Patho Qs Flashcards
When does the proliferation phase of wound healing begin?
6 days
Most important cause of delay in wound healing?
Infection
Hypertrophic scars vs Keloid
Hypertrophic scar - along the edge of the wound
Keloid - beyond original wound edges
Both with same histologic findings
Interstitial fluid compartment makes up what % of TBW?
15%
At what capillary pressure do you expect pulmonary edema?
> 28mmHg
Normal = 7mmHg
Safety factor = 21 mmHg
Pathophysiologic cause of edema in renal insufficiency?
Sodium retention
Pathophysiologic cause of edema in chronic inflammation?
Inflammation
Pathophysiologic cause of edema in DVT?
Increased hydrostatic pressure
What is the most common primary hypercoagulable state?
Factor V Leiden mutation
Amount of protein loss in nephrotic syndrome?
> 3.5g per day
Tx for heparin-induced thrombocytopenia?
Direct thrombin inhibitors (lepirudin, argatroban)
Pathogenesis of APAS?
Antibody-mediated inhibition of t-Pa activity (necessary for trophoblast invasion)
Why can you have a false positive RPR in APAS?
RPR is embedded in cardiolopin, which is found in patients with APAS
Laminations seen in antemortem thrombosis
Lines of Zahn
Gelatinous with dark red dependent portion and yellow “chicken fat” upper portion
Postmortem thrombosis
Location of mural thrombi?
Heart chambers or aortic lumen
MC site of arterial thrombosis?
Coronary arteries
MC site if venous thrombosis?
Lower extremities (90%) - calf veins
MCC of acute endocarditis?
Staph aureus
MCC of native valve endocarditis?
Strep viridans
MCC of subacute endocarditis?
Strep viridans
MCC of prosthetic valve endocarditis?
Staph epidermidis
Bacteria involved in marantic endocarditis?
Strep bovis type 1 (strep gallolyticus)
MCC symptom of pulmo embolism?
Dyspnea
Cardiac auscultation findings in pulmo embolism?
Accentuated pulmonic component of second heart sound
Organs with dual blood supply
Lungs, liver, intestines
Principal test for diagnosing pulmo embolism?
Chest CT with contrast
Gold standard for diagnosis of pulmo embolism?
Pulmonary angiography
Ischemic necrosis of femoral heads, tibia, humerus due to formation of nitrogen bubbles
Caisson’s disease
Dominant histologic characteristic of infarction
Ischemic coagulative necrosis
Infarction –> scar tissue
Septic infarction –> ?
Abscess formation
Valvular heart defect that usually leads to septic embolism to the lungs
Tricuspid valve endocarditis
Tissues that manifest red infarction
Lungs, liver, intestines (organs with dual blood supply)
Organs with end-arterial circulation
Heart, spleen, kidneys
ECG changes seen in cardiogenic shock
Low voltage complex
Type of shock seen in burn patients
Hypovolemic shock
Waterhouse-Fridreichsen syndrome?
Most severe form of meningococcemia (N. meningitidis)
Most severe form of meningococcemia
Waterhouse-Fridreichsen syndrome
Findings in Waterhouse-Fridreichsen syndrome?
Bilateral adrenal hemorrhage leading to acute adrenal cortical insufficiency
Kidney damage in shock
Acute tubular necrosis
Shock lung?
Alveolar damage secondary to shock (non-cardiac cause)
Genetic disorders with high penetrance
Mendelian disorders
Germ cell mutations vs somatic cell mutations
Germ cell mutation - transmitted to progeny
Somatic cell mutation - do not cause hereditary diseases but are important in carcinogenesis
Autosomal dominant disorders are often due to defects in what type of genes?
Structural genes - cause physical, structural problems
What is the probability that the son of a male with a X-linked disorder will have the defect?
None. The affected male does not transmit the disorder to his sons
Loss of intercellular connections between keratinocytes
Acantholysis
Epidermal hyperplasia
Acanthosis
Epidermal intercellular edema
Spongiosis
What is the likelihood that the daughter of a man with a X-linked genetic defect will present with symptoms?
None. All daughters are carriers only.
A man has a X-linked dominant disorder. How many of his sons will be affected? Daughters?
