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Pathological descriptions

Nutmeg Liver Congestive liver, secondary to congestive Right Failure
Cardiac sclerosis/cirrhosis Long-standing congestion of liver; leading to scarring around central vein of liver
What can congenital bicuspid aortic valve lead to later in life (40yrs)? Degenerative Calcific Aortic Valve Stenosis
Which valvular condition is Marfan syndrome associted with? Mitral valve prolapse
What kind of murmur is heard for mitral prolapse? Mid-systolic click
What kind of infection leads to rheumatic fever? Pharyngeal infection (sore throat) with Group A strep (strep pyrogenes
What is a localized myocarditis lesion resulting from acute rheumatic fever called? Aschoff body--> fibrinoid necrosis due to RF in heart, surrounded by macrophages
What are the Jones criteria of Rheumatic Fever? Major: Pancarditis, Migratory polyartheritis, Skin rash (erythema marginatum), subcutaneous nodules, syndenham chorea Minor: Fever, Arthralgia, Elevated acute phase reactants
Syndenham chorea? Seen in children with acute rheumatic fever. Aka St. Vitus' dance
Anitschkow myocytes In rheumatic fever, these are large mesenchymal cells in myocardial lesion
MacCallum's plaques Left atrial endocardial thickening
What are the most common cause of acute endocarditis & subacute endocarditis? Acute endocarditis -- Staph Aureus Subacute endocarditis -- Strep Viridans
Roth spots, Osler nodes, Janeway lesions? All assoc. with endocarditis: Roth spots -- emboli to retina (round white spots on retina surrounded by hemorrhage. Osler nodes -- Painful, red subcutaneous nodules on the finger and toes. Janeway- painful red lesions on palm & sole
Which congenital viral infection is associated with congenitial heart defect? Rubella infection
Which genetic disorder is associated with Preductal coarctation of the aorta? Turner syndrome
Which congenital defect causes nothing of ribs to be observed on x-ray? Postductal coarctation of aorta-- due to high pressure in intercostal arteries, leading to erosion of ribs. Blood is shunted through the intercostals
Collateral circulations associated with postductal coarctation of aorta? Via internal mammary and intercostal arteris
What are the 5 Terrible T's of cyanotic heart disease? Terrible T's are associated with right to left shunt: Tetralogy of fallot Truncus arteriosus Transposition of great vessels Tricuspid atresia Total Anomalies Pulmonary Venous Drainage or Connection (TAPVC)
Eisenmenger syndrome Reversal of an initial left to right shunt (no cyanosis) to a right to left shunt; due to increased pulmonary trunk pressure. Results in late cyanotic condition
Tetralogy of Fallot classic tetrad: Pulmonary outflow obstruction/stenosis, Right ventricular hypertrophy, VSD, overriding aorta
Boot-shaped heart Child with a tetralogy of fallot
Symptoms of Tetralogy of Fallot Early cyanosis, clubbed fingers, polycythemia
Anatomically what is the position of the aorta in Transposition of the great vessels? Aorta will be anterior to the pulmonary trunk Normally pulmonary trunk is anterior to aorta
In what situation is shunts and consistently opened ducts beneficial? Transposition of the great vessels: VSD, ASD, PDA help with blood mixing The more defects baby has, the better the survival rate of baby
Which congenital heart defect can maternal diabetes cause? Transposition of the great vessels
How can ducts of heart be kept open in a neonate? Prostaglandins
Which other defect usually occurs in addition to Tricuspid atresia? Atrial Septal Defect & Right ventricular hypoplasia
What does Total Anomalies of Pulmonary Venous Connection (TAPVC) drain? Coronary sinus or right atrium
What are the first and second most common congenital heart defects? 1st-- Bicuspid aortic valve 2nd-- Ventricular septal defect
What kind of murmur is heart for VSD? Systolic murmur
What is the most common type of ASD Ostium Secundum
What are the 2 complications of ASD Eisenmenger syndrome Paradoxical emboli
Which congenital heart defect is associated with rubella? Patent Ductus Arteriosus
After birth, what causes ductus arteriosus to close High O2 tension and decreased prostaglandin synthesis
What type of murmur is associated with PDA Machinery murmur
How can PDA be closed? Indomethacin administration / Surgery
What is the most common form of cardiomyopathy? Dilated cardiomyopathy
Which drugs can cause dilated cardiomyopathy? Doxorubicin & Cocaine
What is the most common viral infection of the heart? Coxsackie B virus
Which parasitic infection can cause dilated cardiomyopathy? Chagas disease-- Trypanosoma cruzi
Which 2 viral infections can cause dilated cardiomyopathy Coxsackie B virus & Enteroviruses
