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Pathology > Block 11 > Flashcards

Block 11 Flashcards

1
Q

Cancer of WBCs/blood/bone marrow

A

Leukemia

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2
Q

Increased total WBC count

A

Leukocytosis

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3
Q

Increased neutrophil count

A

Neutrophilia

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4
Q

Increased lymphocyte count

A

Lymphocytosis

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5
Q

Decreased total leukocyte count

A

Leukopenia

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6
Q

Low neutrophil count can indicate what

A

Leukemia (bone marrow squished to death)

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7
Q

Decreased neutrophil count

A

Neutropenia

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8
Q

Decreased lymphocyte count

A

Lymphocytopenia

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9
Q

All blood decreased (WBCs/RBCs/ PLTs)

A

Pancytopenia

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10
Q

Peripheral blood compartment: circulating in blood

A

Circulating granulocyte pool

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11
Q

Peripheral blood compartment: adhere to walls of capillaries

A

Marginal granulocyte pool

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12
Q

Increased demand/release of immature neutrophils from bone marrow

A

Shift to the left

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13
Q

Most common causes of neutrophilia with a left shift

A

Acute infections (bacterial) or acute inflammation/tissue necrosis

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14
Q

Least common cause of neutrophilia with a left shift

A

Leukemia

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15
Q

Blood contains mature and immature neutrophils (= 50,000/microL), but not leukemia

A

Reactive leukocytosis

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16
Q

Reactive leukocytosis is easily confused with

A

Chronic myelocytic leukemia (CML)

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17
Q

Reactive leukocytosis is usually in repsonse to

A

Infection

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18
Q

Possible causes of neutropenia

A

Drugs, infection, leukemia

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19
Q

Most common cause of neutropenia

A

Drugs

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20
Q

Most common cause of lymphocytosis

A

Acute viral infections

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21
Q

3 possible causes of lymphocytosis

A

Acute viral infections
Chronic infections
Lymphocytic leukemia

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22
Q

4 causes of lymphocytopeia

A

Genetic
Drugs
AIDS
Leukemia (squishing bone marrow)

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23
Q

How is leukemia diagnosed

A

Bone marrow biopsy

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24
Q

How is lymphoma diagnosed

A

With lymph node biopsy

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25
Q

Most common signs of leukemia

A

Anemia, bleeding

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26
Q

Most common symptoms of leukemia

A

Weigh loss, swollen/bleeding gums, night sweats

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27
Q

Leukemia: rapid progression

A

Acute leukemia

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28
Q

Leukemia: immature cells

A

Acute leukemia

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29
Q

Leukemia: gradual progression

A

Chronic leukemia

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30
Q

Chronic myeloid leukemia (CML) can transition to

A

Acute myeloid leukemia (AML)

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31
Q

Common diagnostic tests for leukemia

A

CBC

Bone marrow as pirate

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32
Q

Type of leukemia: ALL

A

Acute lymphocytic leukemia

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33
Q

Type of leukemia: AML

A

Acute myeloid leukemia

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34
Q

Type of leukemia: CLL

A

Chronic lymphocytic leukemia

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35
Q

Type of leukemia: CML

A

Chronic myeloid leukemia

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36
Q

Most common leukemia in children

A

ALL

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37
Q

Worst leukemia

A

AML

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38
Q

Most common leukemia

A

CLL

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39
Q

Lab findings with leukemia: ALL

A

> 20% blasts in bone marrow

  • WBC extremes (high or low)
  • lymphoblasts express Tdt
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40
Q

Which cell type is ALL usually dealing with

A

B cell

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41
Q

In ALL, lymphoblasts express what

A

Tdt

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42
Q

Prognosis for ALL

A

5 year survival: 70% normal, 95% kids

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43
Q

Patients that AML is typically seen in

A

Adults

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44
Q

Lab findings with leukemia: AML

A

> 20% blasts in bone marrow

  • WBC extremes (high or low)
  • auer rods
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45
Q

