Pathology Flashcards
1
Q
Stained in blue (by hematoxylin)
A
Nucleic acids and calcium salts:
NBC!!
Nuclei and Nucleoli
mRNA in the cytoplasm
Bacteria
Calcium
2
Q
Stained in pink (by eosin)
A
Pink proteins!
Cytoplasm Collagen Fibrin Red blood cells Thyroid colloid
3
Q
Vitamin A deficiency generates:
A
Night blindness Squamous metaplasia (keratomalacia in the conjuntiva) Immune deficiency
4
Q
Vitamin D deficiency generates:
A
Rickets and osteomalacia
5
Q
Vitamin K deficiency generates:
A
Bleeding diathesis
6
Q
Vitamin B12 deficiency generates:
A
Megaloblastic anemia
Neuropathy (Subacute Combined Degeneration: Spinocerebellar, Corticospinal, Dorsal column)
7
Q
Folate deficiency generates:
A
Megaloblastic anemia
Neural cord defects
8
Q
Vitamin B3 or niacin deficiency generates:
A
Pellagra:
diarrhea
dermatitis
dementia
9
Q
Biliary track obstruction is signaled by:
A
Alkaline phosphatase
10
Q
What is Barrett esophagus?
A
A metaplasic change of the esophageal epithelium from squamous to columnar (globet cells are dx of Barrett)
11
Q
Russel bodies are:
A
Intra cytoplasmic accumulations of immunoglobulins
12
Q
Collagen type I is found in:
A
Skin
BONE (1)
Tendons
Most organs
It is the most common form, is strong
13
Q
Collagen type II is found in:
A
Cartilage, CarTWOlage (2)
Vitreous humor
Nucleus pulposus
14
Q
Collagen type III is found in:
A
Blood vessels Granulation tissue Embryonic tissue Uterus Keloid It is pliable, in tissues that need to change shape
15
Q
Collagen type IV is found in:
A
Basement membranes. Heparan sulfate is what gives the basement mb it’s negative charge (Ab against it on Goodpasture sd. hematuria+hemoptysis)
Lens of the eye
16
Q
Warfarin therapy is monitored with:
A
Prothrombin time (extrinsic pathway)
The short one for the strange
17
Q
Heparin therapy is monitored with:
A
Partial thromboplastin time (intrinsic pathway)
The long one for our own
18
Q
Prothrombin time tests:
A
The extrinsic pathway
19
Q
Partial thromboplastin time tests:
A
The intrinsic pathway
20
Q
Thrombin time tests:
A
Fibrinogen levels
21
Q
Fibrin degradation products test:
A
Fibrinolytic system
22
Q
Albinism is due to a deficiency of the enzyme:
A
Tyrosinase (needed to convert tyrosine, an aromatic aa, and DOPA to melanin). This is the most common form and it is autosomal recessive
Other forms affect the tyrosine transporter and neural crest migration
23
Q
The triplets that repeats in Fragile X syndrome is:
A
CGG
24
Q
The triplets that repeats in Huntington disease is:
A
CAG
Caudate
↓ Ach and GABA
↑ DA
25
In Prader-Willi the microdeletion is on:
The paternal chromosome 15
26
In Angelman the microdeletion is on:
The maternal chromosome 15
27
Type I hypersensitivity is mediated by and it’s also called:
IgE
Also called anaphylactic type
28
Type II hypersensitivity is mediated by and it’s also called:
IgG or IgM
Also called antibody-mediated hypersensitivity
29
Type III hypersensitivity is mediated by and it’s also called:
Antibody-antigen immune complexes
Also called immune complex disease
30
Type IV hypersensitivity is mediated by and it’s also called:
Sensitized T lymphocytes
Also called cell-mediated type or delayed type
31
Function of P53:
Prevents cell with damaged DNA to progress from G1 to S-phase
If DNA is damaged upregulates either repair enzymes or BAX to break Bcl2 and promote apoptosis
32
Function of Rb:
Prevents progression from G1 to S-phase
Holds E2F transcription factor, releases it when it is phosphorylated by the cyclinD/CDK4 complex, when E2F is released cell can go to S-phase
Rb PHOSPHORYLATION means cell cycle PROGRESSION; the inactive form is the phosphorylated in which Rb cannot halt progression
33
Name 6 important tumor suppressor genes:
```
P53 (17p): p21 activator
Rb (13q): E2F inhibitor
VHL (3p): hypoxia-induced factor 1a inhibitor
APC (5q): β-catenin regulator
DCC and DPC (18q)
NF-1 (17q): ras supressor!
```
34
Cyanide and CO toxicity mechanism:
Cyanide (bitter almonds)
CO (cherry red)
Both bind mitochondrial Fe in cytochrome oxidase a/a3; cynide binds Fe3+ and CO binds Fe2+; avoid e- to move to O2
On top CO binds Hb and causes left shift in Hb's curve
35
Cocaine mechanism of action:
Prevents dopamine, serotonin and norepinephrine uptake into presynaptic neurons
36
Auerbach plexus refers to ____ ganglia
Myenteric
37
Meissner plexus refers to ____ ganglia
Submucosal
38
The autoimmune reaction involved in diabetes type 1 pathogenesis is:
Type IV hypersensitivity
39
To assess the coagulopathy due to liver disease we use:
The prothrombin time
40
In hepatitis B serology,
HBsAg
HBeAg and
HBV-DNA
Are positive in:
Acute and chronic infection
41
In hepatitis B serology,
HBcAb
Is positive in:
Acute (IgM) and chronic (IgG) infection
Window period (IgM); the one that is not up yet is the HBsAb IgG
Acute battle
42
In hepatitis B serology,
HBcAb IgG
Is positive in:
Prior infection and chronic infection
You don't have IgG in acute; IgG means chronic or passed! Victory but you have had an acute battle!
Chronic active: high liver enzymes
Chronic persistent: asymptomatic, nr labs
43
In hepatitis B serology,
HBsAb IgG
Is positive in:
Prior infection and immunization; victory
HBsAb IgG binds to circulating virus preventing viral entry into hepatocyte (this is the mechanism of the vaccine)
44
Döhle bodies are? and basophilic stippling?
Döhle bodies: aggregates of RER and ribosomes in WBC seen in leukemoid reaction, myelodysplasia, burns
Basophilic stippling: ribosomes precipitated in RBC seen in sideroblastic anemia and thalassemias
45
Reed-Sternberg cells are:
Diagnostic of Hodgkin lymphoma
Have a bilobed nucleus with prominent large inclusion-like nucleolus in each lobe
46
Lacunar cells are:
Characteristic from Nodular sclerosis (most common subtype of Hodgkin lymphoma)
Have a clear space surrounding the malignant tumor cells
47
The tumor marker for seminoma is:
Placental alkaline phosphatase (PLAP) and β-HCG
48
Chvostek sing is:
Twitching of ipsilateral facial muscles after tapping the muscles (neuromuscular excitability)
Occurs in hypoparathyroidism
Is indicative of hypocalcemia
49
Trousseau sign is:
Muscular contractions after inflating the sphygmomanometer cuff above systolic blood pressure for several minutes (neuromuscular excitability)
Occurs in hypoparathyroidism
Is indicative of hypocalcemia
50
Secondary gout can be caused by:
```
Leukemia (excessive WBC cell breakdown) and myeloproliferative diseases (P vera; excessive RBC cell breakdown)
Tumor lysis syndrome
Lesch-Nyhan syndrome
Von Gierke
Chronic kidney disease
Thiazide/loops use
```
51
Pseudogout in a patient younger than 50 should raise suspicions about:
```
Hemochromatosis
Hyperparathyroidism
Hypophosphatemia (low P)
Hypomagnesemia (low Mg)
Join trauma
```
4Hs
52
Marker on cytotoxic T lymphocytes
CD8
53
The mesonephric or Wolffian duct evolves to form:
SEED: Seminal vesicles, Epididymis, Ejaculatory ducts, Ductus deferens and ureter (male internal structures except the prostate). Men are wolfs
In the female forms the Gartner duct; also forms the distal part of female and males forms the trigone of the bladder
54
Poison ivy and poison oak contact lead to:
Hypersensitivity type IV, cell-mediated type or delayed type
55
Side effect of bleomycin:
Pulmonary fibrosis
56
Cyclosporine and tacrolimus side effect:
Nephrotoxicity
57
Cyclosporine and tacrolimus mechanism of action:
Inhibit calcineurin-mediated transcription of IL-2 gene and therefore reduce T-cell activation
58
Risk factors for pigment gallstones:
Cirrhosis
Hemolytic anemias
Liver fluke infection (Clonorchis sinensis)
59
p-ANCAs are elevated in:
Microscopic polyangiitis
Churg-Strauss sd.
Ulcerative colitis
60
Rb tumor suppressor gene is in and is associated with:
Chromosome 13q
Associated with retinoblastoma and osteosarcoma
61
Whooping cough is the hallmark of:
Pertussis infection
62
Typical heart sound in mitral stenosis:
Low-pitched, rumbling diastolic murmur
63
Enzymes missing (2) in panacinar emphysema:
1) Alpha-1 antitrypsin, coded by the gene SERPINA1
Codominant, normal genotype is PiMM and the homozygous for illness genotype is PiZZ
Because alpha-1 antitrypsin can lead to cirrhosis it can present with bleeding due to ↑PT
2) Elastine
64
Histological findings in asthma:
Curschmann’s spirals (mucus)
| Charcot leyden crystals (granules in eosinophils made of eosinophilic major basic protein)
65
Treatment of patent ductus arteriosus:
```
O2
Indomethacin (PGs inhibitor)
```
66
Cause of primary pulmonary hypertension:
Inactivating mutation in BMPR2
67
Where does the transitional cell ca. occur?
On the bladder
68
CREST sd. Manifestations:
```
Calcinosis (Ca deposits in the skin)
Raynaud’s (cold/stress induced vasospasm)
Esophageal dysfunction
Sclerodactyly (atrophy of hand’s skin)
Telangiestasias
```
69
Kartagener syndrome is characterized by:
Immotile cilia due to dynein arms defect
Situs inversus
Chronic sinusitis
Bronchiectasis (airway enlargement)
Infertility
70
Most frequent bacteria in aspiration pneumonia:
Anaerobic: peptostreptococcus, bacteroides, prevotella, fusobacterium
Aerobic: streptococcus
71
The most important inmune effectors in TB are:
CD4 T lymphocytes and macrophages
72
Example of a serine protease inhibitor:
Alpha-1 antitrypsin
73
The a wave of the jugular venous pulse is caused by:
Atrial contraction
74
The c wave of the jugular venous pulse is caused by:
The RV contraction and the closed tricuspid valve bulging into the RA
75
The x descent of the jugular venous pulse is caused by:
Atrial relaXation
76
The v wave of the jugular venous pulse is caused by:
Increase of pressure in the RA because of the filling of RA with a closed tricuspid valve
77
The y descent of the jugular venous pulse is caused by:
Decrease pressure in the RA because the tricuspid valve opens and blood goes to the RV
78
Histological pattern that predisposes to thoracic vs abdominal aortic aneurysms and dissection:
Thoracic: cystic medial degeneration, with myxomatous degeneration of the media layer in large arteries
Abdominal: atherosclerosis
79
Illnesses in MEN1 or Wermer sd:
Pituitary tumors
Parathyroid tumors
Pancreatic endocrine tumors
Kidney stones and stomach ulcers
80
Illnesses in MEN2A or Sipple sd:
Medullary thyroid ca.
Pheochromocytoma (VMA)
Parathyroid hyperplasia
81
Illnesses in MEN 2B sd:
Medullary thyroid ca.
Pheochromocytoma (VMA)
Mucosal neuromas
Marfanoid habitus
82
The only functional parameters increased on the air trapping pattern of COPD are:
What parameter can be normal?
TLC (might be normal initially)
RV
RV/TLC
FRC
FVC can be decreased or nr
Expiratory reserve vol. is decreased
83
ST elevation or Q waves in avL and lead I indicate:
Left circumflex A occlusion (lateral MI)
84
ST elevation or Q waves in V5 and V6 indicate:
Left circumflex A occlusion (lateral MI)
85
ST elevation or Q waves in V1-V4 indicate:
LAD occlusion (anterior MI)
86
ST elevation or Q waves in V3-V4 indicate:
Distal LAD occlusion (anteroapical MI)
87
ST elevation or Q waves in V1-V6, I and avL indicate:
Left main coronary A occlusion
88
ST elevation or Q waves in leads II, III and avF indicate:
Right coronary A occlusion (inferior MI)
The RCA lesion and inferior MI can affect either the RV to the LV because it gives 3 branches:
PDA: causes inferior heart MI
Marginal: causes RV MI leading to hypotension
Atrial branch
89
Clothing factors involved, diagnostic coagulation time and treatment for intrinsic pathway problem:
12, 11, 9 and 8
PTT
HEParin
90
Clothing factors involved, diagnostic coagulation time and treatment for extrinsic pathway problem:
7
PT
Warfarin, cumidin
91
Examples of tumors that contain psammoma bodies:
```
Mesothelioma
Meningioma
Papillary thyroid ca.
Papillary serous ovary/endometrial ca. (psammoma indicates high grade in serous cystosarcoma)
Prolactinoma and somatostatinoma
```
92
Isoniazid therapy leads to deficiency of which vit? And which symptoms?
```
Vit B6, pyridoxine
Sideroblastic microcytic anemia
Chelosis, stomatitis
Peripheral neuropathy
Convulsions
```
93
Permanent tissues, 3 types and main characteristic:
Cardiac and skeletal m. and nerves
| Don’t have stem cells so cannot make new cells so cannot undergo hyperplasia. They undergo hypertrophy only.
94
Budd-Chiari sd. definition and main causes:
Hepatic vein thrombosis that leads to liver infraction
| Main cause is polycythemia vera, hepatocell ca, QT, lupus-anticoagulant
95
Sings of CO poisoning:
Early sing is headache, cherry-red skin
96
Sings and treatment of methemoglobinemia:
Cyanosis with chocolate-color blood
| Methylene blue to reduce Fe
97
Mechanics underlying hemochromatosis and Wilson’s disease:
Free radical generation by Fe and Cu
98
Conditions where you get systemic amyloidosis:
Multiple myeloma (1ry, AL amyloid)
Chronic inflammation as autoimmune diseases, malignancy and Familial Mediterranean fever (2ry, AA amyloid)
Dialysis-related (β2 microglobulin -also helps follow MM-)
99
Conditions where you get localized amyloidosis:
Senile cardiac amyloidosis (transthyretin :) )
Familial amyloid cardiomyopathy (mutated transthyretin :( 👨🏿)
DM 2 (amylin)
Alzheimer’s (A β amyloid)
Medullary thyroid ca. (calcitonin)
100
DD of noncaseating granulomas:
```
Foreign material (breast implants)
Sarcoidosis
Beryllium
Crohn
Cat scratch disease
Schistosoma (bladder)
Syphilis
```
101
DD of caseating granulomas and further testing:
TB, tested with acid fast bacillus (AFB) stain
| Fungi, tested with Grocott methenamine silver (GMS) stain
102
DiGeorge sd. is caused by a microdeletion in:
22q11
103
Collagen change in scaring and cofactor needed:
Collagen type III (pliable) changes to type I (hard) by collagenase that needs Zinc
104
Ca. related to EBV:
Nasopharyngeal ca.
