personal notes Flashcards
BPH- it effects the ?
BPH- it effects the periurethral zone
post- digital rectal exam ID’s prostate cancer in a male, what morphology would classify a worse prognosis?
- 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
Gastric reflux-
causes lower esophageal epithelium to become abnormal squamous before it becomes metaplastic as seen in barretts esophagus
pregnant woman has polyhydraminos and the fetus has 47 XY (+21 chromosome)- the cause of the polyhydraminos?
the baby has duodenal atresia
mousy/musty” smell, intellectual disability, when testing the urine, it turned blueish green
PKU-
man has unilateral hydronephrosis what is his problem?
mass at the vsicoureteral junction
Adult PKD patient has what extra-renal manifestation
either (berry ) aneurism or hepatic cysts or mitral valve prolapse (mid systolic click
Picture of adult _____kidney and asks what the other kidney would look like?
Decreased in size
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
46XY (we believe its androgen insensitivity, which points to 46XY)
Polycystic ovarian syndrome PCOS presents with what lab value?
PCOS presents with elevated LH
an alcoholic male with bright red blood in his stool has hemorrhoids; what is the lining of the vasculature that is leaking blood?
endothelial cells (but not sure thats right)
**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?
i said pernicious anemia bc it was leading towards a B12 deficiency…or is this the renal question…
age >60 yrs anemia cd20+ , cd23+, cd5+ smudge cells ((crushed little lymphocytes ) diagnostic?
CLL
exposed to hydrocarbons, benzene, and etc, what test will be abnormal with respect to the hydrocarbon exposure?
chest x-ray
in a person with Shock- what is reason for low blood pressure/vol?
increased space btw endothelial cells is reason for low blood pressure/vol
what are the nodules on the cirrhotic liver of a patient with chronic hepatitis C- (in Dr. cones liver review)-
regenerative regions
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_____?
Tumor suppressor genes
myxedema, weight gain, slow mental activity and muscle weakness
think hashimoto= Hurthle cells =CD8 destruction of TSH receptor
DiGeorge Syndrome
HYPOPARATHYROID (kid had hypocalcemia)
**NEUTROPHIL CHEMOTRACTANTS -
**NEUTROPHIL CHEMOTRACTANTS - Il-8, C5a, LTB4
MARFANs- complication?
MARFANs- aortic root dilation
t helper cells secrete what? to maintain all granulomas and turn macrophages into epithelioid histiocytes
INF-gamma sec by t helper cells to maintain all granulomas and turn macrophages into epithelioid histiocytes
alpha- 1 antitrypsins deficiency?
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.
teen with Diabetes type 1 has what …
haplotype II, (HLA DR-3/4)
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?
she has Placenta previa but is high risk of placenta acreta !!!
TGF-beta secreted by …
regulatory T cells
baby has many rib fractures, and blue scara what is he deficient in?
type 1 collagen
Boy with IgA @ 250mg/dl , IgG @ 800 and IgM @ 650mg/dl ???????????
Selective IgA Deficiency
- normal B cell count but decrease IgA ; Normal IgM and IgG
- Increase risk of GIARDIA infections
Mismatch of ABO blood typing is common, but ABO hemolytic disease/transfuction reaction of newborns is rare, why is that?
- 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
Girl with full thickness dysplasia of cervical epithelium has what?
carcinoma
child with short stature, corneal clouding… has what deficiency
alpha-L- iduronidase
Strep pneumo
CSF values in patient w/______meningitis: protein ____, glucose___, & leukocytes _____.
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
baby has many rib fractures in different healing stages what is he deficient in?
think osteonesis imperfecta = type 1 collagen
child born cyanotic is found to have right to left shunt has what heart defect?
Transposition of the great vessels
what happened to this patient?
renal artery stenosis with abdominal bruit and an S3
after having a cast removed the woman noticed her calf muscle was smaller, what occurred?
Atrophy
woman with redundant bicuspid valve would show what on examination of the heart….
fusion at the commissures
after an accident, the patients are developed a growth of bone in the affected muscle; what is that called-
myositis ossificans (mesenchymal tissue metaplasia)
child with short stature, corneal clouding… has what deficiency
Hurlers = deficiency in alpha-L- iduronidase
hypoxic Cell damage reversible vs irreversible
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)
Mechanism of apoptosis w/respects to cytochrome c leaking out of mitochondria.
Apoptosis has no associated inflammation but necrosis has acute inflammatory response.
female breast with well circumscribed, firm, and freely movable mass that increases in size during pregnancy-
fibroadenoma
Man goes to doctor and his bones have a mosaic pattern, what was the initiating phase ?
pagets disease initial phase is osteoclasts
patient sx explained…. and then says the nitro blue tetrazolium test was very weak. what might be the problem?
