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164 Cards in this Set
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Mobitz I (Second degree AV block type 1)
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Usually due to inferior MI. Rarely goes into 3rd degree block. Progressively prolonged PR intervals and then a dropped QRS.
Txt w/ Atropine or Isoproterenol. |
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Mobitz II (second degree AV block type 2)
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BBB association. Often goes to 3rd degree AV block. Usually due to anterior MI.
P wave is not always followed by a QRS. |
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P wave
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Atrial depol.
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a wave
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LA contraction
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T wave
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Ventricular repol.
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Wavy fibers
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Eosinophilic bands of necrotic myocytes. Early sign of MI.
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Janeway’s lesions
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Seen in acute bacterial endocarditis. Non-tender, erythematous lesions of palms & soles.
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Osler’s nodes
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Seen in subacute bacterial endocarditis. Tender lesions of fingers & toes.
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Thiamine deficiency can lead to...
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Wet Beri Beri = heart. Dilated (congested) cardiomyopathy due to chronic alcohol consumption
Dry Beri Beri = peripheral neuropathy. Wernicke-Korsakoff = ataxia; confusion; confabulation; memory loss |
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Fibrinous Pericarditis
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Associated w/ MI: Dressler’s
Can also be caused by uremia Most common type of pericarditis |
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Serous Pericarditis
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Associated w/ nonbacterial; viral (Coxsackie) infection; immunologic reaction
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Friction Rub
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Pericarditis association
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Hemorrhagic Pericarditis
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Associated w/ TB or neoplasm
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Restrictive Cardiomyopathy
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aka infiltrative cardiomyopathy that stiffens the heart
Due to amyloidosis in the elderly Also see schaumann & asteroid bodies in young (< 25 yo) |
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PML’s infectious agent
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JC Virus (Papovavirus = dsDNA, naked icosahedral capsid)
Causes inflammation of the white matter and occurs almost exclusively in people with severe immunodeficiency |
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4 ways you can get edema
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1. Increase hydrostatic pressure (more seeps out)
2. Decrease oncotic pressure (less reabsorbed) 3. Increase vessel permeability 4. Block lymphatic drainage |
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Adult Polycystic Kidney Disease
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Commonly see liver cysts, mitral valve prolapse, & Berry aneurysms along w/ kidney cysts. Hematuria & HTN also present.
3 cysts in ea. Kidney w/ + family history confirms diagnosis PDK1 = chromosome 16 (most common and most severe) PDK2 = chromosome 4 |
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Malignant HTN effect on kidneys
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Petehial hemorrhages are seen on kidney surfaces = Flea-Bitten surface = young black men
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Nephritic signs
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Hematuria; RBC casts; HTN
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Nephrotic signs
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Proteinuria (> 3.5 g/day); Hypoalbuminemia; Edema
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Podocyte Effacement seen w/
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Minimal Change (Lipoid nephrosis) disease
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elevated ASO (antistreptolysin O) titer seen w/
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Acute post-streptococcal GN (due to βHGASrtep)
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Crescentic GN
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Rapidly progressive GN – nephritic syndrome
Associated w/ multi system disease or post-strep/post infectious glomerular nephritis Type 1: Goodpasture's Type 2: Lupus Type 3: Pauci immune (vasculitis) |
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Hereditary Nephritis
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Alport’s syndrome. X linked
Renal disease w/ deafness & ocualr abnormalities |
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Membranoproliferative GN
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Can be secondary to complement deficiency; chronic infections; CLL