Burkitt lymphoma
CNS lymphoma
105
Ca. related to HHV-8:
Kaposi sarcoma
106
Ca. related to HTLV-1:
Adult T-cell leukemia/lymphoma
107
Which tumor is associated with KIT mutation?
Gastrointestinal stromal tumor (GIST)
Acral melanoma
Systemic mastocytosis (↑ histamine, flushing, hypotension, pruritus, urticaria, ↑ gastric acid)
(Also seminoma and AML)
Is a tyrosine kinase, can be treated with imatinib as CML!
108
Where do you see t(9,22) and what gets mutated?
ABL (a signal transducer) gets mutated and this is seen in CML and some adult ALL
109
Where do you see t(8,14) and what gets mutated?
C-myc (Congo); a nuclear regulator that gets mutated in Burkitts lymphoma
110
Where do you see t(11,14) and what gets mutated? What is the histology?
```
Cyclin D1 (a cell cycle regulator that allows G1–>S) gets mutated and this is seen in mantle cell lymphoma
Histology: expansion of the region immediately adjacent to the follicle
```
111
What is the cause of thrombotic thrombocytopenic purpura?
Decrease in ADAMTS13 (autoantibodies)
112
What is a classic cause of hemolytic uremic sd?
E. coli O157:H7 dysentery in children that eat undercooked beef (generates a verotoxin)
113
Specific test and treatment for von Willebrand disease:
Abnormal ristocetin test
Acute tto/prophylaxis with desmopressin (ADH analog just binds V2, no vasoconstriction) that increases vWF and factor 8 release from Weibel-Palade bodies (also helps in hemophilia A). Tachyphylaxis due to depletion of endothelial stores
114
What test do you use to measure coagulation on liver failure? why?
PT
| The liver makes coagulation factors, also vit. K activation by epoxide reductase takes place in the liver
115
Vit K function:
Gamma carboxylate and activate factors 2, 7, 9, X, C and S
116
Function of epoxide reductase of the liver and how is blocked:
Activate Vit K, blocked by warfarin (=coumidin)
117
Best screening test for DIC:
Elevated D-dimer (also characterized by low fibrinogen)
118
Causes of DIC:
```
Leaking of amniotic fluid on mother’s blood (amniotic fluid has tissue thromboplastin, tissue factor)
Sepsis
Adenoca.
Acute promyelocytic leukemia
Rattlesnake venom
```
119
Common presentation and cause of death in sickle cell anemia:
Presentation is dactylitis 👶🏿
Death for infection with encapsulated (s.pneumoniae or h. influenzae) 👶🏿 and acute chest sd. (vasooclusion in lung vessels after pneumonia) 👨🏿
120
JAK2 kinase mutation is associated with:
Polycythemia vera
Essential thrombocytopenia
Myelofibrosis
121
What is the most frequent cause of Budd Chiari sd?
Polycythemia vera (can also be caused by hepatocellular ca.)
122
Which tumor can secretes EPO? What are the side effects of EPO?
Renal cell ca.
| SE: polycythemia, thromboembolism, hypertension, ↑GFR (bc ↑ glomerular capillary oncotic pressure)
123
Where do you see t(14,18) and what gets translocated?
Bcl2 is overexpressed and it inhibits apoptosis of B cells
| Follicular lymphoma
124
Serum marker, type of hypersensitivity and micro associated with Polyarteritis Nodosa:
HBsAg, hepatitis B surface antigen
Type 3 hypersensitivity, immune-complex mediated inflammation of the medium-size arteries
Micro: fibrinoid necrosis; different stages of transmural necrotizing inflammation (amorphic eosinophilic materia in blood vessels)
125
Distribution, Ab and tto. of Wegener Granulomatosis:
WeCener:
Distribution: Nasopharynx, lungs (nodules/cavitation) and kidneys, fatigue, weight loss...
Ab: C-ANCA
Micro: necrotizing vasculitis with granulomas
tto: Cyclophosphamide
126
What kind of nephropathy do you get on Henoch-Schönlein Purpura?
IgA nephropathy causing nephritic syndrome (normally after GI/upper respiratory infection on young)
127
When do the different fibrinous (bread and butter) pericarditis happen after MI? How are they called?
Postinfarction fibrinous pericarditis: 1-3 days after an MI (neutrophils phase) only if transmural
Autoinmune pericarditis=Dressler sd that happens weeks after due to an autoimmune phenomenon also causes fibrinous pericarditis
128
What does direct Coombs asks?
Are there RBCs bound to this Ab? Done on baby or patient at risk
129
What does indirect Coombs asks?
Does the patient has Abs in his/her serum?
| Done on mom
130
VSD is associated with:
Fetal alcohol sd.
131
Ostium primum type ASD is associated with:
Down sd.
132
Name 2 important associations of patent ductus arteriosus:
Associated with congenital rubella
| May lead to lower extremity cyanosis later in life
133
Transposition of the great vessels is associated with:
Gestational maternal diabetes
PREgestational diabetes with bad control on the 1st trimester is associated with sacral agenesis and hypertrophic heart
134
Name 2 important associations of infantile coartation of the Aorta:
Associated with Turner sd.
| Has a PDA and causes lower extremity cyanosis at birth
135
Name 2 important associations of adult coartation of the Aorta:
Associated with bicuspid aortic valve
| Causes notching of ribs on x-ray
136
What is the most common cause of nephrotic sd. in african-american and hispanics?
Focal segmental glomerulonephritis/sclerosis because they have lipoprotein L1 allele
Also in sickle, heroin, AIDS (collapsing glomerular form, bad) or of they have less kidney
137
What is the most common cause of nephrotic sd. in children?
Minimal change disease
138
Which is the most common primary cardiac tumor in children? What is associated with?
Rhabdomyoma, associated with tuberous sclerosis
139
Viruses associated and distribution of laryngeal papilloma:
HPV 6 and 11, low risk of ca.
| Single in adults multiple in children
140
Gene deficiency in paroxysmal nocturnal hemoglobinuria and consequences:
Acquired defect in myeloid stem cell's PIGA gene that synthesizes glycophosphatidylinositol so complement inhibitors (CD55=DAF and CD59=MIRL cannot anchor)
Complement break down RBCs: low haptoglobin
Can develop iron deficiency, aplastic anemia!! and 10% will develop AML
141
What is the screening test for adequate surfactant production?
Lecithin (phosphatidylcholine)/ sphingomyelin ratio
142
Name two very mutagenic carcinogens of tobacco:
Polycyclic aromatic hydrocarbons
Arsenic
2-Naphthylamine
143
Findings in Plummer-Vison sd:
Severe iron deficiency anemia
Esophageal web
Beefy-red tongue (glossitis)
Increased risk of squamous ca. of the esophagus
144
What is the most common inherited cause of hypercoagulability? What is the mutation that causes it? What is the pathophysiology?
Factor V Leiden
A506G
Mutated factor 5 that cannot be inactivated by proteins C and S so thrombosis
145
Celiac disease pathophysiology, most prominent location and associations:
T cells against DEAMINATED gliadin damage small bowel villi
Most prominent in duodenum
Some celiacs are IgA deficient
Complications: small bowel ca. T!!! cell lymphoma
146
Right upper quadrant pain that radiates to the right scapula is indicator of:
Acute cholecystitis
147
Presentation of Dubin-Johnson sd:
Asymptomatic but liver is dark because of epi metabolites accumulation in lysosomes
(same but nr liver in Rotor sd.)
148
Principles for serologic markers in Hepatitis B:
Surface antigen (HBsAG) indicates infection
IgM against the core (HBcAB IgM) indicates acute battle
IgG against the surface (HBsAB IgG) indicates victory
Envelope antigen (HBeAG) indicates infectivity
149
Anti mitochondrial Ab indicates:
Primary biliary cirrhosis
150
Primary sclerosing cholangitis is associated with:
Ulcerative colitis; both can have a positive p-ANCA
151
Risk factors of hepatocellular ca:
Chronic hepatitis (80%) cirrhosis and aflatoxins form Aspergillus
Aspergillus grows in grains stored for a long time and aflatoxins induce p53 mutations
152
What are the antibodies against in myasthenia gravis:
Nicotinic Ach receptors on the postsynaptic plate
153
What are the antibodies against in Lambert-Eaton:
Voltage-gated Ca ch. on the presynaptic plate
154
What mediates inmune response in myasthenia gravis and what condition is associated with it?
T cells
| Associated with thymomas or thymic hyperplasia
155
Hallmark cell in acute interstitial nephritis? Causes?
Eosinophils (maybe present in urine as WBC casts ± sterile pyuria) fever, RASH, proteinuria and hematuria
Causes; 5Ps: NSAIDs (pain), penicillin (cephalosporins, sulfa drugs), ppi's, diuretics (pee), rifamPin
156
Minimal change disease is associated with which other conditions? And population?
Hodgkin lymphoma
| Children 👦
157
Focal segmental glomerulosclerosis is associated with which other conditions? And population?
HIV
Heroin use
Sickle cell anemia
Hispanics👨🏽and African Americans👨🏿
158
Membranous nephropathy is associated with which other conditions? And population?
Lupus
Hepatitis B or C
Solid tumors
NSAIDs and penicillamine
Caucasian adults👨🏻
159
Membranoproliferative glomerulonephritis is associated with which other conditions? And population?
Type I: HVC; subENDOthelial deposits
Type II: C3 nephritic factor; intramembranous deposits
Both: Tram tracks (basement mb splitting)
160
H. Pylori colonization of the antrum tends to cause:
Duodenal ulcers
161
How do you differentiate Goodpasture and WeCener sd?
Both have hematuria and hemoptysis
Goodpasture has lineal IF
WeCener has sinus symptoms, negative IF and c-ANCA
162
How do you differentiate microscopic polyangiitis and Chung-Strauss sd?
Both have negative IF and p-ANCA
Chung Strauss has granulomatous inflammation, eosinophilia and asthma
Microscopic polyangiitis does not have granulomas, asthma (DD w Chung-Strauss) or nasopharyngeal involvement (DD w WeCener)
163
Presentation of Alport sd:
Hematuria, hearing loss and ocular disturbances in a family (X-linked dominant)
164
Ammonium magnesium phosphate kidney stones are associated with:
Struvite stones: Urease + infections as Proteus, Klebsiella and ureaplasma urealyticum
Result in staghorn 🦌 coffins-like prisms calculi, in adults 👨 that promote UTIs
Urine smells like ammonia, ammonia makes basic pH so Mg and P precipitate with the ammonia
tto: percutaneous nephrolithotomy
165
Staghorn 🦌 calculi in children 👦 indicates:
Cystine stones due to cystinuria (defect in cystine reabsorption)
166
Dialysis in shrunken end-stage kidney failure leads to:
Cysts that increase the risk of renal cell ca.
167
Paraneoplastic sd. that can be seen in renal cell ca. can secrete:
EPO: polycythemia
Renin: HT
PTHrP: hypercalcemia and SHORT QT (PTH causes SHORT QT)
ACTH: Cushing sd.
Gonadotropins: feminitation
IL: leukemoid reaction, eosinophilia, AA amyloid
In general paraneoplastic sd are rare
168
Tumor suppressor gene lost in renal cell ca:
VHL
169
VIPoma presentation:
WDHA sd: watery diarrhea, hypokalemia and achlorhydia
170
What do high risk HPV viruses produce to make them high risk?
E6 and E7 proteins that destroy p53 (that ↓ transcription of p21) and Rb respectively
171
What’s the name of endometriosis of the myometrium?
Ademyosis
172
What is the most important predictor of progression to ca. in endometrial hyperplasia?
Cellular atypia
173
BRCA mutation carriers are at increased risk of:
```
BRCA1:
Breast ca.
Ovarian serous ca.
Fallopian tuve serous ca.
Prostate
Often elect to have mastectomy+salpingo-oophorectomy
```
BRCA2:
Breast in both sexes
Pancreatic ca.
174
What is Meigs sd. and what type of tumor indicates?
Pleural effusion + ascitis + fibroma of the ovary
175
Treatment for achalasia:
Botulinium toxin injection on the LES
176
Smoking is a risk factor of which ca?
```
Oro pharyngeal ca.
Squamous ca. of the esophagus
Lung ca.
Renal cell ca.
Urothelial ca. (bladder)
```
Cervix ca.
Pancreatic ca.
177
What is the most common testicular tumor in children?
Yolk sac tumor
178
Describe the paraneoplastic sd. of choriocarcinoma:
Syncytiotrophoblasts secrete beta-hCG and the alpha-subunit of hCG is similar to FSH, LH and TSH so patients can have gynecomastia or hyperthyroidism
179
What can happen to an embryonal ca. (of the testicle) after Chemotherapy?
It can differentiate into another type of germ cell tumor as teratoma
180
Which HLA is associated with Hashimoto thyroiditis? which disease is associated with?
HLA-DR5
| NON-Hodgkin lymphoma
181
Familial autosomal dominant form of pseudohypoparathyroidism is due to? And associated with?
Due to a defect of Gs protein
| Associated with short stature and short 4th and 5th digits
182
What benign lesions can present as mammographic calcifications?
```
Fibrocystic changes (sclerosing adenosis)
Fat necrosis
```
183
What mutation is present in some familiar cases of amyotrophic lateral sclerosis?
Zinc-cooper superoxide dismutase mutation
184
What gene is mutated in Friedreich ataxia and what problem causes?
GAA repeat in Frataxin gene essential for mitochondrial iron regulation
Causes free radical damage
185
Cell present on CSF of bacterial meningitis:
Neutrophils
186
Cell present on CSF of viral/fungal meningitis:
Lymphocytes
187
Histological hallmark of Parkinson disease:
Lewy bodies: alpha-synuclein inclusions in eosinophils
188
What is the cause of achondroplasia?
Autosomal dominant activating!! mutation on fibroblast GF receptor 3 (FGFR3) leading to decreased chondrocyte proliferation so there is not endochondal ossification in long bones
All that are alive are heterozygous
189
What is one cause of osteoPETRosis? Consequences and treatment?
