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Path NBME > personal notes > Flashcards

personal notes Flashcards

1
Q

BPH- it effects the ?

A

BPH- it effects the periurethral zone

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2
Q

post- digital rectal exam ID’s prostate cancer in a male, what morphology would classify a worse prognosis?

A
  • disorganized growth = loss of polarity
  • nuclear pleomorphism
  • high nuclear to cytoplasmic ratio ( dark blue nuclei)
  • high mitotic activity with atypical mitosis
  • invasion through basement membrane
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3
Q

Gastric reflux-

A

causes lower esophageal epithelium to become abnormal squamous before it becomes metaplastic as seen in barretts esophagus

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4
Q

pregnant woman has polyhydraminos and the fetus has 47 XY (+21 chromosome)- the cause of the polyhydraminos?

A

the baby has duodenal atresia

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5
Q

mousy/musty” smell, intellectual disability, when testing the urine, it turned blueish green

A

PKU-

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6
Q

man has unilateral hydronephrosis what is his problem?

A

mass at the vsicoureteral junction

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7
Q

Adult PKD patient has what extra-renal manifestation

A

either (berry ) aneurism or hepatic cysts or mitral valve prolapse (mid systolic click

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8
Q

Picture of adult _____kidney and asks what the other kidney would look like?

A

Decreased in size

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9
Q

mother brought her 14 year old daughter to the doctor bc she has not menstruated yet; examination reveals breast, normal hair growth, a vagina that ends in a blind pouch, and no ovaries or uterus- options were: 45XO, 47XXY, 46XX, or 46XY

A

46XY (we believe its androgen insensitivity, which points to 46XY)

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10
Q

Polycystic ovarian syndrome PCOS presents with what lab value?

A

PCOS presents with elevated LH

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11
Q

an alcoholic male with bright red blood in his stool has hemorrhoids; what is the lining of the vasculature that is leaking blood?

A

endothelial cells (but not sure thats right)

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12
Q

**patient comes in with…….and endoscopy revealed a thinning, (and i think it said soft) gastric wall/mucosa and her labs showed an elevated hematocrit, normal bone marrow cells and in normal proportions, they wanted to know what her problem was?

A

i said pernicious anemia bc it was leading towards a B12 deficiency…or is this the renal question…

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13
Q 
age >60 yrs 
anemia 
cd20+ , cd23+, cd5+ 
smudge cells ((crushed little lymphocytes ) 
diagnostic?
A

CLL

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14
Q

exposed to hydrocarbons, benzene, and etc, what test will be abnormal with respect to the hydrocarbon exposure?

A

chest x-ray

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15
Q

in a person with Shock- what is reason for low blood pressure/vol?

A

increased space btw endothelial cells is reason for low blood pressure/vol

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16
Q

what are the nodules on the cirrhotic liver of a patient with chronic hepatitis C- (in Dr. cones liver review)-

A

regenerative regions

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17
Q

Normally molecule X binds damaged DNA and causes the cell to enter the G0 phase, an experiment is done and found that a mutant version of molecule X wont bind damaged DNA leading to uncontrolled cell growth. this molecule X is most similar to_____?

A

Tumor suppressor genes

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18
Q

myxedema, weight gain, slow mental activity and muscle weakness

A

think hashimoto= Hurthle cells =CD8 destruction of TSH receptor

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19
Q

DiGeorge Syndrome

A

HYPOPARATHYROID (kid had hypocalcemia)

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20
Q

**NEUTROPHIL CHEMOTRACTANTS -

A

**NEUTROPHIL CHEMOTRACTANTS - Il-8, C5a, LTB4

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21
Q

MARFANs- complication?

A

MARFANs- aortic root dilation

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22
Q

t helper cells secrete what? to maintain all granulomas and turn macrophages into epithelioid histiocytes

A

INF-gamma sec by t helper cells to maintain all granulomas and turn macrophages into epithelioid histiocytes

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23
Q

alpha- 1 antitrypsins deficiency?

A

inflammation usually leads to neutrophils releases proteases. However, there has to be a balanced. here lack of antitrypsin antiprotease causes a buildup of the proteases which leaves the air sacs vulnerable to pretease-mediated damage. This results in:

LUNG= panacinar emphysema lower lobes
LIVER= cirrhosis = abnormal alpha 1 builds up in liver because of misfolded mutated protein ; only in phenotypes with pathologic polymerization of A1AT in endoplasmic reticulum of hepatocytes
biopsy reveals= pink PAS + globules in hepatocytes.

presents with COPD Symptoms= cough, sputum, wheeze and young pt! increased anterior , posterior diameter ( barrel chest) , hypoxemia bc of destruction of capillaries in alveolar sac and cor pulmonale is late complication.

