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186 Cards in this Set

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cancer grade
low grade --> well differentiated; high grade --> anaplastic
nuclear features of cancer
nuclear/cytoplasmic ratio close to normal with normal mitotic spindles --> benign; increased nuclear/cytoplasmic ratio and atypical mitotic spindles --> malignant
laminin
key adhesion protein in beasement membrane interacts with type IV collagen
fibronectin
key adhesion protein in ECM; binds to collagen, fibrin, integrins
osteoblastic metastases
opacities are seen in x-ray; increased ALP indicates reactive bone formation
osteolytic metastases
radiolucencies seen on x-ray; tumor produces interleukin-1 or PTH-like peptide
cancer effects on host
cachexia (due to TNF alpha), anemia of chronic disease, hypercoagulable state (increased coagulation factors), DIC, fever, paraneoplastic syndromes
hypertrophic osteoarthropathy
periosteal reaction of distal phalanx associated with clubbing; associted with bronchogenic carcinoma
lymphedema
collection of lymphatic fluid in cavities due to radical mastectomy, Turner (cystic hygroma, webbed neck), chylous effusion (contains chylomicrons and triglyceride), damage to thoracic duct; can lead to lymphangiosarcoma
angiomyolipoma
kidney hamartoma associated with tuberous sclerosis
bacillary angiomatosis
due to Bartonella in AIDS; mimics Kaposi
glomus tumor
arteriovenous shunts produce painful red subungual nodule in a digit
c-anca
antibodies against cytoplasmic proteinase 3; Wegner's
p-anca
antibodies against myeloperoxidase; Churge Strauss, PAN, microscopic polyangitis
leukocytoclastic vasculitis
acutely inflamed palpable purpura of small vessels; hemorrhagic, raised and painful; Henoch-Schonlein, graft rejection
causes of concentric hypertrophy
hypertension
causes of eccentric hypertrophy
increased preload in mitral, aortic insuficiency or VSD; also causes dilation
consequences of ventricular hypertrophy
heart failure, angina, S4 sound in late diastole
effect of expiration on heart murmur
increases intensity for left-sided murmurs and abnormal sounds
effect of inspiration on heart murmur
increases intensity for right-sided murmur and abnormal sounds
causes of stable angina
atherosclerosis, aortic stenosis with concentric hypertrophy, hypertrophic cardiomyopathy
Austin Flint murmur
diastolic murmur caused by retrograde flow from aortic insuficiency that hits the anterior mitral leaflet; indicates need for valve replacement
causes of infective endocarditis
viridans MCC overall; staph aureus IV drug abuse; staph epidermidis prosthetic devices; strep bovis colitis or colon CA
marantic endocarditis
sterile nondestructive vegetations on mitral valve due to paraneoplastic syndrome of mucin-producing colon or pancreas cancer
cardiac myxoma
occurs in adults; 90% are in the left atrium; diagnose with transesophageal ultrasound
rhabdomyoma
occurs in children; associated with tuberous sclerosis
site for EPO synthesis
EPO is produced by endothelium of peritubular capillaries
primary site of ferritin storage
bone marrow macrophages
hepcidin
liver protein that prevents release of iron from macrophages which increases stores in AOCD
most sensitive test for B12 deficiency
increased methylmalonic acid
haptoglobin
acute phase reactant that combines with Hb to form a complex phagocytosed by macrophages; intravascular hemolysis --> decreased haptoglobin
difference between extra and intravascular hemolysis
extravascular --> unconjugated hyperbilirubinemia; intravascular --> decreased serum haptoglobin, hemoglobinuria
genetic defect in spherocytosis
1) ankyrin 2) spectrin
renal complication of sickle cell disease
microhematuria and papillary necrosis
types of AIHA
warm IgG 70%; cold IgM 30%
myelofibrosis/myeloid metaplasia
