Pathoma

Front 1

This disease is caused by excess iron

Back 1

Hemocrhomatosis, excess iron causes free radical damage

Front 2

Disorder due to autoimmune production of IgG against platelet antigens (e.g., GPIIb/IIIa)

Back 2

Idiopathic thrombocytopenic purpura (ITP)

autoantibodies against platelets are made in spleen and the platelets are consumed in the spleen. Therefore removal of spleen can treat chronic ITP.

Front 3

Pathologic formation of platelet microthrombi in small vessles is known as?

Back 3

Microangiopathic hemolytic anemia

anemia is caused by the microthrombi shearing the RBCs resulting in hemolytic anemia and schistocytes

Front 4

Microangiopathic hemolytic anemia that is caused by a decrease in ADAMTS13. ADAMTS13 is used to cleave (deactivate) vWf. This leads to microthrombi due to undegraded ADAMTS13.

Back 4

Thrombotic thrombocytopenic purpura

-most common cause is autoimmunity to ADAMTS13

Front 5

Microangiopathic hemolytic anemia that is caused by endothelial damage by drugs or infection.

Back 5

Hemolytic Uremic Syndrome

-caused by EColi O157:H7 verotoxin damaging endothelial cells resulting in platelet microthrombi

Front 6

Syndrome where there is GP1b is deficient leading to platelet adhesion impairment

Back 6

Bernard-Soulier syndrome

-GP1b on platelets are responsible for binding of vWf

Front 7

Syndrome where GP IIb/IIIa is deficient leading to deficient platelet aggregation

Back 7

Glanzmann thombasthenia

-platelet aggregation is impaired since GPIIb/IIIa is responsible for that

Front 8

Platelet destruction that arises secondary to heparin therapy is called?

Back 8

Heparin-induced thrombocytopenia (HIT)

-fragments of destroyed platelets may activate remaining platelets, leading to thrombosis. This is a feared complication.

Front 9

Pathologic activation of coagulation cascade is called?

Back 9

Disseminated Intravascular Coagulation

-activation of cascade burns up all the factors and causes microthrombi everywhere as well as bleeding from mucosal surfaces.

Front 10

This disorder resembles DIC but it has no D-dimers and normal platelet counts

Back 10

Disorders of fibrinolysis due to overactive plasmin

Front 11

What is Virchow's triad?

Back 11

The three major risk factors for thrombosis:

-Disruption of blood flow

-Endothelial cell damage

-Hypercoaguable state

Front 12

What is the mechanism for warfarin skin necrosis?

Back 12

Factor 2,7,9,10 and protein C and S need epoxide reductase. Warfarin inhibits this but protein C and S have the shorter half-lives so C and S are inhibited first leading to a hypercoagulable state.

Front 13

What defect is it when factor V lacks the cleavage site for deactivation by protein C and S?

Back 13

Factor V Leiden

-most common inherited cause of a hypercoagualble state.

Front 14

Disorder that when heparin is given it does not incrase PTT?

Back 14

ATIII deficiency - anti-thrombin 3 is responsible for inhibited thrombin. Heparin works by activating ATIII. Since there is no ATIII to activate then PTT will remain the same.

Front 15

Chronic form of gas emobli characterized by multifocal ischemic necrosis of bone.

Back 15

Caisson Disease

Front 16

What are the 4 types of microcytic anemia?

Back 16

Iron deficiency

Anemia of Chronic Disease

Sideroblastic anemia

Thallesemia

Front 17

Increased hepcidin is mechanism for what disease?

Back 17

Anemia of chronic disease. Chronic disease state produces hepcidin which sequesters iron into ferritin. So lab values:

Ferritin: High

TIBC: low

Serum iron: low

%saturation: low

Front 18

Iron deficiency anemia has what lab values?

Back 18

Ferritin: low

TIBC: high

Serum iron: low

%saturation low

Front 19

Anemia due to defect in protoporphyrin synthesis is called?

Back 19

Sideroblastic anemia

Front 20

What are lab values for sideroblastic anemia?

Back 20

Ferritin: high (macrophages eat all the extra iron)

TIBC: low

Serum Iron: high

%saturation: high

Front 21

Anemia due to defect in globin chains. Due to decreased production.

Back 21

Thalassemia

Front 22

Which anemia has target cells?

Back 22

B-thallesemia

Front 23

What are the two causes for macrocytic anemia?

Back 23

Folate deficiency

Vit B12 deficiency

Front 24

Two etiologies for normocytic anemia? and how to distinguish?

Back 24

peripheral destruction or underproduction.

Reticulocyte count.

Corrected reticulocyte count >3% suggests peripheral destruction

Corrected reticulocyte count <3% suggests underproduction

Front 25

Inherited defect of RBC cytoskeleton-membrane tethering proteins leading to normocytic anemia

Back 25

Hereditary spherocytosis

Front 26

Which disease has Howell-Jolly bodies?

Back 26

Hereditary spherocytosis

Howell-Jowell bodies are DNA in RBCs that are not removed by the spleen. This can occur when the spleen is removed to treat heriditary spherocytosis.

Front 27

Acquired defect in myeloid stem cells resulting in absent GPI (glycosylphophatidylinositol); renders cells susceptible to destruction by complement.

Back 27

Paroxysmal Nocturnal Hemoglobinuria (PNH)

-GPI binds DAF and MIRL, these molecules protect it from complement; at night when you breath shallow it causes a slight acidosis which activates complement, w/o DAF and MIRL your cells are attacked.

Front 28

Inability of Glutathione (an antioxidant) to be regenerated due to a deficiency in an enzyme leading to oxidative stress.

Back 28

G6PD deficiency-

X-linked recessive disorder resulting in reduced half-life of G6PD; renders cells susceptible to oxidative stress.

Glutathione takes the hit from oxidative stress and gets reduced back to glutathione by NADPH; NADPH is produced by G6PD

Front 29

Which disease has bite cells and Heinz bodies?

Back 29

G6PD defiency - Heinz bodies are precipitated Hb due to oxidative stress, when macrophages see those Heinz bodies they bite that part off

Front 30

Antibody-mediated (IgG or IgM) destruction of RBCs is called?

Back 30

Immune hemolytic anemia

Front 31

Coombs test is used to diagnose what disease?

Back 31

Immune hemolytic anemia

-direct tests whether the RBCs are bound by IgG

-indirect tests whether there are antibodies in the serum that can bind RBCs

Front 32

What virus infects progenitor RBCs and temporarily halts erythropoiesis?

Back 32

Parvovirus B19

Front 33

Pathologic process (e.g., metaplastic cancer) that replaces bone marrow; hematopoiesis is impaired, resulting in pancytopenia

Back 33

Myelophthisic process

Front 34

Eosinophilia is classically seen in what disease?

Back 34

Hodgkin lymphoma

Front 35

Basophilia is classically seen in what disease?

Back 35

Chronic myeloid leukemia (CML)

Front 36

Monocytosis is classically seen when?

Back 36

Chronic inflammatory states and malignancy

Front 37

Viruses normally cause lymphocytic leukocytosis, what is one bacteria that can also cause it?

Back 37

Bordetella pertussis - this bacteria creates lymphocytosis-promoting factor which blocks circulating lymphocytes from leaving the bleed to enter the lymph node.

Front 38

EBV infection that results in lymphocytic leukocytosis comprised of reactive CD8+ T cells; CMV is a less common cause.

Back 38

Infectious Mononucleosis

Front 39

How do you differentiate AML vs ALL?

Back 39

AML has Myeloperoxidase

ALL has TdT+ (DNA polymerase)

Front 40

Auer rods are made of what, and what do they indicate?

Back 40

Auer rods are made of myeloperoxidase and indicate AML.

Front 41

ALL is associated with what syndrome?

Back 41

Down syndrome after the age of 5

Front 42

ALL is subdivided into what two categories and how do you distinguish them?

Back 42

B-ALL and T-ALL

B-All expresses CD10, CD19, and CD20

T-ALL expressed CD2-CD8

Front 43

ALL seen in kids has what translocation?

Back 43

t(12;21) - good prognosis

Front 44

ALL seen in adults has what translocation?

Back 44

T(9;22) - Philidelphia+ ALL

Front 45

3T's of acute lymphoblastic lymphoma

Back 45

T-ALL

Thymic Mass

Teenagers

Front 46

AML more common in children or adults?

Back 46

Adults 50-60 years old

Front 47

Acute promyelocytic leukemia is characterized by what translocation?

Back 47

t(15;17) - disrupts retinoic acid receptor, cure is ATRA which is vitamin A, promyelocytes contain Auer rods which increase risk for DIC

Front 48

Acute monocytic leukemia is a proliferation of what cell and what tissue does it commonly involve?

Back 48

Proliferation of monocytes and commonly involves gums

Front 49

Acute megakaryoblastic leukemia is proliferation of what cell and is associated with what?

Back 49

Proliferation of megakaryoblasts and association with down syndrome before age of 5

Front 50

Which leukemia is associated with down syndrome before the age of 5 and after the age of 5?

Back 50

Acute megakaryoblastic leukemia before age of 5

ALL after age of 5

Front 51

What cell is the neoplastic proliferation of CLL? what surface markers are expressed?

Back 51

proliferation of naive B-cells, CD5 and CD20

CD5 is normally on T-cells

Front 52

Smudge cells are classically seen in what disease?

Back 52

CLL

Front 53

Neoplastic proliferation of mature B cells is what disease?

Back 53

Hairy Cell Leukemia - characterized by hair cytoplasmic processes

Front 54

Positive for tartrate-resistant acid phosphatase (TRAP) is indicative of what disease?

Back 54

Hairy Cell Leukemia

Front 55

TRAP mnemonic is for what disease and what are the 3 things it's used for?

Back 55

TRAP = Hairy Cell Leukemia

Trapped in red pulp (splenomegaly of red pulp when usually its white pulp for leukemias)

Trapped in bone marrow - dry tap with bone marrow aspiration

Since they are TRAPPED, lymphadenopathy is usually absent

Front 56

Neoplastic prliferation of mature CD4+ T cells is called?

Back 56

ATLL - Adult T-cell Leukemia/Lymphoma

Front 57

ATLL is associated with what virus?

Back 57

HTLV-1 - most commonly seen in Japan, Human lymphotropic virus 1

Front 58

Pt with lytic bone lesions with hypercalcemia WITH a RASH

Back 58

ATLL (Adult t-cell leukemia/lymphoma) - if without a rash then think multiple myeloma

Front 59

Neoplastic proliferation of mature CD4+ T cells that infiltrate the skin

Back 59

Mycosis fungoides

Front 60

What are aggregates of neoplastic cells in the epidermis called?

Back 60

Pautrier microabscesses

Front 61

Neoplastic proliferation of mature myeloid cells, especially granulocytes, basophils are characteristically increased.

Back 61

CML - Chronic Myeloid Leukemia

Front 62

CML is driven by what translocation?

Back 62

t(9;22), philidelphia chromosome

Front 63

Neoplastic proliferation of myeloid cells, especially RBCs

Back 63

Polycythemia Vera

Front 64

What are the three different causes for painless lymphadenopathy

Back 64

Chronic inflammation

metastatic carcinoma

lymphoma

Front 65

Patients with rheumatoid arthritis have expansion in what region of the lymph node?

Back 65

Follicle

Front 66

Patients with early HIV have expansion in what region of the lymph node?

Back 66

Follicle

Front 67

Patients with a viral infection have expansion in what region of the lymph node?

Back 67

Paracortex - where the T-cells live

Front 68

Follicular lymphoma is driven by what translocation? and what genes are traded?

Back 68

t(14;18) -14 has Ig heavy chain, 18 is Bcl-2,

Bcl-2 is used to stabilize the mitochondrial membrane which prevents cytochrome C from leaking which prevents apoptosis.

Front 69

Most feared complication of follicular lymphoma?

Back 69

Having it progress to diffuse large B-cell lymphoma

Front 70

Mantle cell lymphoma, marginal zone lymphoma, and follicular have expansion of what cell type?

Back 70

Neoplastic small B cells (CD20+)

Front 71

Mantle Cell lymphoma is driven by what translocation? and what genes are being switched?

Back 71

t(11;14) - 11 Cyclin D1, 14 has Ig heavy chain.

Cyclin D1 promotes G1/S transition in cell cycle

Front 72

Neoplastic INTERMEDIATE-sized B Cells (CD20+T that is associated with EBV?

Back 72

Burkitt Lymphoma

Front 73

African form of Burkitt lymphoma most commonly arises where?

Back 73

In the jaw

Front 74

Sporadic form of Burkitt lymphoma most commonly arises where?

Back 74

abdomen

Front 75

Burkitt Lymphoma is driven by what translocation?

Back 75

t(8;14) - 8 is c-myc and 14 is Ig heavy chain

c-myc oncogene promotes cell growth

Front 76

What disease has a starry sky appearance?

Back 76

Burkitt Lymphoma

Front 77

Neoplastic large B-cell (CD20+) that grow diffusely in sheets.

Back 77

Diffuse Large B-cell Lymphoma

Front 78

Most common form of non-hodgkin lymphoma?

Back 78

Diffuse Large B-cell lymphoma

Front 79

Neoplastic proliferation of Reed-Sternberg cells

Back 79

Hodgkin Lymphoma

Front 80

Reed-Sternberg cells have what surface markers?

Back 80

CD15 and CD30

Front 81

Which disease has owl-eye nulclei?

Back 81

Reed-sternberg cells of hodgkin lymphoma

Front 82

Which interleukin is high in multiple myeloma

Back 82

IL-6

Front 83

What disease has an increased serum protein with M spike on SPEP(serum protein electrophoresis) but it has none of the other features of multiple myeloma (no lytic lesions, hypercalcemia, AL amyloid, or Bence-Jones proteinuria)

Back 83

Monoconal Gammopathy of Undetermined Significance

Front 84

Waldenstrom Macroglobulinemia has what type of lymphoma with what type of Ig production?

