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Uworld_sitr > Test 41: Pathology > Flashcards

Test 41: Pathology Flashcards

1
Q

16-yr old boy confusion, fatigue, abdominal pain, excessive thirst, and polyuria.
Urine dipstick: positive for glucose and ketones

What does he have

A

diabetic ketoacidosis

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2
Q

Diabetic ketoacidosis commonly affects patients with what type of diabetes

A

Type 1 diabetes mellitus

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3
Q

What happens in type I diabetes

A

autoimmune response against pancreatic beta cells

- destruction of beta cells through cell-mediated immunity

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4
Q

insulitis

A

infiltration of islets by inflammatory cells

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5
Q

Insulin resistance accompanied by relative insulin deficiency is main cause of what

A

type 2 diabetes mellitus

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6
Q

Cystinuria

A

hereditary defect in renal PCT and intestinal amino acid transporter

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7
Q

cystinuria prevents absorption of what

A 
COLA
cystine
ornithine
lysine
arginine
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8
Q

how does cystinuria impact intestines and kidney

A

intestine: do not develop deficiency, aa absorbed in sufficient quantities as oligopeptides
kidney: formation of cystine kidney stones (ornithine, lysine and arginine soluble in urine)

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9
Q

What are risk factors for cysteine precipitation

A
  • low urine pH

- presence of preexisting crystal nidus and urine supersaturation

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10
Q

aortic dissection is a well-known complication of what disease

A

Marfan syndrome

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11
Q

how is cystinuria inherited

A

autosomal recessive

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12
Q

What hormones cannot be synthesized in congenital adrenal hyperplasia caused by 21-hydroxlase deficiency

A

aldosterone and cortisol

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13
Q

What hormone and over synthesized in 21-hydroxylase deficiency and why?

A

adrenal androgens

  • low cortisol level increases ACTH, since aldosterone and cortisol not made, increase androgen
  • increase 17-hydroxyprogesterone
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14
Q

clinical manifestations of 21-hydroxylase

A

female: virillization
made: normal genitalia

Both: salt-wasting, hypoglycemia,

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15
Q

1 week old boy: vomiting, poor feeding, dehydrated, hypotensive, hyperkalemia, hyponatremia. What does he have

A

21-hydroxylase deficiency

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16
Q

What is the strongest risk factor for cervical dysplasia and carcinoma

A

infection with human papillomarvirus (HPV) type 16 or 18

- need immune system to fight off

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17
Q

27 yr old man: muscle weakness, high blood pressure, very low plasma renin activity? what does he have

A

primary hyperaldosteronism

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18
Q

What causes primary hyperaldosteronism

A
  1. increase secretion of mineralocorticoids from bilateral nodular hyperplasia of adrenal zona glomerulosa
  2. aldosterone-producing adrenal adenoma (Conn syndrome)
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19
Q

What causes muscle weakness in hyeraldosteronism

A

hypokalemia

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20
Q

Why is there no edema in hyperaldosteronism

A

aldosterone escape

- increase renal blood flow and release of atrial natriuretic peptide –> increase sodium excretion

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21
Q

where does pheochromocytoma occur

A
  • chromatin cells of adrenal medulla or extra-adrenal sympathetic chain
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22
Q