Banana-shaped chamber Hypertrophic cardiomyopathy
Which cardiomyopathy causes sudden death in athletes? Hypertrophic cardiomyopathy
Causes of restrictive cardiomyopathy Amyloidosis, Sarcoidosis, Endomyocardial fibroelastosis Loeffler endocarditis
Which part of heart does carcinoid heart disease affect and why? Affects right side of heart (right-sided endocardial and valvular fibrosis). Blood from right heart goes to lungs, monoamine oxidase in lung degrades serotonin
How can carcinoid heart disease be diagnosed Urinary 5-HIAA (metabolite of serotonin)
Where does cardiac myxoma usually occur? Left atrium near fossa ovalis
Ball valve effect cardiac (left atrium) myxoma where tumor slips into mitral valve and cause insufficiency of the valve
What is the most common benign tumor of the heart in Adults? And what kind of episode is it associated with? Cardiac myxoma; associated with multiple syncopal episodes
What kind of cells can be found in cardiac rhabdomyoma microscopically? Spider cells (have central nucleus with clear cytoplasm and lines of chromatin going from the center)
How may atelectasis present on x-ray Mediastinum shifts towards the collapse
What are the 4 types of atelectasis Compression Obstruction/resorption Contraction/Scar Patchy
What are the 2 main types of bacterial pneumonia Lobar (entire lobe is involved) Bronchopneumonia (patchy opacification)
What is the most common cause of lobar pneumonia Strep pneumonia Klebsiella (if alcoholic)
What kind of sputum are produced in pneumonia caused by klebsiella & strep? Klebsiella - Gelatinous / mucus sputum Streptococci - Rusty sputum /yellow-green sputum
What are the 4 classic phases of lobar pneumonia Congestion -- due to hyperemia & edema. Red hepatization -- neutrophil & hemorrhage. Lung with consistency of liver. Grey hepatization --degradation of RBCs REsolution -- healing
Following pneumonia, which bacteria usually cause lung abscess? Staph aureus Klebsiella (in alcoholics)
What is the most common cause of atypical pneumonia (walking pneumonia)? Mycoplasma pneumonia
What is the appearance of mycoplasma on agar? Fried-egg appearance
What kind of agglutinin is mycoplasma associated with? Cold agglutinin-- therefore, cold agglutinin titers will increase in atypical pneumonia
What are the symptoms of TB? Hemoptysis, fever, night sweats, weight loss
Ghon complex? Ghon focus + Hilar lymph node granuloma
Which part of lung will secondary TB be located? Apex of lung (Pancoast tumor)
Simon focus Granuloma at lung apex due to reactivation. Simon focus usually calcify
Stain for TB Acid-fast or Ziehl-Neelson stain Organisms will look red; described as "red snappers"
What is progressive TB disseminating through lymphatics called? Miliary TB
Pott's disease TB which disseminates by hematogenous route to vertebral column; seen in children
Mikulicz syndrome Bilateral inflammatory enlargement of parotid, sublingual and submaxillary, and lacrimal glands and xerostomia, secondary to sarcoidosis, leukemia, lymphoma
What is the appearance of sarcoidosis on x-ray Angel wing's appearance; i.e. bilateral hilar lymphadenopathy
Lab findings of sarcoidosis Hypercalcemia,elevated serum ACE enzyme
What are the microscopic findings of sarcoidosis? Noncaseating granulomas, Asteroid bodies, Schaumann bodies
What are the 2 major types of emphysema? Centriacinar (centrilobular) -- most common and located in upper lobe of lung Panacinar (panlobular)
Which type of emphysema is associated with smoking & pollution and which type is associated with a1-antitrypsin deficiency? Centriacinar/centrilobular-- smoking or air pollution Panacinar-- antitrypsin deficiency
On which chromosome is the gene for a1-antitrypsin. What's the normal and abnormal genes called Chromosome 14 Normal- PIMM Abnormal --PiZZ
Where is antitrypsin enzyme made? Liver; it then gets transported into lungs. Inability to transport to lungs is called "deficiency", which is a misnomer
What are the 2 types of asthma? Intrinsic (Type I hypersensitivity) & Extrinsic
Curschmann's spirals Twisted mucus plugs admixed with sloughed epithelium
Charcot-Leyden crystals eosinophil membrane protein found in sputum of asthmatic
In which 2 lung conditions can mucus plugs be found? Chronic bronchitis & asthma
Kartagener triad syndrome Bronchiectasis, chronic sinusitis, situs inversus
Which conditions can lead to hyaline membrane disease of newborns? Prematurity, maternal diabetes, C-section, multiple births
What is x-ray finding of hyaline membrane disease? Ground-glass in reticuloglandular densities
How can Hyaline membrane disease be avoided? Delayed labor & corticosteroids to mature lung
Caplan's syndrome Coexistence of pneumoconiosis + rheumatoid arthritis; associated with mesothelioma etc.
