Path Flashcards
most common pit. tumor
prolactinoma, amenorrhea, galactorrhea, decreased libido, and bilateral hemianopsia, erectile dysfunction. TX: dopamine agonist
sheehan syndrome
pit. infarct following a hypotensive event after giving birth, trouble with lactation and hypopituitarism
PSGN: post-strep glomer neph
edema, hematuria, hypertension, protienuria. enlarged hypercellular glomeruli, IgG & C3 deposits. “starry sky” or “lumpy bumpy” pattern. casued by strep A test: anti-streptolycin O
goodpasture syndrome
IgG basement membrane antibodies, causes hemoptysis, glomerulomehritis. crescent moon shapes on microscopy
wegener granulomatosis
upper respiratory tract, lungs and kidneys. hematuria, weight-loss, fever, resp. symptoms. c-ANCA +
skin CA w/ best prognosis
basal cell carcinoma
most common mets to brain (3)
lung, breast and melanoma
mesoderm forms?
dermis, most bones, muscles and visceral tissue
surface ectoderm forms?
epidermis and appendages, mammary glands, lens of the eye, others…
neuroectoderm forms?
CNS, preganglionic autonomic neurons, retina, pos. pit.
endoderm forms?
structures derived from inner lining of rimitive gut tube (thyroid follicular cells, epithelium of trachea, bronchi, lungs, liver, biliary tree, the pancreas, GI and bladder.
granulosa cell tumor
secrete estrogen, endometrial hyperplasia, endometrial carcinoma, carr-exner bodies (follicles filled with eosinophils
MS: s/s, diag, tx
progressive demylinating disease. diplopia, incontinence, loss of nerve function any where. diag: oliogoclonal bands in csf, mri = plaques in the brain and spinal chord. tx: corticosteroids
intestinal atresia belwo duodenum is caused by…
vascular occlusion in utero
signet-ring carcinoma
gastric adenocarcinoma, cells contain abundant mucin and can cause linitis plastica
hallmark PFT for COPD?
decreased FEV1/FVC ratio
Meckel’s Diverticulum
most common congenital anomaly of the small intestine- True Diverticulum
forms from incomplete obliteration of omphalmesenteric duct (connects midgut lumen to yolk sac cavity)
connected to ileum and often has other tissue present (typically gastric, pancreatic, colonic, jejunal, duodenal, and endometrial)
most commonly, gastric tissue.. which can cause ulcers. also can present with black tarry stolls (guaiac +).
99mmTc-pertechnetate scan detects presence of gastric mucosa
Rule of 2s: 2% of population, 2in in length, 2ft from ileocecal valve, 2% are asymptomatic, and males are 2x more likely to be affected
Annular Pancreas
abnormal migration of ventral pancreatic bud leads to the head of the pancreas surrounding the duodenum. congenital anomoly (rare) that presents with sx of intestinal obstruction (recurrent bilious vomiting) soon after birth.
Cleft Lip vs Cleft Palate
cleft lip= failure of fusion of of maxillary and medial nasal processes (primary palate)
cleft palate= failure of fusion of the later palatine processes, the nasal septum and/or median palatine process (secondary palate)
Caudal Regression Syndrome
rare congenital abnormality. patients are born with agenesis of the sacrum and occasionally lumbar spine
experience resultant flaccid paralysis of the legs, dorsiflexed contractures of the feet and urinary incontinence.
frequently attributed to poorly controlled maternal diabetes.
Craniopharyngiomas
calcified cystic tumors, most commonly found in kids and young adults. They arise from the remnants of Rathke’s pouch. Usually filled with a yellow viscous fluid, rich in cholesterol.
Usually cause h/a, growth failure, and bilateral hemianopia
Nephrotic Syndromes
Focal Segmental Glomerulosclerosis Membranous Nephropathy Minimal Change Disease (lipoid nephrosis) Amyloidosis Membranoproliferative glomerulonephritis Diabetic Glomerular Nephropthy
Nephritic Syndromes
Acute Post-Strep Glomerulonephritis
Rapidly Progressive (cresentric) glomerulonephritis
Diffuse proliferative glomerulonephritits
Berger’s Disease (IgA Nephropathy)
Alport Syndrome
Berger’s Disease
Ig A Nephropthy
related to henoch-schonlein purpura
IgA based immune complex deposits in mesangium
can present with flares of a URI or acute gastroenteritis
Diffuse Proliferative Glomerulonephritits
Due to SLE or MPGN (membranoproliferative)
Wire looping of capillaries
IgG based immune coplexes with C3 deposits and granular appearance
Most common cause of death for SLE pt’s
Rapidly Progressive Glomerulonephritis
Cresentric Glomerulonephritis
looks like crescent moon, made of fibrin and plasma proteins with glomerular pareital cells, monocytes, and macrophages
Can be from Goodpasutres (hematuria/hemeoptysis), Wegener’s (c-ANCA), or Microscopric polyanginitis (p-ANCA)
Has a poor prognosis (renal failure in day/weeks)
Acute Post-Strep Glomerulonephritis
lumpy bumpy appearance with subepithelial immune complex humps and a granular appearance due to IgG, IgM, and C3 deposition along GBM and mesangium
mostly in kids with perioribital edema, dark urine, and HTN. will resolve spontaneously
Diabetic Glomerulonephropathy
nonenzymatic glycosylation of GBM increasing the permeabilty and thickening the BM
See Kimmelsteil-Wilson lesions- mesangial expansion, GBM thickening, and eosinophilic nodular glomerulosclerosis
Membranoproliferative Glomerulonephritis
Can also be nephritic
TypeI: subendothelial IC deposits - tram-track appearance bc GBM has split from the mesangial ingrowth
Assoicted with HBV, HCV
TypeII: intermembranous IC deposits, “dense deposits”
Associted with C3 nephritic factor
Amyloidosis
Congo Red-stain shows apple green bifringence under unpolarized light
pathogenesis: excessive delivery of light chain proteins that overwhelms the ability of the renal tubules for reabsorption. The excess light chains complex with a glycoprotein found in urine called uromodulin (tamm-horsfall protein) to form light chain casts.
