Uworld Pathophysio1 Flashcards
—— myopathy presents with myalgias, proximal muscle weakness, elevated creatine kinase levels, and delayed relaxation of deep tendon reflexes. The diagnosis can be confirmed with an elevated TSH level. Other common causes of myopathy with elevated creatine kinase levels include inflammatory myopathies, muscular dystrophies, and HMG-CoA reductase inhibitors.
Hypothyroid
Subacute —– thyroiditis is characterized by disruption of follicles and a mixed cellular infiltrate with occasional multinucleated giant cells. Patients may have hyperthyroidism but typically have a painful, tender thyroid gland and high levels of thyroglobulin due to destructive thyroiditis
granulomatous (de Quervain)
—— cancer is a neuroendocrine tumor that arises from calcitonin-secreting parafollicular C cells. Microscopy shows nests or sheets of polygonal or spindle-shaped cells with extracellular amyloid deposits (derived from calcitonin). Clinical features include diarrhea, flushing, and thyroid nodules, but TSH and free T4 are normal
Medullary thyroid
—– disease presents with a diffusely enlarged thyroid gland associated with hyperthyroidism, exophthalmos, and pretibial myxedema. The thyroid follicular epithelium is tall and crowded with hyperactive reabsorption, causing scalloping around the edges of the colloid. High serum levels of thyroglobulin would be seen due to increased thyroid metabolic activity.
Graves disease
Exogenous —-thyroidism is characterized by elevated free thyroxine (T4), suppressed TSH, and low/undetectable thyroglobulin. It can occur with surreptitious levothyroxine abuse, use of animal-sourced thyroid supplements, and erroneous dosing of thyroid replacement therapy. Over time, the lack of TSH stimulation causes the thyroid follicles to become atrophic.
hyperthyroidism
—– hypersensitivity is most commonly seen in elderly men and involves an exaggerated vasovagal response to tactile stimulation of carotid sinus baroreceptors (eg, adjusting a shirt collar or necktie). The resulting increase in parasympathetic output leads to a prolonged sinus pause that contributes to the excessive drop in blood pressure, leading to transient loss of cerebral perfusion that manifests as presyncope (eg, lightheadedness) or syncope
Carotid sinus
Malabsorption is a syndrome of impaired intestinal digestion and absorption. Fats are typically the most severely affected macronutrient in generalized malabsorption, and testing the stool for fat (eg, with —– stain) is the most sensitive strategy for screening for malabsorptive disorders.
Sudan III
New-onset odynophagia in the setting of chronic gastroesophageal reflux disease should raise suspicion for ——-. Diagnosis is made by upper endoscopy.
erosive esophagitis with esophageal ulcers
Atrioventricular nodal reentrant tachycardia is the most common type of paroxysmal supraventricular tachycardia, resulting from abnormal conduction through 2 distinct atrioventricular nodal pathways. ECG typically demonstrates a ——- with a regular rhythm and buried (not visible) P waves.
narrow QRS complex tachycardia
Malabsorption caused by celiac disease can lead to vitamin D deficiency. Patients have —– serum phosphorus, —– serum parathyroid hormone (secondary hyperparathyroidism), and —- serum calcium
decreased serum phosphorus
increased serum parathyroid hormone (secondary hyperparathyroidism),
low (or normal) serum calcium
patient with diarrhea, weight loss, and a positive tissue transglutaminase antibody assay has ——disease, an immune-mediated hypersensitivity to dietary gluten. —- disease is characterized by villous atrophy in the small intestine, leading to malabsorption of dietary fats and fat-soluble vitamins (ie, A, D, E, K). The resulting vitamin D deficiency can present as rickets in children and osteomalacia in adults.
celiac
Anaphylaxis can cause distributive shock due to widespread release of inflammatory mediators (eg, histamine) that leads to massive peripheral vasodilation. Arteriolar vasodilation —– systemic vascular resistance to cause hypotension, and venular vasodilation —— central venous pressure and pulmonary capillary wedge pressure. Cardiac output is often increased in early distributive shock due to reduced SVR and a baroreceptor reflex–mediated increase in heart rate
decreases
Neonatal hypoglycemia is common in infants of diabetic mothers. The pathophysiology involves maternal hyperglycemia, which in turn causes fetal hyperglycemia and compensatory hyperfunctioning of the ——. After birth, persistently elevated insulin levels lead to transient hypoglycemia.
