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High Yield Flashcards

1
Q

In hypovolemic shock, you give fluids to do what two things:

A
  1. Increase preload (extend end diastolic sarcomere length of the myocardium).
  2. Decrease sympathetic response of TPR
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2
Q

Coronary autoregulation via two things:

A
  1. NO* (released in response to NE, AcH, endothelinin, bradykinin, histamine)
  2. adenosine
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3
Q

Cardiac Catheterization:

A

Pulmonary Cathet. Wedge Pressure = Left atrium end diastolic pressure = pulmonary artery pressure distal to site of occlusion

Normal: LAEDP = LVEDP
Mitral stenosis: High LAEDP / Pulm Wedge > LVDEP
Aortic Stenosis: High LVDEP

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4
Q

Paroxysmal supraventricular tachycardia

A
  • most common paroxysmal
  • Similar to A -fib: Due to re-entrant impulses traveling through both slow and fast segments of AV node.
    Dx: Sudden HTN, Tachy, palpations
    Tx: Carotid massage: increase parasymph NS –> prolongs AV node –> slows HR. (risk syncope!)

If not a choice, think:

  1. Pheochromocytoma (with periodic H/A)
  2. Cocaine (with dilated pupils and chest pain = NE inhibited repute ant post synaptic cleft)
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5
Q

bobbing head + diastolic high pitch murmur

A

Aortic regurgitation: back flow (hence diastolic)

Marfans, SLE, RHA, endocarditis, syphillus, ankylosing spondylitis

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6
Q

diastolic rumbling murmur over heart apex + opening snap

A

Mitral valve stenosis: valve opening

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7
Q

Explain Thyroid hormone synthesis

A
  1. Thyroid follicles oxidize Iodide –> Iodine in the lumen
  2. In the Thyroglobulin via thyroid peroxidase: Iodine + tyrosine –> MIT + DIT (di-iodo-tyrosine)
    DIT + DIT –> T4
    DIT + MIT –> T3
  3. Thyroglobulin now has I2 + T4 + T3 + MIT + DIT and is ingested as a whole by lysosomes
  4. Iodotyrosine deiodinase recycles iodine from left over MIT and DIT AND causes T4 –> T3 –> rT3 (inactive) , for more T3 (peripheral tissue)
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8
Q

thyroid hormone axis

A

Hypothalamus (teritiary)–> TRH –> Anterior Pit. (secondary) –> TSH –> Thyroid gland (primary hypothyroidism = Hashimoto) –> T3/T4

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9
Q

Tan Adipose

A
  • Fetal Adipose
  • [Mt] = hogh O2 requirements = high capillaries
  • Heat (No ATP) production via thermogen in oxidative phosphor. of UNCOUPLED ETC.
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10
Q

Gestation week with highest hCG

A 
Week 9 (trophoblast)
- maintains corpus lute until placenta develops (estrogen)
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11
Q

Human Placental Lactogen (hPL)

A
  • trophoblast
  • causes insulin resistance + lipolysis –> high glucose + FA + ketones to be sent to fetus
  • Risk gestational diabetes when pancreas can’t overcome hPL.
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12
Q

Anovulation

A
  • when the hypothal-pit-ovarian axis isn’t working
  • ovarian follicle is released and turns into the corpus lute, but doesn’t make progesterone (although High Estrogen due to active ovaries)
  • Endometrium remains in proliferative stage = irregular menstruation
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13
Q

Confirm menopause

A

-no estrogen = no active ovaries = no feed back = high FSH (early) + LH (later)

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14
Q

Neurophysins

A

Carry signals from hypothalamus to posterior pituitary gland: ADH (supraoptic nuclei) + Oxytocin (paraventricular nuclei)

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15
Q

Secretin

A
  • Released from pancreas and stomach
  • Peptide hormone for water hemostasis
  • Acidic –> S cells –> secretin –> Duodenum–> basic
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16
Q

Pancreatic Juices

A
  1. Secretin
  2. HCO3
  3. Normal Na and K
  4. Low Cl

Trypsin (Trypsinogen) –> activates chemotrypisin, phospholipase A2 and eleastase
Lipase: Lipids –> FA
Amylase: poly (starch) –> monosaccharides (2 glucose)

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17
Q

Stomach acid secretion 3 stages

A
  1. Cephalic = smell/though = cholinergic + vagal
  2. Gastric = Gastrin = Histamine
  3. Intestinal = protein in duodenum = peptide YY causes low acid secretion
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18
Q

40 + fat + female

A

Post fatty meal = Cholysitis

  • Gall stones (i.e. biliary colic).

Risk: necrotic gallbladder = acute calculous cholecystitis (gallbladder obstruction at the cystic duct –> ischemic mucosal layer disruption –> bacterial invasion)

Mechanisms:
A) when fat enters duodenum (site of lipid resorption), I cells in duodenum and jejunum make Cholecystokinin which causes gallbladder contraction and stasis –> bile concentration –> sludge –> cholesterol stones

B) High Estrogen and Progesterone:
E –> cholesterol synthesis –> liver HMG-Coa reductase –> bile + insoluble cholesterol –> bile salts + phosphotidycholine + small water soluble cholesterol (via 7-alpha-hydroxylase)
P –> slows bile secretion –> slows gallbladder emptying

C) when 7-alpha-hydroxylase is impaired, cholesterol cannot become water soluble

D) Chrons Disease = terminal ileum inflammation –> transmural inflammation (NF-KB = cytokines = inflamm) –>

  (1) stricture --> no site of bile acids recycling for FA digestion = thus bile salt has a higher ratio of cholesterol to bile acid = cholesterol ppt due to bile acid wasting 
  (2) fistulas --> caused from inflammation which lead to ulcers. 
 (3) non-caseating granulomas (like sarcoidosis)

In ulcerative colitis, its not transmural (only mucosa and submucosa) inflammation. Thus no fistulas forms. Has continuous mucosal damage with the rectum always involved. Bloody Diarrhea with or without ab pain. Churns Disease always has ab pain.

E) Gallstone at ileocecal valve = gallstone ileus = air in biliary tree (not calcified pancreas which is chronic pancreatitis)

F) Black pigmented gallstones = unconjugated bilirubin precipitates as calcium bilirubinate due to chronic hemolysis

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19
Q

Morphine mechanism

A
  • mu receptor –> 2nd messenger C coupled –> K efflux and low Ca influx –> hyper polarization at post synaptic.
  • tolerance is via glutamate
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20
Q

Hep A person with IgM means what?

