 7

Ischemia (obstruction of arterial blood flow)

Front 8

Describe the sequence of early stage hypoxic cell injury

Back 8

Mitochondria effected, decreased ATP production, failure of Na-K-ATPase pump, retained Na+ causes swelling of ER, diasaggregation of ribosomes and ↓protein synthesis, ↑glycolysis and ↑lactate

Front 9

Name two markers of late-stage cell hypoxia

Back 9

Myelin figures and cell blebs

Front 10

What signifies the point of no return in cell damage

Back 10

Calcium influx, calcification of the mitochondria

Front 11

How long can neurons, muscle cells, cardiac cells and hepatocytes last without oxygen

Back 11

N 3-5 minutes (Purkinjes in cerebellum and neurons of the hippocampus most sensitive)

Front 12

Name two common conditions where oxygen toxicity is due to free radical damage

Back 12

Retrolental fibroplasia – retinopathy of preemies

Front 13

Name the classic ultrastructure markers of barbiturate poisoning

Back 13

Proliferation and hypertrophy of the SER of the hepatocyte

Front 14

Reperfusion following _____ injury is also a major cause of free radical injury

Back 14

Ischemic

Front 15

Name the intracellular enzymes involved in free radical degradation

Back 15

Glutathione peroxidase, catalase, and superoxide dismutase

Front 16

Which vitamins are significant anti-oxidants

Back 16

Vit A, C and E

Front 17

Chemical cellular injury is modeled by _____

Back 17

Hepatocyte injury due to CCl4

Front 18

Briefly discuss this model:

Back 18

CCl4 is processed by P-450 enzymes in the SER, this produc s CCL3-, which initiates lipid peroxidation of intracellular membranes, dissagre-gation of ribosomes, ↓protein synthesis including lipoproteins, thus fatty change occurs

Front 19

Ultimately, the _____ membrane is damaged due to the lipid perox. of SER, this results in

Back 19

Massive calcium influx with resultant mitochondria damage and cell death

Front 20

Necrosis only occurs within

Back 20

Living organisms

Front 21

______ necrosis most often occurs from a sudden cutoff of blood supply to an organ, particularly end-organs like the heart and kidney

Back 21

Coagulative

Front 22

Pathological changes involved?

Back 22

General architecture well preserved, except for nuclear changes

Front 23

_____ is chromatin clumping w/↑basophilia

Back 23

Pyknosis

Front 24

_____ is fragmentation of DNA

Back 24

Karyorrhexis

Front 25

_____ is the fading of chromatin material

Back 25

Karyolysis

Front 26

Enzymatic liquefaction of necrotic tissue, most often in the ____ is aka liquefactice necrosis

Front 27

Where else does liquefactive necrosis occur

Back 27

In bacterial infections

Front 28

_____ necrosis shares features of both coag. And liquefactive necrosis. Most commonly seen in TB granulomas

Back 28

Caseous

Front 29

Which necrosis results from interruption of blood supply to a lower extremity or bowel

Back 29

Gangrenous

Front 30

When is it called WET gangrene

Back 30

When it is complicated by infective heterolysis and consequent liquefactive necrosis

Front 31

Fibrinoid necrosis is marked by

Back 31

Deposition of fibrin-like proteinaceous material in arterial walls

Front 32

It is often associated with

Back 32

Immune mediated vascular damage (vasculitis)

Front 33

Fat necrosis occurs in what two forms

Back 33

Traumatic fat necrosis

Front 34

Traumatic follows severe injury to tissue with high fat content, whereas enzymatic is a complication of

Back 34

Acute hemmorrhagic pancreatitis, where proteolytic and lipolytic enzymes seep into pancreatic parenchyma and digest it, which liberates fatty acids that are then saponified

Front 35

Which has an inflammatory rxn?

Front 36

Fatty change (aka _____) is characterized by

Back 36

Steatosis, accumulation of intracellular parenchymal TGs.

Front 37

Most frequently observed in which organs?

Back 37

Liver, heart and kidney

Front 38

_____ change describes a homogenous, glassy eosinophilic appearance

Back 38

Hyaline

Front 39

Argyria is aka _____

Back 39

Silver poisoning, may cause a permanent gray discoloration of the skin and conjunctivae

Front 40

Decreased melanin pigmentation is seen in what two conditions

Back 40

Albinism and vitiligo

Front 41

Bilirubin is a catabolic product of both _____ and _____

Back 41

Hemoglobin and methemoglobin

Front 42

What is hemosiderin?

Back 42

Iron containing pigment that consists of aggregates of ferritin

Front 43

Stains best with _____

Back 43

Prussian blue

Front 44

Systemic hemosiderosis is hemosiderin deposition without without _____

Back 44

Tissue or organ damage

Front 45

May result from?

Back 45

Hemorrhage, blood transfusions, hemolysis, excessive dietary iron

Front 46

How is hemoCHROMATOSIS different

Back 46

Damage to many tissues and organs, scarring and organ dysfunction

Front 47

Manifests itself as?

Back 47

Hepatic cirrhosis and pancreatic fibrosis, leading to diabetes mellitus

Front 48

Most often caused by

Back 48

Hereditary disorder characterized by ↑iron absorption

Front 49

Caused by a mutation in which gene?

Back 49

Hfe gene on chromosome 6

Front 50

Organs most affected?

Back 50

Liver pancreas and myocardium

Front 51

Triad of findings?

Back 51

Micronodular cirrhosis, diabetes mellitus and skin pigmentation (bronze diabetes)

Front 52

Which pts are at greatest risk for secondary hemochromatosis following transfusion

Back 52

Those with beta-thalassemia

Front 53

_____ is a yellowish, fat soluble pigment and the end product of lipid peroxidation

Back 53

Lipofuscin

Front 54

Combination of lipofuscin and organ atrophy is aka

Back 54

Brown Atrophy

Front 55

Metastatic calcification is caused by

Back 55

Hypercalcemia

Front 56

Often the result of

Back 56

HyperPTH, osteolytic tumors, hypervitaminosis D

Front 57

What is dystrophic calcification

Back 57

Calcification in areas of previously damaged tissue, such as areas of old trauma, TB lesions, scarred heart valves and atherosclerotic lesions

Front 58

Which chaperone protein marks abnormal proteins for degradation

Back 58

Ubiquitin

Front 59

Abnormal protein aggregation is characteristic of which diseases

Back 59

Amyloidosis, Alzheimers, Prion diseases and Huntington’s

Front 61

Inflammation

Front 62

Name the five cardinal signs

Back 62

Red, pain, heat, swelling, LOF

Front 63

Name the three families of adhesion molecules

Back 63

Selectins, integrins, Ig-family adhesion proteins

Front 64

_____ are induced by IL-1 and TNF

Back 64

Selectins

Front 65

L-selectins are expressed on _____ and bind to endothelial cells

Back 65

Neutrophils

Front 66

E and P selectins are expressed on _____ cells and bind to leukocytes

Back 66

Endothelial

Front 67

Which selectins are stored inside endothelial cells and are brought to the surface only after stimulation by histamine and/or thrombin

Back 67

P-selectins

Front 68

______ are expressed on endothelial cells and bind to integrin molecules on leukocytes

Back 68

ICAM-1 and ICAM-2

Front 69

Give an example of the integrins expressed on leukocytes

Back 69

LFA-1

Front 70

____ are the most prominent inflammatory cells in the first 24 hrs

Back 70

Neutrophils

Front 71

Name two important causes of neutrophilia

Back 71

Bacterial infection

Front 72

After 2-3 days, PMNs are replaced by

Back 72

Monocytes/macrophages

Front 73

Name some important causes of monocytosis (i.e. increased # of monocytes in peripheral blood)

Back 73

TB, brucellosis, typhus, salmonella infection

Front 74

Which are the most prominent inflammatory cells in viral infections

Back 74

Lymphocytes (also most prominent in chronic inflammation)

Front 75

Eosinophils are most prominent in

Back 75

Allergic RXNs and parasite infections

Front 76

Which cells are sources of histamine

Back 76

Mast cells and basophils

Front 77

Important causes of basophilia include

Back 77

CML and other myeloproliferative diseases

Front 78

Margination

Back 78

Leukocytes localize to the outer margin of the blood flow

Front 79

Pavementing

Back 79

Occurs as leukocytes line the endothelial surface

Front 80

Rolling (tumbling) is mediated by

Back 80

Endothelial selectins loosely binding to leukocytes

Front 81

Adhesion of leukos to endothelial surface is mediated by

Back 81

Integrins on leukos binding to Ig-family adhesion proteins on endothelium

Front 82

Transmigration across the endothelium is mediated by

Back 82

PECAM-1

Front 83

Chemotaxis?

Back 83

Process by which leukos are attracted and move towards an injury

Front 84

Movement occurs along a

Back 84

Chemical gradient

Front 85

Name the most prominent chemotactic factors

Back 85

Complement components, esp. C5a

Front 86

Define opsonization

Back 86

The coating of particulates by opsonins, which immobilize the particles on the macrophage surface

Front 87

Name the most important opsonins

Back 87

IgG subtypes

Front 88

Which portion of the IgG molecule binds to the phagocytic cells

Back 88

Fc

Front 89

What is the most important intracellular microbicidal killing method

Back 89

Oxygen dependent microbe killing

Front 90

Phagocytosis initiates activity of the _____ shunt, causing an oxidative burst, which supplies electrons to NADPH oxidase in the phagosomal membrane

Back 90

Hexose monophosphate

Front 91

One of the products of the oxidase is ____, which is further converted to _____ by dismutation, which is further mutated to _____

Back 91

Superoxide ion, hydrogen peroxide, hydroxyl radical

Front 92

What does the hyd. Peroxide do for us?

Back 92

In the presence of myeloperoxidase and a halide ion, it oxidizes microbial proteins and disrupts cell walls

Front 93

Exogenous mediators of acute inflammation are most often _____ and are exemplified by _____

Back 93

Of microbial origin, formylated peptides of E.coli

Front 94

Endogenously, _____ from mast cells, basophils and platelets ↑capillary permeability

Back 94

Histamine

Front 95

Binding of what substances to basophils/mast cells causes this acute inflammation

Back 95

IgE, C3a / C5a (anaphylatoxins), and IL-1

Front 96

The AA pathway yields ____ in platelets and _____ in endothelial cells

Back 96

TxA2, PGI2 (prostacyclin)

Front 97

Function of platelet TxA2

Back 97

Powerful vasoconstrictor and platelet aggregant

Front 98

Function of endothelial PGI2

Back 98

Powerful vasodilator and inhibitor of platelet aggregation

Front 99

Function of the leukotrienes released via the lipoxygenase pathway of AA metabolism

Back 99

Chemotactic for PMNs (LTB4)

Front 100

What are the acute phase responses activated by cytokines

Back 100

Fever and leukocytosis

Front 101

The kinin system is activated by

Back 101

The Hageman factor (XIIa)

Front 102

Kinin converts prekallikrein to kallikrein which then cleaves HMWK to _____

Front 103

Which anaphylatoxin activates the lipoxygenase pathway of AA metabolism

Back 103

C5a

Front 104

What (who) forms the MAC (membrane attack complex)

Back 104

C5b-C9

Front 105

Nitric oxide is produced by

Back 105

Endothelial cells

Front 106

Abcesses are cavities filled with pus and are usually the result of

Back 106

Bacterial infections, esp. S.aureus

Front 107

Increased susceptibility to infection may be due to deficiency of

Back 107

Complement components C2,3,5

Front 108

Describe chronic granulomatous disease of childhood

Back 108

Usually X-linked

Front 109

Which organisms are ingested but NOT destroyed

Back 109

Catalase positive – these guys can destroy the hyd. Peroxide generated by bacterial metabolism, and the PMNs are deficient so they cannot generate additional hyd.peroxide, thus none is available as a substrate for myeloperoxidase system

Front 110

Examples of CAT(+) and CAT(-) organisms

Back 110

S.aureus – CAT(+)

Front 111

What type of inheritance is Chediak-Higashi

Back 111

Autosomal recessive

Front 112

Marked by the presence of abnormal

Back 112

WBCs

Front 113

The WBCs have impaired

Back 113

Chemotaxis and migration (microtubules)

Front 114

How do they look morphologically

Back 114

Large cytoplasmic granules (representing abnormal lysosomes)

Front 115

What are the two major patterns of chronic inflammation

Back 115

Chronic nonspecific and granulomatous inflammation

Front 116

Granulomas are nodular collections of specialized macrophages referred to as_____ and are usually surrounded by a rim of _____

Back 116

Epitheliod cells

Front 117

Here’s the process: macrophages present antigen to _____, which in turn secrete _____ that mediate the macrophage conversion to epitheliod cells and giant cells

Back 117

CD4+

Front 118

Granulomas are often characterized by _____ necrosis

Back 118

Caseous

Front 119

However, non-caseating granulomatous disease is most often caused by _____

Back 119

Sarcoidosis (think young, black female)

Front 120

Which giant cells also characterize granulomas

Back 120

Langhans giant cell

Front 121

What is unique about the nuclei of these cells

Back 121

Horseshoe nucleus

Front 122

What infectious agents are classic for granulomas:

Back 122

TB, leprosy, Blasto, Histo, Coccidio, Syphillus, Cat Scratch disease.