marrow fibrosis with extramedullary hematopoiesis (splenomegaly/portal hypertension), splenic infarcts, tear drop cells and leukoerythroblastic reaction
leukoerythoblastic reaction
immature bone marrow cells in peripheral blood (myeloblasts, progranulocytes) and nucleated/tear drop RBCs
myelodisplastic syndrome
<20% myeloblasts, pancytopenia, leukoerythroblastic reaction, ringed sideroblasts; if >20% myeloblasts --> AML
t(12;31)
favorable prognosis in pre-B-cell ALL
pre-B-cell ALL markers
CD10 (CALLA+), TdT+
T-cell ALL markers
CD10- (CALLA-), TdT+, anterior mediastinal mass
adult T-cell leukemia
HTLV-1 virus; activation of TAX gene inhibits p53 with monoclonal proliferation of CD4; lytic bone lesions, hypercalcemia, >20% lymphoblasts, CD4+, TdT-
tartrate-resistant acid phosphatase stain (TRAP)
positive in hairy cell leukemia
testicular cancer node metastasis
para-aortic nodes
penis and vulvar node metastasis
inguinal nodes
squamous cell carcinoma of the floor of the mouth node metastasis
submental/submandibular nodes
cervical node metastasis
head and neck tumors, Hodgkin
left-supraclavicular metastasis
stomach and pancreas cancer
right supraclavicular metastasis
metastatic lung and esophagus cancer or Hodgkin
breast cancer node metastasis
axillary nodes
hilar node metastasis
lung cancer
mediastinal node metastasis
lung cancer, Hodgkin, T-cell lymphoma
extranodal marginal zone lymphoma
gastric MALT lymphoma due to H. pylori
mixed cellularity Hodgkin lymphoma
mainly in males, associated with EBV, reed sternberg cells, eosoniphillia, plasma cells, histiocytes
nodular sclerosing Hodgkin lymphoma
most common, mainly in women, few reed sternberg cells, lacunar cells present, collagen separates nodules
MGUS
monoclonal gammopathy dyscrasia with IgG M spikes and no BJ protein
Lymphoplasmacytic lymphoma
Waldenstrom macrogammaglobulinemia; M spike with IgM with BJ proteins; generalized lymphadenopathy (not present in MM), anemia, hepatosplenomegaly, no lytic bone lesions, hypercoagulable state
prostacyclin synthesis
PGH2 + prostacyclin synthase --> PGI2; not inhibited by aspirin
site of synthesis of tPA
endothelial cells
synthesis of TXA2
PGH2 + thromboxane synthase --> TXA2
heparin-induced thrombocytopenia
due to macrophage removal of platelets covered by IgG against attached heparin
antibodies in ITP
IgGs against GpIIb-IIIa receptor of platelets
causes of DIC
sepsis (e.coli, neisseria), acute promyelocytic leukemia, pancreatic cancer or acute pancreatitis
antiphospholipid syndrome
hypercoagulant state with stroke, thromboembolism, recurrent abortions; seen in SLE, HIV; VDRL postitive
causes of hypercoagulable state
postsurgery, malignancies, folate/B12 deficiency (increases homocysteine), oral contraceptives, Waldestrom, factor V leiden, antithrombin III deficiency, protein C/S deficiency
most common origin of pulmonary thromoboembolism
femoral vein (95%)
causes of secondary pulmonary hypertension
chronic hypoxemia (COPD), chronic respiratory acidosis (chronic bronchitis), loss of vasculature (emphysema), left-right cardiac shunts, mitral stenosis
centrilobular liver necrosis
CHF causes backup congestion of blood around central vein with necrosis; nutmeg liver, painful hepatomegaly, elevated transaminases
Mallory bodies
damaged cytokeratin intermediate filaments in hepatocytes; indicate alcohol hepatitis
Potter disease
oligohydramnios due to renal agenesis or polycistic disease cause pulmonary hypoplasia and low set ears
renal dysplasia
abnormal development of one or both kidneys; enlarged irregular uni/bilateral cyst; MC cyst in children
juvenile polycystic kidney disease
autosomal recessive; bilateral cysts in kidneys and liver; oligohydramnios
adult polycystic kidney disease
autosomal dominant; bilateral cysts in adulthood, liver cysts, berry aneurysms, hypertension, palpable mass, hematuria
diabetic nephropathy