Male parent passes the trait to ALL his daughters but NONE of his sons (assuming female is normal)
A female has a X-linked dominant trait. How many of her daughters are affected? Sons?
Half her sons and half her daughters
Genetic defect in Marfan syndrome
Inherited defect in fibrillin-1 (extra cellular glycoprotein)
Ocular changes in Marfan’s
Ectopia lentis - bilateral subluxation or dislocation (superotemporal)
Cardiac auscultation findings likely seen in a patient with Marfan’s
Mid systolic click (mitral valve prolapse)
What generic disorder predisposes to aortic dissection?
Marfan syndrome
Pathology in aortic dissection?
Tear in the tunica media
Defect in Ehler’s Danlos syndrome
Defect in the synthesis or structure of fibrillar collagen
Most common defect in Ehler’s Danlos
Defect in type 3 collagen
Defect in Familial Hypercholesterolemia disorders
Mutation in the gene encoding for LDL receptors
Deficiency in Tay-Sachs disease
Hexodaminidase a-subunit deficiency
Tay-Sachs disease: what accumulates? What is deficient?
Deficiency: hexosaminisase alpha
Accumulates: GM2 ganglioside
Accentuated macular chorioid contrasted with pale retina
Cherry red macula
Niemann-Pick disease: what accumulates? What is deficient?
Deficient: sphingomyelinase
Accumulates: —
Cytoplasmic bodies resembling concentric lamellated myelin figures
Zebra bodies (seen in Niemann-Pick Disease)
What is the most common lysosomal storage disorder?
Gaucher disease
Gaucher disease. What is deficient? accumulates?
Deficiency: glucocerebrosidase
Accumulation: –
Distended phagocytic cells with crumpled tissue paper appearance
Gaucher disease
Distended phagocytic cells with crumpled tissue paper appearance in the brain
Virchow-Robin spaces (seen in Gaucher disease)
Mode of inheritance of most mucopolysaccharidoses
Autosomal recessive (except Hunter syndrome which is X-linked recessive)
Enzyme defect in Hurler syndrome?
a-L-iduronidase
Enzyme defect in Hunter syndrome
Iduronosulfate sulfatase
Enzyme defect in Morquio syndrome
N-acetylgalactosamine-6-sulfatase
Urinary metabolites that accumulate in Sanfillipo syndrome
Heparan sulfate
Distended cells with apparent clearing of cytoplasm
Balloon cells
Microscopic findings seen in mucopolysaccharidoses
Balloon cells
Zebra bodies
Enzyme deficiency in Pompe disease
a-1,4-glucosidase
Enzyme deficiency in Von Gierke disease
Glucose 6-phosphatase
Enzyme deficiency in Cori Syndrome
Glycogen debranching
Enzyme deficiency in Andersen syndrome
Branching enzyme
Glycogen storage disease that presents with infantile hypotonia
Andersen disease, type IV
Glycogen storage disease deficient in muscle glycogen phosphorylase
McArdle, type V
Enzyme deficient in Alkalptonuria
Homogentisic oxidase
Blue-black pigmentation in ears, nose, cheeks is called? Seen in what disease?
Onchronosis
Seen in Alkalptonuria
No loss of generic material during translocation
Balanced translocation
Robertsonian translocation?
Transfer if segments leads to one very large chromosome and one very small one
Endocardial cushion defects seen in Trisomy 21
ASD primum + AVSD
Ultrasound finding in a baby with Trisomy 21
Nuchal translucency
DiGeorge syndrome - branchial pouches involved
3rd and 4th branchial pouches
Male hypogonadism
Klinefelter syndrome (47 XXY)
Genetically make but phenotypically female
Klinefelter syndrome (47 XXY)
Testosterone and LH levels in primary hypogonadism
Low testosterone
Elevates LH
Testosterone and LH levels in hupogonadotropic hypogonadism
Low testosterone, low LH
Streak ovary seen in?