Kimmelsteil-Wilson nodules are diagnostic for what

A

nodular glomerulosclerosis

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23
Q

Characterize Kimmelsteil-Wilson

A
  • peripheral mesangium

- ovoid or spherical

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24
Q

What is the most common cause of nodular glomerulosclerosis

A

Diabetic nephropathy

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25
Q

What is nodular glomerulosclerosis

A
  • glomerular basement membrane thickening

- increased mesangial matrix deposition

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26
Q

nodular glomerulosclerosis leads to what

A

nephrotic syndrome to renal failure

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27
Q

minimal change disease on electron microscopy

A

podocyte foot process effacement

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28
Q

Minimal change disease can occur secondary to what

A

allergic reaction due to pollen/dust, insect stings, or immunization

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29
Q

Hep C is associated with what kidney problem

A

membranoproliferative glomerulonephritis

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30
Q

Focal segmental glomerulosclerosis can develop secondary to what

A

HIV
heroin
severe obesity

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31
Q

in poststreptococal glomerulonephritis, light microscopy shows

A

diffuse glomerular hypercellularity

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32
Q

What happens in amniotic fluid embolism

A

fetal squamous cells in maternal pulmonary arteries

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33
Q

Hallmark of respiratory distress syndrome

A

hyaline membranes living alveolar ducts

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34
Q

Where is a common lung location for aspiration pneumonia

A

lower lobe of right lung

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35
Q

Common sings for amniotic fluid embolism

A

hypoxia
hypotensive shock
DIC

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36
Q

3week-old male: projectile non-bilious vomiting after every meal, prominent peristalsis in epigastrium, olive-sized mass on deep palpation of right upper abdomen?

A

congenital pyloric stenosis

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37
Q

congenital pyloric stenosis arises secondary to what problem

A

hypertrophy of pyloric muscular mucosae

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38
Q

Free wall rupture of the heart is a catastrophic mechanical complication of what

A

transmural MI

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39
Q

when does Free wall rupture of the heart typically occur? what does it look like

A

first 5-14 days after MI

- slit-like tear

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40
Q

Abrupt rupture of left ventricle leads to what

A

cardiac tamponade –> profound shock

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41
Q

What is the most common cause of sudden cardiac death within the first 48-72 hours after an MI

A

ventricular arrhythmias

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42
Q

What is pulses paradoxus

A

exaggerated drop ( less than 10 mmHg) in systolic blood pressure during inspiration

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43
Q

how is pulses paradoxus calculated

A
  • diference in systolic pressure at which Korotokoff sounds are first audible during expiration AND pressure when Korotkoff sounds are heard throughout all phases of respiration
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44
Q

how does inspiration impact blood vessels

A

increase systemic venous retune

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45
Q

impair expansion into pericardial space of heart, increased right ventricular volume with inspiration leads to what

A

bowing of inter ventricular septum toward left ventricle

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46
Q

Pulsus paradoxus is seen in what conditions

A

cardiac tamponade, asthma, obstructuve sleep apnea, pericarditis, croup

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47
Q

Patient presents with dyspnea, tachypnea, prolonged expiration, bilateral wheezing

A

obstructive pulmonary disease

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48
Q

What is acute obstructive pulmonary disease treated with

A

beta-adrenergic agonists

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49
Q

MOA for beta-adrenergic agonists

A

Gs protein

  • adenylyl cyclase
  • increase cCAMP
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50
Q

role of Cromolyn sodium

A

inhibits mast cell degranulation and release of histamine and leukotrienes

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51
Q

acute synovitis is best evaluated with what

A

diagnostic arthrocentesis and synovial fluid analysis

- fluid sent for crystal analysis, cell count, gram stain/culture

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52
Q

patient with well-demarcated, scaly erythematous plaques involving extensor surfaces of extremities has features of what

A

psoriasis

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53
Q

Additional complications of psoriasis

A
  • arthritis
  • nail changes: yellow-brown discoloration, pitting
  • inflammatory disorder of eye: uveitis
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54
Q

What characterizes dermatitis herpetiformis

A
  • erythematous prussic papules, vesicles, and bull on extensor surfaces, upper back, and buttocks.
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55
Q

Dermatiti herpetiformis is associated with what

A

celiac disease and IgA antibodies against gliadin

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56
Q

What causes Gaucher disease

A

autosomal recessive

  • beta-glucocerebrosidase deficiency
  • accumulation of glucocerebroside and glycolipid component of leukocyte and erythrocyte membranes
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57
Q

Describe Gaucher cells

A

-lipid-laden macrophages

“wrinkled tissue paper”

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58
Q

symptoms of gaucher

A
  • abdominal dissension due to hepatosplenomegaly

- fatigue due to pancytopenia

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59
Q

Clinical presentation for Hodgkin lymphoma

A
  • nontender lymphadenopathy

- B symptoms ( fevers, night sweats, weight loss)