See tram tracking (with type 1) |
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Type I Membrano Proliferative GN deposits
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C3 & IgG deposits
Tram tracking |
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Type II Membrano Proliferative GN deposits
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Only C3 deposits
Aka Dense deposit disease |
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Focal segmental glomerulosclerosis deposits
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IgM & C3 deposits
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Cold agglutinins
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Seen in atypical pneumonia
It is IgM Ab with specificity for I Ag on adult RBCs |
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Scrofula
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TB in the lymph nodes
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Aspirin-Asthma Triad
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Nasal polyps – Rhinitis – bronchoconstriction
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Ferruginous bodies
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Hemosiderin (pigment w/ Fe3-) covered macrophages that have been pahgocytised
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Pancoast’s tumor causes
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Ulnar nerve pain & Horner’s syndrome (ipsilateral miosis, ptosis, anhydrosis)
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Fatty degeneration
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Made up primarily of triglycerides
Most commonly due to alcoholism which commonly leads to hepatic cirrhosis Associated w/ CCl4- |
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Cloudy swelling
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Failure of cellular Na pump
Seen in Fatty degeneration of the liver and in Hydropic (Vacuolar) degeneration of the liver |
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Hydropic degeneration
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Severe form of cloudy swelling
Seen with hypokalemia induced by vomitting/diarrhea |
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Liquefactive necrosis
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Rapid enzymatic break down of lipids
Seen commonly in Brain & Spinal cord (CNS) injuries Seen in suppurative infections = pus formation |
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Coagulation necrosis
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Result of sudden ischemia
Seen in organs w/ end arteries limited collateral circulation) = heart, lung, kidney, spleen |
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Caseation necrosis
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Combination of both coagulation & liquefaction necrosis
Seen w/ M. tuberculosis & Histoplasma capsulatum infection |
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Fibrinoid necrosis
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Seen in the walls of small arteries
Associated w/ malignant hypertension, polyarteritis nodosa, immune mediated vasculitis |
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Fat necrosis
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Result of lipase actions liberated from pancreatic enzymes
Seen w/ Acute pancreatitis = saponification results |
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Hemoptysis
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Blood in sputum
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Pulmonary embolism
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Most commonly thrombus from lower extremity vein
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Phlebothrombosis
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From a vein of lower extremities, of a pregnant uterus, in Congestive heart failure, bed ridden pt
As a complicaiton in a pt w/ Pancreatic CA due to hypercoaguable state |
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Saddle embolus
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Embolus lodged in bifurcation of pulmonary trunks
Increased RV strain = RV & RA dilate = Acute cor pulmonale |
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Paradoxical embolism
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Right to Left shunt allows a venous embolism to enter arterial circulation
Patent ovale foramen or Atrial septal defect |
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Tuberculoid granuloma
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Collection of macrophages w/o caseation
Seen w/ Sarcoidosis (non-caseating); Syphilis; Brucellosis and Leprotic infections |
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Cellulitis
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Spreading infection due to streptococcus
Can also be a cause of post-strep GN (dont always just think of strep throat) |
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PSA
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Prostate Specific Antigen = elevated in prostatic CA
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Elevated 5-HT seen with...
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In cases of metastatic carcinoid, txt w/ Methysergide (5HT antagonist)
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increased alphafeto-protein seen with...
