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Rheumatology > Pathology > Flashcards

Pathology Flashcards

1
Q

Interstitial lung disease: NSIP PATTERN + interstitial fibrosis + concentric arterial thickening?

A

Scleroderma lung

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2
Q

NSIP PATTERN lung disease?

A

Scleroderma lung

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3
Q

EARLY Mediators of scleroderma lung are?

A

IL-8

TNF

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4
Q

LATE mediator of scleroderma lung?

A

TGF beta

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5
Q

All the mediators of scleroderma lung

A 
IL-8 
TNF alpha
MIF1 alpha
RANTES 
TGF beta
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6
Q

Radiographic distribution of scleroderma lung?

A

BASES
Posterior + periphery
GROUND GLASS–> reticular pattern

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7
Q

Fibrosis favoring bases + posterior and periphery?

A

Scleroderma lung

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8
Q

What types of cells are seen in NSIP pattern lung disease?

A

Scleroderma lung–> Lymphocytes + macrophages + fibroblasts

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9
Q

Causes concentric thickening + fibrosis of small Pulmonary arteries–> Pul HTN –> cor pulmonale. what is the associated antibody?

A

Scleroderma–> Anti-centeromere

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10
Q

Systemic signs of Scleroderma lung (NSIP pattern)?

A

Dyspnea
Dry cough
VELCRO crackles @ bases

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11
Q

Anti-DNA topoisomerase antibodies?

A

Systemic sclerosis

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12
Q

Tx for scleroderma lung?

A

Cyclophosphamide

NOT steroids

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13
Q

MCC of death in pt with Anti-Scl70 antibodies?

A

Systemic sclerosis–> NSIP pattern lung disease

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14
Q

Pleuropulmonary disease associated with LUPUS?

A 
PLEURITIS 
NSIP
Vascular disease
Shrinking LUNG 
Acute Lupus pneumonitis
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15
Q

MC pleuropulmonary involvement in Lupus?

A

Pleuritis–> fibrinous

+ small pleural effusion

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16
Q

NSIP Pattern lung disease?

A

Scleroderma

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17
Q

NSIP lung disease?

A

LUPUS

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18
Q

Thromboembolic disease from anti-phospholipid antibodies?

A

LUPUS anticoagulant

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19
Q

Disease causing either UIP or NSIP pattern in significant and likely similar proportions?

A

RA

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20
Q

Pleuropulmonary disease in RA pt MC involves what?

A

Bronchioles

Pleura

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21
Q

Interstitial fibrosis consisting of Temporal heterogeneity + Severe @ periphery and Lower Lobes?

A

UIP pattern–> RA

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22
Q

RA with rheumatoid nodules in lung + pneumoconiosis?

A

Caplan syndrome

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23
Q

Follicular bronchiolitis is associated with what AI disease?

A

RA

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24
Q

More common in RA + obstructive PFTs + Sjogrens + DOES not respond to Steroids?

A

Obliterative Bronchiolitis

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25
Q

More common in RA + acute onset of fever and alveolar infiltrates + responds to Steroids?

A

Organizing pneumonia

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26
Q

Rim of palasading histiocytes + basophilic debris surrounded by fibrosis, lymphocytes, macrophages, and multinucleate Giant cells?

A

Rheumatoid nodule

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27
Q

MCC of death in RA pts?

A

Respiratory failure from fibrosis

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28
Q

What is the most unpredictable serious AE of methotrexate?

A

Pneumonitis

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29
Q

Causes restrictive pattern LD + organizing Pneumonia + NSIP?

A

Polymyositis/ Dermatomyositis

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30
Q

NSIP in lower lobes with LOTS of submucosal secretions and RELENTLESS DRY cough?

A

Sjogren syndrome

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31
Q

NSIP with LYMPHOID follicles (germinal centers) and bronchiolocentric?

A

Sjogren syndrom NSIP

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32
Q

NSIP with LOTS of lymphocyte + macrophages + multi nucleated giant cells?

A

Sjogrens syndrome

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33
Q

CELLULAR NSIP?

A

Sjogren–> excess lymphocyte infiltrates

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34
Q

What Ai disease is associated with HIGHER risk for lymphomas?

