Barone HY Flashcards
What is a richter transformation?
CLL –> large cell lymphoma
Dilated cardiomyopathy causes what murmur?
Described how?
AR
Diastolic BLOWING murmur
Infarction of what artery causes Broca and Wernicke’s?
MCA
Main histo finding in PD?
Lewy bodies that have alpha-synuclein
It’s a sin to show your LEWD body
Aflatoxin causes mutations in what?
Can cause what cancer?
p53 at position 249
HCC
What are the nephrotic syndrome symptoms?
Protein > 3.5 g/day
Generalized edema
Hypercoaguable
Lipiduria - fatty casts (oval fat bodies)
What murmur has an opening snap?
Best heard how?
MS
Bell in left lateral decubitus position
Mutations in what gene for A1AT?
SERPINA1
What causes acute pyelonephritis?
uti VU reflux Pregnancy Diabetics Males w/BPH
What is the following levels in PCOS for the following hormones?
LH FSH Androgen Estrogen Progesterone
High Low High High Low
What stain in liver biopsy for Hemochromatosis?
Tx?
Prussian blue
Phlebotomy, Deferoxamine, Deferusirox
What are the nephrotic syndromes?
MM FAN
MCD Membranous FSGS Amyloidosis Nodular GS
B-ALL has what translocation w/good prognosis?
Bad prognosis?
T(12;21)
t(9;22)
What makes HOCM murmur quieter?
Why?
Squatting, lay down
Increases Venous return (preload) moves big septum out of way
Adenocarcinoma of bladder occurs where? Due to what?
Bladder dome, urachal remnant
If the entire is brain is ischemic, after 5 minutes where will you see red neurons in the brain?
Hippocampus in CA1
Purkinje neurons in the cerebellum
What brain structures degenerates the most in Wilson’s disease?
Mutation in what gene?
Inheritance?
Putamen and GP
ATP7B, ch. 13
AD
What bran problem shows a crescent shaped moon pattern and crosses suture lines?
Due to what?
Subdural hematoma
Ruptured of bridging veins
MC tumor of heart is what?
(+) for what?
Melanoma
HMB-45, S-100
Cresents in RPGN are made of what?
How does it affect GFR?
Fibrin, macrophages, podocytes
Decreases GFR
What HL has excellent prognosis and has popcorn cells?
What does it no have?
Lymphocyte-predom
R-S cells
Alport syndrome due to what mutation?
Sx?
EM shows what?
COL4A5 mutated (COLT45)
Hearing and vision defects w/kidney
basketweave appearance
Lesion to PICA causes what sx?
Called what?
Dysphagia, hoarseness, c/l los of pain/temp
Lateral medullary (Wallenberg) syndrome
Marky Mark Wallenberg has good LATS
What HL is MC, looks like cirrhosis of LN?
Prognosis?
RS cell has what?
Nodular sclerosis
Excellent
Clear space in cytoplasm (lacunar cell)
Goodpasture’s IF shows what? Where?
The antibody is against what?
linear IgG subepithelial
Collagen Type 4 alpha-3 subunit
What makes AS murmur louder?
Why??
Sitting to squatting, lay down
Increase Venous Return
What amoeba has cork scew motility?
Trichamonis vaginalis
What are the germ cell tumors?
Immature teratoma (dermoid cyst)
Dysgerminoma
Seminoma
Pegler-Huet cells seen in what?
Tx?
MDS
Lenalidomide
Wilms tumor is also called what?
What does the microscope show?
Nephroblastoma
Triphasic: metanephric blastema, stroma, epithelial elements (glomeruli and tubules)
What are pink, corkscrew-like eosinophilic structures in the brain called?
Rosenthal fibers
ALS has what mutated gene? Inheritance?
What accumulates in neurons that are dying?
Tx which prolongs life by 2-3 months?
SOD1, AD
TDP-43
Riluzole
What NHL has blasts in the blood that go to your skin, brain, gums and acts like a macrophage that goes to the tissues?
