Usmle Pathology

Front 1

What is normal hematocrit and oxygen saturation?

Back 1

Adult males Ht: 42%-54%
Adult women Ht: 38%-46%
Normal oxygen saturation values are 97% to 99% in the healthy individual.

Front 2

Under what conditions do we see nucleated RBCs in blood smear?

Back 2

Regenerative anemia: In this case, the nRBCs will be accompanied by polychromasia or a reticulocytosis.
Bone marrow injury, e.g. endotoxemia, lead poisoning (plumbism)
Bone marrow neoplasia, e.g. primary myelodysplasia, acute myeloid leukemia
Extramedullary hematopoiesis
Altered splenic function, e.g. splenectomy, splenic hemangiosarcoma

Front 3

Name one test and one physical observation that will support the diagnosis of polycythemia vera

Back 3

Polycythemia vera is an overproduction of red blood cells by the marrow (as well as sometimes of white blood cells and platelets). Most of the health concerns associated with polycythemia vera are caused by a blood-thickening effect that results from an overproduction of red blood cells.

Blood test: Erythropoetin is low.
Phys. finding: itching, especially upon exposure to hot water

Front 4

Name five tumor types associated with increased hematopoesis

Back 4

1. Hepatocellular carcinoma
2. Renal cell carcinoma
3. Hemangioblastoma
4. Pheochromocytoma
5. Uterine Myomata

Front 5

When do we see Reactive Polycythemia and what test would suggest it's presence?

Back 5

With long-standing tissue hypoxia, like in smokers or with COPD. Decreases oxygen saturation on pulse oxymetry is suggestive of reactive polycythemia

Front 6

What is cystinuria?

Back 6

Cystinuria is an inherited autosomal recessive metabolic disorder characterized by the formation of cystine stones in the kidneys, ureter, and bladder.
Caused by defective transepithelial transport of cystine and dibasic amino acids in the kidney and intestine.
Test: Positive Nitroprusside test identifies the presence of cysteine in the urine

Front 7

Mosaic pattern of newly formed woven bone is usually suggestive of?

Back 7

Paget's disease.
There could also be increased hat size
During early lytic phase Paget's disease is characterized by patchwork areas of bone resorption with bizarre, large osteoclasts.
In the middle phase (blastic and lytic) there is a mosaic pattern of new bone formation.
Late phase (sclerotic) the bone is dense and "burned out"
Complication: osteosarcoma, high output heart failure

Front 8

What is the most common cause of acute bacterial endocarditis?

Back 8

Staph Aureus

Front 9

Name several major and minor criterias for endocarditis

Back 9

Major:
- Positive bacterial cultures
- Echo positive for new cardiac lesions or new murmors
Minor:
- Fever
- Presence of immunologic conditions (like glomerulitis)
- Evidence of embolism

Front 10

Brain absess producing ring enhancing lesions associated with a new onset of murmurs is indicative of what infection?

Back 10

A complication of Staph Aureus caused bacterial endocarditis where vegetative fragments become released and produce septic emboli

Front 11

Cranial nerve V function

Back 11

Trigeminal Nerve (Mixed sensory and motor)
Sensory:
Face, cornea, nasal cavity, palate, anterior 2/3 of the tongue and teeth.

Motor:
muscles of mastication, anterior belly of the digastric, tensor tympani and tensor palate

Front 12

Decreased corneal reflext suggests damage to which cranial nerve?

Back 12

Trigeminal or facial nerve
The nasociliary branch of the ophthalmic division (V1) of Trigeminal nerve is sensing the stimulus on the cornea
The 7th cranial nerve is initiating motor response.

Front 13

What cranial nerves are involved in gag reflex?

Back 13

Gag reflex is a reflex contraction of the back of the throat evoked by touching the soft palate.
Afferent - Glossopharyngeal nerve.
Efferent - Vagus nerve

Front 14

Congenital blood vessel weakness can lead to what pathology?

