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Pathology
UWORLD + FA pathology review
| Question | Answer |
|---|---|
| What are "Watershed areas"? | Regions that lie between 2 major blood supplies. |
| What are the two most important Watershed areas of the lower GI tract? | Splenic Flexure and the Rectosigmoid junction |
| Watershed areas are | Most susceptible to ischemic damage during HYPOTENSIVE states, especially in patients with an underlying arterial insufficiency. |
| What are the clinical signs of Ischemic damage to the lower GI watershed areas? | Necrosis of the intestinal wall |
| Colonoscopy of ischemic damage to watershed area shows: | Pale mucosa and petechial hemorrhages. |
| What are complications seen in Ischemic damage to the watershed areas of the lower GI tract? | Acidosis, sepsis, gangrene and perforation. |
| The brainstem is made of the: | Medulla Oblongata, Pons and Midbrain |
| If the damage is above the Red nucleus it means? | 1. Affects the internal capsule and/or the Cerebral hemisphere 2. Causes a DECORTICATE lesion --> flexor posturing |
| If the damage is below the Red nucleus it means? | 1. Affects the Midbrain tegmentum and/or the Pons 2. Causes a DECEREBRATE lesion --> Extensor posturing |
| What 2 structures are above the Red nucleus? | Internal capsule and Cerebral hemisphere |
| What kind of lesion is seen with damage above the Red nucleus? | Decorticate lesion --> Flexor posturing |
| Flexor posturing is referred in case of damage to: | The structures above the Red nucleus |
| What 2 structures are below the Red nucleus? | Pons and Midbrain |
| What kind of lesion is seen with damage below the Red nucleus? | Decerebrate lesion --> Extensor posturing |
| Extensor posturing is seen with people with damage ____________ the Red nucleus. | Below |
| What is the Red nucleus? | Rubber structure in the rostral midbrain involved in Motor coordination. |
| The Red nucleus is involved in what function? | Motor coordination |
| Where is the MC location for a Saddle Pulmonary Embolism? | Straddles the bifurcation of the Main Pulmonary artery |
| What is the Virchow triad? | 1. Endothelial injury 2. Venous stasis 3. Hypercoagulable state |
| Why does malignancy increases the chances of a Venous Thromboembolism? | It produces a Hypercoagulable state |
| What is Multiple Sclerosis? | Autoimmune disorder or the CNS characterized by recurrent episode of Demyelination, leading to reduced saltatory conduction. |
| What are the vision complications seen in Multiple Sclerosis? | Optic Neuritis and Internuclear Ophthalmoplegia (INO) |
| What occurs in the Demyelination seen in Multiple Sclerosis? | Causes a stopin the Saltatory conduction, done by activation of the Na+ -channels at the Node of Ranvier. |
| Activation of the Sodium channels at node of Ranvier is associated with what condition? | Multiple Sclerosis |
| What is the main role of the P450 Microsomal Oxidase system? | Detoxification |
| CCl4 intoxication produces: | Free radicals that start a vicious cycle of hepatic injury |
| CCl4 interferes with the actions of _____________________. | P450 Microsomal Oxidase system |
| What are some common risk factors for testicular cancer? | Age 15-35; Family Hx, Cryptorchidism, |
| What are the main types of Testicular cancer: | Germ cells tumors and Sex cord tumors |
| What are the Testicular Germ Cell tumors? | Seminomatous and Nonseminomatous tumors |
| Which are testicular nonseminomatous tumors? | Embryonal carcinoma, Yolk sac carcinoma, choriocarcinoma, teratoma and Mixed cell tumor. |
| What are the Testicular sex cord (stromal) tumors? | Sertoli cell tumor and Leydig Cell tumor |
| What are common clinical manifestation of Testicular cancer? | Unilateral, painless testicular mass - Dull ache in the lower abdomen |
| What tumor markers are elevated in Testicular cancer? | AFP, b-hCG, and LDH |
| What are the two types of Cardiac hypertrophy? | Concentric and Eccentric hypertrophy |
| Concentric Cardiac hypertrophy is due to ----> | Pressure overload |
| What conditions are associated with Concentric myocardial hypertrophy? | 1. Chronic hypertension 2. Aortic Stenosis |
| Eccentric LV hypertrophy is due to --> | Volume overload |
| What are associated conditions with Eccentric LV hypertrophy? | 1. Aortic or Mitral Regurgitation 2. Ischemic Heart Disease 3. Dilated Cardiomyopathy |
| DCM presents with ______________________ hypertrophy. | Eccentric LV |
| Eccentric ventricular hypertrophy: | results in a DILATED cavity with relative thing ventricular wall due to addition of myocardial contractile fibers in series in response to chronic ovele overload |
| What are the two common cardiac murmurs associated with Eccentric LV hypertrophy? | Aortic Regurgitation and Mitral Regurgitation |
| Actinic Keratosis: | Develops on chronic sun-exposed areas of the skin |
| How are the lesions of Actinic Keratosis? | Erythematous papules with central scale and a rough "sandpaper-like" texture |
| Actinic Keratosis is considered ____________________ lesions and have potential to progress into ________________________. | Premalignant; Squamous cell cancer |
| Acute Atopic Dermatitis: | In children; highly pruritic erythematous papules and plaques |
| What is the LM of Atopic dermatitis? | Spongiosis (edema of the epidermis) |
| Pityriasis rosea initial distribution: | Begins as solitary pink/brownish scale with central clearing on the trunk, neck , or extremities (herald patch) |