AML M5
Budd-Chiari manifests how? What PE finding?
Image with what?
Tx?
Congested nutmeg liver
RUQ pain, palpable liver, jaundice, SM
US
tPA
What ovarian tumor has a PTEN mutation?
Endometrioid
What does a wbc > 100,000 indicate?
LAP is what?
Major sx?
CML
Decreased
HUGE spleen
MVP murmur gets louder when?
Moves closer or further from S2?
Why?
Decreased Preload
Further (closer to S1)
Less blood it contracts more
Flexner-Wintersteiner seen in what tumor?
Retinoblastoma
Which vaccines are killed?
RIP Always Rabies Influenza (Orthomyxovirius) Polio (Salk) HepA
What are Hirano bodies?
Made of what?
Seen in what disease?
Inclusion in dying neurons (made of actin)
AD
What tumor is CD99+?
Occurs in what part of the body?
Has what microscopic finding?
What tumor is basically the same but in your brain?
Ewing sarcoma
Diaphysis of long bones
Pseudo wright-rosettes
Primitive neuroectodermal tumor
What makes AS murmur quieter?
Why?
Sitting to standing, Valsalva
Decreases venous return (preload)
AML is (+) for what?
MPO
CD13, CD 33
How to treat PCOS in pt that wants to become pregnant?
Clomiphene (SERM), prevents (-) feedback inhibition resulting in increased LH and FSH
What are all the nephritic symptoms, think of the mneumonic
“i” –> interstate, you need to use a GPS (Goodpasture’s, PSGN) will see a crescent moon (RPGN) while driving so you stop to get a burger (Berger IgA). If you do not get good miles per gallon (MPGN) do not take the tram tracks. Drive to the airport (Alport’s) and watch the plane touch down on the X-marked spot (X-linked)
Medulloblastoma can cause what kind of hemorrhages?
What has best prognosis?
Bad?
Duret
Wnt
Spreads into CSF and SC –> drop metastases
Sx of Acute interstitial nephritis?
Fever, maculopapular rash, symptoms of renal failure
Wilson’s disease looks like what other diseases?
Copper deposits in what layer of eye?
Treatment? If allergic?
ADHD w/Parkinsonism
Descemet’s membrane
D-penicillamine, if allergic: Trientine
vCJD affects what pts?
In the CSF what will be elevated?
Young pt
14-3-3 protein
What murmur is located subaortic stenosis?
HOCM
AD
What is the MC cause of ATN?
Due to what?
Ischemic acute tubular necrosis
Hemorrhage, vasoconstriction, shock
What is unaffected in acute pyelonephritis?
Urine shows what?
Glomerulus
Pyuria and wbc casts
Bone marrow with blasts > 20% indicates what?
Between 1-20%?
Acute leukemia
Myelodysplasia (pre-leukemia)
What murmur has increased wide pulse pressure, head bobs with each beat of heart?
What else is seen?
AR
Water-hammer pulse, pistol shot bruit in femoral pulse
What are intracytoplasmic round pink eosinophilic inclusions that contain alpha synuclein?
Lewy bodies
Lewy Body Dementia presents what?
Has dementia and PD symptoms, also get VISUAL hallucinations of animals, people
Xanthochromia (yellow) CSF indicates what?
Why?
Bleed in brain
Bc of breakdown of rbc’s
Muddy brown casts indicate what?
Acute tubular necrosis
-ischemia or nephrotoxic injury
Myelofibrosis is due to what?
Sx?
What finding on peripheral blood smear?
Too much PDGF, too many megakaryocytes
Dry tap, enlarged spleen w/extramedullary hematopoiesis
Teardrop rbcs
Which HL has a strong (70%) association with EBV?
Mixed cellularity
How do you track HCC?
AFP
MVP murmur how to make it quieter?
Moves closer or further from S2?
Why?