Back 84

B-cell lymphoma with monoclonal IgM production

Front 85

Neoplastic proliferation of Langerhans Cell

Back 85

Langerhans Cell histiocytosis

Front 86

Birbeck granules (tennis racquet) is characteristic of what disease?

Back 86

Langerhans Cell histiocytosis

Front 87

2 malignant disease of langerhans cells?

Back 87

Letterer-Siwe disease

Hand-Schuller-Christian disease

Front 88

Benign proliferation of langerhans cells in bone

Back 88

Eosinophlic granuloma

Front 89

WBC differential from highest to lowest?

Back 89

Mnemonic: Neutrophils Like Making Everything Better

Neutrophils (54-62%)

Lymphocytes (25-33)

Monocytes (3-7)

Eosinophils (1-3)

Basophils (0-.75)

Front 90

CD14 is cell surface marker for which cell?

Back 90

Macrophages

Front 91

Target Cell is associated with what pathology? (4)

Back 91

"HALT" said the hunter to his target

HbC disease

Asplenia

Liver disease (alcoholism)

Thalassemia

Front 92

What pathology has glutamic acid to lysin mutation at residue 6 in Beta globin?

Back 92

HbC defect - extravascular normocytic anemia

Front 93

Apixaban and rivaroxaban

Drug class and clinical use

Back 93

Class: Direct Factor Xa inhibitor

Mechanism:Bind and directly inhibit the activity of factor Xa

C:DVT and PE

Front 94

Clopidogrel

Drug class and clinical use

Back 94

Drug class: ADP receptor inhibitor

M: inhibit platelet aggregation by irreversibly blocking ADP receptors

C: acute coronary syndrome, coronary stent, prophy for recurrent strokes

T: TTP/HUS may be seen

Front 95

Ticlopidine

Drug class and clinical use

Back 95

Drug class: ADP receptor inhibitor

M: inhibit platelet aggregation by irreversibly blocking ADP receptors

C: acute coronary syndrome, coronary stent, prophy for recurrent strokes

T: TTP/HUS may be seen, NEUTROPENIA

Front 96

Abciximab

Drug class and clinical use

Back 96

GP IIb/IIIa inhibitors

M: prevent aggregation of platelets

Clinical Use: unstable angina, precutaneous transluminal coronary angioplasty

Front 97

Eptifibatide

Drug class and clinical use

Back 97

GP IIb/IIIa inhibitors

M: prevent aggregation of platelets

Clinical Use: unstable angina, precutaneous transluminal coronary angioplasty

Front 98

Which cells are infected in infectious mononucelosis?

Back 98

CD8+ T-cells

Front 99

Hypersegmented neutrophils and elevated MCV is associated with what?

Back 99

Folate or B12 deficient anemias

Front 100

Which blood thinner has increased risk for neutropenia?

Back 100

Ticlopidine - ADP receptor inhibitor which inhibits platelet aggregation

Front 101

What is the mechanism for hydroxyurea in the tx of sickle cell anemia?

Back 101

It increases the formation of HbF which do not sickle.

Front 102

What drug is used for Heparin induced thrombocytopenia? and what is it's mechanism of action?

Back 102

Argatroban which is a direct thrombin inhibitor.

Bivalriduin can also be used.

Front 103

Pt with hemolytic anemia, hypercoaguable state, and thrombocytopenia suggests what disease?

Back 103

Paroxysmal Hemolytic Anemia

Front 104

Which anemia has increased MCHC (mean corpuscular hemoglobin concentration)?

Back 104

Hereditary Spherocytosis

Front 105

Which anemia has osmotic fragility?

Back 105

Hereditary Spherocytosis

Front 106

What drug reverses heparin?

Back 106

Protamine

Front 107

What causes a left shift in oxygen-hemoglobin dissociation curve? Right shift?

Back 107

Left shift = lower

Base

Lower 2,3 DPG

Lower Temperature

Right shift is opposite

Acid

Higher 2,3 DPG

Higher temperature

CADET face RIGHT

CO2

Acid

DPG

Exercise

Temperature

Front 108

What are the acute-phase reactants of inflammation? (4)

Back 108

IL-6

IL-1

TNF-a

IFN-y

Front 109

Granulomatous vasculitis that classically involves branches of the carotid artery

Back 109

Temporal (Giant Cell) Arteritis

Front 110

Granulomatous vasculitis that classically involves the aortic arch at branch points.

Back 110

Takayasu Arteritis

Front 111

Tx for granulomatous vasculitis such as Temporal (giant cell) arteritis or Takayasu arteritis

Back 111

Corticosteroids

Front 112

Pts with Temporal Giant Cell Arteritis have a high risk for what complication?

Back 112

Blindness

Front 113

Medium-Vessel Vasculitis involves what portion of the arteries?

Back 113

It commonly involves the muscular arteries that supply the organs

Front 114

(Medium-Vessel) Necrotizing vasculitis involving multiple organs; lungs are spared.

Back 114

Polyarteritis Nodosa

Front 115

This medium vessel vasculitis is associted with serum HBsAG (Hepatitis B antigen)

Back 115

Polyarteritis Nodosa

Front 116

This disease has a string-of-pearls appearance on imaging

Back 116

Polyarteritis Nodosa

Front 117

Medium-Vessel vasculitis that affects asian children <4 years old

Back 117

Kawasaki Disease

Front 118

Medium-Vessel vasculitis that commonly involves the coronary artery

Back 118

Kawasaki disease

Front 119

Medium-Vessel vasculitis that is highly associated with heavy smoking

Back 119

Buerger Disease

Front 120

What is the treatment for kawasaki disease?

Back 120

Aspirin

Front 121

Rash on the palms and rash on the soles is associated with what medium-vessel vasculitis?

Back 121

Kawasaki disease

Front 122

Necrotizing vasculitis that involves the digits

Back 122

Buerger Disease

Front 123

Necrotizing granulomatous vasculitis the involves the nasopharynx, lungs, and kidneys

Back 123

Wegener Granulomatosis

Front 124

Wegener granulomatosis involves what parts of the body?

Back 124

Nasopharynx, lungs, and kidneys

Front 125

c-ANCA is associated with which small-vessel vasculitis?

Back 125

Wegener Granulomatosis

Front 126

Necrotizing vasculitis involving multiple organs, especially lung and kidney.

Back 126

Microscopic Polyangitis

Front 127

Serum p-ANCA is associated with which small-vessel vasculitis (2)?

Back 127

Microscopic polyangitis

Churg-Strauss syndrome

Front 128

Necrotizing granulomatous vasculitis with eosinophils

Back 128

Churg-Strauss syndrome

Front 129

Which small-vessel vasculitis have granulomas?

Back 129

Wegener and Churg-Strauss

Front 130

Vasculitis due to IgA immune complex depositiion; most common vasculitis in children

Back 130

Henoch-Schnolein purpura

Front 131

This disease presents with palpable purpura on buttocks and legs, GI pain and bleeding.

Back 131

Henoch-Schnolein purpura

Front 132

This small0-vessel vasculitis presents with hematuria (IgA nephropathy)

Back 132

Henoch-Schnolein purpura

Front 133

How does angiotensin II increase blood pressure?

Back 133

-Contracts arteriolar smooth muscle increasing TPR

-Promotes adrenal release of aldosterone, which increases resorption of sodium in the distal convoluted tubule

Front 134

Two causes for renal artery stenosis, one is for elderly males and one is for young females.

Back 134

Elderly male - atherosclerosis

Young female - fibromuscular dysplasia

Front 135

Which portion of the artery becomes thickened in atherosclerosis?

Back 135

Intima

Front 136

Hyaline arterololsclerosis can be caused by what two things? and what does this lead to?

Back 136

Benign HTN - increased pressure forces proteins into the vessel wall

Diabetes - non-enzymatic glycosylation making membrane leaky

Leads to arteriolonephrosclerosis --> chronic renal failure

Front 137

Hyperplastic arteriosclerosis is caused by what? and what does it lead to?

Back 137

Malignant HTN

Acute renal failure

Front 138

Calcification of the media of muscular arteries; non-obstructive; not clinically significant

Back 138

Monckeberg Medial Calcific Sclerosis

Front 139

Intimal tear with dissection of blood through media of aortic wall is called?

Back 139

Aortic Dissection

Front 140

Most common cause of Aortic Dissection

Back 140

HTN

Front 141

Balloon-like dilation of the thoracic aorta is called

Back 141

Thoracic aneurysm

Front 142

Balloon-like dilation of the abdominal aorta is called?

Back 142

Abdominal aneurysm

Front 143

Classic cause of thoracic aneurysm is what?

Back 143

Tertiary syphillis - endarteritis of the vaso vasorum results in luminal narrowing and atrophy of the vessel wall

Front 144

"Tree bark" appearance of aorta is seen in what?

Back 144

Thoracic aneurysm due to syphillis

Front 145

Where do abdominal aortic aneurysms usually occur?

Back 145

below renal arteries but above aortic bifurcation

Front 146

Abddominal aortic aneurysm usually caused by what?

Back 146

HTN

Classically seen in male smokers > 60 years old with HTN

Front 147

Benign tumor comprised of blood vessels?

Back 147

Hemangioma

Front 148

Pt present with hypotension, pulsatile abdominal mass, and flank pain. What is the dx?

Back 148

Abdominal aortic aneurysm rupture

Front 149

Malingnant proliferation of endothelial cells

Back 149

Angiosarcoma

Front 150

This cancer is associated with exposure to PVC

Back 150

Liver angiosarcoma

Front 151

This cancer is associated with arsenic and Thorotrast

Back 151

Liver angiosarcoma

Front 152

Low-grade malignant proliferation of endothelial cells associated with HHV-8

Back 152

Kaposi Sarcoma

Front 153

What percentage of blood flow must be stopped before symptoms emerge?

Back 153

70% stenosis; stable angina does not have symptoms unless there is 70% blockage

Front 154

Which angina has the EKG show ST-segment depression and which has EKG elevation? (3)

Back 154

Stable and unstable have depression due to subendocardial ischemia, prinzmetal has elevation due to transural ischemia

Front 155

Myocardial Infarction usually affects what portion of the heart?

Back 155

Left Ventricle

Front 156

Most sensitive and specific marker for a myocardial infarction

Back 156

Troponin I

Front 157

What marker is useful for detecting reinfarction days after MI?

Back 157

CK-MB, it returns to normal by 72 hours while Troponin I stays high for 7-10 days.

Front 158

Exposure of pericardium to immune system leading to autoimmunity leading to pericarditis

Back 158

Dressler syndrome

Front 159

Stages of MI, 1 day, 1 week, 1 month

Back 159

Coag Necrosis | Neutro then Macro | Granulation Tissue | Scar Tissue

Front 160

What is the main tx for Left-Sided Heart Failure?

Back 160

ACE inhibitor

Front 161

What is the most common cause for Right-sided heart failure?

Back 161

Left-side Heart failure

Front 162

Nutmeg liver is associated with what?

Back 162

Right-sided heart failure

Front 163

Defect in the septum that divides the right and left ventricles

Back 163

Ventricular Septal Defect

Front 164

What is Ventricular septal defect associated with?

Back 164

Fetal alcohol syndrome

Front 165

5 T's of Right to left shunt

Back 165

Truncus arteriosus

Transposition of great vessels

Tricuspid atresia

Tetralogy of fallot

Total anomalous pulmonary venous return

Front 166

Two types of Atrial septal defect: which is most common, which is associated with Down syndrome?

Back 166

Ostium secundum = most common

Ostium primium = Down syndrome

Front 167

Patent ductus arteriosus is associated with what?

Back 167

Rubella

Front 168

What is Eisenmenger syndrome?

Back 168

When a Left to right shunt reverse to a right to left shunt, leading to cyanosis.

Front 169

What is the tetrology of Fallot?

Back 169

PROV

Pulmonary stenosis

Right Ventricular Hypertrophy

Overriding AORTA

Ventricular Septal defect

Front 170

Which congenital defect which becomes cyanotic stops the cyanosis when they squat?

Back 170

Tetralogy of Fallot

Front 171

Boot shaped heart on X-ray is associated with what?

Back 171

Tetralogy of Fallot

Front 172

Transposition of the great vessels is associated with what?

Back 172

Maternal diabetes

Front 173

Infantile form of Coarction of Aorta is associated with what two things and is located where on the aortic arch?

Back 173

Infantile associated with PDA and Turner syndrome and lies distal to the aortic arch but proximal to the PDA

Front 174

Adult form of coarction of aorta is located where and associated with what?

Back 174

Distal to the aortic arch, there is no PDA. Associated with bicuspid aortic valve

Front 175

This present with HTN in upper extremities and hypotension with weak pulse in lower extremities

Back 175

Adult coarction of aorta. This is because the blockage is after the aortic arch. Upper extremities gets all the blood pressure while the lower extremities are blocked by the coarction.

Front 176

Collateral circulation develops across intercostal arteries, engorged arteries causes nothing of ribs on x-ray. What pathology is this?

Back 176

Adult coarctation of aorta

Front 177

Systemic complication of pharyngitis due to group A B-hemolytic streptococci

Back 177

Acute rheumatic fever

Front 178

What is the pathophysiology of acute rheumatic fever?

Back 178

Caused by molecular mimicry; bacterial M protein resembles human tissues

Front 179

What is Jones criteria used for?

Back 179

Acute Rheumatic Fever

Front 180

What are the Major criteria for Acute Rheumatic Fever?

Back 180

Joints - migratory polyarthritis

O = heart problems - pancarditis

Nodules = Subcutaneous nodules

E = Erythema Marginatum

Sydenham chorea = rapid, involuntary muscle movement

Front 181

In acute rheumatic fever which valve is most often involved? and if another valve is involved which one?