A

Sjogren syndrome

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35
Q

Mediastinal LAD + pleural effusion + Lung nodularity + dry mouth?

A

Lymphoma in Sjogrens patient

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36
Q

Autoimmune interstitial pneumonias are usually?

A 
Chronic 
Velcro crackles + dyspnea
BASAL, posterior, Peripheral 
Restrictive PFTs
Decreased DLCO
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37
Q

Acute lung disease in a rheumatology patient is more likely?

A

Infectious

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38
Q

Subacute or chronic dyspnea in rheumatology patient is more likely?

A

Manifestation of rheumatological disease

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39
Q

Nodular lung disease in Rheumatology patient is more likely?

A

Infectious or malignant

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40
Q

Insidious onset of painful fingertips with cold, swelling and itching of hands, generalized weakness and joint aches?

A

Systemic sclerosis

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41
Q

Farmer insidious onset of difficulty getting up, combing his hair, scaly knee lesions, purplish eyelid discoloration, pruritic rash from neck to chest?

A

Dermatomyositis

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42
Q

Network-pattern purplish discoloration of skin due to dilation of blood vessels?

A

Livedo reticularis

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43
Q

MCC of fungal vasculitis?

A

Aspergillus

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44
Q

MCC of bacterial vasculitis?

A

Pseudomonas

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45
Q

MCC of viral vasculitis?

A

CMV

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46
Q

Segmental, Transmural, Granulomatous with MN giant cells centering around/ destroying Internal ELsastic lamina?

A

Temporal Arteritis

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47
Q

Headache, tender artery, Visual disturbance, Jaw claudication?

A

Temporal Arteritis

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48
Q

Transmural arteritis narrowing lumen with prominent Granuloma?

A

Temporal arteritis

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49
Q

Giant cells eating Internal elastic lamina, cell proliferation and lymphocytic biopsy

A

Temporal arteritis

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50
Q

Segmental, transmural, necrotizing, Loosely Granulomatous with MN giant cells, Medial loss of elastic fibers (Thinning)?

A

Takayasu arteritis

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51
Q

Arteritis involving Aorta often causing Dissection?

A

Takayasu arteritis

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52
Q

Segmental, transmural, NODULAR arteritis?

A

Polyarteritis nodosa

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53
Q

Fibrinoid necrosis with PMNs acutely, and PREdominant @ branch points?

A

PAN

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54
Q

Branch points + Fibrinoid necrosis?

A

PAN

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55
Q

Late phase of PAN has what characteristics

A 
HOMOGENOUS lesions 
Inflammation
Fibroblasts
scarring
aneurysms
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56
Q

Lesions at different phases caused by Hepatitis B?

A

PAN

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57
Q

Vasculitis associated with Livedo Reticularis?

A

PAN

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58
Q

Fibrinoid necrosis + PMN infiltrates?

A

Acute phase PAN

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59
Q

Endothelial necrosis with PMNs, Lymphocytes, Wall necrosis, Child, Thrombosis?

A

Kawasaki disease

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60
Q

Tx of Kawasaki disease?

A

Aspirin

IV ig

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61
Q

Kawasaki disease usually involves what arteries?

A

Coronary arteries

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62
Q

Necrotizing granulomatous vasculitis of Arteries + veins in URT + LUNGS + KIDNEYS?

A

Wagerer’s–> Granulomatosis with Polyangiitis

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63
Q

“Geographic” areas of necrosis with debris and Palisaded Histiocytes?

A

Wegener’s

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64
Q

c-ANCA?

A

ANCA-PR3–> Wegener’s

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65
Q

Mucosal ulcers + necrotizing vasculitis?

A

Wegener’s

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66
Q

Asthma + Eosinophilia + Vasculitis?

A

Churg-Strauss syndrome (Allergic granulomatosis with polyangiitis)

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67
Q

Segmental transmural inflammation without Necrosis, + thrombosis, + granulomas, + giant cells?

A

Buerger Disease

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68
Q

Vasculitis causing gangrene or autoamputaion of fingertips?