Increase venous return
Closer to S2 (shorter and quieter)
More blood stretches it out
Ependymoma is tumor of what? Present how?
(+) for what?
Microscopic finding?
4th ventricle, in kids as obstructing hydrocephalus
GFAP
Perivascular pseudorosettes and true rosettes
MVP seen in what?
FAME
Fragile X
ADPKD
Marfan
EDS
Painless enlarging LNs that hurt while drinking indicates what?
HL
What lymphoma is high grade and has sheets of tumor cells?
What other association does it have?
Diffuse large B-cell lymphoma
HHV-8
What has fixed splitting of S2?
ASD
ARPKD is due to a mutation in what protein?
What chromosome?
Fibrocystin
6
What murmur is VERY loud with harsh thrill at left lower sternal border?
VSD
What are the CD markers for Mantle cell lymphoma?
CD5, 19, 20(+)
CD23 (-)
Serous papillary cystadenocarcinoma has what gene mutation?
What major histo?
p53
Psammoma bodies
What brain tumor associated with Tuberous Sclerosis?
Presents how?
What other findings?
Sub-ependymal giant cell astrocytoma
Non-communicating hydrocephalus
Rhabdomyoma, angiofibromas of face, ash-leaf patch, shagreen’s patches
What kidney stones look like rectangular prisms or Coffin lids?
AMP aka struvite stones
RS cells are what CD (+)?
15, 30
What kidney stone is elongated, wedge-shaped and forms rosettes?
Calcium phosphate
SLE class 4 has what special feature?
Deposits of what where?
Wire loops
Subendothelial IgG immune complexes
What are the sex cord-strom tumors?
Fibroma –> Meigs syndrome
Granulosa cell tumor
Sertoli-Leydig Cell tumor
Multiple myeloma sx?
Use mneumonic
CRAB HyperCalcemia Renal Failure Anemia Bone
What are the following lab values for the following in hemochromatosis?
Ferritin
Serum Fe
TIBC
% saturation
Inc
Inc
Dec
Inc
Infarction of the PCA causes what?
What lobe?
Contralateral hemianopsia w/macular sparing
Occipital
What makes HOCM murmur louder?
Why?
Sitting to standing
Valsalva
Decreases venous return
Nephrotoxic Acute Tubular necrosis is bc of what?
Aminoglycosides, sulfa drugs, methicillin
Or crush injury resulting in myoglobinuria
What HL is an old person w/poor prognosis?
Lymphocyte depleted
RCC can invade where on the left?
Left gonadal vein causing bag of worms feeling, will not get better when lying down
Menke’s disease inheritance?
Defective gene?
Need Cu as a cofactor for what?
What major sx?
X-linked
ATP7A, cannot ABSORB copper
Lysyl oxidase
Hypothermia bc need Cu for ETC –>ATP
How to treat ATN w/hyperkalemia showing EKG changes?
To correct HyperK do what?
Calcium gluconate or calcium chloride
Insulin and glucose, beta 2 agonist, bicarbonate
What kidney stone has yellow or red-brown diamond or rhombus shape?
Uric acid
Parkinson Disease has what gene with what structures?
SNCA gene w/alpha-synuclein
What is Tdt(+)?
What other (+) does it have which favors good prognosis?
ALL
B-ALL CD19+
What is used to treat SLE?
What SE?
Hydroxychloroquine
Damage vision
FSGS has what common feature?
Sx?
Who is at highest risk?
Lipoprotein L1
Puffy and swollen, low albumin, high cholesterol
AIDs pt –> collapsing form
What fungus is very common in diabetics, especially when they are in ketoacidosis?
Affects what part of brain?
Mucor aka Rhizopus
Frontal lobe
What organism has falling leaf motility?
Giardia
Treatment for Wilson’s disease?
D-penicillamine
Wilson’s Dick
What causes pigmented bilirubin stones?
Hereditary spherocytosis
Ascending cholangitis from E coli, Ascaris, or Clnorchis sinensis
What kidney stone is flat, yellow and hexagonal?