nodular glomerulosclerosis due to non-enzymatic glycosilation of GM and arterioles; osmotic damage to endothelial cells; hyaline arteriolosclerosis of efferent arteriole produces hyperfiltration
tram-tracks
MPGN
subepithelial spikes
MPGN
subepithelial deposits
post-strep GN
subendothelial deposits
diffuse proliferative GN
crescents
RPGN
sclerotic glomerular arterioles
nodular glomerulosclerosis in diabetics
fusion of podocytes
all nephrotic syndromes
loss of GBM negative charge in glomeruli
cytokine-mediated in minimal change disease
susceptibility of nephron to hypoxia
straight part of proximal tubule (damaged in ATN), medullary segment of thick ascending limb
ischemic acute tubular necrosis
ischemia decreases vasodilators and increases vasoconstrictors which decrease GFR --> acute renal failure
brown pigmented casts
acute tubular necrosis
papillary necrosis
causes are chronic analgesic use, diabetes, sickle cell, acute pyelonephritis; gross hematuria, proteinuria, colic flank pain, tissue fragments in urine and necrotic renal papilla
nephrocalcinosis
hypercalcemia in multiple myeloma deposits calcium in GBM
causes of renal osteodystrophy
low vitamin D (hyperparathyroidism, osteitis fibrosa cystica), osteomalacia (low vitamin D), osteoporosis (metabolic acidosis)
cysts in bone
osteitis fibrosa cystica/secondary hyperparathyroidism in CRF
unmineralized bone osteoid
osteomalacia
loss of organic bone matrix
osteoporosis; thin trabecula, low bone density
angiomyolipoma
kidney tumor with blood vessels, smooth muscle and adipocytes associated with tuberous sclerosis
renal cell carcinoma
yellow mass in upper lobes, flank pain, hematuria, flank mass; proximal tubule cell is malignant; produces EPO and/or parathyroid-like peptide and left varicocele; metastasis to lungs; smoking is risk factor
Wilm's tumor
large, derived from mesonephric ducts, associated with WAGR syndrome; child with palpable mass and hypertension
transitional cell carcinoma
cells of renal pelvis are malignant; smoking is risk factor
retroperitoneal fibrosis
associated with ergot derivatives, sclerosing mediastinitis, Ridel's thyroiditis, sclerosing cholangitis; complications are hydronephrosis and right scrotal varicocele
types of bladder cancer
transitional cell (cigarettes); squamous (schistosoma hematobium); adenocarcinoma (urachal remnants, exostrophy)
urethritis in Reiter
due to chlamydia
hypospadia Vs. epispadia
hypospadia ---> ventral surface due to faulty closure of urethral folds; epispadia --> dorsal surface due to defect in genital tubercule
Bowen's disease
leukoplakia involving shaft of the penis; associated with HPV 16; predisposes to squamous cell carcinoma
erythroplasia of Queyrat
erythroplakia on the mucosal surface of the glans; HPV 16; predisposes to squamous cell carcinoma
Bowenoid papulosis
multiple reddish brown papules on external genitalia; HPV 16; doesn’t predispose to squamous cell cancer
risk factors for squamous cell carcinoma of penis
Bowen's disease (leukoplakia of shaft of the penis); erythroplakia of Queyrat (mucosal surface of glans); HPV 16; lack of circumcision; matastasis to inguinal and iliac nodes
right Vs left varicocele
right --> retroperitoneal fibrosis; left --> kidney metastasis to left renal vein, nephrotic syndrome loss of antithrombin III
hydrocele
persistence of tunica vaginalis
testicular seminoma
gray tumor without hemorrhage or necrosis age 30-35 or >65; rarely produces hCG (10%); metastasis to aortic nodes
testicular embryonal carcinoma
bulky mass with hemorrhage and necrosis, age 20-35; can produce AFP and hCG
testicular yolk sac tumor
children < 4; histology resembles primitive glomeruli; produces AFP
testicular choriocarcinoma
age 20-30; trophoblastic tissue; produces hCG
testicular teratoma
all ages; derived from ecto, meso and endoderm; produces AFP and hCG
hCG
elevation in cancers can result in hyperthyroidism, gynecomastia due to similarity to TSH and LH
testicular mass in children < 4y/o
