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204 Cards in this Set
- Front
- Back
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pericarditis |
complication of AMI (10-20%); sharp pleuritic chest pain irradiated to the neck (phrenic nerves), low fever, friction rub, fibrinous exudate, autoimmune reaction 6-8 weeks after AMI |
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Libman-Sacks endocarditis
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present in 25% os SLE; sterile valve vegetations, fibrosis; AMI can develop due to hypercoagulable antiphospholipid antibody syndrome present in 12-30% of SLE
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heart changes in hypertension
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concentric ventricular hypertrophy without dilation and aortic insuficiency
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heart changes in AMI
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dilated cardiomyopathy
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congenital QT prolongation syndrome
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syncope in healthy young patients due to mutations in iK potassium channels + sensorineural deafness
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localized amyloidosis
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cardiac atria --> ANP; thyroid --> calcitonin; brain --> beta amyloids; pituitary --> prolactin
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RCA thrombosis ECG
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ST elevation in DI, DII and aVF plus sinus bradycardia
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transmural ischemia of septum ECG
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ST elevation in V1, V2 and 3rd degree heart block
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ischemia of left anterior ventricle ECG
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ST elevation in V3, V4
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occlusion of proximal LAD artery ECG
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ST elevation in V1-V4
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ischemia of lateral wall of left ventricle on ECG
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ST elevation in V5 and V6
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post MI causes of death
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cardiogenic shock MCC; free ventricular wall rupture 2nd MCC
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hypertrophic cardiomyopathy
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myofiber disarray + interstitial fibrosis due to mutations in genes encoding cardiac sarcomere proteins; 25% systolic anterior motion of the anterior leaflet of mitral valve which bulges into outflow tract ---> systolic murmur
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diagnosis and Rx of Prinzmetal angina
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Dx: ergonovine; Rx nitrates and CCBs
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normal aging heart changes
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decreased left ventricular chamber, sigmoid shaped ventricular septum, myocyte atrophy with interstitial fibrosis, brownish lipofuscin pigment
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heart findings in hemochromatosis
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dilated cardiomyopathy + hemosiderin granules in myocytes
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aortic stenosis
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systolic pressure gradient between LV and aorta; "SAD" syncope, angina, dyspnea; MCC is senile calcification
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Kusmaul sign
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paradoxical increase in jugular venous pressure with inspiration; diferential diagnosis: cardiac tamponade, restrictive cardiomyopathy, right failure, tricuspid stenosis, constrictive pericarditis
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Down syndrome heart findings
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ostium primum ASD + mitral/tricuspid insuficiency
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suceptibility to infarction of different organs
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CNS, myocardium, kidney, spleen, liver; spleen and liver have double blood supply
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pulsus paradoxus
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exageration of the normal decrease in blood pressure on inspiration; radial pulse disappears in inspiration; cardiac tamponade
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cor pulmonale
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dyspnea on exertion, right ventricular hypertrophy, sudden death
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pulmonary embolus
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acute chest pain, dyspnea tachychardia, tachypnea, hypotension; MCC is DVT; perfusion defect without ventilation defect; lung collapse --> perfusion and ventilation defect
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Osler-Weber-Rendu
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hereditary hemorrhagic telangiectasias, rupture causes epistaxis, GI bleeds, hematuria
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dissecting aorta aneurysm
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hematoma may compress branches of aortic arch --> hypertension in one limb, hypotension in the other
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hemangioma types
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cherry --> adults; strawberry --> kids; cavernous --> associated with VHL
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migratory thrombophlebitis
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pancreatic cancer
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cystic hygroma
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cavernous lymphangioma without luminal blood vessels in the neck or axila; Turner
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Churge-Straus syndrome
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adult onset asthma, eosinophilia, polyneuropathy, p-anca vasculitis
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bronchiolitis obliterans
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due to chronic transplant rejection; affects small airways; dyspnea, wheezing
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acute rejection
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perivascular infiltration of blood vessels with lymphocytes, macrophages and plasma cells
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causes of pulmonary hypertension
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COPD-induced hypoxic vasocronstriction; volume overload in CHF; idiopathic vasoconstriction
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sarcoidosis associations
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associated with high levels of vitamin D/hypercalcemia produced by macrophages
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asbestosis
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localized pleural thickening with calcifications of the lower lobes
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silicosis
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nodular densities and calcifications of the hilar nodes plus birefringent silica particles
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pneumoconiosis
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multiple discrete nodules prominent in upper lobes
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ARDS
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decreased lung compliance, increased work of breathing, V/Q mistmatch, normal pulmonary wedge pressure
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fat embolism
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acute onset of neurologic abnormalities, petechial rash and hypoxemia in traumatized patient; fat exits bone marrow to pulmonary microvessels; via capillary shunts to CNS and adhere to platelets causing thrombocytopenia
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dermatomyositis