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60
Q

What age group does Hodgkin lymphoma attack

A

bimodal

20’s then 60’s

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61
Q

in lymph node biopsy, what distinguishes Hodgkin Lymphoma

A

Reed-Sternberg cells

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62
Q

Burkitt lymphoma presents a mass where

A

abdomen, pelvis, or jaw

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63
Q

Histo for Burkitt lymphoma

A
  • “starry sky” appearance

- sheets of lymphocytes with interspersed “tangible Body” macrophages

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64
Q

clinical presentation for follicular lymphoma

A

“waxing and waning” lymphadenopathy

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65
Q

2 important causes of megaloblastic anemia

A

folic acid and B12 deficiency

- required for DNA synthesis for erythropoiesis

66
Q

Which megaoblastic anemia has neurological dysfunction

A

B12

67
Q

Treating megaloblastic anemia due to vit B12 deficiency with folate does what

A

worsens the neurological dysfunction

68
Q

What type of neutrophils are seen in megaloblastic anemia

A

hypersegmented neutrophils

69
Q

what is MCV value for Vitamin B12 and folic anemias

A

greater than 110 fL

70
Q

CXR: bilateral and diffuse pattern of small irregular (reticulonodular) opacities that are most pronounced in the lower lobules

A

pulmonary fibrosis

71
Q

clinical presentation for pulmonary fibrosis

A

gradual-onset dyspnea

72
Q

PE for pulmonary fibrosis

A

end-inspiratory crackles

73
Q

Advanced pulmonary fibrosis shows up how on

A

honeycomb

74
Q

What drug is used for rheumatoid arthritis that can cause interstitial pneumonitis and fibrosis

A

Methotrexate

75
Q

Atelectasis

A

diminished air volume in part of lung due to obstruction

- opaque on CXR

76
Q

Interstitial fibrosis with cystic air space enlargement

A

idiopathic pulmonary fibrosis

77
Q

What causes honeycomb appearance for pulmonary fibrosis

A

collapse of alveolar

78
Q

FEV1/FVC ratio for restrictive disease

A

greater than 80%

79
Q

Most common benign tumor of the breast

A

Fibroadenoma

80
Q

histo for fibroadenoma

A

myxoid storm that encircles epithelium-lined glandular and cystic spaces

81
Q

How does estrogen impact fibroadenoma

A

increases with size with increased estrogen

82
Q

myasthenia gravis

A

autoantibodies directed against nicotinic acetylcholine receptors on postsynaptic membrane
- complement-mediated damage to postsynaptic membrane

83
Q

clinical presentation for myasthenia gravis

A

fluctuating weakness worsens over course of day

  • extra ocular weakness
  • may have thymoma
84
Q

pathophysiology of Lambert-Easton

A

autoantibodies to presynaptic Ca 2+ channel

- proximal muscle weakness improves with use

85
Q

Leading medical cause of death in athletes age less than 35

A

sudden cardiac death

  • hypertrophic cardiomyopathy
  • ventricular fibrillaiton or v-tach
86
Q

histo for hypertrophic cardiomyopathy

A

massive myocyte hypertrophy and myofiber disarray

87
Q

complications resulting from poor blood flow with varicose veins are

A
  • stasis dermatitis
  • skin ulcerations
  • poor wound healing
  • superficial infections
88
Q

Claudication

A

pain and weakness associated with exertion

89
Q

What is phlegmasia alba dozens? who gets it

A
  • painful white leg “milk leg”

- consequence of iliofemoral venous thrombosis occurring in permpartum women

90
Q

what characterizes small patent ductus arteriosus

A

continuous machinelike murmur

91
Q

PDA clinical features

A

clubbing and cyanosis without blood pressure or pulse discrepancy

92
Q

what is pseudo gout made of

A

calcium pryophosphate disposition disease

93
Q

where does pseudo gout occur and regular gout

A

pseudo: joints
gout: first metatarsophalangeal joint

94
Q

What is in synovial fluid for pseudogout

A
  • elevated WBC
  • neutrophilic predominance
  • Rhomboid-shaped calcium pyrophosphate crystals
95
Q

one of most common constituents of renal calculi

A

calcium oxalate

96
Q

What is deposited in gout

A

monosodium urate

97
Q

birefringment for gout and pseudogout

A

gout: negativiely birefringent
pseudogout: positiviely birefringent

98
Q

Fever, dyspnea, new blowing holosystolic murmur best heard at cardiac apex? what does patient have

