Pathoma Flashcards
Hematopoietic stem cell marker
CD34+
Left shift of the neutrophil curve means
immature neutrophils, massive bacterial infection, tissue necrosis and cortisol overload. Decreased Fc receptors, which helps neutrophils to recognize immunoglobulin which is going to act as an opsonin for phagocytosis. Immature neutrophils won’t have Fc receptors.
Decreased Fc receptor marker
CD16+
Cortisol blocks adhesion to occur in
endothelial neutrophils and drop neutrophils to the blood
Eosinophilia
parasites infections, allergies and Hodgkin lymphoma by increased IL-5 production.
Basophilia
CML
Lymphocytosis
viral infections and Bordetella pertussis.
Mononucleosis with monospot test positive
EBV, test viral capsid antigen
Mononucleosis with monospot test negative
CMV
EBV side effects
Lymphadenopathy (periarterial lymphatic sheath), splenomegaly (rupture), rash if penicillin is given. Dormant in B cell (recurrence, risk for lymphoma).
Hallmark marker for lymphoblast is
TdT+ (DNAse prolymerase)
Key marker of myeloblast
Myeloperoxidase
Auer rods are present in
AML, immature myeloid cells with giant cytoplasmic granules.
T-ALL presents with
Thymoma
B-ALL CD markers
CD10, CD19, CD20
AML t(15:17) responds to:
APL, where there is a disruption of the retinoic acid receptor, inducing differentiation of promyelocytes (which contains Auer rods which induce complement and coagulation cascade and DIC is a complication).
CLL leukemia CD markers
CD20+ and CD5+ (B cell neoplasm)
CLL histology
smudge cells
CLL complications
autoimmune hemolytic anemia
hypogamaglobulinemia
Diffuse large B-cell lymphoma
Hairy cell leukemia manifestations
dry tap bone marrow aspiration because of fibrosis, splenomegaly. Stains TRAP +.
Adult T-cell Lymphoblastic Leukemia
proliferation of mature CD4+ T cells, associated with HTLV-1, usually seen in Japan and the caribbean. Symptoms: rash, generalized splenomegaly and lymphadenopathy, lytic bone lesions with hypercalcemia.
Mycosis fungoides
neoplastic proliferation of mature CD4+ T cells
Sezary syndrome
cells can spread and involve blood, characteristic lymphocytes with cerebriform nuclei on blood smear
BCR-ABL is seen in:
CML, as a tyrosine kinase activator which induce cell proliferation.
Imatinib
tyrosine kinase inhibitor used for the treatment of CML.
Leukocytes alcaline phosphatase low (LAP)
CML; high in infection
Follicular lymphoma
BCL-2 over expression, t(14:18), derived from B-cells. Can progress to diffuse large B-cell lymphoma
Rituximab
anti CD20+ antibody
Burkitt lymphoma translocation
t(8:14) with translocation of the c-myc
Mantell cell lymphoma translocation
t(11:14) with cyclin D translocation, promotes G1/S transition in cell cycle.
Multiple Myeloma
neoplastic plasma cells activate RANK receptor osteoclast, producing punched-out lytic bone lesions on X-ray.
Giant cell (Temporal) arteritis
focal granulomatous inflammation, most commonly affects branches of carotid artery (temporal, ophthalmic), treat with corticosteroids to prevent blindness.
Takayasu arteritis
patients usually less than 40, aortic arch and proximal great vessels granulomatous thickening and narrowing. Pulseless disease (weak upper extremity pulse).
Polyarteritis nodosa
young adult, affects multiple medium vessels (organ supply), transmural inflammation with fibrinoid necrosis, string of pearl appearance, spare the lungs, can affect the kidneys, CNS, abdomen, skin.
Kawasaki disease
Usually children under 4, affects the coronary artery, causing thrombosis and M.I. (give aspirin), conjunctival injection, strawberry tongue, rash in palm and soles, and fever.
Buerger disease
heavy smokers, autoamputation of the digits, Raynaud phenomenon, gangrene. Tx=stop smoking.
Granulomatosis with polyangiitis (Wegener)
(Pharynx, lung and kidney) focal necrotizing vasculitis, with necrotizing granulomas in the lung and URT, and necrotizing glomerulonephritis. c/ANCA. Tx: cyclophosphamide.
Microscopic polyangiitis
necrotizing vasculitis involving the lungs, palpable purpura without nasopharyngeal involvement. No granulomas, p/ANCA. Tx: cyclophosphamide.
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
Asthma, sinusitis, skin nodules or purpura, peripheral neuropathy. Granulomatous, necrotizing vasculitis with eosinophilia. p/ANCA.
Henoch-Scholein purpura
Most common childhood vasculitis involving skin (palpable purpura on buttocks/legs), althralgias and GI (abdominal pain). Secondary to IgA immune complex deposition. Associated with IgA nephropathy (Berger disease). Is self-limited, if severe: steroids.
Liver angiosarcoma is associated with
exposure to polyvinyl chloride, arsenic or thorotrast.