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24
Q

teen with Diabetes type 1 has what …

A

haplotype II, (HLA DR-3/4)

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25
Q

Woman has normal pregnancy and size of uterus consistent with 12 week old child, but the placenta is covering the cervical os, what is she at high risk of?

A

she has Placenta previa but is high risk of placenta acreta !!!

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26
Q

TGF-beta secreted by …

A

regulatory T cells

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27
Q

baby has many rib fractures, and blue scara what is he deficient in?

A

type 1 collagen

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28
Q

Boy with IgA @ 250mg/dl , IgG @ 800 and IgM @ 650mg/dl ???????????

A

Selective IgA Deficiency

  • normal B cell count but decrease IgA ; Normal IgM and IgG
  • Increase risk of GIARDIA infections
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29
Q

Mismatch of ABO blood typing is common, but ABO hemolytic disease/transfuction reaction of newborns is rare, why is that?

A
  • IgG anti-A (or IgG anti-B) antibodies that enter the fetal circulation from the mother find A (or B) antigens on many different fetal cell types, leaving fewer antibodies available for binding onto fetal red blood cells.[15]
  • Fetal RBC surface A and B antigens are not fully developed during gestation and so there are a smaller number of antigenic sites on fetal RBCs
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30
Q

Girl with full thickness dysplasia of cervical epithelium has what?

A

carcinoma

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31
Q

child with short stature, corneal clouding… has what deficiency

A

alpha-L- iduronidase

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32
Q

Strep pneumo

CSF values in patient w/______meningitis: protein ____, glucose___, & leukocytes _____.

A

bac= NO lymphocytes; low glucose at CSF;HIGH protein; high opening pressure

fungal= lymphocytes; low glucose at CSF; HIGH protein; variable opening pressure

viral= lymphocytes; Glucose normal CSF; protein normal to high; normal opening pressure

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33
Q

baby has many rib fractures in different healing stages what is he deficient in?

A

think osteonesis imperfecta = type 1 collagen

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34
Q

child born cyanotic is found to have right to left shunt has what heart defect?

A

Transposition of the great vessels

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35
Q

what happened to this patient?

A

renal artery stenosis with abdominal bruit and an S3

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36
Q

after having a cast removed the woman noticed her calf muscle was smaller, what occurred?

A

Atrophy

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37
Q

woman with redundant bicuspid valve would show what on examination of the heart….

A

fusion at the commissures

38
Q

after an accident, the patients are developed a growth of bone in the affected muscle; what is that called-

A

myositis ossificans (mesenchymal tissue metaplasia)

39
Q

child with short stature, corneal clouding… has what deficiency

A

Hurlers = deficiency in alpha-L- iduronidase

40
Q

hypoxic Cell damage reversible vs irreversible

A 
hypoxic Cell damage reversible (cell swell, loss microvilli, memb. blebing (ribosomes pop off and decrease prt. synth), swelling RER) 
vs irreversible (membrane damage from increased intracell Ca)
41
Q

Mechanism of apoptosis w/respects to cytochrome c leaking out of mitochondria.

A

Apoptosis has no associated inflammation but necrosis has acute inflammatory response.

42
Q

female breast with well circumscribed, firm, and freely movable mass that increases in size during pregnancy-

A

fibroadenoma

43
Q

Man goes to doctor and his bones have a mosaic pattern, what was the initiating phase ?

A

pagets disease initial phase is osteoclasts

44
Q

patient sx explained…. and then says the nitro blue tetrazolium test was very weak. what might be the problem?

A

NADPH oxidase deficiency (CGD patient)

45
Q

CMV - histology slide (may have had owl eyes)…….

A

hodkin lymphoma

46
Q

idiopathic pulmonary fibrosis patient describes and the picture shown. question asked if treated, what would happen?

A

i said they would be managing it for the rest of life

47
Q

what is the purpose of giving hydroxyurea in a sickle cell patient?

A

to induce gamma globulin

48
Q

Question describes child with cretinism- mental retardation, short stature, coarse facial features, and large tongue….

A

hypoPARATHYRODISM = DIgeorge syndrome

  • decreae T cells= recurrent viral and fungal infections
  • decrease PTH
  • Decrease calcium
  • absent thymic shadow on CXR
49
Q

what other levels would be elevated int his patient…

A

i put ALP, other choices were amylase,

50
Q

iron deficiency anemia patient described and then asked what serum level would be elevated-

A

TIBC

51
Q

A 56yo patient described with amyloid plaques in brain

A

Alzheimer disease

52
Q

neutrophil rolling and interns are neutrophil adhesion

A

Selectins-

53
Q

described patent s(ptosis, diplopia-intermitently, normal sensory but decreased muscle weakness) ?