| What is Pityriasis rosea late manifestation: | Ovoid maculopapular rash with lesions classically oriented in Oblique direction along the skin tension lines on the back (Christmas tree distribution) |
| Christmas tree distribution is associated with: | Pityriasis rosea |
| Psoriasis: | Well circumcised-raised papules and plaques covered with a thick silvery scale. |
| What are the most common places to develop Psoriasis? | Scalp, trunk, and extensor areas of extremities (elbows and knees) |
| Seborrheic Keratosis: | Mainly in elderly; "stuck on " deeply pigmented or flesh colored lesions with avelvey or "greasy" surface. |
| Atherosclerotic development is activated by what cells, and what is released by those? | Activated by macrophages, PLATELETS, and endothelial cells that release Growth Factors (PDGF) |
| What is the effect or fuction of PDGF in atheroscleroitc plaque development? | Stimulate the recruitment of smooth muscle cells form the arterial wall media and their subsequent proliferation in the INTIMA. |
| What does Ecchymosis usually indicate? | Deep hemorrhage (hematoma) due to bone fracture, ligamentous rupture, or muscle injury |
| What is characteristic in the physical exam on an ecchymosis? | They do not blanch under pressure, as the RVC are not contained within the vasculature. |
| What is the color change seen in Ecchymoses? | Blue/red ---> Brown ,--> Green ---> Yellow |
| What do the color change in ecchymoses indicate? | Estimated age of injury |
| What is the difference between Petechiae and Purpura? | Petechia is < 5mm in diameter, while Purpura is from 5mm to 1 cm in diameter. |
| What is Petechiae and Purpura? | Cutaneous or subcutaneous collection of extravasated blood from small vessel bleeding that are associated with platelet dysfunction or capillary fragility |
| What are the most common places to see Petechiae or Purpura? | Usually in ankles and feet , due to increased venous pressure |
| Pure Red Cell Aplasia: | Rare form of marrow failure characterized by severe hypoplasia of the marrow ERYTHROID elements in the setting or granulopoiesis and thrombopoiesis. |
| What conditions and/or infections are associated to Red Cell Aplasia? | Thymoma, Lymphocytic leukemias, and Parvo B12 infection. |
| Abetalipoproteinemia is: | An inherited inability to synthesize ApoB, an important component of chylomicrons and VLDL. |
| Where do lipids absorbed by the small intestine are accumulated in a patient with Abetalipoproteinemia? | Interstitial epithelium |
| How are the enterocytes in Abetalipoproteinemia described as: | with a clear or foamy cytoplasm |
| What makes an Enterocytes from a patient unable to synthesize Apo-B, to appear clear or foamy cytoplasm? | The accumulated lipids in the interstitial epithelium. |
| What is the clinical presentation of Glucagonoma cutaneous involvement? | - Erythematous papules/plaques in the face, perineum, and extremities. - As lesions increase in size, they leave a central indurated area with peripheral blistering and scaling. |
| Glucagonoma often develops ________________ and ___________ in patients, along with GI symptoms. | Diabetes mellitus and Hyperglycemia |
| Serum levels indicated markedly elevated Glucagon levels. Possible Dx? | Glucagonoma |
| Gastrinoma: | Elevated gastrin levels, with increased gastric acid leading to gastric ulceration. |
| MC location for a Gastrinoma: | Jejunum |
| What serum level imbalances are distinctive of a VIPoma? | Hypokalemia, achlorhydria and diarrhea. |
| What do VIPoma patients present with low blood pressure? | Due to dehydration (diarrhea) and vasodilatory effects of VIP. |
| Tuberculoid Leprosy will have a __________________. | Strong response of CD4+ Th1 cell- mediated immune response to M. leprae. |
| A positive Lepromin Skin test indicates? | Tuberculoid leprosy; strong CD4+ Th1 immune response |
| A negative Lepromin Skin test would indicate? | Lepromatous Leprosy; weak Th1 cell mediated immune response. |
| What MCV value indicate Megaloblastic anemia? | > 110 |
| What are the MCC of Megaloblastic anemia? | Folic acid and Vitamin B12 deficiency |
| Those patients with chronic hemolytic anemia have_________ | Increase Folic acid requirements due to increased Erythrocyte Turnover and are predisposed to developing Macrocytosis |
| Angiosarcoma is also known as: | "Stewart-Treves syndrome" |
| What hx in patient would increase risk of developing angiosarcoma? | Hx of Chronic lymphedema. |
| What kind of surgery often predisposes patients to lymphedema and even angiosarcoma? | Radical Mastectomy with axillary lymph node dissection |
| Histology of Angiosarcoma is described as? | Infiltration of dermis with slit-like abnormal vascular spaces |
| What are Neurofibromas? | soft, rubbery, asymptomatic cutaneous nodules that commonly appear during the second and third decades of life. |
| What does the Rb protein do? | Regulates the cell cycle |
| Active Rb protein is ______________________. | Hyperphosphorylated |
| An active Rb protein is said to be _____________________, and it _____________________________________. | Hypophosphorylated; prevents damaged cells from progressing past G1 to S checkpoint |
| A mutated Rb protein entails? | An inactive Rb protein, or Hyperphosphorylated; promotes cancer development |