Front 123

____ cells divide actively throughout life and are capable of regeneration after injury

Back 123

Labile

Front 124

____ cells generally undergo very few divisions but can regenerate from G-0 cells when needed. They are also capable of regenerating post-injury.

Back 124

Stable

Front 125

Examples?

Back 125

Liver and kidney cells

Front 126

What is the third class of cells and examples

Back 126

Permanent: neurons and myocardial cells

Front 127

Promotes new vessel formation?

Front 128

_____ tissue is highly vascular, newly formed connective tissue consisting of capillaries and fibroblasts

Back 128

Granulation

Front 129

_____ is produced by fibroblasts

Back 129

Collagen

Front 130

Why does diabetes delay or impede tissue repair

Back 130

↑susceptibility to infection and ↓circulation

Front 131

Why does deficiency of ascorbic acid / protein also delay tissue repair

Back 131

Both are required for collagen formation

Front 133

Hemodynamic Dysfunction

Front 134

Difference between ecchymosis and hematoma

Back 134

Diffuse vs. local hemorrhage

Front 135

Chronic passive congestion of the liver and lower extremities is most often cuased by

Back 135

RHF

Front 136

This results in nutmeg liver, explain:

Back 136

Produced by a combination of dilated, congested central veins and the surrounding brownish-yellow (often fatty) liver cells

Front 137

_____ is necrosis resulting from ischemia

Back 137

Infarction

Front 138

White or pale infarcts are usually caused by

Back 138

Arterial occlusions in the heart, spleen or kidney

Front 139

Red infarcts are

Back 139

Hemorrhagic infarcts in which red cells ooze into the necrotic area

Front 140

Red infarcts characteristically occur in

Back 140

Lung and GI tract (i.e. areas w/redundant supplies)

Front 141

What causes platelet adhesion in thrombogenesis

Back 141

Exposed (damaged) endothelial collagen

Front 142

This platelet surface glycoprotein receptor and subendothelial collagen interaction is mediated by

Back 142

vWF

Front 143

Describe the release reaction

Back 143

Soon after adhesion, platelets release ADP, histamine, PDGF etc

Front 144

Activation of platelet membrane phospholipase leads to what

Back 144

AA pathways, thus TxA2 (recall: potent vasoconstrictor and platelet aggregant

Front 145

Why don’t we become one giant clot?

Back 145

PGI2 is also produced by endothelial cells and is an antagonist to platelet TxA2

Front 146

Endothelial cells are somewhat against clotting, what substances do they secrete

Back 146

Proteoglycans that activate AT-III

Front 147

What does (APC) activated protein C do?

Back 147

Cleaves factors Va and VIIIa

Front 148

What co-factor for APC do endothelial cells synth?

Back 148

Protein-S

Front 149

Extrinsic pathway of coagulation:

Back 149

Factor VII / Tissue Factor, Factor X/Xa etc

Front 150

Factor Xa and Va activate

Back 150

Prothrombin to thrombin

Front 151

Which, in turn, activates

Back 151

Fibrinogen to fibrin

Front 152

What’s important about XIIa

Back 152

XII-to-XIIa activation links the fibrinolytic system, coagulation system, complement system and kinin system

Front 153

Hereditary thrombophilia is common in

Back 153

Adolescents and young women

Front 154

Characterized by

Back 154

Recurrent venous thrombosis/thromboembolism

Front 155

Can be caused by deficiency in

Back 155

AT-III, protein C and/or protein S

Front 156

But, what is the most common cause?

Back 156

Factor-V Leiden – abnormal factor-V with a specific mutation that alters the cleavage site targeted by APC

Front 157

This condition is aka

Back 157

Hereditary resistance to APC

Front 158

Name two more causes

Back 158

Prothrombin 20210A transition

Front 159

Which antiphospholipid antibody associated with SLE can cause a false(+) syphilis test

Back 159

Anti-cardiolipin antibody

Front 160

Mature arterial thrombi with alternating dark gray layers of platelets interspersed with lighter layers of fribrin are aka

Back 160

Lines of Zahn

Front 161

In contrast, venous clots are what color

Back 161

Deep red

Front 162

What is the most frequent form of embolism

Back 162

Thrombo-embolism

Front 163

Which type of pulmonary emboli produce sudden death

Back 163

Saddle emboli

Front 164

How do pulmonary hemorrhagic infarcts appear

Back 164

Wedge shaped and located just below the pleura

Front 165

Where do most arterial emboli develop

Back 165

Mural thrombi in the heart

Front 166

Mural thrombi in the left atrium esp/ assoc with

Back 166

Mitral stenosis w/atrial fibrillation

Front 167

Whereas, mural thrombi in the left ventricle are most often assoc. w/

Back 167

MI

Front 168

Most frequently, which cerebral artery is embolized

Back 168

Middle cerebral artery

Front 169

What are paradoxical emboli

Back 169

Originate in venous system, but become left sided emboli

Front 170

How can this happen

Back 170

Patent foramen ovale or atrial-septal defect

Front 171

What to watch out for in a pt with many fractures following trauma

Back 171

Fat embolism syndrome

Front 172

LHF results in

Front 173

Edema can also be caused by ↓oncotic pressure. Name two causes for this:

Back 173

Nephrotic syndrome – loss of protein, thus hypoalbuminemia

Front 174

_____ aka generalized edema

Back 174

Anasarca

Front 175

Transudate has a low ____ content and SG<?

Back 175

Protein, 1.012

Front 176

Exudate results from

Back 176

↑vascular permeability as a result of inflammation

Front 177

Exudate has a high ____ content and SG>? And characteristically contains large numbers of

Back 177

Protein, 1.020, inflammatory leukocytes

Front 178

Cardiogenic shock is most often caused by

Back 178

LHF due to MI

Front 179

Septic shock most often characterized by what type of infections

Back 179

Gram negative

Front 180

What causes the cascade of cytokines that leads to direct vascular injury

Back 180

Lipopolysaccharide (LPS) from outer membrane of gram negative bacteria

Front 181

What toxic molecules are responsible for toxic shock syndrome

Back 181

Superantigens, most often assoc. w/S.aureus

Front 182

What is the most important anatomical finding in shock

Back 182

Acute tubular necrosis

Front 183

Name some others

Back 183

Patchy mucosal hemorrhage in the colon

Front 184

First Aid Path Start

Front 185

Pt has multiple fractures, anemia, and CN deficits, what cells are dysfunctional

Back 185

Osteoclasts (osteopetrosis)

Front 186

High blood pressure in arms, low BP in legs

Back 186

Coarctation of aorta

Front 187

Pt presents with diffuse goiter and hyperthyroidism, what are the expected TSH and thyroid hormone levels

Back 187

Low TSH, high thyroid hormone levels

Front 188

Obese woman presents with hirsutism and ↑ levels of serum testosterone, what is the DX

Back 188

Polycystic ovarian syndrome

Front 189

Pt with elevated cortisol, 1 mg DEX test does not ↓cortisol, 8 mg does, what is the DX

Back 189

Pituitary tumor

Front 190

Child has been anemic since birth, splenectomy would result in ↑hematocrit in which disease

Back 190

Spherocytosis

Front 191

DX: dizziness, tinnitus, enlarged internal acoustic meatus

Back 191

Schwannoma

Front 192

DX: child with weakness and enlarged calves

Back 192

Duchenne’s muscular dystrophy

Front 193

How is it inherited

Back 193

X-linked recessive

Front 194

25 y/o female, sudden uniocular vision loss, HX of parasthesias and weakness that have resolved

Back 194

MS

Front 195

Teenager presents with nephritic syndrome and hearing loss, DX:

Back 195

Alport’s syndrome

Front 196

Female has recurrent URIs and inability to conceive, she has dextrocardia, which protein is defective

Back 196

Dynein (Kartagener’s)

Front 197

55 y/o man, heavy drinker and smoker, flu-like symptoms, no organisms on Gram stain, silver stain of sputum shows Gram(-) rods?

Back 197

Legionella pneumonia

Front 198

50 y/o man with diarrhea, his face is plethoric and a heart murmur is detected, DX:

Back 198

Carcinoid syndrome

Front 199

Elderly woman present with headache and jaw pain, labs show ↑ESR, DX:

Back 199

Temporal arteritis

Front 200

Woman at 16 weeks gestation, but has abnormally large abdomen, what could be the cause? What blood test will help with the DX?

Back 200

Hydatidiform mole

Front 201

Most likely cause of systolic crescendo-decrescendo murmur

Back 201

Aortic stenosis

Front 202

Woman of short stature with shortened 4th and 5th metacarpals, what endocrine disorder?

Back 202

Albright’s hereditary osteodystrophy, or pseudohyoparathyroidism

Front 203

30 y/o man with BRBPR after stressful event. Colonic biopsy shows transmural inflammation

Back 203

Crohn’s Disease

Front 204

Thus, what would be the key to the biopsy on UC

Back 204

Inflammation through the mucosa/submucosa only

Front 205

Young man with mental deterioration and tremors, brown ring around cornea: DX and TX

Back 205

Wilson’s disease

Front 206

Gross photo of AAA, what is the most likely cause

Back 206

Atherosclerosis

Front 207

Photo of bunch-of-grapes hydatidiform mole, high levels of what substance are found

Back 207

hCG

Front 208

Photo of focal intestinal hemorrhages in a weightlifter, DX

Back 208

Strangulation of a hernia

Front 209

Collapse of middle lobe of right lung, pt has a mass In right bronchus, HX of recurrent pneumonia

Back 209

Bronchogenic carcinoma

Front 210

Middle aged female w/syncope, mass removed from right atrium, wispy mucus-like tissue

Back 210

Myxoma

Front 211

What are the clinical findings in pneumothorax

Back 211

Pleuritic pain, SOB

Front 212

1 y/o baby with red spot on face, it blanches w/pressure, no neurological signs, what is the expected course

Back 212

Regression

Front 213

What similar stain has a much more malignant DX

Back 213

Port-wine stain of Sturge-Weber syndrome

Front 214

H&E of lung biopsy from a plumber shows dumb-bell shaped stuctures, DX?

Back 214

Asbestosis

Front 215

Increased risk for?