Diagnostic of AML

A

Aure rods in myeloblasts

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46
Q

Prognosis of AML

A

Death in weeks if untreated

5 year survival: 25% overall, 66% kids

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47
Q

Type of leukemia: characterized by Philadelphia chromosome

A

CML

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48
Q

Typical age of CML pt

A

Adult

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49
Q

Lab findings with leukemia: CML

A

Elevated WBC

- immature and mature neturophils

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50
Q

Prognosis of CML

A

5 year survival: 60%

- until gleevec –> demonstrate >80% remission

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51
Q

What has increased survival rate of CML

A

Gleevec

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52
Q

Is CLL more common in males or females

A

Males (2:1)

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53
Q

Typical age of pt with CLL

A

Adults

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54
Q

Lab findings in leukemia: CLL

A

Elevated WBC

  • all mature neutrophils
  • Marked lymphocytosis
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55
Q

Prognosis of CLL

A

Median survival for stage 1/2: 10 years

For stage 3/4: <2 years

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56
Q

Which 2 types of leukemia are rare in children

A

CLL and CML

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57
Q

2 major types of lymphomas

A

Hodgkins and non-hodgkins

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58
Q

What age ranges are lymphoma usually presented

A

Mid 20s and mid 50s (bimodal)

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59
Q

Symptoms of lymphomas

A

Present with painless lymphadenopathy

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60
Q

Lab findings for lymphomas

A

Blood usually normal, some presenting as leukemia

- Reed-Sternberg cells if Hodgkins

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61
Q

What cells are seen in lab findings if the pt has Hodgkin’s lymphoma

A

Reed-Sternberg cells

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62
Q

Prognosis of hodgkins

A

5 year survival = 85%

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63
Q

Prognosis of non-hodgkins

A

5 year survival: 69%, many become unresponsive

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64
Q

Plasma cells replace bone marrow

A

Multiple myeloma

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65
Q

Symptoms of multiple myeloma

A

Microfactures (bone pain), usually in lower back

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66
Q

Lab findings for multiple myeloma

A
  • Anemia with normal neutrophil and platelets
  • monoclonal protein spike in urine and blood
    60% secrete IgG
    20% secrete IgA
    20% secrete only light chains
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67
Q

Prognosis of multiple myeloma

A

5 year survival rate = 66% (was 30% in 2000)

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68
Q

Lymphoma staging: cancer in single lymph node group

A

Stage 1

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69
Q

Lymphoma staging: 2 or more lymph node groups on 1 side of diaphragm

A

Stage 2

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70
Q

Lymphoma staging: spread to both sides of diaphragm, or involves the spleen

A

Stage 3

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71
Q

Lymphoma staging: involves liver, bone marrow, or lung

A

Stage 4

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72
Q

What is the HGB rule of 3?

A

HGB x3 = Hematocrit +/- 3

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73
Q

Which WBC nucleus is thee same volume of a RBC

A

Lymphocyte nucleus

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74
Q

Average size of rbc

A

8 microns

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75
Q

How much do RBCs outnumber WBCs

A

1000:1

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76
Q

How many O2 molecules does 1 hemoglobin molecule carry

A

4

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77
Q

Immature circulating rbcs

A

Reticulocytes

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78
Q

HGB and HCT are below normal range

A

Anemia

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79
Q

3 causes of anemia

A

Blood loss
Impaired rbc production
Accelerated rbc destruction

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80
Q

MCV <75

A

Microcytic

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81
Q

Iron deficiency anemia

A

Microcytic

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82
Q

MCV 80-98

A

Normocytic anemia

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83
Q

MCV >100

A

Macrocytic anemia

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84
Q

B12 and folate deficiency anemia

A

Macrocytic

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85
Q

adult norms: HCT male polycythemia

A

> 55

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86
Q

adult norms: male HCT anemia

A

<40

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87
Q

adult norms: female polycythemia

A

> 50

88
Q

adult norms: female HCT anemia

A

<37

89
Q

adult norms: normocytic

A

80-98

90
Q

adult norms: microcytic

A

<75

91
Q

adult norms: macrocytic

A

> 100

92
Q

adult norms: male hemoglobin

A

14-18

93
Q

adult norms: female hemoglobin

A

12-15

94
Q

adult norms: MCHC normochromic

A

32-36

95
Q

adult norms: MCHC hypochomic

A

<32

96
Q

Stage 4 lymphoma is highly

A

Metastasized

97
Q

The leading cause of anemia worldwide

A

Iron deficiency

98
Q

High levels of reticulocytes indicate

A

Hemolysis or blood loss (normocytic anemia)

99
Q

What is serum B12 levels in folate deficiency macrocytic anemia

A

Normal

100
Q

What is serum B12 value in B12 deficiency macrocytic anemia

A

Decreased

101
Q

What are ferritin levels in iron deficency microcytic anemia

A

<20

102
Q

Which depletes quickest, folate or B12?

