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Bud Notes > HBT and the Pancreas > Flashcards

HBT and the Pancreas Flashcards

2
Q

Which drug characteristically causes valvular plaques usual causing MR?

A

Fenfluramine + phentermine (fen-phen.

Plaque is similar to that caused by carcinoid heart disease and methysergide / ergot therapy.

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3
Q

Nonbacterial thromboembolis is increased in underlying malignancy particularly this histologic type

A

Mucinous adenocarcinoma

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4
Q

Hypertrophic cardiomyopathy is associated with ventricular obstruction. The obstruction is dynamic caused by which leaflet of which valve.

A

Anterior leaflet, MV

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5
Q

Most commonly mutated gene in hypertrophic cardiomyopathy affects synthesis of which protein.

A

B-myosin heavy chain

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6
Q

Most common form of restrictive cardiomyopathy worldwide

A

Endomyocardial fibrosis

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7
Q

Form of endomyocarditis associated with peripheral hyper eosinophilia, large mural thrombi a d release of major basic protein

A

Loeffler endomyocarditis

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8
Q

Most common helminth with associated cardiac involvement

A

Trichinosis

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9
Q

Most common tumor metastatic to the heart

A

Lung Ca

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10
Q

Most common location of the most common primary tumor of the heart

A

Myxoma of the left atrium

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11
Q

Cold agglutinins develop in which infections

A

Mycoplasma pneumonia

Infectious mono

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12
Q

Single most important long-term limitation for cardiac transplantation

A

Graft coronary arteriosclerosis

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13
Q

The earliest change in peripheral blood of patients with megaloblastic anemias

A

Hyper segmented neutrophils

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14
Q

When do you see monocytosis?

A 
Chronic infections
Bacterial endocarditis
Rickettsiosis and malaria
Collagen vascular diseases
Inflammatory bowel diseases
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15
Q

When do you see basophilic Leukocytosis?

A

Rare! But may be seen in myeloproliferative disease (CML)

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16
Q

Acute bacterial infection that causes lymphocytosis

A

Bordetella pertussis

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17
Q

Causes of follicular hyperplasia

A

Rheumatoid arthritis
Toxoplasmosis
Early stage HIV

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18
Q

ALL is also known as ____.CLL is also known as ____.

A

ALL = precursor B-cell and T-cell lymphoblastic leukemia

CLL = small lymphocytic leukemia

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19
Q

Staining characteristics of ALL vs AML

A

ALL is Periodic acid Schiff positive.

AML is Periodic acid Schiff negative

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20
Q

Lymphoid Neoplasm Quiz!Most common in adolescent males.Thymic involvement, mediastinal mass.NOTCH1

A

Precursor T cell lymphoma

Aka T-cell ALL

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21
Q

Lymphoid Neoplasm Quiz!85% of childhood acute leukemia

A

Precursor B-cell lymphoblastic leukemia aka

B-cell ALL

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22
Q

Splenomegaly is greatest in which hemolytic condition

A

Hereditary spherocytosis

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23
Q

Lymphoid Neoplasm Quiz!30% of all leukemiasOccurs in older adults

A

Chronic lymphocytic lymphoma

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24
Q

Lymphoid Neoplasm Quiz!Small “cleaved” cells mixed with large cells.t(14;18).CD10+, BCL2+

A

Follicular lymphoma

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25
Q

Lymphoid Neoplasm Quiz!CD+ mature B cells that express cyclin D1 and have surface Ig.t(11;14).Moderately aggressive.

A

Mantle cell lymphoma

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26
Q

B cells home to epithelium creating lymphoepithelial lesions.CD5-, CD10-.Cured by local excision.Association with autoimmune conditions.H pylori associated, associated with MALT

A

Extra nodal marginal zone lymphoma

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27
Q

Intermediate sized round cells with several nucleoli; diffuse tissue involvement with apoptosis (“starry sky”).CD10+.Endemic in Africa.Visceral involvement.