A

Re-infection

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21
Q

Jugular vein distention + low BP + High HR

A

Cardia Tamponade

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22
Q

Bicuspid aortic valve causes

A
  1. Sudden infant death

2. the usually tricuspid arctic valves will eventually use aortic stenosis in the 50’s

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23
Q

Kidney Stone composition

A

normal blood Ca + High urine Ca
(High blood Ca + Urine Ca = HyperPTH or sarcoidosis)

High oxalalate intestinal resorption

  • Renal canaliculi causes stones
  • You need P, Ca, low water, acid,
  • High citrate will prevent it

COLA amino acids (Cysteine, ornithine, lysine, arginine) will result in stones

Cysteinuria = hexagonal shaped crystals in urine = Amino Aciduria
- COLA amino acids can’t be reabsorbed in the proximal renal tubes, leading to supersaturation and hence cystine stones

NOTE: Other kidney stone causes:

  1. Hypercalciuria (Sarcoidosis)
  2. Hyperoxaluria (Chron’s)
  3. Hyperuricosuria (Gout)
  4. Hypocitraturia (Distal tubular acidosis)
  5. Hyperaciduria (Cystien)
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24
Q

Pyelonephritis

A

Urine back flow (vesicouretal junction) into the kidneys
- Leads to UTI in women

Labs show high WBC counts

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25
Q

Myasthemia Gravis

A
  • Antibodies destroy AcH receptors at post synaptic cleft (overall synaptic AcH remains the same) –> no motor end plate potential –> no muscle depolarization
  • Muscle weakness (Eye movement gets worse with activity, but rest relieves symptoms)
    Tx: Anti-cholinesterase (increase AcH), If causes GI issues you must use a muscarinic receptor antagonist = scopolamine.
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26
Q

provoke asthma

A

Methacholine, histamine or cold air

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27
Q

Alpha-q-antitrypsin deficiency

A

emphysema or COPD (low elastase/anti-protease)

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28
Q

Lung infection (cough/sputum) + dyspnea

A

COPD or emphysema

- Air is obstructed due to no elastin in bronchus and low alveolus (low surface area)

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29
Q

Chest X-ray shows flat diaphragm or hyper inflated lungs

A

COPD or emphysema

- inflated lungs are due gas being stuck due to air flow resistance

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30
Q

4 causes of hypoxia

A
  1. Hypoventilation (Resp. Acidosis)
  2. Ventilation-Profusion mismatch (V/Q): embolism (Resp. alkalosis)
  3. R to L shunt
  4. Diffusion impairment: pulmonary fibrosis, end stage lung cancer, emphysema, exercise
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31
Q

Spirometry shows what in COPD patients

A
  1. Low FEV1/FVC ratio
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32
Q

Restrictive lung diseases such as pulmonary fibrosis will show a

A

LOW FRC (functional residual capacity = RV + ERV)

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33
Q

Interstitial lung disease will be at risk for:

A

pulmonary fibrosis

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34
Q

Bronchitis + dyspnea + diffuse lung radiopacities

A

Interstitial fibrosis
- Has elastic recoiling (wide air way = radial traction, or outward pulling by fibrotic tissue, on airway walls)

Opposite of COPD Dx:

  1. High FEV1/FVC
  2. Low FRC, TLC, RV
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35
Q

High RR + Low Tidal Volume

A

Pulmonary fibrosis

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36
Q

High Lung compliance =

Low Lung complaince =

A

A. Emphysema (low elastic)

B. Pulmonary fibrosis (High elastic)

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37
Q

Paget Disease

A

Defect in bone metabolism: Osteoclast –> mixed phase –> osteoblast = bone over growth / mosaic lamellar bone that is dense but hypo vascular = weaker = prone to fracture

  • High alkaline phosphatase (osteoblast)
  • bone pain

Risk: Osteosarcoma

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38
Q

ADH acts via two mechanisms

A

V1 –> vasoconstriction of blood vessels -> increase BP
V2 –> medulla collecting duct –> cAMP –> aquaporin 2 –> ADH response (high urea, low water) –> decrease osmolality –> increase BP

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39
Q

Calculate renal blood flow

A
  1. Use PAH (proximal duct secretion OR K+ collecting duct resulting in amount excreted > amount filtered)
  2. RBF = RPF / 1 - hematocrit)
    where RPF = PAH clearance = (urine [PAH] x urine flow / plasma [PAH])
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40
Q

mast cells will cause what in the bowel?

A

mast cell –> histamine (H2 receptors and increase cAMP) –> Gastric hyper secretion.

Other gastric acid stimulators:
1. AcH or grastrin + M3 receptor –> Ca+

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41
Q

High Ca + cancer

A

PTH related peptide (not PTH alone) = humoral hypercalcemia of malignancy

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42
Q

Normal Ca and PTH levels, but fracture prone

A

osteoporosis

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43
Q

multinucleus cells from bone

A

osteoclasts

- Think paget disease if presented with multiple areas of bone pain

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44
Q

Frothy urine

A

proteinuria or bile salts in urine

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45
Q

ACE inhibitor mechanism

A
  • Elanopril
  • Decrease Angio II

Remember Angio II causes:

  1. vasoconstriction of EFFERENT a.
  2. increase adrenal cortical aldosterone
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46
Q

Abdominal pain + red urine after standing for 24 hours + normal liver

A

Porphyrin synthesis abnormality

Tx: Dextrose

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47
Q

Urinary incontinence causes

A
  1. Surge (laugh) = high ab. pressure > sphinctor OR urethral issue
  2. Urge (frequency) = over-activation detrusor
  3. Overflow (dripping or unfinished urination) = low detrusor contraction OR bladder obstruction (tumor > 50 yrs)
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48
Q

high 5-HIAA in urine

A

metastatic carcinoma

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49
Q

Deficient CD55, CD59

A

Paroxysmal nocturnal hemoglbinuria

- Causes complement activation

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50
Q

RBC without central pallor

A

spherocytosis

  • mild dehydration of the RBC
  • RBC membrane cytoskeleton abnormalities (spectrin, ankyrin)
  • causes high MCV

RISK: parovirus B19 infection, spleenomegaly, anemia, jaundice

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51
Q

high lactate dehydrogenase

A

Hemolysis
Ex: hemolytic anemia

Also seen in idiopathic membranous nephropathy due to renal vein thrombosis (due to loss of antithrombin III that is lost, along with other things, with the high capillary permeability found in nephrotic syndromes )

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52
Q

High gamma globulin

A

M protein with high monoclonal immunoglobulins

Ex: multiple myeloma (plasma cell neoplasm)

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53
Q

Microcytic vs macrocytic anemia

A 
Micro = Fe deficiency
Macro = VB12 or folate deficiency = hyper-segmented PMN. Its VB12 when you have neurological symptoms (i.e. decreases sensation)
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54
Q

Hypotension, Tachy, Rapid Breath, High/Low temp (fever)

OR

fever + chills + high BC + High PMN

A 
Septic Shock (TNF-alpha)
- in sickle cell patients--> splenic --> encapsulated bacteria will cause septic shock = Step. pneumonia or Hem. influenza
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55
Q

vascular lesion + IgA + C3

OR

child + develops after a respiratory disease + bloody stools + bloody urine + palpable skin lesions

A

Type of immune complex vasculitis called Henoch-Schonlein purpora (most common small vessel vasculitis in children)

  • Systemic hypersensitivity rxn
  • Presents with rash (palpable purpura), ab pain (GI pain), polyarthralgia (joint pain)
  • Risk: Glomerulonephritis
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56
Q

White pupillary reflex

A

Retinoblastoma (most common childhood eye cancer)
Mutations of two Rb genes
Risk: Osteosarcoma

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57
Q

Ewing Sarcoma

A

long and flat bones of children

  • neuroectoderm
  • May resemble acute osteomyelitis
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58
Q

medullablastoma

A

most common childhood malignant brain tumor of the cerebellum

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59
Q

immobile sperm

A

Primary Ciliary Diskinesia

  • Form of Kartagner Syndrome
  • Impaired dyne arms
  • Clinical: infertility + bronchial dilation + sinusitis
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60
Q

Ventircular hypertrophy is seen in

A
  1. HTN
  2. Hemolytic anemia (due to Fe deposits)
  3. Cardiomyopathy
  4. CHF
  5. Ischemic heart disease (results in heart failure)

Note: normal aging decreases heart size, causing sigmoid shape septums

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61
Q

Vaginal discharge + positive pregnancy test + normal villi + triploid karyotype

A

partial mole (low risk cancer)

NOTE: complete mole (high risk cancer)
Vaginal discharge + no positive pregnancy + 46XX or XY + trophoblast grape clusters

Both have trophoblast

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62
Q

S3 + holosystolic over heart apex + dyspnea + lung crackers + meds solve symptoms

A

functional mitral regurgitation (Tx: Diuretics which decrease EDV of the Left ventricle)
- When meds do not solve issue –> chorda tindinae rupture issue with infective endocarditis

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63
Q

Artheroscelrotic plaque MI risk

A

the plaque has a fibrous cap that is constantly being remodeled by macrophages, which degrade the college via mettaloproteinases (NOTE: the body responds by dilating the arteries…the body has time to do so because the plaque is slowly growing)

Lysyl oxidase strengthens the collagen cap!