Carbonic anhydrase II mutation
There is not acidic environment to break up bone so: poor osteoclasts function
There is no way to get rid of acid on the renal tubule so: renal tubular acidosis
Tto: bone marrow transplant because osteoclasts derive form monocytes
190
Levels of Ca, P, PTH and AP in osteoporosis:
All normal
191
What are the complications of Paget disease of the bone?
High output heart failure (bc of AV shunts in bone)
Osteosarcoma
Myelophthisic anemia (or myelophthisis) ~ myelofibrosis
192
How do you differentiate osteoid osteoma from osteoblastoma?
Osteoid osteoma is in long bones and pain responds to aspirin
Osteoblastoma is >2cm, happens in vertebrae and pain doesn’t decrease with aspirin
193
Where in the bone does osteomyelitis happens?
EPIphysis: adults 👨
Metaphysis: kids 👦
Epi es un adulto con la Meta de gustar a niños
194
Where do you see t(11,22)?
On Ewing sarcoma
195
Main laboratory finding in rheumatoid arthritis:
Rheumatoid factor: IgM against the Fc portion of IgG. Indicates disease activity and tissue damage but just in 80%
Alpha-cyclin citrullinated peptide antibodies (alpha-CCP): in 95%
196
Inflammatory complications of rheumatoid arthritis and cause:
Due to inmune phase reactants:
Secondary amyloidosis: SAA generates AA that deposits
Anemia of chronic disease: hepcidin blocks the ability to use Fe stored in macrophages
197
What should you do on a patient that presents with dermatomyositis?
Exclude underlying ca. especially gastric ca.
198
How do you differentiate lupus and dermatomyositis?
Both have malar rash and positive ANA
Lupus has positive dsDNA antibody
Dermatomyositis has anti-Jo-1 antibody
199
How do you differentiate dermatomyositis and polymyositis?
In Dermatomyositis you get Perimysial inflammation and CD4+ infiltration
Polymyositis Endomysial inflammation, vascular involvement, CD8+ infiltration and sarcolemmal MHCI overexpression
DP vs PE (2Ps cannot go together)
200
What is the hallmark and cause of Duchenne and Becker disease?
Hallmark: REPLACEMENT of muscle by adipose and connective tissue
In Duchenne you have dystrophin deletion and in Becker dystrophin mutation so Duchenne is more severe
201
Which ulcers are associated with malignancy?
Gastric ulcers can turn into INTESTINAL gastric ca. or MALT lymphoma (not in diffuse)
202
In acute onset shortness of breath + tachypnea (respirations above ~20/min) you should think about:
Pulmonary embolism
203
Which two pathologies are associated with acanthosis nigricans?
Insulin resistance
| Gastric ca.
204
What is Leser-Trélat sd?
Sudden onset multiple seborrheic keratoses
| Think about underlying ca. (especially GI tract)
205
Risk factors of squamous cell ca:
```
UVB light exposure (sun, albinism, xeroderma)
Immunosuppressive therapy
Arsenic
Scar from burn
Draining sinus tract
```
206
Which is the most important px factor predicting metastasis in melanoma?
Breslow thickness: deep of extension
207
Pie in the sky indicates a lesion of:
```
Temporal lobe
Lingual gyrus (external)
```
208
Pie on the floor indicates a lesion of:
```
Parietal lobe
Cuneus gyrus (internal)
```
209
What is the most common trisomy in miscarriages?
16 trisomy (also triploidy) they are never carried to term
210
What is the cause of polycythemia vera? What is the treatment?
Mutation of the proto-oncogene JAK2
Hydroxyurea and ruxolitinib (JAKl/2 inhibitor)
211
What is the mutation and what ca. are more frequent in VHL?
3 letter illness!
Mutation 3p, autosomal dominant
VHL normally suppresses hypoxia inducible factor HIF1α! is no VHL ↑VEGF
Renal cell ca. (often bilateral)
Hemangioblastoma!! in retina cerebellum...
Polycythemia tumors make EPO
Pheochromocytoma (VMA)
Angiomatosis
Benign CYSTS!!! in the liver, pancreas (serous cystoadenoma) and kidney
212
Which illnesses do we treat with octreotide?
```
Carcinoid tumor
VIPoma
Glucagonoma
Acromegaly
Esophageal variceal bleeding
```
213
Cancers that metastasize to bone:
```
Breast
Lung
Thyroid
Renal cell ca.
Prostate
```
214
Where can pathological increased of 1α-hydroxylase and hypercalcemia can be seen? What is the mechanism?
Any granulomatous condition:
Sarcoidosis
TB
Hodgkin lymphoma
Activated T-lymphocytes secrete γ-interferons which increase the expression of 1α-hydroxylase!!!
215
What generates cold agglutinins?
Mycoplasma and mononucleosis!!
Hep C
Wäldestrom macroglobulinemia
CLL
Intravascular coagulation in extremities by IgM
216
What generates warm agglutinins?
Lupus
Drugs: alpha-methyldopa, penicillins
CLL
Extravascular coagulation by IgG
217
Glomerulonephritis with subEPIthelial deposits:
Acute poststreptococcal
| Membranous
218
Glomerulonephritis with subENDOthelial deposits:
```
Diffuse proliferative (type 4 lupus)
MPGN type 1
```
219
Glomerulonephritis with mesangial deposits:
Berger IgA
Amyloidosis
Nodular sclerosis in DM (mesangial expansion)
Class 2 lupus (mesangial expansion)
220
Glomerulonephritis with C3 deposits and other deposits associated:
```
Acute poststreptococcal (IgG, IgM)
Diffuse proliferative (type 4 lupus) (IgG)
MPGN type 2
Focal segmental (IgM,C1)
Membranous (IgG)
```
Just acute poststreptococcal and focal segmental have IgM and focal segmental has C1
221
What are the 4 mechanisms of the body to get rid of free radicals?
Antioxidants vit A,C,E
Superoxide dismutase (for superoxide)
Glutathione peroxidase (for hydroxyl, especially in RBSs needs HMP shunt)
Catalase (for hydrogen peroxidase)
222
Tumors that can secrete EPO and cause hypercoagulability:
```
Renal cell ca.
Hemangioblastoma
Pheochromocytoma (VMA)
Hepatocellular ca.
Leiomyoma
```
DD. With P. Vera where EPO will be low
223
What is the most common site of ectopic pregnancy?
Ampulla of the fallopian tube
224
Rectal involvement in inflammatory bowel disease:
The rectum is always involved in ulcerative colitis and never in Crohn (regional enteritis)
225
Where do you see WBC casts?
Acute interstitial nephritis (eosinophils)
Acute pyelonephritis
Transplant rejection
Be careful, you can see some WBCs in urine in other etiologies but not casts!
226
Main characteristics of pemphigus:
```
Ab against desmosomes (desmoglein 3 -a cadherin-) that connect epithelial cells to one another
Intraepidermal blisters (achantolysis)
Blisters start in the mouth
Break, + Nikolsky
Fatal
```
227
Main characteristics of pemphigoid:
Ab (BPAg1 and 2) against hemidesmosomes (dystonin) that connect epithelial cells to the basement membrane, sub epidermal linear complement deposits
Separation of epithelium and basal lamina, subepidermal blisters
Don't break, - Nikolsky
228
Melanoma stain markers and main gain of function mutation (protoncogene):
Melanocyte markers: S-100+ (neural crest) HMB45+ (melanoma marker) and MART-1+
V600E (alters Braf and can be treated with vemurafenib; also in pilocytic astrocytoma, langerhans histiocytosis and papillary thyroid ca.)
229
Tumors with fried eggs appearance in histology:
Seminoma and dysgeminoma
Renal cell ca.
Oligodendroglioma
They are described as clear cells or cells with clear cytoplasm together with clear cell adenoca. of the vagina
230
Illnesses with high AFP (alpha-fetoprotein):
AFP is made by liver and yolk sac in fetus
Yolk sac tumor
Hepatocelular ca.
Embryonal ca. when mixed (men)
Ataxia-telangiectasia
Pregnancy (high in neural tube defect low in trisomies)
Different form placental alkaline phosphatase in seminoma
231
What is Fanconi anemia?
Autosomal recessive disease due to lack homologous DNA interestrand crosslink repair that leads to aplastic anemia due to bone marrow failure
Presentation: short stature, no thumb!!! increase malignancy as AML and myelodysplastic sd.
232
Which marker goes up first on MI?
Myoglobin, goes up first in MI
Bur it is not specific at all, also goes up in skeletal muscle breakdown causing renal failure
233
MI makes:
Best: Troponis T and I and CK-MB!!!
Most specific and sensitive: Troponins I and T (cTnI and cTnT)
Good for reinfartion: CK-MB (MB fraction of creatinine phosphokinase for muscle -MM for skeletal MB for brain-)
1st to go up: myoglobin; tiny, goes up fast but non specific, also goes up in skeletal muscle breakdown
Others: AST!! (liver and muscle) LDH (goes up 1 day after MI and stays up for 6 days; LDH increases when any cell dies; indicates rapidly growing tumor)
234
What is invasive carcinoma vs carcinoma in situ?
Carcinoma in situ: dysplasia expanding trough all the epithelium with intact basement. In cervix is asymptomatic
Invasive carcinoma: invasion of the basement membrane! using metalloporteinases (cell-cell contact lost by E-cadherin inactivation). In cervix you get symptoms as malodorous discharge and coital bleeding
235
Vessel lesions associated with hypertension:
Fibromuscular dysplasia: string of beads in the renal artery. Cause of secondary hypertension due to renal artery stenosis. Can also involve the carotid, vertebral, mesenteric... Types: perimedial, medial, medial+aneurisms (most common)
Hyaline arteriOLOsclerosis: pink thick vessel due to protein leakage in the endothelium in benign hypertension (in the good kidney of renal A. stenosis) and diabetes
Hyperplastic arteriOLOsclerosis: onion skinning with fibrinoid necrosis and smooth m. proliferation consequence of malignant hypertension, acute renal failure with flea bitten appearance
236
Mutations and treatments that address them in melanoma:
Gain, protoncogene: ckit (acral; imatinib), nras, BRAF v600e (-serine/threonine kinase- vemurafenib, dabrafenib)
Loss, tumor suppressor: pten, CDKN2a (p16 and p14 lost so the cell goes from G1 to S)
237
Clinical picture of Peutz-Jeghers:
```
Hyperpigmented freckels
Harmatomas (intussusception)
GI cancer (colon, pancreas, stomach, breast, ovary, lung...)
```
238
Most of the polysaccharide is secreted in the lung by:
Globet cells
239
Renal papillary necrosis presentation and causes:
Acute renal failure with painless gross HEMATURIA+PROTEINURIA +- renal colic PAIN
Causes: Sickle, acute pyelonephritis, NSAIDs (analgesics) and DM=SAAD
240
Periportal hepatic fibrosis is found in and characteristics of the affected area:
Zone 1. Has the postal tract (hepatic A. portal V. and bile duct) that brings stuff from the GI so:
Viral hepatitis (affected first)
Ingested toxins: cocaine, phosphorus
Makes glucose
241
Panlobular lymphocytic infiltration with spots with apoptotic hepatocytes that look round and pink called councilman bodies is found in:
Acute viral hepatitis; in acute hepatitis you get:
- inflammation of both lobules and portal tracts
- spotty necrosis
- ballooning degeneration (swelling)
- councilman bodies (eosinophilic)
- mononuclear cells
Vs chronic hepatitis where you get inflammation predominantly in the portal tracts, infiltration of lymphocytes, plasma cells, and macrophages.
242
Nodular regeneration is found in:
Cirrhosis
243
Hepatic centrilobular necrosis is found in and characteristics of the affected area:
Zone 3. Contains P450 enzymes, has the hepatic V. that takes stuff out of the liver so:
Ischemia
Metabolic toxins: alcohol, acetaminophen, halothane, rifampin, CCl4. They become toxic after they are metabolized
Congestion and hemorrhage in CHF (nugmet liver)
Breaks down glucose
244
Hepatic lymphocytic infiltration and destruction of small intrahepatic bile ducts is found in:
Primary biliary cholangitis
| Graft-versus-host disease
245
Wedge-shaped areas of hemorrhagic!! necrosis can happen in:
Pulmonary emboli
246
What cleans particles on alveoli, bronchi and nose? What is the size of the particles cleared?
*Nanoparicles less than 0.1μm go into the pulmonary capillaries
Alveoli, macrophages: clean particles smaller than 3μm
Bronchi, mucociliary escalator: clean particles bigger than 3μm
Nose, nasal vibrissae/shallowing: clean particles bigger than 10μm
247
Clean particles on bronchi and bronchioles:
Ciliated epithelial cells
248
Ground-glass hepatocytes are found in:
Chronic hepatitis B
| Hepatocytes with granular eosinophilic cytoplasm
249
Mallory bodies are found in:
Hepatic steatosis; they are cytoskeletal intermediate filaments formed when hepatocytes degenerate
250
Macrovesicular steatosis and lymphoid aggregates in the portal track are found in:
Chronic hepatitis C
251
Pale-pink hepatocytes are found in:
Chronic hepatitis B
252
Hemosiderin-laden macrophages are characteristic of:
Pulmonary edema due to left heart failure
253
What is used to destroy the cytoskeleton?
The ubiquitin-proteasome!! degradation pathway (irreversible!)
(defects in ubiquitin-proteasome system have been implicated in Parkinson)
254
Epithelium change in Barrett esophagus:
From nonkeratinized STRATIFIED squamous to non-ciliated columnar with globet cells (mucin-producing)
255
What type of cellular adaptation is cervical intraepithelial neoplasia?
Dyplasia
256
Sings of reversible cell injury:
Key is cellular swelling that leads to:
| Loss of microvilli, chromatin clumping, blebbing and decrease protein synthesis by the swelling RER
257
Sings of irreversible cell injury:
Key is membrane damage that leads to:
Cellular enzymes in blood (hepatic enz, troponin), loss of inner mitochondrial mb so no e- transport chain, cytochrome c leak so apoptosis and lysosomal enz in cytosol
Nuclear pyknosis (condensation), karyorrhexis (fragmentation) and karyolysis (fading)
258
Phases of loss of the nucleus:
Pyknosis (condensation), then karyorrehxis (fragmentation) and then karyolysis (dissolution)
259
Where can red infarction happen?
Lung or testicle
260
Only organ that doesn’t get coagulative necrosis when blood supply is cut:
Brain (gets liquefactive due to microglia)
261
When can get fibrinoid necrosis a 30 y.o. woman?
This is hyperplastic arteriOLOsclerosis (onion skinning with fibrinoid necrosis and smooth m. proliferation) consequence of malignant hypertension, as in the placenta of preeclampsia; can also happen in vasculitis
262
What does mediate apoptosis and what activates it?