A

Burkitt lymphoma

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28
Q

40-50% of adult lymphomasMature B cellsAggressive; often arise at extra nod areas

A

Diffuse large B-cell lymphoma

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29
Q

Lymphoid Neoplasm Quiz!Most common lymphoid neoplasm in adults.Disseminated bone disease with lytic lesions

A

Plasmacytoma aka plasma cell myeloma

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30
Q

Lymphoid Neoplasm Quiz!Most common cutaneous lymphoid malignancy.Lymphoid cells with convoluted nuclei infiltrating the epidermis (Pautrier microabscess).CD4+ mature T-cells.Association with Sezary syndrome.

A

Mycosis fungoides

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31
Q

Most common adult T-cell lymphoma.Mature T-cell phenotype.

A

Peripheral T-cell lymphoma, NOS

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32
Q

Most common type of Hodgkin lymphoma.Adolescent males

A

HL, nodular sclerosis type

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33
Q

Most common plasma cell dyscrasia

A

Monoclonal gammopathy of undetermined significance

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34
Q

Lesions in multiple myeloma are most commonly found in which bone.

A

Vertebral column

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35
Q

The single most common genetic abnormality in myeloproliferative disorders other than CML (PCV, essential thrombocytemia, myelofibrosis)2

A

JAK2 kinase

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36
Q

What is Hand-Schuller-Christian triad?

A

Calvarial bone defects
Diabetes insipidus
Exophthalmos

Seen in multifocal Langerhans cell histiocytosis

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37
Q

Thromboplastic substances are released by:

A

Placenta in obstetric complications.
Cytoplasmic granules of acute promyelocytic leukemia.
Mucin-secreting adenocarcinoma cells.

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38
Q

Drugs that can cause selective thrombocytopenia

A

Alcohol
Thiazides
Cytotoxic drugs

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39
Q

Infections that can cause thrombocytopenia

A

Measles

HIV

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40
Q

CML characterized by which chromosomal translocation

A

(9;22) translocation moving ABL from chromosome 9 to chromosome 22

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41
Q

Useful bioassay for vWF

A

Ristocetin-dependent platelet agglutination

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42
Q

What are Curschmann spirals? Charcot-Leyden crystals? They are seen in which condition.

A

Curschmann spirals - whirls of shed epithelium seen in mucus plugs
Charcot-Leyden crystals - crystalloids made of eosinophils proteinsIn asthma

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43
Q

Drugs that cause pneumonitis and fibrosis

A

Bleomycin

Amiodarone

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44
Q

‘May well be’ the most common inherited bleeding disorder

A

Von willebrand disease

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45
Q

Causes of noncaseating granulomas

A

Mycobacterial infections
Fungal infections
Berylliosis
Sarcoidosis

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46
Q

This pulmonary disease has a higher prevalence among nonsmokers!

A

Sarcoidosis

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47
Q

Most pulmonary emboli arise from thrombi within ___

A

Deep veins of lower legs

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48
Q

Most common bacterial cause of acute exacerbation

A

Haemophilus influenzae

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49
Q

Complications much more likely with pneumococci serotype ___

A

3

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50
Q

Most common cause of gram negative bacterial pneumonia

A

Klebsiella pneumonia

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51
Q

Most common cause of death resulting from a single infectious agent. It causes death in ___% of a deaths worldwide.

A

TB!6%

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52
Q

How many TB bacilli are required for smear positivity? Pcr?Gold standard for TB diagnosis

A

10,000 organisms.
10 organisms.
TB culture

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53
Q
  1. Most common opportunistic viral pathogen in AIDS2. Most common cause of a CNS lesion
A
  1. CMV

2. Toxoplasma

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54
Q

How many % of certain African and Asian countries are tuberculin positive?

A

80

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55
Q

Most common form of opportunistic CMV disease

A

Retinitis

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56
Q

SCLC is characterized by which gene mutation. NSLCs? Lung adenocarcinoma?

A

SCLC: RB
NSLC: p16/CDKN2A
Adenocarcinoma: KRAS and EGFR

57
Q

Risk for lung CA is how many times increased for heavy smokers? In passive smoking?

A

60x.

2x.