A

Folate (3 months vs B12 3 years)

103
Q

Vegetable associated with hemolysis due to G6PD deficiency

A

Fava beans

104
Q

What medications are associated with hemolysis due to G6PD deficiency

A

NSAIDS
Antimalarials
Sulfa containing drugs

105
Q

Deficient production of HGB beta chain

A

Beta thalassemia

106
Q

Deficient production of HGB alpha-chain

A

Alpha thalassemia

107
Q

Population most at risk for thalassemia

A

Mediterranean (Italy and Greece)

108
Q

Thalassemia causes what kind of anemia

A

Microcytic, hypochomic anemia

109
Q

B12 deficiency is often due to an absence of

A

Intrinsic factor

110
Q

Sickle cell anemia alters HGB and produces

A

HGB S

111
Q

Which anemia is thalassemia most confused with

A

Iron deficient bc both microcytic, hypochromic anemia

112
Q

RDW level in thalassemia

A

Normal to high

113
Q

If RDW is high, what will you look at

A

Ferritin

114
Q

If RDW is high and ferritin is low

A

Iron deficiency

115
Q

High RDW and normal ferritin and has target cells

A

Thalassemia

116
Q

RDW in iron deficiency

A

High

117
Q

Hemoptysis in a 60yo pt who is a smoker is likely a symptom of

A

Lung cancer

118
Q

Most common cause of bacterial sinusitis

A

S. Pneumoniae

119
Q

Most important pathogenic feature that causes sinusitis

A

Mucosal edema an block of mucous draining

120
Q

Pain over cheek upon tapping is a symptom of

A

Sinusitis

121
Q

You suspect your pt has strep throat. What test to confirm you diagnosis

A

Rapid strep test

122
Q

Most common cause of typical community acquired pneumonia

A

S. Penumoniae

123
Q

Where is the inflammation mostly localized in typical community acquired pneumonia

A

Alveoli

124
Q

Where is inflammation mostly localized in atypical community acquired pneumonia

A

Interstitium

125
Q

Why does mycobacterium live comfortably in macrophages

A

Inhibits fusion of phagosome with lysosomes hence preventing destruction by lysosomal enzymes

126
Q

How does TB affect eye

A

Uveitis or retinitis

127
Q

What are symptoms of influenza

A

High fever, runny nose, sore throat, muscle and joint pains, HA, cough, tired, PAIN WITH EYE MOVEMENTS

128
Q

Who would you urge to get a vaccine

A

Everyone; mandatory for people >65 and people with chronic illness

129
Q

What is COPD

A

Progressive, irreversible obstruction to airflow out of the lungs

130
Q

What is the main cause of COPD

A

Smoking

131
Q

The pathophysicologic mechanism of COPD

A

Chronic inflammation leads to destruction of elastic fibers which exert radial traction
Results in bronchiolar collapse during expiration, which increases the pssr and destroys the normal alveolar structure

132
Q

What is asthma

A

Episodic and reversible airway disease of bronchi

133
Q

What is the pathophysiologic mechanism of asthma

A

Abnormal bronchial muscle contraction as a reaction to histamine liberated by mastocytes

  • 2 stages
    1: sensitization
134
Q

Most common origin of emboli

A

Deep veins of lower extremities and pelvis

135
Q

Difference between a thrombus and embolus

A

Embolus is a detached thrombus

136
Q

Pathogeneiss of cor pulmonale

A

Increased pssr in pulmonary arteries –> inc pressure in right ventricle –>ventricle hypertrophies–>ventricle decompensates and dilates –> right heart failure

137
Q

Difference between hydrostatic and oncotic pressure

A 
Hydrostatic = pressure that blood exerts on vessel walls
Oncotic = pssr that plasm proteins create
138
Q

Where does plasma that leaks thru the walls of pulmonary capillaries end

A

Alveoli = drowning

139
Q

What causes interstitial fibrosis in lungs

A

Chronic inflammation

140
Q

What is the result of interstitial fibrosis

A

Fibrosis lung cannot expand to full extend –> difficulties and decreased breathing

141
Q

How do the pulmonary vessels react to hypoventilation? What is the result?