Ovarian day genesis (Turner syndrome)
Cardiovascular problem in Turner syndrome
Preductal coarctation of the aorta
Micro deletion of long arm of chromosome 7
Williams syndrome
Elfin facies, extreme friendliness with strangers
Williams syndrome
Happy puppet, inappropriate laughter
Angelman syndrome
Type of hypersensitivity rxn: Contact dermatitis
Type IV (delayed)
Type of hypersensitivity rxn: GBS
Type IV (delayed)
Type of hypersensitivity rxn: rheumatoid arthritis
Type IV
Type of hypersensitivity rxn: acute rheumatic fever
Type II
Type of hypersensitivity rxn: MS
Type IV
Type of hypersensitivity rxn: MG
Type II
Type of hypersensitivity rxn: SLE
Type III
Type of hypersensitivity rxn: type I DM
Type IV
Type of hypersensitivity rxn: post-strep glomerulonephritis
Type III
Type of hypersensitivity rxn: Graves’ disease
Type II
In what disease can you see nonerosive synovitis with little deformity?
SLE
In what disease can you see erosive synovitis?
Psoriasis
Diseases that histologically show bread and butter appearance?
Rheumatic fever, SLE, MI
Bread and butter appearance
Fibrinous pericarditis
Drugs that cause drug-induced lupus
Hydralazine, isoniazid, procainamide, penicillamine
Anti-histone antibodies seen in?
Drug induced lupus
Earliest finding in Sjögren’s syndrome
Periductal and perivascular lymphocytic infiltration of lacrimal and salivary glands
Drugs for tx of Sjögren’s
Steroids, artificial tears, pilocarpine
Rubber hose inflexibility of the esophagus seen in?
Scleroderma
Lower 2/3 of the esophagus
Extensive subcutaneous fibrosis leading to claw-like flexion deformity
Sclerodactyly (seen in scleroderma)
MCC of death in patients with scleroderma
Renal failure (50%) of patients
Type of fibrosis that damages the kidneys in scleroderma
Fibrinoid necrosis involving renal arteries
Antibodies seen in MCTDs?
Anti-ribonucleoprotein (anti-RNP)
Transplant rejection that shows necrotizing vasculitis with endothelial cell necrosis, neutrophilic infiltration, deposition of Ig, complement and fibrin
Acute humoral rejection - type II hypersensitivity
Type of transplant rejection that shows thrombotic occlusion of capillaries and fibrinoid necrosis in arterial walls
Hyperacute rejection (type II)
Type of transplant that shows vascular changes, interstitial fibrosis and tubular atrophy with loss of renal parenchyma
Chronic transplant - Type IV
Mutation in Bruton agammaglonulinemia
Tyrosine kinase mutation
Virtual absence of B cells
Patients with Bruton’s agammaglonulinemia are predisposed to having infections with what organisms?
Step pneumonia, H. influenzae
Treatment for Bruton’s agammaglonulinemia
Pooled gamma globulin
Selective IgA deficiency pathogenesis
Failure of isotope switching
MC form of severe antibody deficiency? Tx?
CVID
Pooled gamma globulin
Pathogenesis of SCID?
X-linked: mutation in gene encoding common gamma chain/ IL-2
Autosomal: ADA deficiency
How to diagnose CGD?
Nitroblue tetrazolium test
CGD: what is lacking?
NADPH oxidase activity, failure of oxidative burst
Patients with CGD are predisposed to having what kind of infections?
Catalase positive bacteria, fungi (A. fumigatus)
Chediak-Higashi syndrome: pathogenesis?
Failure of phagolysosomal fusion, faulty micro tubules impair neutrophil chemotaxis
Patients with terminal complement deficient are predisposed to having bacteremia secondary to what organisms?
N. meningitidis, N. gonorrhea
Deficiency in Paroxysmal nocturnal hemoglobinuria
Deficiency of decay accelerating factor (DAF)
HIV major capsid protein
p24
HIV screening test? Confirmatory test? Test for monitoring?
Screening: ELISA
Confirmatory: Western blot
Monitoring: CD4 count
Amyloidosis in polarized light? What stain?
