Random Flashcards
Causes of dilated cardiomyopathy?
ABCCCD
Alcohol; Beriberi; Coxsackie; Cocaine; Chagas; Doxorubicin; also hemochromatosis
Restrictive cardiomyopathy with endomyocardial fibrosis with a prominent eosinophilic infilitrate?
Lofflers syndrome
Vasculitis due to IgA deposition following upper respiratory tract infection?
Henoch Schonlein– see fibrinoid necrosis
Destruction of helminths?
Major basic protein released by eosinophils
CD4<50
Pneumocystis– TMP SMX
Toxoplasma– TMP SMX
Avium– Azithromycin
Treatment of histoplasma? (commonly seen in HIV patient from endemic area with CD4 under 150)
Itraconazole
Copper arsenic and gold antidote?
Penicillinamase
Erosions are in?
Mucosa only
Collaterals
a) superior epigastric to? aka internal thoracic or mammary
b) Sup pancreaticodudodenal
c) Middle colic
d) Superior rectal
a) inf epigastric (external iliac)
b) inf pancreaticodudoenal (SMA)
c) middle colic to left colic
d) superior rectal to middle and inferior rectal i.e. IMA to internal iliac
Rectum above pectinate drains into?
Below pectinate drains into?
Above inferior mesenteric vein– adenocarcinoma
Below internal iliac vein– squamous
Zone in liver commonly affected by viral hepatitis?
zone 1
Zone in liver first affected by ischemia?
zone 3– most sensitive to toxic injury
Two AA that are potent stimulators of gastrin?
Phenylalanine and tryptophan
Motilin receptor agonist used to stimulate intestinal peristalssis/
Erythromycin
How does gastrin increase acid secretion?
Through ECL cells–>histamine release (rather than acting directly on the parietal cells themselves)
ACh–>M3 activation–>?
Gq–>phospholipase C– IP3/Ca–>H/K atapase
only…..are absorbed by enterocytes?
Monosaccharides
What are bile acids conjugated to to make them water soluble?
Taurine and glycine
Malignant tumor with mucinous and squamous components of parotid gland– involves what nerve?
Mucoepidermoid carcinoma– involves facial nerve
ingestion of cleaning products associated with?
esophageal strictures
Esophageal squamous cell carcinoma?
Areas of keratinization in well differentiated tumor
65 yo male Pt. presents with steatorrhea, pain in joints, confusion
Whipples– PAS positive– foamy macrophages in LAMINA PROPRIA
3 key features of celic?
Intraepithelial CD8 T cells in lamina propria!
Cryp hyperplasia
Villous atrophy— see loss of villi on histology
Abetalipoproteinemia have RBCs associated with?
Thorny projections called acanthocytes
Cannot aborb essential fatty acids— mutation in microsomal triglyceride transfer protein– MTP
Pernicious anemia affects with part of stomach?
H pylori affects which part of stomach?
Anemia Body
Bacterium Antrum
Histology of Hpylori gastritis?
Intraepithelial neutrophils
subepithelial plasma cells
Gastric adenocarcinoma often presents with?
Acanthosis nigricans
Diffuse adenocarcinoma associated with?
Signet ring cellss
Hpylori virulence?
Flagella; adehsins; urease; CagA
Rupture of posterior wall of duodenum–?
bleeding form gastrodudodenal
ulcer perforations are more common….?
Ulcer hemorrhages are more common…?
1) perforationsa re more common anteriorly
2) Hemorrhages are more common posteriorly
String sign on barium swallow?
Crohn’s disease
Crohns is Th?
UC is Th?
crohns th1
UC th2
Friable mucosal pseudopolyps with freely hanging mesentery?
Ulcerative colitis
Cause of appendicitis in children? adults?
Children? lymphoid hyperplasia
Adults? Fecalith
Difference between Meckels and omphaloesenteric cyst?
Meckels is PERSISTENT vitelline duct
Omphalomesenteric cyst is cystic dilation of vitelline duct
Child presents with painless rectal bleeding– what should you always suspect?
Meckels– persistence of vitelline duct– diagnose with pertechnate study
What does sessile mean?
Fixed in one place
Apple core lesion on barium swallow?
Colorectal cancer
Most common area of colorectal cancer?
Rectosigmoid then Ascending then descending
CEA tumor marker?
Good for monitoring recurrent of CRC; not for screening
Describe transition from normal colon to carcinoma
Loss of APC then KRAS mutation then Loss of p53
Remember: KRAS is an activating mutation!
Carcinoid tumors are derived from? what do you see on hisotlogy? may cause depletion of?
neuroendocrine cells–
See Dense core bodies–
Carcinoid tumors uses tryptophan to make 5HT– tryptophan is also used for niacin so may ahve niacin deficiency
Stimulates fibrosis?