Back 181

Alway Mitral valve maybe also aortic valve

Front 182

Acute Rheumatic fever has these two histological characteristics

Back 182

Aschoff body (foci of chronic inflammation) involving myocardium with anitschkow cells (caterpillar nuclei)

Front 183

Valve scarring that arises as a consequence of rheumatic fever

Back 183

Chronic Rheumatic Heart Disease

Front 184

Narrowing of the aortic valve orifice

Back 184

Aortic Stenosis

Front 185

Aortic stenosis is caused by what?

Back 185

Fibrosis and calcification from "wear and tear"

Front 186

Backflow of blood from aorta into the left ventricle during diastole

Back 186

Aortic Regurgitation

Front 187

Two causes for aortic regurgitation

Back 187

Aortic root dilation (e.g., syphilitic aneurysm) or valve damage (e.g., infective endocarditis)

Front 188

Hyperdynamic circulation is associated with what?

Back 188

Aortic Regurgitation

Front 189

Ballooning of mitral valve into left atrium during systole

Back 189

Mitral Valve Prolapse

Front 190

Myxoid degneration of mitral valve will lead to what?

Back 190

Mitral valve prolapse

Front 191

Reflux of blood from left ventricle into the left atrium during sytole

Back 191

Mitral regurgitation

Front 192

Narrowing of the mitral valve orifice

Back 192

Mitral Stenosis

Front 193

Mitral stenosis is usually due to?

Back 193

Chronic rheumatic valve disease

Acute rheumatic heart disease leads to mitral regurgitation.

Front 194

Most common overall cause of endocardittis

Back 194

Streptococcus viridans

Front 195

Most common cause and valve affected in endocarditis in IV drug users?

Back 195

S. Aureus, Tricuspid valve

Front 196

This bacteria is associated with prosthetic valves

Back 196

S. Epidermidis

Front 197

Endocarditis in patients due to S. Bovis usually have what other pathology?

Back 197

Colorectal carcinoma

Front 198

What are the HACEK organisms and what is the signficance?

Back 198

Haemophilus

Actinobacillus

Cardiobacterium

Eikenella

Kingella

This organisms are associated with endocarditis with negative blood cultures

Front 199

Janeway lesions (erythematous non-tender lesions on the palms and soles) is a clinical feature of what?

Back 199

Bacterial Endocarditis

Front 200

Osler nodes (tender lesions on fingers and toes) is a clinical feature of what?

Back 200

Bacterial Endocarditis

Front 201

Sterile vegatations that arise with hypercoaguable state or underlying adenocarcinoma

Back 201

Nonbacterial thrombotic endocarditis

Front 202

Sterile vegetations associated with SLE

Back 202

Libman-Sacks Endocarditis

Front 203

Dilation of all four chambers of heart

Back 203

Dilated cardiomyopathy

Front 204

Massive hypertrophy of the left ventricle usually due to genetic mutations in sarcomere proteins; most common form is autosomal dominant

Back 204

Hypertrophic cardiomyopathy

Front 205

Sudden death due to ventricular arrhythmias; common cause of sudden death in young adults

Back 205

Hypertrophic cardiomyopathy

Front 206

Decreased compliance of the ventricular endomyocardium that restricts filling during diastole

Back 206

Restrictive Cardiomyopathy

Front 207

Benign mesenchymal tumor with a gelatinous appearance and abundant ground substance on histology

Back 207

Myxoma

Front 208

Restrictive cardiomyopathy presents as what?

Back 208

Congestive heart failure

Front 209

Most common primary cardiac tumor in adults

Back 209

Myxoma

Front 210

Usually forms a pedunculated mass in the left atrium that causes syncope due to obstruction of mitral valve

Back 210

Myxoma

Front 211

This cardiac tumor is associated with tuberous sclerosis

Back 211

Rhabdomyoma

Front 212

Benign hamartoma of cardiac muscle

Back 212

Rhabdomyoma

Front 213

Fetal erythropoiesis order of organs responsible. (4)

Back 213

Yolk Sac (3-8wks)

Liver (6wks-birth)

Spleen (10-28wks)

Bone Marrow (18wks to adult)

Young Liver Synthesizes Blood

Front 214

What are the components of fetal hemoglobin and adult hemoglobin?

Back 214

A2Y2 (alpha2 gamma2) = fetal

A2B2 (alpha2 beta2) = adult

Front 215

Venodilators decrease preload or afterload?

Back 215

Venodilators decrease preload

Front 216

Vasodilators decrease preload or afterload?

Back 216

Vasodilators decrease afterload

Front 217

S1 and S2 sound is due to and where is it located?

Back 217

S1 - Mitral and tricuspid valve closure, loudest at mitral area

S2 - Aortic and pulmonary valve closure. Loudest at left sternal border

Front 218

S3 and S4 sound due to?

Back 218

S3 - in early diastole during rapid ventricular filling phase.

S4 - "atrial kick" in late diastole. High atrial pressure. Associated with ventricular hypertrophy.

Front 219

Receptors in aortic arch transmit via what nerve?

Back 219

Vagus (responds only to increase in BP)

Front 220

Receptors in carotid sinus transmit via what nerve?

Back 220

Glossopharyngeal (responds to decrease and increase of BP)

Front 221

HTN with CHF, cautious of what drug?

Back 221

B-Blockers

Front 222

HTN with Diabetes, should use what drug?

Back 222

ACE inhibitors/ARBs are protective against diabetic nephropathy

Front 223

HMG-CoA reductase inhibitors (statins) effect on LDL, HDL, Triglycerides, MOA, side effects

Back 223

3x decrease of LDL, 1x increase of HDL, 1x decrease of triglycerides. Inhibit HMG-COA reductase, hepatoxicity, rhabdomyolysis

Front 224

Niacin (Vit B3) effect on LDL, HDL, Triglyceride, MOA, side effects

Back 224

2x decrease LDL, 2x increase HDL, 1x decrease triglyceride. Inhibit lipolysis in adipose tissue, reduce hepatic VLDL synthesis. Red, flushed face which is decreased by aspirin.

Front 225

Bile acid resins (cholestyramine, colestipol, colesevelam) effect on LDL, HDL, Triglyceride, MOA, side effect

Back 225

2x decrease LDL, slight increase HDL, slight INCREASE of triglyceride. Prevent intestinal reabsorption of bile acids; liver must use cholesterol to make more. Decrease absorption of fat-soluble vitamins. Gall stones.

Front 226

Cholesterol absorption blockers (ezetimibe) effect on LDL, HDL, Tri, MOA, side effect

Back 226

2x decrease LDL, no effect on HDL or Tri, Prevent cholesterol absorption at small intestine brush border.

Front 227

Fibrates (gemfibrozil, clofibrate, -fibrates) effect on LDL, HDL, TRI, MOA, side effect.

Back 227

decrease LDL, increase HDL, 3x decrease Tri. Upregulate LPL--> TG clearance activates PPAR-a to induce HDL synthesis

Front 228

Which Lipid-lowering agent class best decreases Triglycerides?

Back 228

Fibrates (Gemfibrozil, clofibrate, bezafibrate, fenofibrate)

Front 229

Which lipid-lowering agent class best decreases LDL?

Back 229

HMG-CoA reductase (statins)

Front 230

Which lipid-lowering agent increases triglycerides?

Back 230

Bile acid resins (Cholestyramine, colestipol, colesevelam)

Front 231

Which lipid lower agent has no effect on HDL or Triglycerides?

Back 231

Cholesterol absorption blockers (ezetimibe)

Front 232

Statins in combination with what drugs has increased risk for rhabdomyolysis?

Back 232

Statins with fibrates and niacin

Front 233

When determining metabolic, respiratory, alka vs acidosis what are the steps?

Back 233

Look at pH to determine if its alka or acid, now determine if its resp or meta by looking at bicarbonate.

Front 234

How do beta blockers effect the RAAS?

Back 234

Beta blockers inhibit renin release by blocking beta-1 receptors on Juxtaglomerular cells

Front 235

Most common benign vascular tumor in children? adults?

Back 235

Strawberry hemangioma - children

Cherry hemangioma - adults

Front 236

Anti-hypertensives ending in -zosin have what MOA?

Back 236

They are alpha-1 blockers and are also useful for benign prostatic hyperplasia

Front 237

If you have a child with nasal polyps what should you also be checking for?

Back 237

Cystic fibrosis

Front 238

Pts with ASA-intolerant asthma have what triad?

Back 238

Asthma, aspirin-induced bronchospasms, and nasal polyps

Front 239

Benign tumor of nasal mucosa composed of large blood vessels and fibrous tisse

Back 239

Angiofibroma

Front 240

If an adolescent male has profuse epitaxis what should you suspect?

Back 240

Angiofibroma

Front 241

Malignant tumor of nasopharyngeal epithelium

Back 241

Nasopharyngeal carcinoma

Front 242

Nasopharyngeal carcinoma is associated with what?

Back 242

EBV

Front 243

Nasopharyngeal carcinoma has what type of histology?

Back 243

Pleomorphic KERATIN-POSITIVE epithelial cells

Front 244

Inflammation of the upper airway

Back 244

Laryngotracheobronchitis (Croup)

Front 245

Nodule that arises on the true vocal cord

Back 245

Vocal cord nodule

Front 246

Benign papillary tumor of the vocal cord

Back 246

Laryngeal papilloma

Front 247

Laryngeal papilloma is due to what?

Back 247

HPV 6 and 11

Front 248

Laryngeal papillomas are usually (single/multiple) in adults and (single/multiple) in children

Back 248

Single in adults

Multiple in children

Front 249

Squamous cell carcinoma arising from epithelial lining of vocal cord

Back 249

Laryngeal carcinoma

Front 250

2 key chemical mediators for pain

Back 250

Prostaglandin E2 and Bradykinin

Front 251

Three patterns of pneumonia that can be seen on chest x-ray

Back 251

Lobar pneumonia, bronchopneumonia, interstitial pneumonia

Front 252

Pneumonia characterized by consolidation of an entire lobe of the lung

Back 252

Lobar pneumonia

Front 253

Pneumonia characterized by scattered patchy consolidation centered around bronchioles; often multifocal and bilateral

Back 253

Bronchopneumonia

Front 254

Pneumonia characterized by diffuse interstitial infiltrates.

Back 254

Interstitial (atypical) pneumonia

Front 255

Lobar and bronchopnemonia usually bacterial or viral?

Back 255

Bacterial

Front 256

Interstitial pneumonia is usually bacterial or viral?

Back 256

viral

Front 257

Most common cause for lobar pneumonia (2 bacterias)?

Back 257

Streptococcus Pneumoniae (95%) and Klebsiella pneumoniae

Front 258

Lobar pneumonia in patients who have high chance of enteric flora aspiration (elderly in nursing homes, alcoholics). What is the bacterial cause of the pneumonia?

Back 258

Klebsiella pneumoniae

Front 259

Which type of pneumocyte can replicate Type 1 or 2?

Back 259

Type 2 can replicate

Front 260

Which type of pneumocyte is responsible for producing surfactant?

Back 260

Type 2

Front 261

Which type of pneumocyte is responsible for the epithelial lining?

Back 261

Type 1

Front 262

What are the four classic phases of lobar pneumonia and describe each.

Back 262

Congestion - congested vessels and edma

Red hepatization - exudate, neutrophils, and hemmorrhage filling the alveolar air space

Gray hepatization - degradation of red cells within exudate

Resolution - regeneration

Front 263

Aspiration pneumonia usually affects which side?

Back 263

Right lower lobe (due to anatomy)

Front 264

Which bacteria anaerobic bacteria are normally responsible for aspiration pneumonia? (3)

Back 264

Bacteroidies, fusobacterium, and peptococcus

Front 265

Most common site for systemic spread of TB?

Back 265

Kidneys creating a sterile pyuria

Front 266

Which congenital heart defects are caused by abnormal migration of neural crest cells (3)?

Back 266

Truncus Arteriosus

Transposition of Great Vessels

Tetralogy of Fallot

Front 267

What is the DOC for Beta blocker overdose? and what is the receptor it works on?

Back 267

Glucagon, which increases HR and contractility via cAMP.

Front 268

T-lymphocyte immunodeficiency that resultsin maldevelopment of the third and fourth branchial (pharyngeal) pouches.

Back 268

DiGeorge syndrome

Front 269

DiGeorge syndrome is due to a deletion of what chromosome?

Back 269

Chromsome 22

Front 270

MOA of Dobutamine

Back 270

B1-adrenergic receptor agonist. Is used for acute heart failure due to decreased myocardial contractility

Front 271

Beta-Blockers work where on an EKG?

Back 271

PR interval, they slow AV conduction.

Front 272

(4)Hyper and (2)Hypo problems of Thiazide diuretics

Back 272

Hyperuricemia

Hypercalcemia

Hyperglycemia

Hyperlipidemia

Hypokalemia

Hypotension

Front 273

Doxorubicin can causes what problem with the heart?

Back 273

Dilated cardiomyopathy

Front 274

Sharp pain that is relieved by sitting up and leaning forward suggests what?

Back 274

Pericarditis - associated with SLE

Front 275

Nitrates mixed with drugs for erectile dysfunction are absolutely contraindicated, what is the MOA?

Back 275

Increased cyclic GMP due to nitrates synthesizing and PDE inhibitors inhibiting degradation.

Front 276

What is FVC? Normal amount?

Back 276

Forced vital capacity - breathe in all the way breath out all the way.

5L

Front 277

What is FEV1? Normal amount?

Back 277

Forced Expiratory Volume - How much air you can breath out in the first second.

4L

Front 278

In airway obstruction what are the relative decreases in FVC, FEV1, and FEV1:FVC ratio,FRC, TLC?

