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Uworld > Test 46: Pathology > Flashcards

Test 46: Pathology Flashcards

1
Q

Hepatits B virus infection can produce one of three syndromes

A
  1. acute hepatitis with complete resolution (most common)
  2. chronic hepatitis ( with or without cirrhosis and increase risk of hepatocellular carcinoma)
  3. fulminant hepatitis with liver necrosis
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2
Q

PE for lead poisoning

A

blue “lead lines” at junction of teeth and gingival

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3
Q

diagnostic finding on peripheral blood smear for lead poisoning

A

basophilic stippling on background of hypo chromic microcytic anemia

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4
Q

what does lead inhibit

A

ferrochelatase and ALA dehydratase

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5
Q

What is Mesothelioma

A

rare malignant neoplasm arising from mesothelial cells, which line body cavities

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6
Q

exposure to what is the primary risk factor for mesothelioma

A

asbestos

- mining and industrial applications

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7
Q

histo for mesothelioma

A
  1. long slender microvilli

2. abundant tonofilaments

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8
Q

Difference between adenocarcinoma and mesothelioma

A

adenocarcinoma: short and plump microvilli

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9
Q

Meningioma is derived from what

A

meningothelial cells of arachnoid

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10
Q

symptoms of Meningioma

A

often asymptomatic

- seizures or focal neurologic signs

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11
Q

histo for Meningioma

A
  • Spindle cells arranged in whorled pattern

- psammoma bodies (eosinophilic laminar structures)

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12
Q

location of meningiomas

A

cerebral convexities in adults

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13
Q

46 yr old women: persistent diarrhea, weight loss, abdominal pain, diarrhea improves with fasting. Endoscopy shows post bulbar duodenal and jejunal ulcers

A

Zollinger-Ellison syndrome

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14
Q

What causes Zollinger-Ellison syndrome

A
  • gastrin-secreting neuroendocrine tumor ( gastrinomas)

- located in small intestines or pancreas

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15
Q

role of gastrin? can cause

A

stimulate gastric acid production

  • peptic ulcer that can be located beyond the duodenal bulb
  • diarrhea b/c pancreatic intestinal enzymes inactivated by gastronome
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16
Q

Zollinger-Ellison patients should get tested to rule out

A

multiple endocrine neoplasia type 1

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17
Q

pathophysiology of thrombocitic thrombocytopenia purpura

A
  • decrease or deficiency of ADAMTS13
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18
Q

role of ADAMST13

A

normally cleaves vRF multimers into smaller monomers for depredation

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19
Q

patient with new-onset neurologic symptoms, anemia with schistocytes, thrombocytopenia, and acute kidney injury has

A

thrombotic thrombocytopenia purport TTP

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20
Q

disseminated intravascular coagulation results from

A

abnormal activation of coagulation cascade

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21
Q

What is acute calculous cholecystitis

A

acute inflammation of gallbladder initiated by gallstone obstruction of cystic duct

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22
Q

Persistent gallbladder outflow obstruction promotes what

A

hydrolysis of luminal lecithins to lysolecithins , disrupts protective mucus layer

  • exposed to bile salts releasing prostaglandin
  • inflammation causes hypo motility
  • ischemia
  • bacteria invade injured and necrotic gallbladder wall
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23
Q

Klinefelter syndrome

A

47 XXY

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24
Q

in Klinefelter what is damaged in males

A

Leydig cells resulting in low testosterone

  • excess gonadoptropins
  • increase estrogen
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25
Q

PE for Klinefelter syndrome

A
  • low testosterone
  • tall
  • gynecomastia
  • learning and social difficulties
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26
Q

what can cause concentric hypertrophy

A
  • long standing hypertension
  • aortic stenosis
    • all increase LV afterload
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27
Q

What are 3 type of glial cells

A
  1. astrocytes
  2. Oligodendrocytes
  3. microglia
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28
Q

function of astrocyte

A

tissue repaire

- proliferate cite of injury: astrocytosis

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29
Q

gliosis

A

proliferation of astrocytes in an area of neuron degeneration

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30
Q

What happens to shrunken and deeply eosinophilic neurons of CNS

A

cell death, phagocytized by microglia

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31
Q

Aspirin is a mainstay treatment for what disease

A

Kawasaki

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32
Q

how is the liver impacted in Reye syndrome

A

microvesicular steatosis of hepatocytes without inflammation and cerebral edema

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33
Q

what is NF-kB

A

transcription factors

- role in immune response to infection and inflammation

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34
Q

what inhibits NF-kB

A

IkB kinase

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35
Q

how is IkB kinase degraded

A

ubiquitination

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36
Q

Activated protein C inactivates what

A

factors Va and VIIIa

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37
Q

clinical manifestations of factor V leiden include 3 things

A
  1. deep vein thrombosis
  2. cerebral vein thrombosis
  3. recurrent pregnancy
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38
Q