Back 215

Malignant mesothelioma

Front 216

Multiple mesangial nodules on a glomerulus is indicative of

Back 216

Diabetes mellitus

Front 217

Polycystic kidney disease in adult is inherited by

Back 217

Auto. Dominant

Front 218

Pt with anemia, hypercalcemia, and bony pain on palpation; bone marrow biopsy shows many plasma cells w/large, round, off-center nucleus

Back 218

Multiple myeloma

Front 219

NTDs are asscoiated with ↑levels of

Back 219

Alpha-feto protein in both amniotic fluid and in mother’s serum

Front 220

1.

Back 220

early cyanosis (blue babies)

Front 221

2.

Back 221

late cyanosis (blue kids)

Front 222

1.

Back 222

R-to-L

Front 223

2.

Back 223

L-to-R

Front 224

What are the three T’s of blue babies

Back 224

1.

Front 225

2.

Back 225

Transposition of great vessels

Front 226

3.

Back 226

Truncus arteriosus

Front 227

Children may squat to ↑

Back 227

Venous return

Front 228

What three conditions lead to blue kids

Back 228

VSD > ASD > PDA

Front 229

In fact, ___ is the most common congenital anomaly

Back 229

VSD

Front 230

Progressive pulmonary HT leads to _____ shunt, aka _____

Back 230

R-to-L, Eisenmenger’s

Front 231

Describe Eisenmenger’s syndrome

Back 231

Uncorrected VSD, ASD or PDA leads to progressive pulm. HT, the shunt changes from L-to-R over to R-to-L, which causes late cyanosis, clubbing and polycythemia

Front 232

PROVe pneumonic of Tetralogy of Fallot

Back 232

Pulmonary stenosis

Front 233

Patients suffer _____ spells

Back 233

Cyanotic

Front 234

Cause of the tetralogy?

Back 234

Anterosuperior displacement of the infundibular septum

Front 235

Is transposition of the great vessels compatible with life

Back 235

No, not unless a shunt is present to allow mixing of blood. VSD, PDA or PFO

Front 236

Which babies are at high risk

Back 236

Those born to diabetic mothers

Front 237

In coarctation of aorta, what is the infantile type and adult type

Back 237

Infantile: stenosis proximal to insertion of ductus arteriosus (preductal)

Front 238

Gender bias?

Back 238

Male:female = 3:1

Front 239

Any associated syndromes

Back 239

Infantile is assoc. w/Turner’s syndrome

Front 240

Fetal PDA is a ‘normal’ R-to-L shunt, but perinatal, is the PDA remains, flow switches and RHF results, what type of murmur is heard

Front 241

What maintains patency

Back 241

PGE synthesis, Low oxygen tension

Front 242

Down’ syndrome risk is

Back 242

1:700

Front 243

Duodenal _____ is common, as is congenital _____

Back 243

Atresia, heart disease

Front 244

1.

Back 244

which leukemia?

Front 245

2.

Back 245

Which neurological deterioration

Front 246

1.

Back 246

ALL

Front 247

2.

Back 247

ALLzheimer’s

Front 248

95% of cases are due to

Back 248

Meiotic non-disjunction (MNDJ) of homologous chromosomes

Front 249

MNDJ is assoc. with

Back 249

↑age

Front 250

Edward’s syndrome is trisomy ____

Back 250

18 (Election age is 18)

Front 251

Patau’s syndrome is trisomy ____

Back 251

13 (Puberty is at 13)

Front 252

Which is assoc. with midline defects

Back 252

Patau’s

Front 253

Which is asoc. with polydactyly

Back 253

Patau’s

Front 254

What is one of the most common causes of hypo-gonadism in males

Back 254

Klinefelter’s

Front 255

Genotype

Back 255

XXY

Front 256

Presence of inactivated X chromosome (aka____)

Back 256

Barr body

Front 257

Whereas, in Turner’s syndrome, there is____

Back 257

No Barr body present, because genotype = XO

Front 258

Turner’s is most common cause of

Back 258

Primary amenorrhea

Front 259

Cardiac anomalies?

Back 259

Coarctation of the aorta

Front 260

Double ‘Y’ males (XYY) are phenotypically normal except for

Back 260

Very tall, severe acne

Front 261

Define pseudo-hermaphrodite

Back 261

Disagreement between external genitalia and testes/ovaries (i.e. phenotypic vs. gonadal sex), ambiguous genitalia

Front 262

Most common form of male pseudo- is

Back 262

Testicular feminization (androgen insensitivity),

Front 263

This results from a mutation in

Back 263

The androgen receptor gene

Front 264

Define a true hermaphrodite

Back 264

Both ovary and testicular tissue present

Front 265

microcephaly, retadation, high pitched crying

Front 266

X-linked defect affecting the methylation and expression of FMR-1 gene. It is the 2nd most common cause of mental retardation

Back 266

Fragile X syndrome

Front 267

____ repeat disorder (CGG)

Back 267

Triple

Front 268

Phenotype (appearance)

Back 268

Enlarged testes, long face, large jaw, autism

Front 269

What is the MOST common cause of retardation

Back 269

Downs

Front 270

1. X-linked recessive, dystrophin gene deletion, onset <5y/o, starts in pelvic girdle, big calves

Front 271

Why big calves (pseudohypertrophy)

Back 271

Fatty-fibrous replacement of muscle

Front 272

Gower’s maneuver

Back 272

Using arms to stand one’s self up (indicates proximal limb weakness)

Front 273

How does Becker’s MD differ

Back 273

Dystrophin gene mutations, NOT deletions, thus not as severe

Front 274

How is diagnosis made

Back 274

Muscle biopsy, serum CPK increase

Front 275

CF is due to

Back 275

CFTR gene defect (auto. Recessive) on C7

Front 276

Recurrent pneumonia often due to which organisms

Back 276

Pseudomonas, S. aureus

Front 277

How does this manifest itself in newborns

Back 277

Meconium ileus, failure to thrive

Front 278

How about in adults (esp. males)

Back 278

Infertility, vitamin ADEK deficiencies

Front 280

Autosomal dominant diseases (8)

Front 281

Adult polycystic kidney disease: 90% of cases due to mutation in

Back 281

APKD1 gene on C16

Front 282

Associated conditions

Back 282

Berry aneurysms, mitral valve prolapse

Front 283

Isn’t there a juvenile form as well?

Back 283

Yes – but its recessive

Front 284

_____: elevated LDL due to defective LDL receptor

Back 284

Familial hypercholesterolemia

Front 285

Look for severe _____ early in life

Back 285

Atherosclerotic disease, cholesterol 300-700

Front 286

Classic finding is xanthomas on

Back 286

The Archille’s tendon

Front 287

Marfan’s is due to

Back 287

Fibrillin gene mutation

Front 288

Thus, characterized by

Back 288

Connective tissue disorders

Front 289

Long thin skeletons, fingers etc. But, what cardiac anomalies are present

Back 289

Cystic medial necrosis of aorta, dissecting aortic aneurysms, floppy mitral valve (prolapsing)

Front 290

Any ocular findings

Back 290

Sublaxation of lens

Front 291

_____: café au lait spots, neural tumors, Lisch nodules (pigmented iris hamartomas)

Back 291

NFT1: von Recklinghausens (chromosome 17 because there are 17 letters in name)

Front 292

Findings in von Hippel Lindau

Back 292

Hemangioblastomas of retina / cerebellum / medulla, about 50% get renal carcinomas

Front 293

Which gene is involved

Back 293

VHL gene on C3

Front 294

_____ disease: depression, progressive dementia, chorea

Back 294

Huntington’s

Front 295

What transmitters are affected

Back 295

↓GABA and Ach in the brain

Front 296

Section of brain most affected

Back 296

Caudate nucleus

Front 297

How is this like Fragile X syndrome

Back 297

Triple repeat disorder

Front 298

Which chromosome is involved

Back 298

C4

Front 299

Name the features of Familial Adenomatous Polyposis

Back 299

Deletion on chromosome Five

Front 300

_____ causes hemolytic anemia and splenectomy is curative

Back 300

Hereditary spherocytosis

Front 301

How is MCHC affected

Back 301

Increased

Front 302

End of autosomal dominant disease

Front 303

At this point, you should study the lists of auto.recessive and x-linked diseases

Front 305

Why are female carriers of x-linked diseases rarely affected?

Back 305

B/c of random inactivation of X chromosomes in each cell.

Front 306

___ are assoc. W/low folic acid during pregnancy

Back 306

NTDs

Front 307

Lab tests?

Back 307

Raised alpha-fetoprotein

Front 308

What are the defining features of spina bifida occulta

Back 308

Failure of boney spinal canal closure

Front 309

Meningocele?

Back 309

Meninges alone herniated through spinal canal defect

Front 310

Meningomyelocele, therefore, is when

Back 310

Meninges AND spinal cord herniated through

Front 311

Even though there is no herniation in occulta, what telltale sign is present

Back 311

Tuft of hair on child’s back

Front 312

When is the highest risk (during pregnancy) for FAS (fetal alcohol syndrome)

Back 312

3-8 weeks

Front 313

What is the number one cause of congenital malformations in the US?

Back 313

FAS

Front 314

____ is the abnormal proliferation of cells with loss of size, shape and orientation

Back 314

Dysplasia

Front 315

What two conditions define carcinoma-in-situ

Back 315

1. Malignant cells have not invaded basement membrane

Front 316

How do malig. Cells breach the basement membrane

Back 316

Using hydrolases and collagenases

Front 317

When the BM is breached, this is called

Back 317

Invasive carcinoma

Front 318

In the “seed and soil” theory of metastases, the tumor embolus is the seed, what is the soil

Back 318

The target organ (liver, lungs, bone, brain)

Front 319

When one adult cell type is replaced by another, we call this

Back 319

Metaplasia

Front 320

_____ = abnormal cells lacking differentiation

Back 320

Anaplasia

Front 321

_____ = a clonal proliferation of cells that is uncontrolled and excessive

Back 321

Neoplasia

Front 322

The histiologic appearance of a tumor is aka

Back 322

Grade (usually I-IV)

Front 323

Grading is based on degree of differentiation and number of

Back 323

Mitoses per HPF

Front 324

The STAGE is based on

Back 324

Site and size of primary lesion, spread to LNs, and presence of mets.

Front 325

Which has more prognostic value

Back 325

Stage

Front 326

Describe the TNM staging system

Back 326

T=size of tumor

Front 327

5. bone

Front 328

Down’s

Front 329

Xeroderma pigmentosum

Back 329

Squamous cell and BCC of skin

Front 330

Chronic atrophic gastritis, pernicious anemia

Back 330

Gastric adenocarcinoma

Front 331

Tuberous sclerosis (facial angiofibroma, seizures, mental retardation)

Back 331

Astrocytoma and cardiac rhabdomyoma

Front 332

Actinic keratosis

Back 332

SCC of skin

Front 333

Barret’s

Back 333

Esophageal adenocarcinoma

Front 334

Plummer Vinson syndrome

Back 334

SCC of esophagus

Front 335

What are the symptoms of PV syndrome

Back 335

Atrophic glossitis, esophageal webs, anemia

Front 336

These are all due to

Back 336

Iron deficiency

Front 337

Cirrhosis leads to (ETOH, Hep B or C)

Back 337

Hepatocellular carcinoma

Front 338

UC leads to

Back 338

Colonic adenocarcinoma

Front 339

Paget’s disease of bone

Back 339

Secondary osteosarcoma and fibrosarcoma

Front 340

Immunodeficiency states most often lead to

Back 340

Malignant lymphomas

Front 341

Autoimmune diseases such as Hashimoto’s and MG can lead to

Back 341

Malignant thymomas

Front 342

Acanthosis nigricans (hyperpigmentation and epidermal thickening

Back 342

Visceral malignancy (stomach, lung, breast, uterus)

Front 343

Dysplastic nevus leads to

Back 343

Malignant melanoma

Front 345

Given an oncogene, name the assoc. tumor:

Front 346

c-myc

Back 346

Burkitt’s lymphoma

Front 347

Bcl-2

Back 347

Follicular and undifferentiated lymphomas

Front 348

Erb-B2

Back 348

Breast, ovarian, gastric carcinomas

Front 349

Ras

Back 349

Colon carcinoma

Front 351

Name the chromosomes the following genes are located on, and the tumor that results with their loss

Front 352

Rb

Back 352

13q – retinoblastoma, osteosarcoma

Front 353

BRCA ½

Back 353

13q,17q – breast and ovarian cancer

Front 354

P53

Back 354

17p – most human cancers

Front 356

PSA stands for

Back 356

Prostatic acid phosphatase

Front 357

Which marker is very non-specific but is produced by 70% of colorectal and pancreatic cancers

Back 357

CEA (carcinoembryonic antigen)

Front 358

Which carcinoma elevates alpha-fetoprotein

Back 358

Hepatic carcinoma

Front 359

Beta –hCG is a good marker for

Back 359

Hydatidiform moles, Choriocarcinomas, Gestational trophoblastic tumors

Front 360

S-100 is a good marker for

Back 360

Melanoma, neural tumors, and astrocytomas

Front 361

Alk-phosphatase is elevated in

Back 361

Paget’s disease of bone

Front 363

Name the assoc. disease/cancer (given the virus)

Front 364

HTLV-1

Back 364

Adult T-call leukemia

Front 365

HBV,HCV

Back 365

Hepatocellular carcinoma

Front 366

EBV

Back 366

Burkitt’s, nasopharyngeal carcinoma

Front 367

HPV

Back 367

Cervical carcinoma (16,18)

Front 368

HHV-8

Back 368

Kaposi’s sarcoma

Front 370

Given a toxin, name the affected organ

Front 371

Aflatoxin, vinyl chloride

Back 371

Liver

Front 372

Nitrosamines

Back 372

Esophagus, stomach

Front 373

Asbestos

Back 373

Lung (mesothelioma, bronchogenic carcinoma)

Front 374

Arsenic

Back 374

Skin (SCC)

Front 375

CCl4

Back 375

Centrilobar necrosis, fatty change

Front 378

Prostate adenocarcinoma most often arises from which lobe

Back 378

Posterior lobe (peripheral zone)

Front 379

_____ is a presursor to SCC

Back 379

Actinic keratosis

Front 380

SCC is assoc. with what exposures

Back 380

Sunlight and arsenic

Front 381

Locally invasive but rarely

Back 381

Metastasize

Front 382

Histology?

Back 382

Keratin pearls

Front 383

What is the histology of BCC

Back 383

Palisading nuclei

Front 384

What about the pathognomonic gross appearance

Back 384

Pearly papules

Front 385

Any metastases

Back 385

Almost never

Front 386

So, who DOES metastasize

Back 386

Melanoma

Front 387

____ of tumor correlates with risk of mets

Back 387

Depth

Front 388

____ is a precursor

Back 388

Dysplastic nevus

Front 389

Common benign bone tumor in men <25y/o

Back 389

Osteochondroma

Front 390

Commonly originates from

Back 390

Long metaphysis

Front 391

Another common benign bone tumor that occurs at epiphyseal end of long bones, onset between 20-40 y/o. (distal femur, proximal tibia)

Back 391

Giant cell tumor

Front 392

Characteristic appearance on xray?

Back 392

Soap bubble

Front 393

Most common primary malig. Tumor of bone in men 10-20 y/o.

Back 393

Osteosarcoma

Front 394

Location?

Back 394

Metaphysis of long bones

Front 395

Any predisposing factors?

Back 395

Paget’s disease, familial retinoblastoma

Front 396

Characteristics on xrays?

Back 396

Codman’s triangle

Front 397

Another malig. Sarcoma in boys < 15 y/o?

Back 397

Ewing’s sarcoma

Front 398

Xray characteristics?

Back 398

Onion-skin pattern

Front 399

What type of cells are involved

Back 399

Anaplastic SMALL cells

Front 400

Location in bone?

Back 400

Diaphysis of long bones, pelvis, scapula, ribs

Front 401

Which translocation?

Back 401

11;22 translocation

Front 403

Brain tumors

Front 404

Adult tumors are mostly located______

Back 404

Supratentorial (kids are infratentorial)

Front 405

GBM is most common primary brain tumor. What is its location and PX

Back 405

Cerebral hemispheres

Front 406

Histology

Back 406

Pseudopalisading tumor cells border areas of necrosis and hemorrhage

Front 407

What’s the second most common

Back 407

Meningiomas

Front 408

Locations?

Back 408

Convexities of hemispheres

Front 409

Arise from _____ cells

Back 409

Arachnoid

Front 410

Histology

Back 410

Psammoma bodies (whorled pattern)

Front 411

What rare tumors grow in the frontal lobe and have fried egg appearance

Back 411

Oligodendrogliomas

Front 412

Name the third most common tumor

Back 412

Scwannomas

Front 413

Often localized to ___ nerve and called

Back 413

8th, acoustic neuroma

Front 414

Bilateral schwannomas found in

Back 414

NF2 syndrome

Front 415

Which adenoma is derived from Rathke’s pouch

Back 415

Pituitary

Front 416

Symptoms

Back 416

Prolactin increases

Front 417

Now, for some childhood brain tumors

Front 418

Highly malignant cerebellar tumor that is a form of primitive neurectodermal tumor (PNET)

Back 418

Medulloblastoma

Front 419

Symptoms

Back 419

Can compress 4th ventricle and cause hydrocephaly

Front 420

Histiology

Back 420

Rosette or perivascular perirosette

Front 421

What other cerebellar tumor is asoc. With von Hippel Lindau syndrome when seen with retinoblastomas

Back 421

Hemangioblastomas

Front 422

These tumors can produce ____ leading to ____

Back 422

EPO, polycythemia

Front 423

Which tumors are found most often in the 4th ventricle

Back 423

Ependyomas

Front 424

Which tumor are most often found in the posterior fossa

Back 424

Low-grade astrocytomas

Front 425

Childhood tumor derived from Rathke’s pouch that mimics pituitary adenoma b/c it can also cause bilateral hemianopia

Back 425

Craniopharyngioma

Front 426

_____ is common, which helps with radiologic DX

Back 426

Calcification

Front 428

Lots of Bad Stuff Kills Glia

Back 428

Lung

Front 429

What are the most common sites of mets (after LNs)

Back 429

Liver and Lung

Front 430

Cancer Sometimes Penetrates Benign Liver

Back 430

Colon>Stomach>Pancreas>Breast>Lung

Front 431

BLT with a Kosher Pickle

Back 431

Breast, Lung, Thyroid, Testes, Kidney, Prostate

Front 432

What is the MOST common organ receiving mets

Back 432

Adrenals (due to rich blood supply), first in medulla, then spreads to the rest of the gland

Front 433

Most common organ to SEND mets?

Back 433

Lung > breast & stomach

Front 435

Name the paraneoplastic effect of the tumor:

Front 436

Small cell of lung

Back 436

ACTH (Cushing’s)

Front 437

Small cell of lung and intracranial neoplasms

Back 437

ADH (leads to SIADH)

Front 438

Squamous cell of lung

Back 438

PTH-related peptide (leads to hypercalcemia)

Front 439

Name some more tumors with this same effect

Back 439

Renal cell, breast cancer, multiple myeloma

Front 440

Renal cell carcinoma

Back 440

EPO (leads to polycythemia)

Front 441

Thymoma / bronchogenic carcinoma

Back 441

Antibodies against presynaptic calcium channels at NMJ

Front 442

What can this lead to?

Back 442

Lambert-Eaton syndrome

Front 443

What cause microcytic, hypochromic anemia (MCV<80)

Back 443

Iron deficiency

Front 444

Lab results

Back 444

TIBC↑, ferritin↓, serum iron↓↓

Front 445

What else can cause this type of anemia

Back 445

Thallasemia and lead poisoning

Front 446

Note that vit B12 and folate deficiencies are both associated with

Back 446

Hypersegmented PMNs

Front 447

What causes macrocytic (MCV>100) anemia

Back 447

B12 and folate deficiencies

Front 448

What else?

Back 448

Drugs that block DNA synthesis

Front 449

Examples?

Back 449

Sulfa, trimethoprim, AZT

Front 450

Normocytic, normochromic anemia causes:

Front 451

Enzyme defects

Back 451

G6PD, PK deficiency

Front 452

RBC membrane defects

Back 452

Hereditary spherocytosis

Front 453

Bone marrow disorders

Back 453

Aplastic anemia, leukemia

Front 454

Hemoglobinopathies

Back 454

Sickle cell

Front 455

Autoimmune pblms

Back 455

Hemolytic anemia

Front 456

Common battlefield cause???

Back 456

Hemorrhage

Front 457

How do the following labs change with anemia of chronic disease: TIBC, ferritin, iron

Back 457

TIBC↓, ferritin↑, serum iron↓, ↑storage iron in marrow macrophages

Front 458

↓serum haptoglobin and ↑serum LDH indicate

Back 458

RBC hemolysis

Front 459

How do we distinguish between immune mediated and non-immune mediated hemolysis

Back 459

Coombs Test

Front 460

TIBC, serum iron

Back 460

TIBC = normal

Front 461

_____ anemia: pancytopenia, severe anemia, failure or destruction of multipotent myeloid stem cell lines

Back 461

Aplastic

Front 462

Causes?

Back 462

Radiation, benzene, chloramphenicol, some viruses

Front 463

What are the pathological features (ir, cell morphology, marrow presentation)

Back 463

Pancytopenia with normal cell morphology

Front 464

Characterize hereditary spherocytosis

Back 464

Intrinsic, extravascular hemolysis due to spectrin defect

Front 465

How do RBCs appear

Back 465

Small, round, no central pallor

Front 466

Lab tests to confirm?

Back 466

HgB↑ (MCV↑) b/c there is ‘less’ membrane

Front 467

How to distinguish from Warm Antibody Hemolysis?

Back 467

Use a Coombs test. WAH is (+), hereditary spherocytosis is Coombs (-)

Front 469

Blood dyscrasias

Front 470

What causes sickle cell

Back 470

Single amino acid substitution in the beta-HgB chain: substitute glutamic acid with valine

Front 471

What leads to sickling

Back 471

Low oxygen environment, dehydration

Front 472

How do heterozygotes (trait carriers) benefit

Back 472

Malaria resistant

Front 473

What diseases are homozygotes at ↑risk for

Back 473

Aplastic crisis

Front 474

What TX for HbS involves ↑HbF

Back 474

Hydroxyurea

Front 475

Alpha-thalassemia is due to missing alpha-globins (up to 4). If all 4 are missing, what results in utero

Back 475

Hydrops fetalis and death

Front 476

Beat-minor vs. Beta-major thallassemia

Back 476

Minor=beta chain underproduced (heter)

Front 477

Thalassemia is prevalent in ____ populations

Back 477

Mediterranean

Front 478

Beta-thal. Major can result in

Back 478

Cardiac failure due to secondary hemochromatosis

Front 479

What is the MOST common cause of DIC

Back 479

Obstetric causes (amniotic embolus)

Front 480

Name three more common causes

Back 480

Gram(-) sepsis, transfusion, trauma, malignancy

Front 481

Lab findings

Back 481

PT↑ PTT↑ Fibrin split ptoducts↑ platelets↓

Front 482

What normaly brings in a pt with platelets pblms

Back 482

Gums bleed

Front 483

Whereas, coagulation factor defects bring in the pt with

Back 483

Hemarthroses, bruising, macrohemorrhage

Front 484

Causes of platelet pblms include

Back 484

ITP, TTP, DIC

Front 485

Hemophilia A =

Back 485

Factor VIII deficiency

Front 486

Hemophilia B =

Back 486

Factor IX deficiency

Front 487

What is the most common bleeding disorder

Back 487

Von Willebrand’s

Front 488

Multiple myeloma: monoclonal ____ cell with fried-egg appearance. Produces large amounts of which Ig?