Back 278

FVC - decreases

FEV1 - significant decrease

FEV1:FVC ratio - decreases

FRC - Increased

TLC - increases due to trapped air

Front 279

Chronic productive cough lasting at least 3 months over a minimum of 2 years; highly associated with smoking

Back 279

Chronic bronchitis

Front 280

Destruction of alveolar air sacs leading to COPD

Back 280

Emphysema

Front 281

What enzyme neutralizes proteases in alveolar air sacs?

Back 281

A1AT - a1-antitrypsin neutralizes proteases

Front 282

Deficiency in what can cause emphysema?

Back 282

A1AT - a1-antitrypsin

Front 283

Barrel-chest (increased AP diameter) is found in emphysema or chronic bronchitis?

Back 283

Emphysema

Front 284

Smoking leads to centriacinar or panacinar emphysema?

Back 284

centriacinar

Front 285

A1AT deficiency leads to centriacinar or panacinar emphysema?

Back 285

panacinar

Front 286

In A1AT, the two organs affected are what?

Back 286

Lung emphysema and liver cirrhosis

Front 287

Biopsy of liver in A1AT will reveal what?

Back 287

pink, PAS-positive globules in hepatocytes

Front 288

Prolonged expiration with pursed lips, is which COPD?

Back 288

Emphysema

Front 289

Match: Emphysema and Cystic fibrosis with Increased or Decreased Functional Residual Capacity

Back 289

Emphysema = Increased FRC

Cystic Fibrosis = Decreased FRC

Front 290

Key cytokines released by Th2 helper CD4+ T cells?

Back 290

IL-4, IL-5, IL-10

Front 291

IL-5 main job?

Back 291

recruit eosinophils

Front 292

In asthma allergens stimulate what cells to release what three cytokines which are responsible for what?

Back 292

Th2 CD4+ T cells --> IL-4,IL-5,IL-10

IL-4 = IgE Class switch

IL-5 = recruit eosinophils

IL-10 = inhibit Th1 stimulate Th2

Front 293

Reexposure to allergen has two phases, what is released in the first phase, what is released in the second phase?

Back 293

First phase = release of histamine

Second phase = Release of leukotriene C4,D4,E4

Front 294

What are leukotrienes C4,D4,E4 responsible for?

Back 294

Bronchoconstriction, inflammation, edema

Front 295

What are Charcot-Ledyden crystals and what are they assocaited with?

Back 295

Eosinophil-derived crystals associated with asthma

Front 296

What are Curschmann spirals?

Back 296

spiral-shaped mucus plugs found in asthma

Front 297

What is permanent dilation of bronchioles and bronchi?

Back 297

Bronchiectasis

Front 298

What is the classic cause of bronchiectasis?

Back 298

Classic cause is cystic fibrosis

Front 299

What syndrome is associated with Bronchiectasis, and what is defective?

Back 299

Kartagener syndrome - defect in dynein arm of cilia

Front 300

In restricted lung diseases are these values increased or decreased? TLC, FVC, FEV1,FRC, FEV1:FVC ratio

Back 300

TLC - decreased

FVC - decreased 2x

FEV1 - decreased

FRC - decreased

FEV:FVC ratio - increased

Front 301

Fibrosis of lung interstitium with unknown etiology

Back 301

Idiopathic Pulmonary Fibrosis

Front 302

What chemical mediator drives the process of idiopathic pulmonary fibrosis?

Back 302

TGF-B

Front 303

What is interstitial fibrosis due to occupational exposure

Back 303

Pneumoconioses

Front 304

What are the 4 types of Pneumoconioses?

Back 304

Coal Worker's

Silicosis - sandblasters and silica miners

Beryliosis - berylium miners and aerospace

Absestosis - construction workers, plumbers, shipyard workers

Front 305

Aerospace worker who has lung problmes, what is the dx?

Back 305

Berylliosis

Front 306

What is the name of collections of carbon-laden macrophages, like that seen in Coal Worker's pneumoconiosis?

Back 306

Anthracosis

Front 307

What pneumoconioses increases risk for TB and why?

Back 307

Silicosis - Silica impairs phagolysosome formation by macrophages.

Front 308

Which pneumoconioses has noncaseating granulomas in the lung, hilar lymph nodes, and systemic organs, similar to sarcoidosis?

Back 308

Berylliosis - distinguish by med hx and see if they work in the aerospace industry

Front 309

Absetosis more likely to get lung carcinoma or mesothelioma?

Back 309

Lung carcinoma

Front 310

Systemic disease characterized by noncaseating granulomas in multiple organs

Back 310

Sarcoidosis

Front 311

Asteroid bodies are associated with what disease?

Back 311

Sarcoidosis - stellate inclusions that are often seen within giant cells of the granulomas

Front 312

Sarcoidosis has two lab findings what are they?

Back 312

Elevated serum ACE

Hypercalcemia

Front 313

What is the pathophysiology of hypercalcemia in sarcoidosis?

Back 313

1-alpha hydroxylase activity of epitheliod histiocytes converts vitamin D to its active form - this occurs in all non-caseating granulomas (e.g., sarcoidosis and berylliosis)

Front 314

Granulomatous reaction to inhaled organic antigens where chronic exposure leads to interstitial fibrosis.

Back 314

Hypersensitivity Pneumonitis

Front 315

Aschoff body and anischkow (caterpillar) cells are associated with what?

Back 315

Acute Rheumatic Fever

Front 316

What are plexiform lesions and what are they associated with?

Back 316

Tufts of capillaries; associated with pulmonary HTN

Front 317

Pulmonary HTN leads to what two things?

Back 317

Right ventricular hypertrophy and cor pulmonale

Front 318

If someone presents with exertional dyspnea what should come to mind?

Back 318

Pulmonary HTN

Front 319

Primary pulmonary HTN the etiology is unknown but some familial forms are related to inactivating mutations of what, which leads to what?

Back 319

BMPR2, leading to proliferation of vascular smooth muscles

Front 320

Diffuse damage to the alveolar-capillary interface leads to formation of what? What is this disease called?

Back 320

Leads to formation of hylaine membranes in alveoli, disease is Acute Respiratory Distress Syndrome

Front 321

Diffuse white-out on chest x-ray suggests what?

Back 321

Acute Respiratory Distress Syndrome

Front 322

Which pneumocytes get damaged in Acute Respiratory Distress syndrome?

Back 322

Type I and Type II both get damaged

Front 323

Respiratory distress due to inadequate surfactant levels is called?

Back 323

Neonatal Respiratory Distress syndrome

Front 324

Neonatal Respiratory Distress Syndrome associated with what 3 things?

Back 324

Prematurity

C-Section

Maternal Diabetes

Front 325

What is the major component of surfactant?

Back 325

Phosphatidylcholine (lecithin)

Front 326

Why does C-section delivery cause increased risk for Neonatal Respiratory Distress Syndrome?

Back 326

Lack of stress-induced steroids; steroids increases synthesis of surfactant

Front 327

What is particularly carcinogenic in cigarette smoke?

Back 327

Polycyclic aromatic hydrocarbons

Front 328

What type of cancer is increased in radon miners?

Back 328

Lung cancer

Front 329

Two benign "coin-lesions" that can be seen on a chest x-ray

Back 329

Granuloma and Bronchial Hamartoma

Front 330

What is a benign tumor composed of lung tissue and cartilage; often calcified on imaging?

Back 330

Bronchial Hamartoma

Front 331

Lung carcinoma is divided into what two categories? and what is the significance?

Back 331

Small cell carcinoma and non-small cell carcinoma. Small cell responds to chemo, non-small cell responds to surgery

Front 332

Non-small cell carcinoma with glands or mucin

Back 332

Adenocarcinoma

Front 333

Non-small cell carcinoma with keratin pearls or intracellular bridges

Back 333

Squamous cell carcinoma

Front 334

Non-small cell carcinoma with NO keratin pearls, intracellular bridges, glands, or mucin

Back 334

Large cell carcinoma

Front 335

Small cell carcinoma is associated with what syndrome?

Back 335

Eaton-Lambert syndrome - anti-bodies against calcium channels in NMJ leading to weakness

Front 336

Lung carcinomas that start with S (small cell carcinoma, squamous cell carcinoma) have what common attributes? (3)

Back 336

Smokers, Central, paraneoplastic syndromes

Front 337

Which lung cancer can cause hypercalcemia and what is the mechanism?

Back 337

Squamous cell carcinoma due to production of PTHrP (parathyroid hormone related Peptide)

Front 338

Which lung cancer may produce ADH or ACTH?

Back 338

Small cell carcinoma

Front 339

What is the most common tumor in non-smokers?

Back 339

Adenocarcinoma

Front 340

What is the most common tumor in female smokers?

Back 340

Adenocarcinoma

Front 341

What is the most common tumor in male smokers?

Back 341

Squamous cell carcinoma

Front 342

Name the tumor: Columnar cells that grow along preexisting bronchioles and alveoli; arises from Clara cells

Back 342

Bronchioalveolar carcinoma

Front 343

Which lung cancers are chromogranin positive?

Back 343

Carcinoid tumor and Small Cell Carcinoma

Front 344

Lung cancer with well differentiated neuroendocrine cells

Back 344

Carcinoid tumor

Front 345

Two lung cancers not related to smoking

Back 345

Bronchioalveolar carcinoma

Carcinoid tumor

Front 346

Two lung cancers that are derived from neuroendocrine cells; what is the difference?

Back 346

Small cell carcinoma - poorly differentiated

Carcinoid tumor - well differentiated

Front 347

Which lung cancer presents as a polyp-like mass in the bronchus?

Back 347

Carcinoid tumor

Front 348

Two Most common source for metastasis to lung?

Back 348

Breast and colon cancer

Front 349

This lung cancer has multiple 'cannon-ball' nodules on imaging

Back 349

Metastasis to lung

Front 350

Where do lung cancers like to metastasize?

Back 350

Adrenal gland

Front 351

Lung cancer can lead to Horner syndrome, what are the 3 characteristics?

Back 351

Compression of sympathetic chain leads to

-ptosis (drooping of eyelid)

-miosis (pinpoint pupil)

-anhidrosis (no sweating)

Front 352

Accumulation of air in the pleural space is called?

Back 352

Pneumothorax

Front 353

Pneumothorax caused by rupture of an emphysematous bleb

Back 353

Spontaneous pneumothrax

Front 354

Pneumothorax caused by penetration of chess wall

Back 354

Tension pneumothorax

Front 355

Malignant neoplasm of mesothelial cells of lung

Back 355

Mesothelioma

Front 356

Structures that perforate the diaphragm at T8, T10, T12?

Back 356

T8: IVC

T10: esophagus, (CNX vagus),

T12: aorta, thoracic duct, azygos vein

Front 357

What nerves innervate diaphragm?

Back 357

C3,4,5

Front 358

Fetal Hb has higher or lower affinity for 2,3-BPG? what does this mean?

Back 358

lower affinity for 2,3-BPG which means it has a higher affinity for O2.

Front 359

Pancoast tumors can have what 4 complications?

Back 359

Horner syndrome

SVC syndrome

Sensorimotor deficits

Hoarseness (recurrent laryngeal nerve)

Front 360

Ethambutol can be used to treat TB; what is it's most notable complication?

Back 360

Optic neuritis

Front 361

What is S. pneumoniae's main virulence factor?

Back 361

Having an outer polysaccharide capsule which prevents phagocytosis

Front 362

What should you think of when you see "new screening test"

Back 362

Lead time bias

Front 363

Arterial blood gas for Metabolic acidosis (pH, pCO2, HCO3-)

Back 363

pH decreased

PCO2 decreased

HCO3- decreased

Front 364

Arterial blood gas for Respiratory Acidosis (pH, pCO2, HCO3-)

Back 364

pH decreased

PCO2 increased

HCO3 normal or increased(compensated)

Front 365

Arterial blood gas for Metabolic alkalosis (pH, pCO2, HCO3-)

Back 365

pH increased

PCO2 increased

HCO3 increased

Front 366

Arterial blood gas for Respiratory alkalosis (pH, pCO2, HCO3-)

Back 366

pH increased

PCO2 decreased

HCO3 decreased(compensated) or normal

Front 367

Diabetic ketoacidosis leads to what kind of acid/base imbalance?

Back 367

Metabolic acidosis

Front 368

Overuse of diuretics leads to what kind of acid/base imbalance?

Back 368

Loss of hydrogen ions leading to metabolic alkalosis

Front 369

Panic attacks leads to what kind of acid/base imbalance?

Back 369

Respiratory alkalosis

Front 370

COPD leads to what kind of acid/base imbalance?

Back 370

Respiratory acidosis (compensated)

pH - decreased

PCO2 - increased

HCO3- - inceased

Front 371

What is the inheritance pattern of cystic fibrosis?

Back 371

Autosomal recessive

Front 372

Failure of neutrophils to turn blue on a nitroblue tetrazolium test indicates what disease?

Back 372

Chronic Granulomatous Disease

Front 373

Neutrophils in Chronic Granulomatous Disease are unable to kill what and why?

Back 373

Catalase producing organisms because normally bacteria will kill themselves due to their own production of H2O2. If the organism can break down its own H2O2 then it can survive. The body can not make any H2O2 since NADPH oxidase does not work.

Front 374

Cheyne-stokes breathing is commonly seen in what?

Back 374

advanced congestive heart failure

Front 375

Stimulation of vagus nerve would do what to the lungs (2)?

Back 375

Bronchoconstriction and increased mucus production

Front 376

Cystic fibrosis is caused by what genetic defect? What does it affect as far as going from gene to protein?

Back 376

3-base pair deletion of CFTR (cystic fibrosis transmembrane conductance regulator). This affects post-translational processing.

Front 377

Phospholipid content of amniocentesis is used to check for what?

Back 377

Fetal Lung development (measuring phosaphatidylcholine)

Front 378

Bronchioalveolar lavage of patients with sarcoidosis show elevation in what cell type?

Back 378

CD4+ lymphocytes

Front 379

Bronchioalveolar lavage of patients with lung transplants showing rejection would show elevation in what cell type?