Induces vascular remodeling and stimulates fibroblast growth factor for collagen synthesis
1–TGF beta stimulates fibrosis
2– PDGF induces vascular remodeling
Child comes in with hypoglycemia; hepatomegaly and fatty liver– what is MOA of causative agent?
Aspirin metabolites decrease beta oxidation by reversible inhibition of mitochondrial enzymes–REYES SYNDROME
Pathology of alcoholic hepatitis?
Swollen and necrotic hepatocytes with neutrophilic infiltration– mallory bodies are intracytoplasmic eosinophilic inclusions
Pathology of alcoholic cirrhosis?
Sclerosis around central vein (zone III)
Liver mass associated with oral contraceptive use?
Hepatic ADENoma
Misfolded gene product proteins aggregated in hepatocellular ER?
alpha 1 antitrypsan
This causes cirrhosis with PAS positive globules in liver
Hemochromatosis is associated with HLA…?
HLA3
Black gallstones? Brown?
Hemolysis
Brown= infection
MUMPs can cause acute pancreatitis
freebie
Complication of acute pancreatitis?
Pancreatic pseudocyst lined by GRANULATION tissue which can rupture and hemorrhage
Redness and tenderness on palpation of extremities
Migratory thrombophlebitis– Trousseaus syndrome– pancreatic carcinoma
Southwestern blot detects?
DNA binding protein
Path of primary biliary cirrhosis
lymphocytic infiltration and granulomatous destruction of intralobular ducts
DDx for xanthelesama?
Primary biliary cirrhosis and hypercholesterolemia
99mTc pertechtanate ?
Detects gastric mucosa
Colonic diverticula?
outpouchings of mucosa and submucosa
most common type of colonic polyp?
hyperplastic polyp– serrated appearance
Two bugs that cause biliary tract infection?
Ascaris– roundworm
Clonorchis– endemic to china, korea, and vietnam– also increased risk for cholangiocarcinoma
HEV infection?
In pregnant women associated with fulminant hepatitis and massive hepatic necrosis
Pathology of viral hepatitis?
Inflammation of lobules and portal tracts characterized by apoptosis of hepatocytes
Fibrosis in cirrhosis is mediated by?
TGF beta from stellate cells
Thick mucoid capsule?
Klebsiella
Legionella is best visualized by?
silver stain
IgM against RBCs causing cold hemolytic anemia?
Mycoplasma pneumonia
Causes pneumonia; does not require arthropod vector (survives as highly resistant endospores and does not produce a skin rash
Coxiella– things that distinguish it from other rickettsia
Where does mutant A1AT accumulate?
Misfolded protein accumulates in endoplasmic reticulum of hepatocytes– PAS positive globules in hepatocytes
What is the cause of the hypoxemia in emphysema?
DESTRUCTION OF CAPILLARIES IN ALVEOLAR SAC
WHAT IS CAUSE OF HYPOXEMIA IN EMPHYSEMA
DESTRUCTION OF CAPILLARIES IN ALVEOLAR SACS
Path of asthma?
1) epithelial desquamation
2) smooth muscle hypertrophy
3) mucous plugging
4) BM thickening
5) NO destruction of alveoli or fibrosis
Charcot leyden crystals?
Eosinophils derived crystals seen in asthma
Antimetabolite that causes photosensitivity?
5FU
idiopathic pulmonary fibrosis mediated by?
tgf beta
honeycomb lung
pulmonary fibrosis
joint pain; coal worker; fibrosis of lungs
Caplan syndrome= RA plus diffuse fibrosis– results in carbon laden macrophages that are not clinically significant
egg shell calcifications
silicosis– increased risk for TB
lung cancer derived from neuroendocrine cells?
small cell– may produce ADH or ACTH or cause eaton lambert
lung cancer that may produce PTHrP
squamous cell
adenocarcinomas are found?
peripherally
Columnar cells that grow along preexisting bronchioles and alveoli– type of lung cancer
Bronchioalveolar carcinoma– may present with pneumonia like consolidation on imaging
ON HISTOLOGY LOTS OF DARK PINK (NO CELLULARITY) WITH CONNECTING TALL COLUMNAR CELLS
Polyp like mass in bronchus?
Carcinoid– chromogranin positive
granulomatous vasculitis?
temporal arteritis
Young adult; melena with abdominal pain; skin lesions; hypertension; confusion
Polyarteritis nodosa– spares the LUNGS; associated with Hep B surface antigen
String of pearls appearance on imaging; fibrinoid necrosis; vasculitis
Polyarteritis nodosa
45 yo man sinusitis and ulcer in nasopharynx, coughing up blood; hematuria
Wegeners; rapidly progressive glomerulonephritis causes the hematuria
What is the difference between wegeners and microscopic polyangitis
microscopic polyangitis does not have granulomas OR nasopharyngeal involvement
Churg strauss particularly affects?
