Barone Flashcards
(134 cards)
1
Q
if liver is green and yellow then what
A
cirrhosis
fatty liver from alcohol
2
Q
micronodular cirrhosis is from what
A
alcohol
marco–> other things
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
4
Q
gastrinomas: 25% associated with what
A
MEN1
5
Q
diagnose gastrinoma
A
secretin stimulation test
when give this gastrin, should drop
gastrin goes up with this test in gastrinoma
6
Q
A cell tumor
A
glucagonoma
hyperglycemia
anemia
skin rash (necrolytic migratory erythema)
7
Q
somatostatinoma presentation
A
low acid and malabsoprtion of ood
no GB contaction bc decreased CCK = stones and steatorrhea
also diabetes
8
Q
WDHA syndrome
A
watery diarrhea, hypokalemia, achloryridia
VIPoma
9
Q
migratory thrombophlebitis
A
trousseous syndrome
pancreatic carcinoma
10
Q
number 1 risk factor pancreatic carcinoma
A
smoking
11
Q
80 yr old pt with new onset DM 1
A
think pancreatic carcinoma in body
12
Q
perineural invasion with these tumors is common
A
pancreatic carcinoma
13
Q
whipple procudedure
A
take out part of pancreas, loop of duodenum, bottom part of stomach, and GB
for panc cancer
14
Q
what pts have increased risk cholesterol gallstones
A
native americans
15
Q
biliary tract cancer drug can use
A
traztuzimab
2/3 have HER2-neu overexpression
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)
17
Q
adenocarcinoma of ampulla of vater
A
painless jaundice
blocks pancreatic ducts so get pancreatitis and jaundice
18
Q
CA-15-3 monitors what cancer
A
breast
3 looks like boobs
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
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
21
Q
elevated direct bilirubin with no black liver
A
rotar syndrome
can secrete catecholamines
22
Q
if you have a biliary disesae that looks like a stone that keeps cumming and going think what
A
PBC or PSC
23
Q
stool in biliary disesae
A
stool is pale
24
Q
what lab test for biliary disease
A
alk phos and GGT
25
what is in the nodule of liver cirhossis
regenerating hepatocytes
26
what makes fibrosis in liver
| what does it store?
stellate (ITO cell)
| stores vitamin A
27
viral and toxins is ____nodular
macronodular
everything else like alcohol is micronodular
28
if see trichrome stain then pick what
fibrosis
29
treating esophageal varice
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
30
when the liver fails, what fails next
kidney
31
gynecomastia in liver failure why
bc estrogen cannot be broken down anymore
32
ground glass cytoplasm in hepatocytes (fuzzy)
hepatitis B
33
chronic HCV biopsy
fatty change and lymphoid aggregation
34
what hepatitis with needlestick in hospital
prison?
post transfusion?
B
C
C
35
why does hep D need hep B
needs hepatitis B's capsule to infect the hepatocytes
| surface antigen from the B cell
36
cancer from what hepatitis
b,c,d
37
hepatitis E in what population
what is its struture
pregnant women from india
unenveloped ssRNA
high mortalitiy rate in infected prengnant women
38
macrovesicular steatosis
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
39
GGT normal, ALT>AST =
nonalcoholic fatty liver disease
biopsy same as alcoholic fatty liver
diabetics and obese pts get it
40
hepatocyte swelling and necrosis
| cytokeratin intermdieate filaments
alcoholic hepatitis
| mallory bodies
41
NASH
ALT >AST
looks similar to alcoholic hepatitis
scars
get hisdtory
42
what nucleus does wilsons disease effect
lenticular nucleus
putamin and GP
AR
43
wilsons is on what chrom and what gene
chrom 13
| ATP7B
44
wilsons disease population
young people
45
where is the eye discoloration in wilsons disease
decements membrnae of eye
46
what does wilsons disesae look like
ADHD with parkinsonism
47
treat wilsons
d penicillamine chelator
trientine (something else) if allergic to penicilin
liver transplant if get cirrhosis
48
hemochromotasosis HLA and chromosome