Most common cause of factor V leiden

A
  • inherited hypergoagulabilty in Caucasian
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39
Q

patient with distal duodenal ulcer and high-normal gastrin levels have what

A

Zollinger-Ellison syndrome

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40
Q

ulcers found beyond duodenal bulb suggests what syndrome

A

Zollinger-Ellison

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41
Q

Secretin is released from where

A

duodenum

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42
Q

Action of Secretin

A
  • increase pancreatic bicarb secretion

- inhibit gastrin

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43
Q

exogenous secretin stimualtes what

A

gastrin release from gastronomes

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44
Q

Diabetic CN III mononeuropathy presents

A
  1. acute onset diplopia
  2. “down and out” position
  3. ptosis
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45
Q

what causes diabetic mononeuropathy

A

ischemic nerve damage, usually CN III

46
Q

why is pupillary size and reactivity normal in diabetic CN III mononeuropathy

A

autonomic component for pupillary contraction and accommodation is located in the peripheral aspect of nerve. central is what gets damaged

47
Q

Patient with abdominal pain/distension, bloody diarrhea, fever and signs of shock in setting of untreated ulcerative colitis like has? diagnostic imaging

A

toxic megacolon

- abdominal X-ray to se colonic dilation

48
Q

what diagnostic studies are contraindicated in toxic megacolon

A
  1. barium contrast

2. colonoscopy

49
Q

Gastric biopsy specimen are taken for direct diagnosis for what

A

H. pylori infection

50
Q

Urease impact on urea

A

convert urea to carbon dioxide and ammonia

- causes pH increase

51
Q

C-anca is found in what type of patients

A
  • granulomatosis with polyangiitis (wegener’s)
52
Q

What three things are involved in granulomatous vasculitis

A

1 pulmonary symptoms

  1. upper respriatory tract
  2. renal disease
53
Q

Granulomatosis with polyangiitis ( wegener’s) causes what to the kidney

A

progressive crescentic glomerulonephritis typ 3

54
Q

Role of Prostacyclin in vessels

A
  1. inhibits platelet aggregation and adhesion to endothelium
  2. vasodialtes
  3. increases permeability
55
Q

Protein C needs what vitamin

A

vitamin K

56
Q

pt. early onset asthma, wrist drop, increase eosinophils in blood, antibodies against neutrophil myeloperoxidase, rhino sinusitis

A

eosinophilic granulomatosis with polyangiitis

57
Q

antibodies against neutrophil myeloperoxisdase is what test

A

p-ANCA

58
Q

Another name for Eosinophilic granulomatosis with polyangiitis

A

Churg-Strauss

59
Q

Irreversible cell injury in brain leads to

A

liquefactive necrosis

60
Q

ECG changes in anterior V1-V3 and lateral (I, aVL) chest leads.

ECG: ST-segment elevation in lead I, aVL and V1-3 with deep Q-wave development over next several hours mean?

A
  • transmural infarct of anterolateral left ventricle

- obstructive thrombus superimposed on a ruptured atherosclerotic coronary artery plaque

61
Q

Overlying skin retraction on breast such as dimpling involves what structure

A

suspensory ligament ( cooper ligament)

62
Q

Most common location of invasive breast carcinoma

A

upper outer quadrant

63
Q

what expresses CD31

A

PECAM1

platelet endothelial cell adhesion molecule

64
Q

What is liver angiosarcoma

A

rare malignant vascular endothelial cell neoplasm associated with carcinogen exposure
arsenic and polyvinyl chloride

65
Q

Most common type of lung cancer in the US

A

Adenocarcinoma in situ ( bronchioalveolar carcinoma)

66
Q

Adenocarcinoma in situ of lung is located where and characterize it

A
  • periphery of lung

- growth along intact alveolar septa

67
Q

histo for adenocarcinoma in situ of lung

A

well-differentiated, dysplastic columnar cells

68
Q

clinical manifestation of adenocarcinoma in situ of lung

A
  • bronchorrhea –> watery sputum
69
Q

What is medullary thyroid cancer

A

tumors of parafollicular calcitonin-secreting C-cells

70
Q

mutation in medullary thyroid cancer

A

RET proto-oncogene

71
Q

role of RET proto-oncogene

A

codes membrane bound tyrosine kinase receptor

72
Q

Myeloblast nuclei have what? what does it stain for?