| Does a hypo- or hyperphosphorylated Rb protein promote cancer development? | Hyperphosphorylated Rb protein |
| Inactivation of the Rb protein causes ---> | Allowance of damaged cells to enter mitosis |
| What is the MC infectious agent for Bullous impetigo? | S. aureus |
| Bullous impetigo physical finding description. | Blistering skin rash with tan-to-honey colored crust. |
| What is the cause of Bullous impetigo? | Exfoliative toxin A of S. aureus, which targets DESMOGLEIN 1 in epidermal cell junctions, cause the loss of cell adhesion |
| Desmoglein 1 is targeted by: | The Exfoliative Toxin A of Staph aureus in Bullous impetigo. |
| What protein is targeted by Exfoliative toxin A of Staph aureus in the pathogenesis of Bullous impetigo? | Desmoglein 1 |
| Bullous Pemphigoid is: | AUTOIMMUNE disorder associated with antibodies against Hemidesmosomes,and characterized by tense, subepidermal blisters. |
| Antibodies against Hemidesmosomes | Bullous pemphigoid |
| Antibodies against Desmosomes | Pemphigus vulgaris |
| What is Pemphigus vulgaris? | Autoimmune disorder characterized by intraepithelial cleavage due to auto antibodies against Desmosomes |
| What specific desmosomes are attacked in Pemphigus vulgaris? | Desmoglein 1 and 3 |
| What is the clinical presentation of bullous in Pemphigus vulgaris? | Flaccid bullae, desquamation, and ORAL ulcerations |
| What are the 3 main types of Headaches? | Migraine, Cluster and Tension |
| What are the characteristics of Migraine headaches? | 1. Female > Men 2. Strong Family Hx 3. Variable onset 4. Mostly unilateral 5. Pulsatile and Throbbing. 6. Last form 4-72 hours 7. Associated with Photophobia, Phonophobia, Nausea, and with or without aura. |
| How is the pain described in a Migraine headache? | Pulsatile and Throbbing pain, with a duration form 4-72 hours. |
| Does a migraine come with an aura? | It can be associated with aura, although it may also present without one. |
| What are phobias that accompany a Migraine? | Photophobia and Phonophobia |
| What are the characteristics of a Cluster headache? | 1. Male > Female 2. Variable Family Hx 3. Presents during sleep or similar time daily 4. Pain is behind the eye 5. Excruciating, sharp and steady pain 6. It last form 15 to 180 minutes 7. Associated with Ipsilateral sweating, facial flushing, nasal congestion, and pupillary changes |
| What kind of headache is often presented at night time, or otherwise around the same time everyday? | Cluster headache |
| A patient with a cluster headache would describe pain as? | Pain behind the eye, lasting around 15 minutes to 3 hours, and is a sharp, intense, and steady pain. |
| What conditions or symptoms are associated with a Cluster headache? | Same side sweating, flushed face, miosis or mydriasis, nasal congestion. |
| What are the characteristics of a Tension headache? | 1. Female > Male 2. No family History 3. Under stress 4. Bilateral, band-like pattern around the head pain 5. Pain is dull, tight,and persistent 6. Duration of 30 mins to months and years 7. Associated symptoms include: muscle tenderness in head, neck, and/or shoulders |
| Patient grabs head with both hands around just above the eyebrow, and goes around. Suspected headache? | Tension headache |
| How is the pain described in a Tension headache? | Dull, persistent and tight, with a band-like distribution in head, and joined by muscle tenderness around the head, neck and shoulders. |
| What are the risk factor producing Calcium kidney stones? | 1. Hypercalciuria (HyperPTH) 2. HyperOXALURIA (malabsorption, low-calcium intake) 3. Hypocitraturia (Distal RTA) 4. Diet: High amounts of Na+, Protein, and oxalate Low amounts of calcium |
| What kinds of diuretics are used in the prevention calcium nephrolithiasis? | Thiazide diuretics |
| What conditions or diseases account for the increase risk of Uric acid kidney stones? | Gout and Myeloproliferative disorders |
| What is done to prevent uric acid precipitation in the kidneys? | Urine alkalinization and Allopurinol |
| Allopurinol prevents the formation of ________________ kidney stones. | Uric acid |
| Stravute is made up of? | Magnesium, NH3, and Phosphorus |
| What can increase the risk or chance of forming a Struvite? | Recurrent upper Urinary infections by Klebsiella or Proteus |
| Which are the 2 most common organisms involved in Stratuvide formation? | Klebsiella and Proteus |
| Dehydration may account for formation of ________ type of kidney stones. | All |
| CXR description of Pulmonary fibrosis: | Bilateral Reticulonodular Opacities |
| CXR description of Atelectasis: | Opacification (collapse) of corresponding lobe or lobule |
| CXR description of Pulmonary Hypertension: | Enlargement of Pulmonary arteries and Right-ventricle |
| CXR of LV failure: | Cardiomegaly, pulmonary edema, pleural effusions, and enlarged pulmonary vessels |
| What is the triad of Psoriatic Arthritis? | 1. Psoriasis in extensor areas of extremities (elbow and knee) 2. Nail changes: yellow/brown discoloration, pitting, thickening, or crumbling. 3. Inflammatory disorders of the eye: Conjunctivitis, Blepharitis,or Uveitis |
| What are Chiari malformations? | Congenital disorder that result from under development of the Posterior Fossa, causing parts of the cerebellum and medulla to herniate through the Foramen Magnum. |
| What is the common presentation of Chiari Type 1 malformation? | Relative bening and presents during childhood with occipital headache and cerebellar dysfunction |