pancreas (ie, hyperinsulinemia)
Increased bone resorption in primary —— leads to osteoporosis primarily involving the cortical bone of the appendicular skeleton. The cortical thinning appears radiologically as subperiosteal erosions. More advanced disease can present as osteitis fibrosa cystica (ie, granular decalcification of the skull, osteolytic cysts, and brown tumors).
hyperparathyroidism
Asymptomatic left ventricular systolic dysfunction is a common stage in the progression of heart failure. Neurohormonal mechanisms, including the sympathetic nervous system and renin-angiotensin-aldosterone system, help maintain the asymptomatic period by increasing volume retention and peripheral resistance to maintain organ perfusion. There will be —- levels angio2, NE and ANP
increased
Hyperprolactinemia suppresses secretion of GnRH, which leads to reduced —- in women. Low estrogen levels are a risk factor for accelerated bone loss.
estrogen
Because of the pulmonary location of angiotensin conversion, levels of angiotensin II are higher in the pulmonary —- (on the way out of the lungs) than in the pulmonary artery (on the way into the lungs).
vein
The right ventricle (RV) is relatively protected from myocardial infarction (MI), and contractile function of the RV usually returns to normal following MI. Factors contributing to this protection include ——-, perfusion throughout the cardiac cycle, and heightened ischemic preconditioning.
relatively small muscle mass with high capacity to increase oxygen extraction
—– disease is an immune-mediated disorder triggered by dietary gluten that causes small-bowel malabsorption. Because the proximal small bowel is primarily affected, iron deficiency leading to microcytic anemia is common. Histopathology is characterized by intraepithelial lymphocytosis, loss of intestinal villi, and mucosal atrophy.
Celiac
Sex hormones promote both growth and —– closure; hence, precocious puberty may result in a shorter stature, despite an initial growth spurt.
Gigantism is caused by excessive pituitary production of growth hormone; these patients achieve enormous heights because, unlike excessive sex steroids, excessive —- does not lead to premature closure of the epiphysis.
epiphyseal plate
IGF-1
Pulmonary infection (eg, community-acquired pneumonia, tuberculosis) causes pleural effusion primarily via an inflammatory increase in vascular and pleural membrane permeability. Such effusions are exudative by Light criteria, typically with relatively high pleural fluid —- and —– concentrations. Tuberculosis pleural effusions typically demonstrate a lymphocyte-predominant leukocyte pattern.
high pleural fluid protein and lactate dehydrogenase
Chronic obstructive pulmonary disease is a combination of emphysema and chronic bronchitis and commonly presents with progressive dyspnea and recurrent upper respiratory infections. Bronchial obstruction and alveolar destruction cause air trapping that manifests on pulmonary function testing as —–forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. Residual volume and total lung capacity are ——
decreased forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio
Residual volume and total lung capacity are increased
Intrinsic factor (IF) is a glycoprotein that is normally secreted by parietal cells in the stomach and is necessary for the absorption of vitamin B12 in the ileum. Patients who have undergone a total gastrectomy require lifelong —– supplementation due to inability to produce IF.
vitamin B12
Decreased cardiac output in heart failure triggers neuroendocrine compensatory mechanisms to maintain organ perfusion; however, the compensatory mechanisms are maladaptive over the long term. Increased sympathetic output and activation of the renin-angiotensin-aldosterone system stimulate vaso—- and volume retention, compounding the hemodynamic stress on an already failing heart and creating a vicious cycle of decompensation.
vasoconstriction
Atheroembolic disease typically occurs after an invasive vascular procedure due to mechanical dislodgement of atherosclerotic plaque, resulting in the showering of cholesterol-rich microemboli into the circulation. —– in affected vessels are diagnostic. Commonly involved organs include the kidneys (eg, acute kidney injury), skin (eg, blue toe syndrome, livedo reticularis), gastrointestinal tract (eg, bleeding, infarction), and CNS (eg, stroke, amaurosis fugax)
Needle-shaped cholesterol clefts
——– is a chronic autoimmune liver disease characterized by destruction of small and midsized intrahepatic bile ducts with resulting cholestasis. It is most common in middle-aged women and is frequently associated with other autoimmune disorders (eg, Sjögren syndrome, rheumatoid arthritis). Clinical features include fatigue, itching (pruritus), and hepatomegaly. Serum alkaline phosphatase is elevated, and antimitochondrial antibody titers are positive in most cases. Biopsy findings in PBC typically show patchy lymphocytic inflammation, leading to granulomatous destruction of intrahepatic bile ducts (ie, florid duct lesion), with necrosis and micronodular regeneration of periportal tissues.
