test47: pathology Flashcards
child with serologic tests showing autoantibodies that react with tissue transglutaminase has?
Celiac disease
Celiac disease patients react to what? where does it come from
gliadin, product of gluten
What part the digestive tract does celiac disease hit
duodenum and jejunum
hydrogen breath tests for
lactose intolerance
Rectal suction biopsy is gold standard in diagnosing what
Hirschsprung disease or congenital aganglionic megacolon
Terminal ileum biospy is performed for what disease
Crohn disease
periodic acid-Schiff stain (PAS) stains for what
glycogen
PAS can be used to diagnose what
Whipple disease ( tropheryma whipple)
alkaline phosphatase is an enzyme marker of what
osteoblasts
pathophysiology for pemphigus vulgaris
- autoantibodies against desmosomes ( desmoglzins 1 and 3)
- disrupt intraepithelial cleavage
Nikolsky sign
new blisters may form with gentle traction or rubbing
Asboe-Hansen sign
bullae spread laterally when pressure is applied on top
Lowest pH of nephron is found where
distal tubules and collecting ducts
what precipitates uric acid crystals
low pH
what is tumor lysis syndrome
lysis of tumor cells cause intracellular ions, K, phosphorous and uric acid to join serum
prevention of tumor lysis
hydration and urine alkalinization
54 man: history of Hep C. vomiting red blood, abdominal distention, gynecomastia, repetitive flickering motion of hands, what causes altered mental status
increase load of nitrogenous substances absorbed by the gut
liver disease and Bun value and why
Decreased BUN b/c ammonia is not efficiently converted to urea.
Grave disease
hyperthyroidism
treatment for graves
radioactive iodine
how is iodine taken up into thyroid
- against concentration gradient via sodium-iodide symporter
- also transports perchlorate and pertechnetate
What exercises strengthen pelvic floor muscles and can improve symptoms of stress urinary incontinence
Kegel exercise
Levator ani and coccygeus
pelvic floor muscles
what can cause stress incontinence
increase intra-abdominal pressure
sciatica ( siatic nerve compression) presents hoq
low back pain radiating down on one side of the hip to the leg, without urinary incontinence
how do uremic toxins in blood impact platelets? causes? txt?
- qualitative platelet disorder
- prolonged bleeding time
- dialysis
patient with excessive bleeding around catheter exit site to start dialysis what what PT, PTT, platelet count, and bleeding time
everything normal except bleeding time is increased
abnormal myelocyte precursors contain what in cell
aurer rod: coarse rod shaped intracytoplasmic granules
myelocyte precursor cells are founding what
acute myelogenous leukemia
What is the M3 variant for AML
acute promyelocytic leukemia
translocation for acute promyelocytic leukemia
t (15;17)
17: retinoid acid receptor alpha
15: promyelocytic leukemia
t(8:14)
Burkitt lymphoma
8: c-myc
14: Ig heavy chain
t(11;14)
mantle cell lymphoma
older women with intermittent abdominal pain and cholesterol-containing mass lodged at ileocecal valve has what
gallstone ileus
how does gallstone ileum erode insetting lumen
cholecystoenteric fistula
what are signs of small bowel obstruction
abdominal distension
tenderness
high-pitched bowel sounds
pneumobilia? causes
air in biliary tree,
caused by fistula between gallbladder and GI tract
What is the main cause of acute cholecystitis
gallstone obstruction of cystic duct
what is the preferred initial imaging test for diagnosis of acute cholecystitis
ultrasound: wall thickening, pericholecystic fluid
- when not conclusive: nuclear medicine hepatobiliary scanning
explain hepatobiliary scan
radio tracer give IV
- taken up by hepatocytes
- excreted in bile
- gallbladder not visualized
pt with cardiogenic shock and evidence of watershed necrosis likely suffered from
hypoxic-ischemic encephalopathy
what part of the brain are most vulnerable to ischemic injury
pyramidal cells of hippocampus and purkinje cells of cerebellum
where is watershed zones of brain
- located at borders between areas perfused by anterior, middle, and posterior cerebral arteries
how do cortical watershed infarcts typically appear
bilateral wedge-shaped strips of necrosis over cerebral convexity, parallel and adjacent to longitudinal cerebral fissure
daytime somnloence, non restorative sleep and elevated blood pressure in the setting of underlying obesity, morning headaches suggest?