Caspases
Activated by:
Lack of Bcl2 and cytochrome c leak (intrinsic mitochondrial)
FAS death receptors (thymus) and TNF receptors (extrinsic)
Cytotoxic CD8+ trough perforines and granzyme
263
Organ most commonly affected by systemic amyloidosis and consequence:
Kidney, nephrotic sd.
264
What is the defining characteristic of a granuloma?
Epitheloid histiocystes (they are macrophages with abundant pale pale cytoplasm) CD14+
265
Where are the stem cells of the small and large bowel?
On the crypts
266
Where are the stem cells of the skin?
On the basal layer
267
Which are the stem cells of the bone marrow and what is their marker?
The hematopoietic stem cells, CD34+
268
Which are the stem cells of the lung?
Type II pneumocytes; they can proliferate in response to injury but they have a low rate of proliferation in normal conditions
269
Vimentin and keratin are markers of which type of tumors and how do they spread?
Vimentin: mesenchimal (endothelium, fibroblasts, chondroblasts, vascular smooth muscle) tumors, SARCOMA; spread HEMATOGENOUSLY (so they go to the lungs!! besides GI sarcomas that go to the liver)
Ketatin, cytokeratin: epithelial tumors, CARCINOMA; spread by LYMPHATICS (but renal, hepatocell, follicular thyroid and chorioca.)
270
Desmin is a marker of:
Muscle tumors (design helps the interactions between the sarcolemma and the Z disk), rhabdomyosarcoma
271
GFAP is a marker of:
Neuroglial tumors
272
Chromogranin and neuron-specific enolase are markers of:
Neuroendocrine cell tumors: small cell ca. of the lung, carcinoid tumors, neuroblastoma, pheochromocytoma, VIPoma...
Can form rosettes
273
S-100 is a marker of:
```
Neural crest tumors:
Melanoma
Schwannoma
Neurofibroma
Astrocytoma
```
Neural tumors
Langerhans cell histiocytosis
274
What do the Weiner-Palade bodies of the endothelial cells secrete?
W: von Willebrand factor (for platelet-endothelium adhesion)
P: P-selectine (for neutrophil rolling)
275
Thromboxane A2 derives from:
Platelet cyclooxygenase 1 (not 2, that is why celecoxib is prothrombotic)
276
Endothelial mechanisms to protect from thrombosis:
Blocks underlying collagen
Produces PGI2, NO, heparin-like molecules (that increase antithrombin 3), tissue plasminogen activator and thrombomodulin
277
What does the amniotic fluid contain that makes it thrombogenic?
Tissue thromboplastine/ factor; you can have tissue thromboplastine leaking into the circulation and DIC without amniotic fluid embolus.
Amniotic fluid emboli will go to the lungs, they are venous and will cause hypotension and cariogenic shock. Micro: fetal squamous cells in the pulmonary vasculature
278
Where is iron absorbed?
In the duodenal enterocytes by ferroportin
279
What is the most sensitive cell to radiation (what is it's mechanism?)? and QT?
RT: Lymphocytes and other rapidly dividing cells (by DNA double strand breaks! and free radicals). Fixed by NONhomologous recombination
QT: Granulogytes (neutropenia). Treat with filgrastim or sargramostim
280
Characteristic of immature neutrophils (left shift):
Have less Fc (CD16) receptors
281
Specific marker for ALL:
Lymphoblasts have TdT (terminal deoxynucleotidyl transferase) on their nucleus (a DNA polymerase)
282
Which acute leukemia infiltrates the gums?
Acute monocytic leukemia (M5 AML)
283
Translocations associated with B-ALL:
t(12,21) good px 👶. Kids like palindromes
| t(9,22) bad px 👨. Philadelphia typic in CML brings bad px to ALL
284
Specific marker for AML:
```
Positive staining for myeloperoxidase
Auer rods (myeloperoxidase aggregates)
```
285
Type, translocation, defect and treatment of acute promyelocytic leukemia:
```
Type of AML
t(15,17)
Disrupts the retinoic acid receptor
The promyelocytes contain Auer rods that predispose to DIC
Tto with all-trans-retinoic acid
```
286
Characteristic e- microscopy finding in langerhans cell hystiocytosis:
Birbeck or tennis racket granules
287
In which vessel wall layer does atherosclerosis happens?
Intima
288
In which pathologies do you get hyaline arteriolosclerosis?
In benign hypertension and diabetes
Looks very pink in histology
Hyaline is gentle fibrinoid is malignant
289
In which pathologies do you get hyperplastic arteriolosclerosis?
Just in malignant hypertension
Then can lead to fibrinoid necrosis seen in malignant HT and vasculitis (polyarteritis nodosa)
Hyaline is gentle fibrinoid is malignant
290
Small cell ca. can express:
```
Neuron-specific enolase
Chromogranin
Synaptophysin
Neural cell adhesion molecule (NCAM)
Neurofilaments
Rosettes
Uniform round nuclei
```
291
Where is the juxtaglomerular apparatus?
In the tunica media of the afferent arteriole
292
What is affected on Kartagener sd?
The dynein arm of cilia, needed for ciliary movement
293
What is the histological hallmark of pulmonary hypertension?
Plexiform lesions in long lasting disease
294
What is the histological hallmark of respiratory distress sd?
Hyaline membranes and fluid in the alveolar space
295
Signet ring cells are a sing of:
Diffuse gastric ca. that infiltrates the gastric wall leading to linitis plastica
296
What do the Mallory bodies contain? Where do you see them? What markers will be high?
Damaged intermediate filaments within hepatocytes
Alcoholic hepatitis
Aspartate aminotransferase: AST (AST/ALT ratio is high); can increase in MI
Gamma-glutamyl transpeptidase: GGT (biliary disease)
Mean corpuscular volume: MCV
297
Histological changes seen in Reye sd:
Microvesicular steatosis with fat vacuoles on hepatocytes
| CNS edema
298
Histological hallmark of diabetic nephropathy:
Kimmelstiel-Wilson nodules in the mesangium
299
Which cells produce EPO?
Renal interstitial peritubular fibroblasts so there is anemia in chronic renal failure
EPO is secreted in IPFs
300
The most common variant of renal cell ca. originates from:
Clear cell type, it originates from the epithelium of the proximal renal tubules! It's always them!!!
Renal cell ca comes form the proximal convoluted tubule
Renal oncocytoma comes from the collecting duct
301
Where are the stem cells of the endometrium?
On the basalis (they regenerate the functionalis every cycle)
302
Multiple white whorled masses on an asymptomatic premenopausal woman indicates:
Leiomyoma
303
When we find immature tissue on a teratoma what is the most common type?
And if we find somatic malignancy?
1) Skin turns malignant causing squamous cell ca. of the skin, normally malignization comes form skin tissue
2) Neural ectoderm can turn malignant causing gliomas
304
What type of characteristic inclusions do Leydig cells have?
Reinke crystals
305
Mutation that leads progression form normal tissue to adenomatous polyp:
APC Ch5q (loss); polyp has 5 letters
306
Mutation that leads to increase size of the adenoma:
K-ras (gain)
| KRAS mutation is associated with colorectal ca. and non-small cell lung ca.
307
Mutation that leads to malignant transformation of a polyp:
TP53 Ch17p (loss)
308
Histology of prostatic ca:
Small invasive glands with PROMINENT NUCLEOLI
309
Where are the beta cells of the pancreas?
In the center of the islet of Langerhans
310
Name a metaplastic change that doesn’t increase the risk for ca:
Apocrine metaplasia in fibrocystic breast change.
Metaplasia almost always is associated with increased risk for ca.
311
Histological characteristic of breast lobular ca. in situ and invasive lobular ca.
Dyscohesive single-file pattern due to lack of E-cadherin
312
What is the histological hallmark of rheumatoid arthritis and which HLA is associated with it?
Synovitis leading to formation of a pannus (granulation tissue)
HLA-DR4
313
What is the major site of synthesis of steroid hormones, TG and phospholipids?
Smooth endoplasmic reticulum; contains for example 21-hydroxylase
314
What is the major site of detoxification of drugs and poisons?
Smooth endoplasmic reticulum
315
Which ovarian tumor gives you Meigs sd?
Hydrothorax and ascites due to ovarian FIBROMA
316
CA tumor markers:
CA 15-3: breast ca!! 3 on it's side looks like breast
CA 19-9: pancreas
CA 125: ovarian ca. (papillary/serous epithelial cystadenoca.) and uterine ca! 25 look like uterus and ovary
317
DD of CIS of the penis:
Bowen disease: white plaque in the shaft
Erythroplasia of Queyrat: red plaque in the tip
Bowenoid papulosis: multiple red papules on the shaft (not sure if malignant)
318
Difference between cryoprecipitate and FFP:
```
Cryoprecipitate just contains:
Fibrinogen
Factor 8 and 13
VonWillebrand
Fibronectin
```
FFP contains all
319
Characteristics of dysplastic nevus syndrome:
Autosomal dominant
Loss of function mutations in the CDKN2A gene in chromosome 9
Unusual nevi and multiple melanomas
Also pancreatic ca.
320
What does right and left dominance mean?
```
Right dominance (70%): the right coronary gives the posterior descending
Left dominance (10%): the left circumflex gives the posterior descending
```
The left circumflex normally irrigates the side of the LV
321
Acute tubular necrosis presentation and causes:
Acute renal failure with oliguria and granular muddy casts
Causes: ischemia, ahminoglycosides ('mycins'), lead, cisplatin, ethylene glycol (antifreeze), contrast, myoglobin, hemoglobin
322
What does ca. in situ mean?
Takes over the whole epithelium but does not penetrate the basement membrane!
323
Types of UV light and how are they blocked?
Aging, phototoxicity: UVA, blocked by avobenzone and zinc oxide
Sun: UVB, most important cause of sunburn, blocked by PABA in current sunscreen, zinc oxide and you can apply petrolatum (vaseline) to the lips as a barrier
324
Which metabolic processes happen in zones 1 and 3 of the liver?
Zone 1: makes glucose (gluconeogenesis, glycogen breakdown, FA oxidation)
Zone 3: breaks down glucose (glycolysis, glycogen synthesis, lipogenesis)
325
Atypical MI presentation:
Jaw/epigastric pain
| Most common in females
326
Where are calcitonin and PTH secreted from?
Parafollicullar C cells of the thyroid: calcitonin (lowers Ca)
Chief cells of the parathyroid: PTH (increases Ca)
327
Causes of renal diffuse cortical necrosis:
DIC (due to a combination of vasospasm and DIC)
328
Difference between ephelides and lentigines:
Ephelides: freckles, pecas; increase granules of melanin
Lentigines: lunar; increase in number of melanocytes
329
Ca. associated with BCL-2 mutation and treatment:
CLL
Follicular lymphoma
Breast (good px)
tto: venetoclax
330
Tuberous sclerosis presentation:
```
HARMATOMASSS:
Harmatomas in cns, skin and lung
Adenoma sebaceoum
Rhabdomyoma of the heart, benign
Mitral regurgitation
Ash-leaf (fluorescent with UVA, Wood's lamp)
TSC1-harmatin (Ch9) TSC2-tuberin (Ch16) that inactivate mTOR
autosomal dOminant
Mental retardation
Angiomyolipona of the kidney (vessel+muscle+lipid)
Seizures from cortical tubers
Subungual fibromas
Shagreen
SEGA: subependymal astrocytoma
```
331
Neurofibromatosis type 1 presentation:
```
Cafe au lait
Lisch nodules (iris harmatomas)
Neurofibromas on the skin
Optic gliomas and Pilocytic astrocytoma
Pheochromocytomas (VMA) and Wilms
Scoliosis
Mental retardation and seizures
Ch17
```
332
Neurofibromatosis type 2 presentation:
```
Bilateral schwannomas
Meningiomas
Ependymomas
Cataracts
Ch22
```
333
Sturge-Weber syndrome presentation:
SSTURGGE:
Sporadic, nonhereditary!!! 0% prob of giving it to your kid
Stain in face (nevus flammeus)
Tram track calcifications in opposing gyri (leptomeningeal angiomatosis)
Unilateral
mental Retardation
Glaucoma (congenital can give leukocoria)
activating mutation of GNAQ gene
Epilepsy
Pheochromocytoma (VMA)
334
Von Hippel-Lindau presentation:
```
Renal cell ca.
Pheochromocytomas (VMA) FEO!
Hemangioblastomas in retina, cerebellum... EPO
Cysts!! in the liver, pancreas...
Angiomatosis
Ch 3p
```
3 letter illness!
Mutation 3p, autosomal dominant
VHL normally suppresses hypoxia inducible factor HIF! is no VHL ↑VEGF
335
Which illnesses affect the globing gene?
Beta globin
Beta thalassemia: point mutation in the noncoding intron deleting/decreasing gene
Sickle cell anemia: point mutation at position 6 of the exon that changes Glutp(p) to Val(n) making HbS
HbC disease:point mutation at position 6 of the exon that changes Glut(p) to Lys(p) making HbC
Alpha globin
Alpha thalassemia: gene deletion forming HbH (--/-α excess β) or Barts Hb (--/-- 4: excess γ)
336
Osler-Weber-Rendu presentation:
Hereditary hemorrhagic telangiectasia
Autosomal dominant
Telangiectasias: epistaxis, GI bleeding, hematuria, AV malformations
337
DD of abdominal mass in kids:
Wilms: doesn't cross
From nephroblast (embryonic kidney)
WT1 mutation Ch 11
Micro: triphasic with tubules, sheets and stroma
± hypertension (renin secretion), hematuria ±:
WARG: WT1 is associated with anhiridia, genitourinary malformation, retardation. PAX6 next to WT1 is important for iris formation, contiguous gene deletion
Denys-Drash: WT1 is associated with Difusse mesangial sclerosis (nephrOtic) and Dysgenesis of gonads
Beckwith-Wiedemann: WT2 is associated w macroglossia, hemihyperplasia, low sugar and high insulin because over expression of ILGF2, omphalocele, hepatoblastoma
```
Neuroblastoma: crosses and calcifies
From neural crest (adrenal medulla± hypertension)
Micro: Homer pseudorosettes
Can cause blueberry-muffin baby!
M-YCN! mutation (poor px)
High homovanillic acid
```
338
In which chromosomes are WT1 and WT2?
11p (world trade center 11S)
| In Willms and also in mesothelioma!
339
In which chromosome is TP53?
17p
340
In which chromosomes are BRCA1 and BRCA2?
BRCA1: 17q
BRCA2: 13q
341
In which chromosomes are APC and DCC?
APC: 5q
DCC: 18q
342
In which chromosome is VHL?