Apple-green birefringence with Congo Red
Protein structure involved in Amyloidosis
Secondary protein structure (Beta pleated sheets)
Most common and most serious form of Amyloidosis
Renal Amyloidosis
Tapioca-like granules in the splenic follicles
Amyloidosis (sago spleen)
Map-like areas in walls of splenic sinuses
Lardaceous spleen - seen in Amyloidosis
Benign or malignant? Mature teratoma in women
Benign
Benign or malignant? Mature teratoma in men
Malignant
Benign or malignant? Hepatoma
Malignant
Benign or malignant? Immature teratoma
Malignant
Benign or malignant? Hemangioma
Benign
Benign or malignant? Leukemia
Malignant
Normal cells in normal location but with overgrowth
Hamartoma
Normal cells in abnormal locations
Choristoma
Reversible or Irreversible? Hyperplasia
Reversible
Reversible or irreversible? Metaplasia
Reversible
Reversible or irreversible? Dysplasia
Reversible
Reversible or irreversible? Anaplasia
Irreversible
Fibrous tissue formation in response to neoplasm
Desmoplasia
Degree of cellular differentiation based on histologic appearance, reflects the character of the tumor itself.
Tumor grade
What does the tumor stage reflect?
Degree of localization/ spread. Has more prognostic value than tumor grade.
MC cancer in children
Leukemias (ALL)
MC cancer in women
Breast CA
MC cancer in men
Prostate CA
Most common cancer that causes death in men?
Lung CA. Also for women.
Eating large amounts of smoked food is associated with what CA?
Gastric adenocarcinoma. Common among Japanese.
Infectious agents associated with cholangiocarcinoma
Chlonorchis sinensis
Opistorchis viverrini
Schistosoma hematobium is associated with what malignancy?
Bladder squamous carcinoma
Cytokine involved in cahexia
TNF-alpha
Paraneoplastic syndrome associated with small cell CA of the lung?
SIADH
Trousseau syndrome is associated with what cancer?
Pancreatic cancer
Disease with antibodies against the pre synaptic calcium channel
Lambert Eaton myasthenia
Tumor marker for ovarian CA
CA-125
Tumor marker for pancreatic adenocarcinoma
CA 19-9
Tumor marker for gastric CA
CEA
Tumor markers (2) for prostrate cancer
PSA, prostatic acid phosphatase
Tumor marker for melanoma
S-100
Tumor marker for choriocarcinoma
b-HCG
Tumor marker for Hairy cell leukemia
Tartrate-resistant acid phosphatase (TRAP)
Where are Weibel-Palade bodies seen?
Endothelial cells
True vs False aneurysm
True - intact wall
False - with extravasation of blood in between two vessel layers
MC location of AAA?
Below the renal arteries
Triad of AAA rupture
Flank pain, hypotension, pulsatile mass
MC site of berry aneurysm
ACOM. Junction of the communicating branches with the main cerebral vessels
What vessel (and parts) are involved in syphillitic aneurysm?
Invasion of the vasa vasorum of the thoracic aorta
Appearance of syphillitic aorta
Tree-bark appearance with wrinkling of the tunica intima
Aortic dissection involves what layer?
Dissection of blood between and along the laminar parts of the tunica media
Aortic dissection is more frequent in Marfan’s or Ehler’s Danlos?
Marfan’s
Type of aortic dissection with worse prognosis
Type A - Proximal
Associated with ascending or both ascending and descending
What is the MC per-existing histologic lesion of aortic dissection
Cystic medial degeneration/necrosis
Presenting s/s if aortic dissection
Acute severe reteosternal chest pain radiating to the back with loss of upper extremity pulses and aortic valve regurgitation
MC site if varicose veins
Superficial saphenous veins
Which is more common, left or right varicocele? Why?
Left. The right drains directly into the IVC.
Phlebothrombosis most common location
Calf deep vein
Phlebothrombosis = aka DVT
Pain on foot dorsiflexion
DVT
Orange discoloration and ischemic ulcers around the ankles
DVT
Phlebothrombosis vs Thrombophlebitis
Phlebothrombosis: DVT, vein thrombosis without inflammation
Thrombophlebitis: pain and tenderness of the superficial vein secondary to inflammation
Carcinoma associated with thrombophlebitis
Pancreatic cancer (head) - superficial migratory thrombophlebitis
Compression of the neurovascular components of the neck
Thoracic outlet syndrome
Adson test
Test for thoracic outlet syndrome
Physical examination for DVT
Homan’s test
Lymphangitis is commonly due to what organism
GABHS
Differentiate the primary lymphedema caused by Turner’s syndrome and Lymphedema praecox
Turners - females, newborn, upper part of the body (cystic hygroma)
Lymphedema praecox - females, puberty, lower part of the body (cankles!)
