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