A

Auer rods that stain for peroxidase

73
Q

Hairy cell leukemia stain for what

A

TRAP

tartate resistant acid phosphatase

74
Q

When do you see myeloblast in blood smear

A

acute myelogenous leukemia

75
Q

finding of impaired sperm motility raises concern for what

A

primary ciliary dyskinesia

76
Q

PE for primary ciliary dyskinesia? Also called

A
  1. chronic sinusitis
  2. situs inversus ( received right/left positioning of internal organs)
  3. infertility

Kartagener syndrome?

77
Q

Man comes in with immobile sperm due to abnormal tail function also has what problem

A

persistent bronchial dilation

78
Q

what congenital cardiac anomaly has increase risk for cerebral hemorrhage ( berry aneurysms)

A

Coarctation of aorta

79
Q

pt has phospholipase A2 receptor with IgG4 antibodies, with peripheral edema and proteinuria. renal disease?

A

membranous nephropathy

80
Q

what causes renal disease in multiple myeloma

A

deposition of light chains

81
Q

Shrunken nuclei, detectable Nissle substance, and eosinophilic cystoplasm, what happened to cell

A

irreversible cell injury

82
Q

red neuron

A

neuron reacting to acute irreversible damage

83
Q

role of microglia

A

phagocytize dead neurons

84
Q

Cardiac arrest leads to rapid cessation of cerebral blood flow and causes what to brain

A

global cerebral ishcemia

85
Q

What is the first area damaged during global cerebral ischemia

A

hippocampus (pyramidal cells

Second: neocortex and parking cells of cerebellum

86
Q

patient with firm, palpable gallbladder and extensive calcification through out bladder wall has

A

porcelain gallbladder

87
Q

Radiographic features of porcelain gallbladder

A

thickened gallbladder wall with rim of patchy calcification

88
Q

Procelain gallbladder is a potential manifestation of what

A

chronic cholecystitis

89
Q

Procelain gallbladder is associated with an increase risk of what

A

adenocarcinoma of the gallbladder

90
Q

Acalculous cholecystitis commonly occurs in who

A

critically ill patients ( those with sepsis, severe burns, trauma, immunosuppression

91
Q

what can cause acalculous cholecystitis

A

ischemia

92
Q

clinical features of calculus cholecystitis

A
  • fever
  • right upper quadrant pain
  • leukocytosis
93
Q

58 yr old patient: abrupt-onset severe chest pain radiates to his back, blood pressure higher in left arm than right arm but both high. no ST- segment elevation.

A

intimal tear–> aortic dissection

94
Q

primary risk factor for aortic dissection

A

hypertension

95
Q

atherosclerosis predisposes patient to what aorta problem

A

aortic aneurysm

96
Q

What is Monckeberg sclerosis

A

calcific deposits in medial layer of muscular arteries

97
Q

Tertiary syphilis can cause what to the heart

A

obliterative endarteritis of the vasa vasorum

  • weakens aortic wall
  • predispose to aneurysms
98
Q

34 yr old man: low-grade fever, anorexia/nausea, dark-colored urine, right upper quadrant abdominal tenderness

A

acute viral hepatitis

99
Q

what is the most common cause of acute viral hepatitis in young adults

A

Hep A

100
Q

histo for acute viral hepatitis

A
  • hepatocyte necrosis: cellular swelling and cytoplasmic emptying
  • monocyte infiltration
  • Councilman bodies: hepatocyte apoptosis–> cellular shrinkage and eosinophilia
101
Q

is HAV associated with a increased risk of hepatocellular cancer

A

no

but B, C and aflatoxin B exposure is

102
Q

Middle-aged adult, presenting with dyspnea on exertion, nodular densities on x-ray, calcified hillier lymph nodes, and birefringent particles on biopsy

A

Silicosis

103
Q

What is silicosis

A

inhalation of mineral dusts

104
Q

What is the distinguishing feature of silicosis

A
  • eggshell calcification and birefringent silica particles
105
Q

What is the single most important risk factor for development of intimal tears leading to aortic dissection

A

hypertension

106
Q

what congenital things can cause aortic dissection

A
  • bicuspid valve

- Marfan

107
Q

Atherosclerosis predisposes aorta to what

A

aortic aneurysm

108
Q

demyelination of peripheral nerves in response to administration of myelin-like susbtance

A

Guillain-Barre

109
Q

Beriberi ( thiamine deficiency) can do what do peripheral nerves

A

demyelination

no inflammation like Guillain-Barre

110
Q

What causes Werdnig-Hoffman syndrome

A

anterior horn cell damage

111
Q

Patients with medically intractable symptoms of Parkinson disease may benefit from high-frequency deep brain stimulation of what area

A

Globus pallidus or subthalamic nucleus

- inhibit firing of nuclei

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