USMLE World 2 Flashcards
pericarditis
complication of AMI (10-20%); sharp pleuritic chest pain irradiated to the neck (phrenic nerves), low fever, friction rub, fibrinous exudate, autoimmune reaction 6-8 weeks after AMI
Libman-Sacks endocarditis
present in 25% os SLE; sterile valve vegetations, fibrosis; AMI can develop due to hypercoagulable antiphospholipid antibody syndrome present in 12-30% of SLE
heart changes in hypertension
concentric ventricular hypertrophy without dilation and aortic insuficiency
heart changes in AMI
dilated cardiomyopathy
congenital QT prolongation syndrome
syncope in healthy young patients due to mutations in iK potassium channels + sensorineural deafness
localized amyloidosis
cardiac atria –> ANP; thyroid –> calcitonin; brain –> beta amyloids; pituitary –> prolactin
RCA thrombosis ECG
ST elevation in DI, DII and aVF plus sinus bradycardia
transmural ischemia of septum ECG
ST elevation in V1, V2 and 3rd degree heart block
ischemia of left anterior ventricle ECG
ST elevation in V3, V4
occlusion of proximal LAD artery ECG
ST elevation in V1-V4
ischemia of lateral wall of left ventricle on ECG
ST elevation in V5 and V6
post MI causes of death
cardiogenic shock MCC; free ventricular wall rupture 2nd MCC
hypertrophic cardiomyopathy
myofiber disarray + interstitial fibrosis due to mutations in genes encoding cardiac sarcomere proteins; 25% systolic anterior motion of the anterior leaflet of mitral valve which bulges into outflow tract —> systolic murmur
diagnosis and Rx of Prinzmetal angina
Dx: ergonovine; Rx nitrates and CCBs
normal aging heart changes
decreased left ventricular chamber, sigmoid shaped ventricular septum, myocyte atrophy with interstitial fibrosis, brownish lipofuscin pigment
heart findings in hemochromatosis
dilated cardiomyopathy + hemosiderin granules in myocytes
aortic stenosis
systolic pressure gradient between LV and aorta; “SAD” syncope, angina, dyspnea; MCC is senile calcification
Kusmaul sign
paradoxical increase in jugular venous pressure with inspiration; diferential diagnosis: cardiac tamponade, restrictive cardiomyopathy, right failure, tricuspid stenosis, constrictive pericarditis
Down syndrome heart findings
ostium primum ASD + mitral/tricuspid insuficiency
suceptibility to infarction of different organs
CNS, myocardium, kidney, spleen, liver; spleen and liver have double blood supply
pulsus paradoxus
exageration of the normal decrease in blood pressure on inspiration; radial pulse disappears in inspiration; cardiac tamponade
cor pulmonale
dyspnea on exertion, right ventricular hypertrophy, sudden death
pulmonary embolus
acute chest pain, dyspnea tachychardia, tachypnea, hypotension; MCC is DVT; perfusion defect without ventilation defect; lung collapse –> perfusion and ventilation defect
Osler-Weber-Rendu
hereditary hemorrhagic telangiectasias, rupture causes epistaxis, GI bleeds, hematuria
dissecting aorta aneurysm
hematoma may compress branches of aortic arch –> hypertension in one limb, hypotension in the other
hemangioma types
cherry –> adults; strawberry –> kids; cavernous –> associated with VHL
migratory thrombophlebitis
pancreatic cancer
cystic hygroma
cavernous lymphangioma without luminal blood vessels in the neck or axila; Turner
Churge-Straus syndrome
adult onset asthma, eosinophilia, polyneuropathy, p-anca vasculitis
bronchiolitis obliterans
due to chronic transplant rejection; affects small airways; dyspnea, wheezing
acute rejection
perivascular infiltration of blood vessels with lymphocytes, macrophages and plasma cells
causes of pulmonary hypertension
COPD-induced hypoxic vasocronstriction; volume overload in CHF; idiopathic vasoconstriction
sarcoidosis associations
associated with high levels of vitamin D/hypercalcemia produced by macrophages
asbestosis
localized pleural thickening with calcifications of the lower lobes
silicosis
nodular densities and calcifications of the hilar nodes plus birefringent silica particles
pneumoconiosis
multiple discrete nodules prominent in upper lobes
ARDS
decreased lung compliance, increased work of breathing, V/Q mistmatch, normal pulmonary wedge pressure
fat embolism