| What is the common presentation of Chiari Type 2 malformation? | Severe form of Chiari malformation, that affects neonates and is often associated with lumbar myelomeningocele and hydrocephalus. |
| Hydrocephalus is: | Enlargement of the Ventricles( with or without elevated pressure) |
| What are the causes of Hydrocephalus? | 1. Neuronal Volume loss (hydrocephalus ex-vacuo) 2. Excessive CSF accumulation (due to flow obstruction or impaired absorption) |
| Hydrocephalus Ex-vacuo: | Associated with AIDS dementia. It is due to cortical atrophy, which allow ventricles to expend while keeping normal CSF pressure. |
| What type of Hydrocephalus is produced by Obstruction of flow of the CSF? | Non-Communicating Hydrocephalus |
| What are types of Non-Communicating Hydrocephalus? | 1. Aqueductal stenosis 2. Arnold-Chiari malformation |
| Decreased CSF absorption lead to the development of _______________ hydrocephalus. | Communicating |
| Communicating Hydrocephalus are divided into: | - Normal Pressure Hydrocephalus (NPH) - High Pressure Hydrocephalus |
| How are the levels in CKD? | Hypocalcemia and Hyperphosphatemia |
| The increase of PTH levels in CKD is referred as: | Secondary Hyperparathyroidism |
| Following the Secondary Hyper PTH in setting of CKD, the increased bone resorption gives as result_____________________. | Osteitis fibrosa cystica |
| Chronic kidney disease first step is to decrease the amount of _____________________ and the ____________________ ______________. | 1, 25-(OH)2 Vitamin D and the Phosphate filtration (both decreased) |
| What is a common complication of acute Pancreatitis? | Pancreatic Pseudocyst |
| What is a pancreatic pseudocyst? | A collection of fluid rich in enzymes and inflammatory debris. |
| What is the histology found in a pancreatic pseudocyst? | Wall of cyst cost of Granulation tissue and fibrosis |
| Pseudocysts are NOT lined with _________________, as regular cysts are. | Epithelium |
| What is the most common location for a Pancreatic Pseudocyst? | Lesser Peritoneal sac, bordered by the stomach, duodenum and transverse colon. |
| Which structures border the Lesser Peritoneal sac? | Stomach, duodenum and the transverse colon. |
| What is the type of tissue found in Serous Pancreatic Neoplasms? | Glycogen-rich cuboidal epithelium |
| What kind of tissue is present in Mucinous Pancreatic neoplasm? | Columnar mucinous epithelium |
| Papillary Pancreatic adenocarcinoma presents with: | Atypical cells forming papillary projections. |
| WHat is the MC hormonally active Pituitary adenoma? | Prolactinoma |
| How are the clinical manifestations presented in Prolactinoma? | Excess prolactin produced by this tumors can cause Galactorrhea and amenorrhea in Premenopausal women |
| A large-size Prolactinoma may cause? | Visual changes and headache may occurs due to compression of the Optic chiasm |
| What is structure is commonly compressed by a Prolactinoma? | Optic chiasm |
| What are the clinical features of Prolactinoma in a Premenopausal woman? | Oligomenorrhea/amenorrhea, infertility, galactorrhea, hot flashes, decreased bone density |
| What is Galactorrhea? | Nipple discharge (milky) |
| To what neoplasm is Galactorrhea often associated? | Prolactinoma |
| What are the clinical features of Prolactinoma in Post-menopausal women? | Mass-effect symptoms such as headache and visual fiel defects |
| What re the clinical features of Prolactinoma in men? | Infertility, decreased libido, impotence and Gynecomastia |
| Prolactin levels are abnormally high at: | >200 ng/mL |
| What other tests, besides prolactin levels, are performed to diagnose Prolactinoma? | 1. Creatine (to rule out Renal insufficiency) 2. TSH, Thyroxine (to rule out Hypothyroidism) |
| What is the histology in Multiple Myeloma? | Replacement of the normal bone marrow with plasma cells and blasts |
| What is Multiple Myeloma? | Plasma cell malignancy that replicates in the bone marrow and causes osteolytic bone lesions, bone resorption, HYPERCALCEMIA, and pathologic fractures. |
| Labs result in Multiple Myeloma demonstrate: | - Normocytic anemia - Renal insufficiency - Hypercalcemia (constipation, muscle weakness) - Monoclonal paraproteinemia (M-spike) |
| What is the histologic description of Carcinoid tumors? | Composed of islands or sheets of uniform cells with Eosinophilic cytoplasm and oval-to-round stippled nuclei. |
| Carcinoid tumors are derived from: | Neuroendocrine cells in the GI tract |
| Where is the MC place to incidentally find a Carcinoid tumor? | The appendix |
| What symptoms are produced upon Carcinoid tumor metastases? | It most likely affects the liver, and causes Carcinoid syndrome presenting with flushing, diarrhea, and bronchospasms. |
| Why is Carcinoid Syndrome produced? | Carcinoid tumor for GI tract metastasis to the liver. |
| What are the characteristic symptoms of Carcinoid syndrome? | Flushing, Diarrhea, and bronchospasm. |
| What virus is found in 50% of systemic B-cell lymphomas? | EBV |
| All primary CNS lymphomas occurring the setting of HIV infection, often also seem affected by what other virus? | EBV |
| What value will indicated a high mitotic index? | High Ki-67 fraction |
| Which non-Hodgkin lymphoma is associated with EBC and a high Ki-67 fraction? | Burkitt Lymphoma |
| t(8;14) | Burkitt Lymphoma |
