Test 46: Pathology Flashcards
Hepatits B virus infection can produce one of three syndromes
- acute hepatitis with complete resolution (most common)
- chronic hepatitis ( with or without cirrhosis and increase risk of hepatocellular carcinoma)
- fulminant hepatitis with liver necrosis
PE for lead poisoning
blue “lead lines” at junction of teeth and gingival
diagnostic finding on peripheral blood smear for lead poisoning
basophilic stippling on background of hypo chromic microcytic anemia
what does lead inhibit
ferrochelatase and ALA dehydratase
What is Mesothelioma
rare malignant neoplasm arising from mesothelial cells, which line body cavities
exposure to what is the primary risk factor for mesothelioma
asbestos
- mining and industrial applications
histo for mesothelioma
- long slender microvilli
2. abundant tonofilaments
Difference between adenocarcinoma and mesothelioma
adenocarcinoma: short and plump microvilli
Meningioma is derived from what
meningothelial cells of arachnoid
symptoms of Meningioma
often asymptomatic
- seizures or focal neurologic signs
histo for Meningioma
- Spindle cells arranged in whorled pattern
- psammoma bodies (eosinophilic laminar structures)
location of meningiomas
cerebral convexities in adults
46 yr old women: persistent diarrhea, weight loss, abdominal pain, diarrhea improves with fasting. Endoscopy shows post bulbar duodenal and jejunal ulcers
Zollinger-Ellison syndrome
What causes Zollinger-Ellison syndrome
- gastrin-secreting neuroendocrine tumor ( gastrinomas)
- located in small intestines or pancreas
role of gastrin? can cause
stimulate gastric acid production
- peptic ulcer that can be located beyond the duodenal bulb
- diarrhea b/c pancreatic intestinal enzymes inactivated by gastronome
Zollinger-Ellison patients should get tested to rule out
multiple endocrine neoplasia type 1
pathophysiology of thrombocitic thrombocytopenia purpura
- decrease or deficiency of ADAMTS13
role of ADAMST13
normally cleaves vRF multimers into smaller monomers for depredation
patient with new-onset neurologic symptoms, anemia with schistocytes, thrombocytopenia, and acute kidney injury has
thrombotic thrombocytopenia purport TTP
disseminated intravascular coagulation results from
abnormal activation of coagulation cascade
What is acute calculous cholecystitis
acute inflammation of gallbladder initiated by gallstone obstruction of cystic duct
Persistent gallbladder outflow obstruction promotes what
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
Klinefelter syndrome
47 XXY
in Klinefelter what is damaged in males
Leydig cells resulting in low testosterone
- excess gonadoptropins
- increase estrogen
PE for Klinefelter syndrome
- low testosterone
- tall
- gynecomastia
- learning and social difficulties
what can cause concentric hypertrophy
- long standing hypertension
- aortic stenosis
- all increase LV afterload
What are 3 type of glial cells
- astrocytes
- Oligodendrocytes
- microglia
function of astrocyte
tissue repaire
- proliferate cite of injury: astrocytosis
gliosis
proliferation of astrocytes in an area of neuron degeneration
What happens to shrunken and deeply eosinophilic neurons of CNS
cell death, phagocytized by microglia
Aspirin is a mainstay treatment for what disease
Kawasaki
how is the liver impacted in Reye syndrome
microvesicular steatosis of hepatocytes without inflammation and cerebral edema
what is NF-kB
transcription factors
- role in immune response to infection and inflammation
what inhibits NF-kB
IkB kinase
how is IkB kinase degraded
ubiquitination
Activated protein C inactivates what
factors Va and VIIIa
clinical manifestations of factor V leiden include 3 things
- deep vein thrombosis
- cerebral vein thrombosis
- recurrent pregnancy
Most common cause of factor V leiden
- inherited hypergoagulabilty in Caucasian
patient with distal duodenal ulcer and high-normal gastrin levels have what
Zollinger-Ellison syndrome
ulcers found beyond duodenal bulb suggests what syndrome
Zollinger-Ellison
Secretin is released from where
duodenum
Action of Secretin
- increase pancreatic bicarb secretion
- inhibit gastrin
exogenous secretin stimualtes what
gastrin release from gastronomes
Diabetic CN III mononeuropathy presents
- acute onset diplopia
- “down and out” position
- ptosis
what causes diabetic mononeuropathy
ischemic nerve damage, usually CN III
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
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
what diagnostic studies are contraindicated in toxic megacolon
- barium contrast
2. colonoscopy
Gastric biopsy specimen are taken for direct diagnosis for what
H. pylori infection
Urease impact on urea
convert urea to carbon dioxide and ammonia
- causes pH increase
C-anca is found in what type of patients
- granulomatosis with polyangiitis (wegener’s)
What three things are involved in granulomatous vasculitis
1 pulmonary symptoms
- upper respriatory tract
- renal disease
Granulomatosis with polyangiitis ( wegener’s) causes what to the kidney
progressive crescentic glomerulonephritis typ 3
Role of Prostacyclin in vessels
- inhibits platelet aggregation and adhesion to endothelium
- vasodialtes
- increases permeability
Protein C needs what vitamin
vitamin K
pt. early onset asthma, wrist drop, increase eosinophils in blood, antibodies against neutrophil myeloperoxidase, rhino sinusitis
eosinophilic granulomatosis with polyangiitis
antibodies against neutrophil myeloperoxisdase is what test
p-ANCA
Another name for Eosinophilic granulomatosis with polyangiitis
Churg-Strauss
Irreversible cell injury in brain leads to
liquefactive necrosis
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
Overlying skin retraction on breast such as dimpling involves what structure
suspensory ligament ( cooper ligament)
Most common location of invasive breast carcinoma
upper outer quadrant
what expresses CD31
PECAM1
platelet endothelial cell adhesion molecule
What is liver angiosarcoma
rare malignant vascular endothelial cell neoplasm associated with carcinogen exposure
arsenic and polyvinyl chloride
Most common type of lung cancer in the US
Adenocarcinoma in situ ( bronchioalveolar carcinoma)
Adenocarcinoma in situ of lung is located where and characterize it
- periphery of lung
- growth along intact alveolar septa
histo for adenocarcinoma in situ of lung
well-differentiated, dysplastic columnar cells
clinical manifestation of adenocarcinoma in situ of lung
- bronchorrhea –> watery sputum
What is medullary thyroid cancer
tumors of parafollicular calcitonin-secreting C-cells
mutation in medullary thyroid cancer
RET proto-oncogene
role of RET proto-oncogene
codes membrane bound tyrosine kinase receptor
Myeloblast nuclei have what? what does it stain for?