3p
343
In which chromosome is RB1?
13q
344
Why the combination of alcohol and acetaminophen can predispose to hepatic necrosis?
Chronic alcohol is a P450 inducer so high P450 activity converts acetaminophen to N-acetyl-p-benzoquinone that depletes glutathione
345
Which pathologies give you a dry tap?
Myelofibrosis (different than myelodysplastic that is pre-leukemia and hypercellular)
Hairy cell leukemia
Aplastic anemia (idiopathic, fanconi anemia, QT, bezene, carbamazepine, EBV, hepatitis, different than B19 that causes mostly aplastic crisis just anemia)
In all those normally get pancytopenia
Aplastic anemia will not have splenomegaly
346
Plasmin functions:
Breaks down fibrin cloths
Breaks down fibrinogen
Destroys coagulation factors
Blocks platelet aggregation
347
What can cause a disorders of fibrinolysis and how can be treated?
Urokinase released after prostatectomy, it activates plasmin
Cirrhosis, α2-antiplasmin is missing so plasmin is not destroyed
Gives you a presentation similar to DIC bc plasmin destroys coagulation factors so ↑PT, PTT and bleeding but nr platelet count and D-dimer (bc the coagulation cascade is not activated so thrombin and therefore fibrin are not formed)
tto: aminocaproic acid
348
Mechanism of heparin-induced thrombocytopenia:
Heparin makes a complex with platelet factor 4 and the body makes IgG against this complex so it ends up destroying the platelets
349
Definitive treatment for preeclampsia? How is the urine?
Delivery
Renal fx: oliguria, increased specific gravity, yes protein no blood in urine, high serum Cr (that should be low in normal pregnant)
350
Illnesses that cause hyper coagulable state:
Protein C and S deficiency, autosomal dominant, do not give warfarin because high risk of skin thrombosis
Factor 5 Leiden mutation, cannot be inactivated by proteins C and S
Prothrombin 20210A point mutation, increases prothrombin gene expression
AT3 deficiency, PTT does not increase with nr dose heparin but yes at high dose
Estrogens increase production of clothing factors
351
```
Genes associated with:
Neuroblastoma
Burkit
Lung small cell
Wilms
CML
Melanoma
Breast
Medullary thyroid
```
```
N-MYC: Neuroblastoma
C-MYC: Burkit (Congo)
L-MYC: Lung small cell (all L,N and C)
WT1: Wilms tumor, nephroblastoma, also mesothelioma!
ABL: CML
CDK4: melanoma
Erb2: breast
RET: medullary thyroid and MEN2s
```
352
Complications of uremia:
```
Platelet dysfunction (due to complement inhibition)
Anemia
Acute gastritis
Pericarditis
Heart disease
Encephalopathy with asterixis
Deposition of urea crystals on the skin
High ANION GAP metabolic acidosis
```
353
```
Translocations associated with:
Edwing
Follicular thyroid
Synovial sarcoma
Leiomyosarcoma
Alveolar rhabdomyosarcoma
Clear cell sarcoma
```
```
t(11,22) FLI1-EWSR1 CD99+ MIC1+: Edwing
t(2,3) PAX8-PPARγ: follicular thyroid
t(X,18): Synovial sarcoma
del(1p): leiomyosarcoma
t(2,13): alveolar rhabdomyosarcoma
t(12,22): Clear cell sarcoma; similar to melanoma
```
354
Which tumors most likely cause pseudomyxoma peritonei?
1) mucinous adenocarcinoma of the appendix 2) mucinous cystadenocarcinoma (adnexal mass indicates bad px, kills because adhesions)
Cavity tumors tend to spread through seeding: on top of 1) and 2) serous endometrial ca., and gallbladder ca. can seed
355
Which tumors present desmoplasia? What is its function?
Invasive ductal ca. of the breast
Pancreatic ca.
Helps the tumor to grow, gives blood supply and can protect form QT
356
Where can you find pseudostratified columnar epithelium?
Nasal cavity, trachea, bronchi
| Epididymis
357
Which component of Hb is low in each of the microcytic anemias?
Hemoglobin=Heme + Globin (↓ in thalasemia)
| Heme=Fe (↓ in iron deficiency/chronic disease) + protoporphyrin (↓ in sideroblastic)
358
Parietal cell characteristics:
Have Proton pumps, make acid
Pink (Chief are blue)
Destroyed in Pernicious anemia
Prodruce IF!!!
359
Labs differences between intra and extravascular hemolysis:
Extravascular: RBCs eaten by spleen
Jaundice (↑ unconjugated bilirubin)
Bilirubin gallstones
Intravascular: RBCs broken in blood vessels
Hb in blood and urine
Hemosiderinuria (tubular cells with iron fall off a few days later)
↓ Free haptoglobin
360
In which two anemias do you see high mean corpuscular hemoglobin concentration?
Spherocytosis and autoinmune anemia; in both there are spehrocytes that keep loosing their membrane so Hb gets more concentrated
361
Which cell adaptation leads to splenomegaly in extravascular hemolysis? and in infections?
Extravascular hemolysis, spherocytosis: Work hypertrophy!!
Infections and autoimmune: Reticuloendotelial (white pulp) hyperplasia
362
Name 4 causes of obstructive shock:
```
Physical obstruction to the great vessels:
Cardiac tamponade
Constrictive pericarditis
Pulmonary embolism
Tension pneumothorax
```
363
Name 4 causes of distributive shock:
Sepsis (septic)
CNS injury (neurogenic)
Anaphylactic
Endocrine, acute pancreatitis
364
When do you get skin necrosis after warfarin?
When you have protein C and S deficiency, protein C has a very short half life
The low protein C and S will stop inhibiting factor 5 and 8 so factors 5 and 8 activity will increase causing a hypercoagulable state
365
Urinary sample markers of pheochromocytoma vs carcinoid tumor:
Pheochromocytoma: makes epi, NE and DA so in urine you see homovanillic and vanillylmandelic acid
Carcinoid: makes 5HT so in urine you see 5-hydroxyindoleacetic acid
366
In which illnesses can you see excessive platelets?
Essential thrombocytopenia
| Iron deficiency anemia
367
Risk factors for bladder ca:
Squamous: S. Haematobium, long term Foley catheter, stones, chronic cystitis
Transitional: tobacco, aromatic amine, naphthylamine, dyes, cyclophosphamide, phenacetin, radiation, rubber, plastics, textiles, leather
Adeno: urachal remnant (bladder dom), extrophy, cystitis glandularis
368
Which are the different lymph node regions, which cells contain and when do they expand?
Cortex, follicular (B): early HIV (follicular dendritic cells are a reservoir for HIV), rheumatoid arthritis
Paracortex (T): virus, mono
Medullary sinus (histiocytes=macrophages!!): ca. drainage, TB
369
Which papillary m. is most commonly ruptured?
Posteromedial m. particularly in inferior MI. causing mitral regurgitation and therefore pulmonary edema
If you see a posterior MI think papillary m. rupture!!
It has single blood supply form the posterior descending A.
370
Presentation, macro, histological hallmark and marker of seminoma and dysgerminoma:
Most common in 15-35 yo
PainLESS firm homogeneous testicular enlargement, lobulated (dysgerminoma is a common cause of ovarian ca. in pregnant)
Large polygonal clear cells (with watery large cytoplasm) forming lobules + fried egg (membranes and central nucleus)
Placental alkaline phosphatase and β-HCG (seminoma) lactate dehydrogenase (dysgerminoma)
371
Presentation, macro, histological hallmark and marker of yolk sac (endodermal sinus or INFANTILE embryonal ca.) tumor:
Most common in prepuberal children
Yellow mucinous mass
Endodermal sinus formation with Schiller-Duval bodies (glomeruloid structures lined by germ cells) and hyaline droplets
α fetoprotein (± α1 antitrypsin)
372
Presentation, macro, histological hallmark and marker of embryonal ca:
Painful mass in 20-30 yo, rare and metastasizes fast
Hemorrhagic mass with necrosis, commonly mixed
Glandular/papillary normally mixed with other tumors
hCG (+ α fetoprotein when mixed)
373
What is Beck's triad of cardiac tamponade?
Hypotension
JVD
Muffled heart sounds
374
Where do you see schistocytes?
TTP and HUS
DIC
HELLP sd
Traumatic hemolysis: valve prothesis
375
Where do you see target cells?
```
HALT:
Hb C disease
Asplenia (so also in sickle after autoinfarction)
Liver disease
Thalassemia
```
They are due to a high area/vol
376
DD of the different types of lichen:
All are itchy
Lichen planus: Flat purple lesion with wickham striae. Sawtooth infiltrate and thickening of the granulosum, hypergranulosis + lymphocytes at the dermoepidermal junction. Associated to Hep C. Risk of ca.
Lichen sclerous: White plaque (leukoplakia) with purple border. THINing of the epidermis that leads to erosions. Postmenopausal. Risk of ca.
Lichen simplex: THICK skin patch with enhanced margins form scratching. Leather- like hyperplasia of the squamous epithelium. No risk of ca.
Tto: Corticoids
377
What are the fibrocystic changes associated with ↑ risk of breast ca:
Sclerosing adenosis with epithelial hyperplasia/atypia
378
Illnesses with high CEA (carcinoembryonic antigen):
Adenocarcinomas: colon, stomach, breast, lung, medullary thyroid
Bad px is very high
379
What are the markers for Red-Sternberg cells? What is the only subtype without Red-Sternberg cells?
CD15 (granulocyte marker)
CD30
The only subtype without is lymphocyte predominant that had popcorn cells are CD20 and CD45
380
What is the illness associated with mutation in GNAS?
Intraductal papillary pancreatic ca
| Malignant tumors in general
381
Proximal and distal esophagus are formed by which type of m?
Proximal: striated m. affected in dermatomyositis
| Distal and LES: smooth m.
382
What are atypical lymphocytes pathognomonic from?
Mononucleosis (not lymphoma!)
| Atypical lymphocytes on peripheral blood smear
383
Which kind of patients get squamous cell ca. of the head and neck? what is the histology?
Old man who smokes, drinks and has rotten teeth (if it presents with hoarseness is probably on the vocal cords)
A raising RF is HPV!!
Histology: irregular foci of keratinization (keratin pearls), intracellular bridges, eosinophilic pink cytoplasm
384
Where do the proteins accumulate in centriacinar emphysema PiZ?
In the endoplasmic reticulum of hepatocytes forming pass + granules
385
Where does idiomatic pulmonary fibrosis starts and what mediates it?
Starts in the subpleural region
| TGF-beta mediated
386
Name one endothelial tumor marker:
CD31, PEcam-1 for diaPEdesis
| Is only on vessels and neutrophils so you will know the tumor is vascular, for example an agiosarcoma
387
Syndromes associated with hepatoblastoma:
Beckwith-wiedemann sd
Familial adenomatous polyposis
Glycogen storage diseases
388
Syndromes associated with mitral valve prolapse:
Women and fame:
Young female
Klinefelter (increased risk of breast ca.)
```
FAME:
Fragile X
ADPKD
Marfan
Ehler Danlos
```
389
Protective and RF of breast, ovarian (epithelial) and endometrium ca:
🙁 unopposed estrogen/more cycles: no babies, first baby old, early menarche and late menopause, ovarian dysfunction (anovulatory cycles), fat, DM, postmenopausal hormonal therapy
🙂 progesterone added to estrogens (actually the risk of breast ca. is ↑ even if progesterone is added to estrogen)/less cycles: combination contraceptives, babies, breastfeeding, exercise, tubal ligation for ovarian
390
What is a Rokitansky-Aschoff sinus?
Hernitation of the gallbladder mucosa into the muscular wall seen on chronic cholecystitis
391
Causal agents of viral hepatitis:
Hepatitis virus, EBV and CMV
392
What is the alcoholic metabolite that causes alcoholic hepatitis? why does it elevate AST more than ALT?
Acetaldehyde mediates the damage, it is a mitochondrial poison and AST is in the mitochondria
393
Illness that cause dilated vs hypertrophic cardiomyopathy:
Dilated:
Carnitine deficiency (MCAT)
Duchenne Muscular Dystrophy
Hypertrophic:
Pompe
Friedreich ataxia
394
Causes of avascular necrosis of the femoral head:
```
Legg-Calve-Perthes disease
Gaucher
Sickle cell anemia (is DD for Gaucher disease)
Corticoid use
Alcoholism
```
395
Which infection is associated with porphyria cutanea tarda?
Hepatitis C
396
Risk factors of both types of esophageal ca:
```
Squamous upper 2/3:
alcohol
hot liquids
caustics
strictures
smoking, achalasia
```
Adenoca. lower 1/3:
GERD (barret, obesity, nitroglycerin, coffee, chocolate, mint, hiatal hernia)
processed meats
smoking, achalasia
397
What is the most common RF for Ca stones in adults? Which other 2 RF exist?
Idiopathic hypercalciURIA; Calcium in plasma remains normal (paradoxically, people with moderately high Ca in the diet have lower risk of calcium-oxalate stones bc ca binds oxalate in the gut so less oxalate gets absorbed)
HyperoxalURIA
HYPOcitratURIA (potassium-citrate is prevention of recurrent calcium stones)
398
How long after fertilization does the β-HCG become detectable in serum? and in urine?
8 days in serum
| 14 days in urine
399
What should you suspect if you see enterovirus or giardiasis on a kid?
Burton agammaglobulinemia, no B cells in blood
400
Markers of ALL-B:
TdT (terminal deoxynucleotidyl transferase)
CD10
CD19, Negative CD20 (cannot use rituximab)
401
Markers of ALL-T:
TdT (terminal deoxynucleotidyl transferase)
| CD2-8
402
Markers of hairy cell leukemia:
CD11c
CD25
BRAF
CD103
CD19, 20
403
Markers of CLL:
CD5
CD23
No CD10!
CD19, 20
404
Markers of Langerhans cell histiocytosis:
CD1a
CD11c
BRAF
S-100
405
Markers of mantle cell lymphoma:
CD5
No CD23!
CD19, 20
406
Markers of Hodgkin lymphoma:
CD15
CD30
All except lymphocyte predominant
407
Markers of lymphocyte predominant lymphoma:
Popcorn cells:
CD20
CD45
No CD15, 30!
408
Stains for fibrosis:
Trichrome
| Reticulin
409
What can stain with PAS?
```
Paget in nipple (stains mucus)
Whipple
Diabetes (nodular glomerulosclerosis)
AML: erythroleukemia M6
Fungi
alpha 1 antitrypsin
Glycogen storage diseases
```
410
How do free radicals cause damage?
Directly damages the DNA causing strand breaks
Generate radioactive oxygen spices
411
Which is the most sensitive and specific marker for pancreatic disease?