Back 14

Berry aneurysms - rupture leads to stroke

Front 15

Cystic media necrosis is associated with what pathology?

Back 15

Disecting aneurysms as seen in Marfan's syndrome

Front 16

Syphilitic aneurysm usually involves what vessel and in what location?

Back 16

Cardiovascular manifestation of tertiary syphillis.
Usually involves the aortic root as it leaves the heart.

Front 17

What additional findings are likely to be present in a person with this vascular birthmark>

Back 17

A port-wine stain or naevus flammeus is a vascular birthmark consisting of superficial and deep dilated capillaries in the skin.
Must evaluate for the presence of Sturge-Weber Syndrome often associated with meningeal angiomatosis that can result in seizures, hemiparesis etc

Front 18

What disease are acoustic neuromas associated with?

Back 18

Neurofibromatosis Type II

Front 19

What disease are cerebellar hemangioblastomas associated with?

Back 19

Von Hippel - Lindau Syndrome

Front 20

What disease are neurofibromas associated with?

Back 20

Neurofibromatosis Type I

Front 21

Karyolysis

Back 21

Degenerative change affecting nuclei seen as decrease in nuclear basophilia presumably as a result of DNAse activity.

Front 22

Pyknosis

Back 22

Nuclear shrinking and basophilia

Front 23

Karyorrhexis

Back 23

Is a pattern of degradation in which pyknotic or partially pyknotic nuclei undergo fragmentation followed by complete lysis

Front 24

The greatest risk factor for laryngeal squamous cell carcinoma?

Back 24

Smoking (followed by alcohol consumption, radiation, HPV infection)

Front 25

Name the traid of symptoms seen in Wegener's granulomatosis

Back 25

1. Necrotizing granulomas of the upper respiratory tract
2. Vasculitis affecting small to medium size vessels
3. Renal disease
Positive c-ANCA (cytoplasmic anti-neutrophil Abs)

Front 26

Name several diseases associated with immune complex deposition (Type III Hypersensitivity)

Back 26

- Postinfectious glomerulonephritis
- Lupus nephritis
- Henoch - Schonlein purpura
- Cryoglobulenemia
- Bacterial endocarditis

Front 27

Describe these nuclear and cytoplasmic changes. What are they indicative of?

Back 27

HPV infection of the cervix is characterized by the presence of koilocytosis (nuclei with irregular contours that appear raisin-like, cytoplasm vacuolization creates a perinuclear halo)

Front 28

Name the high risk HPV types and why are they higher risk?

Back 28

HPV Type 16 and 18. They carry with them proteins E6 and E7 that inactivate tumor supressor genes p53 and Rb.

Front 29

What infection type is koilocytosis indicative of?

Back 29

HPV. Koilocytosis is a low grade squamous intraepithelial lesion

Front 30

What infection is associated with itching and frothy white vaginal discharge in women and usually asymptomatic in men?

Back 30

Trichomonas infection

Front 31

What is a male pseudohermaphridite?

Back 31

Phenotypic female with 46 XY karyotype
Could be due to testicular feminization syndrome when the body fails to respond to Testosterone

Front 32

What is female pseudohermaphrodite

Back 32

Phenotypic male with 46 XX karyotype. Usually due to adrenal tumors producing virulizing hormones

Front 33

What is true hermaphrodite?

Back 33

Rare. Have both male and female structures

Front 34

Name three symptoms commonly seen in cardiac tamponade

Back 34

Hypotension
Jugulovenous distension
Muffled heart sounds
Rupture of left ventricular wall is a frequent complication of an MI --> blood rushes our, filles myocardial sac --> compression of the left ventricle --> cardiac tamponade --> person dies from cardiogeneic shock

Front 35

Define ischemia

Back 35

Decreased arterial blood flow to tissues (ex. due to coronary artery stenosis or decreased cardiac output)

Front 36

Define hypoxemia

Back 36

Low arterial partial pressure of oxygen (PaO2)
Ex. in respiratory acidosis, atelectasis, pulmonary embolization etc,

