Pathoma Ch 7, 8, 11, 15 (Vascular, Cardiac, Liver, Endo) Flashcards
7. Vascular Path 8. Cardiac 11. Exocrine Pancreas, GB, Liver 15. Endocrine
Explain why alk phos is elevated in primary hyperparathyroidism
Alkaline phosphatase = enzyme in osteoblasts that produced alkaline environment that makes it possible for Ca2+ to get deposited in bone
PTH actually activates osteoclasts (bone breakdown) indirectly by activation osteoblasts first, so elevated alk phos is a result of osteoblast activity
But basically alk phos elevated b/c of bone breakdown
Name the JONES criteria for ARF
Joints: migratory polyarthritis of big joints (knees)
Cardiac: pericarditis (all 3 layers, MR then MS)
Nodules: subcutaneously
Erythema marginatum: rash is most red at the borders
Sydenham’s chorea: involuntary muscle contractions
All except the cardiac are self-limited
Child radiated for severe acne, at increased risk for what cancer?
Specifically ionizing radiation increases risk for papillary carcinoma of the thyroid (MC thyroid malignancy)
Henoch-Schloen Purpura
(a) Clinical context
(b) Physical exam finding
(c) Mechanism
(d) Associated kidney d/o
HSP = small vessel vasculitis
(a) Typically in a child after a upper respiratory tract infection (b/c URI stimulates IgA production)
(b) Palpable purpura
- purpura look like bruising, but they’re palpable (unlike normal bruising) b/c of the underlying vessel inflammation
(c) Mechanism = IgA immune complex deposition
(d) IgA nephropathy = IgA deposition in the mesangium
2 main clinical features of Sheehan syndrome
Sheehan syndrome (hormone demand during pregnancy is so high that pituitary gland basically doubles in size and outgrows its blood supply, so very vulnerable to hypoxia/ischemia during huge volume loss such as hemorrhage during birth) presents as
- poor lactation
- **loss of pubic hair (b/c stimulated by androgens that requires stimulation of LH from anterior pituitary)
Mechanism by which DM II increases risk of
(a) Atherosclerosis
(b) Nephrotic syndrome
(c) Peripheral neuropathy
(d) Cataracts
(e) Retinopathy
DM II complications
(a) Atherosclerosis 2/2 nonenzymatic glycosylation of large and medium blood vessel walls
(b) Nephrotic syndrome 2/2 nonenzymatic glycosylation of small blood vessels making up the glomeruli
(c) Peripheral neuroathy 2/2 osmotic damage: glucose converted to sorbitol damage schwann cells (that myelinate peripheral nerves)
(d) Cataracts b/c lens takes up glucose independent of insulin => damaged via sorbital like schwann cells
(e) Retinopathy b/c pericytes of retinal blood vessels undergo osmotic damage
Dx of DM II- lab values
Diagnose type II diabetes w/ random glucose over 200 or fasting glucose over 126
-or serum glucose over 200 2 hrs after oral load
MC cancer seen after pt is put on immunosuppressive therapy
Squamous cell carcinoma- has same but additional RF than BCC including immunosuppression and chronic inflammation
What is dermatitis herpetiforms?
(a) Tx
Dermatitis herpetiforms = IgA deposition along the tip of the dermal papillae => very tiny blisters (that look like herpes, hence herptiform)
(a) High association w/ Celiac disease => dietary restriction of gluten often resolves dermatitis herpetiforms
- IgA made in Celiac disease cross react with reticulan antigen dermal papillae
Differentiate the endocarditis caused by S. Viridans and S. Aureus
Strep Viridans (MC overall) is a low virulence organism => can only cause endocarditis of already damaged heart valves -also causes small vegetations => subacute endocarditis that doesn't destroy the valve
Staph aurus (MC in IVDU) is high virulence => can infect non-damaged valves, esp tricuspid (b/c right sided first to get it from IVDU) -large vegetations => acute endocarditis that destroys the valve
2 RF for pancreatic adenocarcinoma
RF for pancreatic adenocarcinoma
- smoking
- chronic pancreatitis (EtOH mostly)
Tumor marker for pancreatic andenocarcinoma
CA 19-9
Classic historical cause of thoracic aneurysm
Tertiary syphilis
Where do cardiac mets MC go to?
(a) MC cancers to met
Cardiac mets go to the pericardium and cause pericardial effusion
(a) Breast and lung, melanoma, lymphoma met to the lungs
Significance of aldose reductase in diabetes
Aldose reductase catalyzes glucose to sorbitol, which causes osmotic damage in diabetes in cells that uptake glucose independent of insulin
- osmotic damage to Swann cells => neuropathy
- Pericytes of retinal blood vessels => retinopathy
- Lens => cataracts
Explain the pathophysiology of hyperosmolar non-ketotic coma in DM II
Hyperosmolarity of serum due to such high serum glucose (like over 500 holey crud) causes such a life threatening (via coma) diuresis
- ketones are abscent b/c tiny bit of insulin in blood prevents production
- but hyperosmolarity of blood causes such severe diuresis => hypotension and coma
How does T4 levels impact TSH secretion?
T4 feedback on TSH works by regulating TRH-receptors on anterior pitutiary
When T4 is low (hypothyroidism)- TRH-receptors on anterior pituitary are upregulated, stimulating anterior pituitary production and release of TSH
2 main histologic features of the most common type of thyroid malignancy
Histologic features of papillary carcinoma (80% of thyroid malignancies)
- Orphan annie bodies (nuclei w/ central white clearing)
- Psamomma bodies (calcification)
Polyarteritis Nodosa
(a) Spares what organ?
(b) Explain appearance on imaging
Polyarteritis Nodosa = medium vessel vasculitis
(a) Polyarteritis meaning it affects arteries of many systems, but spares the lungs
(b) String of pearls appearance on imaging b/c the lesions are at different stages
- early lesions undergoing fibrinoid necrosis = the string
- then the beads are the older lesions that form bump/nodes (hence nodosa)
Differentiate presentation of pancreatic adenocarcinoma at head vs. tail/body of pancreas
Adenocarcinoma in head of pancreas => jaundice 2/2 obstruction of biliary tree
Islets (endocrine part of pancreas) are more in the body/tail, so adenocarcinoma of tail/body may present w/ secondary diabetes mellitus
Murmur characteristic of
(a) AS
(b) AI
(c) MS
(d) MR
(e) MVP
Murmur
(a) AS: systolic ejection click w/ crescendo-decrescendo murmur
(click due to opening of stenotic valve, then crescendo as high pressure forces blood out)
(b) AI: early diastolic blowing murmur
(c) MS: Opening snap followed by diastolic rumble
(d) MR: Holosystolic blowing murmur
(e) MVP: mid-systolic click as mitral valve balloons out into the LA
Clinical features of somatostatinoma
Somatostatin inhibits both gastrin (=> achlorhydria = lack of H+ in gastric secretions) and CCK (=> steatorrhea and cholelithiasis)
CCK stimulates gall bladder contraction => secretion of bile salts needed for fat absorption
- w/o GB contraction, increased risk of status (cholelithiasis)
- w/o bile salt secretion, can’t absorb fats (steatorrhea)
Congenital heart disorder MC associated w/
(a) FAS
(b) Downs
(c) Congenital rubella
(d) Maternal diabetes
MC congenital heart d/o associated w/
(a) Fetal alcohol syndrome = VSD
(b) Downs = ostuim primum type of ASD
(c) Congenital rubella and PDA
(d) Maternal diabetes and TGA (transposition of the great arteries)
MC cause of death in aortic dissection
Cardiac tamponade
-dissection travels backwards, blood gets into the pericardial sac