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proximal muscle weakness, heliotrope rash, violaceous eruption on the knuckles; muscle lymphocytic infiltrate
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hamartoma
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benign and composed of fibrous and adipose tissue
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Reid index
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thickness of mucous gland layer / wall thickness > 0.4 --> chronic bronchitis
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stages of pneumonia
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red congestion (24 hours); red hepatization (3 days); gray hepatization
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retrolental fibroplasia
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retinal neovascularization due to O2 treatment in ARDS of newborn
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pneumonia complication
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absess due to lysosomal enzymes from neutrophils and macrophages
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pneumothrorax
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unilateral chest pain, hyperresonance and absent breath sounds; due to blebs, emphysema, trauma
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causes of lung absess
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MCC is aspiration of fusobacteria, peptostrep and bacteroides associated with seizures, alcoholism, anesthesia; bacterial pneumonia and sepsis
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green discoloration of pus/sputum
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due to heme-containing myeloperoxidase
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NSAID-induced nephropathy
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seen in chronic arthritis treated patients; reversible renal failure, papillary necrosis, chronic interstitial nephritis
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multiple myeloma
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easy fatigability due to anemia; constipation due to hypercalcemia; back pain due to osteoclast activating factor; azotemia; eosinophilic casts with bence-jones proteins
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complication of nephrotic syndrome
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loss of antithrombin III --> renal vein thrombosis --> varicocele
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renal cell CA
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arises from proximal tubule cells; MC is urothelial cancer --> painless hematuria, proximal tubule cells filled with glycogen and lipids
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ethylene glycol intoxication (antifreeze)
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acute renal failure, anion gap metabolic acidosis and calcium oxalate crystals in urine
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glomerular membrane histology
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fenestrated endothelium is selective for size; GBM has negative charge
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acute tubular necrosis
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oliguric stage --> volume retention, oliguria, anion gap metabolic acidosis, hyponatremia, hyperkalemia; recovery phase --> polyuria, hypernatremia, hypokalemia
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microalbuminuria
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30-300mg of albumin in 24-hour urine; first sign of diabetic nephropathy
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crescents
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glomerular parietal cells, monocytes, macrophages, abundant fibrin
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muddy brown casts
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pathognomonic for acute tubular necrosis
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minimal change disease
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loss of GBM negative charge; selective proteinuria consists of albumin and no IgG or alpha-2-macroglobulin
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diabetic nephropathy
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increased mesangial matrix, thickening of GBM and nodular glomerulosclerosis, hyaline arteriosclerosis
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nephrotic syndrome
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increased glomerular permeability --> proteinuria --> edema --> decreased effective blood volume --> increased ADH and aldosterone plus increased liver synthesis of proteins including lipoproteins
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T cell ALL
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mediastinal mass causes superior vena cava syndrome, dysphagia, dyspnea and throat pain
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high EPO
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obstructive sleep apnea, COPD, right-left shunts, high altitude
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factor VIII
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synthesized in the liver, stored in endothelial cells; desmopressin stimulates release
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SLE pancytopenia
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due to IgGs against RBCs
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Factor V leiden
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leads to less deactivation by protein C --> hypercoagulable state --> DVT/pulmonary thromboembolism
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spherocytosis
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increased MHCH is diagnostic
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G6PDH deficiency inheritance
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X-linked recessive
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spherocytosis inheritance
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autosomal dominant
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vonWillenbrand inheritance
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autosomal dominant with variable penetrance
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pure red cell aplasia
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normo anemia plus decreased reticulocytes; associated with thymoma and parvoB19
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vonWillenbrand disease
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vW factor is carrier for factor VIII --> increased BT and PTT
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Reed-Sternberg cells
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abundant cytoplasm bilobed or double nucleus surrounded by halo, inclusion-like eosinophilic nucleoli
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sodium metobisulfate
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induces sickling in sickle cell trait
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lipoprotein lipase
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synthesized by adipocytes, cardiac and skeletal muscle cells; deficiency leads to hypertriglyceridemia and acute pancreatitis
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acute pancreatitis lab findings
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hypocalcemia, macrocytosis, increased serum lipase and amylase
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colon adenoma to carcinoma sequence
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polyp (mutation of APC gene) --> large polyp (mutation of k-ras) --> malignant polyp (mutation of p53)
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acute pancreatitis risk factors
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gallstones, alcohol, ERCP, hypertriglyceridemia, hypercalcemia
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complication of Crohn's disease
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gallstones due to loss of enterohepatic circulation and increased cholesterol/bile acid ratio; also oxalate stones due to increased absorption of dietary oxalate because calcium is flushed with lipids and doesn’t bind oxalate
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zollinger ellison
