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Boards DF > Barone > Flashcards

Barone Flashcards

1
Q

if liver is green and yellow then what

A

cirrhosis

fatty liver from alcohol

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2
Q

micronodular cirrhosis is from what

A

alcohol

marco–> other things

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3
Q

22 year old girl that is sexually active, has UC, collapses and dies: what happened?

A

toxic megacolon, with UC so bacteria got in lead to peritonitis, then septic shock

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4
Q

gastrinomas: 25% associated with what

A

MEN1

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5
Q

diagnose gastrinoma

A

secretin stimulation test
when give this gastrin, should drop
gastrin goes up with this test in gastrinoma

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6
Q

A cell tumor

A

glucagonoma
hyperglycemia
anemia
skin rash (necrolytic migratory erythema)

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7
Q

somatostatinoma presentation

A

low acid and malabsoprtion of ood
no GB contaction bc decreased CCK = stones and steatorrhea
also diabetes

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8
Q

WDHA syndrome

A

watery diarrhea, hypokalemia, achloryridia

VIPoma

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9
Q

migratory thrombophlebitis

A

trousseous syndrome

pancreatic carcinoma

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10
Q

number 1 risk factor pancreatic carcinoma

A

smoking

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11
Q

80 yr old pt with new onset DM 1

A

think pancreatic carcinoma in body

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12
Q

perineural invasion with these tumors is common

A

pancreatic carcinoma

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13
Q

whipple procudedure

A

take out part of pancreas, loop of duodenum, bottom part of stomach, and GB
for panc cancer

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14
Q

what pts have increased risk cholesterol gallstones

A

native americans

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15
Q

biliary tract cancer drug can use

A

traztuzimab

2/3 have HER2-neu overexpression

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16
Q

cholangiocarcinoma cause and site

A

bifurcaiton of R and L hepatic ducts

liver fluke in asia

PSC can cause this to (walter peyton)

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17
Q

adenocarcinoma of ampulla of vater

A

painless jaundice

blocks pancreatic ducts so get pancreatitis and jaundice

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18
Q

CA-15-3 monitors what cancer

A

breast

3 looks like boobs

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19
Q

what vitamin do you want to give a baby with jaundice when you are using blue light

A

vitamin B2 bc light breaks it down

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20
Q

what makes the liver black in dubin johnson syndrome

A

catecholamines

the transporter for excretion of bile is used by catecholamines too so it gets stuck in there

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21
Q

elevated direct bilirubin with no black liver

A

rotar syndrome

can secrete catecholamines

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22
Q

if you have a biliary disesae that looks like a stone that keeps cumming and going think what

A

PBC or PSC

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23
Q

stool in biliary disesae

A

stool is pale

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24
Q

what lab test for biliary disease

A

alk phos and GGT

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25
Q

what is in the nodule of liver cirhossis

A

regenerating hepatocytes

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26
Q

what makes fibrosis in liver

what does it store?

A

stellate (ITO cell)

stores vitamin A

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27
Q

viral and toxins is ____nodular

A

macronodular

everything else like alcohol is micronodular

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28
Q

if see trichrome stain then pick what

A

fibrosis

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29
Q

treating esophageal varice

A

lactulose for upper GI bleed in cirrhosis
flushes out blood and colon
is an acid so binds with ammonia and traps it and then it is pooped out

can give broad spectrum antibiotic too

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30
Q

when the liver fails, what fails next

A

kidney

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31
Q

gynecomastia in liver failure why

A

bc estrogen cannot be broken down anymore

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32
Q

ground glass cytoplasm in hepatocytes (fuzzy)

A

hepatitis B

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33
Q

chronic HCV biopsy

A

fatty change and lymphoid aggregation

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34
Q

what hepatitis with needlestick in hospital
prison?
post transfusion?

A

B
C
C

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35
Q

why does hep D need hep B

A

needs hepatitis B’s capsule to infect the hepatocytes

surface antigen from the B cell

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36
Q

cancer from what hepatitis

A

b,c,d

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37
Q

hepatitis E in what population

what is its struture

A

pregnant women from india

unenveloped ssRNA

high mortalitiy rate in infected prengnant women

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38
Q

macrovesicular steatosis

A

alcoholic fatty liver
binge for 3-4 days in a row
drink for yrs then fibrosis in centrilobular macrovesicular steatosis
GGT will go up with alcohol and stays elevated for several days

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39
Q

GGT normal, ALT>AST =

A

nonalcoholic fatty liver disease
biopsy same as alcoholic fatty liver
diabetics and obese pts get it

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40
Q

hepatocyte swelling and necrosis

cytokeratin intermdieate filaments

A

alcoholic hepatitis

mallory bodies

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41
Q

NASH

A

ALT >AST
looks similar to alcoholic hepatitis
scars
get hisdtory

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42
Q

what nucleus does wilsons disease effect

A

lenticular nucleus
putamin and GP
AR

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43
Q

wilsons is on what chrom and what gene

A

chrom 13

ATP7B

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44
Q

wilsons disease population

A

young people

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45
Q

where is the eye discoloration in wilsons disease

A

decements membrnae of eye

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46
Q

what does wilsons disesae look like

A

ADHD with parkinsonism

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47
Q

treat wilsons

A

d penicillamine chelator
trientine (something else) if allergic to penicilin
liver transplant if get cirrhosis