Associated with chronic conditions like MM, TB, RA
Minimal Change Disease
glomeruli lok normal under light microscopy. see foot process effacement under electomicroscopy
Selective loss of albumin, not globulins, caused by GBM polyion loss
Maybe triggered by recent infection or immune stimulus
Usually in kids
Tx: corticosteroids
Membranous nephropathy
diffuse capillary GBM thickening. will see “spike and dome” appearance with subepithelial deposits
2nd most common cause of primary nephrotic syndrome in adults.
Can be idiopathic or caused by syphilis, HBV, HCV, malaria, malignancy, SLE, gold salts and penicillamine
tx: prednisone
Focal Segmental glomerulosclerosis
segmental sclerosis and hyalinosis with effacement of foot processes
**MOST COMMON cause of nephrotic syndrome in adults
associated with HIV, heroin use, massive obesity, INF tx, and chronic kidney disease to congenital absence or surgical removal
Tranistional Cell Carcinoma Risk Factors
Pee SAC
Phenacetin Smoking, Aniline Dyes, and Cyclophosphamide
“Risk factors are smoking (most common), radiation exposure, aniline dyes, artificial sweeteners, and cyclophosphamide. Working with rubber, leather, textiles and paint products also increases the risk of bladder cancer. The classic presentation is painless hematuria. Frequency, dysuria, and urgency are common manifestations of the condition.”
Acute Tubular Necrosis
MOST COMMON CAUSE OF INTRINSIC RENAL FAILURE
associted with renal ischemia from shock, sepsis, or a crush injury (myoglobinuria), drugs, or toxins
See muddy brown (granular) casts
Occurs in 3 stages: 1. inciting phase, maintenance/oliguric (when death usually occurs), and recovery phase (self-reversible in some cases, may become hypokalemic)
Disease states that can cause renal papillary necrosis
DM, Acute pyelonephritis, Chronic phenaticin use, and sickle cell anemia/trait
Renal Osteodystrophy
consequence of renal failure that causes a failure of Vit D hydroxylation , hypocalcemia, and hyperphosphatemia.
secondary hyperparathyroidism
the hyperphosphatemia decreases serum Ca by causing tissue calcifications and Ca is furhter decreased by a lack of 1,25 OH Vit D, decreasing intestinal Ca reabsorption
Medullary Cystic Disease
inherited disease cauing tubulointerstital and progressive renal insufficency with inability to concentrate urine
No cysts
Shrunken kidneys
Poor prognosis
Acute Interstitial Nephritis (AIN)
fever, rash, eosinophilia, white blood cell casts, hematuria and eosinophiluria.
Most commonly if from allergic reaction to a drug (penicillins, cephalosporins, NSAIDs, phenytoin, diuretics, and sulfonamides). Also from infectious diseases or immunologic diseases (Sjogren’s, SLE, sarcoid).
Intrinsic renal failure: BUN:Creatinine ratio of 40mEq/L, and FENa >2%, urine osmalility <350 mosm/kg. and hyperkalemia
“Fried Egg” appearance
Clear cytoplasm with round nucleus
Giant Cell Tumor (Osteoclastoma)
aggressive benign bone tumor at epiphyseal end of long bones
20-40yo
usually distal femur/proximal tibia (knee area)
Double Bubble on Xray
Spindle shaped with multinucleated giant cells
Osteochondroma
Most common benign tumor
males <25yo
mature bone with cartilage cap usually from long metaphysis
can turn into chondrosarcoma, but rare
Ewing’s Sarcoma
malignant bone tumor at diaphysis of long bone, pelvis, scapular, or ribs
boys <15yo
anaplastic small blue cell malignant cell that is aggressive with early mets
responsive to chemo
Onion skin appearance in bone
associated with t11:22 translocation
Osteosarcoma
2nd most common malignant bone tumor
male>female 10-20yo
risks: pagets, bone infarcts, radiation, familial retinoblastoma
X-ray: Codman’s triangle (elevation of
periosteum) or sunburst pattern.
Aggressive. Treat with surgical en bloc resection
(with limb salvage) and chemotherapy.
Chondrosarcoma
men 30-60 yo
usually in pelvis, scapula, spine, humerus, tibia or femur
malignant cartilaginous tumor- expansive glistening mass within medullary cavity
Rheumatoid Factor
anti-IgG antibody
Sjogren’s
lymphocytic infiltration of exocrine glands (esp. salivary and lacrimal)
classic triad: dry eyes, dry mouth, arthritis
Pseduogout vs. Gout
Pseduogout: weakly birefringent rhomboid crystals (blue), crystals made from calcium pryophosphate, men and women equally affected
Gout: negatively birefringent needle shaped crystals (yellow), made from urate, men mostly affected
most common site of osteonecrosis
femoral head
Polymyositis
progressive, symmetrical proximal muscle weakness (usually shoulders)
endomysial inflammation with CD8
Dermatomyositis
polymoysitis by with malar rash
also, gattron’s papules (DIP), helotrope rash
“mechanic’s hands and shawl and face rash”
perimysial inflammation and atrophy with CD4
Lambert-Eaton Myesthenic Syndrome
autoantibodies to presynaptic Ca++ channel decreasig ACh release
proximal muscle weakness that improves with use
associated with small cell lung caner
AChE inhibitors will NOT help