| What causes the overexpression of c-MYC? | t(8;14) translocation of Burkitt lymphoma |
| What is the histology of Burkitt lymphoma? | 1. Diffuse medium-sized lymphocytes 2. HIgh proliferation index represented by a high Ki-67 fraction 3. "Starry-sky" appearance |
| What produces the "starry-sky" appearance of Burkitt lymphoma under the LM? | Presence of benign macrophages |
| Histology of Kaposi Sarcoma: | Large cells, big nuclei, and prominent nucleoli |
| What is Erythema Multiforme? | Target-shaped, inflammatory skein lesion |
| What kind of infections or conditions are associated with E. multiforme? | Typically arises in the setting of infection with HSV or Mycoplasma pneumoniae |
| What it the pathogenesis of E. multiforme? | Deposition of infection antigens in the Keratinocytes, leadin got a STRONG cell-mediated (cytotoxic T-cell) immune response |
| Erythema nodosum: | Delayed-type hypersensitivity reaction that causes nodes in the subcutaneous fat. |
| What is the clinical presentation of E. Nodosum? | Tender (painful), erythematous nodules on the BILATERAL SHINS |
| What is Psoriasis? | Immune-mediated inflammatory disease associated with cytokine driven keratinocyte hyperproliferation parakeratosis |
| What is the clinical presentation of Psoriasis? | Erythematous, chronic skin plaques with silvery scales on extensor elbow, scalp, and/or knees. |
| Dermatitis herpetiformis is due to: | Gluten-sensitivity |
| Dermatitis herpetiformis is caused by the: | Subepidermal deposition of IgA |
| Dermatitis hepatitis dermis is associated with: | Celiac Disease |
| What is the description of Dermatitis herpetiformis? | Pruritic papules and vesicles on forearms, knee, adn or scalp |
| Urticaria is caused by: | the release of inflammatory and vasoactive mediators form mast cell in superficial epidermis |
| Urticaria is often seen with: | Parasites |
| Describe the appearance of Urticaria: | Well-circumcised, raised, pruritic erythematous plaques with or without central pallor. |
| What is Sjogren's syndrome? | Autoimmune disease characterized by Lymphocytic inflammation of the Exocrine glands (lacrimal and Salivary) |
| What are the common features of Sjogren's Syndrome? | Dry eyes (Keratoconjunctivitis) Dry mouth (Xerostomia) Dry skin (Xerosis) Raynaud phenomenon Cutaneous vasculitis |
| What is Sjogren's syndrome positive antibodies? | Anti-Ro (SSA) and Anti-La (SSB) |
| What are the common complications of Sjogren's Syndrome? | 1. Non-Hodgkin lymphoma, due to chronic B-cell proliferation 2. Corneal damage, dental caries |
| SLE relation with thrombotic events | Increase of arterial and venous thrombosis due to autoantibody production (antiphospholipid antibodies) |
| Renal artery Stenosis is seen with: | Advanced atherosclerosis or fibromuscular dysplasia and causes treatment for hypertension to be resistant |
| Pathology of BPH: | Associated with stromal and glandular growth in the Periurethral and Transitional zone of the prostate |
| Why is there gross hematuria in BPH? | The hyperplastic cells are supported by the formation of new blood verses, where fiable and prone to bleeding. |
| What are the two main classifications of BPH symptoms? | Voiding (obstructive) and Storage (irritative, filling) symptoms |
| What are the Voiding (obstructive) symptoms of BPH? | Weak urinary stream, Intermittency, Incomplete emptying, hesitancy, and straining to void |
| Which are the Storage symptoms of BPH? | Frequency, urgency, nocturia, and incontinence |
| What is AAT? | Serine protease inhibitor that regulates the activity of elastase in the lung. |
| What substance regulates Elastase activity in the lung? | AAT (serine protease) |
| What does AAT stand for? | Alpha-1-antitrypsin |
| AAT deficiency leads to: | Alveolar destruction and Panacinar emphysema |
| What is the result of improperly folded AAT proteins in the hepatocyte? | Liver dysfunction and cirrhosis |
| AAT is associated to conditions in which to organs? | Liver (liver dysfunction and cirrhosis) and Lungs (Panacinar emphysema) |
| What is the common description of a CXR of a patient with AAT deficiency Panacinar emphysema? | Lung hyperinflation and flattening of diaphragm. |
| What joints are involved in Rheumatoid arthritis? | PIP, MCP, and MTP |
| Pain in morning but betters with use and during course of day? | Rheumatoid arthritis |
| Rheumatoid arthritis often involves which Bone area? | Cervical Spine |
| What can be produced by the Cervical spine involvement in RA? | Cervical spine subluxation and cord compression |
| Compression of the Cervical spine may produce: | Flaccid paralysis and areflexia |
| What happens in the synovial fluid of a patient with RA? | The accelerated metabolic rate of the inflamed synovial tissue lead to LOCAL HYPOXIA and increased production of HYpoxic-induced factor 1 and VEGF by local macrocapshand fibroblast, resulting in synovial angiogenesis (neovascularization) |
| What substances are secreted by macrophages, due to the Local hypoxia seen in synovial tissue of RA patients? | Factor-1 and VEGF |
| What condition or disease is associated with Synovial angiogenesis? | Rheumatoid arthritis |
| What is the MC malignancy of childhood? | ALL (Acute Lymphoblastic Leukemia) |
| B-cell ALL accounts for ______________ of all cases. | 70-80% |
| T-cell ALL accounts for ______________ of all cases. | 15-17% |