Auer rods that stain for peroxidase
Hairy cell leukemia stain for what
TRAP
tartate resistant acid phosphatase
When do you see myeloblast in blood smear
acute myelogenous leukemia
finding of impaired sperm motility raises concern for what
primary ciliary dyskinesia
PE for primary ciliary dyskinesia? Also called
- chronic sinusitis
- situs inversus ( received right/left positioning of internal organs)
- infertility
Kartagener syndrome?
Man comes in with immobile sperm due to abnormal tail function also has what problem
persistent bronchial dilation
what congenital cardiac anomaly has increase risk for cerebral hemorrhage ( berry aneurysms)
Coarctation of aorta
pt has phospholipase A2 receptor with IgG4 antibodies, with peripheral edema and proteinuria. renal disease?
membranous nephropathy
what causes renal disease in multiple myeloma
deposition of light chains
Shrunken nuclei, detectable Nissle substance, and eosinophilic cystoplasm, what happened to cell
irreversible cell injury
red neuron
neuron reacting to acute irreversible damage
role of microglia
phagocytize dead neurons
Cardiac arrest leads to rapid cessation of cerebral blood flow and causes what to brain
global cerebral ishcemia
What is the first area damaged during global cerebral ischemia
hippocampus (pyramidal cells
Second: neocortex and parking cells of cerebellum
patient with firm, palpable gallbladder and extensive calcification through out bladder wall has
porcelain gallbladder
Radiographic features of porcelain gallbladder
thickened gallbladder wall with rim of patchy calcification
Procelain gallbladder is a potential manifestation of what
chronic cholecystitis
Procelain gallbladder is associated with an increase risk of what
adenocarcinoma of the gallbladder
Acalculous cholecystitis commonly occurs in who
critically ill patients ( those with sepsis, severe burns, trauma, immunosuppression
what can cause acalculous cholecystitis
ischemia
clinical features of calculus cholecystitis
- fever
- right upper quadrant pain
- leukocytosis
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
primary risk factor for aortic dissection
hypertension
atherosclerosis predisposes patient to what aorta problem
aortic aneurysm
What is Monckeberg sclerosis
calcific deposits in medial layer of muscular arteries
Tertiary syphilis can cause what to the heart
obliterative endarteritis of the vasa vasorum
- weakens aortic wall
- predispose to aneurysms
34 yr old man: low-grade fever, anorexia/nausea, dark-colored urine, right upper quadrant abdominal tenderness
acute viral hepatitis
what is the most common cause of acute viral hepatitis in young adults
Hep A
histo for acute viral hepatitis
- hepatocyte necrosis: cellular swelling and cytoplasmic emptying
- monocyte infiltration
- Councilman bodies: hepatocyte apoptosis–> cellular shrinkage and eosinophilia
is HAV associated with a increased risk of hepatocellular cancer
no
but B, C and aflatoxin B exposure is
Middle-aged adult, presenting with dyspnea on exertion, nodular densities on x-ray, calcified hillier lymph nodes, and birefringent particles on biopsy
Silicosis
What is silicosis
inhalation of mineral dusts
What is the distinguishing feature of silicosis
- eggshell calcification and birefringent silica particles
What is the single most important risk factor for development of intimal tears leading to aortic dissection
hypertension
what congenital things can cause aortic dissection
- bicuspid valve
- Marfan
Atherosclerosis predisposes aorta to what
aortic aneurysm
demyelination of peripheral nerves in response to administration of myelin-like susbtance
Guillain-Barre
Beriberi ( thiamine deficiency) can do what do peripheral nerves
demyelination
no inflammation like Guillain-Barre
What causes Werdnig-Hoffman syndrome
anterior horn cell damage
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