A

described patent with myasthenia gravis ; you had to know it was Ab to the ACh receptors.

54
Q

gangrenous part of the colon removed from newborn and was caused by…

A

enterocolitis= hirschsprung disease

  • lack of ganglion cells = defective relaxation and peristalsis
  • failure of ganglion cells ( neural crest derived) to descend into myenteric and submucosal plexus
  • associated with down syndrome
55
Q

boy having a splenectomy should receive what vaccination 2 weeks before splenectomy-

A

N. Meningitis and pneumococal vaccine

56
Q

described a lesion in a traveling man
- site of a sand fly bite. Multiple moist cutaneous lesions appear on the extremities and are associated with marked local subcutaneous infiltration and regional lymphadenitis.

A

Cutaneous Leshamniasis

57
Q

Respiratory question about a patient with panacinar emphysema and what their labs would be for: TLC___, RV___, FVC___, and something else___

A

TLC= INC
RV=INC
FVC= DEC

58
Q

described the silvery plaques; thickening of epithelial tissue

A

psoriasis

59
Q

Karyorexis vs karyolysis vs pyknosis

A

Loss of the nucleus=death of cell

By condensation (pyknosis)
fragmentation (karyorrhexis), and
dissolution (karyolysis)

60
Q

hypoxic injury causes a switch from anaerobic to aerobic glycolysis causing less ATP production, increased LA, decreased cellular pH and that causes DNA & proteins to precipitate.

A

increased LA,

decreased cellular pH and that causes DNA & proteins to precipitate.

61
Q

Fat in the stool what test?

A

do a chloride sweat test

•Measures amount of fat in the stool which can help gauge the percentage of dietary fat the body does not absorb.

62
Q

holosystolic murmur travels to axilla

A

mitral regurge

63
Q

man has chronic gastric ulcers and is treated with omeprazole what happens to his serum gastrin levels?

A

increase

64
Q

HIV will be replicating in what cells?

A

macrophages (bc CD4 cells were not an option)

65
Q

smoker patients with bladder cancer

A

Transitional epithelium of bladder in smoker patients

66
Q

vitamin A is good/required for ?

A

epithelial cells;
t’s necessary for differentiation of specialized epithelial surfaces (e.g. conjunctiva), and essential for the maturation of certain immune cells (such as neutrophils).

*Note: also helps reduce mortality in measles

67
Q

pt presents with purple patches , plaques and nodules on skin ( lower legs)
- low grade malignant proliferation of endothelial cells -

A

Kaposi sarcoma= a type of vascular tumor !!!
- associated with hhv-8
classically seen in
1- older eastern european males- tumor remains localized to skin ( legs)
2- Aids- tumor spreads early; treatment is antiretroviral agents
3- transplant recipients- tumor spreads early

68
Q

borrelia bugdoferi stages
reservoir ?
transmission?

A

reservoir? mice
transmission? Ixodes deer tick = same as babesia

stage 1 = early localized erythema migrans (bulls eyes) and flu like symptoms
stage 2= early disseminated ; secondary lesions, carditis, AV block ,
facial nerve Bell palsy, migratory myalgias/ transient arthritis
stage 3= late disseminated ; neuropathy , encephalopathies and chronic arthritis

69
Q

schistocytes and decreased fibrinogen.

A

DIC

70
Q
  • napkin ring lesion
  • presents = decreased stool caliber, left lower quadrant pain and blood- streaked stool
  • change in bowel habits = constipation
A

left side colorectal carcinoma
apple core sign = known as the napkin ring sign (bowel), is most frequently associated with constriction of the lumen of the colon by a stenosing annular colorectal carcinoma.

71
Q

Tubulovillous adenoma

A

A type of polyp that grows in the colon and other places in the gastrointestinal tract and sometimes in other parts of the body. These adenomas may become malignant (cancer).

72
Q
  • woman with new cat and has multiple cuts from cat all over; was describing woman with cat scratch disease…
  • bacillary angiomatosis = Vascular necrosis
  • Solitary or multiple red, purple, flesh-colored, or colorless papules (hemangiomalike lesions) varying in size from 1 mm to several centimeters
  • Nodules, often covered with a fine, tightly adherent scale
  • Large, friable, pedunculated, or polypoid exophytic masses
  • Hyperpigmented, hyperkeratotic, indurated plaques, typically on the extremities and often overlying osseous defects
A

cat scratch= Bartonella Henselae.