acute onset of neurologic abnormalities, petechial rash and hypoxemia in traumatized patient; fat exits bone marrow to pulmonary microvessels; via capillary shunts to CNS and adhere to platelets causing thrombocytopenia
dermatomyositis
proximal muscle weakness, heliotrope rash, violaceous eruption on the knuckles; muscle lymphocytic infiltrate
hamartoma
benign and composed of fibrous and adipose tissue
Reid index
thickness of mucous gland layer / wall thickness > 0.4 –> chronic bronchitis
stages of pneumonia
red congestion (24 hours); red hepatization (3 days); gray hepatization
retrolental fibroplasia
retinal neovascularization due to O2 treatment in ARDS of newborn
pneumonia complication
absess due to lysosomal enzymes from neutrophils and macrophages
pneumothrorax
unilateral chest pain, hyperresonance and absent breath sounds; due to blebs, emphysema, trauma
causes of lung absess
MCC is aspiration of fusobacteria, peptostrep and bacteroides associated with seizures, alcoholism, anesthesia; bacterial pneumonia and sepsis
green discoloration of pus/sputum
due to heme-containing myeloperoxidase
NSAID-induced nephropathy
seen in chronic arthritis treated patients; reversible renal failure, papillary necrosis, chronic interstitial nephritis
multiple myeloma
easy fatigability due to anemia; constipation due to hypercalcemia; back pain due to osteoclast activating factor; azotemia; eosinophilic casts with bence-jones proteins
complication of nephrotic syndrome
loss of antithrombin III –> renal vein thrombosis –> varicocele
renal cell CA
arises from proximal tubule cells; MC is urothelial cancer –> painless hematuria, proximal tubule cells filled with glycogen and lipids
ethylene glycol intoxication (antifreeze)
acute renal failure, anion gap metabolic acidosis and calcium oxalate crystals in urine
glomerular membrane histology
fenestrated endothelium is selective for size; GBM has negative charge
acute tubular necrosis
oliguric stage –> volume retention, oliguria, anion gap metabolic acidosis, hyponatremia, hyperkalemia; recovery phase –> polyuria, hypernatremia, hypokalemia
microalbuminuria
30-300mg of albumin in 24-hour urine; first sign of diabetic nephropathy
crescents
glomerular parietal cells, monocytes, macrophages, abundant fibrin
muddy brown casts
pathognomonic for acute tubular necrosis
minimal change disease
loss of GBM negative charge; selective proteinuria consists of albumin and no IgG or alpha-2-macroglobulin
diabetic nephropathy
increased mesangial matrix, thickening of GBM and nodular glomerulosclerosis, hyaline arteriosclerosis
nephrotic syndrome
increased glomerular permeability –> proteinuria –> edema –> decreased effective blood volume –> increased ADH and aldosterone plus increased liver synthesis of proteins including lipoproteins
T cell ALL
mediastinal mass causes superior vena cava syndrome, dysphagia, dyspnea and throat pain
high EPO
obstructive sleep apnea, COPD, right-left shunts, high altitude
factor VIII
synthesized in the liver, stored in endothelial cells; desmopressin stimulates release
SLE pancytopenia
due to IgGs against RBCs
Factor V leiden
leads to less deactivation by protein C –> hypercoagulable state –> DVT/pulmonary thromboembolism
spherocytosis
increased MHCH is diagnostic
G6PDH deficiency inheritance
X-linked recessive
spherocytosis inheritance
autosomal dominant
vonWillenbrand inheritance
autosomal dominant with variable penetrance
pure red cell aplasia
normo anemia plus decreased reticulocytes; associated with thymoma and parvoB19
vonWillenbrand disease
vW factor is carrier for factor VIII –> increased BT and PTT
Reed-Sternberg cells
abundant cytoplasm bilobed or double nucleus surrounded by halo, inclusion-like eosinophilic nucleoli
sodium metobisulfate
induces sickling in sickle cell trait
lipoprotein lipase
synthesized by adipocytes, cardiac and skeletal muscle cells; deficiency leads to hypertriglyceridemia and acute pancreatitis
acute pancreatitis lab findings
hypocalcemia, macrocytosis, increased serum lipase and amylase
colon adenoma to carcinoma sequence
polyp (mutation of APC gene) –> large polyp (mutation of k-ras) –> malignant polyp (mutation of p53)