NADPH oxidase deficiency (CGD patient)
CMV - histology slide (may have had owl eyes)…….
hodkin lymphoma
idiopathic pulmonary fibrosis patient describes and the picture shown. question asked if treated, what would happen?
i said they would be managing it for the rest of life
what is the purpose of giving hydroxyurea in a sickle cell patient?
to induce gamma globulin
Question describes child with cretinism- mental retardation, short stature, coarse facial features, and large tongue….
hypoPARATHYRODISM = DIgeorge syndrome
- decreae T cells= recurrent viral and fungal infections
- decrease PTH
- Decrease calcium
- absent thymic shadow on CXR
what other levels would be elevated int his patient…
i put ALP, other choices were amylase,
iron deficiency anemia patient described and then asked what serum level would be elevated-
TIBC
A 56yo patient described with amyloid plaques in brain
Alzheimer disease
neutrophil rolling and interns are neutrophil adhesion
Selectins-
described patent s(ptosis, diplopia-intermitently, normal sensory but decreased muscle weakness) ?
described patent with myasthenia gravis ; you had to know it was Ab to the ACh receptors.
gangrenous part of the colon removed from newborn and was caused by…
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
boy having a splenectomy should receive what vaccination 2 weeks before splenectomy-
N. Meningitis and pneumococal vaccine
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.
Cutaneous Leshamniasis
Respiratory question about a patient with panacinar emphysema and what their labs would be for: TLC___, RV___, FVC___, and something else___
TLC= INC
RV=INC
FVC= DEC
described the silvery plaques; thickening of epithelial tissue
psoriasis
Karyorexis vs karyolysis vs pyknosis
Loss of the nucleus=death of cell
By condensation (pyknosis)
fragmentation (karyorrhexis), and
dissolution (karyolysis)
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.
increased LA,
decreased cellular pH and that causes DNA & proteins to precipitate.
Fat in the stool what test?
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.
holosystolic murmur travels to axilla
mitral regurge
man has chronic gastric ulcers and is treated with omeprazole what happens to his serum gastrin levels?
increase
HIV will be replicating in what cells?
macrophages (bc CD4 cells were not an option)
smoker patients with bladder cancer
Transitional epithelium of bladder in smoker patients
vitamin A is good/required for ?
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
pt presents with purple patches , plaques and nodules on skin ( lower legs)
- low grade malignant proliferation of endothelial cells -
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
borrelia bugdoferi stages
reservoir ?
transmission?
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
schistocytes and decreased fibrinogen.
DIC
- napkin ring lesion
- presents = decreased stool caliber, left lower quadrant pain and blood- streaked stool
- change in bowel habits = constipation
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.
Tubulovillous adenoma
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).
- 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
cat scratch= Bartonella Henselae.
-bacillary angiomatosis commonly have a history of HIV infection, organ transplantation, leukemia, or chemotherapy
AIDs pt with severe waterly diarrhea
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
- 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
- BRUTONS AGAMMAGLOBULINEMIA (X LINKED)
- enteroviruses = POLIO, ECHO,COXACKIE
- GIARDIA
- H . flu
- strep pneumonia encapsulated bacteria
Diabetes type 1 genetics ?
heavy chain
Endocarditis- IV drug user abuse with large vegetation’s, what was the bug?
staph aureus - large vegetation of tricuspid
Slurred speech, normal intelligence, coordination, DM problem in ?
Friedrich ataxia = CEREBELLUM
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…
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
- 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
- MELANOMA ( not basal cell carcinoma)
- actinic keratosis = a scaly plaque is a precursor to squamous cell carcinoma.
CIN
HPV 16 AND 18
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 ?
- 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
-Coxiella Brunetti
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
pain improves with meals
duodenal ulcer- never malignant
pain worsen with meals
GASTRIC ULCER
hashimoto thyroiditis presentation
-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
colorectal carcinoma genetics ( 2 ways)
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.
polypoid mass , bleeding occult blood on stool
iron deficiency anemia
right sided colorectal carcinoma
Deposition in kidney, spleen, liver and sometimes heart; most commonly presents as renal insufficiency/ nephrotic syndrome
Associated disease= secondary amyloidosis (auto immune disease, chronic infection)
AA
Amyloidosis that causes Dementia
Alzheimer = AB
Amyloidosis- most commonly musculoskeletal, with deposits in muscles, ligaments, synovium, bone, resulting in arthropathy, carpal tunnel, fractures
Associated disease- long term hemodialysis
AB2M
primary amyloidosis - systemic includes heart and kidney
AL = light chain deposition
Primary amyloidosis mostly cardiac problems
ATTR