Back 488

Plasma call

Front 489

Pt presents with

Back 489

Bone lesions and hypercalcemia, ↑susceptibility to infection and anemia

Front 490

Xray findings?

Back 490

Punched out lesions

Front 491

Associated with primary _____

Back 491

amyloidosis

Front 492

What is characteristic on serum protein electrophoresis

Back 492

“M” spike

Front 493

Urinalysis?

Back 493

Ig light chains (Bence Jones proteins)

Front 494

Blood smear show anything?

Back 494

RBCs stacked like poker chips (rouleau formation)

Front 495

How does MM compare with Waldenstroms macroglobinemia?

Back 495

The “M” spike is IgM and there are NO lytic lesions

Front 496

What causes achalasia

Back 496

Loss of myenteric plexus (Auerbachs) results in failure of relaxation of LES

Front 497

Assoc. w/↑risk of

Back 497

Esophageal carcinoma

Front 498

Secondary achalasia results from

Back 498

Chaga’s disease

Front 499

Barium swallow shows

Back 499

Bird’s beak

Front 500

Barrett’s: replacement of ___ with ___

Back 500

Stratified squamous, columnar

Front 501

Barrett’s becomes _____

Back 501

Adenocarcinoma

Front 502

2. Type B

Front 503

Both types ↑ risk of

Back 503

Gastric carcinoma

Front 504

Name the 2 types of PUD

Back 504

Gastric and duodenal

Front 505

Which has ↑ pain w/meals and weight loss

Back 505

Gastric

Front 506

Compare H. pylori infection in the two types

Back 506

70% in gastric

Front 507

How does food affect duodenal ulcers

Back 507

Pain is relieved, thus, weight gain

Front 508

Duodenal ulcers due to

Back 508

1. ↑ gastric acid secretion

Front 509

Duodenal also assoc. with hypertrophy of

Back 509

Brunner’s glands

Front 510

Who has 2X risk of PUD

Back 510

Smokers

Front 512

Chrohn’s vs. UC

Front 513

Which is infectious and which is autoimmune

Back 513

Crohn’s: infectious, UC: autoimmune

Front 514

Location affected?

Back 514

Crohn’s: anywhere in GI tract / SKIP lesions

Front 515

Who is transmural

Back 515

Crohn’s

Front 516

Which has cobblestone appearance

Back 516

Crohn’s

Front 517

Bowel wall thickening (string-sign on xray)

Back 517

Crohn’s

Front 518

Which has mucosal pseudopolyps and freely hanging mesentery

Back 518

UC

Front 519

Crypt abscesses and ulcers

Back 519

UC

Front 520

Which leads to colorectal carcinoma

Back 520

UC

Front 521

Which causes malabsorption deficiencies

Back 521

Crohn’s

Front 522

Which leads to toxic megacolon

Back 522

UC

Front 523

Creeping fat????

Back 523

Crohn’s

Front 525

Risk factors for diverticulosis

Back 525

Age (>60  50%), low-fiber diet

Front 526

Most common location in bowel

Back 526

Sigmoid colon

Front 527

Classic presenting symptoms

Back 527

LLQ pain

Front 528

Hirschsprung’s disease: absence of

Back 528

Parasympathetic ganglion cells (Auerbach’s and Meissner’s plexuses)

Front 529

Due to failure of

Back 529

Neural crest migration

Front 530

The dilated portion of colon is _____ to the aganglionic segment

Back 530

Proximal

Front 531

Is Putz-Jeghers a risk factor for colon cancer?

Back 531

No

Front 532

Diffuse fibrosis of liver with nodular regeneration=

Back 532

Cirrhosis

Front 533

What do the nodules look like

Back 533

Micronodular (<3mm in size)

Front 534

When would the nodules be macro-?

Back 534

Significant liver injury leading to necrosis (post-infectious or drug induced)

Front 535

In alcoholic hepatitis, AST:ALT ratio >?

Back 535

Usually greater than 1.5

Front 536

Budd-Chiari syndrome: associated with?

Back 536

PCV, pregnancy, hepatocellular carcinoma

Front 537

What exactly happens in BCS?

Back 537

IVC occlusion (or hepatic veins) leads to congestive liver disease

Front 538

_____ is failure of copper to enter circulation in the form of ceruloplasmin

Back 538

Wilson’s disease

Front 539

Neurologic side effects

Back 539

Dementia, choreiform mvmts, basal ganglia degen.

Front 540

“Classic” finding

Back 540

Keyser-fleischer rings

Front 541

Absent UDP-glucuronyl transferase, early death

Back 541

Crigler-Najjar

Front 542

Findings?

Back 542

Jaundice, kernicterus, ↑unconj. Billirubin

Front 543

What is kernicterus?

Back 543

Billirubin deposited in brain

Front 544

TX

Back 544

Plasma phoresis / phototherapy

Front 545

What is the milder form?

Back 545

Gilbert’s

Front 546

What condition causes ↑conjugated bilirubin due to defective liver excretion

Back 546

Dubin-Johnson syndrome

Front 547

Gross pathology?

Back 547

Black liver

Front 548

What is the most common primary malignant tumor in the adult liver

Back 548

Hepatocellular carcinoma (aka hepatoma)

Front 549

↑incidence assoc. with

Back 549

Hep B/C, Wilson’s, hemochromatosis, alpha1-anti-trypsin deficiency, ETOH cirrhosis, aflatoxin B1

Front 550

What two carcinomas are commonly spread by hematogenous dissemination

Back 550

Renal and Hepatocellular

Front 551

Child with hepatomegaly, coma and hypoglycemia, what could be the cause

Back 551

Reye’s syndrome

Front 552

Which viruses are involved

Back 552

VZV, Influenza B

Front 553

Name the three types of gallstones

Back 553

Cholesterol, pigmented, mixed

Front 555

Which is most common

Back 555

Mixed

Front 556

Which do Native Americans get

Back 556

Cholesterol

Front 557

What type do alcolholic get

Back 557

Pigmented

Front 558

What are the Four risk factors for stones

Back 558

Fat, Fertile, Female over Forty

Front 559

What is Charcot’s Triad

Back 559

Epigastric/RUQ pain

Front 560

Epigastric abdominal pain radiating to back is probably

Back 560

Acute pancreatitis

Front 561

Likely labs

Back 561

↑amylase and ↑lipase

Front 562

Lots of causes for acute, but chronic pancreatitis is strongly assoc. with

Back 562

Alcoholism

Front 563

Tumors (adenocarcinoma) in the pancreas are most often in the

Back 563

Head (obstructive jaundice)

Front 564

What is Trousseau’s syndrome

Back 564

Migratory thrombophlebitis

Front 566

Lungs

Front 567

What is the hallmark of obstructive lung disease

Back 567

FEV/FVC ratio is decreased

Front 568

Why

Back 568

Air gets trapped inside the lungs

Front 569

Who are the blue-bloaters

Back 569

Those with chronic bronchitis

Front 570

DX

Back 570

Productive cough for >3 consecutive months in 2 or more years

Front 571

Hypertrophy of the mucous secreting glands in the bronchioles leads to a Reid index >?

Back 571

50%

Front 572

Leading cause?

Back 572

Smoking

Front 573

Who are the Pink Puffers

Back 573

Emphysema pts

Front 574

Enlargement of___ with decreased ___

Back 574

Air spaces, recoil

Front 575

If caused by smoking, it is

Back 575

Centriacinar

Front 576

If caused by alpha1-antitrypsin deficiency, it is

Back 576

Panacinar

Front 577

In panacinar, you would also look for

Back 577

Liver cirrhosis

Front 578

PE findings?

Back 578

↓breath sounds, tachycardia

Front 579

Which two lung conditions cause ↓I/E ratios

Back 579

Asthma and emphysema

Front 580

____ is a chronic necrotizing infection of bronchi

Back 580

Bronchiectasis

Front 581

How do the cilia play a role

Back 581

Poor mvmt, ↑infections causes purulent sputum

Front 582

Restrictive lung diseases characterized by

Back 582

Restricted expansion, thus, ↓lung volumes (↓VC and ↓TLC)

Front 583

What do the PFT’s look like?

Back 583

FEV/FVC > 80%

Front 584

Name two diseases that can cause poor muscular effort

Back 584

Polio

Front 585

How do pneumonia and pulm. Edema lead to RLD

Back 585

Defective alveolar filling

Front 586

Interstitial fibrosis causes increased recoil which is the same as saying

Back 586

Decreased compliance

Front 587

Lethal complications?

Back 587

Cor pulmonale

Front 588

Can be due to pulomany fibrosis caused by which two drugs

Back 588

Bleomycin

Front 589

obstructive

Front 590

Asbestosis has two histological features

Back 590

Ferruginous bodies (fiber coated w/hemosiderin)

Front 591

Surfactant is produced after the ___ week

Back 591

35th

Front 592

What ratio is a measure of lung maturity

Back 592

Lecithin-to-sphingomyelin in the amniotic fluid

Front 593

What is this ratio in neonatal RDS

Back 593

<1.5

Front 594

Chemical name for surfactant

Back 594

Dipalmitoyl phosphatydlcholine

Front 595

TX

Back 595

Maternal steroids pre-birth, surfactant at birth

Front 596

What is Kartagener’s syndrome

Back 596

Immotile cilia due to defective dynein arm

Front 597

How does this affect fertility (male) and lung function

Back 597

Sterility

Front 598

What other MAJOR defect is seen

Back 598

Situs inversus

Front 599

Which lung cancer has a clear link to smoking

Back 599

Squamous and small cell

Front 600

Which tumor arise peripherally in the lung

Back 600

Adenocarcinoma

Front 601

Which is thought to NOT be related to smoking

Back 601

Bronchioalveolar

Front 602

Which organism causes lobar pneumonia

Back 602

Pneumococcus

Front 603

Characteristics

Back 603

Intra-alveolar exudates / consolidation of up to entire lung

Front 604

What organisms cause bronchopneumonia

Back 604

S. aureus, H. flu, Klebsiella, S. pyogenes

Front 605

Looks like

Back 605

Acute inflammatory infiltrates from bronchioles into alveoli

Front 606

Whereas, interstitial pneumonia looks like

Back 606

Inflammation localized to interstitial areas at alveolar walls

Front 607

And its common bugs are

Back 607

RSV, adenoviruses, mycoplasma, legionella

Front 608

Pancoast’s tumor characteristics

Back 608

Ptosis, miosis, anhydrosis

Front 609

What plexus is involved

Back 609

Cercical sympathetic

Front 611

What is the most common cause of dementia in elderly

Back 611

Alzheimer’s

Front 612

Senile plaque have the

Back 612

Amyloid core

Front 613

What has the abnormally phosphorylated tau protein

Back 613

Neurofibrillary tangles

Front 614

Familial form of AD associated with chromosomes

Back 614

1,14,19,21

Front 615

Which disease is specific for the frontal / temporal lobes and has intracytoplasmic inclusion bodies

Back 615

Pick’s

Front 616

Lewy bodies, substantia nigra, MPTP in street drugs….

Back 616

Parkinson’s

Front 617

2 spinocerebellar diseases

Back 617

Olivopontocerebellar atrophy

Front 618

Baby born floppy and with tongue fasciculations??