acute pancreatitis risk factors
gallstones, alcohol, ERCP, hypertriglyceridemia, hypercalcemia
complication of Crohn’s disease
gallstones due to loss of enterohepatic circulation and increased cholesterol/bile acid ratio; also oxalate stones due to increased absorption of dietary oxalate because calcium is flushed with lipids and doesn’t bind oxalate
zollinger ellison
ulcers at distal duodenum, diarrhea due to inactivation of lipases by gastric acid
Whipple disease
PAS+ macrophages with rods
PAS stain
stains carbon-carbon bonds bright pink
colon cancer marker
CEA to detect recurrence after resection
MC site of colon adenocarcinoma
ascending colon; rectosigmoid is 2nd MC site
duodenal Vs. gastric ulcer pain characteristics
duodenal –> pain 2-4 hours after food or before eating relieved by food and antacids; gastric ulcer –> pain inmediately after eating not relieved by antacids
pseudocyst Vs. cyst
pseudocyst is complication of acute pancreatitis; wall is composed of granulation tissue and fibrosis (not epithelium like true cyst)
causes of malabsorption
cystic fibrosis, chronic pancreatitis, celiac sprue, whipple, Crohns, diverticulosis, diabetic neuropathy
screening test for malabsorption
sudan stain stains fat in stools
consequences of malabsorption
ADEK deficiency; petechiae (vit K), bone pain and tetany (vit D), muscle wasting and edema (protein waste), hyperkeratosis (vit A)
false Vs. true diverticula
false –> mucosa and submucosa only, acquired, pulsion; true –> also muscular layer, congenital, traction
Reye syndrome
viral infection + aspirin –> vomiting, hepatomegaly, increased AST, ALT, hyperamonemia with encephalopathy, liver microvesicular steatosis without necrosis
acalculous cholecystitis
inflamation of gallbladder without stones due to sepsis, immunosupression, trauma, diabetes
formation of cholesterol gallstones
cholesterol precipitation –> stones; phosphatidylcholine and bile salts –> solubility
HBV damage to liver
no cytopathic effect; HBsAg and HBcAg stimulate CD8 cytotoxicity
halothane hepatotoxicity
fulminant, liver shrinks, increased AST, ALT and PT, eosinophilia; histologically the same as hepatitis
ceruloplasmin
globulin that accounts for 95% of circulating copper; copper is eliminated in bile
echinococcus cysts
mass in the liver; aspiration can cause anaphylaxis
cavernous hemangioma
MC benign liver tumor; Rx with resection, no biopsy
MCC of liver malignancy
metastasis is MCC > HCC
gallbladder hypomotility
due to pregnancy, weight loss, parenteral nutrition, octeotride –> billiary sludge –> stones/cholecystitis
types of gallstones
yellow –> cholesterol; brown –> billiary infection; black –> hemolysis
porcelain gallbladder
calcifications associated with carcinoma
outcome of hepatitis B infection
complete resolution (95%); chronic hepatitis/cirrhosis/HCC (4-5%); fulminant hepatitis (<1%)
gallbladder changes in pregnancy
estrogen-induced cholesterol hypersecretion and progesterone-induced hypomotility –> gallstones
ulcer erosions
penetrate submucosa, inner and outer muscular but not muscularis mucosa
abetalipoproteinemia
no apoB for chylomicrons –> lipid accumulation makes epithelium look foamy –> no lipids in blood, acanthocytes, ataxia and retinitis pigmentosa
polyps with adenocarcinoma potential
adenomatous polyps and specially villous adenomatous
squamous cell CA of esophagus
keratin pearls look like fibrosis
adenomatous polyps
villous adenomas –> large, sessile, dysplastic –> bleeding, secretory diarrhea and partial obstruction
anal fissures
90% are found in posterior midline distal to dentate line; due to low fiber diet and constipation
effect of atherosclerosis on stomach
can affect gastric branches of celiac trunk –> epigastric pain 30 minutes after eating
ischemic colitis
affects splenic angle because it lies between SMA and IMA areas of perfusion
HAV infection
low grade fever, anorexia, nausea, coluria, RUQ tenderness, hepatocyte swelling, mononuclear infiltrate, councilman apoptotic bodies
ascending cholangitis Vs. hepatic absess
enteric bacteria (ascending) or staph (hematogenous)
HBV Vs. HCV histology
HBV –> granular cytoplasmic inclusions; HCV –> lymphoid aggregates and steatosis