What are the 2 families of crystalline silicates (asbestos)? Amphibole and Serpentine
Which family of asbestos is more deadly and can cause mesothelioma? Amphibole
Which 2 malignancies can result from asbestosis? Bronchogenic carcinoma & Malignant mesotheliomas
What type of hypersensitivity reaction occurs with Berylliosis? Type IV, resulting in granuloma formation
What oncogene gene defect leads to adenocarcinoma? Which gender is adenocarcinoma more common in? K-ras Females
What are the microscopic findings of squamous cell carcinoma? Invasive nests of squamous cells Intercellular bridges (desmosomes) Keratin production (keratin pearls)
What is the most common paraneoplastic syndrome associated with small cell carcinoma? Hypercalcemia
What are the paraneoplastic syndromes associated with small cell carcinoma ACTH (cushing's), Aldosterone (SIADH), PTH (hypercalcemia)
What kind of syndrome can Pancoast tumor cause? Horner's syndrome; due to interfering with sympathetic ganglion
What is treatment for small cell carcinoma? Chemotherapy & radiotherapy; because metastasis usually occurs before it's diagnosed
What is treatment for non-small cell carcinoma (adenocarcinoma of lung, squamous cell carcinoma)? Surgery
During first half of gestation where does amniotic fluid come from? 2nd half? Fetal membrane, kidneys
What is the consequence of renal agenesis in fetus? Diminished amniotic fluid (Oligohydramnios)
What are the characteristics of a baby with bilateral renal agenesis? Potter facies, Tallipes equinovarus, Pulmonary hypoplasia
What kind of renal conditions can a baby with unilateral renal agenesis have? Renal hypertrophy, may develop Progressive Glomerular Sclerosis
What is a person with horseshoe kidney prone to? Renal calculi
What is the genetic difference between Adult polycystic kidney disease and infantile polycystic kidney disease? Adult -- Autosomal dominant. Infant -- Autosomal recessive
What is the mutation that causes Adult polycystic kidney disease? Mutation in PKD1, PKD2 or PKD3 genes on chr 16. PKD1 gene produces a transmembrane protein; polycystin 1
What kind of vascular pathology is Adult polycystic kidney disease associated with? Berry Aneurysm, mitral valve prolapse
Where do the cysts for Adult and Infantile Polycystic kidney disease arise from? Infantile -- kidney is smooth, because cysts arise from the collecting duct in the medulla. Adult -- cysts arise from the proximal convoluted tubule
What are the extrarenal manifestations of polycystic kidney disease in ADULTS? Berry aneurysm, liver cysts, Mitral valve prolapsed, colonic diverticula
What is the appearance of Medullary sponge kidney disease microscopically? Swiss cheese appearance
Which 2 renal diseases can occur due to patient undergoing renal dialysis? Acquired polycystic disease, renal cell carcinoma
What is the overall charge of basement membrane in kidney? Negative
What amount of protein loss is considered proteinuria? <3.5g/day in urine
Which lab test can be used to check for rheumatic fever and poststrep glomerulonephritis? Elevated ASO for both
What is the immunofluorescence appearance of Goodpastures disease in kidney? Poststrep glomerulonephritis? Goodpastures -- linear pattern of IgG and C3. Poststrep glomerulonephritis -- granular (lumpy-dumpy)pattern of IgM, IgG and C3
Which 2 conditions cause hematuria and hemoptysis at the same time? What's the difference? Goodpasture's syndrome & Wegner's granulomatosis. Goodpastures involves only the lower respiratory tract. Wegners involves hematuria, hemoptysis AND SINUSITIS. Wegners also involves both upper and lower respiratory tract
What is complication of Goodpastures? Rapidly Progressive Glomerulonephritis, leading to renal failure
