Test 41: Pathology Flashcards
16-yr old boy confusion, fatigue, abdominal pain, excessive thirst, and polyuria.
Urine dipstick: positive for glucose and ketones
What does he have
diabetic ketoacidosis
Diabetic ketoacidosis commonly affects patients with what type of diabetes
Type 1 diabetes mellitus
What happens in type I diabetes
autoimmune response against pancreatic beta cells
- destruction of beta cells through cell-mediated immunity
insulitis
infiltration of islets by inflammatory cells
Insulin resistance accompanied by relative insulin deficiency is main cause of what
type 2 diabetes mellitus
Cystinuria
hereditary defect in renal PCT and intestinal amino acid transporter
cystinuria prevents absorption of what
COLA cystine ornithine lysine arginine
how does cystinuria impact intestines and kidney
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)
What are risk factors for cysteine precipitation
- low urine pH
- presence of preexisting crystal nidus and urine supersaturation
aortic dissection is a well-known complication of what disease
Marfan syndrome
how is cystinuria inherited
autosomal recessive
What hormones cannot be synthesized in congenital adrenal hyperplasia caused by 21-hydroxlase deficiency
aldosterone and cortisol
What hormone and over synthesized in 21-hydroxylase deficiency and why?
adrenal androgens
- low cortisol level increases ACTH, since aldosterone and cortisol not made, increase androgen
- increase 17-hydroxyprogesterone
clinical manifestations of 21-hydroxylase
female: virillization
made: normal genitalia
Both: salt-wasting, hypoglycemia,
1 week old boy: vomiting, poor feeding, dehydrated, hypotensive, hyperkalemia, hyponatremia. What does he have
21-hydroxylase deficiency
What is the strongest risk factor for cervical dysplasia and carcinoma
infection with human papillomarvirus (HPV) type 16 or 18
- need immune system to fight off
27 yr old man: muscle weakness, high blood pressure, very low plasma renin activity? what does he have
primary hyperaldosteronism
What causes primary hyperaldosteronism
- increase secretion of mineralocorticoids from bilateral nodular hyperplasia of adrenal zona glomerulosa
- aldosterone-producing adrenal adenoma (Conn syndrome)
What causes muscle weakness in hyeraldosteronism
hypokalemia
Why is there no edema in hyperaldosteronism
aldosterone escape
- increase renal blood flow and release of atrial natriuretic peptide –> increase sodium excretion
where does pheochromocytoma occur
- chromatin cells of adrenal medulla or extra-adrenal sympathetic chain
Kimmelsteil-Wilson nodules are diagnostic for what
nodular glomerulosclerosis
Characterize Kimmelsteil-Wilson
- peripheral mesangium
- ovoid or spherical
What is the most common cause of nodular glomerulosclerosis
Diabetic nephropathy
What is nodular glomerulosclerosis
- glomerular basement membrane thickening
- increased mesangial matrix deposition
nodular glomerulosclerosis leads to what
nephrotic syndrome to renal failure
minimal change disease on electron microscopy
podocyte foot process effacement
Minimal change disease can occur secondary to what
allergic reaction due to pollen/dust, insect stings, or immunization
Hep C is associated with what kidney problem
membranoproliferative glomerulonephritis
Focal segmental glomerulosclerosis can develop secondary to what
HIV
heroin
severe obesity
in poststreptococal glomerulonephritis, light microscopy shows
diffuse glomerular hypercellularity
What happens in amniotic fluid embolism
fetal squamous cells in maternal pulmonary arteries
Hallmark of respiratory distress syndrome
hyaline membranes living alveolar ducts
Where is a common lung location for aspiration pneumonia
lower lobe of right lung
Common sings for amniotic fluid embolism
hypoxia
hypotensive shock
DIC
3week-old male: projectile non-bilious vomiting after every meal, prominent peristalsis in epigastrium, olive-sized mass on deep palpation of right upper abdomen?
congenital pyloric stenosis
congenital pyloric stenosis arises secondary to what problem
hypertrophy of pyloric muscular mucosae
Free wall rupture of the heart is a catastrophic mechanical complication of what
transmural MI
when does Free wall rupture of the heart typically occur? what does it look like
first 5-14 days after MI
- slit-like tear
Abrupt rupture of left ventricle leads to what
cardiac tamponade –> profound shock
What is the most common cause of sudden cardiac death within the first 48-72 hours after an MI
ventricular arrhythmias
What is pulses paradoxus
exaggerated drop ( less than 10 mmHg) in systolic blood pressure during inspiration
how is pulses paradoxus calculated
- 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
how does inspiration impact blood vessels
increase systemic venous retune
impair expansion into pericardial space of heart, increased right ventricular volume with inspiration leads to what
bowing of inter ventricular septum toward left ventricle
Pulsus paradoxus is seen in what conditions
cardiac tamponade, asthma, obstructuve sleep apnea, pericarditis, croup
Patient presents with dyspnea, tachypnea, prolonged expiration, bilateral wheezing
obstructive pulmonary disease
What is acute obstructive pulmonary disease treated with
beta-adrenergic agonists
MOA for beta-adrenergic agonists
Gs protein
- adenylyl cyclase
- increase cCAMP
role of Cromolyn sodium
inhibits mast cell degranulation and release of histamine and leukotrienes
acute synovitis is best evaluated with what
diagnostic arthrocentesis and synovial fluid analysis
- fluid sent for crystal analysis, cell count, gram stain/culture
patient with well-demarcated, scaly erythematous plaques involving extensor surfaces of extremities has features of what
psoriasis
Additional complications of psoriasis
- arthritis
- nail changes: yellow-brown discoloration, pitting
- inflammatory disorder of eye: uveitis
What characterizes dermatitis herpetiformis
- erythematous prussic papules, vesicles, and bull on extensor surfaces, upper back, and buttocks.
Dermatiti herpetiformis is associated with what
celiac disease and IgA antibodies against gliadin
What causes Gaucher disease
autosomal recessive
- beta-glucocerebrosidase deficiency
- accumulation of glucocerebroside and glycolipid component of leukocyte and erythrocyte membranes
Describe Gaucher cells
-lipid-laden macrophages
“wrinkled tissue paper”
symptoms of gaucher
- abdominal dissension due to hepatosplenomegaly
- fatigue due to pancytopenia
Clinical presentation for Hodgkin lymphoma
- nontender lymphadenopathy
- B symptoms ( fevers, night sweats, weight loss)
What age group does Hodgkin lymphoma attack
bimodal
20’s then 60’s
in lymph node biopsy, what distinguishes Hodgkin Lymphoma
Reed-Sternberg cells
Burkitt lymphoma presents a mass where
abdomen, pelvis, or jaw
Histo for Burkitt lymphoma
- “starry sky” appearance
- sheets of lymphocytes with interspersed “tangible Body” macrophages
clinical presentation for follicular lymphoma
“waxing and waning” lymphadenopathy