billiary atresia
congenital obstruction of bile ducts –> clay stools, coluria, hepatomegaly, conjugated hyperbilirubinemia
primary billiary cirrhosis
pruritus, increased liver alkaline phosphatase
aflatoxins
HCC due to mutation of p53
gallstone ileus
large stone passes through fistula into ileum and allows air to pass into billiary tree
Wernicke encephalopathy
confusion, ataxia, ocular abnormalities; Rx thiamine
Korsakoff confabulation psychosis
damage to medial dorsal nucleus and/or mamillary bodies of thalamus
Alzheimer’s biochemistry
decreased ACh in basal nucleus of Meynert and hippocampus
alcohol changes in brain
upregulation of GABAa receptors and NMDA receptors; increased DA, 5HT and NE
complications of subarrachnoid hemorrhage
vasospasm (treat with nimodipine) and rebleeding
transtentorial herniation
uncus of temporal lobe herniated through tentorium –> compression of CN III, PCA and corticospinal tract
MC extracranial childhood cancer
neuroblastoma associated with N-myc; retroperitoneal mass, episodic hypertension, neuroblast is malignant cell
SSPE
complication of measles; anti-measles antibodies in CSF, no anti-M protein antibodies
meningioma histology
psamoma bodies in brain tumor –> meningioma
Schwanoma marker
S100
Pick’s disease
pronounced atrophy of frontal lobes, progressive dementia, behavioral dishinibition, dysarthria, aphasia, primitive reflexes
Charcot-Bouchard aneurysms
associated with hypertension; found in small arteries of basal ganglia; rupture –> intraparenchymal hemorrhage and focal deficits
berry aneurysms
associated with APCKD, Marfan, ED; anterior cerebral arteries most affected; leads to subarachnoid hemorrhage
hypoxic encephalopathy
wedge-shaped areas of necrosis on the surface of cerebral convexities and lateral to interhemispheric fissure; due to cardiogenic shock or shock; affects hyppocampus first
pontine myelinolysis
too fast correction of hypernatremia; spastic quadriplegia and pseudobulbar palsy
stroke scar
cystic cavity surrounded by wall of astrocytes
Creutzfeld-Jakob
rapidly progressive dementia and myoclonus; vacuoles in gray matter looks like sponge; due to prion
normal pressure hydrocephalus
urinary incontinence, ataxia and progressive dementia
Friederich ataxia
triple repeat mutation; spinocerebellar tract degeneration (ataxia), degeneration of dorsal columns, kyphoscoliosis, hypertrophic cardiomyopathy, diabetes
lacunar infarcts
small ischemic infarcts involving basal ganglia, pons, internal capsule; due to hypertensive arteriosclerosis of small penetrating arterioles
ischemic stroke changes
red neurons (48 hours); neutrophils (72 hours); macrophages (5 days); gliosis/angiogenesis (2 weeks); glial scar (>2 weeks)
Arnold-Chiari malformation
small posterior fossa results in herniation of medulla and cerebellum through foramen magnum
multiple sclerosis
demyelination, decreased oligodendrocytes, lipid-ladden macrophages, astrocytosis, lymphocytic inflamation
CN III diabetic neuropathy
only affects somatic fibers sparing parasympathetic due to different blood supply
cerebellar masses
mostly in children; astrocytoma or meduloblastoma
tumor associated with myasthenia gravis
thymoma
tumor associated with Lambert-Eaton
lung cancer
vitamin E deficiency
affects dorsal column and spinocerebeallar tracts; mimics Friederich ataxia
temporal lobe encephalitis
aphasia, olfactory abnormalities, personality changes; due to HSV-1
myotonic dystrophy
triple repeat mutation, sustained muscle contraction (myotonia) with muscular weakness and atrophy; cataracts, baldness, gonadal atrophy
cerebral amyloid angiopathy
recurrent hemorrhagic strokes
Duchene
x-linked recessive; fibrofatty muscle replacement
diabetic neuropathy
due to osmotic damage to axons and Schwann cells and microangiopathy of endoneural arterioles
lead poisoning tratment
dimecarpol, EDTA; heavy metal chelators
cystic tumors in cerebellum
pilocytic astrocytoma mostly in kids
Meniere
tinitus, vertigo, hearing loss; too much endolymph
pretibial myxedema
non-pitting myxedema and thickening of skin around tibia in Graves disease
craniopharyngioma