What is the immunofluorescence appearance in Rapidly Progressive Glomerulonephritis? Could be linear or granular appearance. Depends on what it is secondary too. It will be linear if secondary to Goodpastures. All others will be granular
What is the most common cause of recurrent hematuria? Buerger's disease / IgA nephropathy
What is the most common glomerulonephritis? IgA nephrophathy / Buerger's disease
Which diseases are associated with IgA nephropathy (Buerger's disease) Celiac sprue & Henoch-Schonlein purpura
What kind of history or prior condition is expected from patient with Buerger's disease? IgA-related diseases such as mucosal infections of GI, urinary tract or pulmonary tract
IgA deposit on basement membrane of kidney? IgA deposit in mesangium? BM, will lead to nephrotic syndrome Mesangium, will lead to nephritic syndrome
What is the appearance called when BM splits due to mesangial proliferation? In which disease does this happen? Tram-Track appearance in MPGN type I. Occurs in Membranoproliferative glomerulonephritis (MPGN)
What are the lab findings in Membranoproliferative GN? Decreased serum C3, C3 nephritis factor increase in MPGN type II
What are the differences between Type I and II MPGN? Type I (aka dense deposits): has granular pattern of C3, often with IgG, C1q and C4. There is tram-tracking Type II: Granular and linear pattern of C3. There will be ribbon-like deposits of C3 in BM, due to actiavtion of C3 by C3 nephritic factor
Alport syndrome Rare X-linked disorder caused by defect in type IV collagen, characterized by hereditary nephritis, hearing loss and ocular abnormalities. Most common mutation is in COL4A5 gene
What is the etiology of membranous glomerulonephritis? Drugs (penicillamine), Infections (hep B,C, syphilis), SLE, Cancers (lung, colon): DISC
EM description of membranous glomerulonephritis? Spike and dome appearance on BM
What kind of history will patient with Minimal Change disease have? History of immunization
What are the microscopic findings of Minimal change disease? No change in glomerulus; hence the name minimal change. Lipid accumulation in proximal tubule; hence the AKA name Lipoid nephrosis. EM shows foot process effacement. Selective loss of albumin (not globulin), due to GBM polyanion loss
What is treatment for Minimal Change Disease? Corticosteroid; dramatic response to steroid in children
How can Minimal change be differentiated from Focal Segmental Glomerulosclerosis? Minimal change responds very well to steroids. Focal segmental does not.
Which drug is associated with focal segmental glomerulosclerosis? Heroin
Kimmelstiel-Wilson disease This is glomerulonephritis which is secondary to diabetes. Nodular glomerulosclerosis forms and nodules are PAS positive. Nonenzymatic glycosylation NEG of GBM. Increase permeability; nephrotic
What is the microscopic appearance of SLE which causes a nephrotic syndrome? Wire loop appearance: i.e. BM is so thick that it looks like a loop of wire
Full house pattern of SLE renal disease This means deposition of everything; i.e. IgG, IgM, IgA, C3 etc
What is the finding of urinalysis in chronic glomerulonephritis Broad waxy casts
What are the findings of Acute tubular necrosis? Dirty brown granular casts and epithelial casts
For ischemic Acute Tubular Necrosis, what is the ratio of BUN to creatine? BUN : creatine = 40:1
What is BUN to creatine ratio for nephrotoxic ATN? BUN : creatine = 15-20 : 1
Which renal condition will cause white casts in urine? Pyelonephritis (neutrophils), due to ascending infection which could be from bladder, ureter, UTI
What will be the most common cause of pyelonephritis in a young active female? Staph saprophyticus
What is thyroidization of the kidney associated with? Chronic pyelonephritis. Thyroidization means that the tubules dilate and fill with protein which looks like thyroid colloids. These are EOSINOPHILIC CASTS.