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Hepatocarcinoma
Neural tube defects |
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CEA
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Carcinoembryonic Antigen = elevated in Colon CA
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Chromosome 13
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Retinoblastoma
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Chromosome 11p
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Wilms tumor of the kidney
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Vinyl Chloride
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Associated w/ Angiosarcoma of the liver
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Agent Orange
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Contains dioxin
Implicated as a cause of Hodgkin's disease, non-Hodgkin’s lymphoma & soft tissue sarcomas |
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Parasites & CA
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Schistosoma haematobium = Urinary bladder CA
S. mansoni = Colon CA Aspergillus flavus = potent hepatocarcinogen |
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Ochronosis
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Alkaptonuria
Error in tyrosine metabolism due to Homogentisic acid (oxidizes tyrosine) Involving intervertebral disks = Ankylosing Spondilitis = Poker spine See dark urine; dark coloration of sclera, tendons, cartilage |
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Lead poisoning
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Acid fast inclusion bodies
increased urinary coproprophyrin Anemia: microcytic/ hypochromic Stippling of the basophils Gingival line & lead line in bones: x-ray Mental retardation |
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Heroin OD, clinically
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Massive pulmonary edema w/ frothy fluid from the nostrils
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Fetal alcohol syndrome
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Small head, small eyes, funnel chest, ASD, mental deficiency, and hirsutism
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Atypical mycobacterium
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M. kanasasii & M. avium intracellulare
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Cold abscesses
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Liquefied TB lesions similar to pyogenic abscesses but lacking acute inflammation
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Actinomyces isrealli
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Farmers infection
Lumpy jaw (from chewing grain) & PID (IUD), but most common is due to saprophyticus |
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Congenital Syphilis
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Saddle nose, Saber shin, Hutchinson’s teeth, nerve deafness, interstitial keratitis
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Warthin-Finkeledy cells
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Reticuloendothelial giant cells on tonsils, lymph nodes, spleen
Seen with Rubeola (measles) due to paramyxovirus |
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Diphyllobothrium latum
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Tapeworm infection causing megaloblastic anemia by consuming large amount of vit B12 in the host
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Subacute Bacterial Endocarditis
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alpha Hemolytic Streptococci (S. viridans) = usually in pt w/ pre-existing heart problem
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Acute Bacterial Endocarditis
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Staph aureus, β Hemolytic Streptococci, E. coli
Common among drug addicts & diabetics |
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Mitral Insufficiency
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Ruptured papillary muscle
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Left Anterior Descending branch
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Branch of the Left Coronary artery
Highest frequency of thrombotic occlusion MI = anterior wall of the LV, especially in apical part of interventricular septum |
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Left Circumflex branch
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Branch of the Left Coronary artery
Occlusion = MI of posterior/lateral wall of the LV |
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Dissecting Aneurysm
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False aneurysm: it is splitting of the media of the aorta
Usually accompanied w/ long history of severe hypertension, also seen w/ familial hyperlipidemia, atherosclerotic disease, Marfan’s Collagen disease Zones of medial necrosis +/- slitlike cysts = Medial Cystic Necrosis of Erdheim |
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Cor Pulmonale
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Right ventricular strain, associated w/ right ventricular hypertrophy
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Acute Cor Pulmonale
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Sudden right ventricular strain due to a massive pulmonary embolism
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Bronchopneumonia
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Lobular (rather than lobar)
Due to Staph aureus; Pseudomonas aeruginosa; Klebsiella; E. coli Abscess formation is common |
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Lobar pneumonia
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Due to Strep. Pneumoniae infection (5% due to Klebsiella)
Red Hepatization: days 1-3 of the pneumonia Gray Hepatization: days 3-8 of untreated pneumonia Complicaitons: pleural effusion; atelectasia; fibrinous pleuritis; empyema; fibrinous pericarditis; otitis media |
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Bronchiectasis
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Permanent dilatation of the bronchi – predisposed by chronic sinusitis and post nasal drip
Supparation associated Lower lobe > than upper lobe involvement |
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Panlobular Emphysema
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alpha1 – antitrypsin deficiency, causing increase in elastase, leading to decrease in lung compliance
Starts in lower lobes but can involve the whole lung |
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Bulla
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Associated w/ Emphysema = “Bleb” = outpouching - If it ruptures causes Pneumothorax
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Farmer’s Lung
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Due to Micropolyspora faeni (thermophilic actinomycetes)
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Bagassosis
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Due to M. vulgaris (actinomycetes)
Inhalation of sugar cane dust |
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Silo-Filler’s Lung
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Due to Nitrogen dioxide from nitrates in corn
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G6PDH Deficiency
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Sex-linked chronic hemolytic anemia w/o challenge or after eating fava beans
Heinz Bodies appear in RBCs |
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increased HbF seen in...