A

Buerger disease

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69
Q

Capillary and post capillary venule infiltration by PMNs causing Leukocyoclasia (NUCLEAR DUST)?

A

Hypersensitivity Angiitis

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70
Q

Leukocytoclastic angiitis + lymphocytes + Homogenous lesions?

A

Hypersensitivity Angiiitis–> Late phase

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71
Q

Child post URTi, skin lesions, joint pain, Abdominal discomfort, and Renal damage+ IgA deposition?

A

Henoch- Schoenlein Purpura

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72
Q

MCC of Hypersensitivity angiitis in adults?

A

Drugs

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73
Q

Most common joint issue in ER?

A 
Ankle 
Wrist 
Knee 
Hip
Shoulder 
Elbow
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74
Q

Necrotizing muscle infection with sudden onset of severe pain @ trauma site, Bronzing of skin followed by red purple discoloration?

A

Clostridial myonecrosis (Gas gangrene)

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75
Q

Post trauma with TENDER skin and Bullae formation?

A

Clostridial myonecrosis

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76
Q

Clostridium perfringens VF: alpha toxin + hemolytic toxin + phospholipase + sphingomyelinase DO WHAT?

A

Platelet aggregation
PMN adherence to endothelium
NEGATIVE INOTROPE
inhibits Cardiac pump function

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77
Q

What causes rapid irreversible decline in muscle blood flow and ischemic necrosis due to formation of occlusive intravascular masses of activated platelets(GP 2b/3a). leukocytes, and fibrin?

A

Alpha toxin of Clostridial

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78
Q

Post trauma + RE-perfusion + tender but normal appearing skin + Pain with movement?

A

Compartment syndrome

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79
Q

Pain with passive muscle stretch, Tense firm wood-like compartment, Diminished sensation, muscle weakness?

A

Compartment syndrome

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80
Q

Most ligamentous injuries int the knee present with what?

A

hemarthroses

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81
Q

Straight or cross leg raise test is for?

A

Lumbar disk herniations

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82
Q

Low back pain, bladder dysfunction, fecal incontinence and sexual dysfunction?

A

Cauda equina syndrome

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83
Q

Name four surgical emergencies?

A

Necrotizing fasciitis
Cauda equina syndrome
Acute loss of arterial supply
Acute compartment syndrome

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84
Q

Vast majority of ankle fractures are?

A

Malleolar –> UNImalleoalar

NO joint space disruption

85
Q

Colles fracture?

A

Distal radial metaphysis fracture with “dinner fork” deformity

86
Q

Sudden onset of hip pain, leg shortened + externally rotated?

A

Hip fractures–> Displaced

87
Q

MCC of back pain?

A

Herniation of disk

88
Q

Predictors of drug-seeking behavior?

A

ask for Drug by name
multiple visits for same complaint
suspicious history
symptoms out of proportion with exam

89
Q

Small LEG Trauma–> erythema w.out sharp margins + swelling + warm + shiny + tender+ severe pain?

A

Necrotizing fasciitis

90
Q

What is normal compartment pressures?

91
Q

Pain in compartment syndrome develop when pressures is @?

A

20-30 mmHg

*Pressure within 25mmHg of MAP causes compromised Blood flow

92
Q

What pressure might be needed for action in compartment syndrome?

A

Perfusion pressure (diastolic) of <30mmHg

93
Q

What are the causes of traumatic + spontaneous Clostridial myonecrosis?

A

Trauma–> C. perfringens

Spon–> C. septicum

94
Q

Muscle necrosis in Gas gangrene is severe due to?

A

Absence of PMNs–> Alpha toxin induces PMN margination

95
Q

What is seen in clostridial myonecrosis biopsy?

A

Muscle necrosis
Box car shaped G+ Rods
NO PMNs

96
Q

Triad of muscle pain, weakness, and Dark urine?

A

Rhabdomyolysis

97
Q

MCC of Rhabdomyolysis?

A 
Trauma 
Exertion 
Alcohol + Drugs
statins 
colchicine
98
Q

Elevated CK, myoglobinuria, no hematuria?

A

Rhabdomyolysis

99
Q

Anti-CCP?

100
Q

Anti-centromere?