Back 379

CD8+ lymphocytes

Front 380

Structure of MHC Class I

Back 380

Heavy chain and B2 microglobulin

Front 381

Structure of MHC Class II

Back 381

Alpha and beta polypeptide chains

Front 382

Which cells are MHC Class I molecules expressed?

Back 382

All cells

Front 383

Which cells are MHC Class II molecules expressed?

Back 383

Antigen Presenting Cells

Front 384

Describe V/Q in base vs apex

Back 384

Higher in apex lower in base

Front 385

What is used as a marker for mast cell activation (anaphylaxis)?

Back 385

Tryptase

Front 386

Symptoms of Theophylline overdose? (3)

Back 386

abdominal pain, vomiting, seizures

Front 387

Behcet syndrome has what 3 parts?

Back 387

Apthous ulcers, genital ulcers, and uveitis

Front 388

Pathophysiology of behcet's syndrome

Back 388

Immune complex vasculitis involving small vessels

Front 389

Most feared complication of mumps?

Back 389

Orchitis leading to sterility

Front 390

Benign cystic tumor with abundant lymphocytes and germinal centers found in salivary gland

Back 390

Warthin tumor

Front 391

Congenital defect resulting in a connection between the esophagus and trachea

Back 391

Tracheoesophageal fistula

Front 392

Thin protrusion of esophageal mucosa, most often in the upper esophagus

Back 392

Esophageal web

Front 393

What are the components of Plummer-Vinson syndrome?

Back 393

Severe iron deficiency anemia, esophageal web, beefy-red tongue due to atrophic glossitis

Front 394

Outpouching of pharyngeal mucosa through acquired defect in the muscular wall of the esophagus

Back 394

Zenker Diverticulum

Front 395

Longitudinal laceration of mucosa at the GE junction

Back 395

Mallory-Weiss syndrome

Front 396

What is the cause of Mallory-Weiss syndrome? and what 2 populations is it seen in?

Back 396

Severe vomiting due to bulimia or alcoholism

Front 397

rupture of esophagus leading to air in mediastinum and subcutaneoues emphysema

Back 397

Boerhaave syndrome

Front 398

Mallory-Weiss syndrome has a risk of what?

Back 398

Boerhaave syndrome

Front 399

Dilated submucosal veins in the lower esophagus

Back 399

Esophageal varices

Front 400

Esophageal varices arise secondary to what?

Back 400

portal HTN

Front 401

Painless hematemesis is found in what?

Painful hematemesis is found in what?

Back 401

Painless = esophageal varices

Painful = Mallory-Weiss syndrome

Front 402

Most common cause of death in cirrhosis?

Back 402

Esophageal varices that rupture

Front 403

Disordered esophageal motility with inability to relax lower esophageal sphincter

Back 403

Achalasia

Front 404

Achalasia is due to damage of what?

Back 404

Ganglion cells in MYENTERIC plexus

Front 405

Achalsia can be due to infection by what bacteria, and what is the name of the disease?

Back 405

Trypanosoma cruzi = Chagas disease

Front 406

Reflux of acid from the stomach due to reduced LES tone

Back 406

GERD

Front 407

Metaplasia of the lower esophageal mucosa from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells

Back 407

Barrett Esophagus

Front 408

Two types of esophageal carcinoma

Back 408

Adenocarcinoma and squamous cell carcinoma

Front 409

Most common esophageal cancer worldwide

Back 409

squamous cell carcinoma

Front 410

Most common esophageal cancer in the west

Back 410

adenocarcinoma

Front 411

(1)Upper 1/3, (2)Middle 1/3, and (2)Lower 1/3 of esophageal cancers involve what lymph nodes?

Back 411

upper = cervical

middle = mediastinal and tracehobroncial nodes

lower = celiac and gastric

Front 412

Congenital malformation of the anterior abdominal wall leading to exposure of abdominal contents

Back 412

Gastroschisis

Front 413

Persistent herniation of bowel into umbilical cord

Back 413

Omphalocele

Front 414

Congenital hypertrophy of pyloric smooth muscle

Back 414

Pyloric Stenosis

Front 415

Acidic damage to the stomach mucosa

Back 415

Acute Gastritis

Front 416

Projectile nonbilious vomiting indicates?

Back 416

Pyloric stenosis

Front 417

Which cells in the stomach produce mucous?

Back 417

foveolar cells

Front 418

What is a cushing ulcer?

Back 418

Acute gastritis induced ulcer due to increased stimulation of vagus nerve to release acetylcholine which leads to increased acid production

Front 419

What are the 3 receptors on parietal cells that can induce it to secrete acid?

Back 419

Acetylcholine

Gastrin

Histamine

Front 420

What are the two types of chronic gastritis?

Back 420

Chronic Autoimmune gastritis

Chronic H pylori gastritis

Front 421

Autoimmune destruction of gastric parietal cells leads to?

Back 421

Chronic gastritis

Front 422

What regions are gastric parietal cells located in the stomach?

Back 422

Fundus and Body

NOT Cardia and Antrum

Front 423

What region is Chronic H pylori gastritis normally affect?

Back 423

Antrum

NOT fundus, body, or cardia

Front 424

Solitary mucosal ulcer that occurs in the duodenum 90% of the time and in the distal stomach 10% of the time

Back 424

Peptic ulcer disease

Front 425

Duodenal or gastric ulcers; pain improves with meals?

Back 425

Duodenal

Front 426

Malignant proliferation of surface epithelial cells in the stomach

Back 426

Gastric carcinoma

Front 427

Two types of gastric carcinoma

Back 427

intestinal type

diffuse type

Front 428

Gastric carcinoma which presents as large, irregular ulcer with heaped up margins

Back 428

intestinal type

Front 429

Gastric carcinoma which is characterized by signet ring cells that infiltrate the gastric wall

Back 429

Diffuse type

Front 430

Blood type A is associated with what cancer?

Back 430

Intestinal Type of gastric carcinoma

Front 431

describe a signet ring cell?

Back 431

Nucleus pushed off to the edge due to production of mucin

Front 432

Leser-Trelat sign can indicate what?

Back 432

Gastric carcinoma

Front 433

Gastric carcinoma normally spreads to which node?

Back 433

Left supraclavicular node (virchow node)

Front 434

Which node is Virchow node?

Back 434

Left supraclavicular node

Front 435

Distant metastasis of gastric carcinoma most commonly involves what organ?

Back 435

Liver

Front 436

Intestinal type of gastric carcinoma classically spreads where?

Back 436

Preumbilical region (Sister Mary Joseph nodule)

Front 437

Diffuse type of gastric carcinoma classically spreads where?

Back 437

Bilateral ovaries (Krukenberg tumor)

Front 438

What disease has translocation at 12,21

Back 438

ALL (kids)

Front 439

What disease has translocation at 9,22

Back 439

ALL (adults) and CML

Front 440

What disease has translocation at 15,17

Back 440

Acute Promyelocytic Leukemia

Front 441

What disease has translocation at 14,18

Back 441

Follicular lymphoma

Front 442

What disease has translocation at 11,14

Back 442

Mantle Cell Lymphoma

Front 443

What disease has translocation at 8,14

Back 443

Burkitt Lymphoma

Front 444

Congenital failure of small bowel to canalize

Back 444

Duodenal atresia

Front 445

What is duodenal atresia associated with?

Back 445

Down syndrome

Front 446

Double-bubble sign indicates what pathology?

Back 446

Duodenal atresia

Front 447

Outpouching of all three layers of bowel wall

Back 447

Meckel Diverticulum

Front 448

This pathology occurs due to failure of the vitelline duct to involute

Back 448

Meckel diverticulum

Front 449

What are the (4) Rule of 2's and what does it apply to?

Back 449

Meckel Diverticulum

Seen in 2% of population

Usually 2 inches long

Within 2 feet of ileocecal valve

Present during first 2 years of life

Front 450

Twisting of bowel along its mesentery

Back 450

Volvulus

Front 451

Telescoping of proximal segment of bowel forward into distal segment

Back 451

Intussusception

Front 452

Most common cause for intussusception in adults

Back 452

tumor

Front 453

Most common cause for intussusception in children

Back 453

Lymphoid hyperplasia

Front 454

Immune-mediate damage of small bowel villi due to gluten exposure

Back 454

Celiac disease

Front 455

What is the most pathogenic component of gluten?

Back 455

Gliadin

Front 456

What is the process by which Gliadin causes damage to villi?

Back 456

Gliadin is deamidated by tTg (tissue transgutaminase), it is then presented to APC via MHC Class II. Helper T cells mediate tissue damage

Front 457

Dermatitis herpetiformis is associated with what GI pathology?

Back 457

Celiac disease - small, herpes-like vesicles may arise on skin due to IgA deposition at the tips of dermal papillae; resolve with gluten-free diet

Front 458

What laboratory findings are there for celiac disease?

Back 458

IgA antibodies against endomysium, tTG, or gliadin

Front 459

In celiac disease which portion of the small intestine is most involved?

Back 459

Duodenum

Front 460

If there is refractory disease after continuing a gluten free diet when dx with celiac what should you suspect (2)?

Back 460

Small bowel carcinoma and T-cell lymphoma (eneteropathy associated T-cell lymphoma)

Front 461

Damage to small bowel villi due to an unknown organism resulting in malabsorption

Back 461

Tropical sprue

Front 462

In tropical sprue which portion of the small intestine is involved?

Back 462

Jejunum and Ileum

Front 463

Where is folic acid absorbed?

Back 463

Jejunum

Front 464

Where is Vit B12 absorbed?

Back 464

Ileum

Front 465

What is whipple disease?

Back 465

Systemic tissue damage characterized by macrophages loaded with Tropheryma Whippelii organisms

Front 466

Two key findings in whipple disease?

Back 466

fat malabsorption and steatorrhea

Front 467

Abetalipoproteinemia has what inheritance pattern and is a deficiency in what two proteins

Back 467

Autosomal recessive deficiency of apolipoprotein B-48 and B-100

Front 468

Patient has absent plasma VLDL and LDL, what is the dx and what is the pathophysiology?

Back 468

Abetalipoproteinemia - VLDL and LDL require apolipoprotein B-100

Front 469

Abscence of apolipoprotein B-48 indicate what disease and has what feature due to this absence?

Back 469

Abetalipoproteinemia - absence of B-48 leads to defective chylomicron formation

Front 470

Carcinoid tumor in the gut most commonly arises where?

Back 470

Small bowel

Front 471

Carcinoid tumor of small bowel secretes what? which is metabolized where?

Back 471

Serotonin metabolized in liver into 5-HIAA

Front 472

What are the 3 clinical features of carcinoid syndrome?

Back 472

bronchospasm, diarrhea, and flushing of skin

Front 473

What is the pathophysiology for carcinoid syndrome from a carcinoid tumor in the small gut?

Back 473

Metastasis of carcinoid tumor to liver allows serotonin to bypass liver metabolism leading to excess serotonin in the systemic circulation

Front 474

What is carcinoid heart disease?

Back 474

Right-sided valvular fibrosis leading to tricuspid regurgitation and pulmonary valve stenosis.

Front 475

Why do you not get left sided valvular fibrosis in carcinoid heart disease?

Back 475

Serotonin gets metabolized by MAO in the lung

Front 476

What quadrant is there pain in acute appendicitis?

Back 476

right lower quadrant (McBurney) point

Front 477

Chronic, relapsing inflammation of bowel

Back 477

Inflammatory Bowel Disease

Front 478

Which IBD has full thickness inflammation with knife-like fissures?

Back 478

Crohn disease

Front 479

Which IBD has mucosal and submucosal ulcers?

Back 479

Ulcerative colitis

Front 480

Which IBD skips around and which one is continuous?

Back 480

Ulcerative colitis is continuous, Crohn's skips around

Front 481

Which IBD has left lower quadrant pain?

Back 481

Ulcerative colitis

Front 482

Which IBD has right lower quad pain?

Back 482

Crohn disease

Front 483

Which IBD has histology with crypt abscesses with neutrophils?

Back 483

Ulcerative Colitis

Front 484

Which IBD has loss of haustra "lead pipe" sign on imaging?

Back 484

Ulcerative colitis

Front 485

Which IBD has cobblestone mucosa?

Back 485

Crohn disease

Front 486

Which IBD has pseudopolyps?

Back 486

Ulcerative colitis

Front 487

Which IBD has toxic megacolon as a complicatoin?

Back 487

Ulcerative colitis

Front 488

Which IBD has p-ANCA positivity?

Back 488

Ulcerative colitis

Front 489

Which IBD is protected by smoking?

Back 489

Ulcerative colitis

Front 490

Which IBD has increased risk due to smoking?

Back 490

Crohn disease

Front 491

Which IBD has lymphoid aggregates with granulomas?

Back 491

Crohn disease

Front 492

Which IBD has string-sign on imaging?

Back 492

Crohn disease

Front 493

Which IBD has calcium oxalate neprholithiasis?

Back 493

Crohn disease

Front 494

Defective relaxation and peristalsis of rectum and distal sigmoid colon

Back 494

Hirschsprung disease

Front 495

What is hirschsprung disease associated with?

Back 495

Down syndrome

Front 496

Rectal suction biopsy reveals lack of ganglion cells what disease is this?

Back 496

Hirschsprung disease

Front 497

Outpouching of mucosa and submucosa through the muscularis propria

Back 497

Colonic diverticula

Front 498

Acquired malformation of mucosal and submucosal capillary beds

Back 498

Angiodysplasia

Front 499

High stress on the left lower quadrant leads to what?

Back 499

Colonic diverticula

Front 500

High stress on the right colon leads to what?

Back 500

Angiodysplasia

Front 501

If a patient has stool or air in urine what is the reason and what is the disease called?

Back 501

Inflamed diverticulum ruptures and attaches to a local structure.

Colovesicular fistula due to colonic diverticula.