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Sickle Cell Anemia
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Multiple Myeloma
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Lytic lesions of flat bones (“salt & pepper lesions”) = vertebrae, ribs, skull; Hypercalcemia; Bence-Jones protein casts
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Hodgkin’s Disease
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Malignant neoplasm of the lymph nodes causing pruritis; fever = looks like an acute infection
Reed Sternberg cells |
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Polyarteritis Nodosa
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Immune complex disease of Ag-Ab complexes on blood vessel wall
Half of the immune complexes have Hepatitis B Ag Can see fever, abd. pain, weight loss, HTN, muscle aches |
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Sprue
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Celiac disease due to a gluten-induced enteropathy = small intestine villi are blunted
High titers of anti-gliadin Abs & ↑ IgA levels |
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Regional Enteritis
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Crohn’s Disease
Association w/ Arthritis; Uveitis; Erythema Nodosum |
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Whipple’s Disease
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Intestinal Lipodystrophy = malabsorption syndrome
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Kulchitsky cells
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Neural cest cells from which carcinoids arise = of the Bronchi; GIT; Pancreas
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Ulcerative Colitis
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Inflammatory disease of the colon w/ increased colon CA incidence
Crypt abscess in the crypts of Lieberkuhn Pseudopolyps when ulcers are deep Not transmural involvement |
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Vaginal Adenosis
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Women exposed to DES (Diethylstilbesterol) in utero before the 18th week of pregnancy
Some develop clear cell adenocarcinoma of the vagina & cervix |
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Scirrhous Carcinoma
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Infiltrating Duct Carcinoma w/ fibrosis – most common type of breast carcinoma
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Hofbauer Cells
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Lipid laden macrophages seen in villi of Erythroblastosis Fetalis
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Retinopathy of Prematurity
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Retrolental Fibroplasia = cause of bindness in premies due to high O2 concentrations
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IgA deficiency
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Pt has recurrent infections & diarrhea w/ increased respiratory tract allergy & autoimmune diseases
If given blood w/ IgA = develop severe, fatal anaphylaxis reaction |
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Primary Sjorgen’s
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Dry eyes & dry mouth, arthritis. Increased risk for B cell lymphoma. HLA-DR3 frequent. Autoimmune disease.
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Secondary Sjorgen’s
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Rheumatoid arthritis, SLE, or systemic sclerosis association
RA association shows HLA-DR4 |
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LDH1 & LDH2
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From myocardium. LDH1 higher than LDH2 = Myocardial Infarction
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LDH3
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Found in lung tissue
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LDH4 & LDH5
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Found in liver cells
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Keratomalacia
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Severe Vit A deficiency. See Bitot’s spots in the eyes = gray plaques = thickened, keratinized ET
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Metabisfite Test
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Suspending RBCs in a low O2 content solution
Can detect Hemoglobin S, which sickles in low O2 |
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Microangiopathic Hemolytic Anemia
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Can be due to Hemolyitc Uremic Syndrome & Thrombotic Thrombocytopenic Purpura (TTP)
See Helmet cells |
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Wright’s stain
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Stain for Burkitt’s lymphoma
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Mononucleosis
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Due to EBV infection
If Mono is treated w/ Ampicillin, thinking that it is a strep pharyngitis, a rash will occur. |
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t(8;14)
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Burkitt’s lymphoma = c-myc oncogene overexpression
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t(9;22)
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CML = c-abl/bcr gene formation = Philadelphia translocation
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Langerhan Cell Histiocytosis
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Letter Sirwe syndrome; Hand Schuller Christian Disease; Eosinophilic Granuloma
Birbeck granules are present = tennis racket shape |
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Myeloid Metaplasia
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Alkaline phosphatase is increased/normal; compare to CML = low to absent
Anemia; splenomegaly; platelets > 1 million = extensive extra-medullary hematopoiesis |
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Multiple Myeloma