Back 618

Werndig-Hoffman disease (motor neurons)

Front 619

Disease with only lower-motor neuron symptoms

Back 619

Polio

Front 620

Necrosis, hemorrhage, ‘butterfly’ distribution with poor PX

Back 620

GBM (adults)

Front 621

What order doe these tumors occur in children: medulloblastoma, astrocytoma, ependymoma

Back 621

A > M > E

Front 622

Which hematoma results from ruptured middle meningeal artery

Back 622

Epidural (lucid interval and death)

Front 623

Subdural caused by

Back 623

Bridging veins – seen in infants/elderly

Front 625

Subarrachnoid hemorrhage usually do to

Back 625

Berry aneurysm (or AVM)

Front 626

What’s seen on LP

Back 626

Blood

Front 627

Parenchymal brain hematomas due to

Back 627

HT, amyloid angiopathy, DM

Front 628

Where do berry aneurysms occur

Back 628

Bifurcation in the circle of willis

Front 629

Most commonly at the

Back 629

Ant. Communicating artery

Front 630

Berry aneurysms most often assoc. with

Back 630

ADPKD

Front 631

What’s seen in the CSF of MS patients

Back 631

↑protein (IgG)

Front 632

Classic triad of MS: SIN

Back 632

Scanning speech

Front 633

What is PML

Back 633

Progressive multifocal leukoencephalopathy

Front 634

Inflammation and demyelination of peripheral nerves and motor fibers of ventral roots

Front 635

Pt presents with

Back 635

Symmetric ascending muscle weakness beginning in lower distal extremities

Front 636

Is GB assoc. with any particular infections

Back 636

HSV, C. jejuni, inoculations and stress

Front 637

Polio is transmitted via

Back 637

Fecal-oral

Front 638

Lifecycle?

Back 638

Replicates in oropharynx and small intestine before spreading to blood / CNS

Front 639

Once in the CNS, it destroys

Back 639

Anterior horn of the spinal cord, leading, in turn, to LMN destruction

Front 640

Virus can be recovered from

Back 640

Stool or throat

Front 642

Most common cause of adult seizures

Back 642

Tumor, trauma, stroke

Front 643

And kids?

Back 643

Genetic, infection, trauma

Front 644

Name the partial seizures

Back 644

Simple partial

Front 645

Name the generalized seizures

Back 645

Absence – blank stare (petit mal)

Front 646

Most common cause of seizures in the elderly

Back 646

Stroke, tumor, trauma

Front 647

Wernicke’s

Front 648

Superior temporal gyrus=

Back 648

Broca’s area

Front 649

Horner’s involves a lesion above what level

Back 649

T1

Front 650

What pathway is interrupted in Horner’s

Back 650

Oculosympathetic pathway

Front 651

______ : a softening and cavitation around central canal of spinal cord

Back 651

Syringomyelia

Front 652

How would pt present

Back 652

Bilateral loss of pain and temp sensation in upper extremeties w/o loss of touch

Front 653

Level or injury

Back 653

C8-T1

Front 654

Fibers of which tract are damaged

Back 654

Spinothalamic

Front 655

Degeneration of dorsal columns and roots due to tertiary syphilis, resulting in impaired proprioception and locomotor ataxia

Back 655

Tabes dorsalis

Front 656

Other symptoms/signs

Back 656

Shotting (lightening) pain

Front 657

What are the systemic features of RA

Back 657

Fever, fatigue, pleuritis, pericarditis

Front 658

What type of Ig’s are the RA antibodies

Back 658

Anti-IgG antibodies

Front 659

Gout: precipitation of ____ into joints due to ____

Back 659

Monosodium urate crystals, hyperuricemia

Front 660

Cuased by

Back 660

Lesch-Nyhan, PRPP excess, glucose-6-phospatase deficiency or just decreased excretion

Front 661

This last category can be due to which RX

Back 661

Thiazides (competitive inhibitors)

Front 662

Pdagra?

Back 662

MTP joint of big toe

Front 663

Symmetric or asymmetric involvement?

Back 663

Asymmetric

Front 664

What is pseudogout caused by

Back 664

Calcium pyrophosphate crystals

Front 665

Shape of crystal

Back 665

GOUT: needle

Front 666

Classic joint involvement

Back 666

Knee (large joints in general)

Front 667

Gender bias

Back 667

GOUT: men

Front 668

TX for P-GOUT?

Back 668

None

Front 669

Findings in celiac sprue

Back 669

Northern Europeans

Front 670

SLE causes LSE?

Back 670

Libman-Sacks Endocarditis

Front 671

SLE can cause false (+) _____ tests

Back 671

Syphilis

Front 672

What is LSE?

Back 672

Non-bacterial verrucous vegetations on valves

Front 673

SLE is a risk for _____ phenomenon

Back 673

Raynaud’s

Front 674

What kind of lesions seen in kidney

Back 674

Wire-loop

Front 675

Labs to DX

Back 675

ANA (sensitive, but NOT specific to SLE)

Front 676

SLE is most common and severe in what population

Back 676

Black, female

Front 677

What drugs responsible for reversible SLE syndrome

Back 677

INH

Front 678

What disease is prevelant in black females and is known for widespread non-caseating granulomas

Back 678

Sarcoidosis

Front 679

What enzyme is elevated

Back 679

ACE

Front 680

GRAIN for sarcoidosis

Back 680

Gammaglobulinemia

Front 681

HLA-B27 most often associated with

Back 681

Ankylosing spondylitis

Front 682

Which is a sero-negative spondyloarthropathy

Back 682

Reiter’s

Front 683

Classic triad

Back 683

Can’t see, pee, or dance

Front 684

Dry mouth, dry eyes and an arthritis?

Back 684

Sjoergen’s

Front 685

What gland is enlarged in Sjoergen’s

Back 685

Parotid

Front 686

Predominantly affects _____ between ___and ___

Back 686

Females, 40-60

Front 687

Dry eyes, mouth, nose and vagina along with chronic bronchitis and reflux esophagitis=?

Back 687

Sicca syndrome

Front 688

_____ = excessive fibrosis and collagen deposition throughout the body

Back 688

Scleroderma

Front 689

Diffuse scleroderma assoc. with _____ antibody

Back 689

Anti-Scl-70

Front 690

CREST syndrome is the other type of scleroderma

Back 690

Calcinosis

Front 691

Associated with _____ antibody

Back 691

Anti-centromere

Front 692

Symptoms of Goodpastures

Back 692

Hemoptysis, hematuria, pulmonary hemorrhages, renal lesions, crescentic glomerulonephritis

Front 693

Most common afflicts

Back 693

Men 20-40 y/o

Front 695

Endocrine / reproductive

Front 696

cushing's disease (as compared to Cushing's syndrome) is caused by

Back 696

primary pituitary adenoma secreting ACTH

Front 697

how is this different from a primary adrenal hyperplasia / neoplasia causing Cushing's syndrome

Back 697

ACTH↓

Front 698

Carcinoid syndrome causes _____ AVCTH secretion

Back 698

ectopic

Front 699

The most common cause is

Back 699

iatrogenic (exogenous administration), ACTH↑

Front 700

in addition to the moon facies, buffalo hump, what are the cardio and metabolic signs

Back 700

HT

Front 701

what is the primary cuase of hyperaldosteronism

Back 701

Conn's syndrome (aldosterone secreting tumor)

Front 702

Symptoms

Back 702

HT, hypokalemia, LOW renin level

Front 703

TX

Back 703

includes spironolactone

Front 704

name some causes of secondary hyperaldosteronism

Back 704

Renal artery stenosis

Front 705

mechanism of secondary causes

Back 705

kidney perceives low intravascular volume, results in hyperactive renin-angio system

Front 706

thus, renin would be

Back 706

Hign

Front 707

____ disease is a primary deficiency of aldosterone and cortisol due to adrenal atrophy

Back 707

Addison's

Front 708

patient presents with

Back 708

hypotension and skin hyperpigmentation (↑MSH)

Front 709

why hypotension?

Back 709

lack of cortisol leads to hyponatremic volume contraction

Front 710

how is Addison's different than secondary deficiency

Back 710

no skin pigmentation in secondary

Front 711

____ is the most common tumor of the adrenal medulla in adults

Back 711

Pheo

Front 712

what about in kids?

Back 712

neuroblastoma

Front 713

note that a neuroblastoma can occur anywhere along

Back 713

the sympathetic chain

Front 714

pheos are detected by ___ in urine and ___ in blood

Back 714

VMA, catecholamines

Front 715

pheos are assoc. with what other conditions

Back 715

MEN II/III

Front 716

TX with

Back 716

phenoxybenzamine (a nonselective, irreversible alpha antagonist)

Front 717

what is the rule of 10's that applies to pheos

Back 717

10% malignant, bilateral, extraadrenal, calcify, kids, familial

Front 718

MEN Type I is aka

Back 718

Wermer's syndrome

Front 719

What are the three-P's

Back 719

Pancreas

Front 720

what are the common pancreas afflictions

Back 720

ZE syndrome, insulinomas, VIPomas

Front 721

MEN Type II is aka

Back 721

Sipple's syndrome

Front 722

what three conditions are prevalent in MEN II

Back 722

medullary carcinoma of thyroid

Front 723

how are all MEN syndromes inherited

Back 723

auto. dominant

Front 724

how is MEN III different than MEN II

Back 724

oral and intestinal ganglioneuromatosis instead of parathyroid tumor

Front 725

pretibial myxedema, diffuse goiter, proptosis and EOM swelling, this patient has

Back 725

graves disease

Front 726

what are the labs like in HYPOthyroidism

Back 726

TSH↑, T4↓ and T3↓

Front 727

what about in HYPERthyroidism

Back 727

TSH↓, T4↑ and T3↑

Front 728

cretinism is a result of

Back 728

lack of iodine

Front 729

it is endemic wherever _____ is present

Back 729

endemic goiter

Front 730

what do these cretin-kids look like

Back 730

pot-bellies, pale and puffy faced

Front 731

what type of coma results from Type I diabetes

Back 731

DKA

Front 732

and from Type II?

Back 732

hyperosmolar coma

Front 733

insulin deficiency (and glucagon excess leads to what 2 'increases' and what 1 'decrease'

Back 733

Increases: protein catabolism, lipolysis

Front 734

↑lipolysis leads to what accumulation

Back 734

↑plasma FFAs, ketonuria, ketonemia

Front 735

the ↑protein catabolism leads to

Back 735

↑plasma AA's and nitrogen loss via urine

Front 736

the small vessel disease in DM is due to

Back 736

BM thickening

Front 737

↑plasma FFas lead to

Back 737

large vessel atherosclerosis, CAD

Front 738

cataracts and glaucoma due to

Back 738

sorbitol accumulation

Front 739

what lab measures long-term diabetic control

Back 739

HbA1-c

Front 740

hyperglycemia increases intracellular sorbitol, thereby ↓ intracellular _____ levels

Back 740

myoinositol

Front 741

altered inositol pathway leads to ↓ in cellular ____ activity

Back 741

Na-K-ATPase

Front 742

what is the genetic predisposition (strong or weak) of Type I/II DM

Back 742

type I - weak

Front 743

which ahs the HLA association

Back 743

Type-I, HLA-DR 3 and 4

Front 744

DKA is often triggered by

Back 744

stress (ie infection)

Front 745

Kussmaul hyperpnea is

Back 745

rapid, deep breathing

Front 746

what type of metabolic acidosis in DKA

Back 746

anion gap

Front 747

what are two deadly infections that diabetics get

Back 747

Mucormycosis

Front 748

intense thirst and polyuria together with an inability to concentrate urine is known as

Back 748

diabetes insipidus

Front 749

central DI is due to

Back 749

lack of ADH

Front 750

nephrogenic DI is due to

Back 750

lack of renal response to ADH

Front 751

what two drugs can cause DI

Back 751

Lithium

Front 752

lab findings: SG & serum osmolarity

Back 752

SG < 1.006 and osmolarity > 290

Front 753

TX for central DI

Back 753

intranasal desmopressin (ADH analog)

Front 754

TX for nephrogenic DI

Back 754

thiazide, amiloride, indocin

Front 755

In contrast to DI, what are the results of SIADH

Back 755

excess water retention, hyponatremia

Front 756

note that very low sodium levels can lead to

Back 756

seizures

Front 757

which cancer can lead to ectopic ADH secretion

Back 757

small cell lung cancer

Front 758

second common cause

Back 758

head trauma

Front 759

carcinoid syndrome is caused by carcinoid tumors of neuroendocrine cells, esp. of the ______

Back 759

small bowel

Front 760

these tumors secret high levels of ____ that does not get metabolized due to liver metastases

Back 760

serotonin (5HT)

Front 761

symptoms?