Aortic dissection complications
pericardial tamponade, rupture and obstruction of branching arteries.
Thoracic aneurysm is commonly due to
tertiary syphilis
Abdominal aortic aneurysm is primarily due to
atherosclerosis, smokers, hypertension.
Dressier syndrome
autoimmune pericarditis, months after an infarction.
Stable angina EKG shows
ST segment depression due to subendocardial ischemia.
Unstable angine EKG shows
ST segment depression due to subendocardial ischemia
Prinzmetal angina EKG shows
ST segment elevation due to transmural ischemia.
Most commonly involved artery in MI
left anterior descending artery
Troponin 1
most sensitive and specific marker for MI, return to normal after 7-10 days.
CK-MB
useful for detecting reinfarction, return to normal by 72 hours.
Hemosiderin-laden marophages
heart-failure cells
VSD is associated with
fetal alcohol syndrome
Eisenmenger syndrome
right ventricle hypertrophy with R-L shunt.
ASD is associated with
Down syndrome, resulting in a split S on auscultation, paradoxical emboli are an important complication. 1
PDA is associated with
Congenital Rubella
In Tetralogy of Fallot, patients learn to squat in response to
a cyanotic spell, increased arterial resistance decreases shunting and allows more blood to reach the lungs. Boot shaped heart on X-rays.
Transposition of Great Vessels is associated with
Maternal diabetes.
Coarctation of the Aorta is associated with
Turner syndrome, engorged arteries cause notching of ribs on X-ray. Associated with bicuspid aortic valve.
Cause of acute rheumatic fever
molecular mimicry of bacterial M protein that resembles proteins in human tissue.
Aschoff bodies
foci of chronic inflammation, reactive histiocytes with slender, way nuclei (Anitschkow cells).
Chronic rheumatic fever can lead to
fusion of the commissure in aortic valves, and almost always involves the mitral valve; leads to thickening of chordae tendinae and cusps.
Aortic stenosis can lead to
microangiopathic hemolytic anemia (RBC’s are damaged, producing schistocytes while crossing the calcified valve)
Pulse pressure
is the difference between systolic and diastolic pressure
In aortic regurgitation systolic and diastolic pressures…..
Systolic pressure increases and diastolic pressure decreases, increasing the pulse pressure.
Pulses seen in aortic regurgitation
bounding pulse (water-hammer pulse), pulsating nail bed (Quincke pulse) and head bobbing.
Mitral valve prolapse can be seen in
Marfan syndrome or Ehler Danlos syndrome
In mitral valve prolapse, murmur becomes softer with
squatting (increasing systemic resistance decreases left ventricular emptying)
Mitral regurgitation murmur will be louder with
squatting and expiration
Mitral stenosis sound
opening snap followed by diastolic rumble
HACEK endocarditis microorganisms
Haemophilus, Actinobacillus, Cardiobacterium, Eikenella and Kingella.
Libman-Sacks is an
endocarditis due to sterile vegetations that arise in association with SLE.
Myxoma
benign mesenchymal tumor with a gelatinous appearance. Most common primary tumor in adults. Usually forms a pedunculate mass in the left atrium that causes syncope due to obstruction of the mitral valve.
Rhabdomyoma
most common primary cardiac tumor in children; associated with tuberous sclerosis. Usually arise in the ventricle.
azotemia
increased nitrogenous waste products in the blood, measured by BUN:Creatinine levels.
Polycystic kidney disease newborn can present with
Potter sequence
APKD can present with
hepatic cyst, berry aneurism and mitral valve prolapse
Part of the nephron more prone to acute tubular necrosis
proximal tubule and medullary segment of the thick ascending limb
Causes of acute tubular necrosis are:
aminoglycosides, heavy metals, myoglobinuria, ethylene glycol, radio contrast dye and urate (tumor lysis syndrome)
Are used prior chemotherapy to decrease the risk of irate-induced ATN
Allopurinol and hydration
Acute interstitial nephritis presents with
eosinophils in the urine and may progress to renal papillary necrosis.
Renal Papillary necrosis causes includes:
sickle cell disease, sickle cell traits, diabetes mellitus and chronic analgesic abuse.
Nephrotic syndrome may be accompanied with:
hyperlipidemia and hypercholesterolemia
Minimal change disease is related to
hodgkin lymphoma
Focal segmental glomerulosclerosis may be associated with
HIV, heroin use and sickle cell disease
Membranous nephropathy (immune deposition) may be associated with
caucasian, hepatitis B and C, solid tumors, SLE or drugs (NSAID’s and penicillamine).
Spike and dome appearance.
Membranoproliferative glomerulonephritis
tram-track appearance due to immune complex deposition.
Diabetes mellitus can lead to renal failure by:
non enzymatic glycosylation resulting in hyaline arteriolosclerosis (Kimmelstiel-Wilson nodules). ACE inhibitors slow the progression.
Alport syndrome presents as
isolated hematuria, sensory hearing loss and ocular disturbances.