Which 2 drugs can cause Tubulointerstitial nephritis? Methicillin and history of analgesic abuse
What can cause urate nephropathy? Deposition of urate crystals, secondary to leukemia treatment, lead poisoning and gout
What are the 4 types of renal calculi? Calcium oxalate (most common), Magnesium ammonium phosphate (struvite), Urate stones, Cystine stones
Which bacteria can cause renal calculi and which type? Proteus (urea-splitting bacteria) can cause struvite stones. Requires urine to be alkaline
Where do struvite stones form? Renal pelvis, and form as one intact stone called staghorn calculi. Cannot be passed
What is the measurement of benign tumors of the kidney (cortical adenomas)? Always less than 3cm
What are the risk factors of Renal Cell Carcinoma? Cigarette smoking, Chronic analgesic use, Asbestos exposure,Von Hippel-Lindau disease
What is the most likely cause of hematuria in old patients? Renal cell carcinoma & Transitional cell carcinoma
What is the gross description of renal cell carcinoma? Large solitary yellow mass at the upper pole of kidney. Often invades renal vein and may extend into IVC and heart. It's yellow because cells are filled with lipids and glycogen, giving it a clear cell carcinoma appearance under micro.
What is the classic clinical triad of renal cell carcinoma? Hematuria, Palpable mass, flank pain
Why is Renal cell carcinoma called the great mimicker? Due to paraneoplastic syndrome of ectopic hormone production: Polycythemia (erythropoietin release), Hypertension (renin), Cushing syndrome (corticosteroid synthesis, can secrete ACTH), Hypercalcemia (secrete PTH-like hormone)
WAGR syndrome Wilms tumor, Aniridia, Genitourinary anomalies, mental Retardation
What are the risk factors of Wilms tumor? WAGR syndrome & Beckwith Wiedermann syndrome
Which TSG are affected in Wilms tumor? WT-1 (11p13)del. WT-2 (11p15)
Which tissues does Transitional cell carcinoma involve? Renal pelvis and urinary bladder
Flea-bitten kidney Little petechiae lesions on surface of kidney due to increased pressure leading to rupture of arterioles on kidney surface. Occurs in Malignant (accelerated) Hypertension or Nephrosclerosis
Onion-skin pattern Occurs in Malignant hypertension, leading to hyperplasia of the intima of blood vessels. Occurs in Arteriolosclerosis
What is the description of renal infarct Wedge-shaped pale coagulative necrosis
What kind of infarct does sickle cell anemia cause? Medullary infarction, due to blockage of blood flow in the medullary vessels
Which drug causes retroperitoneal fibrosis Methysergide (used to treat migraines)
Besides retroperitoneal fibrosis, what other condition can Methysergide cause? Riedel's thyroiditis (causes the fibrosis of the thryoid)
What is the most common ureteral carcinoma? Transitional cell carcinoma
Which drug and which organism can cause cystitis? Cyclophosphamide & Staph saprophyticus
Which occupational exposure and organism cause Transitional cell carcinoma? Naphthylamine
Which organism can cause squamous cell carcinoma of the bladder? Schistosoma Hematobium (common in Egypt, snail)
Exstrophy of the bladder? What can it lead to? Developmental failure of formation of the abdominal wall and bladder that leaves bladder to body surface. It can lead to adenocarcinoma
In Tracheosophageal fistula what is the opening of the fistula lined by? Esophageal side is lined by squamous epithelium, while opening of tracheal side is lined by pseudostratified ciliated columnar epithelium
What condition is Tracheosophageal fistula usually associated with? Esophageal atresia
Plummer-Vinson syndrome. What's the other name? Triad of Dysphagia, Iron deficiency anemia and esophageal webs. Also also associated with glossitis and koilonychia (spoon nail). Aka Patterson-Brown-Kelly syndrome
Schatzki ring? Web-like narrowing at the GE junction or just above the squamocolumnar junction. It's the most common cause of intermittent solid food obstruction
Which organism can cause dilated cardiomyopathy achalasia and possibly toxic megacolon? Trypanosoma cruzi (chagas disease; South America)