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48
Q

hemochromotasosis HLA and chromosome

and gene

A

HLA-A3
chromosome p
HFE gene C282Y
second most common is H63D

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49
Q

physio hemochromatosis

A

liver stops making hepcidin so Fe unregulated entry through gut

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50
Q

treat hemochromatosis

A

phlebotomy, women wont get until post menopause

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51
Q

people set off metal detector at airport

A

hemochromatosis

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52
Q

hemochromatosis can lead to

A

micronodular cirrhosis and HCC bc of increased free radicals in liver

can deposit into pituitary and stop gonadotropin = hypogonadism

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53
Q

gene in a1 antitrypsin deficiency

A

SERPINA1
serine protease inhib gene or Pi
Pimm normal
PiZZ abnormal

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54
Q

liver biopsy in a1 antitrypsin

A

PAS positive, eosinophilic cytoplasmic globules in hepatocytes

55
Q

what change would you see in reye syndrome

A

injures mitochondria
hepatic fatty change (MICROVESICULAR steatosis) bc acute so micro
cerebral edema/encephalopathy

56
Q

most common tumor within liver is

A

metastatic

57
Q

most common primary tumor of the liver

A

benign hemangioma
red and spongy
dont need to treat just dont biopsy
incidental finding

58
Q

liver neoplasm:

young women related to estrogen
pregnant women and women on OCs

A

hepatocellular adenoma

59
Q

woman with severe abdominal pain and tap it, get blood, with well circumscirbed mass under liver, will see normal liver but NO PORTAL TRIADs =

A

hepatocellular adenoma

60
Q

hepatocelluar adenoma in man

A

steroids or transgender

61
Q

hepatocellular adenoma can turn to

A

HCC

B-HCA has beta catenein mutations

62
Q

nodule in liver with central stellate scar

A

focal nodular hyperplasia

63
Q

grains that get moldy and then eaten, homeless guy eats old peanut butter, grows on peanuts

A

aflatoxin B1 =249 mutation in p53

64
Q

aflatoxin spreads

check what
marker for tumor
looks like what

A

hematogenously to portal and hepatic veins
can get budd chiari

check lungs
AFP is tumor marker
yellow green single invasive mass

65
Q

risk factors for hepatic angiosarcoma

A

VAT
vinyl chloride
arsenic
thorotrast

66
Q

untreated meningitis

A

leads to sepsis and DIC then get bilateral hemmorhagic adrenal damage

67
Q

leptomeninges in meningitis

A

opaque b have lots of puss

diffuse cerebral edma and fatal herniations

68
Q

treat rabbies

A

active vaccination with antigen and give passive Igs (put near bite)
put vaccine far away

69
Q

rabies binds ____ then ges endocytoses in nerves and goes retrograde in nerves to brain

A

ACHR

70
Q

every virus that starts with ___ is and RNA virus

A

R

71
Q

double stranded RNA virus

A

reo

72
Q

cd4 count for pml

A

under 50

73
Q

what lobe does mucor penetrate

A

frontal

74
Q

cork screw motiltiy

A

trich vaginalis

75
Q

toxo bacterial absecess where

A

basal ganglia

76
Q

cruetzfeldt jakob

A

PrPc (politically correct form)

changes to b pleated sheet conformation (PRPsc (scrape) your brain

77
Q

spongiform encephalopathy

A

vacuoulization of neuropil

holey brain all over, kuru plaques

78
Q

14-3-3 protein

A

rapid neuronal death with proper history then can diagnose prion disese

79
Q

amaurosis fugax

A

curtain closing down virion

warning stroke

80
Q

global cerebral ischemia location

A

hippocampus, CA1 area is where you see red neurons
if cerebellum then purkinje
infarction = watershed

81
Q

what is usually spared in TIA

A

peripheral gray

82
Q

use thromboylytics for ___ infarcts seen on CT

A

pale

83
Q

spinal tap has blood means what

A

subarachnoid hemorrhage

84
Q

most common cause of preceding incident of subarachnoid hemorrhage

A

sex

also if strenously lifting boxes, or cocaine

85
Q

CT of subarachnoid hemorrhage

A

CT will show bleed on bottom of brain

then do CT angiogram so you can localize bleed

86
Q

get vasospasm from arteries compresed around blood in SAH so give

A

CCB

87
Q

mot common sites of subarach hemm

A

anterior communicating artery most comon
MCA 2nd most common
ICA area is 3rd

88
Q

crescent shaped bridging vein rupture

A

subdural hematoma

risk is brain atrophy

89
Q

subdural hematoma onset of symptoms

A

long lucid interval, 12-24 hrs

90
Q

syringomyelia is assocaited with what other problem

A

arnold chiari malformation

91
Q

huge cystic space in spot where should have cerebellum, dilated 4th ventricle

A

dandy walker

youll be a dandy of a walker bc you didn’t develop center of cerebellum (vermis)