| T-cell ALL symptoms are due to: | Mediastinal mall that cause respiratory symptoms, dysphagia, or Superior Vena Cava syndrome |
| B-cell and T-cell ALL are positive for ______________. | Tdt |
| What CD markers are positive in B-cell ALL? | CD10+, CD19+, and CD20+ |
| What CD markers ar positive in T-cell ALL? | CD2+, CD3+, CD4+, CD5+, CD7+, and CD8+ |
| What is the MCC of Nephrotic syndrome in children (2-3 yo)? | Minimal Change Disease (MCD) |
| What is the pathogenesis of MCD? | - T-cell mediated injury to PODOCYTES - Production of glomerular permeability factor |
| What are the distinctive clinical features of Minimal Change disease? | - Edema, frothy urine - Proteinuria, hypoalbuminemia, and hyperlipidemia |
| What is seen in LM of MCD? | Normal glomeruli |
| What is seenin IM of MCD blood smear? | No immune deposits |
| What is the distinctive findings of EM in a MCD patient ? | Diffuse podocyte foot process effacement |
| Kallmann Syndrome is due: | Absence of GnRH secretary neuron in the Hypothalamus due to defective migration from the olfactory placode. |
| Defective migration of neurons to the Hypothalamus form the Olfactory placode. Dx? | Kallmann syndrome |
| What is the clinical presentation of Kallmann Syndrome? | Central hypogonadism and ANOSMIA, andofter perested with delayed puberty. |
| 16 year old female with amenorrhea and markedly underdeveloped breast buds and genital area, complains of no taste in food. Dx? | Kallmann syndrome; Anosmia is usually accompanied by Ageusia. |
| Rash with Target-like lesions. Dx? | Erythema multiforme |
| What two infectious bodes are often causative of E. multiforme? | Herpes simplex virus and Mycoplasma |
| What populations have higher incidence of Sarcoidosis? | Young adults and African-Americans |
| What are the extrapulmonary symptoms of Sarcoidosis? | Skin lesions, Anterior/Posterior uveitis, and Lofgren syndrome |
| What are the classical features of Sarcoidosis? | Cough, dyspnea,an chest pain, along with Parathyroid gland swelling, and some skin, uveitis, and lofgren syndrome expressiitvy. |
| What is seen imaging of Sarcoidosis CXR? | 1. Bilateral hilar adenopathy 2. Pulmonary reticular infiltrates |
| What are the important labs in Sarcoidosis? | 1. Hypercalciuria and Hypercalcemia 2. Elevated serum ACE level |
| Elevated ACE level and cough. Dx? | Sarcoidosis |
| Sarcoidosis Bx of affected tissue will show? | Noncaseating granulomas that stain negative or function and acid-fast bacilli |
| Sarcoidosis non-caseating granulomas are found in scattered along the patient's _____________. | Liver |
| Where is the MC location of Esophageal adenocarcinoma? | The distal esophagus |
| What is a common condition for development of Esophageal adenocarcinoma? | Barreths esposhagus |
| What is the MC risk for developing Barrett's esophagus? | Long-standing GERD |
| Risks for developing esophageal carcinoma? | Smoking, Obesity, medications to lower LES pressure ,and nitroso rich food. |
| How does Obesity influences the development of Esophageal adenocarcinoma? | Increased intragastric pressure, increased frequency of LES relaxation and increase rate of hiatal hernia, which promote GERD |
| What kind of medication are protective of GERD development? | NSAIDs |
| How is Cherry-Hemangioma described? | small, red, cutaneous papules common in aging adults |
| Cherry-Hemangiomas: | do not regress with age, and tend to increase in number during adulthood. |
| LM of Cherry hemangiomas? | Proliferation of capillaries and postcapillary venules in papillary dermis |
| Another name for Skin tags | Acrochordons |
| What are acrochordons? | Skin tags; pedunculated outgrows of normal skin |
| Where are the MC places to find acrochordons? | Areas of constant friction such as axilla, inframammary, and groin, in patient obese or with chronic DM |
| What are Cavernous hemangiomas? | Dilated vascular spaces with thin walled endothelial cells |
| What are the most common locations for Cavernous hemangiomas? | Skin, mucosa, deep tissues and viscera |
| Cavernous hemangiomas are associated with : | von Hippel-Lindau disease (vHL) |
| Soft, blue, compressive masses up to few centimeters in size and associated with VHL gene mutation. | Cavernous hemangiomas |
| Cystic hygromas are: | Lymphatic cysts lined by thin endothelium. |
| What syndromes are associated with Cystic hygromas? | Down and Turner Syndrome |
| What are the most likely locations to find Cystic hygromas? | Posterior neck and lateral chest wall |
| What is Synaptophysin? | Protein found in Presynaptic vesicles of neuron, neuroendocrine and neuroectodermal cells |
| What are the Neoplasms of GLIAL origin? | Astrocytomas, Ependymomas, and Oligodendrogliomas |
| Tumors of glial origin stain positive for _____. | GFAP |
| What type of CNS tumor account for their vast majority? | Those of Glial origin that stain positive for GFAP. |
| Angiosarcoma is due to: | Chronic lymphedema |
| What is the MCC of Hereditary Hemochromatosis? | Missense mutation of the HFE gene |
| What is the result of HFE gene mutation? | Excessive intestinal iron absorption and organ damage, due to the accumulation of iron within parenchymal tissues. |
| Granuloma formation involves the activation of which cell? | Th1 macrophage |
| Granuloma: | Characterized by large number of epithelioid macrophages may fuse together to form multinucleated cells (Langhans Giant cells) surrounded by band of lymphocytes. |