yolk sac tumor; produces AFP
testicular mass in 30-35 y/o
seminoma; produces hCG in 10%; non hemorrhagic mass
testicular mass in 20-30 y/o
embryonal carcinoma (AFP and hCG, hemorrhagic mass) or choriocarcinoma (hCG only, trophoblastic tissuue)
testicular mass in >65 y/o
seminoma (hCG in 10%) or malignant lymphoma (MCC)(involves both testes)
testicular mass produces hCG
seminoma, embryonal carcinoma, choriocarcinoma
testicular mass produces AFP
embryonal carcinoma or yolk sac tumor
BPH Vs. prostate cancer
BPH --> signs of obstruction; affects entire gland; cancer --> obstruction (involved bladder) + low back pain and increased ALP due to osteoblastic metastasis; affect peripheral parts of gland
prolactin
inhibits GnRH/LH/FSH
Kallman syndrome
AD; abnormal development of olfactory bulb and GnRH cells of hypothalamus; delayed puberty, anosmia, color blind
policystic ovarian syndrome
increased LH and decreased FSH results in hirsutism; excess androgens are aromatized to estrogen in adipocytes which increases risk for endometrial hyperplasia; oligomenorrhea, hirsutism, infertility, obesity
causes of hirsutism
policystic ovarian syndrome, obesity, hypothyroidism (decreased SHBG increases free testosterone), Cushing's
surface-derived ovarian tumors
derive from coelomic epithelium; serous cystadenoma and cystadenocarcinoma; mucinous cystadenoma and cystadenocarcinoma; endometrioid
serous ovarian tumors
cysts lined by ciliated cells; serous cystadenocarcinoma has psamomma bodies
psamomma bodies in ovarian tumor
serous cystadenocarcinoma
mucinous ovarian tumors
cysts lined by mucus-secreting cells with large multiloculated tumors
gonadoblastoma
combination of dysgerminoma with sex-cord stromal ovarian tumor
mole Vs. choriocarcinoma
mole --> chorionic villi present; choriocarcinoma --> chorionic villi not present, trophoblast is malignant
Down syndrome triple test
decreased urine estriol, decreased AFP, increased hCG
fibrocystic change
bilateral enlargement of breast with cysts and fibrosis; changes with menstrual cycle; <50y/o
fibroadenoma
discrete movable estrogen sensitive mass in women < 35y/o; can be painless of painful
intraductal papilloma
bloody nipple discharge; benign; women <50y/o; no increased risk for cancer
causes of hypopituitarism
nonfunctioning adenoma, Sheehan's, craniopharyngeoma, apoplexy
nephrocalcinosis
metastatic calcification of collecting duct basement membrane due to multiple myeloma; can cause nephrogenic diabetes insipidus
osteopetrosis
autosomal recessive defect in osteoclasts; too much bone; fractures, anemia (bone marrow compression), cranial nerve compression
osteochondroma
bony outgrowth capped by cartilage in a 10-30y/o at femur metaphysis
endochondroma
ingrowth of cartilage in 20-50y/o predisposes to chondrosarcoma
osteoma
occurs at any age and affects facial bones; associated with Gardner's
osteoid osteoma
10-20y/o; radiolucent focus surrounded by sclerotic bone in phalanges
Paget bone disease
combined lytic and osteoblastic lesions; increased ALP; multinucleated osteoclasts
chondrosarcoma
malignant cartilage at 30-60y/o; endochondroma predisposes
osteosarcoma
calcified malignant osteoid in 10-25y/o at metaphysis of tibia
Ewing's sarcoma
10-20y/o; affects diaphysis and metaphysis with periosteal reaction
positive Vs negative birefringence
yellow = negative birefringent monosodium urate; blue = positive birefringent calcium pyrophosphate
other name for pseudogout
chondrocalcinosis
erythema chronicum migrans
Bull's eye rash pathognomonic of Lyme disease
erythema infectiosum
slapped-cheek rash associated with parvoB19
erythema marginatum
associated with rheumatic fever
erythema multiforme
hypersensitivity to mycoplasma or drugs (sulfonamides, penicillin, lamotrigine) vesicles and bullae; Steven-Johnson
erythema nodosum
erythematous and painful nodules of inflammation of subcutaneous fat associated with coccidioides, histoplasma, tuberculosis, leprae