Plaque over-all mechanism:
endothelial injury –> endothelial permeability –> leukocyte attachment + platelet + growth factors + cytokines –> smooth cells migrate from intima media

Tx: adenosine or dipurimadole
- increase in arteriole dilation. This causes more flow to normal tissue, and less to the already maximally dilated artieries affecting ischemic tissue

Body protects against platelet aggregation via endothelium secretion of prostacyclin

Irreversible Injury = Mt with vacuoles or phospholipids –> can’t produce ATP via oxid. phosph

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64
Q

Zollinger-Ellison syndrome

A

PUD –> Gastrinoma risk (Gastric acid tumors of the pancreas)
- G cells = gastrin = gastric acid

Dx: High gastrin levels in response to secretin release (Should be opposite)

NOTE: VI peptide (Vasoactive Intestinal) is made by pancreas islet and gastric mucosa to relax GI smooth muscle, inhibit acid, and stimulate bicarb from pancreas (like secretin).

Duodenum S cells = Secretin = FA activity in duodenum = causes pancreas and bile to release bicarb = decrease acidity

Somatostatin Delta cells = decrease acid and all GI hormones

Other causes of Ulcers in duodenum = H. pylori, NSAIDs (But should see high gastric acid with low secretin)

PUD Hx + high alkaline phosphatase (bile tree destruction) + onion skin histology = sclerosing cholangitis

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65
Q

somatostatin

A

decreases all GI hormone (gastrin, secretin, VI peptide, cholecsyokinin)

Without somatostatin (Delta Cells) –> High gastrin –> parietal cells release acid –> duodenal ulcers

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66
Q

Types of diarrhea

A
  1. secretory = tea colored + odorless (VIPomas)
  2. inflammatory = pus + blood
  3. osmotic = lactose/diet intolerance
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67
Q

Tea colored diarrhea + odorless

A

VIPomas

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68
Q

High bilirubin + death

A

think Crippler-Najjar syndrome

- No UGT (uridinediphosphate-glucornyl-transferase) enzyme from conduction in liver ER.

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69
Q

HIV + blurred vision

A

CMV induced retinitis from retinal detachment due to tearing of thin, scar tissue post inflammation

Tx: Ganciclovir (similar to acyclovir but is stronger specifically against CMV DNA polymerase)

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70
Q

older person + progressive vision loss + gray macula

A

age related macular degeneration

Types:

  1. Wet = Acute vision loss within weeks (ECM accumulation –> hypoxia –> vascular endothelial growth factor + gray/green retina
  2. Dry = gradual vision loss (oxidative retina pigment damage) + retinal duress deposits
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71
Q

painful swallowing

A

esophagitis (in HIV, think CMV, candida or HSV-1)

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72
Q

pneumonocystic pneumonia

A

Pneumonocystis jiroveci (only occurs in immunocompromised patients)

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73
Q

periodic + long duration + large amplitude + non-peristalic

A

Angina Pectoris

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74
Q

inability of the lower esophageal sphincter to relax during swallowing

A

Achalasia

  • relaxing of the LES is to allow the food bolus travel to the stomach.
  • In achalasia, the LES is elevated to prevent this.

NOTE:

  • cricopharyngeal m. is in the UES which contracts to push the food bolus into the esophagus resulting in inability to swallow = choking sensation
  • uncoordinated contractions results in diffuse esophageal spasms with non-cardiac chest pains
  • GERD: opposite of achalasia
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75
Q

Alcoholic that persistently vomits + mucosal wall tears

A

Mallord-Weiss tears

  • upper esophagogastric junction mucosal tear
  • leads to metabolic alkalosis (loss of gastric acid)
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76
Q

High serum iron + hereditary

A

Hemochromatosis

- Intestinal absorption

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77
Q

excess copper is excreted via

A

hepatic excretion into bile

  • Accumulation of copper in the organs (i.e. brain and eyes = Kayer-Fleischer rings of copper in cornea) is Wilson’s Disease. Also see low ceruloplasmin, test via slit lamp exam.
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78
Q

Bright red blood in vomit

A

GI bleed –> Nitrogen –> converts to ammonia for urea release

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79
Q

Liver Cirrhosis

A

Gynecomastia (liver can’t metabolize estrogen)
Edema
Ascites
Spider angiomata (high estradiol)
testicular atrophy / low body hair (high estradiol)
hepatic encephalopathy
malodorous breath (no ammonia recycling)
Portal HTN = esophageal varices, spleenmegaly

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80
Q

ischemic effect of myocardial cells at 60 sec and 30 min

A

60 sec = loss of contractility

30 min = irreversible damage due to loss of 50% [adenine]

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81
Q

serum creatinine kinase

A

cell membrane damage in heart, brain, skeletal muscle (i.e. from ischemia, DVT)

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82
Q

CHF + drug dilates arterioles and veins + diuretic

A

Natriuretic peptide

Types:
ANP = Aorta
BNP = Ventricles

Released in response to volume overload (i.e. CHF) to act as vasodilation –> ventricular hypertrophy

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83
Q

Dyspnea + must sleep upright

A

CHF

Mechanism: low renal BP –> low GFR of macula dense –> renin is secreted –> liver secretes angiotensinogen –> Angio I –> ACE converts Angio I to Angio II –> vasoconstriction (increase arteriolar resistance) + aldosterone + sodium retnetion (water retained)

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84
Q

Uterus “bunches of grapes”

A

Hydatidiform mole
- from trophoblast obliteration
Dx: vaginal bleeding + nausea
Risk: Choriocarconoma (monitor B-HcG)

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85
Q

Pre-ecamlampsia + seizures

A

Eclampsia

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86
Q

Pregnancy + HTN + edema (leg swelling) + Protenuria

A

Pre-Eclampsia
- RISK: HEELP

Hemolytic Anemia
Elelvated liver enzymes
Low Platelets

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87
Q

Endometrial hyperplasia

A

Think high Estrogen levels (supplements or tumor = granolas cell tumor)

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88
Q

female with facial hair and acne

A

High androgen levels

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89
Q

obesity + facial hair + abnormal menstruation

A

Polycycstic Ovarian Syndrome

  • Obesity = insulin resistance
  • Facial hair = androgens

RISK: DM II and endometrial adenocarcinoma

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90
Q

Adnexal Mass

A

CA-125 = Malignant ovarian epithelial tumor

due to high number of ovulations. Thus, lower number of ovulation (with oral contraceptives) result in lower cancer risk

Remember, CA-125 is a poor marker for only ovarian cancer since it codes for cervix, endometrium, fallopian tube cancers)

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91
Q

High CEA

A

colorectal and pancreatic tumor

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92
Q

High B-HcG

A

Pregnancy, trophoblast tumors (Hyadtidiform, choriocarcinomas)