obstructive sleep apnea
complications of obstructive sleep apnea
- pulmonary hypertension, right heart failure, arrhythmias
abdominal pain and pancreatic calcifications suggest
chronic pancreatitis
low hemoglobin and elevated mean corpuscular volume is what type of anemia
macrocytic anemia
most common cause of chronic pancreatitis
ethanol
Folic acid synthesis what in RBC
thymidine
purine and pyrimidine bases
pancreatic insufficiency is associated with what vitrine
B12 deficiency
- pancreatic enzymes cleave R factor of B12, allowing binding to intrinsic factor
Libman-Sacks endocarditis occurs in who
Systemic lupus erythematosus
what is libeman-sacks endocarditis
small cardiac valvular vegetations on either side of value
- fibrotic valve thickening and deformity
68 caucsasion male: chewing difficulty, persistent headaches, tenderness over patient’s temples
giant cell arteritis
Takayasu arteritis and giant cell arteritis have what in common
granulomatous inflammation of media of artery
aortic and pulmonary stenosis have what type of murmor
crescendo-decrescendo systolic murmur
what causes multiple endocrine neoplasia type 1
mutation in MEN1 gene
what tumors are in MEN1
parathyroid
pancreas
pituitary
initial manifestation of MEN1
renal stones
43 yr old man: neck surgery, recurrent renal stones, bitemporal visual field defects. what other organ should be checked
pancreas
- MEN
is BRCA1/2 a tumor suppressor gene or proto-oncogene
tumor suppressor gene
role of BRCA1/2
DNA repair gene
- repair of double-stranded DNA breaks
why does gynecomastia occur in liver cirrhosis
- increase adrenal production of androstenedione –> estrone –> estradiol
- estradiol induces sex hormone-binding globulin production in liver, uterus and testes
- decrease free testosterone/estrogen ratio
- increase free estrogen
Spider angiomata
subcutaneous vascular lesions consisting of central arteriole surrounded by many small vessels that blanch on compression
hyperestrinism from liver failure causes what in patient
- spider angiomata
- testicular atrophy with decreased body hair
what type of lymphocytic proliferation is strong evidence of malignancy
monoclonal
what causes benign lymph node enlargement? what type of proliferation
- antigenic stimulation
- polyclonal proliferation
Platelet count for DIC
decrease
bleeding time for DIC
increase
PT time for DIC
increased
PTT time for DIC
increase
AT what lab values should DIC be suspected
- increase PT and PTT
- platelet and fibrinogen decrease
- D-dimer elevated in DIC ( fibrine degradation products)
Bleeding in DIC compare with TTP-HUS
DIC: bleeds
TTP-HUS: do not bleed
PT and PTT compare DIC and TTP-HUS
DIC: prolonged PT and PTT
TTP-HUS: normal PT and PTT
fibrinogen levels compare DIC and TTP-HUS
DIC: fibrinogen and increased FDP
TTP- HUS: normal
What cells are involved with granulomatous inflammation with caseous necrosis
macrophages, multi nucleated giant cells, CD4T lymphocytes
clinical manifestations of carcinoid syndrome
flushing
watery diarrhea
bronchospasms
lab diagnosis for carcinoid syndrome that has metastasized
increase urinary excretion 5-HIAA
vasoactive substances secreted by localized intestinal carried tumor, what happens to it
metabolized by liver, no carcinoid syndrome
Patient with painful enlargement of thyroid gland has typical feature of what
subacute granulomatous thyroiditis
Subacute granulomatous thyroiditis usually follows what health problem
viral illness
histo for granulomatous thryroiditis
first, neutrophilic infiltrate with microabscess formation
then, multinucleated giant cells
decreased breath sounds, increased chest anteroposterior diameter, and decreased diaphragmatic excursion
COPD
TLC and FVC in restrictive lung disease
decreased due to reduced lung expansion
FEV1/FVC ratio in COPD
decreased
Sharp chest pain that radiates to the left shoulder suggests
acute pericarditis
sharp chest pain that radiates to left shoulder, with facial rash and proteinuria suggests
SLE lupus
what type of inflammation is seen in SLE
serosal inflammation: manifests as pleuritis and pericarditis
What increases pericarditis pain
inspiration
what relieves pericarditis pain
sitting up and leaning forward
What is a syndrome associated with congenital long QT syndrome
Jervell and Lange-Nielson syndrome
- autosomal recessive
what is Jervell and Lange-Nielson syndrome
sensorineural deafness
Acute promyelocytic leukemia is what translocation