A

They contract; pulmonary hypertensiton –> cor pulmonale –> right heart failure

142
Q

What diagnosis would yo ususpect in a 35yo African American woman with uveitis, mild dyspena and reddish skin nodules

A

Sarcoidosis

143
Q

What are the earliest symptoms of lung cancer

A

Cough, weight loss, hemoptysis

144
Q

What types of lung cancers are there? Which ones are more strongly connected to smoking and which are less?

A

Adenocarcinoma (less connection with smoking, somewhat better prognosis), small cell carcinoma (most related to smoking), squamous cell carcinoma, large cell carcinoma, bronchial carcinoid

145
Q

Wat is an oncogene

A

mutated genes that normally determine cell survival and division. Once escaped the normal cellular gene control these genes determine uncontrolled cellular division which eventually produces tumor cells.

146
Q

What is a suppressor gene

A

gene that normally triggers apoptosis. If there is a mutation affecting such a gene which makes it inefficient, the affected cell becomes “immortal” and sooner or later becomes a tumor cell.

147
Q

Describe horner’s syndrome

A

Ptosis, miosis and anyhdrosis
- compression and destruction of sympathetic nerves innervating the eye most often caused by tumor, originating from apex of lung

148
Q

What causes the ptosis in Horner’s syndrome?

A

Besides motor innervation from the facial nerve of m. levator palpebrae the upper lid also has a small smooth muscle (called the Mueller’s muscle) that keeps it open by sympathetic innervation from the upper sympathetic ganglion. Upon sympathetic destruction by a tumor this innervation is lost and the eyelid sags.

149
Q

Which GI disorder is most likely to be confused with angina

A

GERD

- bc of location of pain

150
Q

Incomplete relaxation of lower esophageal sphincter

- dont digest food

A

Achalasia

151
Q

If a patient has achalasia, what are that at an increased risk for

A

Esophageal squamous cell carcinoma

152
Q

Herniation of the stomach through the esophageal hiatus of diaphragm

A

Hiatal hernia

153
Q

Reflux or backward movement into esophagus

- related to eating

A

GERD

154
Q

Weak or incompetent lower esophageal sphincter causes

A

GERD

155
Q

Respiratory diseases are secondary to

A

GERD

156
Q

Symptoms of GERD are relieved by

A

Sitting upright

157
Q

Barrett’s esophagus can lead to

A

Esophageal adenocarcinoma

158
Q

What happens in Barrett’s esophagus

A

Squamous cells are replaced by columnar epithelium contains goblet cells

159
Q

2 types of esophageal cancer

A

Adenocarcinoma

Squamous cell carcinoma

160
Q

Where in the esophagus do adenocarcinoma occur

A

Distal third

161
Q

Cancerous complication of GERD and Barrett’s esophagus

A

Adenocarcinoma (bottom 1/3)

162
Q

What part of the esophagus does squamous cell carcinoma occur

A

Middle (top 2/3)

163
Q

Main presenting complaint in esophageal cancer

A

Dysphagia

164
Q

What is not seen in chronic gastritis but is seen in acute gastritis

A

Grossly visible erosions

165
Q

3 types of chronic gastritis

A

Helicobacter pylori gastritis
Autoimmune gastritis
Chemical gastropathy

166
Q

2 common complications of Barrett’s esophagus

A

Strictures and ulcers

167
Q

Usually transient and may be accomapanied by hemorrhage

A

Acute gastritis

168
Q

Most common cause of chronic gastritis

A

Helicobacter pylori gastritis

169
Q

Small s shaped gram negative rods (stain pink) having multiple flagella

A

Helicobacter pylori gastritis

170
Q

Treatment of helicobacter pylori gastritis is

A

Combo therapy with 2/3 antibiotics with a proton pump inhibitor

171
Q

Autoimmune gastritis can lead to what

A

Adenocarcinoma

172
Q

10% of cases of chronic gastritis are

A

Autoimmune gastritis

173
Q

Autoimmune gastritis is often associated with

A

Other autoimmune disorders

- diabetes, hashimotos, Addison’s)