A

CREST syndrome

101
Q

Anti-Jo-1 (anti-synthetase)?

A

Polymyositis

102
Q

Anti-Topoismerase?

A

Systemic sclerosis Diffuse

103
Q

Anti-RNA polymerase (Anti- U3 RNP)?

A

Systemic Sclerosis (RENAL CYSTS)

104
Q

Anti- U1 RNP?

A

Mixed connective tissue disease

105
Q

Anti-Sm?

106
Q

Anti-dsDNA?

107
Q

ANA?

A

LUPUS
Sjogren
Rheumatic disease

108
Q

Anti-Ro (SSA)?

A

Sjogren
Neonatal Lupus
Sub Q lupus

109
Q

Anti-La (SSB)?

A

Sjogren
neonatal lupus
Sub Q lupus

110
Q

p-ANCA is against?

A

Myeloperoxidase

111
Q

Anti-myeloperoxidase?

A

Microscopic polyangiitis

Churg-Strauss

112
Q

c-ANCA is against?

113
Q

Anti-PR3?

A

Granulomatosis with polyangiitis (Wegener’s)

114
Q

Neoplastic growths located in the Diaphysis?

A

Ewing
Chondrosarcoma
Fibrous dysplasia
Endochondroma

115
Q

Neoplastic growths at Epiphysis?

A

Giant cell tumor

Chondroblastoma

116
Q

Neoplastic growth at Metaphysis?

A

Osteosarcoma
Osteochondroma
Osteoid Osteoma

117
Q

McCune Albright syndrome?

A

Polostotic Fibrous dysplasia
Cafe au lait
Endocrinopathies

118
Q

X-ray showing “moth eaten” + “ground glass” bone?

A

Fibrous dysplasia

119
Q

<2 yo +Benign medullary Histiocytoma?

A

Fibrous cortical defect

120
Q

X-ray showing “Scooped out” lesions?

A

Fibrous cortical defect

Non ossifying fibroma

121
Q

Spongy bone filled with BLOOD + can Expand rapidly?

A

Aneurysmal bone cyst

122
Q

Gardener’s syndrome?

A

Familial Colorectal Ployposis + Osteomas

123
Q

20 yo + Painful tibial lesion worsen by ETOH?

A

Osteoid osteoma–> Relieved by Aspirin

124
Q

Caused by displacement of Growth plate?

A

Osteochondroma

125
Q

Usually in the medullary cavity of Hands + Feet?

A

Endochondroma

126
Q

Multiple Endochondromas + soft tissue Hemangiomas?

A

Maffuccii syndrome

Olliers without Hemangiomas

127
Q

Codman triangle on x-ray?

A

Osteosarcoma

128
Q

Homer-wright rossets?

A

Ewings sarcoma

129
Q

PNET t(11;22) ?

A

Ewing sarcoma

130
Q

10-15 yo WHITE male with Long bone tumor. What is on X-ray?

A

Onion skin periosteum

131
Q

MC metastatic tumors to Bone?

A 
Prostate 
Breast
Lung 
Kidney 
Thyroid
132
Q

Metastatic bone tumor causing Lots of Bleeding?

A

Renal cell carcinoma

133
Q

Blastic metastatic bone tumor?

134
Q

Non cancerous growth of Dermal Dendritic cells and lesion with central “DIMPLE”?

A

Dermatofibroma

135
Q

Children associated soft tissue neoplasia?

A

Rhabdomyosarcoma

136
Q

Clonal cells that are Estrogen sensitive and show “Cigar shaped” nuclei?

137
Q

Micro-architectural deterioration + thinning of Trabeculae?

A

Osteoporosis

138
Q

Risk factors for Osteoporosis?

A 
Age 
Menopause 
Glucocorticoids 
Obesity 
Diabetes
Alcohol
139
Q

Pg of Menopause Osteoporosis?

A

Decrease estrogen= Increased IL-1 + IL-6 + TNF

Increase RANKL–> Increase Osteoclast actions

140
Q

Macrophages react to micro-fractures and Hemorrhage?

A

BROWN TUMOR–> Hyperparathyoidism

141
Q

Increased bone activity with peritrabecular fibrosis and Cystic brown tumors?