Front 502

What is the inheritance pattern for hereditary hemorrhagic telangiectasia?

Back 502

Autosomal dominant

Front 503

Ischemic damage to the colon usually at the splenic flexure

Back 503

Ischemic colitis

Front 504

This GI disease presents with postprandial pain and weight loss

Back 504

Ischemic colitis

Front 505

Relapsing abdominal pain with bloating, flatulence, and change in bowel habits (diarrhea or constipation)

Back 505

Irritable bowel syndrome

Front 506

Raised protrusion of colonic mucosa

Back 506

Colonic polyps

Front 507

Two most common types of colonic polyps

Back 507

Hyperplastic polyps and adenomatous polyps

Front 508

This type of polyp are due to hyperplasia of glands; classically show a serrated appearance on microscopy

Back 508

Hyperplastic polyp

Front 509

Which of the two most common colonic polyps is benign not malignant, and which is benign but premalignant?

Back 509

Hyperplastic polyp is benign

Adenomatous polyp is premalignant

Front 510

What chromosome is APC located on?

Back 510

Chromosome 5

Front 511

What is the adenoma-carcinoma sequence (3 steps)

Back 511

1.APC (adenomatous polyposis coli gene) mutation leads to increased risk for formation of polyps

2. K-ras mutation leads to formation of polyps

3. p53 mutation and increased expression of COX allow for progression to carcinoma

Front 512

What can impede the progression of adenoma to carcinoma in colonic polyps?

Back 512

Aspirin due to the inhibition of COX

Front 513

What 3 characteristics of a colon polyp biopsy indicates an increased risk for progression from adenoma to carcinoma?

Back 513

Size >2cm

sessile growth as opposed to pedunculated

villous histology as opposed to tubular

Front 514

Autosomal dominant disorder characterized by 100s to 100s of adenomatous colonic polyps

Back 514

Familial adenomatous polyposis

Front 515

What is the inheritance pattern for familial adenomatous polyposis?

Back 515

Autosomal dominant

Front 516

What is familial adenomatous polyposis with fibromatosis and osteomas?

Back 516

Gardner syndrome

Front 517

What is familial adenomatous polyposis with CNS tumors?

Back 517

Turcot syndrome

Front 518

Sporadic hamartomatous (benign) polyp that arises in children

Back 518

Juvenile polyp

Front 519

Hamartomatous (benign) polyps throughout GI tract with mucocutaneous hyperpigmentation on lips, oral mucosa, and genital skin?

Back 519

Peutz-Jeghers syndrome

Front 520

What is the inheritance pattern for Peutz-Jeghers syndrome?

Back 520

Autosomal dominant

Front 521

Peutz-Jeghers syndrome has increased risk for what 3 cancers?

Back 521

colorectal

breast

GYN

Front 522

What is the 3rd most common site of cancer and the 3rd most common cause of cancer-related death?

Back 522

Colorectal carcinoma

Front 523

What are the two pathways that colorectal carcinoma can arise?

Back 523

Adenoma-carcinoma sequence and microsatellite instability (MSI)

Front 524

Hereditary nonpolyposis colorectal carcinoma (HNPCC) is due to inherited mutations in what?

Back 524

DNA mismatch repair enzymes

Front 525

Inherited mutations in DNA mismatch repair enzymes can lead to what hereditary GI disorder?

Back 525

Hereditary nonpolyposis colorectal carcinoma (HNPCC)

Front 526

HNPCC has increased risk for what 3 cancers?

Back 526

Colorectal (most common)

Ovarian

Endometrial carcinoma

Front 527

Which side do napkin-ring lesions for colorectal carcinoma usually arise?

Back 527

left side

Front 528

Which side do raised lesion for colorectal carcinoma usually arise?

Back 528

right side

Front 529

Colonic carcinoma is associated with an increased risk for what kind if infection?

Back 529

Streptococcus bovis endocarditis

Front 530

Left sided colorectal carcinoma is associated with what molecular pathway?

Back 530

Left Adenoma-carcinoma pathway

Right MSI pathway

Front 531

Most common site for colorectal carcinoma metastasis?

Back 531

Liver

Front 532

What serum tumor marker is useful for assessing tx response and detecting recurrence of colorectal carcinoma

Back 532

CEA

Front 533

CEA is useful for assessing tx response and detecting recurrence but not useful for what?

Back 533

Not useful for screening

Front 534

Where is Iron (Fe2+) absorbed?

Back 534

Duodenum

Front 535

Developmental malformation in which the pancreas forms a ring around the duodenum; risk of duodenal obstruction

Back 535

Annular pancreas

Front 536

Annular pancreas has an increased risk for what?

Back 536

Duodenal obstruction

Front 537

Inflammation and hemorrhage of pancreas

Back 537

Acute pancreatitis

Front 538

What is the first enzyme to get activated in acute pancreatitis?

Back 538

Trypsin

Front 539

Alcohol and gall stones are the most common cause for what?

Back 539

Acute pancreatitis - alcohol constricts sphincter of oddi and gall stones create a blockage

Front 540

Fibrosis of pancreatic pancrenchyma; secondary to recurrent acute pancreatitis

Back 540

Chronic pancreatitis

Front 541

Most commonly due to alcohol and cystic fibrosis; many cases are idiopathic

Back 541

Chronic pancreatitis

Front 542

Alcohol and cystic fibrosis are the most common cause of what?

Back 542

Chronic pancreatitis

Front 543

Adenocarcinoma arising from pancreatic ducts

Back 543

Pancreatic carcinoma

Front 544

What are the two major risk factors for pancreatic carcinoma?

Back 544

Smoking and chronic pancreatitis

Front 545

If a thin elderly female recently dx with diabetes what should you think of?

Back 545

DDX should include pancreatic carcinoma

Front 546

What is the serum tumor marker for pancreatic carcinoma?

Back 546

CA 19-9

Front 547

Failure to form or early destruction of extrahepatic biliary tree

Back 547

Biliary atresia

Front 548

Solid, round stones in the gall bladder

Back 548

Cholelithiasis (Gall stones)

Front 549

Cholelithiasis can occur due to precipitation of what two things?

Back 549

Cholesterol or bilirubin

Front 550

Important side effect of cholestyramine and MOA for the side-effect

Back 550

Gallstones due to decreased solubility of bilirubin. Bile acids are bound by cholestyramine leading to decreased solubility and formation of gall stones.

Front 551

Which gall stone is radiolucent? radiopaque?

Back 551

Cholesterol stone is radiolucent, bilirubin stone is radiopaque

Front 552

Waxing and waning right upper quadrant pain is usually due to?

Back 552

Biliary colic

Front 553

Biliary colic pathophysiology for pain

Back 553

This is due to gallbladder contracting against a stone lodged in the cystic duct

Front 554

Acute inflammation of the gallbladder wall

Back 554

Acute cholecystitis

Front 555

Right upper quadrant pain, radiating to the right scapula indicates what?

Back 555

Acute cholecystitis

Front 556

Chronic inflammation of the gallbladder

Back 556

Chronic cholecystitis

Front 557

Rokitansky-Aschoff sinus is associated with what? and what is it?

Back 557

Chronic cholecystitis - these sinuses are herniations of the gallbladder mucosa into the muscular wall. Normally you should not have mucosa into the smooth muscle.

Front 558

Porcelain gallbladder is associated with what?

Back 558

Chronic cholecystitis

Front 559

This presents with vague right upper quadrant pain, especially after eating

Back 559

Chronic cholecystitis

Front 560

Bacterial infection of bile ducts

Back 560

Ascending cholangitis

Front 561

Gallstones enters and obstructs small bowel

Back 561

Gallstone ileus

Front 562

What is gallstone ileus due to?

Back 562

Cholecystitis with fistula formation between gallbladder and small bowel

Front 563

Adenocarcinoma arising from glandular epithelium that lines the gallbladder wall

Back 563

Gallbladder carcinoma

Front 564

Elderly woman presents with cholecystitis, what does this suggest?

Back 564

Gallbladder carcinoma

Front 565

What is scleral icterus?

Back 565

yellowing of the eye

Front 566

How does extravascular hemolysis or ineffective erythropoiesis cause jaundice?

Back 566

High levels of UCB overwhelm the conjugating ability of the liver

Front 567

Dark urine in extravascular hemolysis is due to what? what is it not due to?

Back 567

Increased urobilinogen NOT UCB (UCB is not water soluble)

Front 568

Extravascular hemolysis or ineffective erytrhopoiesis has an increased risk for what hepatic disorder?

Back 568

pigmented bilirubin gallstones

Front 569

How does physiologic jaundice of the newborn cause jaundice?

Back 569

Newborn liver has transiently low UGT activity

Front 570

What enzyme conjugates unconjugated bilirubin?

Back 570

Uridine Glucuronyl Transferase (UGT)

Front 571

What is kernicterus associated with and what is the pathophysiology of it?

Back 571

Kernicterus is associated with Physiologic jaundice of the newborn and Crigler-Najjar syndrome. UCB is fat soluble and can deposit in the basal ganglia leading to neurological deficits and death.

Front 572

How does phototherapy work for physiologic jaundice of the newborn?

Back 572

It makes the UCB water soluble but does NOT conjugate the UCB

Front 573

How does Gilbert syndrome cause jaundice?

Back 573

Midly low UGT activity. Usually enough UGT not to cause jaundice but at times of high stress will cause jaundice

Front 574

What is the inheritance pattern for gilbert syndrome?

Back 574

Autosomal recessive

Front 575

How does Crigler-Najjar syndrome cause jaundice?

Back 575

Complete absence of UGT, usually fatal

Front 576

Why is Criger-Najjar syndrome usually fatal?

Back 576

Kernicterus

Front 577

What are the two syndromes with disruption of UGT?

Back 577

Gilbert Syndrome - mildly low

Criger-Najjar syndrome - complete absence

Front 578

How does Dubin-Johnson syndrome cause jaundice?

Back 578

Deficiency of bilirubin canalicular transport protein

Front 579

What is the inheritance pattern for Dubin-Johnson syndrome?

Back 579

Autosomal recessive

Front 580

Which disease that causes jaundice has a dark liver?

Back 580

Dubin-Johnson syndrome

Front 581

What syndrome is similar to Dubin-Johnson syndrome but does not have the dark liver?

Back 581

Rotor syndrome

Front 582

How does biliary tract obstruction cause jaundice?

Back 582

Buildup of CB in gallbladder leaks out into the blood

Front 583

Why is urine dark in biliary tract obstruction?

Back 583

Due to conjugated bilirubin

Front 584

How does viral hepatitis cause jaundice?

Back 584

Inflammation disrupts hepatocytes and small bile ductules leading to increase in CB and UCB

Front 585

Why is urine dark in viral hepatitis?

Back 585

Due to conjugated bilirubin

Front 586

Which disease that causes jaundice has pruritis and why does it have pruritis?

Back 586

Biliary tract obstruction - pruritis is due to increased plasma bile acids

Front 587

Which disease that causes jaundice has xanthomas and why does it have xanthomas?

Back 587

Biliary tract obstruction - hypercholestermemia leads to xanthomas

Front 588

Which disease that causes jaundice has steatorrhea with malabsorption of fat-soluble vitamins?

Back 588

Biliary tract obstruction

Front 589

Viral hepatitis is usually due to hepatitis virus but what other two viruses can cause it?

Back 589

EBV and CMV

Front 590

Viral hepatitis has elevated liver enzymes which one is higher than the other?

Back 590

ALT > AST

Front 591

Alcohol-related liver disease has elevated liver enzymes which one is higher than the other?

Back 591

AST > ALT

Front 592

Which Hepatitis virus has fecal-oral transmission?

Back 592

HAV and HEV

Front 593

Which hepatitis is commonly acquired by travelers?

Back 593

HAV

Front 594

Which hepatitis is commonly acquired from contaminated water or undercooked seafood?

Back 594

HEV

Front 595

Which hepatitis is associated with pregnant woman with fulminant hepatitis (liver failure with massive liver necrosis)?

Back 595

HEV infection

Front 596

Which hepatitis has only an acute state and no chronic state?

Back 596

HAV and HEV

Front 597

Which hepatitis is transferred parenterally?

Back 597

HBV and HCV

Front 598

What marker must be present for 6 months to indicate chronic hepatitis B?

Back 598

HBsAG (antigen)

Front 599

Presence of what indicates that you have beat hepatitis B?

Back 599

HBsAB (antibody)

Front 600

What marker indicates that HBV is infectious?

Back 600

HBeAG (envelope antigen)

Front 601

Which hepatitis often progresses to chronic phase, which hepatitis 20% of the time progresses to chronic phase?

Back 601

HCV - most of the time

HBV - 20% of time

Front 602

What marker indicates HCV infection and indicates chronic disease if persistent?

Back 602

HCV-RNA

Front 603

Which hepatitis virus needs another hepatitis virus to infect?

Back 603

HDV

Front 604

What is more severe? Superinfection of HBV/HDV or co-infection of HBV/HDV?

Back 604

Superinfection

Front 605

End-stage liver damage characterized by disruption of the normal hepatic parenchyma by bands of fibrosis and regenerative nodules of hepatocytes

Back 605

Cirrhosis

Front 606

Fibrosis of liver is mediated by what cell which secretes what cytokine?

Back 606

Stellate cells secreting TGF-B

Front 607

What are mallory bodies and what is it associated with?

Back 607

Mallory bodies are damaged intermediate filaments within hepatocytes and is associated with alcoholic hepatitis

Front 608

Nonalcoholic fatty liver disease has increased liver enzymes, which is higher than the other?

Back 608

ALT > AST

Front 609

What is nonalcoholic fatty liver disease associated with?

Back 609

obesity

Front 610

Primary Hemochromatosis has what kind of inheritance pattern?

Back 610

Autosomal recessive

Front 611

Primary hemochromatosis is due to a mutation in which gene?