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93
Q

High DHEA

A

Adrenal tumor

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94
Q

Cervical Intraepithelial Neoplasia III (CIN III)

A

HPV 16, 18 (Sex)

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95
Q

Female with Hx of PID + ammenhorea + vaginal bleeding

A

Ectopic Pregnancy = vaginal enlarged (but Uterus is NOT enlarged), soft uterus = hormones mimic normal pregnancy = decidualized endometrium WITHOUT embryonic tissue or chorion

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96
Q

normal appearing endometrial glands + enlarged uterus

A

Adenomyosis (Not ectopic pregnancy bc pt does not have enlarged uterus)

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97
Q

post menopause + abnormal bleeding

A

think Adenocarcinoma

- Menopause = 50 years old

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98
Q

Hypotension + Tachy + Fever / low temp + low Na + high K + hypoglycemia

A

Shock + low Na + high K + low glucose = Adrenal Crisis (ie. Adrenal Hemorrhage)

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99
Q

child + fever + vomit + nuchal rigidity + rash

A

meningococcal meningitis (N. gonohrrea)

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100
Q

meningococcal meningitis + adrenal crisis

A

Waterhouse-Friderichsen syndrome

Meningitis = Child + vomit + nuchal rigidity + rash
Adrenal Crisis: Hypotension + tacky + fever + low Na + high K + low glucose

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101
Q

brain base

A

sella turcica = anterior (Rathkes pouch) and posterior (hypothalamus neurons) pituitary

RISK: craniopharyngiomas of the Rathke’s Pouch

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102
Q

most common thyroid cancer

A

papillary carcinoma

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103
Q

Long fingers + arms exceeding height

A

Marfanoid Syndrome (Also could be MEN2 if with mucosal neuromas which are flesh colored nodules on lips and tongue; along with thyroid mass)

Risk:Medial degeneration –> Aortic disease (Aortic regurgitation/aneurysm)

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104
Q

Thyroid nodule + High Calcitonin

A

Medullary Thyroid Cancer (Parafollicular C cells)

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105
Q

High 17-hydroxyprogesterone + testosterone + very early puberty

A

21-hydroxylase deficiency (adrenal cortical hyperplasia)

- NOT Leydig cell tumors

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106
Q

High catecholamines

A

Adrenal medullary hyperplasia

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107
Q

High TSH + Low T3/T4 + enlarged thyroid gland

A

Hypothyroidism (Hashimoto’s = mononuclear infiltrate into well defined germinal centers = lack of iodine)

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108
Q

lower leg skin thickening and induration

A

Hyperthyroidism (Grave’s Disease)

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109
Q

most common anterior pituitary gland tumor

A

Lactotroph (prolactin)

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110
Q

MEN1 tumors

A

3 Ps = Pituitary, Parathyroid, Pancrease

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111
Q

Highest risk for DM patients

A

Coronary artery disease (MI)

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112
Q

No dystrophin gene

A

Duchenne Muscular Dystrophy
- Hypertrophy of muscle fibers (early stage) –> muscle fibers replaced by fat and CT (late stage)

At 2-5 years old, the patient would “climb up” from a squat using his hands

113
Q

High metalloproteinase

A

impaired healing = contraction, dehiscence (wound opening = abdomen), or scars.

NOT ulcers (which are due to unvascularized areas) or infections

Tumors will show high numbers of metalloprotineases if invasion is high

114
Q

spongiosis

A

contact dermatitis (CD4 T-cells)

115
Q

BRAFF marker

A

melanoma

116
Q

SCC

A

keratin pearls

117
Q

Cancer Growth

A

Melanoma: active vertical growth (If horizontal and superficial, then the melanoma is benign)
Nipple Inversion in Breast cancer: Suspensory Cooper ligament invasion

118
Q

Psoriasis

A

Chronic inflammation of the skin –> Salmon colored crusts, well-demarcated plaques with silver skin

v thin or non-existent stratum granulosum + prominent parakerotic stratum corneum.

RISK: R.A. like symptoms

119
Q

Eczema

A

Chronic inflammation of skin in response to environmental factors (i.e. contact dermatitis, food ingestion).

Impaired skin barrier –> IgE + Eosinophils

RISK: Asthma, allergic rhinitis (Allergy Triad)

120
Q

Slowly growing skin lesion that is bright red

A

Capillary hemangioma: first increase in size, then regress before puberty.

  • Children: Strawberry hemangioma
  • Adults: Cherry hemangioma

Spider angiomas: Pregnancy due to increase in vasculature and high estrogen levels

121
Q

Skin tags under the arms, posterior neck or groin (flexural areas) + skin condition +

A

Acanthosis Nigricans

  1. Malignant: Gastric adenocarcinoma
  2. Benign: insulin resistance
122
Q

fecal occult test is used for diagnosing….

A

GI bleeds

123
Q

subcutaneous bums at achilles tendon

A

xanthomas

- Lipid filled histiocytes in derma (cholesterol, phospholipids , TGA)

124
Q

longitudinal mucosal tears near astro-esophagus junction

A

mallory-weiss (Intrabdominal pressure, EtOH)

125
Q

Anti-cholinergic symptoms from overdose of…

A

atropine, amitriptylin (block muscarinic receptors)

126
Q

multiple long bone fractures risk what?

A

fat embolisms

127
Q

Fever for > 5 days +

A

Kawasaki disease

  • Medium size arteries
  • RISK: coronary artery inflammation –> coronary a. aneurysm
128
Q

Marfan Syndrome with chronic HTN will risk what?

A

Dissecting aneurysms of the aorta

Aortic Dissecting aneurysms

  • pain that radiates to back (retrosternal pain)
  • from a tear in the intima (tear from media = Giant Cell Arteritis or Takayasu; tear at vast vasorum is from tertiary syphillus)
129
Q

H/A + epitaxis (nose bleeds) are cause by what?

A

HTN arteries in the head and neck

130
Q

H/A + epitaxis + large palpable intercostal vessels (pulse on rib cage) + low perfusion on lower extremities (muscle leg weakness)

A

Aortic coarctation

RISK: brain aneurysm

131
Q

Kidney presents with a pale-wedge shape lesion, with the apex pointing to the medulla

A

Coagulative infarct due to the “end organ” nature of the kidneys (small number of collateral vessels)

Mostly due to systemic emboli:

  • left atrium or left ventricle
  • MI
  • A fib
  • Aortic aneurism
  • infective endocarditis (S. aureus, tricuspid regurgitation)
132
Q

Sudden death of a soccer player

A

Sudden Cardiac Hypertrophy

  • Cardiac sacromere protein mutation –> beta myosin heavy chain –> mitral valve + interseptal obstruction –> left ventricular outflow obstruction
  • Inherited
133
Q

Recurrent epitaxis + spider like lesions

A

Osler-Weber-Rendu Syndrome

134
Q

NF1 versus NF2

A 
NF1 = Von Recklinghausen's Disease = peripheral NS tumor = neurofibromas, optic nerve gliomas, Lisch nodules (Iris pigmented nodules), cafe-au-lait spots (hyperpigmented cutaneous macules)
NF2 = main NS tumor = Bilateral CN 8 (vertigo, hearing loss) Shwannomas, meningiomas
135
Q

Arthritis (joint pain) + pharyngitis (sore throat) + new heart murmur

A

Acute Rheumatic Fever (think bacterial endocarditis with young, fatigue, new murmur –> immune complex injury to kidneys)

RISK: severe myocarditis

Chronic RA = Mitral stenosis

136
Q

Explain polyrteritis Nodosa (PAN)

A

segmental, transmural, necrotizing inflammation of medium to small arteries of any organs

  • Can result in ischemia
  • Affect: Liver, heart, kidneys, GI tract (NOT LUNGS)
137
Q

Amlodipine

A

Ca channel blocker = vaso-dilator = anti-HTN = anti-angina

138
Q

Phentolamine

A

alpha 1, alpha 2 adrenergic antagonist = vasodilator

139
Q

Main cause of aortic stenosis

A

valve calcification

- Heart sound: desc-asc rhythm

140
Q

Fluid in heart risks what?