Primary biliary cholangitis
The work of breathing is minimized in patients with increased elastic resistance (eg, pulmonary fibrosis) when their respiratory rate is —– and tidal volume is —-(fast, shallow breaths). In contrast, patients with diseases that increase airflow resistance (eg, asthma, chronic obstructive pulmonary disease) breathe at a lower respiratory rate and higher tidal volume (slow, deep breaths) to minimize the work of breathing.
high
low
Advanced hypoxic lung disease (eg, chronic obstructive pulmonary disease, interstitial lung disease, obesity hypoventilation syndrome) is a common cause of pulmonary ——- The increase in pulmonary arterial pressure mainly results from chronic and diffuse hypoxic vasoconstriction, with a lesser degree of vascular remodeling than in (primary) pulmonary arterial hypertension.
hypertension (ie, increased right ventricular afterload).
Patients with multiple sclerosis often develop a spastic bladder a few weeks after developing an acute lesion of the spinal cord. These patients present clinically with increased urinary frequency and urge incontinence. Urodynamic studies show the presence of bladder ——
hypertonia
Multiple myeloma is a plasma cell malignancy associated with purely radiolucent (osteolytic) bone lesions due to the stimulation of ——- and the inhibition of osteoblasts. Myeloma cells stimulate —— development by secreting RANK-ligand and destroying osteoprotegerin, which increases RANK activity and results in osteoclast differentiation.
osteoclasts
The absence of normal enteral stimulation in patients receiving total parenteral nutrition leads to decreased —– release, biliary stasis, and increased risk of gallstones. Resection of the ileum can also increase the risk of gallstones due to disruption of normal enterohepatic circulation of bile acids.
cholecystokinin
The 2 most common cardiac abnormalities seen in Marfan Syndrome patients are mitral valve prolapse and cystic medial degeneration of the aorta. In more than 75% of MFS patients, cystic medial degeneration of the aorta results in aneurysmal dilation. If untreated, this can cause aortic —-, the most common cause of death in MFS patients
dissection
Loss of cardiomyocyte contractility occurs within — seconds after the onset of total ischemia. When ischemia lasts less than 30 minutes, restoration of blood flow leads to reversible contractile dysfunction (myocardial stunning), with contractility gradually returning to normal over the next several hours to days. However, after about 30 minutes of total ischemia, ischemic injury becomes irreversible.
60
Pheochromocytomas are catecholamine-secreting tumors arising from the —- cells of the adrenal medulla or extra-adrenal sympathetic chain, and typically present with severe hypertension. Pheochromocytomas stimulate the renin-angiotensin system due to high circulating catecholamine levels, and are associated with tachycardia and symptoms of catecholamine excess (eg, sweating, palpitations, headache).
chromaffin
Primary hyperaldosteronism (PH), a very common cause of secondary hypertension. PH is usually due to increased secretion of mineralocorticoids from bilateral nodular hyperplasia of the adrenal zona —- or an aldosterone-producing adrenal adenoma (Conn syndrome).
glomerulosa
The main effect of aldosterone is to stimulate absorption of sodium and excretion of potassium and hydrogen ions in the renal collecting tubules. Aldosterone secretion from the zona glomerulosa is normally regulated by angiotensin II and potassium levels. Overproduction of aldosterone can result in sodium retention, hypertension, and feedback suppression of the renin-angiotensin system (ie, very low renin activity). Some patients also develop metabolic alkalosis and hypokalemia, which can be exacerbated by increased distal tubule sodium delivery (eg, diuretics, increased sodium intake). Symptomatic hypokalemia may cause muscle weakness, cramps, and, occasionally, rhabdomyolysis and cardiac arrhythmias.
—– neuropathy is common in type 1 diabetics and can cause overflow incontinence due to inability to sense a full bladder and incomplete emptying.Increased Postvoid residualor catheterization can confirminadequate bladder emptying.
Diabetic autonomic
Patients with cystic fibrosis have thick, viscous mucus that accumulates in the airways and promotes colonization of bacteria, particularly Pseudomonas. This gram-negative rod can produce biofilms, which act as a protective matrix that allows bacterial —- to develop, causing persistent infection
macrocolonies
5-Alpha reductase inhibitors (eg, finasteride, dutasteride) are used in the treatment of benign prostatic hyperplasia. These medications block the conversion of testosterone to dihydrotestosterone; the excess testosterone is then available for conversion to estrogens (eg, estradiol) by aromatase, which can lead to —–
gynecomastia
—- heart refers to physiologic cardiac adaptations that improve cardiac function in response to high-level endurance training. There is predominant left ventricular (LV) eccentric hypertrophy with a small component of concentric hypertrophy, leading to an overall increase in LV mass, enlarged LV cavity size, slightly increased LV wall thickness, and decreased resting heart rate.