A

Osteitis Fibrosa Cystica–> HPT

142
Q

Cells that sense mechanical stress in bone and regulate Ca++ and Phosphorus?

A

Osteocytes

143
Q

Mesenchymal becomes cartilage–> Osteoblasts lay down bone on preformed cartilage mold?

A

Endochondral bone formation

144
Q

Bones without medullary cavities + Misshapen + pancytopenia?

A

Osteopetrosis

145
Q

Membrane of GRANULATION tissue containing Macs + Osteoclasts + Fibroblasts which destroy Articular Cartilage?

A

PANNUS —> RA

146
Q

Fever + chalky white skin deposits?

147
Q

OLD + Knee pain + crystals?

A

Pseudogout

148
Q

What is the process of bone healing (1-7)?

A 
CALLUS FORMATION 
Clot
Recruitment 
Neovascularization 
Fibroblast organization
removal of Dead tissue 
Osteocyte ingrowth 
Osteoclast remodeling
149
Q

Bone within Bone or Double bone appearance on X-ray?

A

Osteonecrosis

150
Q

what is the cellular composition of normal bone marrow?

A

50% Cellular

50% Fat

151
Q

Hematogenous spread to Metaphysis?

A

Osteomyelitis in Children

152
Q

Saddle nose + Sabre shin?

A

Congenital Syphilis

153
Q

What types of cells predominate in Acute vs. Chronic Osteomyelitis?

A

PMNs for BOTH

154
Q

Sinuses + Involucrum + sequestrum?

A

Osteomyelitis

155
Q

Sinus drainage of osteomyelitis is a risk factor for developing?

156
Q

Sexual transmission + painful ulcer heals spontaneously?

A

Primary Syphilis

157
Q

Symmetrical Non Pruritic Rash (SOLES + PALMS)

Headache + LAD + Arthritis + renal/hepatic dysfunction?

A

Secondary Syphilis

158
Q

Soft tissue like granuloma + Degeneration of Joints + Loss of proprioception + might be severe with spread to heart or CNS?

A

Tertiary Syphilis

159
Q

GUMMA?

A

Soft tissue granuloma of tertiary Syphilis

160
Q

Congenital Syphilis?

A

Sabre shins

Saddle nose

161
Q

Segmental Granulomatous inflammation + fibrosis can cause Blindness?

A

Temporal arteritis

162
Q

ESR > 100 + Headache + Jaw claudication. Tx?

A

Temporal Arteritis== Corticosteroids

163
Q

Granulomatous inflammation @ Aortic Brach points?

A

Takayasu arteritis

164
Q

“pulseless Disease” Tx?

A

Takayasu arteritis == Corticosteroids

165
Q

Necrotizing vasculitis that spare the LUNG?

166
Q

What disease is associated with PAN?

A

Hepatitis B

167
Q

Aneurysms + fibrinoid necrosis?

168
Q

2 yo with Fever, conjunctivitis, palmar/ sole Rash, cervical LAD. What are major complications?

A

Kawasaki disease
Coronary artery Thrombosis–> MI
Strawberry TONGUE

169
Q

3 yo child with coronary artery vasculitis. Tx?

A

Aspirin or IVIg

170
Q

Mono clonal cryoglobulin, RF - , associated with Malignancy and causes Hyper viscosity?

A

Type I cryoglobulin

171
Q

Polyclonal (IgG and IgM), RF + , HEP C/ Sjogren/ SLE associated, causes IC vasculitis?

A

Type II & III Cryoglobulins

172
Q

Medium, Granulomatous necrotizing vasculitis that affect all organs EXCEPT the LUNGS?

173
Q

Granulomatous vasculitis that is associated with Smoking. what Abs and ANCAs directed against?

A

Beurger disease
Abs–> Collagen, Elastin, Laminin, endothelial cells
ANCAs–> MPO . lactoferrin, Elastin

174
Q

Palpable purpura is the classical sign for what?

A

IC mediated Vasculitis

175
Q

Small/ Skin vessel vasculitis due to drugs or infections?