Cysteine stone
Ssssssix sides
Wernicke’s is due to damage in what specific area?
Superior temporal gyrus of temporal lobe
Oligodendroglioma is (+) for what?
Microscopy show what?
What has better prognosis?
GFAP
chicken wire, fried egg (perinuclear halos)
1q and 19q deletions
What is the pathognomonic finding for chronic pyelonephritis?
Looks like thyroid tissue
Tubules are dilated and filled w/colloid
Dry Tap, big spleen and pancytopenia = what?
(+) for what?
Hairy cell
CD11c, 19, 20, 103
What is the presenting symptom of Goodpasture’s?
Tx?
Hemoptysis then smoky urine
Steroids, cyclophosphamide
Who’s at risk for getting hepatocellular adenoma?
Presents how?
Young women who are on BCPs or pregnant
AND male bodybuilders on steroids
Abdominal pain
What parasite goes to the intestine and liver?
Causes what?
Spine located where?
Schistosoma mansoni
Pipestem fibrosis
Lateral side
Who is at risk to get HepE?
Pregnant women
People from developing countries (India)
How do you treat M3 AML?
What translocation?
All trans retinoic acid
T(15; 17)
PML –> a-RAR on Zn finger
If pt has multiple ring-enhancing lesions on CT and you treat them but they are not improving at all, what do they most likely what?
NHL –> diffuse B-cell large Lymphoma
What murmur has diastolic blowing after S2?
AR
Russel bodies w/Mott cell and IgA that makes flame cells seen in what?
Tx?
Multiple myeloma
Bortizomib
Waxy casts seen in what?
Chronic glomerulonephritis
What hepatitis has morphology of ground glass appearance of hepatocytes, fuzzy cytoplasm?
HepB
What parasite can go to the bladder and cause squamous cell cancer?
Spine located where?
Schistosoma haemotobium
Tail
Anti-microsomes antibodies seen in what?
Hashimoto’s
What has a M spike to due IgM
Lymphoplasmacytic lymphoma –> Waldenstrom’s
Lesions to anterior spinal artery causes what?
Called what?
C/L paralysis of UE and LE
I/L CN 12 dysfunction (tongue deviates toward dysfunctional side)
Medial medullary syndrome
CML shows what major features?
Wbc > 100,000
INCREASED basophils
Biggest spleen ever
What shows a spike and dome appearance?
Deposits located where?
Associated with what other disease?
Membranous
Subepithelial
HepB
Degree of dementia in AD correlates to what?
Seen on what stain?
NF tangles aka flame figures
Silver stain
M.S. HLA?
Treat w/what?
2 letters –> HLA-DR2
IFN-B, Natalizumab
CLL has what (+) CDs?
What special finding?
5, 19, 20
Smudge cells
What microscopic findings will you see in alcoholic hepatitis?
Mallory bodies (ubiquinated cytokeratin) and hepatocyte swelling
What cancer is associated w/warm autoimmune hemolytic anemia which gives a + direct COOMBS test?
CLL
Which kidney stones look like the back of an envelope?
How else is it described?
Calcium oxalate
Octahedron w/square X in center
What RCC has a GOF in MET?
What type has the best prognosis? Stains how?
Papillary
Chromophobe, DARKLY
What hepatitis has fatty cytoplasm and lymphoid aggregates and follicles?
HepC
what is a neuroblastoma?
Makes what?
What mutation?
Presents how?
Mal tumor of adrenal medulla
Epi and NE
N-myc amplification
Myoclonus w/dancing eyes, bluberry muffin baby
RCC due to a VHL mutation causes what type?
Microscopically has what pattern?
Clear cell (full of lipid and glycogen)
Alveolar growth
Pilocytic Astrocytoma located where?
What microscopic finding?
Mutation in what?
Tx how?