| and gene
HLA-A3
chromosome p
HFE gene C282Y
second most common is H63D
49
physio hemochromatosis
liver stops making hepcidin so Fe unregulated entry through gut
50
treat hemochromatosis
phlebotomy, women wont get until post menopause
51
people set off metal detector at airport
hemochromatosis
52
hemochromatosis can lead to
micronodular cirrhosis and HCC bc of increased free radicals in liver
can deposit into pituitary and stop gonadotropin = hypogonadism
53
gene in a1 antitrypsin deficiency
SERPINA1
serine protease inhib gene or Pi
Pimm normal
PiZZ abnormal
54
liver biopsy in a1 antitrypsin
PAS positive, eosinophilic cytoplasmic globules in hepatocytes
55
what change would you see in reye syndrome
injures mitochondria
hepatic fatty change (MICROVESICULAR steatosis) bc acute so micro
cerebral edema/encephalopathy
56
most common tumor within liver is
metastatic
57
most common primary tumor of the liver
benign hemangioma
red and spongy
dont need to treat just dont biopsy
incidental finding
58
liver neoplasm:
young women related to estrogen
pregnant women and women on OCs
hepatocellular adenoma
59
woman with severe abdominal pain and tap it, get blood, with well circumscirbed mass under liver, will see normal liver but NO PORTAL TRIADs =
hepatocellular adenoma
60
hepatocelluar adenoma in man
steroids or transgender
61
hepatocellular adenoma can turn to
HCC
| B-HCA has beta catenein mutations
62
nodule in liver with central stellate scar
focal nodular hyperplasia
63
grains that get moldy and then eaten, homeless guy eats old peanut butter, grows on peanuts
aflatoxin B1 =249 mutation in p53
64
aflatoxin spreads
check what
marker for tumor
looks like what
hematogenously to portal and hepatic veins
can get budd chiari
check lungs
AFP is tumor marker
yellow green single invasive mass
65
risk factors for hepatic angiosarcoma
VAT
vinyl chloride
arsenic
thorotrast
66
untreated meningitis
leads to sepsis and DIC then get bilateral hemmorhagic adrenal damage
67
leptomeninges in meningitis
opaque b have lots of puss
| diffuse cerebral edma and fatal herniations
68
treat rabbies
active vaccination with antigen and give passive Igs (put near bite)
put vaccine far away
69
rabies binds ____ then ges endocytoses in nerves and goes retrograde in nerves to brain
ACHR
70
every virus that starts with ___ is and RNA virus
R
71
double stranded RNA virus
reo
72
cd4 count for pml
under 50
73
what lobe does mucor penetrate
frontal
74
cork screw motiltiy
trich vaginalis
75
toxo bacterial absecess where
basal ganglia
76
cruetzfeldt jakob
PrPc (politically correct form)
| changes to b pleated sheet conformation (PRPsc (scrape) your brain
77
spongiform encephalopathy
vacuoulization of neuropil
| holey brain all over, kuru plaques
78
14-3-3 protein
rapid neuronal death with proper history then can diagnose prion disese
79
amaurosis fugax
curtain closing down virion
| warning stroke
80
global cerebral ischemia location
hippocampus, CA1 area is where you see red neurons
if cerebellum then purkinje
infarction = watershed
81
what is usually spared in TIA
peripheral gray
82
use thromboylytics for ___ infarcts seen on CT
pale
83
spinal tap has blood means what
subarachnoid hemorrhage
84
most common cause of preceding incident of subarachnoid hemorrhage
sex
also if strenously lifting boxes, or cocaine
85
CT of subarachnoid hemorrhage
CT will show bleed on bottom of brain
then do CT angiogram so you can localize bleed
86
get vasospasm from arteries compresed around blood in SAH so give
CCB
87
mot common sites of subarach hemm
anterior communicating artery most comon
MCA 2nd most common
ICA area is 3rd
88
crescent shaped bridging vein rupture
subdural hematoma
| risk is brain atrophy
89
subdural hematoma onset of symptoms
long lucid interval, 12-24 hrs
90