A

Pericardial effusion –> Cardiac tamponade (pressure) –> atrial collapse –> higher pressure than normal at ventricular septum (jugular venous pressure drops normally decrease systemic venous return –> low preload –> low output –> cariogenic shock (no O2 delivery)

RISK: Pulsus paradoxus (exaggeration of normal decrease in systolic pressure during inspiration. Found in cardiac tamponade, cor pulmonale, pericardial disease). Test with Kaussmaul sign.

141
Q

thick, fibrous tissue in pericardial space

A

constrictive pericarditis. Effect similar to cardiac tamponade (Kaussmaul sign)

142
Q

“blowing” holosystolic murmur at heart apex risks what?

A

Mitral Regurgitation secondary to bacterial endocarditis. - - - - Can be seen as Janeway lesions on palm, feet and under the finger nails (micro embolisms, similar but not, primary focal infections)
- RISK in Down Syndrome

143
Q

mid-systolic “rumble” at heart apex

A

mitral stenosis

- May cause ventricular dilation –> recurrent laryngeal n. impingement –> hoarseness and dyspnea.

144
Q

machine like murmur

A

L –> R shunting (PDA = continuous with ascending systolic)

  1. PDA = isolated cyanosis + clubbing (unoxygenated blood distal to left subclavian artery). NOTE: a small PDA may not show cyanosis. Tx: indomethacin. Risk: Rubella infections
  2. ASD, VSD

Note: whole body cyanosis = teratology of fallot (R–>L)

145
Q

pulsating abdominal mass

A

abdominal aortic aneurysm (below renal a.)
- transmural inflammation of artery wall –> proteases degrade elastin and collagen -> weak walls

RISK: splenic flexture involvement = watershed infarction

146
Q

Migratory thrombophlebitis

A

Think Cancer

147
Q

febrile fever (unknown origin) + salicylate

A

Reye’s Syndrome = Liver failure (micro vesicular steatosis of hepatocytes without inflammation and jaundice) and acute encephalopathy (cerebral edema)

148
Q

constipation + narrow rectum

A

Hirschsprung Disease
- Neural crest cells fail to migrate to intestinal wall.
- Dx: no ganglion cells in the narrow part of the submucosa
+ fails to pass meconium

149
Q

hypotension + hospital bed (not DVT) + upper right abdominal pain

A

Aute acuculous cholesystitis = no gallstones = just an enlarged and inflammed gallbladder due to stasis

150
Q

AST:ALT ration > 2:1

A

EtOH hepatitis

Stages:

  1. Steatosis (reversible) = Fat vesicles in liver
  2. Hepatitis = Hep B with ground class cells in liver = fine granules = eosinophilic in appearance
  3. Cirrhosis (Irreversible) = portal inflammation + obstruction of bile tree + liver parenchyma
151
Q

High ALT + High AST + High Alkaline phosphatase

A

Acute Viral Hepatitis
OR Dx is: IV drug user + fever + jaundice + acidic liver + mononuclear cells + hepatomegaly. The acidophilic cells are from apoptosis post staining.

152
Q

High unconjugated bilirubin (total bilirubin)

A

Gilbert Syndrome

  • slow bilirubin conjugation to direct bilirubin
  • but NO LIVER disease

If with liver disease, think biliary atresia

153
Q

Wrist drop + asthma + high eosinophils + antibodies neutrophil myeloperoxidase (p-ANCA)

A

Churg-Struss Syndrome

- asthma, sinusitis

154
Q

ischemic heart cells increase in size due to:

A

retained Ca+ (NOT K, b/c the K/Na-ATPase does not work, and Ca is recycled naturally in the Sarcoplasmic Ret)

155
Q

Endocarditis:
(A) What is a risk factor to predisposition of endocard.
(B) consequence
(C) mechanism

A

A. valve inflammation and scarring (rheumatic fever)
B. ruptured chordea tendinae
C. Fibrin and platelet deposits –> vegetation

156
Q

chewing difficulty + H/A + temporal artery tenderness

A

Giant Cell Arteritis (GCA)

  • Granuloma inflammation of the media of the artery
  • Similar to Takayasu arteritis
157
Q

Rapid jerking involuntary movement

A

sydenham chorea = NOT parkinsons, but Rheumatic fever (valve heart disease)

158
Q

sharp chest pain + relieved when sits up

A

not CHF, but acute pericarditis.
This may be due to MI or rheumatic fever.
Test: Frictional rub.

159
Q

varicose veins are complicated by

A

ulcers, skin infections, stasis dermatitis

- Varicose veins are dilated and complex leg views due to dysfunctional valves

160
Q

List common sites for atherosclerotic plaque

A

Abdominal aorta > coronary a. > popliteal a. > nternal carotid > circle of willis

161
Q

non-infectious endocarditis

A

Cancer in liver and pancreas (mucin adenocarcinomas) –> Pro-coagulants –> hyper coagulable state
- similar to Trousseau Syndrome

162
Q

persistent lymphedema + Hx of mastectomy

A

RISK: Lymphangiosarcoma

163
Q

Diet supplements risk what cardiac event?

A

-fluramines cause pulmonary HTN –> R ventricular hypertrophy –> cor pulmonale –> paroxymal pulsus

164
Q

SLE is associated with?

A

bacterial endocarditis

165
Q

V fib is the most common cause of death in coronary artery disease

A

ok

166
Q

Mitral stenosis with pedunculated mass

A

myxoma –> vascular endothelial growth factors –> scattered cells in mucopoly stroma

167
Q

V.V. high BP (240/110)

A

Emergency HTN –> onion ring artery thickening –> intracranial hemorrhages (papiledema = optic disc thickening)

168
Q

Summary of murmurs

A

Aortic Stenosis: Loud systolic ejetion –> Ca deposits of leafs
Aortic Regurg: Head bob + femoral pulse
Aorta = Sternal border / heart Base

Mitral stenosis: snap + rumble
Mitral Regurg.: Holosystolic + blowing
Prolapse: Mid-systolic click –> [Chordea tendon] –> [CT] –> myxoma degredation

Tricuspid Regurg.: Holosystolic that increase in intensity with inspiration

PDA, VSD, AVD: L–> R
Teratology of ballot: R –> L

169
Q

Inflammatory GI polyps (Inflam. Bowel Disease)

A

Think Chrons Disease or Ulcerative Colitis

If transmural inflammation (i.e. fistulas) = chrons
If only at mucosa and submucosa layer (ulcer only,no fistula) = ulcerative colitis

RISK: Toxic megacolon = no neuromuscular activity of the LARGE bowel (intestine) –> distention –> ulcer –> death

Lab Test:
IBD = Barium enema (large bowel radio dye)
Flat plain X-ray = Toxic megacolon (so it won’t rupture the ulcers)

170
Q

Malignant polyps are most likely villous or tubular?

A

Villous, regardless of size.