Presenting s/s of Monckeberg medial calcific sclerosis
None. Patients are asymptomatic.
Necrotizing arteriolitis
Hyperplastic arteriolosclerosis
Major characteristic of benign nephrosclerosis
Hyaline variant arteriolosclerosis
Hyaline vs Hyperplastic variant arteriolosclerosis: which is associated with benign hypertension and DM
Hyaline variant
Hyaline vs Hyperplastic variant arteriolosclerosis: which is associated with onion-skinning
Hyperplastic variant
MCC of MI
Atherosclerosis
Why do males have an increased risk for MI?
Estrogen is cardio protective
Earliest lesion in atherosclerosis
Fatty streak
Lipid core surrounded by a fibrous plug
Atherosclerotic plaque
MC site for atherosclerosis
Abdominal aorta
Earliest manifestation of hypertensive heart disease
Increase in transverse diameter of myocytes
p-ANCA: with antibodies against?
Antibodies against myeloperoxidase (MPO)
c-ANCA: with antibodies against?
Proteinase-3 (PR-3)
MC systemic vasculitis in adults
Temporal (Giant Cell) arteritis
Vessels most commonly involved in Giant Cell arteritis
Temporal artery, ophthalmic artery, vertebral artery, aorta
Vasculitis that presents with nodular intimal thickening of large vessels with multinucleate giant cells
Temporal arteritis
Polymyalgia rheumatica is seen in?
Temporal arteritis
Pulseless disease
Takayasu arteritis
Weakened upper extremities with BP difference > 10mmHg between arms
Takayasu arteritis
Aortic arch syndrome
Takayasu arteritis
Granulomatous inflammation of the aorta with giant cells
Takayasu arteritis
MC vessel involved in PAN?
Renal artery > coronary > hepatic > mesenteric arteries
Treatment for Takayasu arteritis
Steroids
What organ is not involved in PAN?
Pulmonary arteries
Segmental transmural necrotizing inflammation of small to medium sized arteries
Polyarteritis nodosa
MC acquired heart disease in children
Kawasaki disease
Vessels most frequently involved in Kawasaki disease
Coronary arteries
Treatment for Kawasaki disease
IVIg, Aspirin
Where can you see leukocytoclastic vasculitis
Microscopic Polyarteritis/ polyangitis
Penicillin can induce this small vessel vasculitidis
Microscopic polyangitis
Necrotizing vasculitis with granulomas with eosinophilic necrosis
Churg-Strauss
Syndrome
What is spared in: Churg-Strauss syndrome
Renal vessels
What is spared in: Polyarteritis
Nodosa
Pulmonary vessels
Necrotizing vasculitis of Wegener Granulomatosis is most prominent in what organ?
Lungs
Geographic patterns of central necrosis and accompanying vasculitis
Wegener Granulomatosis
4 C’s of Wegener Granulomatosis
C ANCA
C resenteric GN
C yclophosphamide
C orticosteroids
Buerger’s syndrome: commonly involves what age group?
< 35yo
Sharply segmental acute and chronic vasculitis of medium sized and small vessels; thrombus with microabscesses
Thromboangitis obliterans
Resting pain on forefoot
Thromboangitis obliterans
Morphology of arterial walls in Raynaud’s phenomenon
Normal arterial walls except in late stages (intimal thickening)
Arsenic is associated with what tumor?
Hepatic angiosarcoma
Rust colored sputum
Left sided heart failure
Bat wing configuration
CXR finding - perihilar congestion in left sided heart failure
First symptom of CHF
Dyspnea
First sign of left sided HF
Left sided S3
Predictor of survival in CHF
BNP levels
Hallmark of right sided heart failure
Ankle/ pedal and pretibial edema
Nutmeg liver
Chronic passive congestion of liver secondary to CHF
4 causes of high output cardiac failure
Beri-beri
Anemia
Hyperthyroidism
AV fistula
Greatest risk factor for developing congenital heart disease
Congenital heart disease in a parent or preceding sibling
Most important component of TOF
Pulmonic stenosis
Congenital heart disease associated with diabetic mothers
TGA
Heart shape: TOF
Boot shaped
Heart shape: TGA
Egg shaped, egg on a string
Most common variant of TAPVR
Supra cardiac (drains to inominate/ brachoicephalic
Cardiac auscultation findings in ASD
Fixed widely split S2
MC variant of ASD
Secundum
ASD variant associated with Trisomy 21
ASD primum
Likely congenital heart disease in a patient with fetal alcohol syndrome
VSD
MC type of VSD
Membranous (90%) - hole is in the membranous septum
Multiple VSDs seen in the muscular septum
Swiss cheese septum
Management of VSD
50% will close spontaneously
Surgical correction if still persistent at 1yr old
Congenital heart problem associated with Rubella
PDA
Cardiac auscultation findings in PDA
Continuous harsh machinery-like murmur at 2nd ICS left
Types of AVSD
Partial - primary ASD and cleft anterior mitral leaflet causing mitral insufficiency
Complete - hole in the center of the heart; 1/3 with trisomy 21
Infantile coarctation of the aorta associated with?