| Clinical features of PDA? | - Differential clubbing and cyanosis without BP or pulse discrepancy |
| Why is clubbing and cyanosis more pronounced in the legs of a PDA patient? | The PDA delivers OXYGENATED blood distal to the Left Subclavian artery |
| PDA delivers O2-poor blood distal to what arterial vessel? | Left Subclavian artery |
| Where is the MC location for coarctation of the Aorta? | In the Juxtaductal region just distal to the Left Subclavian artery |
| What is a distinctive cardiovascular features of Coarctation of the Aorta/ | Presents with Blood pressure and pulse discrepancy between arms and legs. |
| Characterized by whole-body cyanosis at birth, as result of the Right-to-Left shug via VSD. | Tetralogy of Fallot |
| Right to Left Shunts preset with: | Large septal defects |
| What happens in people with uncorrected Right to Left shunts? | Development of Esisember Syndrome (shunt reversal) |
| What are the metalloproteinases? | Zinc-containing enzymes that degrade the extracellular matrix |
| What is the role or function of Metalloproteinases? | Participate in moral tissue remodeling an in tumor invasion through the basement membrane and connective tissue. |
| How do metalloproteinases participate in tumor invasion? | They cause degradation of the basement membrane by actions of Proteolytic enzymes, such as metalloproteinases and cathepsin D protease. |
| What are the most common Proteolytic enzymes involved in basement membrane degradation? | Metalloproteinases and Cathepsin D protease. |
| Role of Acid Hydrolases: | function at acidic pH; mainly degradative lysosomal enzymes |
| Alkaline Phosphatase is: | Concentrated in human liver cells; High levels lead to Obstructive biliary processes. |
| Carboxypeptidases function: | Cleave peptide bonds of the carboxyl-terminal; |
| Carboxypeptidases are often involved in: | Synthesis of insulin and neuropeptides |
| ECM component | Hyaluronic acid |
| The presence of Schistocytes highly suggests: | Microangiopathic Hemolytic anemia |
| What disorders are seen with presence of Schistocytes? | HUS, TTP, DIC, and Prosthetic valves |
| Schistocytes + children affected + bloody diarrhea. Dx? | HUS |
| Abnormal PT and PTT times + Schistocytes + anemia. Dx? | DIC |
| HUS and TTP have ____________________________. | Normal PT and PTT times |
| Schistocytes are: | Fragmented red cells and few platelets |
| What is a common complication of acute MI of the LV? | Acute Pulmonary edema |
| What is the pathogenesis of Acute Pulmonary edema? | Elevated hydrostatic pressure in the Pulmonary venous system lead to engorged capillaries with transudative fluid into the alveoli, apperatin as acellular PINK material on histology. |
| + Hemosiderin-laden macrophages | Indicative of chronic lung congestion |
| Histology analysis of Bacterial pneumonia: | Numerous neutrophils in alveolar fluid |
| Focal necrosis of alveolar walls with intra alveolar hemorrhage, is seen in : | Goodpasture Syndrome and other vasculitis |
| Tumors of MEN type 1: | 1. Pituitary tumor (MC Prolactinoma) 2. Primary Hyperparathyroid 3. Pancreatic Endocrine tumor |
| What are the effects of a Primary HyperPTH tumor in MEN 1? | Hypercalcemia, Constipation, and Kidney stones |
| What feature of MEN type 1 accounts for the development of kidney stones? | Primary HyperPTH tumor as it produces too much Ca2+ |
| What is the most common Pancreatic endocrine tumor in MEN type 1? | Gastrinoma |
| What are some Pancreatic endocrine tumors? | Gastrinoma, Insulinoma, Somatostatinoma, and VIPoma |
| What are the associated neoplasms in MEN 2A? | 1. Medullary Thyroid cancer 2. Pheochromocytoma 3. Primary HyperPTH |
| What kind of Thyroid cancer is seen MEN type 2A and 2B? | Both have MEDULLARY thyroid cancer |
| Which neoplasm causes a rise in calcitonin in MEN 2A? | Medullary Thyroid cancer |
| What are the neoplasms associated to MEN type 2B? | 1. Medullary Thyroid cancer 2. Pheochromocytoma 3. Mucosal neuromas/Marfanoid habitus |
| How are serum calcium levels different in MEN type 1 and MEN type 2A/2B? | MEN type 1 has hypercalcemia, and MEN type 2 features a hypocalcemic status due to increased levels of calcitonin |
| Why are vegetations caused? | Bacterial colonization and growth on a sterile fibrin -platelet nidus that forms on the damaged/disrupted endothelial surcea of the valvular aparatus. |
| Why are valves predispose to fibrin deposition? | They are areas of high blood flow and turbulence |
| Endomyocardial fibrosis: | a restrictive cardiomyopathy characterized by thickening and fibrosis of the apical endocardial surface |
| Myxomatous degeneration in the mitral valve indicates: | Thickened and redundant mitral leaflets with elongated cohade leading to prolapse of the one of both mitral leaflets. |
| How is Friedreich Ataxia characterized? | Cerebellar ataxia (Spinocerebellar tract degeneration) adn loss of position / vibration sensation (dorsal column/dorsal root ganglia degeneration), kyphoscoliosis, and HCM. |
| What are some distinctive features of Friedreich ataxia syndrome? | Foot abnormalities and Diabetes mellitus |
| Damage to the Spinocerebellar tract --> | Gait ataxia |
| Damage to the Lateral corticospinal tract ---> | Spastic muscle weakness |
| Damage to the Dorsal column and Dorsal root ganglia --> | Loss of position and vibration sensation |
| Where is the most common location of Squamous cell carcinoma of the Esophagus? | Proximal 2/3 of esophagus (MC middle third) |