Back 761

cutaneous flushing and diarrhea, wheezing and carcinoid heart disease

Front 762

this is the most common tumor of the _______

Back 762

appendix

Front 763

detected by right sided valvular disease and ____ in urine

Back 763

↑5-HIAA

Front 764

these carcinoid tumors are TX with

Back 764

octreotide

Front 765

what type of tumor is assoc. with ZE syndrome

Back 765

gastrin secreting tumor located in the pancreas

Front 766

may be assoc. with

Back 766

MEN-I

Front 767

what is the relation to race for osteoporosis

Back 767

whites>blacks>asians

Front 768

Type I=

Back 768

post-menopausal

Front 769

Type II=

Back 769

senile

Front 770

type I caused by

Back 770

↑bone resorption due to ↓estrogen

Front 771

pt present with

Back 771

loss of height, kyphosis, vertebral crush

Front 772

age onset for type-II

Back 772

>70 y/o

Front 773

pt presents with

Back 773

distal radius (Colle's) fractures

Front 774

BPH is characterized by nodular enlargement of the ______ lobes of the prostate

Back 774

periurethral (lateral and middle)

Front 775

BPH is NOT considered a

Back 775

pre-malignant lesion

Front 776

what is a hydatidiform mole

Back 776

a pathologic ovum

Front 777

results in swelling of _____ and proliferation of

Back 777

chorionic villi, chorionic epithelium (trophoblast)

Front 778

HM is the most common precursor to

Back 778

choriocarcinoma

Front 779

marker?

Back 779

high beta-hCG

Front 780

how does the uterus appear

Back 780

honeycombed, bunch of grapes

Front 781

genotype of a complete mole is

Back 781

46 XX

Front 782

and is purely ____ in origin

Back 782

paternal

Front 783

there is no ____ actually present

Back 783

fetus

Front 784

a partial mole is commonly

Back 784

triploid or tetraploid

Front 785

endometriosis results in ____ cysts

Back 785

blood filled, chocolate

Front 786

____ is the most common site

Back 786

ovary

Front 787

endometrial hyperplasia, on the other hand, is caused by excess

Back 787

estrogen stimulation

Front 788

most commonly manifest by

Back 788

vaginal bleeding

Front 789

what is the most common gyn. Malignancy

Back 789

endometrial carcinoma

Front 790

peak ages

Back 790

55-65

Front 791

presents with vag. bleeding and often proceeded by

Back 791

endo. hyperplasia

Front 792

risk factors

Back 792

prolonged estrogen use, obesity, diabetes and HTN

Front 793

what is the single MOST common tumor of females

Back 793

leiomyoma

Front 794

race bias?

Back 794

↑occurrence in blacks

Front 795

is it estrogen sensitive?

Back 795

yes, size ↑ in pregnancy and ↓ in menopause

Front 796

does it lead to any malignancies?

Back 796

not usually

Front 797

however, what is the de novo malig. Counterpart

Back 797

leimyosarcoma

Front 798

Appearance

Back 798

bulky with areas of hemorrhage and necrosis

Front 799

what hormone is elevated in polycystic ovary disease

Back 799

LH

Front 800

where does it come from and what is the effect of the ↑LH

Back 800

peripheral estrogen production and it leads to leads to anovulation

Front 801

how does the typical pt present

Back 801

amenorrhea, infertility, obesity, hirsutism

Front 802

TX?

Back 802

weight loss, OCP, gonadotropin analogs, surgery

Front 803

pt presents with diffuse breast pain and multiple lesions, it is deemed to be fibrocystic disease, is it a risk for carcinoma?

Back 803

not usually, only with the occurrence of atypical cells in epithelial hyperplasia

Front 804

____ = a large bulky mass of connective tissue and cysts, breast surface has a leaf-like appearance

Back 804

cystosarcoma phyllodes

Front 805

benign or malig.?

Back 805

benign!

Front 806

____ = most common <25 y/o, small mobile firm mass with sharp edges, ↑ in size and tenderness w/pregnancy

Back 806

fibroadenoma

Front 807

benign tumor of lactiferous ducts that presents with nipple discharge

Back 807

intraductal papilloma

Front 808

Now for the malignant tumors:

Front 809

most common carcinoma?

Back 809

infiltrating ductal

Front 810

feels like?

Back 810

firm fibrous mass

Front 811

eczematous patches on nipple

Back 811

Paget's

Front 812

cheesy consistency of tumor due to central necrosis

Back 812

comedocarcinoma

Front 813

common risk factors for breast cancer

Back 813

early menarche (<13 y/o)

Front 814

important to know that risk is NOT ↑ by what two common occurrences

Back 814

fibroadenoma

Front 816

Cardiovascular

Front 817

race bias for HTN

Back 817

black>white>asian

Front 818

how much is due to essential hypertension

Back 818

90%

Front 819

remaining 10% due to

Back 819

mostly renal disease

Front 820

pathology of HTN?

Back 820

hyaline thickening and atherosclerosis

Front 821

____ is the triad of HTN, proteinuria & edema

Back 821

preeclampsia

Front 822

eclampsia is the addition of

Back 822

seizures

Front 823

risk ↑ with

Back 823

HTN, diabetes, renal disease, autoimmune disorders

Front 824

clinical presentation

Back 824

edema of face, blurry vision, abdominal pain

Front 825

TX for pre-eclampsia

Back 825

bed rest, salt restriction, monitor

Front 826

TX for eclampsia

Back 826

medical emergency: IV MgSO4 and diazepam

Front 827

highest risk sites for atherosclerosis

Back 827

abdominal aorta > coronary artery > politeal artery > carotid artery

Front 828

angina occurs when CAD narrowing > ?%

Back 828

>75%

Front 829

stabile angina manifests as what kind of pain

Back 829

retrosternal chest pain with exertion

Front 830

prinzmetal's is secondary to

Back 830

coronary artery spasm

Front 831

MI most often occurs in CAD involving which artery

Back 831

left anterior descending

Front 832

sudden cardiac death is within 1 hr and is most often due to

Back 832

arrhythmia

Front 833

coronary artery occlusion: LAD > ? > ?

Back 833

LAD > RCA > circumflex

Front 834

color of infarcted cardiac tissue 1 day - 7 weeks

Back 834

2-4 days: pallor and hyperemia

Front 835

maximum neutrophil immigration around

Back 835

4 days

Front 836

macrophages show up around

Back 836

5-10 days (same time as ingrowth of granulation tissue)

Front 837

gold-standard of MI detection in first 6 hrs?

Back 837

EKG

Front 838

what lab test can be used from 4 hrs up to 7 days

Back 838

troponin-I (most specific)

Front 839

____ is the test of choice in the first 24 hrs post-MI

Back 839

CK-MB

Front 840

which LDH is also elevated

Back 840

LDH-1

Front 841

transmural ischemia on EKG shown as

Back 841

ST elevation

Front 842

what about transmural infarct

Back 842

Q-waves

Front 843

MOST common complication of MI???

Back 843

arrhythmias (90% of the time)

Front 844

4-10 days post-MI, look out for

Back 844

rupture of ventricular free wall, inter-vent. septum, and papillary muscle

Front 845

friction rub most common ____ days post-MI

Back 845

3-5 days

Front 846

and what is it??

Back 846

several weeks post MI

Front 847

what are the ABCDs of systolic dysfunction

Back 847

Alcohol

Front 848

the ABCDs above lead to dilated (congestive) cardiomyopathy. xray findings?

Back 848

dilated heart (ballooned)

Front 849

Hypertrophy of ____ is often asymmetric involving septum

Back 849

HCM

Front 850

is it genetic?

Back 850

yes - 50% cases are familial, inherited AD

Front 851

how does LV chamber look on echo?

Back 851

banana shaped

Front 852

endomyocardial fibrosis, sarcoidosis and amyloidosis all lead to

Back 852

restrictive / obliterative cardiomyopathy

Front 853

name the murmur cause:

Front 854

crescendo-decrescendo systolic

Back 854

aortic stenosis

Front 855

high-pitched 'blowing' diastolic murmur

Back 855

aortic regurgitation

Front 856

rumbling-late diastolic murmur, LA>LV pressure during diastole, opening snap

Back 856

mitral stenosis

Front 857

high-pitched 'blowing' holosystolic murmur

Back 857

mitral regurgitation

Front 858

most frequent valvular lesion (esp. in young women)

Back 858

mitral prolapse

Front 859

VSD causes what type of murmur

Back 859

holosystolic murmur

Front 860

PDA causes

Back 860

continuous machine-like murmur

Front 861

___ are the most common cardiac tumor and 90% occur in the

Back 861

myxomas, atria (mostly LA)

Front 862

usually described as a ____ obstruction

Back 862

"ball-valve"

Front 863

____ are the most frequent cardiac tumors in kids

Back 863

rhabdomyomas

Front 864

in pulmonary congestion due to LV failure, what special type of "cells" do we see

Back 864

heart-failure cells (hemosiderin laden macrophages)

Front 865

↓contractility leads to ↓CO leads to ↓arterial volume, what two ways does the body compensate

Back 865

Renin↑ and sympathetic outflow↑

Front 866

what compenent in the renin pathway leads to ↑renal vasoconstriction

Back 866

angiotensin II (as does ↑symp. outflow)

Front 867

what causes ↓GFR

Back 867

renal vasoconstriction

Front 868

this causes?

Back 868

↓urine excretion of NA and water

Front 869

what is predisposed by Virchow's triad

Back 869

DVTs

Front 870

name the triad

Back 870

stasis, hypercoagulability, endothelial damage

Front 871

pt has a new murmur, anemia and fever....what do you think

Back 871

bacterial endocarditis

Front 872

three classic lesions involved

Back 872

Roth spots (round whit spots on retina surrounded by hemorrhage)

Front 873

what other sign is on nailbed

Back 873

splinter hemorrhages

Front 874

2. subacute

Front 875

subacute involves

Back 875

smaller lesions on preciously abnormal valves

Front 876

which is assoc. w/dental procedures

Back 876

subacute

Front 877

what is the histologic feature of RHD

Back 877

Aschoff bodies

Front 878

other key indicators?

Back 878

migratory polyarthritis, erythema marginatum

Front 879

any elevated titers?

Back 879

ASO titers

Front 880

how does tertiary syphilis cause heart disease

Back 880

disrupts vasa-vasorum of aorta with consequent dilatation of aorta and valve ring

Front 881

any particular region of aorta affected

Back 881

aortic root / ascending aorta

Front 882

how does the aorta appear?

Back 882

tree-bark appearance

Front 883

Burger's Disease aka

Back 883

smoker's disease

Front 884

signs/symptoms

Back 884

intermittent claudication, superficial nodular phlebitis, Raynaud's, severe pain

Front 885

TX?

Back 885

quit smoking

Front 886

____ aka Pulseless Disease

Back 886

Takayasu's arteritis

Front 887

why 'pulseless'?

Back 887

thickening of aortic arch and great vessels leads to weak upper extremity pulses

Front 888

primarily affects

Back 888

young, Asian females

Front 889

FAN MY SKIN ?

Back 889

Fever, Arthritis, Night sweats, MYalgia, SKIN nodules

Front 890

what are the findings in Temporal Arteritis

Back 890

Elderly, ↑ESR, unilateral headache, jaw claudication, impaired vision

Front 891

TX?