A

Hypersensitivity vasculitis

176
Q

Purpura + arthritis + glomerulonephritis + abdominal pain?

A

Henoch Schonlein purpura

Might be: HS vasculitis

177
Q

Child with non granulomatous vasculitis and lower leg non-blanching purport. What is the Pg?

A

IgA IC deposition post INFECTION

178
Q

What are cryoglobulins?

A

Antibodies that ppt from serum in COLD

179
Q

Causes hyper viscosity syndromes?

A

Type I cryoglobulins (monoclonal)

180
Q

Palpable purpura with ulcers, peripheral neuropathy, Raynauds. Hep C infection. What will lab findings be?

A

Cryoglobulinemia vasculitis:
RF+
C4 decreased

181
Q

IgM + C3 deposits around arteries?

A

Cryoglobulinemia vasculitis

182
Q

Granulomatous with thoracic aortic Aneurysms?

A

Giant cell arteritis

183
Q

Pt with Shoulder + pelvic pain, morning stiffness is most likely to have what type of vasculitis?

A

Giant cell–> polymyalgia rheumatica

184
Q

Visual disturbances + jaw pain + arthralgia + headache. What is the most significant Lab finding?

A

HIGHLY elevated ESR

185
Q

Biopsy showing lymphocytes on the internal elastic lamina and adventitia?

A

EARLY Giant cell arteritis

186
Q

Elastic membrane destroyed by histocytes + plasma cells + fibroblast?

A

LATE GC arteritis

187
Q

Granulomatous vasculitis of Aorta and branches + asian women?

188
Q

MCC of acquired heart disease in Japan. What are some of the clinical signs and symptoms?

A

Kawasaki disease

PALM/ Soles rash + conjunctivitis + strawberry tongue + Myocarditis

189
Q

Myocarditis + strawberry tongue + profound Lymphocytosis. Tx?

A

Aspirin + IViG

190
Q

Cutaneous vasculitis is associated with what two lab findings?

A

Hypocomplementemia and Increased ANA

191
Q

IgG and C3 deposition around Dermal blood vessels?

A

Cutaneous vasculitis

192
Q

Purpuric lesions and DEEP cutaneous ulcer over Malleoli?

A

Rheumatoid vasculitis

193
Q

Granular IgM and C3 deposition and IC-complement cryoglobulins?

A

Rheumatoid vasculitis

194
Q

Glomerulonephritis + Pulmonary hemorrhage + neuropathy + skin involvement. what is the confirmatory Lab test?

A

p-ANCA positive–> Microscopic polyangiitis

195
Q

Focal granulomatous vasculitis with Chronic sinusitis + ulcerations + otitis media + saddle nose . What are the typical organs affected?

A

ERK–> Wegners
ENT–> ulcers
Respiratory–> hemorrhage
Kidney–> GN

196
Q

Dyspnea, cough, asthma, vasculitis?

A

Chrug Strauss

197
Q

Eosinophilia + vasculitis. What is the lab test?

198
Q

Oral + genital ulcers + arthritis + Middle eastern Man?

A

Bachet’s disease

199
Q

Associated with Hepatitis B?

200
Q

Causes Neuropathy, renal HTN, pericarditis, NO LUNG or GN what is the skin finding?

A

PAN–> Livedo Reticularis

201
Q

Thrombosis + aneurysms + fibrinoid necrosis?

202
Q

Ischemic digital ulcers + splinter hemorrhages?

A

Beurger disease

203
Q

Plasma + COLD + ppt with serum cold

precipitate?

A

Cryopercipitate

204
Q

Serum+ COLD + ppt?

A

Cryoglobulin

205
Q

Plasma cold ppt w. out serum ppt?

A

Cryofibrinogen

206
Q

Positive pathergy test, clinical symptoms?

A

Bechet-> Oral and genital lesions

207
Q

Destructive lesion in Vertebrae + Psoas abscess?

A

TB osteomyelitis

208
Q

What are the biochemical markers for bone formation?

A

ALP
Osteocalcin
P1NP

209
Q

What are the biomarkers for bone resorption?

A

Pyramidine crosslinks
n-teropeptide
CTX1

Rheumatology (4 decks)

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