porphyria cutanea tarda
photosensitive bullae due to uroporphyrinigen decarboxylase deficiency
cerebral edema
signs are papilledema (swelling of optic disc), headache, projectile vomit without nausea, bradycardia, HTN
pseudotumor cerebri
intracranial hypertension without evidence of tumor
hydrocephalus ex vacuo
cortex atrophy allows ventricles to enlarge in Alzheimer's
Arnold Chiari
small posterior fossa with herniation of cerebellar vermis and medulla through foramen magnum, noncommunicating hydrocephalus, platybisia, syringomyelia
Dandy-Walker
hypoplasia of cerebellar vermis, cystic dilation of fourth ventricle, noncommunicating hydrocephalus
tuberous sclerosis
autosomal dominant mental retardation, seizures, kidney angiomyolipoma, heart rhabdomyosarcoma
adrenoleukodystrophy
x-linked deficiency of beta oxydation of long chain FA in peroxisomes; demyelination and adrenal insuficiency
metachromatic leukodystrophy
lysosomal storage disease due to deficiency of arylsulfatase A and accumulation of sulfatides in brain
Krabbe's disease
lysosomal storage disease with deficiency of galactocerebrosidase; brain shows multinucleated histiocytes
pathologic changes in Alzheimer's
cerebral atrophy with hydrocephalus ex vacuo; neurofibrillary tangles in cytoplasm; senile plaques composed of amyloid beta surrounded by neuronal processes containning tau protein
Wilson's
combined defect in copper excretion in bile and synthesis of ceruloplasmin; accumulates in liver (cirrhosis) and putamen (atrophy and cavitations); parkinsonism, chorea, dementia
astrocytoma
glioblastoma multiforme is most common in adults; necrosis and hemorrhagic cysts
meningioma
benign tumor in adults with psamomma bodies
ependymoma
arises in cauda equina in adults or fourth ventricle in children; ependymal cells produce CSF
medulloblastoma
most common in children; arises from external granular layer of cerebellum and invades fourth ventricle
oligodendroglioma
oligodendrocytic tumor in adults with frontal lobe calcifications
presbycusis
degeneration of cochlear hairs; sensorineural hearing loss in elderly
otosclerosis
fussion of middle ear ossicles; conduction deafness in the elderly
otitis media
conduction deafness in children due to strep or haemophilus
external otitis
swimmer's ear by pseudomonas, staph; malignant external otitis due to pseudomonas in diabetics
opthalmia neonatorum
conjunctivitis in newborn due to neisseria (1st week) or chlamydia (2nd week)
bacterial conjunctivitis
painful purulent eye without blurry vision due to staph
viral conjunctivitis
watery exudates due to adenovirus or HSV-1
stye
infection of eyelid due to staph
chalazion
granulomatous inflammation of the meibomian gland of eyelids
orbital cellulitis
periorbital redness and swelling secondary to sinusitis; fever, proptosis, opthalmoplegia
pterygium
thickened conjuctiva
optic neuritis
inflammation of optic nerve due to multiple sclerosis or ethambutol; blurry vision and optic atrophy
central retinal artery occlusion
emboli from internal carotid or opthalmic artery; or temporal arteritis; sudden painless monocular blindness
central retinal vein occlusion
sudden painless monocular blindness with swelling of optic disk due to hypercoagulable state
glaucoma
increased intraocular pressure due to too much aqueous humor or decreased clearance through canal of Schelm; acute angle closure presents with painful red eye and fixed pupil; chronic open angle presents night blindness and progressive deterioration and atrophy of optic disk
optic nerve atrophy
pale optic disk due to optic neuritis or open angle glaucoma
uveitis
inflammation of iris, cilliary body or choroid due to sarcoidosis or seronegative arthritis; normal IOP, miosis, blurry vision
macular degeneration
progressive permanent blindness in elderly; macula is pale
CMV retinitis
blindness in AIDS with < 50 CD4