Test 48: Pathology Flashcards
The 2 most important factors in osteoclast differentiation to osteoclasts include
M-CSF: macrophage colony-stimulating factor
RANK-L: receptor for activated nuclear factor kappa B ligand
Interaction of RANK-L with RANK is blocked by what
osteoprotegerin (OPG)
Bone turnover is regulated by what ratio
OPG to RANK-L
Estrogen role on bone
- inducing production of OPG by osteoblasts and stromal cells
- decrease RANK on osteoclast precursor
drug used in postmenopausal osteoprosis
Denosumab
Skin rash, photosensitivity, arthralgia and renal disease in young women suggests
SLE
Name 3 antibodies in SLE
- antinuclear abs (ANA)
- anti-double stranded DNA (anti-dsDNA) abs : specific
- Anti-Smith abs : specific
Abs found in primary biliary cirrhosis
antimitochondiral abs
Liver mass with increased alpha-fetoprotein has what
hepatocellular carcinoma
which hepatitis can increase risk for hepatocellular carcinoma
B and C
how does HBV invade liver
- integration of viral DNA into genome of host hepatocytes
- tiggers neoplastic changes
14 yr old boy: minimally raised yellow spots on inner surface of abdominal aorta? what is this
fatty streaks
What is in fatty streaks
collection of lipid-laden macrophages ( foam cells)
HPV produce what viral proteins?
E6 and E7
What do E6 and E7 inhibit
E6: p53
E7: Rb
- inhibit cell cycle regulation
clinical feature of acute adrenal insufficiency ( adrenal crisis)
-hypotension/shock
treatment for acute adrenal insufficiency ( adrenal crisis)
- hydrocortisone or dexamethasone immediate
- fluid resuscitation
Patient has severe hypotension, skin hyper pigmentation, weight loss, hypothyroidism puts her at risk of other autoimmune endocrinopathies, has what
primary adrenal insufficiency
Mini-Mental Sate Examination MMSE does not test what? what can be used instead
executive function
- can be tested with clock drawing
patient must have what to demonstrate dementia
- impairment across several cognitive domains
2. functional impairment in activities of daily living
test for concentration
reciting months of year backwards
test for comprehension
following multistep commands
cerebellar vermis controls what? via?
axial/truncal posture coordination
- via medial descending motor system
acute lesions in cerebellar vermis would present as
-truncal and gait ataxia
Lesions in corticospinal tracts in cerebral subcortical white matter and brainstem cause
hemiparesis
lesions to the lower cerebellum vermis and flocculonodular lobe cause what
- vertigo/nystagmus
live biopsy shows, extensive lymphocyte infiltration and granulomatous destruction of interlobular bile ducts. what is this
primary biliary cirrhosis
What gets destroyed in primary biliary cirrhosis
-intrahepatic interlobular bile ducts
clinical features of primary biliary cirhhosis
- fatigue and pruritus ( first symptoms)
- Cholestasis
- xanthelasma
Fever, abdominal pain an jaundice in homeless man suggests
acute viral hepatitis
Fatigue and high alkaline phosphatase in a man with a long history of UC, suggests
primary sclerosing cholangitis
fever and prolonged episode of severe right upper abdominal pain after fatty mean ingestion in middle-aged, obese women suggests
acute cholecystitis
Weight loss, abdominal discomfort, jaundice and epigastric mass in older women suggests
pancreatitc cancer
What can cause functional heart murmurs in the absence of fixed valve lesion
acute hemodynamic changes
Dilatation of the left ventricle in response to increased preload can have what valve impact
functional mitral regurgitation
Holosystolic murmur over cardiac apex
mitral regurgitation
S3 gallop sound indicates
increased left ventricular filling rate during mid diastole
27 yr old male: infertility, bilateral gynecomastia, small firm testes. lower extremities are abnormally long
Klinefelter
47XXY
inhibit levels in Klinefelter
decreased because sertoli cell damage
Decreased LH, normal FSH, and evaluated testosterone in setting of low sperm count suggests
exogenous testosterone use
Normal LH and testosterone, elevated FSH, and a low spurn count suggests
cryptorchidism
D-xylose is what type of molecule
monosaccharide
what type of molecules are readily absorbed in GI tract
monosaccharides
If there is multi system invovlement and a biopsy shows transmural inflammation of the arterial wall with fibrinoid necrosis. what is ti
Polyarteritis nodosa
Polyarteritis nods greatest predisposing factor is what