171
Q

1st degree relative transfer + colon cancer + not the typical polyp +

A

Lynch Syndrome (Hereditary non-polyposis colon cancer)

  • No involvement of mutations, onco-geners
  • Due to mismatch repair (no proof reading of DNA)
172
Q

Diverticulitis

A

Outputting of a weak organ wall via propulsion (pulsion)

Types:
Meckel Diverticulum = Transmural, congenital, intestine wall
Zencker Diverticulum = esophagus

173
Q

Brown pigment stones

A

Biliary tract infection

174
Q

Black pigment stones

A

Sickle Cell Disease (chronic hemolytic anemia) or Chron’s Disease (due to high cycling of bilirubin)

175
Q

Acute pancreatitis is caused by

A
  1. EtOH
  2. Gallstones
  3. High Ca
  4. High Triglycerides

Will see chalky white lining of mesentery + fat cell destruction (thus High TGA) and Ca deposits

NOTE:
High Cholesterol indicates artheroscleoris, with renal stones
High Urine Oxalate indicates Chron’s Disease, with renal stones

176
Q

Right vs Left side colon cancer

A

RIGHT: SMALLER = Exophytic masses = mimic iron deficiency anemia (weight loss, fatigue) = no obstruction

LEFT: LARGER = Intestinal obstruction (encircle the lumen) = constipation, cramps, distention, vomit, nausea)

177
Q

p53

A

GI cancer (adenocarcinoma)

p53 is normally an anti-oncogene which kills via APOPTOSIS defective DNA in the GI tract

p53 + DCC = GI adenocarcinoma.

THINK p53 abnormality when sporadic cancers occur (i.e. brain, bone, breast)

BRCA-1 is normally an anti-tumor. But when mutated, causes breast and ovarian cancer.

NOTE:
k-RAS = increases poly size from early –> late adenomas

Adenocarcinoma Phases: APC –> COX 2 –> K-RAS –> p53

K-RAS is the only pro-onco gene (high replicative potential)

178
Q

Inversion of a part of the intestine inside another part of the intestine

A

intussusception

RISK: meckel’s diverticulum or intestinal tumor

179
Q

Does portal vein thrombosis affect the liver?

A

Causes portal hypertension, but does not affect the liver

Budd-Chiari Syndrome obstructs hepatic vien, which will affect the liver.

180
Q

High alpha-fetal protein

A

think Hepatocellular carcinoma (High Risk with Hep B and C, NOT Hep A)

NOTE: the most common metastatic cancer of the liver is Metastatic Liver Disease.

181
Q

loss of stomach villi

A

Celiac’s disease

“flat” intestinal epithelium

182
Q

nocturnal cough + sore throat

A

GERD (silent)

RISK: Barrets –> esophageal adenocarcinoma

183
Q

Highest risk factor for pancreatic cancer

A

Smoking

184
Q

neonate with projectile vomiting after every meal

A

pyloric stenosis

- smooth m. (pyloric muscular) hypertrophy behind the stomach

185
Q

Parietal Cells are found where

A

funds and body of stomach

Gastrin –> Parietal cells –> H+

186
Q

Peptic Ulcers think:

A

NSAIDS or H. pylori

187
Q

Least malignant GI ulcer location

A

First part of duodenum

188
Q

Clinical sign of malabsorption and the types of malabsorption.

A

Steatorrhea (foul smelling, frothy, greasy, lots of fat in the stool)

Types:
1. Low Pancreas hormones: No digestion –> Chronic Pancreatitis, Cystic Fibrosis

  1. Intestinal mucosa defect: No nutrient transport –> Celiac, Chron’s
  2. High bacteria: Bacteria compete for food.

Test for malabsopriton: Stool sample for [FAT].

189
Q

Ulcer symptoms + PAS positive

A

Whipple disease

Tropheryma Whippi

190
Q

Fluctuating constipation and diahrrea + pain is relieved with bathroom use

A

Irritable Bowel Syndrome

191
Q

Neonate with areas of thin lucency paralleling the bowel walls + abdominal pain + bloody stools

A

Necrotizing Enterocolitis
- Preterm birth risks low immune system –> Bacteria proliferation–> to gas gangrene –> perforation –> death

Survivors risk fibrosis –> bowel obstruction

192
Q

most common benign liver tumor

A

Cavernous Hemangioma
- Enlarge via ectasia (not hypertrophy)

RISK hemorrhage if biopsied

193
Q

Marker for ovarian cancer

A

CA-125

194
Q

Mechanism of acute appendicitis

A

Fecalith lumen obstruction –> mucus retention –> distention –> hypoxia –> bacterial proliferation

195
Q

Granulomatous bile duct destruction + infiltration

A

Primary Biliary Cirrhosis (leads to xanthelsma formation)

196
Q

Tumor at lung apex

A

Pancoast Syndrome =

- Arises from superior sulcus (subclavian site). Thus radiates unilaterally with pain from neck down to wrist.

197
Q

Green Fecal mass obstructing lumen distal to ileum

A

small bowel obstruction

- RISK: pneumonia or cor pulmonale

198
Q

Asbestos exposure risks:

A
  1. Bronchogenic Carcinoma (common)
  2. malignant mesothelioma (Rare)

Mechanism:

  1. Epithelial cell injury –> parietal pleural plaques –> Pleural thickening with calcifications
  2. Macrophages
  3. Pulmonary fibrosis –> Asbestos bodies (gold-brown rods with translucent centers, seen with prussian blue stain)

NOTE: Silica inhalation shows lung apex egg shell calcifications

199
Q

Lung Hilar lymphadenapathy (Hilar Fullness) + Large epithelial cells (non-caseating macrophages)

A

Sarcoidosis

  • High ACE levels
  • High Calcium
  • scattered granulomas

V. common in young black females

Stages:

  1. Hilar fullness
  2. Hilar fullness + infiltration
  3. Infiltration only
  4. Lung fibrosis
200
Q

most agressive lung cancer

A

small cell carcinoma

  • Highly metastatic, thus surgery is not an option, only chemo and radiation.
  • Shows neuroendocrine markers: chromogranin and enolase, neurofilaments, synaptophysin

NOTE:
Most common malignant lung cancer: adenocarcinoma (non-small cell carcinoma)

201
Q

air fluid levels in the lungs mean what?

A

Lung abscess

202
Q

thick bronchi + infiltrates + mucous gland enlargement + squamous cell metaplasia

A

chronic bronchitis

  • Mostly caused by smoking (environmental factor)
  • severity is based on submucosal gland enlargement
203
Q

Puffy face + dyspnea + cough + clear heart sounds + bilateral dilated vessels

A

Impaired venous return due to mediastinal masses = superior vena cava syndrome

RISK: lung cancer, non-hodgkin lymph

204
Q

Harmatoma

A

Benign tumor of heart and lungs made of cartilage

205
Q

green sputum

A

Neutrophil myeloperoxidase

- S. pneumonia

206
Q

CREST Syndrome

A

Due to pulmonary artery thickening

207
Q

Risk factors of adult resp. distress syndrome

A
  1. Sepsis
  2. Shock

No pulmonary edema, which means normal capillary pulmonary wedge pressure

Low lung complaince

208
Q

Neonate + persistent crying + tremors + diarrhea + tachy + Mother with Hx of Hep C

A

Opioid withdrawal (Neonatal Abstinence Syndrome)

Tx: Methadone or Morphine (Opioids for a short period to withdrawl)

209
Q

Fever + rash + oliguria (Acute Renal Failure) + POST Tx with beta lactic antibiotic (Ampicillin) + Eosinophilia

A

Drug Induced Interstitial Nephritis (NSAIDs)

