Test 46: Pathology Flashcards
1
Q
Hepatits B virus infection can produce one of three syndromes
A
- acute hepatitis with complete resolution (most common)
- chronic hepatitis ( with or without cirrhosis and increase risk of hepatocellular carcinoma)
- fulminant hepatitis with liver necrosis
2
Q
PE for lead poisoning
A
blue “lead lines” at junction of teeth and gingival
3
Q
diagnostic finding on peripheral blood smear for lead poisoning
A
basophilic stippling on background of hypo chromic microcytic anemia
4
Q
what does lead inhibit
A
ferrochelatase and ALA dehydratase
5
Q
What is Mesothelioma
A
rare malignant neoplasm arising from mesothelial cells, which line body cavities
6
Q
exposure to what is the primary risk factor for mesothelioma
A
asbestos
- mining and industrial applications
7
Q
histo for mesothelioma
A
- long slender microvilli
2. abundant tonofilaments
8
Q
Difference between adenocarcinoma and mesothelioma
A
adenocarcinoma: short and plump microvilli
9
Q
Meningioma is derived from what
A
meningothelial cells of arachnoid
10
Q
symptoms of Meningioma
A
often asymptomatic
- seizures or focal neurologic signs
11
Q
histo for Meningioma
A
- Spindle cells arranged in whorled pattern
- psammoma bodies (eosinophilic laminar structures)
12
Q
location of meningiomas
A
cerebral convexities in adults
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
14
Q
What causes Zollinger-Ellison syndrome
A
- gastrin-secreting neuroendocrine tumor ( gastrinomas)
- located in small intestines or pancreas
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
16
Q
Zollinger-Ellison patients should get tested to rule out
A
multiple endocrine neoplasia type 1
17
Q
pathophysiology of thrombocitic thrombocytopenia purpura
A
- decrease or deficiency of ADAMTS13
18
Q
role of ADAMST13
A
normally cleaves vRF multimers into smaller monomers for depredation
19
Q
patient with new-onset neurologic symptoms, anemia with schistocytes, thrombocytopenia, and acute kidney injury has
A
thrombotic thrombocytopenia purport TTP
20
Q
disseminated intravascular coagulation results from
A
abnormal activation of coagulation cascade
21
Q
What is acute calculous cholecystitis
A
acute inflammation of gallbladder initiated by gallstone obstruction of cystic duct
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
23
Q
Klinefelter syndrome
A
47 XXY
24
Q
in Klinefelter what is damaged in males
A
Leydig cells resulting in low testosterone
- excess gonadoptropins
- increase estrogen
25
PE for Klinefelter syndrome
- low testosterone
- tall
- gynecomastia
- learning and social difficulties
26
what can cause concentric hypertrophy
- long standing hypertension
- aortic stenosis
- - all increase LV afterload
27
What are 3 type of glial cells
1. astrocytes
2. Oligodendrocytes
3. microglia
28
function of astrocyte
tissue repaire
| - proliferate cite of injury: astrocytosis
29
gliosis
proliferation of astrocytes in an area of neuron degeneration
30
What happens to shrunken and deeply eosinophilic neurons of CNS
cell death, phagocytized by microglia
31
Aspirin is a mainstay treatment for what disease
Kawasaki
32
how is the liver impacted in Reye syndrome
microvesicular steatosis of hepatocytes without inflammation and cerebral edema
33
what is NF-kB
transcription factors
| - role in immune response to infection and inflammation
34
what inhibits NF-kB
IkB kinase
35
how is IkB kinase degraded
ubiquitination
36
Activated protein C inactivates what
factors Va and VIIIa
37
clinical manifestations of factor V leiden include 3 things
1. deep vein thrombosis
2. cerebral vein thrombosis
3. recurrent pregnancy
38
Most common cause of factor V leiden
- inherited hypergoagulabilty in Caucasian
39
patient with distal duodenal ulcer and high-normal gastrin levels have what
Zollinger-Ellison syndrome
40
ulcers found beyond duodenal bulb suggests what syndrome
Zollinger-Ellison
41
Secretin is released from where
duodenum
42
Action of Secretin
- increase pancreatic bicarb secretion
| - inhibit gastrin
43
exogenous secretin stimualtes what
gastrin release from gastronomes
44
Diabetic CN III mononeuropathy presents
1. acute onset diplopia
2. "down and out" position
3. ptosis
45
what causes diabetic mononeuropathy
ischemic nerve damage, usually CN III
46
why is pupillary size and reactivity normal in diabetic CN III mononeuropathy
autonomic component for pupillary contraction and accommodation is located in the peripheral aspect of nerve. central is what gets damaged
47
Patient with abdominal pain/distension, bloody diarrhea, fever and signs of shock in setting of untreated ulcerative colitis like has? diagnostic imaging
toxic megacolon
| - abdominal X-ray to se colonic dilation
48
what diagnostic studies are contraindicated in toxic megacolon
1. barium contrast
| 2. colonoscopy
49
Gastric biopsy specimen are taken for direct diagnosis for what
H. pylori infection
50
Urease impact on urea
convert urea to carbon dioxide and ammonia
| - causes pH increase
51
C-anca is found in what type of patients
- granulomatosis with polyangiitis (wegener's)
52
What three things are involved in granulomatous vasculitis
1 pulmonary symptoms
2. upper respriatory tract
3. renal disease
53
Granulomatosis with polyangiitis ( wegener's) causes what to the kidney
progressive crescentic glomerulonephritis typ 3
54
Role of Prostacyclin in vessels
1. inhibits platelet aggregation and adhesion to endothelium
2. vasodialtes
3. increases permeability
55
Protein C needs what vitamin
vitamin K
56
pt. early onset asthma, wrist drop, increase eosinophils in blood, antibodies against neutrophil myeloperoxidase, rhino sinusitis
eosinophilic granulomatosis with polyangiitis
57
antibodies against neutrophil myeloperoxisdase is what test
p-ANCA
58
Another name for Eosinophilic granulomatosis with polyangiitis
Churg-Strauss
59
Irreversible cell injury in brain leads to
liquefactive necrosis
60
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?