Lung and heart; eosinphils in multiple organs; p-ANCA levels correlate with disease activity
Purple spot on but and legs; GI pain and bleeding; hematuria; child was sick two weeks ago
IgA nephropathy– henoch shonlein purpura
Describe pathogenesis of arteriosclerosis?
1) Damage to endothelium and lipid leak into intima–>2) lipids are oxidized and then consumed by macrophages via scavenger receptors resulting in foam cells–>3)Inflammation and healing leads to deposition of ECM and proliferation of smooth msucle
Describe pathogenesis of arteriosclerosis?
1) Damage to endothelium and lipid leak into intima–>2) lipids are oxidized and then consumed by macrophages via scavenger receptors resulting in foam cells–>3)Inflammation and healing leads to deposition of ECM and proliferation of smooth msucle
Intrinsic tyrosine kinase/
Insulin (intrinsic); think growth factors; IGF; PDGF
RPF is best estimated using?
PAH
hyperplastic arteriolosclerosis is a consequence of?
malignant hypertension
hypotension pulsatile mass and flank pain?
abdominal aortic aneurysm
EKG shows what on prinzemetal angina?
transumural ischemia===st segment elevation
Infarcation of posterior wall caused by block in which artery?
Right coronary artery
infarcatino of left circumflex causes?
lateral wall infarction
Morphological changes of myocardium at 12 hours? 48 hours; 5 days? 2 weeks? months?
12 hours= coagulative necrosis; dark discoloration– removes nucleus; at risk for arrhythmia
48 hours= neutrophils– fibrinous pericarditis may arise (chest pain with friction rub)
5 days= macrophages– may lead to rupture of ventricular free wall–>cardiac tamponade
2 weeks= red border emerges as granulation tissue enters from edge of infarct– granulation tissue with plump fibroblasts, collagen, and blod vessels are seen on histology
months= white scar; fibrosis; dressler syndrome, aneurysm mural thrombus
6 drugs that cause hyperkalemia?
1) ARBs 2) ACEI 3) Nonselective Beta blockers 4) Cardiac glycosides 5) K sparing diuretics 6) NSAIDs
Paradoxical splitting caused by?
Delayed left ventricular ejection
Heart findings in marfans?
Cystic medial degeneration of aorta
Murmurs that are increased by valsalva or abrupt standing?
Mitral valve prolapse or HCM
Mitral valve prolapse and HCM decrease on?
Squatting or passive leg raise
Which ions are increased in myocytes when there is no ATP?
Ca and Na
Prevents cholesterol reabsorption at small intestine brush border
ezetimibe
Gray hepatization ?
degradation of RBCs within the pulmonary exudate
Alveolar exudate contains neutrophils, fibrin, and erythrocytes
Red hepatization
Gynecomastia and galactorrhea– lung cancer?
Large cell (large breasts)
thrombocytopenia; hypoxemia; neurologic abnormaltities; petechial rash
fat embolus– platelets coat fat microglobules causing thrombocytopenia
Eggshel calcification
silicosis– may disrupt phagolysosomes and impair macrophages increasing susceptibility to TB
Asbestosis affects this part of the lung while silicosis affects this part of the lugn
Silicosis upper
Asbestosis lower
initial damage of alveoli in ARDS is dt?
release of neutrophilic substances toxic to alveolar wall, activation of coagulation cascade and oxygen derived free radicals–WHITE OUT ON CHEST XRAY
white out on chest xray?
ARDS
Difference in physical findings between pleural effusion and atelectasis (bronchial obsturction)?
atelectasis has tracheal deviation (toward side of lesion) while pleural effusion doesn’t
hemorrhagic pleural effusions and pleural thickening
Mesothelioma– and see psammoma bodies
intraalveolar exudate?
lobar pneumonia
treatment of paroxysmal nocturnal hemoglobinuria
eculizumab
venous thrombosis; pancytopenia; and hemolytic anemia
PNH
Endomyocardial fibrosis with prominent eosinophilic infiltrates and hemochromatosis
Lofflers syndrome
White spots on retina surrounded by hemorrhage
roth spots of bacterial endocarditis
Drugs/states that cause digoxin toxicity
renal failure; hypokalemia; quinidine
class of antiarrhythmics that cause thrombocytopenia?
IA
high hcg
Downsyndrome, chorio, dysgerminoma,hydaditiform mole
Prevent nephrotoxicity of cisplatin with?
amifostine
1 of 2 viruses that infect a cell has a mutation that results in a nonfunctional protein. the nonmutated virus helps out the mutated one by making a functional protein that serves both viruses
Complementation
Genome of virus A coated with surface proteins of virus b?
Phenotypic mixing