Back 611

HFE gene

Front 612

Bronze skin and bronze diabetes is associated with what?

Back 612

Hemochromatosis

Front 613

For hemochromatosis hepatocytes are brown, but you need to distinguish the iron from what? what stain do you use to do this?

Back 613

Lipofuscin caused by normal wear and tear, use prussian blue stain to stain the iron.

Front 614

Autosomal recessive defect in ATP-mediated copper transport

Back 614

Wilson disease

Front 615

Wilson disease has what inheritance pattern?

Back 615

Autosomal recessive

Front 616

Autoimmune granulomatous destruction of intrahepatic bile ducts

Back 616

Primary biliary cirrhosis

Front 617

Primary biliary cirrhosis, etiology is unknown but something is present, what is it?

Back 617

antimitochondrial antibody

Front 618

Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts

Back 618

Primary sclerosing cholangitis

Front 619

Periductal fibrosis with an "onion-skin" appearance on histology indicates what hepatic disease?

Back 619

Primary sclerosing cholangitis

Front 620

What hepatic disorder is associated with ulcerative colitis?

Back 620

Primary sclerosing cholangitis

Front 621

What hepatic disorder is p-ANCA positive?

Back 621

Primary sclerosing cholangitis

Front 622

What is reye syndrome?

Back 622

Fulminant liver failure and encepholopathy in children with viral illness who take aspirin

Front 623

Benign tumor of hepatocytes

Back 623

Hepatic adenoma

Front 624

Reye syndrome is likely related to what kind of damage?

Back 624

mitochondrial damage of hepatocytes

Front 625

Hepatic adenoma is associated with what drug?

Back 625

oral contraceptive

Front 626

Malignant tumor of hepatocytes

Back 626

Heptaocellular carcinoma

Front 627

Alfatoxins derived from Aspergillus is associated with what cancer? what mutation does it cause?

Back 627

Hepatocellular carcinoma - p53 mutation

Front 628

What is the serum tumor marker for hepatocellular carcinoma?

Back 628

alpha-fetoprotein

Front 629

Which glucose transporter is responsible for transportation to the blood?

Back 629

GLUT-2

Front 630

Rate limiting enzyme for bile synthesis

Back 630

Cholesterol 7a-hydroxylase

Front 631

What is a curling ulcer?

Back 631

Ulcer that forms when there is decreased plasma volume (burn victims) which leads to sloughing of gastric mucosa

Front 632

Which gastric cancer is associated with nitrosamines (Smoked food)

Back 632

Intestinal

Front 633

What is Charcot triad of cholangitis?

Back 633

Jaundice, Fever, RUQ pain

Front 634

Drugs ending in -dine have what MOA?

Back 634

H2 blocker

Front 635

Drugs ending in -prazole have what MOA?

Back 635

Proton pump inhibitor

Front 636

MOA of Misoprostol

Back 636

PGE1 analog, increases gastric mucosa barrier

Front 637

MOA of Octreotide

Back 637

Long-acting somatostatin analong

Front 638

MOA of Infliximab and what is it used for?

Back 638

Monoclonal antibody to TNF-a

Chron disase, ulcerative colitis, RA, psoriasis, ankylosing spondylitis

Front 639

MOA of Sulfasalazine

Back 639

combo of sulfapyridine (antibacterial) and 5-ASA (anti-inflammatory). Activated by colonic bacteria

Front 640

MOA of Ondansetron and what is it used for?

Back 640

5-HT3 blocker; decrease vagal stimulation. Powerful central acting anti-emetic.

Front 641

MOA of Metoclopramide and what is it used for?

Back 641

D2 receptor antagonist. Increase resting tone, contractility, LES tone, motility. Used for GERD, anti-emetic, gastric emptying.

Front 642

Drugs ending in -odipine have what MOA?

Back 642

Calcium channel blockers that block L-type calcium channels, thereby reducing cardiac muscle contractility.

Front 643

MOA of hydralazine

Back 643

increase cGMP leading to smooth muscle relaxation.

Front 644

What two drugs are used in a hypertensive emergency and what is their MOA?

Back 644

Nitroprusside - increase cGMP via direct release of NO.

Fenoldopam - Dopamine D1 receptor agonist causing vasodilation.

Front 645

MOA of nitroglycerin

Back 645

Vasodilate by increasing NO in vascular smooth muscle.

Front 646

MOA of digoxin

Back 646

Direct inhibition of Na/K atapase leads to indirect inhibition of Na/Ca exchanger/antiport. Increase in Ca leads to positive inotropy (cardiac contraction). Stimulates vagus nerve to decrease HR.

Front 647

MOA of drugs ending in -en/-ine or en/-ate?

Back 647

1st gen H1 blockers (diphenhydramine, dimenhydrinate, chloropheniramine)

Front 648

MOA of drugs ending in -adine?

Back 648

2nd gen H1 blockers (Loratidine, fexofenadine, desloratadine, cetirizine

Front 649

What does guaifenesin?

Back 649

Expectorant - thins respiratory secretions, does not suppress cough reflex

Front 650

What does N-acetylcysteine do?

Back 650

Mucolytic - can loosen mucous plugs in CF patients

Front 651

MOA of dextromethorphan?

Back 651

Antitussive (antagonizes NMDA glutamate receptor)

Front 652

MOA of pseudoephedrine and phenylephrine?

Back 652

alpha agonist

Front 653

MOA of albuterol? what is it used for?

Back 653

B2 agonist, asthma

Front 654

MOA of salmeterol? what is it used for?

Back 654

B2 agonist, asthma

Front 655

MOA of formoterol? what is it used for?

Back 655

B2 agonist, asthma

Front 656

MOA of theophylline and what is it used for?

Back 656

causes bronchodilation by inhibiting phosphodiesterase which increase cAMP due to decrease in cAMP hydrolysis. Asthma.

Front 657

MOA of ipratropium and what is it used for?

Back 657

competitive block of muscarinic receptors, preventing bronchoconstriction. Asthma.

Front 658

MOA beclomethasone and what is it used for?

Back 658

Inhibit synthesis of virtually all cytokines. Inactivate NF-kB, the transcription factor that induces production of TNF-a and other inflammatory agents. Asthma.

Front 659

MOA of fluticasone and what is it used for?

Back 659

Inhibit synthesis of virtually all cytokines. Inactivate NF-kB, the transcription factor that induces production of TNF-a and other inflammatory agents. Asthma.

Front 660

MOA of drugs ending in -lukast (Montelukast, Zafrilukast) and what is it used for?

Back 660

block leukotriene receptors. Especially good for aspirin-induced asthma. Asthma

Front 661

MOA of Zileuton and what is it used for?

Back 661

5-lipoxygenase pathway inhibitor blocks conversion of arachidonic acid to leukotrienes. Asthma

Front 662

MOA of omalizumab and what is it used for?

Back 662

Monoclonal anti-IgE antibody. Binds mostly unbound serum IgE. Asthma

Front 663

MOA of methacoline and what is it used for?

Back 663

Muscarinic receptor agonist. Used to dx asthma

Front 664

Drugs ending in -navir have what MOA and treat what?

Back 664

Protease inhibitor, specifically inhbits HIV-1 protease (pol gene). Protease inhibitors prevent maturation of new viruses.

Front 665

MOA of Raltegravir

Back 665

Inhibits HIV genome integration to host cell chromosome by reversibly inhibiting HIV integrase

Front 666

MOA of Enfuviritide

Back 666

Binds gp41, inhibiting viral entry

Front 667

MOA of Maraviroc

Back 667

Binds CCR-5 on surface of T cells/monocytes, inhibiting interaction with gp120

Front 668

MOA of Zidovudine

Back 668

Nucleoside Reverse Transcriptase Inhibitor

Front 669

IL-8 is responsible for what?

Back 669

Released by macrophages to recruit neutrophils

Front 670

IL-3 is responsible for what?

Back 670

Stimulating growth and differentiation of stem cells in bone marrow.

Front 671

What do each of the blotting techniques detect?North, south, west, southwest?

Back 671

North = RNA

South = DNA

West = Protein

Southwest = DNA binding protein

Front 672

MOA of Ribavarin?

Back 672

Inhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase

Front 673

Cricopharyngeal motor dysfunction can lead to what?

Back 673

Zenker diverticulum

Front 674

Two effects of a VIPoma and how do you treat VIPoma?

Back 674

diarrhea and inhibition of gastric. Tx with somatostatin

Front 675

MOA of diphenoxylate and what is it used for?

Back 675

opiate anti-diarrheal that slows down motility

Front 676

What is a liver specific enzyme that can use break down products of triglyceride?

Back 676

Glycerol kinase

Front 677

What two compounds are elevated in lead poisoning?

Back 677

delta-aminolevulinic acid and pyroxidal phosphate

Front 678

Where are lipids digested? where are they absorbed?

Back 678

Duodenum digests, jejenum absorbs

Front 679

Which portion of the GI tracts is ALWAYS affected in hirschprung disease?

Back 679

Rectum

Front 680

Where are Brunner's glands located and what do they secrete?

Back 680

Alkaline mucous

Front 681

Where are peyer's patches found in the small intestine?

Back 681

Ileum

Front 682

What triggers hepatocellular carcinoma when HBV infects the liver?

Back 682

Integration of the viral DNA with the host DNA.

Front 683

Conjoined kidneys usually connected at the lower pole.

Back 683

Horseshoe kidney

Front 684

Where is the horseshoe kidney located, what does it get stuck on?

Back 684

Located in lower abdomen it gets stuck on inferior mesenteric artery on its ascent.

Front 685

Absent kidney formation

Back 685

Renal agenisis

Front 686

Describe the Potter sequence?

Back 686

Bilateral renal agenesis leads to

-oligohydraminos

-lung hypolplasia

-flat face with low set ears

-development defects of extremities

Front 687

Noninherited, congenital malformation of renal parenchyma characterized by cysts and abnormal tissue.

Back 687

Dysplastic kidney

Front 688

Inherited defect leading to bilateral enlarged kidneys with cysts in the renal cortex and medulla

Back 688

Polycystic Kidney Disease

Front 689

Which cystic kidney disease is unilateral and which is bilateral?

Back 689

Dysplastic kidney - usually unilateral

Polycystic Kidney disease - bilateral

Front 690

Autosomal recessive or dominant PKD presents in infants?

Back 690

Recessive

Front 691

Autosomal recessive or dominant PKD presents with worsening renal failure and HTN?

Back 691

Recessive and Dominant

Front 692

Autosomal recessive or dominant PKD may present with potter sequence?

Back 692

Recessive

Front 693

Autosomal recessive or dominant PKD associated with congenital hepatic fibrosis and cysts?

Back 693

Recessive

Front 694

Autosomal recessive or dominant PKD presents in young adults?

Back 694

Dominant

Front 695

Autosomal dominant PKD is due to either of what two mutations?

Back 695

APKD1 or APKD2

Front 696

Autosomal recessive or dominant PKD presents with hematuria?

Back 696

Dominant

Front 697

Autosomal recessive or dominant PKD associated with berry aneurysm

Back 697

Dominant

Front 698

Autosomal recessive or dominant PKD associated with mitral valve prolapse and hepatic cysts?

Back 698

Dominant

Front 699

Autosomal dominant PKD presents with what three cysts?

Back 699

Cysts in Kidney

Cysts in Brain (berry aneurysm)

Cysts in Liver

Front 700

Medullary cystic kidney disease has what inheritance pattern?

Back 700

Autosomal Dominant

Front 701

Cysts in medullary collecting ducts

Back 701

Medullary cystic kidney disease

Front 702

Parenchymal fibrosis results in SHRUNKEN kidneys and worsening renal failure

Back 702

Medullary cystic kidney disease

Front 703

Hallmark of Acute renal failure?

Back 703

Azotemia often with oliguria

Front 704

Acute renal failure due to decreased blood flow to kidney

Back 704

Prerenal azotemia

Front 705

Acute renal failure due to obstruction of urinary tract downstream from kidney

Back 705

Postrenal azotemia

Front 706

Prerenal or postrenal azotemia: BUN:Cr ratio >15?

Back 706

Prerenal or Postrenal (early) - BUN is reabsorbed due to aldosterone secretion while creatinine can not be reabsorbed

Front 707

Prerenal or postrenal azotemia: BUN:Cr ratio <15?

Back 707

Postrenal (late) - can not reabsorb BUN because the renal tubles or no longer intact?

Front 708

Prerenal or postrenal: FENa < 1%

Back 708

Fractional Excretion of sodium < 1 percent in Prerenal

Front 709

Prerenal or postrenal: FENa >2%

Back 709

Fractional excretion of sodium is >2% in postrenal (late) azotemia

Front 710

Prerenal or postrenal: Urine osmalality > 500 mOsm/kg?

Back 710

Prerenal or postrenal (early)

Front 711

Prerenal or postrenal: Urine osmalality < 500 mOsm/kg?

Back 711

Postrenal (late) - inability to concentrate urine

Front 712

Injury and necrosis of tubular epithelial cells; most common cause of acute renal failure

Back 712

Acute tubular necrosis

Front 713

Pathophysiology of acute tubular necrosis

Back 713

Necrotic epithelial cells of tubules plug tubules; obstruction decreases GFR

Front 714

What renal disease has brown, granular casts that are seen in urine?

Back 714

Acute tubular necrosis

Front 715

Is BUN:Cr < or > 15 in acute tubular necrosis?

Back 715

BUN:CR is < 15 because of inability to reabsorb BUN

Front 716

Is FENa <1 or >2 in acute tubular necrosis?

Back 716

Fractional Excretion of Na (FENa) is >2 because of decreased reabsorption of sodium

Front 717

Is urine osm < or > 500 in acute tubular necrosis?

Back 717

Inability to concentrate urine leads to urine osm to be <500.

Front 718

What are the two major etiologies for acute tubular necrosis?