58
Q

Causes of cornea verticillata

A
  1. Fabry’s disease (a-galactosidase deficiency causing accumulation globotriaosylceramide)
  2. Amiodarone
59
Q

‘Soap bubble lesions’ in the brain are seen in which infection

A

Cryptococcosis. Due to expansion of perivascular Virchow-Robin spaces

60
Q

Experimental model of membranous nephritis

A

Heymann nephritis.

Induced in animals by immunization with renal tubular brush border proteins

61
Q

HIstologic type of heroin nephropathy and HIV nephropathy

A

FSGS

62
Q

Most characteristic change in post infectious GN under light microscopy

A

Uniformly increased cellularity of glomerular tufts

63
Q

Drugs that cause interstitial non necrotizing granulomas in kidneys

A

Thiazides
Methicillin
Rifampin

64
Q

Aside from Berger’s disease, name another disease characterized by IgA deposition in the mesangium.

A

HSP. However this is a systemic syndrome involving skin, GI, joints and kidneys.

65
Q

Pathophysiology of Cushing ulcers

A

Increased ICP cause direct stimulation of vagus which increased gastric acid secretion

66
Q

Favored region of gastric carcinomas

A

Lesser curvature of the antropyloric region

67
Q

Hirschsprung characterized by mutations in the:

A

RET gene

68
Q

2 other viruses that cause diarrhea

A

Adenovirus (ad40, ad41)

Astrovirus

69
Q

Most common location of diverticulosis

A

Sigmoid colon

70
Q

Major cause of endemic bacillary dysentery in locations of poor hygiene in developing and developed countries

A

Shigella flexneri

71
Q

EHEC produces most severe disease in the:

A

Right colon

72
Q

Diagnosis of lactose intolerance is made by:

A

Breath hydrogen tests

Reflects bacterial overgrowth in the presence of excess intraluminal carbohydrate

73
Q

Major cause of childhood diarrhea

A

Cryptosporidiosis

74
Q

Hallmark of Whipple disease

A

Distended PAS+ macrophages in the lamina propia

75
Q

Crohn’s disease is most common in:

A

Terminal ileum

76
Q

Villous adenomas can produce this electrolyte abnormality

A

Hypokalemia. (And hypoproteinemia.)

They secrete mucoid material rich in K and protein.

77
Q

Peutz-Jeghers syndrome is characterized by germ line mutations in this gene which codes for what.

A

LKB1.

Serine threonine kinase.

78
Q

PTEN is a tumor suppressor. How does it work?

A

Encodes a phosphatase.

  1. Interrupts signals from several tyrosine kinase receptors (used by growth factors)
  2. Favors apoptosis through BAD/BCL2
79
Q

NSAIDs may reduce incidence of colorectal Ca. How?

A

Inhibition of COX-2 (over expressed in 90% of colorectal Ca.)

PGE2 increased by COX2 action favor epithelial cell proliferation, inhibit apoptosis, enhance angiogenesis (by increasing VEGF.)

80
Q

Although the vast majority of hyper plastic polyps have no malignant potential, ___ which is found in the right side of the colon may be precursors of colorectal Ca.

A

Sessile serrated adenoma

81
Q

Earliest event in the formation of adenomas

A

Loss of the APC tumor suppressor gene

82
Q

How does APC function as a tumor suppressor gene?

A

APC increases degradation of beta catenin. The latter can translocation to the nucleus and activate transcription of genes such as MYC and cyclin D1.

83
Q

What is the antecedent lesion in colorectal Ca developing via the APC/beta-catenin pathway? In the DNA mismatch pathway?

A

APC: tubular/villous adenomas (leads to differentiated adenocarcinoma in the left colon)

MSI: sessile serrated adenomas (leads to mucinous Ca in the right colon)

84
Q

How does microsatellite instability lead to colorectal CA?

A

Some microsatellite sequences are located in coding or promoter regions of type 2 TGFB and BAX.

  1. TGFB2 inhibits colonic epithelial growth.
  2. BAX is a pro-apoptotic protein.
85
Q

How does mutation of K-RAS lead to cancer formation?

A

Mutated RAS (G protein) is trapped in an activated state (bound to GTP) that delivers mitotic signals and prevents apoptosis.

86
Q

Most GISTs are characterized by a somatic mutation in the ___ gene which encodes a ____. Drug of choice?