t(15;17)
17: retinoid acid receptor alpha
because of the translocation of 15;17 what goes wrong
abnormal receptor
how do you treat acute promyelocytic leukemia
all-trans-retinoid acid
vitamin A derviative
translocation for chronic myeloid leukemia
9;22
histo for burkitt lymphoma
“starry sky”
MOA of Warfarin
- inhibition of vitamin K-dependent gamma-carboxylation of clotting factors II, VII, IX, X, protein C and S
role of protein C and S? compare
anticoagulant effects
C- shorter half-fe
how does warfarin-induced skin necrosis come about? solution
- protein C reduced ( short half life)
- II, IX, and X continue to have procoagulant effects
- give with heparin
MOA of metyrapone stimulation test
- blocks cortisol synthesis by inhibiting 11-Beta-hydroxylase
- if ACTH is working, increase 11-deoxycorticosterone
role of 11-beta-hydroxylatse
converts 11-deoxycortisol to cortisol
zona fasciculata
who metabolizes 11-deoxycortisol? what does it turn into
liver
17-hydroxycorticosteroids
impaired driving in low light conditions ( “night blindness”) and thickened, dry skin ( hyperkeratosis) suggests
vitamin A deficiency
What can cause vitamin A deficiency besides malnutrition
- biliary obstruction
- exocrine pancreatic insufficiency
- small-bowel resection
Who usually gets granuloma cell tumors of ovary
postmenopausal women
histo for granuloma cell tumors of ovary
Call-Exner bodies: small and cuboidal in shape, grow in cords or sheets, Rosette-like structures
gross granuloma cell tumors of ovary
lipid content
- yellow color
granuloma cell tumor of ovary secrete what and results in
estrogen
- endometrial hyperplasia
alpha-fetoprotein can be seen in what
- pregnancy
- hepatocellular carcinoma
- nonseminomatous testicular carcinoma
- ovarian carcinoma
How do pulmonary emboli typically appear on gross lung
multiple wedge-shaped hemorrhagic lesions in periphery of lung
Do patients with pulmonary emboli get hemorrhages or ischemic infarction
hemorrhages
young patient with recent IV drug use and acute presentation with septic shock most likely developed what pulmonary emboli from
tricuspid valve endocarditis
patient has fatigue, pruritus, hepatomegaly and an elevated alkaline phosphatase suggesting
cholestatic liver disease
- secondary to hepatocellular dysfunction
Cardiac dilation can result from deficiency in what vitamin
thiamine B1
timeframe for acute transplant rejection
within first 6 months
chronic lung transplant can cause what
bronciolitis obliterans
Who produces Surfactant
type II pneumocytes
in cells where is surfactant stored and allows transportation to cell surface
lamellar bodies
describe lamellar bodies
organelles containing parallel stacks of membrane lamellae
what is the most common type of congenital adrenal hyperplasia
21-hydroxylase deficiency
11-beta-hydroxilyase deficiency impacts levels of what things
- decreased glucocorticoid synthesis
- increase production of adrenal androgens
17 alpha-hydroxylase impairs synthesis of what
androgens, estrogens, and cortisol
Wallerian degeneration
axon is damaged, resulting in axonal degeneration and breakdown of myelin sheath distal to the site of injury
six months after an acute subcortical infarct in the left internal capsule, what is seen in brain
Myelin debris: persist for year because macrophages must cross BBB
- suppresses axonal growth
astrocytes: glial scars, act as barrier to axon regeneration
why does axonal regeneration not occur in CNS
- persistence of myelin debris
- secretion of neuronal inhibitory factors
- dense glial scarring
esophagus lining
nonkeratinazed stratified squamous epithelium
epithelium changes in smoking
trachea and bronchi: columnar epithelial cells ciliated replaced by stratified squamous epithelial cells
What causes familial chylomicronemia syndrome
- lipoprotein lipase (LPL) deficiency
what other problems come with hyper chylomicronemia
- acute pancreatitis
- lipemia retinalis
- hepatosplenomegaly
Schwannomas are what lab test positive
S-100
- also for melanoma
Common site of intracranial schwannomas is
cerebellopontine angle at CN VIII
clinical presentation for Schwannomas
tinnitus
vertigo
hearing loss
patient has anemia, thrombocytopenia (easing bruising), neutropenia ( recent respiratory infection), reticulocytopenia, normal cell lines on peripheral smear, no splenomegaly
aplastic anemia
What PE finding is not seen in aplastic anemia
splenomegaly