  • Affects renal interstitium
  • A drug induced hypersensitivity rxn (IgE + Cell Mediated Rxn = PMNs, MO)
210
Q

Child + Acute Renal Failure (Red urine) + Diarrhea (Loose bloody stools)

A

Hemolytic Uremic Syndrome

- Due to Shiga toxin and E.coli toxin –> injure preglomerular artery endothelium –> [platelets] –> microthrombi

211
Q

Right kidney is v. smaller than the left

A

Renal Artery Stenosis
- When RBF juxtaglamulerous –> renin –> aldosterone –> vasoconstriction –> increase glomerular flow rate due to the resulting HTN

212
Q

Define:

  1. Selective proteinuria

2. Overload proteinuria

A
  1. loss of albumin + minimal bulky protein loss (i.e. IgG) in urine (i.e. minimal change disease –> direct podocyte damage)
  2. High amount of low molecular weight proteins in urine (i.e. multiple myeloma with [immunoglobuin light chains in urine]
213
Q

Sickle Cell Disease + Hematuria

A

Renal Papillary Necrosis (due to ischemia)

  • Also caused by:
    1. Analgesic Nephropathy (NSAIDs = decreases prostaglandin synthesis resulting in limited RBF)
    2. D.M.
    3. Acute pyelonephritis and UT obstruction
214
Q

Red urine + Facial edema

A

Think Glomerulonephritis

- Age determines prognosis in post-strep glomerulonephritis (Children recover well)

215
Q

Eosinophil-hyaline material layers on small renal arteries (hematoxylin-eosin stain)

A

non-malignant HTN or DM

216
Q

Surgery at the:

  1. cervix risks what?
  2. Prostate or bladder?
A
  1. Ligating the ureter (RISK: Hydronephrosis)

2. Vesicouretal reflux (RISK: Pyelonephritis)

217
Q

Auto dominant and Auto Rec. poly cystic kidney disease is found mostly in children or adults?

A

Auto Domin = Adults. As children, kidney’s look completely normal where the cysts are too small to see
Auto Rec = Kids (die at first decade due to renal failure, haptic fibrosis, pulmonary hypoplasia)

218
Q

Elderly + easy fatigue + constipation + bone pain (back pain) + renal Failure

A 
Mulitple Myeloma
- Fatigue (due to anemia)
- Constipation (hypercalcemia)
- Bone pain (osteoclast via myeloma cells)
Lab: Eosinophil cast + Bence Jones Cells
219
Q

painless hematuria

A

Think Urothelial Cancer (Renal Cell Carcinoma)

  • VHL genes
  • Histology will show clear cytoplasm from high lipid and glycogen content (which normally is dissolved in the lab solvent, but is retained due to the cancer)
  • Golden yellow mass
  • Originate from epithelial cells or proximal renal tube
220
Q

muddy brown casts in urine

A

Acute Tubular Necrosis

  • Can result from internal hemorrhage
  • Most regain re-epithelialization and normal renal function

Stages:
Initiation: ischemic injury (MI, surgery, hemorrhage)

Maintenance: Low urine output, fluide overload, high BUN/creatinine, High K+

Recovery: High volume diuresis (from gradual inquire or output), low K, low Mg, low P, low Ca from slow tubular recovery.

221
Q

Low RBF (as seen in MI) will affect what parts of the kidney the most?

A

Proximal Tubules and ASCD loop
- These structures are located outside the medulla and normally recieve low blood flow. They also use ATP to actively transport ions.

222
Q

Hematuria + facial edema + proteinuria + pharyngial or skin infection

A

Post strep glomerulonephritis (Strep or impetigo)

  • Both kidney glomeruli are enlarged with leukocyte infiltration
  • IgG + C3 “lumpy” deposits
  • Epithelial side of basement membrane humps are seen
  • Will see RBCs (No RBC seen in nephrotic syndrome)
  • Must have 1+ proteinuria (3/4+ is nephrotic syndrome)
223
Q

NSAID associated chronic renal injury is characterized by what?

A

Papillary necrosis or chronic interstitial nephritis

- Usually reversible when NSAID use stops

224
Q

Crescent formation on glomerulus

A

Rapidly Progressive Glomerulonephritis (RPGN)

- Renal failure

225
Q

Nephrotic Syndrome mechanism

A

glomerular basement membrane thickens –> mesangial matrix expansion –> increase permeability of glomeruli to plasma proteins –> loss of negative charged proteins –> massive protein loss (Albumin) –> liver synthesis of albumin is not enough with such a rapid loss of albumin –> drop in colloid osmotic pressure in blood –> edema –> drop in RPF –> Angiotensin II system –> renin –> ADH + Aldosterone –> Na/H20 retention –> exacerbates the edema

Also, the liver is attempting to make more albumin, but also make more lipoproteins –> high cholesterol + TAG + LDL + VDL –> lipiduria

THIS IS THE SAME MECHANISM FOR Diabetic Nephropathy

TX: ACE inhibitors in diabetics

WHEN in Children

226
Q

Child 2-8 years old + facial edema + huge loss of protein in urine

A

Minimal Change Disease (presents as nephrotic syndrome)

  • Electron microscopy will show diffuse defacement of podocyte foot processes
  • Normal glomeruli
  • No immunoglobulin or complement deposits
  • Normal renal function
  • Excellent prognosis, even though recurrence is possible

TX: Corticosteroids are v. effective

227
Q

Chronic kidney disease (i.e. DM) will result in what type of PTH rxn?

A

secondary HYPER-PTH with a high PTH secretion, but a low Ca response

228
Q

joint pain + heart murmur

A

Rheumatic Heart Disease

- M protein antibodies against strept. cross react with glycoproteins in the heart and joints

229
Q

Granulomatosis + Polyangititis

A

Wegner’s

  • c-ANCA antibodies
  • Paci immune = no immune complex or immunoglobulin deposits
230
Q

malar rash + pleural effusion

A

SLE

  • Circulating immune complex nephritis
  • anti-ANA, ds-DNA, anti-Sm
231
Q

dysphagia + scelodactyl

A

CREST syndrome

- anti-centromere

232
Q

child 2 years old + non-rhythmic eye movement

A

neuroblastoma

  • Most common extra-cranial childhood cancer
  • Form neuroblasts in adrenal medulla
  • Abdominal mass which displaces the kidney
233
Q

Muscle weakness that is progressive, in an ascending order

A

Guillain-Barre Syndrome

  • Campylobacter jejuni
  • segmental peripheral demylenation = endoneural inflammatory infiltration
234
Q

Dimentia patient think what?

A

Alzheimers

  • Low AcH in basal nucleus of Meynert (memory and cognition) and hippocampus (new memory)
  • Localized amyloid deposits
  • Neurofibrillary triangles
235
Q

S-100

A

Neural Crest = Shwannoma and Melanoma

236
Q

Diabetic Neuropathy Mechanism

A

Similar to nephrotic syndrome
In addition to:
1. Non-enzymatic glycosylation of proteins –> thick hyalinization and narrowing of artery walls –> microangiopathy of endoneural arterioles –> ischemic nerve damage

  1. Intracellular hyperglycemic –> aldose reductase converts glucose to sorbitol + fructose –> sorbitol increase cell osmolarity with water influx into cell –> lysis of axons/shwann cells
237
Q

Headache + sudden unilateral blindness

A 
Temporal arteriritis (large artery arteritis)
- May be seen with polyarthritis (jaw pain during a meal)

RISK: Permanent blindness

TEST: ESR (> 100), although biopsy is required.