Back 718

Ischemic and nephrotoxic

Front 719

Prerenal azotemia can progress to what disease?

Back 719

Acute tubular necrosis

Front 720

Which drug class can cause acute tubular necrosis?

Back 720

Aminoglycosides

Front 721

Crush injury can lead to what?

Back 721

Myoglobinuria which leads to acute tubular necrosis

Front 722

Ingesting ethylene glycol can lead to what?

Back 722

Acute tubular necrosis

Front 723

Acute tubular necrosis leads to what acid/base imbalance?

Back 723

Metabolic acidosis

Front 724

Drug-induced hypersensitivity involving the interstitium and tubules of kidneys

Back 724

Acute interstitial nephritis

Front 725

What three drugs can cause interstitial nephritis?

Back 725

NSAIDS, PCN, and diuretics

Front 726

What is pathognomonic for acute interstitial nephritis?

Back 726

Eosinophils seen in urine

Front 727

Presents as oliguria, fever and rash days to weeks after starting a drug

Back 727

Acute interstitial nephritis

Front 728

Necrosis of renal papillae

Back 728

Renal papillary necrosis

Front 729

Glomerular disorders with proteinuria >3.5g/day characterizes what group of disorders?

Back 729

Nephrotic syndrome

Front 730

Nephrotic syndromes result in 2 hypos and 3 hypers

Back 730

Hypoalubminemia - pitting edema

Hypogammaglobulinemia - increases risk of infection

Hypercoagulable state - loss of antithrombin III

Hyperlipidemia

Hypercholesterolemia - may lead to fatty casts in urine

Front 731

Which nephrotic syndrome is associated with Hodgkin lymphoma?

Back 731

Minimal change disease

Front 732

What is the most common nephrotic syndrome in children?

Back 732

Minimal change disease

Front 733

Which nephrotic syndrome has effacement of foot processes that is mediated by cytokines?

Back 733

Minimal change disease mediated by cytokines that are released from reed-sternberg cells of hodgkin lymphoma

Front 734

Which nephrotic syndrome has normal glomeruli on H&E stain?

Back 734

Minimal change disease

Front 735

Which nephrotic syndrome has no immune complexes so negative immunofluorescence. (2)

Back 735

Minimal change disease and Focal segmenting glomerulosclerosis

Front 736

Which nephrotic syndrome has selective proteinuria? (loss of albumin but not immunoglobulin)

Back 736

Minimal change disease

Front 737

Which nephrotic syndrome has an excellent response to steroids?

Back 737

Minimal change disease because the damage is mediated by cytokines from T cells and the steroids inhibit that. No other neprhotic syndromes respond to steroids.

Front 738

Most common cause of nephrotic syndrome in hispanics and african americans?

Back 738

Focal segmental glomerulosclerosis

Front 739

Which nephrotic syndrome is associated with HIV?

Back 739

Focal segmental glomerulosclerosis

Front 740

Which nephrotic syndrome is associated with heroin use?

Back 740

Focal segmental glomerulosclerosis

Front 741

Which nephrotic syndrome is associated with sickle cell disease?

Back 741

Focal segmental glomerulosclerosis

Front 742

What is focal segmental glomerulosclerosis? (break down the name)

Back 742

Focal = some glomeruli

Segmental = involving only part of the glomerulus

Sclerosis on H&E stain

Front 743

Which nephrotic syndrome has effacement of foot processes? (2)

Back 743

Minimal change disease and focal segmenting glomerulosclerosis

Front 744

Most common cause of nephrotic syndrome in caucasian adults

Back 744

Membranous nephropathy

Front 745

Which nephrotic syndrome is associated with hepatitis B or C? (2)

Back 745

Membranous nephropathy and Type 1 membranoproliferative glomerulonephritis

Front 746

Which nephrotic syndrome is associated with solid tumors?

Back 746

Membranous nephropathy

Front 747

Which nephrotic syndrome is associated with SLE?

Back 747

Membranous nephrophaty

Front 748

Which nephrotic syndrome is associated with drugs?

Back 748

Membranous nephropathy

Front 749

Which nephrotic syndrome has a "tram-track" appearance?

Back 749

Membranoproliferative glomerulonephritis

Front 750

Which nephrotic syndromes have immune complex deposition therefore have granular immunofluorescence? (2)

Back 750

Membranous nephropathy and membranoproliferative glomerulonephritis

Front 751

Which nephrotic syndrome has a "spike and dome" appearance on EM?

Back 751

Membranous nepropathy

Front 752

What are the two types of membranoproliferative glomerulonephritis?

Back 752

Type 1 = subendothelial

Type 2 = dense deposit disease, intramembranous

Front 753

Which nephrotic syndrome is associated with an antibody called C3 nephritic factor?

Back 753

Type 2 Membranoproliferative glomerulonephritis

Front 754

Name the three nephrotic syndromes based on location: Subepithelial, intramembranous (basement membrane), subendothelial

Back 754

Subepithelial = membranous nephropathy

Intramembranous (basement membrane) = Type 2 membranoproliferative glomerulonephritis

Subendothelial = Type 1 membranoproliferative glomerulonephritis

Front 755

Which nephrotic syndrome can also cause nephritic syndrome?

Back 755

Membranoproliferative glomerulonephritis

Front 756

Why is GFR increased in diabetes induced nephrotic syndrome?

Back 756

The efferent arteriole is more affected than the afferent arteriole

Front 757

Why do ace inhibitors help the kidneys with patients who have diabetes mellitus?

Back 757

Angiotensin II constricts the efferent arteriole so by blocking it you block the vasoconstriction

Front 758

What are Kimmelstiel-Wilson nodules and what are they associated with?

Back 758

Sclerosis of mesangium of nephrons and is associated with diabetic nephropathy. Looks like an empty nephron filled with hyaline material.

Front 759

Which organ is most commonly involved in systemic amyloidosis?

Back 759

Kidney

Front 760

Which nephrotic syndrome is characterized by apple-green birefringence under polarized light?

Back 760

Nephrotic syndrome caused by systemic amyloidosis

Front 761

0-14 years old which leukemia?

Back 761

ALL

Front 762

15-39 which leukemia?

Back 762

AML blasts with auer rods

Front 763

40-59 which leukemia?

Back 763

AML and CML

Front 764

40-59 year old how do you differentiate AML from CML?

Back 764

AML has blasts greater than 30%

Front 765

60+ years old which leukemia?

Back 765

CLL

Front 766

4 hallmarks of nephritic syndrome that differentiates it from nephrotic syndrome

Back 766

Limited proteinuria <3.5g/day

RBC casts and dysmorphic RBC in urine

Glomerular inflammation

Periorbital edema

Front 767

Nephritic syndrome that arises after group A B-hemolytic streptococcal infection of the skin (impetigo) or pharynx

Back 767

Poststreptococcal Glomerulonephritis (PSGN)

Front 768

Hallmark of this nephritic syndrome are subepithelial "humps"

Back 768

Poststreptococcal glomerulonephritis

Front 769

Nephritic syndrome that progresses to renal failure in weeks to months

Back 769

Rapidly progressive glomerulonephritis

Front 770

Which nephritic syndrome is characterized by crescents in bowmans space and what are those crescents comprised of?

Back 770

Rapidly progressive glomerulonephritis - crescents are made of fibrin and macrophages

Front 771

If IF pattern shows linear (anti-basement membrane antibody) which disease caused the rapidly progressive glomerluonephritis?

Back 771

Goodpasture syndrome

Front 772

If IF pattern show Granular(immune complex deposition) which disease caused the rapidly progressive glomerulonephritis? (2)

Back 772

PSGN or diffuse proliferative glomerulonephritis

Front 773

Rapidly progressive glomerulonephritis that is due to diffuse antigen-antibody complex deposition, usually sub-endothelial

Back 773

Diffuse proliferative glomerulonephritis

Front 774

Most common type of renal disease in SLE patients?

Back 774

Diffuse proliferative glomerulonephritis

Front 775

If IF pattern show negative IF (pauci-immune) which disease caused the rapidly progressive glomerulonephritis? (3)

Back 775

Wegener granulomatosis, microscopic polyangiitis, and Churg-Strauss sydnrome

Front 776

What distinguishes Churg-Strauss from microscopic polyangiitis? (3)

Back 776

Churg-Strauss has granulomatous inflammation, eosinophilia, and asthma.

Front 777

Which nephritic syndrome has IgA immune complex deposition in mesangium of glomeruli

Back 777

IgA Nephropathy (Berger Disease)

Front 778

Which nephritic syndrome has inherited defect in type IV collagen?

Back 778

Alport syndrome

Front 779

Alport syndrome presents with what three key findings?

Back 779

Isolated hematuria

hearing loss

ocular disturbances

Front 780

Infection of bladder

Back 780

Cystitis

Front 781

Gold standard measurement for Cystitis

Back 781

Culture - greater than 100,000 CFU

Front 782

Most common cause for cystitis (bacteria)?

Back 782

E. Coli 80%

Front 783

Cystitis with an alkaline urine and an ammonia scent is most likely due to which bacteria?

Back 783

Proteius mirabilis

Front 784

Name the 5 bacterial causes for cystitis with a positive culture?

Back 784

E. Coli

Staph Saprophyticus

Klebsiella pneumonia

Proteus mirabilis

Enetercoccus faecalis

Front 785

Sterile pyuria with a negative urine culture suggests infection with what? (2)

Back 785

Chlamydia trachomatis

Neisseria gonorrhoeae

Front 786

Infection of kidney

Back 786

Pyelonephritis

Front 787

3 most common pathogens in pyelonephritis

Back 787

E. Coli

Enterococcus faecalis

Klebsiella species

Front 788

Interstitial fibrosis and atrophy of tubules due to multiple bouts of acute pyelonephritis

Back 788

Chronic pyelonephritis

Front 789

Atrophic tubules containing eosinophilic proteinaceous material resemble thyroid follicles suggests what?

Back 789

Chronic pyelonephritis

Front 790

Precipitation of a urinary solute as a stone

Back 790

Nephrolithiasis

Front 791

Treatment for calcium oxalate and/or calcium phosphate stones?

Back 791

Hyrdocholothiazide (calcium-sparing diuretic) - decreases amount of calcium going into urine.

Front 792

Most common cause of this nephrolith is idiopathic hypercalciuria

Back 792

Calcium oxalate and/or calcium phosphate

Front 793

List the four most common nephrolith in order from most to least.

Back 793

Calcium oxalate and/or calcium phosphate

Ammonium magnesium phosphate

Uric Acid

Cysteine

Front 794

Most common cause of this nephrolith is infection with urease-positive organisms (proteius vulgaris or klebsiella).

Back 794

Ammonium magnesium phosphate

Front 795

What is the pathophysiology of the ammonium magnesium phosphate stone?

Back 795

Infection with a urease positive organism leads to alkaline urine which forms a stone.

Front 796

Which nephrolith classically results in a staghorn calculi in renal calyces? (2) one is for adults and one is for children

Back 796

Ammonium magnesium phosphate (adults)

Cysteine (children)

Front 797

Which of the nephroliths are radiolucent?

Back 797

Uric acid

Front 798

This nephrolith is commonly seen in children

Back 798

Cysteine

Front 799

Where is EPO created?

Back 799

renal peritubular interstitial cells

Front 800

Hamartoma comprised of blood vessels, smooth muscle, and adipose tissue?

Back 800

Angiomyolipoma

Front 801

Angiomyolipoma have increased frequency in what?

Back 801

Tuberous sclerosis

Front 802

Malignant epithelial tumor arising from kidney tubules

Back 802

Renal Cell Carcinoma

Front 803

What is the classic triad for renal cell carcinoma

Back 803

Hematuria

Palpable Mass

Flank pain

Front 804

Which of the renal diseases can release excess EPO, renin, PTHrp, or ACTH?

Back 804

Renal cell carcinona - paraneoplastic syndrome

Front 805

Why do you only see left sided varicocele in renal cell carcinoma? why not right?

Back 805

Left spermatic vein drains into renal vein while right spermatic vein drains directly into IVC

Front 806

What kind of cells are seen in renal cell carcinoma?

Back 806

Clear cells

Front 807

What is the pathogenesis of renal cell carcinoma starting with loss of which gene?

Back 807

Loss of VHL (3p) tumor suppressor gene

-increased IGF-1 promotes growth

-increased HIF transcription factor (increases VEGF and PDGF)

Front 808

What is the key risk factor in the spontaneous pathway of renal cell carcinoma?

Back 808

Smoking

Front 809

What disease has an increased risk for renal cell carcinoma? and what other tumor does it have a increased risk for?

Back 809

Von Hippel-Lindau disease and hemangioblastoma of the cerebullum

Front 810

What is the inheritance pattern of Von Hippel-Lindau disease?

Back 810

Autosomal dominant

Front 811

Most common malignant renal tumor in children?

Back 811

Wilms tumor

Front 812

Malignant kidney tumor comprised of blastema, primitive glomeruli and tubules, and stromal cells

Back 812

Wilms tumor

Front 813

Wilms tumor is associated with what mutation?

Back 813

WT1

Front 814

What does WAGR syndrome stand for?

Back 814

Wilms tumor

Aniridia

Genital Abnormalities

Retardation

Front 815

What are the 4 features of Beckwith-Wiedemann syndrome?

Back 815

Wilms tumor

Neonatal hypoglycemia

Muscular hemihypertrophy

Organomegaly especially tongue

Front 816

Malignant tumor arising from urothelial lining of renal pelvis, ureter, bladder, or urethra.

Back 816

Urothelial carcionma

Front 817

Azo dyes increased the risk for what cancer?

Back 817

Urothelial carcinoma

Front 818

Longterm cyclophosphamide or phenacetin can increase risk for what cancer?

Back 818

Urothelial carcinoma

Front 819

What are the two pathways that urothelial carcinoma arises?

Back 819

Flat and papillary