Amylase: sensitive; goes up fast, also released by salivary glands
Lipase: specific; takes several days to increase but just increases in pancreatic disease
Fecal elastase: decreased in pancreatic insufficiency
412
How do you differentiate between biliary and bone disease if you see high ALP?
You need to look at GGT, if it is high is biliary pathology if it is low it is the bone
413
Which illnesses are associated with thymoma?
Pure red cell aplasia!!
Good syndrome (low immunoglobulins, immunodeficiency)!!!
Myasthenia gravis
414
DD of beaten appearance (string of beads) in angiogram?
Polyarteritis nodosa: everywhere but the lung
Fibromuscular dysplasia: young with renal artery stenosis
Primary sclerosing cholangitis: beaded on ERCP
415
Effects of excess phosphate in chronic kidney disease:
↑P causes the release of fibroblast growth factor 23 (FGF-23=Klotho) from the bone which lowers 1,25-vitD (calcitriol) and GI Ca absorption
416
Presentation, macro and histological hallmarks of osteochondroma:
Presentation: most frequent, benign, condro part can transform in chondrosarcoma
Macro: bony spike covered by a cartilage cap on the metaphysis (almost tip)
Micro: spike is continuous wit the marrow
417
Presentation, macro and histological hallmarks of chondrosarcoma:
Presentation: in adults >50 around the pelvis. *Osteochondromas are a lot more frequent, benign, happen in kids and their condro part can transform in chondrosarcoma
Macro: moth eaten lytic appearance with popcorn-like spiculated calcifications in Rx
Micro: irregular cartilage and calcifications
418
Presentation, macro and histological hallmarks of osteoid osteoma:
Presentation: Less than 2cm and pain at night relieved by NSAIDs (vs osteoblastoma that is bigger than 2cm, not relived! and in vertebra). Benign
Macro: on the cortex of the diaphysis (side), Rx radiolucent core of osteoid (dark) surrounded by sclerosis (white)
Micro: woven bone lined by a single layer of ~blasts
419
Presentation, macro and histological hallmarks of giant cell/osteoclatoma:
Presentation: benig but locally aggressive and may recur. Female=male
Macro: on the epiphysis!!! (tip) of the knee. Rx soap bubble. Nonsclerotic sharply defined border
Micro: tumor cells with RANK-L (~blasts) and multinucleated giant cells (~clasts)
420
Presentation, macro and histological hallmarks of osteosarcoma/ osteogenic sarcoma:
Presentation: Most common malignant. Painful enlarging mass or fracture. Bimodal teenager (retinoblastoma) and old (paget, radiation). Aggressive
Macro: on the metaphysis (almost tip) of the knee. Rx codman triangle (periostial elevation, swelling) or sunburst (litic, tiny fragments of bone)
Micro: plemomorphic cells making osteoid; malignant proliferation of osteoblasts (spindle shaped pink)
Malignant osteoblasts arise form mesenchymal stem cells in the PERIOSTEUM
421
Presentation, macro and histological hallmarks of Ewing sarcoma:
Presentation: 2nd most common malignant. Painful and swelling, ±fever, boys, good px
Macro: on the diaphysis of femur, grows inside the narrow and pressures the periosteum that grows on onion skin reaction
Micro: mesenchymal but small blue w Homer-Wright pseudorosettes and glycogen +CD99, +MIC2, t(11;22) EWS-FLI1 for DD with lymphoma and osteomyelitis
422
Causes of macro and micronodular cirrhosis:
Macro: viruses, toxins (CCl4, amanita phalloides)
Micro: Reye, hemochromatosis, Wilson's, alcohol, biliary cholangitis
423
HER2/neu type of gene, type of receptor and gene product, how is it expressed? associated tumors and treatments:
Oncogene
Tyrosine kinase receptor of epidermal GF that accelerates cell proliferation (activates Ras and MAPKinases (GTP bound); Epidermal GFs stimulate growth through tyrosine kinases). If + worse px and higher grade and recurrence, 1/3 has metastasized to the brain
Overexpressed by AMPLIFICATION
Breast, gastric and gallbladder ca!!
Trastuzumab (blocks receptor), pertuzumab (block receptor production)
424
RET type of gene, type of receptor and gene product, how is it expressed? and associated tumors:
Oncogene
Tyrosine kinase receptor (glial neurotrophic)
Point mutation
Overexpression causes endocrine tumors (MEN2A 2B papillary thyroid ca, pheochromocytoma) knock down causes Hirschsprung
425
RAS type of gene, gene product, how is it expressed? associated tumors and treatments:
Oncogene
GTP binding protein, GTPase!!! if mutated GTPase activity is lost and GTP never goes to GDP so there is a constitutive activation
Point mutation
Colon, lung, pancreas
K-RAS: Epidermal GF receptor activates K-RAS downstream. Targets are Cetuximab, panitumumab (only for wild-type K-RAS if K-RAS mutation leading to constitutive activation they will not work)
426
MYC type of gene, gene product, how is it expressed? and associated tumors:
Oncogene
Transcription factor
t(8,14)
C: Burkitt; L: little lung ca; N: neuroblastoma
427
VHL type of gene, gene product, how is it expressed? and associated tumors:
Tumor suppressor gene, Ch3
Inhibits hypoxia-inducible factor 1a
Mutation (born with 1 mutation in VHLsd or 2 mutations in RCC in old/smoker)
Renal cell ca, hemangioblastoma, pheochromocytoma, cysts
428
WT1,2 type of gene, gene product, how are they expressed? and associated tumors:
Tumor suppressor gene, Ch 11
Urogenital development transcription factor
Mutation
Wilms tumor (WARG: Anhiridia+ Retardation+ Genitourinary malformation) Denis-Drash (Diffuse mesangial sclerosis, Disgenic gonads) Beckwith-Wiedemann (macroglosia, some body areas larger, omphalocele, hepatoblastoma)
429
RB type of gene, gene product, how is it expressed? and associated tumors:
Tumor suppressor gene, Ch 13
Inhibits E2F, stops the progression G1→S cell cycle
Mutation (born with 1 mutation or 2 mutations)
Retinoblastoma, osteosarcoma
430
TP53 type of gene, chromosome, gene function, how is it expressed? and associated tumors:
Tumor suppressor gene, Ch 17
Activates p21, stops the progression G1→S cell cycle
Mutation (born with 1 mutation in Li-Fraumeni or 2 mutations as most cancers progress)
Li-Fraumeni sd: sarcoma, breast, leukemia, adrenal... at young age. Mutated in most ca. progression
431
BRCA1,2 type of gene, gene product, how are they expressed? and associated tumors:
Tumor suppressor gene, 1 in Ch 17 2 in Ch13
BRCA1,2 proteins fix strand breaks by homologous recombination (repairing using complementary strand)
Mutation
BRCA 1) Breast, ovarian and fallopian serous BRCA 2) both sexes get breast ca. and pancreatic ca.
432
APC type of gene, gene product, how is it expressed? and associated tumors:
Tumor suppressor gene, Ch 5 (5 letters in colon)
Negative regulator of β-catenin or WNT pathway
Mutation (born with 1 mutation in FAP or 2 mutations as colon cancers progresses)
Colon ca
433
NF1,2 type of gene, gene product, how are they expressed? and associated tumors:
Tumor suppressor gene, 1 in Ch 17 2 in Ch22
NF1: neurofibromin a Ras GTPase that shuts RAS off
NF2: merlin (schwannomin) stops growth by contact inhibition
Mutation
NF1: neurofibroma, optic glioma and pilocytic astrocytoma, lisch nodules (iris harmatomas), pheochromocytoma
NF2: bilateral schwannoma, meningioma, ependymomas
434
Clinic and how you differentiate alpha thalassemia minor and beta thalassemia minor?
Both are normal until anemia when they are in stress, have target cells
Alpha has normal electrophoresis
Beta has aBnormal electrophoresis ↑HbA2(2α2δ) ↑HbF(2α2γ)
435
Sickle trait symptoms:
Normally asymptomatic until they go to high altitude
They can get renal medulla ischemia so they will get isosothenuria because they cannot concentrate the urine so pee in bed
436
DD of stroke in young women:
```
Takayasu
Thrombotic thrombocytopenic purpura
Antiphospholipid syndrome
Fibromuscular dysplasia
AV malformation
```
437
Uric acid stones look like:
Broken glass, barrel shape
438
Cysteine stones look like:
Cyst=6; hexagon
439
Ca oxalate stones look like:
Envelope, dumbbell
440
Ammonium magnesium phosphate stones look like:
Struvite stones: Coffins, prisms
441
Types of papillary tumors and characteristics:
Ovarian, bladder, thyroid, renal (MET oncogene expansion, how I met your papi?)
All are bilateral and multifocal
442
Syndromes associated with Wilms tumor:
WARG: WT1 is associated with anhiridia, genitourinary malformation, retardation. PAX6 next to WT1 is important for iris formation, contiguous gene deletion
Denys-Drash: WT1 is associated with Difusse mesangial sclerosis (nephrOtic) and Dysgenesis of gonads
Beckwith-Wiedemann: WT2 is associated w macroglossia, hemihyperplasia, low sugar and high insulin because over expression of ILGF2, omphalocele, hepatoblastoma
443
Risk factors of gastritis:
Gastritis: lost of folds in stomach;
Chronic:
H. pylori: bug in ANTRUM mucosa surrounded by ammonia, more frequent if smoking, causes duodenal ulcers. Drink radioactive urine and if H.pylori is there, its urease will break it into ammonia and CO2 that will come out into the breath. Silver stain biopsy is gold standard. also fecal antigen testing.
If has Cag A gene expression can cause adenoca. and MALToma
Autoimmune: pernicious anemia B12 deficiency bc antibodies against IF, a type 2 hypersensitivity + lymphocytes kill parietal cells, a type 4 hypersensitivity in BODY AND FUNDUS. Associated with intestinal metaplasia: adenoca.
```
Acute:
Alcohol
NSAIDs, steroids
QT
H.pylori
Uremia
Shock: curlings
Brain injury: cushings
Zollinger-ellison: a lot of ulcers, thick folds
```
444
Risk factors of peptic ulcers and intestinal gastric ca:
Duodenal:
H.pylori ~100% (smoking)
Blood group O (vs Blood group A RF of gastric ca.)
Zollinger-ellison: a lot of ulcers, thick folds
MEN1
Cirrhosis
COPD
Stomach:
H. pylori ~75% (smoking)
NSAIDs
```
Intestinal gastric ca:
H. pylori and autoimmune gastritis
Smoking
Nitrosamines
Blood group A
```
445
What gene mutation, type of lymphocytes and antibodies are associated with Crohn and ulcerative colitis?
Crohn: NOD2; UC: HLA-B27
Crohn: Th1; UC: Th2
Crohn: ASCA (anti-saccharomyces cerevisiae ab); UC: P-Anca
Crohn: transmural, granulomas, cobblestone; UC: crypt abscesses, neutrophils in crypt lumina and pseudopolyps
446
What is the most frequent location of carcinoid tumor?
Terminal ileum: presents later
Appendix: 2nd most frequent, less aggressive because it causes apendicitis
It can lead to pellagra
447
Which illness has anti mitochondrial and which one antimicrosomal antibodies?
Anti mitochondrial is in primary biliary cholangitis
Anti microsomal (anti-thyroid peroxidase) is in Hashimoto
448
Histological difference between chronic hep B and C:
B: ground glass cytoplasm bc HBsAg accumulates!!
C: fatty change and lymphoid agreggates!!
449
Inclusions in ALS and in some cases of fronto-temporal dementia:
Tar DNA protein 43 (TRP-43)
450
Mutation that indicates lower grade astrocytoma:
IDH (isocitrate dehydrogenase) present in grade 2 (fibrillary, oligodendroglioma) and 3 (anaplastic) astrocytomas, indicates that is not glioblastoma or that is a glioblastoma that progressed from a lower grade, they have a better prognosis
451
Mutations related to medulloblastoma:
🙂 Wnt (it went well)
😐 sonic the hedgehog
☹️ P53 C-myc
452
Tumors that might have expression of PD-1 receptors for CD8 cells therefore could be treated with pembrolizumab or nivolumab:
Melanoma
Renal cell ca.
Non small lung ca.
A small % of breast and colon ca.
453
Tumors associated with loss of tumor suppressor gene PTEN:
Prostate
Thyroid
Endometrioid
Glioblastoma
454
Which two tumors can metastasize to the ovary?
Krukenberg from diffuse gastric ca. that infiltrates the gastric wall leading to linitis plastica
Lobular breast ca.
455
Histological subtypes of breast ca in order from worse to best:
Inflammatory: peu d'orange bc of suspensory Cooper ligs (worse one, is in the lymphatics)
LOObular (does not have HER2/neu)
Ductal (can be associated with Paget, Paget is in situ)
Medullary (host response, good if local but triple - bad if they spread)
Mucinous (clusters of tumor floating in mucin)
Tubular (best, rare, very similar to breast tissue)
456
Subtypes of breast ca depending on receptor status in order from worse to best:
Basal-like, myoepithelium cell tumors: triple negative (normally in BRCA1)
Luminal: + E,P receptors -HER2/neu
HER2/neu enriched: ± E,P receptors +HER2/neu
457
Genetic abnormality related to all germ cell tumors?
Isochromosome 12p (so you have an extra copy of short arms and deletion of the long arm)
458
Ca. that can be treated with vemurafenib? Why?
They have V600E mutation that alters Braf
Melanoma (40-60%)
Pilocytic astrocytoma
Langerhans histiocytosis
Papillary ca. of the thyroid
459
Which mutation is associated with aortic stenosis?
NOTCH1
460
Triad of aspirin induced asthma:
Asthma and aspirin intolerance
Chronic sinusitis
Nasal polyps
461
Cirrhosis manifestations secondary to high estrogen:
Palmar erythema
Spider angiomas
Testicular atrophy
Gynecomastia
462
Unilateral bloody nipple discharge indicates:
Do not present with masses, just with bloody nipple discharge
In young, benign (can hide atypia or ductal ca in situ): Intraductal papilloma (it's vascular stalk twists and bleeds). Micro: epithelial and myoepithelial cells lining a fibrovascular core forming papillae within a duct. Excision
In old, malignant: Ductal carcinoma in situ. Micro: ducts distended by pleomorphic cells with central necrosis that do not penetrate the basement mb. the basal (myoepithelial) layer of the duct is uninvolved
463
Organs that tend to give liver metastasis:
Colon>>Stomach>Pancreas (Cancer Sometimes Penetrates the liver)
464
What is the second most common cause of lung ca?