Posterior fossa (cerebellum)
Rosenthal fibers
BRAF
Vermurafenib (Ser Thr kinase inhibitor)
What HS is AIN?
What causes acute interstitial nephritis?
If Type 1 HS rxn, see eosinophils in urine, if not then Type 4
caused by methicillin and NSAIDs, other antibiotics
What are the characteristics of PSGN in nephritic syndrome?
Elevated levels of what?
IF shows what?
Located where?
M12 serotype
ASO titers and DNase B
Granular deposits of IgG and complement
Subepithelial —> lumpy bumpy
C3 deficiency with silver stain nephrotic syndrome is what?
MPGN
What are the nephritic syndrome symptoms?
Hematuria (colo/tea-colored urine)
Periorbital edema
Azotemia and oliguria
New onset HTN
What kidney stone is not viewable on xray?
Uric acid –> gout
Lesion to AICA causes what?
Called what?
Facial droop same side
Loss of pain and temp c/l side
Lateral Pontine syndrome
What are the sx of Acute tubular injury?
What type of casts are seen?
Oliguria and azotemia
Metabolic acidosis
Brown/muddy brown dirty casts
Arnold chiari type 1 is what?
Type 2?
asymptomatic
Faulty craniospinal junction, no room, cerebellum grows downward and 4th ventricle is CRUSHED
What is the main structure in the brain that is affected by AD?
Hippocampus, medial aspect of temporal lobe
Subfalcine hernia compresses what?
What else?
Sx?
Cingulate gyrus
ACA
C/L LE weakness
Subarachnoid hemorrhage due to what?
Where is the bleeding located?
Ruptured berry aneurysm aka saccular aneurysm (#1 branch points in Ant. Circle of Willis)
BASE of brain
MGPN type 1 deposits where?
Type 2?
Subendothelial
BM shows Dense Deposits
When a brain CT shows calcified frontal lobe mass presenting w/a seizure, what is dx?
Oligodendroglioma
Leggo my EGGgo w/Fried Chicken
Rabies binds to ____ receptors and gets endocytosed into the nerve and travels ________ with this protein:
ACh
Retrograde
Dyenin
What causes syringomyelia?
What structure is affected?
Dilated area in the spinal cord, mostly bc of Arnold Chiari
Spinothalamic tract (pain/temp)
Arnold-chiari type 2 sx?
Obstructive NON-communicating hydrocephalus
Inc. ICP
HA
GBM shows what microscopic finding?
What mutation has a good prognosis?
Overall what is the prognosis?
Pseudopalisading necrosis
IDH1
BAD
Dandy-Walker is what?
Sx?
Missing cerebellum (roof of 4th ventricle), will have HUGE dilated 4th ventricle
Ataxia
My he’s DANDY waLker…NOT
What is Charcot’s triad?
Reynaud’s pentad?
Biliary colic, jaundice, high fever
+ hypotension and mental status change
AIDS pt dies w/scattered hemorrhages, think what?
If they are abscesses?
Aspergillus
Toxoplasmosis
PBC causes granulomas that block bile ducts in liver called what?
Florid duct lesion
Broca’s is due to damage of what specific area?
Inferior frontal gyrus of frontal lobe
Eculizumab treats what?
MOA?
PNH
Knocks out C5
E is 5th letter of alphabet
What causes macronodular cirrhosis? What size is it?
What causes micronodular?
Viral or Toxin, > 3mm
Alcohol, everything else
Major causes of aseptic meningitis?
Enteroviruses:
Polio
Coxsackie A + B
Echovirus
Hemochromatosis due to what gene mutation?
Due to what substitutions?
Liver stops making what?
What sx?
HFE, C282Y or N63D
Hepcidin
Arthritis, diabetes, bronzing, arrhythmia, hypogonadism
Hyper-Vit A causes what sx?
Increased ICP
Pseudotumor
What has a central stellate scar, you do not have to resect and is found incidentally on CT, not a cancer?
Focal nodular hyperplasia