Turner’s syndrome
Rib notching is associated with what malformation?
Coarctation of the aorta - post-ductal type
Congenital heart defects associated with Marfan Syndrome
MVP, Aortic dissection
What does the LAD artery supply?
Anterior wall of LV, anterior ventricular septum, apex
Romano-Ward syndrome
Autosomal dominant long QT syndrome that’s a risk factor in sudden cardiac death
Two classifications of MI
Q-wave (ST elevation) and Non-Q-wave (ST depression)
Layers of the heart involved in Q wave infarction
Full thickness/ transmural (endo, myo and epicardium)
Layers of the heart involved in Non-Q wave infarction
Subendocardium, endocardium
Most common vessel blocked causing MI
LAD
Slender beaded gram positive organisms arranged in branching filaments
Nocardia asteroides
Haze of bacteria entangled with the cilia of bronchial epithelia
Bordetella Pertussis
Where can you see Meyers-Kouvenaar bodies?
Tropical Pulmonary Eosinophilia
Liver finding in severe schistosomiasis
Pipe stem fibrosis
Pipe stem fibrosis - seen where?
Severe schistosomiasis
Diffuse mucosal damage and glandular atrophy of oxyntic mucosa
Autoimmune gastritis
Islands, trabeculae, strands, glands or sheets of uniform cells with sly and pepper chromatin
Carcinoid tumor
Pedunculated, smooth surfaced, reddish lesions with cystic spaces in the colon
Juvenile polyps
Multiple GI hamartomatous polyps and mucocutaneous hyperpigmentation most common in the small intestines
Peutz-Jeghers syndrome
Most common and clinically important neoplastic colonic polyps
Colonic adenoma
Hyperplastic polyps: risk for CA?
None. They have no malignant potential.
Risk factor most closely associated with colorectal cancer
Dietary factors
Whitish ulcerated oral mucosal lesions near the opening of Stensen’s duct
Koplick spots, seen in Measles/ Rubeola
Multinucleated giant cells, cough, fever, hyperemic conjunctiva
Warthin-Finkeldey cells
Perivenous demyelination and perivascular mononuclear cuffing
Mumps encephalitis
Lobe involved in Herpes Simplex encephalitis
Temporal lobe
Dewdrop on a rose petal
Varicella
Ganglion involved in shingles
Dorsal root ganglion
Mononuclear infiltration with herpetic intranuclear inclusions; facial nerve paralysis
Ramsay Hunt syndrome
Another name for herpes simplex oticus
Ramsay Hunt Syndrome
Ganglion involved in Herpes Simplex Oticus
Geniculate ganglion
Prominent intranuclear basophilic inclusions surrounded by a halo
Owl’s eye inclusions
Atypical lymphocytes seen in EBV infection
Downey cells
Green to brown deposits of copper in Descemet’s membrane in the corneal limbus
Kayser-Fleischer rings
Kayser-Fleischer rings
Green to brown deposits of copper in Descemet’s membrane in the limbus of the cornea
Eye manifestations of Wilson’s disease
Kayser-Fleischer rings
Round to oval cytoplasmic globular inclusions in hepatocytes
Alpha-1 anti trypsin deficiency
Inflammation of the pancreas with irreversible destruction of exocrine parenchyma
Chronic pancreatitis
Localized collections of necrotic-hemorrhagic material rich in pancreatic enzymes
Pancreatic pseudocyst
Tumor marker for pancreatic cancer
CA 19-9