- transmural infarct of anterolateral left ventricle
| - obstructive thrombus superimposed on a ruptured atherosclerotic coronary artery plaque
61
Overlying skin retraction on breast such as dimpling involves what structure
suspensory ligament ( cooper ligament)
62
Most common location of invasive breast carcinoma
upper outer quadrant
63
what expresses CD31
PECAM1
| platelet endothelial cell adhesion molecule
64
What is liver angiosarcoma
rare malignant vascular endothelial cell neoplasm associated with carcinogen exposure
arsenic and polyvinyl chloride
65
Most common type of lung cancer in the US
Adenocarcinoma in situ ( bronchioalveolar carcinoma)
66
Adenocarcinoma in situ of lung is located where and characterize it
- periphery of lung
| - growth along intact alveolar septa
67
histo for adenocarcinoma in situ of lung
well-differentiated, dysplastic columnar cells
68
clinical manifestation of adenocarcinoma in situ of lung
- bronchorrhea --> watery sputum
69
What is medullary thyroid cancer
tumors of parafollicular calcitonin-secreting C-cells
70
mutation in medullary thyroid cancer
RET proto-oncogene
71
role of RET proto-oncogene
codes membrane bound tyrosine kinase receptor
72
Myeloblast nuclei have what? what does it stain for?
Auer rods that stain for peroxidase
73
Hairy cell leukemia stain for what
TRAP
| tartate resistant acid phosphatase
74
When do you see myeloblast in blood smear
acute myelogenous leukemia
75
finding of impaired sperm motility raises concern for what
primary ciliary dyskinesia
76
PE for primary ciliary dyskinesia? Also called
1. chronic sinusitis
2. situs inversus ( received right/left positioning of internal organs)
3. infertility
Kartagener syndrome?
77
Man comes in with immobile sperm due to abnormal tail function also has what problem
persistent bronchial dilation
78
what congenital cardiac anomaly has increase risk for cerebral hemorrhage ( berry aneurysms)
Coarctation of aorta
79
pt has phospholipase A2 receptor with IgG4 antibodies, with peripheral edema and proteinuria. renal disease?
membranous nephropathy
80
what causes renal disease in multiple myeloma
deposition of light chains
81
Shrunken nuclei, detectable Nissle substance, and eosinophilic cystoplasm, what happened to cell
irreversible cell injury
82
red neuron
neuron reacting to acute irreversible damage
83
role of microglia
phagocytize dead neurons
84
Cardiac arrest leads to rapid cessation of cerebral blood flow and causes what to brain
global cerebral ishcemia
85
What is the first area damaged during global cerebral ischemia
hippocampus (pyramidal cells
| Second: neocortex and parking cells of cerebellum
86
patient with firm, palpable gallbladder and extensive calcification through out bladder wall has
porcelain gallbladder
87
Radiographic features of porcelain gallbladder
thickened gallbladder wall with rim of patchy calcification
88
Procelain gallbladder is a potential manifestation of what
chronic cholecystitis
89
Procelain gallbladder is associated with an increase risk of what
adenocarcinoma of the gallbladder
90
Acalculous cholecystitis commonly occurs in who
critically ill patients ( those with sepsis, severe burns, trauma, immunosuppression
91
what can cause acalculous cholecystitis
ischemia
92
clinical features of calculus cholecystitis
- fever
- right upper quadrant pain
- leukocytosis
93
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.
intimal tear--> aortic dissection
94
primary risk factor for aortic dissection
hypertension
95
atherosclerosis predisposes patient to what aorta problem
aortic aneurysm
96
What is Monckeberg sclerosis
calcific deposits in medial layer of muscular arteries
97
Tertiary syphilis can cause what to the heart
obliterative endarteritis of the vasa vasorum
- weakens aortic wall
- predispose to aneurysms
98
34 yr old man: low-grade fever, anorexia/nausea, dark-colored urine, right upper quadrant abdominal tenderness
acute viral hepatitis
99
what is the most common cause of acute viral hepatitis in young adults
Hep A
100
histo for acute viral hepatitis
- hepatocyte necrosis: cellular swelling and cytoplasmic emptying
- monocyte infiltration
- Councilman bodies: hepatocyte apoptosis--> cellular shrinkage and eosinophilia
101
is HAV associated with a increased risk of hepatocellular cancer
no
| but B, C and aflatoxin B exposure is
102
Middle-aged adult, presenting with dyspnea on exertion, nodular densities on x-ray, calcified hillier lymph nodes, and birefringent particles on biopsy
Silicosis
103
What is silicosis
inhalation of mineral dusts
104
What is the distinguishing feature of silicosis
- eggshell calcification and birefringent silica particles
105
What is the single most important risk factor for development of intimal tears leading to aortic dissection
hypertension
106
what congenital things can cause aortic dissection
- bicuspid valve
| - Marfan
107
Atherosclerosis predisposes aorta to what
aortic aneurysm
108
demyelination of peripheral nerves in response to administration of myelin-like susbtance
Guillain-Barre
109
Beriberi ( thiamine deficiency) can do what do peripheral nerves
demyelination
| no inflammation like Guillain-Barre
110
What causes Werdnig-Hoffman syndrome
anterior horn cell damage
111
Patients with medically intractable symptoms of Parkinson disease may benefit from high-frequency deep brain stimulation of what area
Globus pallidus or subthalamic nucleus
| - inhibit firing of nuclei