A

c-KIT aka CD117
Tyrosine kinase receptor
Imatinib mesylate

87
Q

Most SI adenocarcinoma arise in the:

A

Duodenum (including the ampulla of Vater)

88
Q

Appendiceal inflammation may be due to a ball of these worms.

A

Oxyuriasis vermicularis

89
Q

Histologic criterion for the diagnosis of appendicitis

A

Neutrophilic infiltration of the muscularis propia

90
Q

Cells of the ___ constitute a reserve compartment of progenitor cells for hepatocytes and bile duct cells. What do you call these cells?

A

Canals of Hering.

Oval cells

91
Q

What underlying genetic abnormality is seen in clear cell Ca? Papillary renal cell Ca? What do these genes normally encode?

A

Clear cell CA.
VHL (3p25) encodes protein involved in limiting angiogenic response to hypoxia.

Papillary renal cell CA.
MET (7q31) is a tyrosine kinase receptor for hepatocyte growth factor.

92
Q

Bilateral complete ureteral obstruction causes anuria. Bilateral partial ureteral obstruction causes ____.

A

Polyuria!

Due to defects in tubular concentrating mechanisms and this may obscure the true nature of the disturbance.

93
Q

Feathery degeneration in liver is due to:

A

Retained biliary material.Diffuse, foamy, swollen hepatocytes.

94
Q

How does CKD and hyperparathyroidism cause peptic ulcers?

A

Hypercalcemia stimulates gastrin production and acid secretion

95
Q

Wilm’s tumor contains a variety of cell and tissue components all derived from ____

A

Mesoderm

96
Q

Occupational exposure to ___ increases risk of renal cell Ca.

A

Cadmium

97
Q

What is the effect of pH on kidney stone formation?

A

High pH favors Ca stone, struvite stone formation.

Low pH favors urate, cystine stones

98
Q

Nephron segments most susceptible to ischemia

A

Straight portion, PCT

Ascending thick limb

99
Q

Avitaminosis A can cause renal stones! How?

A

Desquamated cells from the metaplastic epithelium of the collecting system act as nidi.

100
Q

Which arteries undergo onion skinning in malignant nephrosclerosis

A

Interlobular arteries and larger vessels

101
Q

Most common genetic cause of end-stage renal disease in children and young adults.What is the underlying abnormality?

A

Nephronophthisis-medullary cystic disease

Mutation in NPHP which encode components of the epithelial cell cilia

102
Q

The underlying defect in cystic diseases of the kidney is a defect in the:

A

Cilia centrosome complex

103
Q

Causes of hepatic dysfunction WITHOUT overt necrosis

A

Tetracycline toxicity
Reye Syndrome
Acute fatty liver of pregnancy

104
Q

Major source of excess collagen in cirrhosis are the ___

A 
Stellate cells (formerly the Ito Cells);
produce TGF-B
105
Q

Conversion of heme to bilirubin occurs where

A

Mononuclear phagocytes

106
Q

Histologic hallmark of serious liver damage

A

Deposition of fibrous tissue

107
Q

Name one antibiotic that causes noncaseating epithelioid granuloma.

A

Sulfonamide

108
Q

Liver biopsy reveals numerous blood-filled cavities NOT lined by endothelial cells. What is this condition? What two drugs cause this pattern of hepatic injury?

A

Peliosis hepatis.

  1. Anabolic steroids
  2. Tamoxifen
109
Q

Two drugs which cause microvesicular steatohepatitis with Mallory bodies

A

Ethanol

Amiodarone

110
Q

Three agents associated with liver angiosarcoma

A

Thorotrast
Vinyl chloride
Arsenic

111
Q

Most common metabolic liver disease

A

Non-alcoholic fatty liver disease

112
Q

Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis is associated with which underlying metabolic abnormality

A

Insulin resistance

113
Q

Asymptomatic fatboy had routine serum electrolytes done. Aminotransferases were elevated. What is the cause?

A

Non-alcoholic fatty liver disease is the MOST COMMON cause of incidental elevation of serum transaminases.

114
Q

3 mechanisms by which insulin resistance causes hepatic steatosis.