| What is commonly associated with middle third Esophageal Squamous cell carcinoma? | Mediastinal Lymphadenopathy |
| Histology seen in Esophageal Squamous cell carcinoma? | - Sheets of Eosinophilic squamous cells - Keratin pears, intercellular bridges. |
| What is the triad seen in Aplastic anemia? | 1. Low hemoglobin 2. Thrombocytopenia 3. Absent hematopoietic cells in bone marrow |
| Patients with aplastic anemia will have a compensatory: | Increase in circulating ERYTHROPOIETIN levels |
| Increased Reticulocyte index is indicative of : | hemolytic or hemorrhagic anemia, assuming normal bone marrow function |
| Activation of Procarcinogens cause: | Cancer development |
| By what are Procarcinogens metabolized? | Cytochrome P450 monooxygenase (enzyme) |
| Classic, salt-wasting 21-(OH) deficiency features: | - Girls --> present at birth with ambigous genitalia -Boys ---> present at 1-2 weeks with failure to thrive, dehydration, hyperkalemia, and hyponatremia |
| Classic, NON-salt wasting 21-(OH) deficiency is seen with: | Girls --> since bith wth ambibous genitalia Boys ---> Present after 2-4 years from birth, with signs of EARLY virilization |
| Nonclassic, Delaved 21-(OH) deficiency is featured by: | - Premature pubarche or sexual precocity in school age children - Young women can present with Acne, Hirsutism, and menstrual irregularity. |
| What lab findings are seen in al 3 types of 21-(OH) deficiency? | Increased serum concentration of 17-Hydroxyprogesterone and Androgens |
| Elevated Androgens and serm [17-(OH)] | 21-(OH) deficiency |
| What is the treatment of 21-(OH) deficiency? | Administration of low doses of Exogenous corticosteroids in order to suppress ACTH secretion |
| What is the ultimate purpose of low doses of corticosteroids to 21-(OH) deficiency patients? | The removal of excess ACTH stimulation, exogenous corticosteroids can decrease androgen production by the adrenal cortex |
| Duchenne Muscular dystrophy is characterized as: | X-linked recessive disorder; Myopathy characterized by Proximal muscle weakness and enlargement of the calf muscles in boys of age 2-5. |
| What kind of gene mutation is seen in Duchenne Dystrophy? | Frameshift affecting the Dystrophin gene |
| What is the role of Dystrophin? | Provides an stabilizing interaction between the sarcolemma and the intracellular contraction apparatus |
| A disruption of the Dystrophin protein causes? | Membrane damage and myonecrosis |
| What are some common conditions with Proximal Muscle weakness? | Myopathy, Muscular dystrophy, Myasthenia, Myosists |
| What is meant with Proximal muscle weakness? | Affection of muscles closer to the midline of the body |
| What is meant by Distal muscle weakness? | Affection of the muscles further in the limbs |
| What are osem conditions seen with Distal muscle weakness? | Peripheral Neuropathy, Distal muscular dystrophies, and Inclusion body myositis |
| What is a severe complication of Meningococcal septicemia? | Acute adrenal Crisis |
| Waterhouse-Friderichsen Syndrome is : | Acute adrenal crisis by Meningococcal septicemia |
| Bilateral hemorrhagic infarction of the adrenal gland | Acute adrenal Crisis |
| What is the most common organism involved in Waterhouse-Friderichsen syndrome? | Neisseria meningitidis |
| What DIC symptoms are present in adrenal Crisis? | low platelet count, petechial rals, and abnormal bleeding (oozing from venipuncture sites) due to sepsis |
| Adrenal crisis presented with shock symptoms, which include: | Hyponatremia, hyperkalemia, hypoglycemia |
| Fever, altered mental status and nuchal rigidity + DIC symptoms. Dx? | Meningitis (MC N. meningitidis) |
| Which part of the stomach is most related to formation of Gastric ulcer? | The body of stomach |
| Duodenal ulcer form due to H. pylori colonization in which part of the stomach? | Gastric antrum |
| What infectious agent is associated with Duodenal ulcer formation? | H. Pylori |
| What causes duodenal ulcers MC? | H. pylori infection in gastric antrum decreases the release of Somatostatin from antral D cells, which las to increase production of Gastrin and tee Increase H+ secretion into stomach lumen by Parietal cells |
| What cells does Clear cell Renal carcinoma arises from? | Renal Proximal Tubular cells |
| What is the MC renal malignancy? | Clear Cell carcinoma |
| LM show: Round or Polygonal cells with abundant clear cytoplasm in tissue from the patients PCT. Dx? | Clear Cell carcinoma |
| What are the most common sites for Spontaneous lobar hemorrhage? | Occipital and Parietal lobes |
| What it ehe MCC of spontaneous lobar hemorrhage in elderly? | Cerebral Amyloid Angiopathy |
| How many days after ischemic even in the brain does microglia appear? | 3-7 days |
| What is the purpose of Microglia after CNS ischemic event? | Phagocytize the fragments of neurons, myelin and necrotic debris |
| What kind of neuron are found in the Hippocampus? | CA1 pyramidal neurons, which are the ones most affected by Global cerebral ischemia |
| Krukenberg tumor is: | Gastric tumor that metastasized to the ovary and can only present with unintentional weight loss, epigastric pain and adrenal massed |
| The histology of an Krukenberg tumor is: | Large amounts of Mucin with apically displaced nuclei --> Signet ring appearance. |
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