92
Q

arnold chiari type I

A

asmptomatic

93
Q

arnold chiari type II

associations

A

faulty carniospinal junction
bones of posterior fossa fuse too early so too small so no room for cerebellum, so instead it grows down and crushes 4th ventricle and grows down to push on syrnix (syningomyelia)

also associated with lumbar meningomyelocele

94
Q

HLA for MS

A

HLA DR2

95
Q

diagnosing MS

A

MRI

96
Q

axons are or are not attacked in MS

A

not damaged so can remyelinate, never get 100% function back

just oligodendrocytes attacked

97
Q

different areas of brain involved at different times is key for diagnosis of

A

MS

98
Q

treatment for MS

A

interferon beta
natalizumab
(monoclonal antibody aginast CAM a4-integrin)

99
Q

natalizumab could reactivate what

A

JC virus and cause PML

100
Q

treatment for PNH

A

eculizumab

knocks out MAC
which is activated at night at lyses red cells bc of decreased pH from decreased breathing at sleep

ew, liz peed on me at night (PNH)

101
Q

gene mutation possible in parkinsons

A

SNCA for alpha synuclein (lewy bodies)

most cases sporadic

102
Q

what increases risk for parkinsons disease

A

meperidine (demoral)

MPTP

103
Q

main cause of death in parkinsons

A

aspiration and bronchopneumonia

104
Q

intracytoplasmic round eosionphilic inclusion in brain that contains __

A

a synuclein

lewy body

105
Q

lewy body dementia

A 
parkinsons with dementia 
get dementia early
visual hallucinations
get orthostatic HTN when stand up
hyposmia and contipation is early clue
106
Q

huntingtons mutaiton

A

CAG repeat
toxic GOF mutaiton
caudate atrophy

107
Q

treatment for huntingtons

A

only can treat chorea

dopaine blocking agent

108
Q

hydrocephalus ex vacuo

A

normal pressure but more fluid bc brain atrpohy

alzheimers, picks, huntingtons

109
Q

protective of alzheimers

A

smoking and high education

increased Ach

110
Q

APP presenilin 1 and 2

A

alzheimers

111
Q

E4 vs E2

A

E4 is higher risk on apolipoprotein

increased atheroscelrosis

112
Q

most important for degree of dementia in alzheimers

A

tangles > plaques

113
Q

tangles are what

A

hyperphosphorylated tau

alzheimers

114
Q

hirano bodies

A

made of actin filaments in alzheimers pts

115
Q

affected area in brain in alzheimers

A

hippocampus in the medial aspect of the temporal lobe

116
Q

tacrine

A

to treat alzheimers

117
Q

SOD1

A

ALS

118
Q

accumulation of _____ in cytoplasm of dying neurons for ALS

A

TDP-43
DNA binding protein should be in the nucleus
also accumulates in the cytoplasm in picks disease

119
Q

rizluzole

A

treatment for ALS
decreases release of glutamate
only gives extra 2-3 months to live

think about rizzuto from happy gilmore so relate the baseball player to lou gherigs disease (baseball player)

120
Q

most common malignant brain tumor in kids

A

medulloblastoma

121
Q

most common benign tumor in kids

A

pilocytic astrocytoma

122
Q

GFAP positive brain tumor

describe histology

A

pilocytic astrocytoma
neoplastic astrocytes with long bipolar processes
(looks like hair)

123
Q

good mutation in Glioblastoma multiforme

A

IDH1

124
Q

high mitotic rate, necrosis, vascular proliferation
pseudopallisading of neoplastic tumor cells around areas of necrosis
midline crossing, ring enhanceing

A

GBM

evil tumor
so evil that neoplastic tumor cells gather around and look at the areas of necrosis (pseudopallisading)

125
Q

GFAP positive
adults that present with seizure
calcified frontal lobe mass

A

oligodendolioma

126
Q

capillaries criss cross each other so look like chicken wire

A

oligodendroglioma

127
Q

good muations with oligodendroglioma

A

1p and 19q

128
Q

GFAO positive lines ventricles so mass in ventricles

pappillary mass in 4th ventricle of children

A

ependymoma

129
Q

what adults get epednymoma

A

adults get it in the spinal cord when they have NF2

130
Q

perivascular pseudorossetes in brain tumor

A

ependymoma

131
Q

ebryonal tumor

A

from neuroectoderm
make neuropil
hoer wright rossettes

132
Q

good mutation in medulloblastoma

A

WNT

133
Q

drop metastasis

A

medullloblastoma that spreads to CSF and goes to spinal cord, gives tumor masses in spinal cord

134
Q

neuroblastoma in adrenal medulla

like what, mutation, makes what, look for what
cross midline?

A

just like pheo bc can make epinephrine and norep
n myc mutation
looks for VMA/HVA/free metanephrine
does cross midline bc malignant and it calcifies (so not wilms)
if goes to skin then blueberry muffin baby

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