A

mitral regurgitation likely due to infective endocarditis

99
Q

Describe Janeway lesions

A

nontender, macular, erythematous lesions

- typically on palms and soles

100
Q

what can cause laneway lesion

A

septic embolization from valvular vegetarians

-composed of bacteria, neutrophils, necrotic material, subcutaneous hemorrhage

101
Q

pathogenesis for Osler nodes

A

immune-complex deposition in skin

102
Q

granuloma serves to do what

A

wall off offending agent

103
Q

Th1 CD4 + cells secrete what? what does it activate

A

interferon-gamma

activates macrophages

104
Q

Marjolin’s ulcer

A

aggressive, ulcerating squamous cell carcinoma that presents in areas of previously traumatized, chronically inflamed, or scarred skin

105
Q

how do keloids form

A

excessive granulation tissue formation during tissue repair`

106
Q

Ascending paralysis that starts a few weeks after a febrile illness is a typical presentation of what? usually precedes what?

A

Guillain-Barre syndrome

- usually precedes upper respiratory or GI infection

107
Q

What happens in guillain-Barre

A

acute demyelinating disease with autoantibodies cross react with the myelin of spinal roots and peripheral nerves
- “endoneural inflammatory infiltrate” consisting of lymphocytes and macrophages

108
Q

Toxin penetration through the Blood-nerve barrier occurs in what

A

diphtheria

109
Q

Hyalinization of nerve arterioles is seen in what

A

diabetes mellitus

110
Q

Polymyositis

A

inflammatory disease of unknown etiology that affects skeletal muscles

111
Q

Pilocytic astrocytomas and medullublastomas arise where

A

cerebellum

112
Q

Sheets of primitive cells with many mitotic figures describes what cerebellar tumor

A

Medulloblastoma

113
Q

most common location of medulloblastoma

A

cerebellar vermis

114
Q

symptoms for medulloblastoma

A
  • increased intracranial pressure ( morning headache, voting, lethargy)
  • cerebellar dysfuction
115
Q

Most common brain neoplasm of childhood

A

pilocytic astrocytoma

116
Q

histo for pilocytic astrocytoma

A

astrocytes and Rosenthal fibers

117
Q

histo for ependymoma

A

rosettes

118
Q

compare prognosis for pilocytic astrocytoma and medulloblastoma

A
  • pilocytic astrocytoma: low-grade tumor, better prognosis

- medulloblastoma: bad prognosis and poorly differentiated

119
Q

pseudocyst consists of what

A

granulation tissue and no epithelial lining

120
Q

Glycogen-rich cuboidal epithelium is seen in what pancreas problem

A

serous pancreatic neoplasm

121
Q

columnar mutinous epithelium is seen in what pancreas problem

A

mucinous cystic neoplasms of pancreas

122
Q

late phase of an atopic asthma attack involves what

A

mucosal infiltration by eosinophils, basophils, neutrophils

123
Q

What protein do basophils release

A

anti-helminthic toxin

- can damage epithelial and endothelial cells

124
Q

What is Metalloproteinase

A

zinc-containing enzyme: degrease components of ECM and basement membrane

125
Q

how do tumor cells detach from each other

A

decrease expression of E-cadherins

126
Q

Most common cause of xanthelasmas

A

LDL receptor abnormality

127
Q

15 yr old girl: gait instability, mild weakness, “clumsiness” in lower limbs, hold on to rails when walking down stairs due to several recent falls, kyphoscoliosis, pets cavus, joint position and vibration impaired

A

Fredreich ataxia

128
Q

heat like in frediech ataxia

A

hypertrophic cardiomyopathy

129
Q

degeneration of spinocerebellar tracts

A

gait ataxia

130
Q

degeneration of posterior columns and dorsal root ganglia

A

impaired joint and vibration sense

131
Q

lymphoblast in precursor B-ALL are

A

TdT +
CD10
CD19

132
Q

lymphoblast in precursor T-ALL are

A

tDt
CD1a
CD2,3,4,5,7,8

133
Q

What is the most common predisposing condition for infective endocarditis in developed nations? developing nations?