A
  1. Impaired oxidation of fatty acids
  2. Increased synthesis and uptake of fatty acids
  3. Decreased hepatic secretion of VLDL
115
Q

Micronodular pattern of cirrhosis is seen in which two conditions.

A
  1. Alcoholic cirrhosis

2. Hereditary hemochromatosis

116
Q

Reye syndrome is heralded by:

A

Pernicious vomiting!

With irritability, or lethargy and hepatomegaly.

117
Q

Key pathologic finding in the liver of patients with Reye syndrome

A

Microvesicular steatosis

118
Q

Primary biliary cirrhosis vs primary sclerosing cholangitis

  1. 95% AMA positive
  2. ‘Beading’ on cholangiography
  3. Association with IBD, pancreatitis and idiopathic fibrosing disease
  4. Association with Sjogren, scleroderma, and thyroid disease
A
  1. PBC (PSC is 80% p-ANCA positive)
  2. PSC
  3. PSC
  4. PBC
119
Q

This condition is due to toxic injury to the sinusoidal endothelium causing release of RBCs into the space of Disse leading to proliferation of stellate cells and fibrosis of terminal branches of the hepatic vein. What are the causes of this condition?

A

Sinusoidal obstruction syndrome
(aka veno-occlusive disease)

Drinking bush-tea with pyrrolizidine alkaloid (in Jamaicans)
Cyclophosphamide and total body irradiation (in post bone marrow transplant patients)

120
Q

Most common benign lesion of the liver

A

Cavernous hemangioma

121
Q

How does aflatoxin cause CA?

A

It binds COVALENTLY with DNA and cause p53 mutations.

122
Q

Liver specimen contains a single, large hard “scirrhous tumor.” Histology reveals well-differentiated polygonal cells growing in nests or cords and separated by lamellae of dense collagen bundles. Diagnosis?

A

Fibrolamellar carcinoma, a variant of HCC

123
Q

Radioopaque or radiolucent?

Cholesterol gallstone
Brown stone
Black stone

A

20% of cholesterol stones are radioopaque.
50-75% of black strones are radioopaque.
Brown stones are radiolucent.

124
Q

Route of entry of bacteria in cholangitis

A

Through the Sphincter of Oddi,

NOT via the hematogenous route

125
Q

Parasitic causes of cholangitis

A
  1. Fasciola hepatica
  2. Schistosomiasis
  3. Clonorchis sinensis
  4. Opisthorchis viverrini
126
Q

Most common clinically significant congenital pancreatic anomaly

A

Pancreas divisum

127
Q

How does pancreas divisum predispose patient to develop pancreatitis?

A

In pancreas divisum, the fetal duct systems have failed to fuse. The main duct of Wirsung is thus very short, draining only a small portion of the head; while the accessory duct drains the bulk of the pancreas. This relative stenosis caused by the bulk of secretions passing through the minor papilla increases risk of pancreatitis.

128
Q

Name drugs that can cause pancreatitis.

A 
Thiazides
Azathioprine
Estrogen
Sulfonamide
Furosemide
Methyldopa
Pentamidine
Procainamide
129
Q

Name three infectious causes of pancreatitis.

A

Mumps
Coxsackie
Mycoplasma pneumoniae

130
Q

Metabolic derangements which can cause pancreatitis

A

Hypercalcemia
Hypertriglyceridemia
Hyperparathyroidism

131
Q

Most frequently altered oncogene in pancreatic CA

A

K-RAS

132
Q

Most frequently inactivated tumor suppressor gene in pancreatic CA

A

p16 (CDKN2A)

Blocks RB phosphorylation by blocking cyclinD-CDK4 complex

133
Q

Firs mutation in pancreatic CA sequence

A

According to the figure in p683, telomerase shortening and then mutations of the K-RAS

134
Q

Most pancreatic cancers arise in the:

A

Head (60%)
Body (15%)
Tail (5%)
Diffuse (20%)

135
Q

AIDS has the tat protein while Hep B has this protein which is a transcriptional transactivator. Required for viral infectivity

A

HBV-X protein

136
Q

Average asymptomatic incubation period for hepatitis B

A

120 days

Bud Notes (25 decks)

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