-bacillary angiomatosis commonly have a history of HIV infection, organ transplantation, leukemia, or chemotherapy

73
Q

AIDs pt with severe waterly diarrhea

A

crysptosporium = only parasite that stains oocyts on acid fast

  • each oocyst is composed of 4 motile sporozoits
  • sporozoites attach to intestinal wall and cause waterly diarrhea
74
Q
  • low b CELL COUNT.
  • x linked= tyrosine kinase gene mut
  • because loss of IgA = there is an increase of GI bacteria pathogen infections
  • NO B cell MATURATION= NO GERMINAL CENTER and decrease Ig of all classes
A
  • BRUTONS AGAMMAGLOBULINEMIA (X LINKED)
  • enteroviruses = POLIO, ECHO,COXACKIE
  • GIARDIA
  • H . flu
  • strep pneumonia encapsulated bacteria
75
Q

Diabetes type 1 genetics ?

A

heavy chain

76
Q

Endocarditis- IV drug user abuse with large vegetation’s, what was the bug?

A

staph aureus - large vegetation of tricuspid

77
Q

Slurred speech, normal intelligence, coordination, DM problem in ?

A

Friedrich ataxia = CEREBELLUM

78
Q

patient with history of stable angina, but recently has had dyspnea without exertion, and this morning again while watching TV but her ECG came back normal, what was going on…

A

unstable angina= rupture of atherosclerotic plaque with thrombosis and INCOMPLETE occlusion of a coronary artery.

  • represents reversible injuroes to myocytes = no necrosis
  • ekg - can be normal or ST depression sue to subendocardial ischemia
79
Q
  • squamous cell carcinoma picture; S100+
  • DEPTH OF TUMOR CORRELATES ( BRESLOW THICKNESS) with risk of metastasis.
  • often driven by mutation on BRAF KINASE ( activating)
  • lower lip, ears , hands, scull,
  • associated with excessive exposure to sunlight
  • locally invasive may spread to lymph nodes
  • ulcerative red lesions with frequent scale = keratin pearls
A
  • MELANOMA ( not basal cell carcinoma)

- actinic keratosis = a scaly plaque is a precursor to squamous cell carcinoma.

80
Q

CIN

A

HPV 16 AND 18

81
Q

woman comes in for eye exam and it reveals veins being crossed with artery, and…what was the cause- ?
- ACUTE PAINLESS blurring or loss of vision. It almost always happens in just one eye. At first, the blurring or loss of vision might be slight, but it gets worse over the next few hours or days. Sometimes there is a complete loss of vision almost immediate
-
what else you can see in eye exam>?
what is the cause ?

A
  • pale retina and cherry red macula
  • Central retinal artery occulcion ( arterivenious nicking)
  • causes : embolic source
    1-carotid artertherosclerosis ( CAD)
    2- cardiac vegetations
    3- patent foramen ovale
82
Q

-Coxiella Brunetti

A 
high fever = Q fEVER (103+) 
Severe headache
Fatigue
Chills
Cough
Nausea
Vomiting
Diarrhea
Sensitivity to light
  • no anthropod vector
  • spores inhaled as aerosols from cattle/ sheep amniotic fluid. presents as pneumonia
83
Q

pain improves with meals

A

duodenal ulcer- never malignant

84
Q

pain worsen with meals

A

GASTRIC ULCER

85
Q

hashimoto thyroiditis presentation

A

-enlarged NONTENDER thyroid
auto immune disorder with antithyroid peroxidase and antithyroglobulin antibodies.
Associated with increased of non-hodgkin lymphoma (typically B cell origin)

-hurthle cells= lymphoid aggregates with germinal centers

86
Q

colorectal carcinoma genetics ( 2 ways)

A 
A) polyps
- mutation in tumor suppresion genes 
1- APC gene mut = hyperproliferative epithelium ( COX2 overexpresion ) 
2- increase EGFR = Small adenoma forms 
3- k-ras mut= large adenoma 
4- p53 mut = colon carcinoma

B) no polyps= Lynch syndrome = HNPCC
- Mut MSH or MLH DNA mistmatch repair genes which causes microsatellite instability.

87
Q

polypoid mass , bleeding occult blood on stool

iron deficiency anemia

A

right sided colorectal carcinoma

88
Q

Deposition in kidney, spleen, liver and sometimes heart; most commonly presents as renal insufficiency/ nephrotic syndrome

A

Associated disease= secondary amyloidosis (auto immune disease, chronic infection)
AA

89
Q

Amyloidosis that causes Dementia

A

Alzheimer = AB

90
Q

Amyloidosis- most commonly musculoskeletal, with deposits in muscles, ligaments, synovium, bone, resulting in arthropathy, carpal tunnel, fractures

A

Associated disease- long term hemodialysis

AB2M

91
Q

primary amyloidosis - systemic includes heart and kidney

A

AL = light chain deposition

92
Q

Primary amyloidosis mostly cardiac problems

A

ATTR

Path NBME (4 decks)

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