Radon (in basements)
Other RF: smoking (cause 90% cases) arsenic, asbestos, chromium, radiation and air pollution)
465
What is a possible screening for lung ca? when can you do it
Yearly low dose chest CT
| On 30 year-pack history smokers
466
Define cutaneous small vessel vasculitis:
Drugs (penicillins, cephalosporins, sulfonamides, phenytoin, allopurinol) or a virus (Hepatitis, HIV) before purple/red raised lesions (palpable purpura)
Micro: inflamed blood vessels with fibrinoid necrosis
467
Common locations where cholesterol emboli lodge:
Kidney: acute kidney injury
Foot: blue toe, livedo reticularis
GI: intestinal infarction/ bleeding
CNS: stroke/ amaurosis fugax
Normally happens after dislodgment of atherosclerosis
468
What is Stewart-Treves sd?
Angiosarcoma due to chronic lymphedema after radical mastectomy with lymph node dissection
Micro: dermal inflammation with slit-like abnormal vascular spaces
Bad prognosis
469
Interrupted aortic arch and tetralogy of Fallot associated with:
Di George sd.
470
Diagnosis of irregular nodule with small lymphocytes and germinal center effacement:
Follicular (nodular) lymphoma
It is not large B cell lymphoma until you get sheets of lymphocytes without any clear nodules
471
Hypertensive encephalopathy: cause, symptoms and micro:
Cause: malignant hypertension (vs a lacunar infarct is due to chronic HT)
Generalized symptoms as headache, confusion, somnolence, maybe coma, No focality!
Micro: edema, petechial hemorrhages, fibrinoid necrosis
472
Which cells are most affected by ionizing radiation?
```
Rapidly dividing cells:
Hematopoietic stem cells
Spermatogonia and oogonia
Basal keratinocytes and hair follicle stem cells
Intestinal crypt cells
```
473
Which system transforms pro carcinogens in carcinogens?
Cytochrome P450= microsomal monooxygenase; present in hepatic microsomes and in ER of most tissues
474
Name medical illnesses that cause erectile dysfunction and premature ejaculation:
Erectile dysfunction: nerve function and blood flow problems as diabetes
Premature ejaculation: prostatitis or thyroid disease
475
How do you calculate the gamma gap? Which illness does a high gamma gap indicate?
Total protein-Albumin> or =4 indicates multiple myeloma
476
Histology of osteoporosis:
Loss of trabecular bone, thinning and perforation with loos of the interconnecting bridges
477
What is the function of c-myc?
Transcription activator
478
What is the function of BRCA?
DNA repair
479
What is the function of Bcl2?
Apoptosis inhibitor
480
What is the function of cyclin D1?
Promoter of G1 to S transition
481
What is the function of BCR-ABL?
TK upregulator
482
Subarachnoid hemorrhage complications and timing:
```
COMMUNICATING hydrocephalus (impaired absorption of CSF by ARACHNOID granulations): hours after; dilated ventricles and deteriorating mental status
Spider talk!
```
Vasospasm: 4-14 days after; presents with acute change in mental status and new focality
483
DD. between abruptio placentae, placenta accreta, placenta previa, vasa previa and uterine rupture:
ABRUPTIO placentae: premature separation of the placenta from the uterus. In PREECLAMPSIA, tx, SMOKING...
PAIN, vaginal bleeding and firm uterus
Placenta ACCRETA: abnormal trophoblastic invasion into the myometrium. In previous CESAREAN, multiparty...
POSTPARTUM! vaginal bleeding (vs uterine atony that w respond to uterotonic agents)
Placenta PREVIA: placenta extending over the cervix. In previous CESAREAN, >35, smoker
NO PAIN but yes vaginal bleeding, no fetal distress
VASA previa: fetal vessels extending over the cervix
No pain but yes vaginal bleeding + FETAL BRADYCARDIA
Uterine rupture: rupture of the uterine myometrium and serosa. Prepartum PAIN, vaginal bleeding and fetal parts palpable from abdomen. After previous cesarean
484
Diagnosis of painless otorrhea with conductive hearing loss and pearly mass behind the tympanic membrane:
Cholesteatoma (collection of squamous cell derbis)
485
Which pathology is associated with increase β-glucuronidase activity?
Brown stones
| Colonic bacteria have β-glucuronidase activity!
486
What is the most important predictor of success in rehabilitation?
Activity level before the fracture
487
What is the recurrence of schizophrenia in identical twins?
50%
488
What is core binding factor α1 (Cbfa1) important for?
Osteoblast, it is essential transcription factor in osteoblast differentiation and bone formation
If you see decrease alkaline phosphatase it indication decreased osteoblast function!!
489
What is Felty's syndrome?
Rheumatoid arthritis + Splenomegaly + Neutropenia (repeated infections)
490
What does the retropulsion or pull test indicate?
Parkinson or parkinsonism (for example due to antipsychotics)
The retropulsion test evaluates the ability of patients to recover from a backward pull on the shoulders, if patient cannot recover, as in parkinsonism, it indicates postural instability
491
Where do you see target cells and hemoglobin crystals?
Hemoglobin C disease
492
Sterile immunocomplex with platelet thrombi vegetations are indicative of:
Libman-Sacks endocarditis
Easily dislodged sterile vegetations made of platelets interwoven with fibrin strands and mononuclear cells indicate lupus or mucin-producing tumors
493
Explain the pathophysiology of hepatorrenal sd:
Liver failure leads to RAAS activation that causes splanchnic vasodilation + renal vasoconstriction leading to prerenal azotemia
Kidneys will be normal in size and shape
494
Which kind of chronic pyelonephritis is associated with proteus?
Xanthogranulomatous pyelonephritis
495
Arteriolar medial hypertrophy and fibrointimal proliferation indicate:
Hyaline atherosclerosis (endothelial damage) in hypertensive nephrosclerosis
496
Ulcers beyond the duodenal bulb suggest:
Zollinger-Ellison
497
Extension, appearance, mediator and sensation of primary, secondary and tertiary burns:
1ry: epidermis; yes blanching and NO blisters; painful
2ry: all epi + some dermis; yes blanching and blisters; painful
3ry: all epi + some dermis; NO blanching and yes blisters; painless
Edema can be because of inflammatory mediators as histamine and bradykinin that contract endothelial cells creating gaps in venules or the gaps can be directly caused by injury
498
What is the rout of metastasis of prostate ca?
Batson plexus; from the prostatic venous plexus to the vertebral venous plexus
499
Define labile, stable and permanent cells:
Labile: multiply constantly throughout life
Stable: spend most of the time in the quiescent G0 but can be stimulated to enter the cell cycle when needed
Permanent: incapable of regeneration
500
What is the reason why a diabetic gets hypoglycemia after injecting insulin?
In DM1 there is an impaired response of glucagon to hypoglycemia! On top, insulin inhibits glucagon release
Alpha cells failure leads to the rapid hypoglycemia
501
Flank pain irradiating to the groin+nausea indicates:
| Right upper quadrant pain+nausea indicates:
Groin: nephrolithiasis
| Right upper: gallstones
502
What are cysts and pseudocysts lined by?
True: epithelial cells
Pseudo: granulation tissue (pancreatic pseudocyst after acute pancreatitis)
503
Causes of pure red cell aplasia:
Thymoma
CLL, ALL
Parvovirus B19
504
Which bleed is associated with vacuum delivery?
Subgaleal hemorrhage, between the periosteum and the galea aponeurosis (outside the skull)
505
What is the function of the gloms bodies under the nails?
Thermoregulation
506
Which phase of wound healing do excessive matrix metalloproteinases and actin-containing fibroblasts correspond to?
Contracture
507
Which signaling pathway is associated with Dupuytren?
Wnt signaling pathway
508
What is the most common cause of temporal epilepsy?
Hippocampal sclerosis (astrocytic proliferation, glyosis)
509
What do you think if you see JVD+hepatomegaly?
Right heart failure and CENTRILOBULAR ZONE 3 hepatic congestion (nutmeg liver)
510
Name 4 main rickets symptoms:
Frontal bossing and rachitic rosary: due to increased proportion of OSTEOID deposition
Pigeon-breast
Leg bowing
511
What needs to be intact for male internal genitalia, external genitalia and inhibition of female internal genitalia in male development?
Male internal genitalia: Y chromosome, SRY gene, testes (because they make testosterone) and testosterone→ SRY is missing you will have inside ♀ outside ♀
Male external genitalia: Dihydrotestosterone→ if DHT or 5-alpha reductase are missing you will have inside ♂ outside ♀ (or smaller genitalia)
Inhibition of female internal genitalia: MIF (antimullerian hormone) and intact Sertoli cells in the testes (because they make MIF) → if Sertoli cells don't work you will have inside ♂ and ♀ outside ♂
512
DD of chromatin negative nuclei on a female:
Chromatin negative nuclei= no Barr bodies
Male karyotype: androgen insensitivity
Turner
513
What changes cause binge and chronic drinking in the liver?
Binge: fatty change
Chronic: alcoholic hepatitis with cellular swelling
514
Another name for usual interstitial pneumonitis:
It is the histological definition of Idiopathic pulmonary fibrosis
515
Pathological changes after CNS stroke/hemorrhage:
12-48 Hrs = red neurons
1-3 days = neutrophils (liquefactive necrosis)
3-5 days = macrophages (microglia). They are + CD40, CD11b, CD68, and CD45
1-2 weeks = Reactive gliosis = astrocyte proliferation (liquefactive necrosis + vascular proliferation)
More than 2 weeks = Glial scar, made of astrocytes
516
What is the cause of cataracts in normal patient?
Age-related oxidative injury
517
How does IκB interact with NF-κB?
IκB binds and inactivates NF-κB in the cytoplasm
Binding of an antigen to a toll-like receptor activates IκB kinase that ubiquitinates IκB
Then, the free NF-κB can go to the nucleus and synthesize inflammatory proteins
518
What is the clinic of middle temporal lobe herniation vs subfalcine herniation:
Transtentorial; Temporal/uncal herniation beneath the tentorium cerebelli:
Early: ipsi blown pupil+contralateral hemiparesis
Late: contralateral blown pupil+ipsilateral hemiparesis
SUbfalcine; cingUlate gyrus herniation beneath the fall cerebri: awake+contralateral hemiparesis because compresses the anterior cerebral A. =)
519
Presentation and histology of intraductal papilloma:
Bloody nipple discharge (it's vascular stalk twists and bleeds) on young woman (benign).
Micro: epithelial and myoepithelial cells lining a fibrovascular core forming papillae within a duct
520
DD. between bipolar I, II and cyclothymia:
1; just needs 1: mania±depression
2; needs 2: hypomania+depression
Cyclothymic: more than 2 years fluctuating between mild hypomanic and depressive
521
DD. between marrow aspirate in myelofibrosis, myelodysplasia and aplastic anemia:
Myelofibrosis: fibrotic marrow with collagen bands and clusters of megakaryocytes
Megakaryocytes secrete TGF-β that stimulates fibroblasts
There is extramedullary hematopoiesis and therefore hepatosplenomegaly and dracrocytes
Myelodysplasia: dysplastic progenitor cells
No hepatosplenomegaly but yes oval macrocytic RBCs and neutrophilis
Can process to AML
Aplastic anemia: hypocellular marrow replaced by adipose cells
Hematopoietic stem cells are destroyed by drugs, radiation, viruses...
All 3 have anemia + leukopenia + thrombocytopenia
522
Hepatic inflammation and necrosis with neutrophilic infiltration is found in:
Acetaminophen overdose
523
Joint involvement in Osteoarthritis, Rheumatoid arthritis and Psoriatic arthritis:
Osteoarthritis: DIP (heberden), PIP (bouchard); the distal and thumb's carpometacarpal
Rheumatoid: PIP, metacarpophalangeal and wrist
Psoriatic: DIP
524
What do you think about if you see diarrhea+anemia?
Celiac disease; causes iron deficiency anemia because iron is absorbed in the duodenum
525
Which prostatic ca. histology is associated with better response to finasteride?
Those with predominance of epithelia hyperplasia
Those with stromal hyperplasia (with collagen/smooth m.) respond worse because finasteride acts on the epithelial components
526
DD. between Right heat failure, Budd-Chiari and Portal vein thrombosis:
RHF: liver =( cirrhosis nugmet liver; post-hepatic JVD+
Budd-Chiari is Hepatic vein thrombosis: liver =( cirrhosis nugmet liver; post-hepatic JVD-
Portal vein thrombosis: liver =) pre-hepatic JVD-
In all you have splenomegaly (thrombocytopenia), portal HT, varices, ascitis, edema
527
What is the histology of erythema nodosum?
Type 4 hypersensitivity
| Panniculitis without vasculitis
528
What is the histology of tophy?
Giant cell granulomas surrounding crystal deposition
529
What is the histology of rheumatoid nodules?
Palisading histiocytes with central necrosis
530
Which polyps are characterized by sawtooth appearance?
Hyperplastic polyps; they are also the most common polyps
531
Which gland makes the majority of mucus secretions? which one the majority of serous secretions?
Mucus: sublingual
Serous: parotid
532
What is the histology of valve stenosis due to previous rheumatic fever?
Fibrous bridging between thickened, calcified leaflets
533
What is the histology of the area where you get a pap smear from?
Transition zone: transition from squamous to columnar epithelial cells; is where metaplasia and dysplasia are more common
534
Which is the earliest change in rheumatoid arthritis?
Synovial neovascularization
535
Define subclavian steal sd:
Due to subclavian stenosis you get reversed flow form the contralateral vertebral A. to the ipsilateral vertebral to reperfuse the subclavian that is stenotic
536
How does meconium ileus present?
Baby that is days old with distal small bowel obstruction of green dehydrated (inspissated) meconium
537
What do engorged alveolar capillaries indicate? and hypertrophy of the pulmonary vascular smooth muscle?
Engorged capillaries: indicate increased pulmonary venous pressure normally due to left-sided heart failure
Hypertrophy of the pulmonary vascular smooth muscle: indicate pulmonary arterial hypertension
538
Which is the best predictor factor for atherosclerotic plaque rupture?
Instability (better predictor than size) that depends on strength of the fibrous cap; metalloproteinases secreted by macrophages decrease stability by collagen degradation!
539
What is the key way to differentiate Berger's disease and hemolytic-uremic syndrome? And what is the key way to differentiate ITP and hemolytic-uremic syndrome
Both have red urine after a GI infection on a kid
DD with Berger's: Look at the platelets! in Berger's they will be normal and in HUS will be low!
DD with ITP: platelets will be low in both but ITP will not have schistocytes on the smear
540
Hystologies of HPV and Molluscum contagiosum lessions:
Wart (HPV): epidermal hyperplasia, cells with big nuclei, perinuclear halos and cytoplasmic vacuolization (koilocytosis)
Umbilicated flesh-colored papule (Molluscum contagiosum): cytoplasmic inclusion bodies
541
What is the biggest RF for osteoarthritis?