syringomyelia is assocaited with what other problem
arnold chiari malformation
91
huge cystic space in spot where should have cerebellum, dilated 4th ventricle
dandy walker
youll be a dandy of a walker bc you didn't develop center of cerebellum (vermis)
92
arnold chiari type I
asmptomatic
93
arnold chiari type II
associations
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
HLA for MS
HLA DR2
95
diagnosing MS
MRI
96
axons are or are not attacked in MS
not damaged so can remyelinate, never get 100% function back
| just oligodendrocytes attacked
97
different areas of brain involved at different times is key for diagnosis of
MS
98
treatment for MS
interferon beta
natalizumab
(monoclonal antibody aginast CAM a4-integrin)
99
natalizumab could reactivate what
JC virus and cause PML
100
treatment for PNH
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
gene mutation possible in parkinsons
SNCA for alpha synuclein (lewy bodies)
most cases sporadic
102
what increases risk for parkinsons disease
meperidine (demoral)
| MPTP
103
main cause of death in parkinsons
aspiration and bronchopneumonia
104
intracytoplasmic round eosionphilic inclusion in brain that contains __
a synuclein
| lewy body
105
lewy body dementia
```
parkinsons with dementia
get dementia early
visual hallucinations
get orthostatic HTN when stand up
hyposmia and contipation is early clue
```
106
huntingtons mutaiton
CAG repeat
toxic GOF mutaiton
caudate atrophy
107
treatment for huntingtons
only can treat chorea
| dopaine blocking agent
108
hydrocephalus ex vacuo
normal pressure but more fluid bc brain atrpohy
| alzheimers, picks, huntingtons
109
protective of alzheimers
smoking and high education
| increased Ach
110
APP presenilin 1 and 2
alzheimers
111
E4 vs E2
E4 is higher risk on apolipoprotein
| increased atheroscelrosis
112
most important for degree of dementia in alzheimers
tangles > plaques
113
tangles are what
hyperphosphorylated tau
alzheimers
114
hirano bodies
made of actin filaments in alzheimers pts
115
affected area in brain in alzheimers
hippocampus in the medial aspect of the temporal lobe
116
tacrine
to treat alzheimers
117
SOD1
ALS
118
accumulation of _____ in cytoplasm of dying neurons for ALS
TDP-43
DNA binding protein should be in the nucleus
also accumulates in the cytoplasm in picks disease
119
rizluzole
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
most common malignant brain tumor in kids
medulloblastoma
121
most common benign tumor in kids
pilocytic astrocytoma
122
GFAP positive brain tumor
| describe histology
pilocytic astrocytoma
neoplastic astrocytes with long bipolar processes
(looks like hair)
123
good mutation in Glioblastoma multiforme
IDH1
124
high mitotic rate, necrosis, vascular proliferation
pseudopallisading of neoplastic tumor cells around areas of necrosis
midline crossing, ring enhanceing
GBM
evil tumor
so evil that neoplastic tumor cells gather around and look at the areas of necrosis (pseudopallisading)
125
GFAP positive
adults that present with seizure
calcified frontal lobe mass
oligodendolioma
126
capillaries criss cross each other so look like chicken wire
oligodendroglioma
127
good muations with oligodendroglioma
1p and 19q
128
GFAO positive lines ventricles so mass in ventricles
| pappillary mass in 4th ventricle of children
ependymoma
129
what adults get epednymoma
adults get it in the spinal cord when they have NF2
130
perivascular pseudorossetes in brain tumor
ependymoma
131
ebryonal tumor
from neuroectoderm
make neuropil
hoer wright rossettes
132
good mutation in medulloblastoma
WNT
133
drop metastasis
medullloblastoma that spreads to CSF and goes to spinal cord, gives tumor masses in spinal cord
134
neuroblastoma in adrenal medulla
like what, mutation, makes what, look for what
cross midline?
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