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ulcers at distal duodenum, diarrhea due to inactivation of lipases by gastric acid
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Whipple disease
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PAS+ macrophages with rods
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PAS stain
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stains carbon-carbon bonds bright pink
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colon cancer marker
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CEA to detect recurrence after resection
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MC site of colon adenocarcinoma
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ascending colon; rectosigmoid is 2nd MC site
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duodenal Vs. gastric ulcer pain characteristics
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duodenal --> pain 2-4 hours after food or before eating relieved by food and antacids; gastric ulcer --> pain inmediately after eating not relieved by antacids
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pseudocyst Vs. cyst
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pseudocyst is complication of acute pancreatitis; wall is composed of granulation tissue and fibrosis (not epithelium like true cyst)
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causes of malabsorption
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cystic fibrosis, chronic pancreatitis, celiac sprue, whipple, Crohns, diverticulosis, diabetic neuropathy
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screening test for malabsorption
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sudan stain stains fat in stools
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consequences of malabsorption
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ADEK deficiency; petechiae (vit K), bone pain and tetany (vit D), muscle wasting and edema (protein waste), hyperkeratosis (vit A)
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false Vs. true diverticula
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false --> mucosa and submucosa only, acquired, pulsion; true --> also muscular layer, congenital, traction
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Reye syndrome
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viral infection + aspirin --> vomiting, hepatomegaly, increased AST, ALT, hyperamonemia with encephalopathy, liver microvesicular steatosis without necrosis
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acalculous cholecystitis
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inflamation of gallbladder without stones due to sepsis, immunosupression, trauma, diabetes
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formation of cholesterol gallstones
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cholesterol precipitation --> stones; phosphatidylcholine and bile salts --> solubility
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HBV damage to liver
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no cytopathic effect; HBsAg and HBcAg stimulate CD8 cytotoxicity
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halothane hepatotoxicity
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fulminant, liver shrinks, increased AST, ALT and PT, eosinophilia; histologically the same as hepatitis
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ceruloplasmin
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globulin that accounts for 95% of circulating copper; copper is eliminated in bile
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echinococcus cysts
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mass in the liver; aspiration can cause anaphylaxis
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cavernous hemangioma
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MC benign liver tumor; Rx with resection, no biopsy
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MCC of liver malignancy
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metastasis is MCC > HCC
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gallbladder hypomotility
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due to pregnancy, weight loss, parenteral nutrition, octeotride --> billiary sludge --> stones/cholecystitis
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types of gallstones
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yellow --> cholesterol; brown --> billiary infection; black --> hemolysis
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porcelain gallbladder
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calcifications associated with carcinoma
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outcome of hepatitis B infection
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complete resolution (95%); chronic hepatitis/cirrhosis/HCC (4-5%); fulminant hepatitis (<1%)
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gallbladder changes in pregnancy
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estrogen-induced cholesterol hypersecretion and progesterone-induced hypomotility --> gallstones
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ulcer erosions
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penetrate submucosa, inner and outer muscular but not muscularis mucosa
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abetalipoproteinemia
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no apoB for chylomicrons --> lipid accumulation makes epithelium look foamy --> no lipids in blood, acanthocytes, ataxia and retinitis pigmentosa
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polyps with adenocarcinoma potential
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adenomatous polyps and specially villous adenomatous
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squamous cell CA of esophagus
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keratin pearls look like fibrosis
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adenomatous polyps
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villous adenomas --> large, sessile, dysplastic --> bleeding, secretory diarrhea and partial obstruction
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anal fissures
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90% are found in posterior midline distal to dentate line; due to low fiber diet and constipation
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effect of atherosclerosis on stomach
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can affect gastric branches of celiac trunk --> epigastric pain 30 minutes after eating
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ischemic colitis
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affects splenic angle because it lies between SMA and IMA areas of perfusion
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HAV infection
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low grade fever, anorexia, nausea, coluria, RUQ tenderness, hepatocyte swelling, mononuclear infiltrate, councilman apoptotic bodies
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ascending cholangitis Vs. hepatic absess
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enteric bacteria (ascending) or staph (hematogenous)
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HBV Vs. HCV histology
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HBV --> granular cytoplasmic inclusions; HCV --> lymphoid aggregates and steatosis
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billiary atresia
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congenital obstruction of bile ducts --> clay stools, coluria, hepatomegaly, conjugated hyperbilirubinemia
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primary billiary cirrhosis
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pruritus, increased liver alkaline phosphatase
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aflatoxins
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HCC due to mutation of p53
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gallstone ileus
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large stone passes through fistula into ileum and allows air to pass into billiary tree
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Wernicke encephalopathy
