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