A

developed: mitral valve prolapse
developing: rheumatic heart disease

134
Q

During healing process, fibroblast migration and proliferation are controlled by what growth factors

A
  • platelet-derived growth factor (PDGF)

- transforming growth factor-beta (TGF-beta)

135
Q

how is hypertrophic cardiomyopathy inherited and what happens

A

autosomal dominant

- mutations in cardiac sarcomere proteins

136
Q

left ventricular outlaw tract obstruction in heart results in what

A
  • systolic anterior motion of anterior leaflet of mitral valve toward inter ventricular septum
  • mitral regurgitation
137
Q

bcl-2 normally inhibits what

A

cell death cascade

138
Q

Follicular lymphoma has what translocation

A

t (14;18)

14: heavy-chain Ig
18: bcl-2

139
Q

What is primary biliary cirrhosis

A

autoimmune destruction of intrahepatic bile ducts and cholestasis

140
Q

who gets primary biliary cirrhosis

A

middle-aged women

141
Q

first symptom of biliary cirrhosis

A

pruritus

142
Q

paradoxical emboli

A

venous thromboembolic that enter systemic arterial circulation via intracardiac or intrapulmonary shunt. (patent foramen oval, atrial petal defect

143
Q

atrial septal defects with left-to-right shunting typically causes what sounds

A

wide and fixed splitting (no change with respiration) of 2nd heart sound

144
Q

What is diastolic decrescendo murmur

A

aortic regurgitation

145
Q

systolic ejection murmur that increases with intensity with standing is in who

A

hypertophic cadriomyopathy

146
Q

1 week old boy: normal till now. Grade II/VI harsh, holosystolic murmur best heard at the left mid to lower sternal border ? what does he have

A

small ventricular septal defect

147
Q

when do small ventral septal defects show on babies and why

A

4-10 days after born

- pulmonary vascular resistance declines, enabling left-to-right shunting

148
Q

clinical presentation of Ebstein Anomaly

A
  • cyanosis

- heart failure from severe tricuspid regurgitation

149
Q

Atrial septal defects and patent ductus arterioles are what type of heart defects?

A

non-cyanotic congenital heart disease

150
Q

What is Ebstein anomaly

A

displacement of malformed tricuspid valve into right ventricle

151
Q

patient with history of rheumatic fever now presenting with exertion dyspnea and diastolic murmur at cardiac apex most likely has what

A
  • mitral stenosis
152
Q

PE for mitral stenosis

A
  1. loud first heart sound S1
  2. Early diastolic opening snap
  3. low-pitched diastolic rumble
153
Q

Where is mitral valve best heard

A

cardiac apex

154
Q

The opening snap sound in mitral stenosis is caused by what

A

sudden opening of mitral valve leaflets when left ventricular pressure falls below he left arterial pressure at beginning of diastole

155
Q

Patient with hypertrophic cardiomyopathy has increased intensity of murmur in what position

A 
standing up (Valvsalva)
nitroglycerin administration 
- b/c they both decrease preload therefore increase murmur intensity
156
Q

Phenylphrine

A

alpha 1 agonist

157
Q

patient presents with bitemporal hemianopsia and hypogonadism ( erectile dysfunction and decreased libido)

A

prolactin-secreting pituitary adenoma

- prolactinoma

158
Q

what negatively regulates prolactin

A

dopamine from hypothalamus

159
Q

pituitary tumor can give what eye problems

A

bitemporal hemainopsia

160
Q

Prolactin surpasses what hormone

A

GnRH

161
Q

What increases prolactin recreation

A

TRH

Uworld_sitr (42 decks)

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