Athlete’s
Dubin-Johnson syndrome is a benign disorder characterized by defective hepatic excretion of bilirubin glucuronides across the canalicular membrane, resulting in direct hyperbilirubinemia and jaundice. Grossly, the liver appears black due to impaired excretion of —– metabolites, which histologically appear as dense pigments within lysosomes.
epinephrine
Hypovolemia triggers a variety of compensatory mechanisms to improve tissue perfusion. These include activation of the renin-angiotensin-aldosterone system (resulting in — aldosterone and endothelin release), increased vasopressin release, and increased sympathetic tone
increased
——- is marked by widespread activation of the coagulation cascade, leading to excessive thrombin production and formation of microthrombi. Subsequent conversion of plasminogen to plasmin results in increased fibrinolysis to clear the thrombi. Laboratory studies show a consumption of clotting factors (prolonged PT/PTT) and platelets (thrombocytopenia) and signs of excessive fibrinolysis (eg, elevated D-dimer).
Disseminated intravascular coagulation
Patients with severe iron deficiency anemia (IDA) typically have evidence of hypochromic, microcytic erythrocytes on peripheral blood smear with poikilocytosis. Laboratory studies will reveal low red blood cell count, low hepcidin, and —- transferrin. Although erythropoietin is markedly elevated in IDA, there is not enough iron to efficiently generate erythrocytes; therefore, —– count is low.
high transferrin
reticulocyte
—- is characterized by medullary thyroid cancer, pheochromocytomas, mucosal neuromas (ex multiple 4- to 8-mm soft papules on the lips and tongue), and marfanoid habitus.
mutatation in RET pro-oncogene
MEN2B
febrile, ill-appearing patient with respiratory distress who is in the tripod position likely has epiglottitis, a rare, potentially fatal infection most commonly caused by Haemophilus influenzae type b. Edema of the epiglottis can cause laryngeal obstruction that leads to inspiratory —
stridor.
——-, presents with jaundice, dark urine, and acholic stools (pale/clay colored) in the first 2 months of life due to conjugated hyperbilirubinemia. Biopsy reveals intrahepatic bile duct proliferation, portal tract edema, and fibrosis.
Physical examination may also reveal firm hepatomegaly due to inflammation. Laboratory findings, including elevated direct bilirubin and gamma-glutamyl transferase, are consistent with cholestasis.
Biliary atresia, or obstruction of extrahepatic bile ducts
Neutrophil elastase is released by both neutrophils and macrophages and is the primary protease responsible for extracellular elastin degradation. The major serum inhibitor of elastase is alpha-1 antitrypsin (AAT). In this study, the patients whose serum is unable to inhibit elastin degradation likely have AAT deficiency, a condition characterized by early-onset panacinar emphysema due to the unopposed action of neutrophil elastase on alveolar walls. —- exposure dramatically accelerates the development of emphysema in patients with AAT deficiency by inducing inflammation
Tobacco
Initial management of Transposition of the great arteries must ensure mixing of oxygenated and deoxygenated blood. For example, administration of —– maintains patency of the ductus arteriosus. Balloon atrial septostomy, which opens or widens the foramen ovale, may also be performed to allow for mixing at the atrial level and typically improves oxygen saturation immediately.
prostaglandin E1
Pulsus paradoxus is defined by a decrease in systolic blood pressure of >10 mm Hg with inspiration. It is most commonly seen in patients with —– but can also occur in severe asthma, chronic obstructive pulmonary disease, and constrictive pericarditis
cardiac tamponade
Stable angina results from fixed coronary —– that limits blood flow to downstream myocardium, preventing the myocardial oxygen supply from increasing during exertion. Dobutamine mimics the effects of exercise and increases myocardial oxygen demand; it can be used during stress testing to provoke areas of ischemic myocardium, which can be recognized on imaging by a localized and transient decrease in contractility (ie, wall motion defect) (decrease in ejection fraction).
artery stenosis
Gigantism in kids is from excessive production of what?