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Weakness; wt. loss; recurrent infection; proteinuria; anemia; increased proliferation of plasma cells in BM = plasma cell dx
Serum M protein spike – most often of IgG or IgA Hypercalcemia (increased bone destruction) |
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t(14;18)
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NH Lymphoma = bcl2 proto-oncogene overexpression seen w/ Small Cleaved Cell (Follicualr) Lymphoma
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Focal Segmental GN exs
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IgA Focal GN = Berger’s disease; SLE; PAN; Schonlein-Henoch purpura (anaphylactoid purpura)
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Nephrotic Syndrome exs
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Focal (Segmental) GN; Membranous GN; Lipoid (Minimal Change) GN; Membranoproliferative GN; Hep B; Syphilis; Penicillamine
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Schistosoma Haematobium
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Infection is assocaited w/ Squamous cell CA of the Bladder (most common Bladder CA is transitional cell type)
Associated w/ portal HTN due to intrahepatic obstruction |
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Penicillin Resistant PID
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PID is usually due to N. Gonorrhoeae, but if unresponsive to penicillin think of Bacteroides species
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Duret Hemorrhages
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Severe increase in ICP w/ downward diplacement of cerebellar tonsils into Foramen Magnum causing a compression on the brainstem w/ hemorrhaging into the pons & midbrain
Nearly always associated w/ death due to damage to the vital centers in these areas |
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Hypertensive Hemorrhage
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Predilection for lenticulostriate arteries = putamen & internal capsule hemorrhages
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Cerebral Embolism from...
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MI w/ Mural Thrombi; Atrial Fib Thrombi = Marantic thrombi; L-sided Bacterial Endocarditis; Paradoxical Embolism of septal defect
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Neurosyphilis
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Tabes Dorsalis = decreased joint position sensation, decreased pain sensation, ataxia, Argyl Robertson pupils
Syphilitic meningitis Paretic neurosyphilis |
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5p-
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Cri di Chat: mental retardation; small head; wide set eyes; low set ears; cat-like cry
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Trisomy 13
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Patau’s: small head & eyes; cleft lip & palate; many fingers
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Acute Cold Agglutination
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Antibodies to I blood group Ag. Mediated by IgM antibodies
Complication of EBV or Mycoplasma pneumoniae infections |
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Chronic Cold Agglutination
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Associated w/ lymphoid neoplasms. See agglutination & hemolysis in tissue exposed to cold. IgM Abs
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RBC Osmotic Fragility
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Hereditary Spherocytosis
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Non-Hodgkin’s Lymphomas (5 types)
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1. Small Lymphocytic: low grade B cell lymphoma of the elderly. Related to CLL.
2. Small Cleaved cell (Follicualr): low grade B cell lymphoma of the elderly. T(14;18) bcl-2 oncogene 3. Large Cell 4. Lymphoblastic: high grade T cell lymphoma of kids progressing to T-ALL 5. Small Non Cleaved = Burkitt’s: high grade B cell lymphoma. EBV infection. Starry sky histo appearance. T(8;14) c-myc proto-oncogene. Related to B-ALL |
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Singer’s Nodules
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Benign laryngeal polyps associated w/ smoking & overuse of the voice
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Paraseptal emphysema
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Associated w/ blebs (large subpleural bullae) that can rupture and cause pneumothorax
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Superior Vena Cava Syndrome
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Obstructed due to bronchogenic carcinoma. Causing swollen face & cyanosis.
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Betel nuts
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Associated to oral cancer.
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Fundal (Type A) Gastritis
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Antibodies to parietal cells; pernicious anemia; autoimmune diseases
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Antral (Type B) Gastritis
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Associated w/ Helicobacter (Campylobacter) pylori infection. 90% of duodenal ulcer
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Primary Biliary Cirrhosis
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Autoimmune origin; middle aged women; anti-mitochondrial Abs
Jaundice; itching; hypercholesterolemia (can see cutaneous xanthomas) |
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Acute Pancreatitis
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increased pancreatic enzymes = fat necrosis; sapponification = hypocalcemia; increased serum amylase
Severe epigastric ab pain; prostration; radiation to the back |
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Abdominal pain radiating to the back is associated with...