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confusion, ataxia, ocular abnormalities; Rx thiamine
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Korsakoff confabulation psychosis
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damage to medial dorsal nucleus and/or mamillary bodies of thalamus
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Alzheimer's biochemistry
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decreased ACh in basal nucleus of Meynert and hippocampus
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alcohol changes in brain
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upregulation of GABAa receptors and NMDA receptors; increased DA, 5HT and NE
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complications of subarrachnoid hemorrhage
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vasospasm (treat with nimodipine) and rebleeding
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transtentorial herniation
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uncus of temporal lobe herniated through tentorium --> compression of CN III, PCA and corticospinal tract
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MC extracranial childhood cancer
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neuroblastoma associated with N-myc; retroperitoneal mass, episodic hypertension, neuroblast is malignant cell
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SSPE
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complication of measles; anti-measles antibodies in CSF, no anti-M protein antibodies
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meningioma histology
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psamoma bodies in brain tumor --> meningioma
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Schwanoma marker
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S100
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Pick's disease
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pronounced atrophy of frontal lobes, progressive dementia, behavioral dishinibition, dysarthria, aphasia, primitive reflexes
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Charcot-Bouchard aneurysms
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associated with hypertension; found in small arteries of basal ganglia; rupture --> intraparenchymal hemorrhage and focal deficits
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berry aneurysms
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associated with APCKD, Marfan, ED; anterior cerebral arteries most affected; leads to subarachnoid hemorrhage
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hypoxic encephalopathy
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wedge-shaped areas of necrosis on the surface of cerebral convexities and lateral to interhemispheric fissure; due to cardiogenic shock or shock; affects hyppocampus first
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pontine myelinolysis
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too fast correction of hypernatremia; spastic quadriplegia and pseudobulbar palsy
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stroke scar
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cystic cavity surrounded by wall of astrocytes
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Creutzfeld-Jakob
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rapidly progressive dementia and myoclonus; vacuoles in gray matter looks like sponge; due to prion
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normal pressure hydrocephalus
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urinary incontinence, ataxia and progressive dementia
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Friederich ataxia
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triple repeat mutation; spinocerebellar tract degeneration (ataxia), degeneration of dorsal columns, kyphoscoliosis, hypertrophic cardiomyopathy, diabetes
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lacunar infarcts
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small ischemic infarcts involving basal ganglia, pons, internal capsule; due to hypertensive arteriosclerosis of small penetrating arterioles
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ischemic stroke changes
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red neurons (48 hours); neutrophils (72 hours); macrophages (5 days); gliosis/angiogenesis (2 weeks); glial scar (>2 weeks)
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Arnold-Chiari malformation
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small posterior fossa results in herniation of medulla and cerebellum through foramen magnum
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multiple sclerosis
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demyelination, decreased oligodendrocytes, lipid-ladden macrophages, astrocytosis, lymphocytic inflamation
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CN III diabetic neuropathy
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only affects somatic fibers sparing parasympathetic due to different blood supply
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cerebellar masses
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mostly in children; astrocytoma or meduloblastoma
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tumor associated with myasthenia gravis
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thymoma
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tumor associated with Lambert-Eaton
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lung cancer
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vitamin E deficiency
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affects dorsal column and spinocerebeallar tracts; mimics Friederich ataxia
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temporal lobe encephalitis
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aphasia, olfactory abnormalities, personality changes; due to HSV-1
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myotonic dystrophy
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triple repeat mutation, sustained muscle contraction (myotonia) with muscular weakness and atrophy; cataracts, baldness, gonadal atrophy
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cerebral amyloid angiopathy
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recurrent hemorrhagic strokes
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Duchene
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x-linked recessive; fibrofatty muscle replacement
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diabetic neuropathy
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due to osmotic damage to axons and Schwann cells and microangiopathy of endoneural arterioles
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lead poisoning tratment
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dimecarpol, EDTA; heavy metal chelators
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cystic tumors in cerebellum
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pilocytic astrocytoma mostly in kids
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Meniere
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tinitus, vertigo, hearing loss; too much endolymph
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pretibial myxedema
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non-pitting myxedema and thickening of skin around tibia in Graves disease
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craniopharyngioma
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remnant of Rathke's pouch bulges into 3rd ventricle; cystic solid mass with calcifications; headaches, visual deficits and hypopituitarism
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hypoglycemia in neonate of diabetic mother
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mother's hyperglycemia induces islet hyperplasia with increased insulin production
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mechanism of amenorrhea in anorexia
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low body fat fails to induce pulsatile secretion of GnRH; also seen in cachexia and athletes
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psamoma bodies
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concentric calcified structures; pathognomonic for papillary thyroid CA and meningioma