174
Q

Chronic injury due to alkaline duodenal reflux

A

Chemical gastropathy

175
Q

Periodic pain is the hallmark for

A

Peptic ulcer disease

176
Q

Rare condition with IR respectable gastronomes in duodenum and pancreas; 2/3 malignant and 1/3 have metastasize

A

Zollinger-Ellison syndrome

177
Q

2 types of stress ulcers

A

Curling ulcers

Cushing ulcers

178
Q

Major stress like burns, trauma, sepsis, liver failure

- often in fundus

A

Curling ulcers

179
Q

Gastric, duodenal and esophageal ulcers in people with intracranial injury

A

Cushing ulcers

180
Q

15th leading cause of death

A

Stomach cancer

181
Q

5 year survival of stomach cancer

A

31%

182
Q

Is detection easy or hard in stomach cancer

A

Hard

183
Q

Risk factors of stomach cancer

A

Genetics

Preserved and smoke foods

184
Q

Diagnosis of stomach cancer

A

X-ray or ct scan

Cytologic studies

185
Q

Treatment of stomach cancer

A

Radical subtotal gastrectomy

Irradiation and chemotherapy

186
Q

Most common cause of ulcers

A

Heliobacter pylori

187
Q

Location and lesions seen in crohn’s disease

A

SKIP lesions
In any portion of gi tract
Spare rectum

188
Q

Location of ulcerative colitis

A

Colon
Continuous inflammation
Rectal involvement

189
Q

Where is pain in Crohn’s disease

A

Lower right abdomen

190
Q

Where is pain in ulcerative colitis

A

Lower left abdomen

191
Q

Colon wall in Crohn’s disease

A

Thickened (cobblestone like) containing fistulas

192
Q

Colon wall in ulcerative colitis

A

Thinner with pseudopolyps

193
Q

Complication of ulcerative colitis

A

Colorectal carcinoma

194
Q

Is there bleeding from rectum in crohn’s disease

A

No

195
Q

Is there bleeding from rectum in ulcerative colitis

A

Commonly

196
Q

Which is more likely to have ocular manifestations, crohn’s or ulcerative colitis

A

Crohn’s

197
Q

Ocular findings in crohn’s or ulcerative colitis are

A

Non granulomatous uveitis

198
Q

1 automimmune disorder in the US

A

Celiac disease

199
Q

What triggers celiac disease

A

Gluten (gliadin)

- barley, rye, oats, wheat

200
Q

Type of rash seen in Celiac disease

A

Pruritic rash

- itching and burning

201
Q

How do diagnose celiac disease

A

History
IgA:anti tTG (high IgA)
Biopsy (flatted gut)

202
Q

How to treat celiac disease

A

Remove gluten from diet

203
Q

2 chronic inflammatory disorders related to inflammatory bowel disease

A

Crohn’s disease and ulcerative colitis

204
Q

What may be the patients initial complaint in Crohn’s disease or ulcerative colitis

A

Uveitis

205
Q

Treatment of inflammatory bowel disease

A

Anti-inflamm agents
Immunosuppressive agents
Steroids
Surgery

206
Q

Chronic, recurrent, functional abdominal disorder

A

Irritable bowel syndrome

207
Q

Main trigger of irritable bowel syndrom

A

Stress and certain foods (processed, HFCS, milk formulas)

208
Q

Recurrent pain 3days a month for the last 3 moths with 2 of 3 different associations. What are the associations

A
  • pain relieve with defecation
  • change in bowel habits
  • change in stool form
209
Q

Treatment of irritable bowel syndrome

A

Stress management
Increase fiber
Avoid: fatty, gas producing foods, alcohol and caffeine
Drugs

210
Q

Is diverticulosis asymptomatic or symptomatic

A

Asymptomatic

211
Q

Is diverticular disease asymptomatic or symptomatic

A

Symptomatic

212
Q

Where is pain in appendicitis

A

Right lower quadrant

213
Q

What is rebound pain and what is it seen with

A

Pain goes away when you press on your appendix

- appendicitis

214
Q

How to treat stage 1 colon cancer

A

Full size surgery removal

215
Q

How to treat stage 2 and 3 colon cancer

A

Reduce size with radiation and then surgery

216
Q

How to treat stage 4 colon cancer

A

Surgery, then chemo and radiation

Pathology (5 decks)

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