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Chronic pancreatitis
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Complete Hydatidiform Mole
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No embryo. Paternal derivation only. 46XX
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Partial Hydatidiform Mole
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Embryo. 2 or more sprems fertilized 1 ovum: triploidy/tetraploidy occurs
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Cold Nodules
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Hypoplastic Goiter nodules that do not take up radio active iodine. [Opposite: hot & do take up iodine]
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Acidophils
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Mammotrophs = Prolactin
Somatotrophs = GH |
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Basophils
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Thyrotrophs = TSH
Gonadotrophs = LH Corticotrophs = ACTH & FSH |
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Lacunar Strokes
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Small/focal aa occlusions. Purely motor or sensory.
Sensory: lesion of thalamus Motor: lesion of internal capsule |
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CSF of Bacterial Meningitis
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decreased glucose; increased protein; increased neutrophils; increased opening pressure
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CSF of Viral Meningitis
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Normal Glucose; protein can be elevated or normal; increased Lymphocytes
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Marble Bone Disease
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Osteoporosis: Albers-Schonberd Disease = inspite of increased bone density, many fractures = decreased osteoclasts
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C5a
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Involved in Chemotaxis (for Neutrophils)
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C3b
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Involved in Opsonization (& IgG)
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Anaphylotoxins
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C3a & C5a (mediate Histamine release from Basophils & Mast cells)
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Vasoactive Mediators (ie what are the dilators and constrictors)
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1. Vasoconstriction: TxA2; LTC4; LTD4; LTE4; PAF
2. Vasodilation: PGI2; PGD2; PGE2; PGF2α; Bradykinin; PAF 3. Increased Vascular Permeability: Hist.; 5HT; PGD2; PGE2; PGF2α; LTC4; LTD4; LTE4; Bradykinin; PAF |
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Platelet Aggregation
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ADP; Thrombin; TxA2; collagen; Epinephrine; PAF
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Platelet Antagonist
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Prostacyclin (PGI2)
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Intrinsic Pathway
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Factor XII (Hagman): APTT
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Extrinsic Pathway
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Factor VII: PT
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Lines of Zahn
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Aterial thrombi = pale red colored (dark red is venous thrombi)
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Currant Jelly appearance
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Post mortem clots
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Emigration: Chemotaxis
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1. Margination
2. Pavementing 3. Adhesion 4. Chemotaxis 5. Phagocytosis 6. Intracellular microbial killing |
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Transudate
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Specific gravity < 1.012 – low protein
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Exudate
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Specific gravity > 1.020 – high protein
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Hurler’s
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Lysosomal storage disease (alpha L Iduronidase – Heparan/Dermatan Sulfate accumulation)
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Galactosemia
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Deficiency of Galactose 1 Phosphate Uridyl Transferase resulting in increased Galactose 1 Phosphate
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Phenylketonuria
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Deficiency: Phenylalanine Hydroxylase. Increased Phenyalanine & degradation products
Mousy body odor |
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Autosomal Dominant Diseases (name 9)
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1. Adult Poly Cystic Kidney Disease
2. Familial Hypercholestrolemia Disease 3. Hereditary Hemorrhagic Telengectasia (Osler-Weber-Rendu) 4. Hereditary Spherocytosis 5. Huntington’s Disease (chromosome 4p) 6. Marfan’s Syndrome 7. Neurofibromatosis (von Recklinghausen’s) 8. Tuberous Sclerosis 9. Von Hippel Lindau Disease |
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Autosomal Recessive Diseases (name 11)
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1. Tay-Sachs
2. Gaucher’s 3. Niemann-Pick 4. Hurler’s 5. Von Gierke’s 6. Pompe’s 7. Cori’s 8. McArdle’s 9. Galactosemia 10. PKU 11. Alcaptonuria |