Back 891

responds well to steroids

Front 892

P-ANCA

Back 892

polyarteritis nodosa

Front 893

_______ is characterized by focal necrotizing vasculitis, necrotizing granulomas in the lung and upper airway and necrotizing glomerulonephritis

Back 893

Wegener's granulomatosis

Front 894

TX

Back 894

cyclophosphamide, corticosteroids, MTX

Front 895

ethanol is converted to acetaldehyde, how does this lead to fatty change?

Back 895

acetaldehyde to acetate to acetyl-CoA to increased FA synthesis to fatty liver

Front 896

what ratio is ↑

Back 896

NADH/NAD

Front 897

name two neurological manifestations of alcoholism

Back 897

flapping tremor of hands

Front 898

what causes Wernicke-Korsakoff syndrome

Back 898

Thiamine (B1) deficiency

Front 899

classic triad of symptoms (of Wernicke's encephalopathy)

Back 899

psychosis, opthalmoplegia, ataxia

Front 900

Progression to Korsakoff syndrome involves

Back 900

memory loss, confusion and confabulation

Front 901

argyl-robertson pupil pathognomonic for

Back 901

tertiary syphilis

Front 902

what do you see?

Back 902

constricts with accomodation but not reactive to light

Front 903

ARP

Back 903

accomodation reaction present

Front 904

primary amyloidosis seen with what 2 conditions

Back 904

multiple myeloma, waldenstroms macroglobulinemia

Front 905

histology?

Back 905

apple-green birefringence with Congo Red stain

Front 906

link to Alzheimer's?

Back 906

beta-amyloid deposition in cortex

Front 907

whereas, islet cell amyloid deposits seen in

Back 907

DM Type II

Front 908

granuloma with giant cells aka

Back 908

Aschoff Bodies

Front 909

Aschoff bodies AND _____ are found in RHD

Back 909

Anitschkow's cells

Front 910

Think of two ____ with RHeumatic heart disease

Back 910

RHussians (ascoff and anitschkow)

Front 911

Auer rods pathognomic for

Back 911

acute promyelocytic leukemia

Front 912

what are they?

Back 912

cytoplasmic inclusions in granulocytes and myeloblasts

Front 913

presence of Casts in urine indicates that hematuria / pyuria is or _______ origin

Back 913

renal

Front 914

RBC casts =

Back 914

bladder cancer

Front 915

WBC casts =

Back 915

acute cystitis

Front 916

____ casts often seen in normal urine

Back 916

hyaline

Front 917

____ casts are often seen in chronic renal failure

Back 917

waxy

Front 918

ESR best used to DX and monitor

Back 918

temporal arteritis and polymyalgia rheumatica

Front 919

____ = TB granulomas with lobar or perihylar LN involvement

Back 919

Ghon complex

Front 920

indicative of

Back 920

primary infection or exposure

Front 921

arcus senilis and xanthomas indicative of

Back 921

hyperlipidemia

Front 922

Psammoma bodies seen in (PSaMM)

Back 922

Papillary adenocarcinoma of thyroid

Front 923

helmet cell or schistocyte indicates

Back 923

DIC, traumatic hemolysis

Front 924

Teardrop shaped RBC indicates

Back 924

myeloid metaplasia with myelofibrosis

Front 925

Target cells seen in

Back 925

thalassemias, liver disease

Front 926

Poikilocytes =

Back 926

nonuniform shapes in TTP/HUS, DIC

Front 927

Burr cells =

Back 927

TTP/HUS

Front 928

PAIR pneumonic for HLA-B27

Back 928

Psoriasis

Front 929

____ = distinctive tumor giant cell seen in Hodgkin's

Back 929

Reed-Sternberg

Front 930

Describe

Back 930

large, bi-nucleate or bi-lobed with the two halves being mirror images (Owl-eyed)

Front 931

sufficient or necessary for DX

Back 931

necessary but NOT sufficient

Front 932

of the 4 types of Hodgkin's, which is more prevalent in women

Back 932

nodular sclerosis

Front 933

what is it's PX

Back 933

excellent

Front 934

____ = presumptive evidence of malignant visceral neoplasm (even medical students can detect this!)

Back 934

Virchow's Node

Front 936

Renal

Front 937

which glumerular pathology is characterized by hematuria, HT, oliguria and azotemia

Back 937

nephritic syndrome (i=inflammation)

Front 938

what do glomeruli look like under LM in post-strep glomerulonephritis

Back 938

enlarged and hypercellular, PMNs, lumpy-bumpy

Front 939

most frequently seen in kids, what are the presenting symptoms

Back 939

peripheral and peri-orbital edema

Front 940

TX?

Back 940

resolves spontaneously

Front 941

what type of glomerulonephritis has crescent-moon shape under LM

Back 941

rapidly progressing (crescentic)

Front 942

what does the pt have if they present with hematuria and hemoptysis

Back 942

goodpastures

Front 943

IF pattern?

Back 943

linear

Front 944

any antibodies?

Back 944

anti-GBM

Front 945

which glomerulonephritis has Tram-Track appearance on EM

Back 945

membranoproliferative

Front 946

which has mesangial deposits of IgA

Back 946

Berger's IgA nephropathy

Front 948

what glomerular pathology presents with massive proteinuria, hypoalbuminemia, edema, hyperlipidemia (due to loss of proteins)

Back 948

nephrotic (o=proteinemia)

Front 949

what's the common cause of adult nephrotic syndrome

Back 949

membraneous glomerulonephritis

Front 950

what's seen on LM and EM

Back 950

LM: diffuse capillary and BM thickening

Front 951

what's the most common cause of childhood nephrotic syndrome

Back 951

minimal change disease (good PX)

Front 952

responds well to

Back 952

steroids

Front 953

what's seen on EM?

Back 953

effacement of foot processes

Front 954

Kimmelstiel-Wilson lesions seen in

Back 954

diabetic nephropathy

Front 955

wire-loop patterns?

Back 955

SLE

Front 956

name the 4 major types of kidney stones

Back 956

calcium

Front 957

which comprises the majority of stones

Back 957

calcium

Front 958

xray findings?

Back 958

stones are radiopaque

Front 959

recurrence rate?

Back 959

high

Front 960

____ are the second most common and are formed in alkaline urine by urease (+) bugs

Back 960

ammonium

Front 961

name some bugs

Back 961

proteus vulgaris

Front 962

which go hand-in-hand with gout

Back 962

uric acid stones

Front 963

often seen in conjunction with what type of disease

Back 963

those with ↑ cell proliferation and turnover, i.e. leukemia and myeloproliferative disorders

Front 964

xray findings?

Back 964

radiolucent (so are cystine stones)

Front 965

most common renal malignancy?

Back 965

renal cell carcinoma

Front 966

most common in

Back 966

men, 50-70 y/o

Front 967

assoc. with which syndrome? which chromosome?

Back 967

von Hippel Lindau, C3

Front 968

presenting symptoms

Back 968

hematuria, flank mass, pain, secondary polycythemia

Front 969

spread?

Back 969

via IVC to blood!

Front 970

most common renal malignancy of kids

Back 970

Wilm's tumor

Front 971

gene involved?

Back 971

deletion of tumor suppressor gene WT-1 on C11

Front 972

what is the WARG complex

Back 972

Wilm's tumor

Front 973

tumor in urinary tract is probably

Back 973

transitional cell carcinoma

Front 974

presents with

Back 974

painless hematuria

Front 975

exposure risks?

Back 975

phenacetin, analine dyes, cyclophosphamide, smoking

Front 976

how do you calculate anion gap

Back 976

Gap = NA - (Cl+HCO3)

Front 977

normal range

Back 977

8-12

Front 978

if elevated, what's the pneumonic

Back 978

MUD PILES

Front 979

acute renal failure is most often due to

Back 979

hypoxia

Front 980

and chronic?

Back 980

HTN and diabetes

Front 981

Renal Failure: how do the following result;

Front 982

Anemia

Back 982

failure to make EPO

Front 983

renal osteodystrophy

Back 983

failure of active Vit-D production

Front 984

Hyperkalemia

Back 984

↓urine output

Front 985

metabolic acidosis

Back 985

↓acid secretion

Front 986

Uremia

Back 986

↑BUN, creatinine

Front 987

CHF, pulmonary edema

Back 987

↓Na and water loss

Front 989

Tetany caused by ↓?

Back 989

Calcium

Front 990

what else is caused by ↓Ca

Back 990

rickets, osteomalacia

Front 991

what else is deficient in rickets / osteomalacia

Back 991

phosphate

Front 993

metabolic acidosis: what parameter is massively↓

Back 993

HCO3-

Front 994

how are pH and pCO2

Back 994

both ↓

Front 995

causes?

Back 995

DKA, diarrhea, lactic acidosis, aspirin OD, acetazolamide OD

Front 996

compensatory response

Back 996

hyperventilation to ↓acidity

Front 997

parameters for respiratory acidosis

Back 997

pH↓ pCO2↑↑↑ HCO3-↑

Front 998

Causes

Back 998

COPD, airway obstruction

Front 999

Compensation

Back 999

renal HCO3- reabsorption

Front 1000

parameters for respiratory alkalosis

Back 1000

pH↑ pCO2↓↓ HCO3-↓

Front 1001

Causes

Back 1001

hyperventilation, high altitude

Front 1002

Compensation

Back 1002

renal HCO3- secretion

Front 1003

parameters for metabolic alkalosis

Back 1003

pH ↑ pCO2↑ HCO3-↑↑

Front 1004

Causes

Back 1004

vomiting

Front 1005

Compensation

Back 1005

hypoventilation

Front 1006

henderson-hasselbach equation

Back 1006

pH=pKa +log [HCO3-] / [0.03 pCO2]

Front 1007

what's the blood pH cutoff for acidosis / alkalosis

Back 1007

pH>7.4 = alkalosis, pH<7.4 for acidosis

Front 1008

what's the pCO2 value to know

Back 1008

40

Front 1009

pt presents with pH of 7.3 and pCO2 of 51, what is there classification

Back 1009

resp. acidosis

Front 1010

pt with pH=8.0, pCO2 of 15

Back 1010

resp. alkalosis

Front 1011

pt with pH=7.28 and pCO2=30

Back 1011

metabolic acidosis w/compensation

Front 1012

give two values that lands you in metabolic alkalosis

Back 1012

pH>7.4

Front 1013

what's the next step after discovering that a pt is in metabolic acidosis

Back 1013

determine if it is anion gap acidosis

Front 1014

if not anion gap caused, what's a common cause

Back 1014

diarrhea, glue sniffing renal tubular acidosis

Front 1015

30y/o chemical worker presents with MPTP exposure – what neurotransmitter is depleted?

Back 1015

Dopamine

Front 1016

A woman taking tetracycline shows photosensitivity – what are the clinical manifestations?

Back 1016

Rash on sun exposed regions of the body?

Front 1017

Young girl with congenital valve disease is given PCN prophylactically but develops endocarditis – what should you give her now?

Back 1017

Beta-lactamase resistant PCN.

Front 1018

Non-diabetic pt presents with hypoglycemia but low levels of C peptide – what is the diagnosis?

Back 1018

Surreptitious insulin injection

Front 1019

Black man who goes to Africa develops anemia after taking prophylactic medicine – what is the likely enzyme deficiency?

Back 1019

G6PD

Front 1020

27 y/o female with a hx of psychiatric illness develops urinary retention while on a neuroleptic – what medication would help treat this?

Back 1020

bethanechol

Front 1021

A farmer presents with dyspnea, salivation, miosis, diarrhea, cramping, and blurry vision – what is the likely cause and mechanism of action?

Back 1021

Insecticide poisoning, inhibition of actylcholinesterase

Front 1022

55yo man undergoing tx for BPH has decreased levels of testerone and DHT, gynecomastia, and edema – what is the drug?

Back 1022

Estrogen(DES)

Front 1023

Farmer with a recent kidney transplant is on cyclosporine for immunosuppression and now requires oral meds for candidiasis? What medication given concurrently would result in cyclosporine toxicity?

Back 1023

Ketoconazole