remnant of Rathke’s pouch bulges into 3rd ventricle; cystic solid mass with calcifications; headaches, visual deficits and hypopituitarism
hypoglycemia in neonate of diabetic mother
mother’s hyperglycemia induces islet hyperplasia with increased insulin production
mechanism of amenorrhea in anorexia
low body fat fails to induce pulsatile secretion of GnRH; also seen in cachexia and athletes
psamoma bodies
concentric calcified structures; pathognomonic for papillary thyroid CA and meningioma
pituitary apoplexy
acute bleeding into a preexisting pituitary adenoma; bitemporal hemianopia, sudden headache; complication is cardiovascular collapse due to adrenocortical insuficiency
type II diabetes associations
amyloid deposition in beta cells
seminoma
increases hCG which is similar to TSH and can cause hyperthyroidism
MCC of death in diabetics
AMI
primary hyperaldosteronism
hypokalemic metabolic alkalosis with hypertension and normal [Na] because of compensatory natriuresis
medullary thyroid carcinoma histology
polygonal or spindle-shaped cells with extracellular amyloid deposits seen with congo red
glucagonoma
necrolytic migratory erythema rash and hyperglycemia
MEN III
medullary thyroid carcinoma, pheochromocytoma, mucosal neuromas and marfanoid habitus
ret gene
MEN
fibromyalgia
stiffness, pain, poor sleep, emotional disturbance; pain and stiffness gets worst with exercise; tender spots over multiple joints
osteoporosis histology
thin trabecula
osteopetrosis histology
unmineralized spongiosa
Paget’s histology
focal formation of bone
vitamin D deficiency histology
unmineralized osteoid
hyperPTH histology
cystic degeneration of bones
pseudogout
weakly birefringent rhomboid-shaped calcium pyrophosphate crystals
wound contracture
myofibroblasts + metalloproteinases in excess
parvovirus B19 associations
slapped cheek rash and can cause self-limiting arthritis-like disease, pure red cell aplasia; aplastic anemia in sickle cell patients
digital clubbing
associated with prolonged hypoxia in COPD patients
gout
deposition of monosodium urate crystals that are negativley birefringent
presbyiopia
sclerosis of the lens
cause of skin wrinckles
decreased collagen and increased elastases and collagenases
actinic keratosis
erythematous papules with central scale and sandpaper texture with acanthosis, parakeratosis and hyperkeratosis
acanthosis
thick epidermis
parakeratosis
nuclei in stratum corneum
hyperkeratosis
thick corneum
acanthosis nigricans
associated with insulin resistant states (DM, acromegaly, obesity) as well as GI cancer
avascular necrosis of femoral head
associated with sickle cell, lupus and high-dose steroid therapy
atopic dermatitis
also called eczema; pruritus, erythematous papules; associated with allergens, asthma and rhinitis
hypercalcemia in sarcoidosis
due to increased 1,25vitD by macrophages
shaken baby syndrome
retinal hemorrhages + subdural hematoma; report child abuse
rheumatoid arthritis
does not involve DIP joints; stiffness lasts more than 30 minutes
osteoarthritis
can have morning stiffness < 30 minutes and subcutaneous nodules; can involve DIP joints
dermatomyositis
heliotrope rash and papules in the MCP, PIP and DIP joints
osteomyelitis
affects long bone metaphysis
retinoblastoma
associated with osteosarcoma
contact dermatitis
spongiosis
psoriasis
reduced stratum granulosum, parakeratosis, acanthosis and dividing cells in epidermis
seborrheic keratosis
benign epidermal tumor, tan , flat, round, greasy, coin-like stuck on appearance
acute interstitial nephritis
due to drug allergy; fever, acute renal failure, maculopapular rash and eosinophiluria
cysteine stone crystals
hexagonal crystals, acid urine, recurrent stones at young age, positive cyanide-nitroprusside test
papillary necrosis
sickle cell patients or carriers; acute colic pain, gross hematuria, passage of tissue fragments in urine
hydronephrosis
due to prolonged urinary obstruction in nephrolithiasis, tumor, anatomic defects, neurogenic bladder, BPH; atrophy of cortex with scarring and interstitial fibrosis with inflamation
most important mediator of sepsis
TNF alpha
cryptorchidia
decreases inhibin with increased FSH and normal LH/testosterone; remove testis to prevent malignancy