238
Q

HIV CNS tumor

A

Primary CNS lymphoma

- i.e. EBV

239
Q

Chorea + dimentia + abnormal behavior

A

Huntington

  • 100% penetrance (Auto Dom)
  • GABA loss
  • Striatum atrophy = caudate nucleus + putamen)
240
Q

Temporal lobe hemorrhagic necrosis

A

HSV-1 encephalitis

241
Q

Slow relaxation of muscles (can’t release a door handle as fast)

A

Myotonic Dystrophy

  • atrophy of muscle fibers (Type I)
  • Trinucleotide repeat of CTG
  • Seen with cataracts
242
Q

Positive Babinski sign

A
  • Extension of toes (dorsi flexion) due to loss of upper motor neurons = pyramidal
  • Causes Pyramidal Signs:
    1. Hyper-reflex (brisk deep tendon reflex)
    2. muscle weakness/paralysis
    3. spasticity (increase muscle tone)
243
Q

no pain an temperature sensation

A

Syrinx (spinal cord) = Syringomylia

244
Q

bilateral loss of sensation of first three fingers + radial 1/2 of 4th digit

A 
Carpal Tunnel (not diabetic nueropathy)
- median nerve compression at the palmer surface of the wrist
245
Q

HIV + dementia

A

HIV-associated dementia

  • affected subcortical and deep grey matter
  • inflammatory activation of microglial cells

HIV monocytes enter the brain –> become macrophages –> fuse to become multinuclear giant cells

246
Q

intranuclear basophilic vs acidophilic inclusions

A 
Basophils = CMV
Acidophils = HSV
247
Q

Abnormal behavior + language issue

A

Picks Dementia
- Frontal lobe degeneration

NOTE:
Abnormal behavior + chorea = Huntington
Amyloid brain deposits + anterograde amnesia = Alzhiemers (Hippocampus)

248
Q

MI affects which part of the brain first?

A

Pyramidal cells of the Hippocampus

Perkinje cells of the Cerebellum

249
Q

Types of Hydrocephalus (Ventricle Enlargements)

A
  1. non-communicating hydrocephalus = obstructed CSF flow where only the ventricles close the obstruction are enlarged
  2. communicating hydrocephalus = CSF flows freely between ventricles and subarachnoid space due to decreased CSF reabsorption. The entire ventricular system is enlarged.
  3. True or ex vacou hydrocephalus = increase in CSF volume and pressure post brain atrophy
250
Q

fragmented RBC

A

Shistocytes

Due to:

  1. Mechanical valves
  2. DIC (narrow valves) –> Low Haptoglobin + High LDH + High Bilirubin
  3. HUS
  4. Thrombocytopenic purpura

Low haptoglobin means hemolytic anemia

251
Q

Warfarin induced skin necrosis

A

Hyper-coagulation due to deficient protein C or S.

Warfarin naturally drops Factor 7 and Protein C (a natural anti-coagulant)

TX: Fresh Frozen plasma increases Protein C

When Protein C resistance = Factor V Leiden mutation = RISK: DVT

252
Q

High dose folic acid is given to treat what?

A

Megaloblastic anemia = low folate/folic acid or Vit B12 deficiency.

When an infusion of folate still leads to leg numbness (loss of sensation = neurologic symptoms), the Dx is Vit B12 deficiency.

Megaloblastic anemia = High MCV + low Hb. EtOH can also cause this due to thymidine deficiency!

Low MCV is Fe deficiency anemia and beta thalessemia

253
Q

ERB-B2

A

Breast cancer (aggressive)

BRCA-1 (breast and ovarian cancer)

254
Q

High HbA2 content

A

beta thalesemmia

255
Q

Tumor stage vs grade

A 
Stage = expansion
Grade = Differentiation

Stage is most important for prognosis

256
Q

Anaplastic tumors mean what?

A

Undifferentiated = share no resemblance to the natural tissues = high grade tumors.

Usually high mitotic, giant cells, multinucleate, pleomorphic, high Nu: cytoplasm ratio

Dysplasia is a reversible change in epithelium. It precedes cancer.

low grade dysplasia –> High grade –> Carcinoma in-situ –> invasive carcinoma. Only the reversibility of changes (invasion) differentiates each stage.

Lymph nodes presenting with high monoclonal T-cell proliferation (T-cell gene rearrangements) are most at risk for malignancy

257
Q

N-MYC

A

neuroblastoma, small cell carcinoma of the lung

258
Q

chemical causing cancer

A

cytochrome P450 mirosomal monooxygenase prevents the conversion of chemical induced tumors

259
Q

C-MYC

A

Burkitts lymphoma = rapidly enlarged jaw in african americans. C-MYC is a transcription activator for cell proliferation, differentiation and apoptosis.

Will see high basophilic color, high proliferation rate in HIV individuals, must think Burkitts Lymphoma

260
Q

BCR-ABL

A

CML = philadelphia chromosome

261
Q

High plasma cell count in bone marrow

A 
multiple myeloma (High Plasma Cell neoplasm)
- RISK: bone reposition, high Ca, infection, amyloid, renal failure
262
Q

Blast cells in blood indicate what?

A

Blast cells = immature hematopoietic cells
indicates leukemia

Types:
ALL: Children = B cell (without mediastinal compression OR T cell precursor (if with mediastinal mass compression or superior vena cava syndrome)
AML: vitamin A = retinoic acid
CML: Old people
CLL
263
Q

easy bruising + lipid content in bone marrow

A

Aplastic anemia = High erythropoietin (hypo cellular bone marrow with fat cells)

  1. bruising = hypocoagulation or low platelets
  2. high lipid content = hematopoietic cell aplasia or hypoplasia

Dx: pancytopenia without splenomegaly + normocytic, normochromic RBC

264
Q

fluctuating cervical lymphadenopathy

A

non-hodgkin lymphoma

  • B-cell
  • bcl-2 oncogene
  • follicular small cleaved cell lymphoma
265
Q

High erythrocyte production

A

polycethma vera

- Mutation in JAK2 = cytoplasmic tyrosine kinase

266
Q

EtOH will show what type of anemia?

A

folate deficiency (NOT Vit B12) = hypersegments ( > 6 lobes) of neutrophils

267
Q

HbAS means what?

A

Sickle Cell Anemia

- Evolutionary protection against plasmodium falciparum (malaria)

268
Q

Normal platelet + High PT + High Bleeding time

A

Von Willenbrands

269
Q

Thrombocytopenia + High PT

A

DIC

270
Q

Pancytopenia + splenomegaly

A

cancer

271
Q

Thrombocytopenia + normal heme + normal leukocyte + no meds + normal spleen + normal INR/PT

A

acquired thrombocytopenia = Immune thrombocytopenic purpura → autoimmune destruction of platelets

272
Q

psammoma bodies

A

meningiomas

273
Q

Absent thymic shadow

A

DiGeorge Syndrome

  • 3rd/4th pharyngeal pouch
  • No T-cells = No paracortex

(NOTE: B-cells = follicles)

274
Q

Most toxic Vitamin for pregnancy

A

Vit A (teratogenic)

275
Q

HIV + temporal lobe

A

HSV-1

276
Q

HIV + multiple ring enhancing brain lesions

A

toxoplasmosis gondii

277
Q

Exudates vs Transudate

A

Exudates will have HIGH: Protein, LDH, WBC, and LOW GLUCOSE

NOTE: High Amylase is seen with lung adenocarcinoma and pancreatitis.

278
Q

Heavy menstruation

A

Think Leiomyoma (If not a choice, then cervical cancer)

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