Hep B
Most common vasculitis associated with antibiotic use
microscopic polyangiitis
Vasculitis linked to asthma is
Churg-Strauss syndrome
crescent formation on light microscopy is diagnostic of what renal disease
rapidly progressive (crescent) glomerulonephritis
What are 3 different abs in rapidly progressive glomerulonephritis
- antiglomerular basment membrane abs
- immune complex
- Pauce-Immune
Pauce-Immune in rapidly progressive glomerulonephritis have what in kidney and serum
- no immunoglobulin or complement deposits in basement membrane of kidney
- antineutrophil cytoplasmic abs (ANCA) in their serum
What do UVA wavelengths do to the skin
penetrate deeper into skin and cause photo aging
- decreased collagen fibril production `
how does photoaging present on skin
- thinning of epidermis
- increase cross linking of collagen, with deposition of collagen breakdown products
what is the most likely responsible for patien’ts wrinkles
- collagen fibril production
- elastin degration also occurs but not most likely
Most common primary cerebral neoplasm in adults
glioblastoma
location of glioblastoma
cerebral hemispheres
Grossly what does Glioblastoma look like
necrosis and hemorrhage
“butterfly glioma” is seen in what
Glioblastoma, when cerebral hemisphere cross midline
symptoms of low back pain and morning stiffness in young man. HLA-B2, Fusion of sacroiliac joints
akylosing spondylitis
enthesitis
pain, tenderness, and swelling at sites of tendon insertion into bone
complications from ankylosing spondylitis
- Respiratory: limit chest wall expansion, hypoventilation
- Cardiovascular: ascending atrocities lead to dilation of aoritic ring and aortic insufficiency
- Eye: anterior uveitis
Why wouldn’t peak expiration flow be a good measurement used in ankylosing spondylitis
- PEF is determined from airway resistance and abdominal wall muscular function
- Ankylosing spondylitis interrupts costovertebral and coststernal junction
At what event is dysplasia no longer considered reversible
dysplastic cells breached the basement membrane
Another name for high-grade dysplasia
carcinoma in situ
Clinical clue for degenerative osteroarheritis
relieved with rest
clinical clue for radiculopathy ( disc herniation)
- radiates to leg
- positive straight leg raise test
clinical clue for spondyloarthropathy
relieved with excercise
clinical clue for vertebral osteomyelitis
Recent infection
IV drug use
advanced age, pain that is worse at night , and persistent and progressive pain not relieved with position changes or analgesics suggests
spinal metastases
55 yr old women: fatigue, bradycardia, weight gain, constipation and slowed relaxation of deep tendon reflexes suggest
hypothyroidism
most sensitive marker for hypothyroidism
TSH serum
24 hour urinary cortisol and dexamethasone suppression test screen for what
Cushing’s syndrome
TRH stimulates what in the pituitary
prolactin
Location of Schwannomas
Cerebellopontine angle attached to CN VIII
- acoustic neuromas
what is gene is involved with Schwannomas
NF-2
Difference between NF-2 and NF-1
NF-2: fewer cutaneous manifestations
- CNS involvement
chromosome location for NF-2
22
chromosome location for NF-1
17
difference between NF-1 and NF-2 mutation
1: neurofibromin dysfunction
2: merlin dysfunction
mutation on APC gene on chromosome 5
familial adenomatous polyposis syndromes of colon cancer
mutation on RB1 on chromosome 13
retinoblastoma and osteosarcoma
mutation of VHL gene on chromosome 3
Von-Hippel-Lindau disease
45 yr old women: inability to walk, symmetric myelin layer vacuolization, axonal degeneration
vitamin B12 deficiency
what tracts are damaged in vit. B12 degeneration
- dorsal column
- lateral corticospinal tracts
- axonal degeneration of peripheral nerves
damage to dorsal column
- bilateral loss of position and vibration sensation
- gait abnormalities, especially when eyes closed
damage to lateral corticospinal tracts
upper motor neuron signs
- spastic paresis, hyperreflexia, Babinski sign
damage to axonal degeneration of peripheral nerves
numbness or parenthesis
Myelopathy associated with Vit B12 deficiency is also called
subacute combined degeneration
Poliomyelitis effects what
anterior horns of spinal cord
what is tabes dorsalis
damage to dorsal columns and dorsal roots of spinal cord
p53 is what type of gene
tumor suppressor gene
bcr-abl is what translocation? codes for? disease?