Age
542
Which deficiency do you think about if you see glossitis, brittle nails, dry mouth, tongue papillae atrophy, alopecia or pagophagia?
Iron deficiency anemia
543
Which is the most important RF of postpartum endometritis?
C-section
544
Which is the most important daily screening for a diabetic?
Feet inspection; feet ulcers are due to atherosclerosis
545
Name an important genetic cause of premature osteoporosis
Osteogenesis imperfecta
546
What is the pathophysiologic mechanism of achalasia?
Inflammation and degeneration of neurons in the esophageal wall
547
Name the HLA associated with psoriasis and the 3 most important histological characteristics:
HLA-C
Hyperkeratosis (corner thickening)
Parakeratosis (nuclei retention)
Acantolisis (loss of cohesion between keratinocytes)
548
If you see double vision, dilated pupils and loss of strength you think about:
Botulism
Diplopia, Dysarthria, Dysphagia (descending paralysis) and Dispnea
Paralysis is a way to differentiate it form organophosphate poisoning
549
Which type of cell is found in pemphigoid?
Eosinophils within sub epidermal blisters
550
Which virus causes hepatocelular ca. earlier hepB or hepC?
HepB
| Hepatocelular ca. can occur without cirrhosis!
551
Which parameter is common for both obstructive and restrictive disease?
Decreased VITAL capacity of FV!!!C
552
What do juxta-articular erosions with overhanging edges and subcortical bone cyst indicate? what is the key mediator? if you see edema, what is the cause?
Gout
Neutrophils
Increased vascular permeability
553
Presentation and histology of infiltrative ductal carcinoma:
Rock-hard mass + axillary lymph nodes
| Anastomosing sheets of pleomorphic cells that invade the stroma
554
Pathologies that release tissue factor causing hypercoagulation:
Amniotic fluid emboli
| Pancreatic ca.
555
Which cell secretes cytokines and which cell is stimulated by those cytokines in atherosclerosis pathogenesis?
Macrophages secrete cytokines and growth factors that recruit vascular smooth m. cells
The vascular smooth muscle cells secrete matrix proteins and make collagen which makes the fibrous cap
556
What is the most important factor determining if a pleural effusion will progress to tamponade?
Rate of fluid accumulation
557
Causes of communicating and non-communicating hydrocephalus:
Communicating: Decreased CSF absorption by ARACHNOID villi; meningitis and subarachnoid hemorrhage!!!
Non-communicating: Ventricular obstruction; tumor and aqueduct stenosis
Ex-vacuo: alzheimer, schizophrenia
558
Histological findings in pleomorphic adenoma, Warthin tumor and mucoepidermoid carcinoma:
Pleomorphic adenoma: benign and most common; multiple cell types, typically epithelial cells in a chondromyxoid stroma
Warthin: benign; germinal centers or follicles and large pink cells called oncocytes
Mucoepidermoid carcinoma: most common malignant; mucinous and squamous components
559
What does leukocytoclastic vasculitis mean?
Palpable purpura
560
What is the diagnosis when a patient tells you that he/she cannot talk in public or use public bathrooms?
Social anxiety disorder
Different from specific phobia where you are afraid of spiders...
561
What do you think if you see acute epigastric pain that radiates to the back?
Acute pancreatitis
562
Which area of the heart do eosinophils invade in Loeffler's syndrome and what does it cause?
The end-myocardial layer causing restrictive cardiomyopathy leading to thrombi
563
From which cells does lung adenocarcinoma come from? Which translocation is associated with?
Club cells
t(EML4,ALK) causes an activating mutation of ALK
Also activating mutations in EGFR and KRAS are associated with adenoca.
There is targeted therapy for this mutations
564
What is the cause os the gallbladder stones in Chron's?
Chron's increases enterohepatic circulation of bilirubin and decreases enterohepatic circulation of bile acids.
The bile acids are not absorbed therefore are conjugated by the colonic bacteria forming bilirubin that is absorbed and makes stones.
Therefore the stones are black (bilirubin and hemolysis)
565
Which part of the kidney is the most damaged in vesicoureteral reflux?
The upper and lower poles, where compound papilla are situated
566
What are ferruginous bodies?
Macrophages that have phagocytosed and attempted to digest the asbestos fibers
567
What do intercostal retractions, wormian appearance and costochondral thickening indicate?
Intercostal retractions and brittle bones, fractures: OI
Wormian appearance: OI
Costochondral thickening= Rachitic rosary, bendy bones: rikets
568
What is the key histologic finding in postinfectious encephalopathy?
Perivenous infiltration
| MRI: dark nodules on brain
569
Complications of O2 therapy for neonatal respiratory distress sd? and what are the complications of neonatal respiratory distress sd itself?
O2 therapy: RIB
R = Retinopathy of prematurity
I = Inraventricular hemorrhage
B = Bronchopulmonary dysplasia
Neonatal respiratory distress sd: ground glass opacities and diffuse atelectasis
570
Describe the key main sites of protein digestion:
Stomach: acid and pepsinogen (from chief cells) cut proteins
Duodenum: pancreatic proteases cleave large polypeptides into smaller (dipeptides and tripeptides). Trypsinogen makes trypsin that activates Trypsinogen, Chymotripsiniogen and Procarboxypeptidase
Intestinal mucosa: BRUSH BORDER aminopeptidases break down dipeptides and tripeptides into aa, which can be co-transported with Na+ and H+ into the intestinal cell
571
How do you differentiate between chronic, gestational hypertension, preeclampsia and eclampsia?
Chronic HT: HT onset before 20 w
Gestational HT: HT onset after 20 w
Preeclampsia: HT onset after 20 w + proteinuria
Eclampsia: HT onset after 20 w + proteinuria + seizures
572
Which intermediate filaments do Z discs contain?
Vimentin and desmin (sarcoma markers)
573
What is a bronchogenic cyst and when does it develop?
Cysts that arise on the baby's lung in utero
| They are due to abnormal budding of the foregut and bronchi dilation
574
What are xanthomas made of?
Lipoprotein extravasation
575
Effects of testosterone on RBCs:
High testosterone causes erythrocytosis
| Low testosterone causes anemia
576
Consequences of cryptorchidism:
Low sperm count + low inhibin
577
Osteitis fibrosa cystica hallmark:
Subperiosteal erosions
578
Why is there pruritus in biliary obstruction and no pruritus in Dubin-Johnson syndrome?
Because in biliary obstruction on top of secreting conjugated bilirubin into the blood you also secrete bile salts, which cause the pruritus
In Dubin-Johnson syndrome bile salts are excreted normally
579
Which injuries cause permanent vs transient diabetes insipidus?
Permanent: hypothalamus (supraoptic)
Transient: posterior pituitary
580
DD of Biliary colic, Cholecystitis, Choledocholithiasis and Ascending cholangitis:
Biliary colic:
Stone on the gallbladder
Pain for less than 6h
tto: ursodiol/ ursodeoxycholic acid
```
Cholecystitis:
Stone on the cystic duct
Pain for more than 6h + Murphy sign, pericholecystic fluid and ↑ wall thickness
± fever, leukocytosis
NO jaundice no ↑ alkaline phosphatase
tto: cholecystectomy
```
Choledocholithiasis:
Stone on common bile duct
Less severe pain + JAUNDICE + ↑ alkaline phosphatase
Liver enzymes do not have to be ↑
NO fever, no leukocytosis, no Murphy sign
Ascending cholangitis:
Infection of the biliary tree due to enteric organisms as E.Coli, Klebsiella, clonorchis sinensis
Charcot triad: pain + jaundice + fever
+ leukocytosis + ↑ alkaline phosphatase
Reynolds pentad if progresses to shock: + hypotension + metal status changes
tto: piperacillin+tazobactam then surgery
581
Which area is ablated in flutter?
The area between the tricuspid and the IVC
582
What is the cause of MODY?
Defect in expression of glucokinase gene
583
What causes milk-alkali syndrome?
Taking a lot of antacids
Decrease vit D activation so 24,25-Dihydroxycholecalciferol accumulates
584
What is the key histologic finding in acute rheumatic fever?
Aschoff bodies, fibrinoid necrosis with histiocytic infiltrate or myocardial granulomas
Anitschkow cells, mononuclear cardiac histiocytes
585
What is the key distinguishing factor between 5HT syndrome, neuroleptic malignant syndrome and malignant hyperthermia?
5HT syndrome: clonus, you are moving a lot → give cyproHEPtadine
Neuroleptic malignant syndrome and malignant hyperthermia: rigidity, you cannot move → give dantrolene
586
What is the key histologic finding in CIN?
Expansion of immature basal cells to the epithelial surface
587
If you see a mass in the posterior mediastinum, what should you think?
Neurogenic tumor as neurofibroma and schwannoma
588
What is the main polyp type in Peutz Jeghers syndrome?
Hamartomas
589
Where are the eye deposits on Wilson's disease?
Cornea!
590
Which type of cerebral edema is associated with brain tumors?
Vasogenic edema, due to BBB disruption and vascular leakage
591
Diagnosis on a girl that gets to puberty and starts developing male characteristics:
5-alpha reductase deficiency; inside ♂ outside ♀ (or smaller genitalia) but when they get to puberty do not develop menarche and the increase in testosterone makes develop male secondary sexual characteristics
592
What does lead pipe sign on barium enema indicate?
Ulcerative colitis
593
Signs of iron deficiency anemia:
```
Brittle nails
Glossitis
Dry mouth
Tongue papillae atrophy
Alopecia
Pagophagia: compulsive consumption of ice or iced drinks
```
594
What should you think if you see weakly birefringent needles surrounded by concentric layers of hyalinized collagen in the lung?
Silicosis
595
Which growth factor contributes to the migration of smooth m. cells into in atherosclerosis?
PDGF by biding to TK receptors
596
How do you differentiate fibroadenoma from phyllodes tumor?
Both are benign, solitary, painless and mobile
Fibroadenoma: in younger than 35. + popcorn calcifications in mammography. Micro: benign hyper plastic stroma encapsulating ductal tissue
Phyllodes: older than 35. Micro: leaf-like appearance
597
What does hypotension, bradycardia, respiratory depression and spontaneous bruising of the upper eyelids indicate?
Elevated intracranial pressure
598
Which are the key histologic finding in wrinkles?
There is less collagen: less synthesis and more degradation
Decreased elatin fiber assembly
Normal or even increased crosslinking
599
Which is the most common type of ovarian mass in young women of reproductive age? And in pregnant? And in complete mole?
Non-pregnant ± PCOS: Follicular cyst (cause irregular bleeding). No vascular
Normal in pregnant: Corpeus luteum cyst. Vascular
Complete mole or twins: Theca lutein cyst (bilateral)
600
Which infections is an AIDS patient at risk if his/her CD4 count is below 500/mm3 but greater than 200/mm3?
Oral hairy leukoplakia
Oral thrush
HHV-8 infection
Squamous cell carcinoma
601
Which layers of the gut are affected in Hirschsprung disease?
SUbmucosa and MUscular Externa of the narrow segment!
SUMUjÉ
The submucosa normally contains the Meissner (submucous) plexus, while the muscularis externa contains the Auerbach (myenteric) plexus
602
How are the stools in lactose intolerance?
Acid, low pH
| Increase still osmotic gap (unabsorbed lactose increases the gap)
603
What is the histologic hallmark of thromboangiitis obliterans?
Segmental thrombosing inflammation with sparing of the internal elastic lamina
604
How do you differentiate duct CIS and invasive clinically and in histology?
Non palpable and is detected due to micro calcifications on Rx→ In situ: ducts distended by pleomorphic cells with central necrosis that do not penetrate the basement mb
Firm mass dimpling the skin→ invasive: disorganized nests of glandular cells with surrounding fibrosis
605
How do you differentiate peau d'orange from invasion of the suspensory ligaments in breast ca?
Swelling and pitting→ peau d'orange→ Inflammatory: dermal lymphatics by malignant tumor
Retraction and dimpling→ tightening and shortening of the suspensory ligaments (Cooper ligaments)→ invasive lobular: disorganized nests of glandular cells with surrounding fibrosis
606
Phases of pneumonia:
1-2 days: Congestion: red, purple→ bacteria
3-4 days: Red hepatization: brown→ ALL; fibrin, bacteria, RBCs and WBCs
7-5: Gray hepatization: gray→ ALL BUT BACTERIA; fibrin, lysed RBCs and WBCs
8 days: Resolution→ macrophages have eaten all
607
What is the main difference between PTH and PTHrP?
Unlike PTH, PTHrP does not stimulate the hydroxylation of 25-dihydroxyvitamin D to 1,25-dihydroxyvitamin D
608
Which channels are over expressed in CF?
Na ch. in respiratory epithelial cells
CF causes decrease in Cl- in lung secretions. This causes an increase in the activity of Na+ channels so water gets reabsorbed resulting in abnormally thick bronchial secretions
609
Giant pronormoblasts in the bone marrow indicate:
Giant pronormoblasts with glassy intranuclear inclusions
| Aplastic anemia due to Parvovirus B 19 infection
610
Periostitis of the distal diaphysis of long bones indicates
Hypertrophic osteoarthropathy (clubbing), associated with adenocarcinoma of the lung
611
Which extracellular deposition is a marker of acute inflammation? and of chronic inflammation?
Acute: fibrin, it is thought to be an important local defense mechanism because it sequesters and walls off bacterial spillage
Chronic: collagen, fibrosis
612
Why is there estrogen excess in cirrhosis?
Failure fo the liver to degrade estrogens!!!
| Increase peripheral conversion of androgens to estrone by aromatase
613
What is the histologic hallmark of chronic bronchitis?
Squamous metaplasia of the pseudostratified columnar epithelium in the bronchi and bronchioles
614
Diagnosis on a girl with complete hypogonadism, streak ovaries and XY genotype?
Swyer syndrome, deficient expression of SRY gene
615
DD of Oral hairy leukoplakia, Oral leukoplakia and In-situ oral squamous cell carcinoma:
All are white patches that cannot be scraped off
Oral hairy leukoplakia; EBV only in immunocompromised. Only in lateral surfaces of the tongue, hairy or feathery
Micro: marked hyperkeratosis and parakeratosis
Oral leukoplakia; precancerous, in smoker/alcoholic
single or multiple asymptomatic white plaques with granular texture. Any part of the oral cavity can be affected
Micro: marked hyperkeratosis and parakeratosis
In-situ oral squamous cell carcinoma; micro: dysplastic changes extending to the basement membrane
616
What is the most common cause of hepatic abscess?
Colangitis, ascending infection from a biliary tract