Front 37

Describe what happens to Hb concentration, SaO2 and PaO2 in anemia

Back 37

Hb - decreased due to decreased production or increased destruction
SaO2 and PaO2 are normal

Front 38

Describe what happens to Hb concentration, SaO2 and PaO2 in methemoglobinemia

Back 38

Methemoglobin (MetHb) is a heme with Fe3+ - cannot bind oxygen (happens due to oxidant stresses - nitrite and sulfur containing drugs, sepsis)
Hb - normal
SaO2 low because heme cannot bind oxygen
PaO2 normal

Front 39

CO Poisoning

Back 39

Decreased O2 content in blood
Hb normal
SaO2 decreased because CO has higher affinity for heme than oxygen
PaO2 normal

Front 40

Name three causes of tissue hypoxia with normal oxygen content

Back 40

1. Ischemia - MCC
2. Cyanide Poisoning
3. Uncoupling of oxidative phosphorylation (alcohol, salycilates, dinitrophenol)

Front 41

Ghon focus

Back 41

primary TB

Front 42

Gilbert's syndrome

Back 42

benign congenital unconjugated hyperbilirubinemia

Front 43

Gillian Barre

Back 43

Ascending musle paralysis. Lose motor function but not sensory function. Also see albuminocytologic disssociation.

Front 44

HCG elevation is seen in

Back 44

HCG:
Hydaditiform mole
Choreocarcinoma
Germ cell tumors

Front 45

Heinz bodies

Back 45

Denatured Hb (in G6PD defficiency, severe Alpha thalassemia - beta chains ppt out, Chronic liver disease)

Front 46

Henoch-Schonlein Purpura

Back 46

1. lower extremiry purpura
2. artharlgia
3. joint pain
4. abdominal pain
5. IgA nephropathy

Front 47

High Output cardiac failure with dilated cardiomyopathy is most often caused by?

Back 47

Wet BeriBeri (Thiamine, B1 defficiency)

Front 48

Ptosis, miosis and anhidrosis are manifestations of what disease?

Back 48

Horner syndrome - usually due to a tumor at the apex of the lung that interrupts sympathetic fibers.

Front 49

Huntigton's disease

Back 49

Caudate degeration
Crazy - dimentia
Chromosome quatro - Chromosome 4
Decreased Ach
Chorea
CAG repeat disorder

Front 50

Hyperpigmentation of the skin is seen in

Back 50

Primary adrenal insufficiency - Addison's disease

Front 51

Hypersegmented neutrophils

Back 51

Macrocytic anemia (B12 or Folate defficiency)

Front 52

What is the pathology behind Marfan's syndrome?

Back 52

Aut dominant disorder due to a defect in Fibrillin gene, major component of elastin associated microfibrils (common in large blood vessels and suspensory ligaments of the lens) - could lead to cystic medial necrosis of the aorta or sublixation of the lens, mitral valve prolapse and shortened life span

Front 53

Describe the signs and symptoms of secondary syphillis and name the best diagnostic test for detecting 2ry syphillis

Back 53

Maculopapular bronzing rash that coveres the entire body including hands and feet. Also, candyloma lata (flat wart-like growth on perineal skin).
Best initial test - Venerial Disease Lab Test - detect the presence of Abs

Front 54

Name the stages of syphilis

Back 54

1. 10 days to 3 mo after infection - nontender chancres with indurated edges - infectios - can dx with darkfield microscopy
2. Secondary syphillis (1-3 mo later) - broze, maculopapular rash that includes hands and feet, canduloma lata - dx - use VDLT
3. Gummas - happens in 30% of infected years later (syphillitic granulomas, aortitis)

Front 55

Describe the mechanism behind pseudohypoparathyroidism

Back 55

Usually due to tissue insensitivity to PTH. This most frequently stems from defective Gs. Since PTH signals via activating cAMP cascade, absence of functional Gs prevents an increase in cAMP levels. This could be proven by injecting cAMP and then checking cAMP levels in urine