9:22 philadelphia chromsome
codes for tyrsoine kinase
chromic myelogenous leukemia
murmur for patent ductus arteriosus
-continuous murmur
heard at left infraclavicular region
Peptostreptococcus and Fusobacterium in lung means
lung abscess
Peptostreptococcus and Fusobacterium are normally found where
normal mouth flora
what are risk factors for oropharyngeal aspiration
loss of consciousness or dsyphagia
leukemoid reaction
over-exuberant WBC response associated with bacterial infection or malignancy
what is chronic myelogenous leukemia
uncontrolled mature granulocyte production
Difference between leukemoid reaction and CML
- CML: decreased alkaline phosphatase
Recurrent nephrolithiasis in young patient should raise suspicion for
cystinuria
pathogenic finding for cystinuria
hexagonal-shaped crystals
What is diagnostic test for cystinuria
sodium cyanide-nitroprusside test
What is Eczematous dermatitis
group of conditions
- erythematous, papulovesicular weeping lesions
what causes acute allergic contact dermatitis
Type IV (delayed) hypersensitivity
histo for acute eczematous dermatitis
-spongiosis: accumulation of edema fluid in intracellular spaces of epidermis
What can cause a subarachnoid hermorrhage
rupture of saccular ( berry) aneurysm or arteriovenous malformation
what can occur a couple of days after subarachnoid hemorrhage? txt?
vasospasm
- Nimodipine: calcium channel blocker
subarachnoid hemorrhage can occur between what brain layers
subarachnoid and pia mater
how do females present with 21-hydroxylase deficiency
ambitious genitalia at birth
treatment of 21-hydroxylase deficiency is targeted at directly suppressing which hormone
ACTH
costosternal syndrome (costochondritis) pain is characterized how
pain that is reproducible with palpation and worsened with movement of changes in position
What timing is abnormal in hemophilia A and B
PTT time decreased
increase bleeding time
degeneration occurs where in frontotemporal demantia
- frontal lobes progresses to temporal lobes
symptoms of frontotemporal dementia
- early personality and behavioral changes ( social inappropriateness)
- altered speech patterns
Difference between Alzheimer and frontotemporal dementia
alzheimer: impairment involving recent memory
caudate atrophy presents in what disease
Huntington disease
in Alzheimer was the first region to suffer damage
hippocampus
depletion of dopamine in substantial nigra occur in
Parkinsons
what explains the complication of strictures and fistulas in Crohn’s disease
transmural inflammation
malignant hypertension can cause what to vessels
hyperplastic arteriolosclerosis
histo for hyperplastic arteriolosclerosis
- onion-like concentric thickening of arteriolar walls in renal vasculature
Transmural inflammation of arterial wall with fibrinoid necrosis is characteristic of what
polyarteritis nodosa
Granulomatous inflammation of media characterizes
temporal giant cell arteritis
lymph node biopsy has noncaseating granulomas, elevated calcium, scattered crackles, nontender cervical lymphadenopathy
Sarcoidosis
1-alpha-hydroxylase is expressed in what cell? role
activated macrophages
- produced 1,25-dihydroxyvitamin D (activated)
- creates hypercalcemia
PTH levels during sarcoidosis
decreased
what stains congo red and viewed under polarized light, deposits have apple-green birefringence
amyloid
Amyloid deposition in Alzheimer can occur where
Brain parenchyma ( neuritic plaques) wells of cerebral vessels ( amyloid angiopathy)
intracellular eosinophilic inclusions composed of alpha-synuclein
Lewy Bodies
Parkinson disease
Odynophagia, dysphagia accompanied by fever or burning chest pain. endoscopy shows linear and shallow ulcerations? what is it
CMV esophagitis
histo for CMV esophagitis
enlarged cells with intranuclear inclusions
Child with vascular lesions with IgA and C3 deposition
Henoch-Schonlein purpura
triad for Henoch-Schonlein purpura
- skin rash
- arthralgias
- abdominal pain
63 yr old male: abdominal pain, mesenteric vein thrombosis, absence of CD 55 on surface of RBC
Paroxysmal nocturnal hemoglobinuria
What gene is defected is paroxysmal nocturnal hemoglobinuria
PIGA gene, synthesizes GPI anchor for dear-accelerating factor (DAF)
what goes wrong in paroxysmal nocturnal hemoglobinuria
uncontrolled complement-mediated hemolysis
Chronic hemolysis with breath down of iron-containing erythrocytes can also lead to what
iron deposition in kidney
What is given after nuclear accidents to protect the thyroid from radioactive iodine
potassium iodide
normal intestinal mucosal architecture, enterocytes contain clear or foamy cytoplasm more prominent at tips of villi
abetalipoproteinemia
what is abetalipoproteinemia
caused by impaired formation of apolipoprotein B
Abetalipoproteinemia is defective in what gene
MTP gene
peripheral blood smear for abetalipoproteinemia
acanthocytes
PE for abetalipoproteineimai
neurologic abnormalities
What is polycythemia vera
uncontrolled erythrocyte production
clinical features of polycythemia vera
- aquagenic pruritus
- facial plethora
- splenomegaly
Polycythemia vera have a mutation in what
JAK 2, non-receptor (cytoplasmic) tyrosine kinase associated with erythropoietin receptor