IGF-1 from liver
Prolonged, untreated Obstructive Sleep Apnea can cause pulmonary —— and —– heart failure. Most patients with OSA will develop systemic hypertension due to chronic sympathetic stimulation and elevated plasma norepinephrine levels.
pulmonary hypertension and right heart failure
Patients with severe emphysema typically have chronic CO2 retention leading to chronic respiratory —- with metabolic compensation (high PaCO2, compensatory high bicarbonate, slightly acidic pH), often accompanied by hypoxemia (PaO2<75 mm Hg on room air).
respiratory acidosis
Thrombotic thrombocytopenic purpura is a thrombotic microangiopathy resulting in microangiopathic —– anemia and thrombocytopenia, findings that are essential for making the diagnosis. It is triggered by severe deficiency in —– levels.
hemolytic anemia
ADAMTS13
—– syndrome causes infertility characterized by primary hypogonadism (elevated FSH and LH, low testosterone) and azoospermia. Other findings include long lower extremities; small, firm testes; and gynecomastia.
Klinefelter syndrome (47,XXY)
Nonclassic congenital adrenal hyperplasia is due to mild deficiency of 21-hydroxylase, an enzyme that converts progesterone to —— and 17-hydroxyprogesterone to 11-deoxycortisol. In adolescent girls, it presents with signs of hyperandrogenism (eg, hirsutism, acne, menstrual irregularities) as well as increased 17-hydroxyprogesterone and testosterone levels
progesterone to 11-deoxycorticosterone
Chronic —– causes a reduction in diastolic blood pressure and a compensatory increase in left ventricular stroke volume. These changes create a high-amplitude, rapid rise-rapid fall pulsation (ie, widened pulse pressure) and the other characteristic findings (eg, head bobbing, “pistol-shot” femoral pulses).
aortic regurgitation
During pregnancy, increased metabolic demands lead to multiple physiologic cardiovascular changes, including decreased systemic vascular resistance and increased blood volume. These changes cause —- preload and —- afterload, resulting in increased stroke volume and cardiac output. Heart rate also gradually increases during pregnancy and is the major contributor to increased cardiac output in late pregnancy.
increased preload
decreased afterload
Bronchial challenge testing is a highly sensitive but nonspecific measure that can help exclude a diagnosis of asthma. A provocative stimulus (typically aerosolized methacholine) is administered at increasing concentrations to induce bronchoconstriction. Patients with asthma are hyperresponsive to this stimulus and experience a decline in —- at lower doses than nonasthmatics.
FEV1
Emphysema from any cause leads to increased total lung capacity as the lungs hyperinflate, decreased FEV1/FVC ratio, and —– DLCO (diffusing capacity for carbon monoxide) due to destruction of alveoli and adjoining capillary beds
decreased
This patient with morbid obesity has normocytic anemia with a low reticulocyte count, raising strong suspicion for anemia of ——. Because —- is triggered by long-standing elevations in serum inflammatory cytokines, it is classically associated with underlying rheumatologic disease, persistent infection, or malignancy. However, it is also commonly caused by less obvious sources of inflammation such as type 2 diabetes mellitus, congestive heart failure, severe traumatic injury, and morbid obesity.
The major inflammatory cytokine that drives ACD is —–
chronic disease (ACD)
hepcidin
Hyponatremia following cerebral injury (eg, subarachnoid hemorrhage) is commonly due to ——–. Injury to the hypothalamus leads to increased secretion of antidiuretic hormone, which in turn leads to water retention, low serum osmolality, and increased urinary sodium excretion
the syndrome of inappropriate antidiuretic hormone secretion
The third heart sound (S3) is a low-frequency sound occurring immediately after S2 that is commonly associated with increased —– volume. S3 frequently occurs in the setting of mitral regurgitation and systolic heart failure (eg, dilated cardiomyopathy).
ventricular end-systolic
Traumatic —- can involve puncture of either the chest wall (eg, penetrating chest trauma) or the lung (eg, by fractured ribs), allowing air to enter the pleural space. Patients usually experience chest pain and difficulty breathing.
physical examination reveals: decreased breath sounds and decreased tactile fremitus on the affected side.
hyperresonance to percussion & subcutaneous crepitus (ie, crackling during palpation).
pneumothorax
Sicle cell pt. The smear findings indicated by the arrow most likely reflect which of the following processes?
This patient’s peripheral smear shows a Howell-Jolly body, a dark-purple remnant of a red blood cell (RBC) nucleus that is normally removed by the spleen. In patients with asplenia, which can be anatomic (eg, splenectomy) or functional (eg, sickle cell disease [SCD]), Howell-Jolly bodies are not removed from circulation and are therefore present on peripheral smear. This patient also has sickle-shaped RBCs and polychromasia (indicative of reticulocytosis) on peripheral smear, consistent with her underlying SCD.