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pituitary apoplexy
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acute bleeding into a preexisting pituitary adenoma; bitemporal hemianopia, sudden headache; complication is cardiovascular collapse due to adrenocortical insuficiency
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type II diabetes associations
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amyloid deposition in beta cells
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seminoma
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increases hCG which is similar to TSH and can cause hyperthyroidism
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MCC of death in diabetics
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AMI
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primary hyperaldosteronism
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hypokalemic metabolic alkalosis with hypertension and normal [Na] because of compensatory natriuresis
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medullary thyroid carcinoma histology
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polygonal or spindle-shaped cells with extracellular amyloid deposits seen with congo red
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glucagonoma
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necrolytic migratory erythema rash and hyperglycemia
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MEN III
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medullary thyroid carcinoma, pheochromocytoma, mucosal neuromas and marfanoid habitus
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ret gene
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MEN
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fibromyalgia
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stiffness, pain, poor sleep, emotional disturbance; pain and stiffness gets worst with exercise; tender spots over multiple joints
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osteoporosis histology
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thin trabecula
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osteopetrosis histology
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unmineralized spongiosa
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Paget's histology
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focal formation of bone
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vitamin D deficiency histology
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unmineralized osteoid
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hyperPTH histology
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cystic degeneration of bones
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pseudogout
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weakly birefringent rhomboid-shaped calcium pyrophosphate crystals
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wound contracture
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myofibroblasts + metalloproteinases in excess
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parvovirus B19 associations
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slapped cheek rash and can cause self-limiting arthritis-like disease, pure red cell aplasia; aplastic anemia in sickle cell patients
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digital clubbing
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associated with prolonged hypoxia in COPD patients
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gout
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deposition of monosodium urate crystals that are negativley birefringent
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presbyiopia
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sclerosis of the lens
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cause of skin wrinckles
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decreased collagen and increased elastases and collagenases
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actinic keratosis
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erythematous papules with central scale and sandpaper texture with acanthosis, parakeratosis and hyperkeratosis
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acanthosis
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thick epidermis
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parakeratosis
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nuclei in stratum corneum
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hyperkeratosis
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thick corneum
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acanthosis nigricans
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associated with insulin resistant states (DM, acromegaly, obesity) as well as GI cancer
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avascular necrosis of femoral head
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associated with sickle cell, lupus and high-dose steroid therapy
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atopic dermatitis
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also called eczema; pruritus, erythematous papules; associated with allergens, asthma and rhinitis
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hypercalcemia in sarcoidosis
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due to increased 1,25vitD by macrophages
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shaken baby syndrome
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retinal hemorrhages + subdural hematoma; report child abuse
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rheumatoid arthritis
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does not involve DIP joints; stiffness lasts more than 30 minutes
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osteoarthritis
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can have morning stiffness < 30 minutes and subcutaneous nodules; can involve DIP joints
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dermatomyositis
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heliotrope rash and papules in the MCP, PIP and DIP joints
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osteomyelitis
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affects long bone metaphysis
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retinoblastoma
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associated with osteosarcoma
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contact dermatitis
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spongiosis
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psoriasis
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reduced stratum granulosum, parakeratosis, acanthosis and dividing cells in epidermis
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seborrheic keratosis
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benign epidermal tumor, tan , flat, round, greasy, coin-like stuck on appearance
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acute interstitial nephritis
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due to drug allergy; fever, acute renal failure, maculopapular rash and eosinophiluria
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cysteine stone crystals
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hexagonal crystals, acid urine, recurrent stones at young age, positive cyanide-nitroprusside test
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papillary necrosis
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sickle cell patients or carriers; acute colic pain, gross hematuria, passage of tissue fragments in urine
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hydronephrosis
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due to prolonged urinary obstruction in nephrolithiasis, tumor, anatomic defects, neurogenic bladder, BPH; atrophy of cortex with scarring and interstitial fibrosis with inflamation
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most important mediator of sepsis
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TNF alpha
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cryptorchidia
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decreases inhibin with increased FSH and normal LH/testosterone; remove testis to prevent malignancy
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