Gross appearance of achalasia Dilatation of esophagus proximal to the LES. Barium swallow shows bird's peak at distal part of esophagus
What is the microscopic finding in achalasia? Loss of ganglion cells in they MYENTERIC PLEXUS
What is the treatment for achalasia? Myotomy or LES balloon dilation
In which conditions is Mallory-Weiss sydrome common? Bulimia and alcoholis (alcoholic gastritis)
Boerhaave's Syndrome Complication of Mallory-Weis, leading to rupture of esophagus
Hamman's sign Mediastinal crunch or precordial crackles synchronous with heart beat, but not with respiration. Associated with Boerhaave's syndrome
Which esophageal condition is secondary to portal hypertension due to cirrhosis? Esophageal varices: Dilated SUBMUCOSAL VEINS in the lower 3rd of esophagus. Because of the cirrhosis, mostly associated with alcoholics
What is treatment for esophageal varices? Sclerotherapy or balloon tamponade
Most common cause of esophagitis? GERD
What kind of hernia can cause GERD, esophagitis? Hiatial hernia
Which leukocyte must be present in abundance before Barrett's can be diagnosed? Eosinophil: the acid acts as an allergan to the esophagus
What can be a complication of Barrett's? Esophageal adenocarcinoma
Which region of esophagus can a squamous cell carcinoma located? Mid-esophageal region
What are the risk factors of esophageal squamous cell carcinoma? Smoking, alcohol, tylosis, prior lye ingestion, plummer-vinson syndrome, achalasia
Which congenital syndromes are associated with pyloric stenosis? Turner and Edward's syndrome
How can vomitus be used to differentiate pyloric stenosis from duodenal atresia? Pyloric stenosis -- Nonbilious vomitus. Duodenal atresia-- bilious vomitus
Double-bubble sign Positive x-ray and barium swallow test for duodenal atresia
Morgagni hernia A type of diaphragmatic hernia which occurs more on the right than on the left
Menetrier's disease A hypertrophic gastropathy; where there is enlarged rugal folds in the body and fundus of stomach (gyri-sulcus appearance). Has a cerebral form appearance of mucosa. Leads to increase secretions, low acid production Diarhea and loss of protein are key
What change occurs in stomach in Zollinger Ellison's syndrome? Rugal fold thickening
Curling's ulcer? Stress erosions and ulcers occurring in the proximal duodenum and associated with severe burns or trauma from ischemia of gastric mucosa
Cushing's ulcer Ulcer of stomach, proximal duodenum or esophagus. Leads to hemorrhage or perforation. Assoc. with increased intracranial pressure or injury & high gastric acid
What are features of Chronic gastritis-- Fundic type(type A) Autoimmune, antibodies to intrinsic factors. Pernicious anemia, low gastric acid, high serum gastrin, loss of rugal folds, risk of gastric carcinoma
What are the characteristics of chronic gastritis type B (antral type) caused by helicobacter pylori. Risk of peptic ulcers, gastric carcinoma. Triple antibiotic therapy & Bismult salt
Which ulcers are reversible? Stress ulcers
What is cause of duodenal peptic ulcer? H. Pylori-- 100% of the time
Which blood group is prone to duodenal peptic ulcers? What are the other risk factors? Blood group O. MEN type I, ZES, cirrhosis, COPD
Where are Gastric and duodenal peptic ulcers usually located? Gastric -- less curvature of the antrum Duodenal ulcer--anterior wall of proximal duodenum
What is the gross appearance of gastric peptic ulcer? small (<3cm), round, oval solitary ulcer, overhanging margins, radiating mucosal folds
What's the difference between gastric and duodenal peptic ulcer in terms of eating? Gastric-- pain worsens after eating Peptic -- pain is relieved 1-3hrs after eating
What are risk factors of gastric carcinoma? H. pylori, smoked fish, nitrosamines, smoking, Blood type A, chronic atrophic gastritis, Menetrier disease
Where is gastric carcinoma located? Lesser curvature of antrum
Linitis plastica Also known as Brinton's disease or leather bottle stomach, is a morphological variant of diffuse (or infiltrating) stomach cancer. Will have signet-ring cells that infiltrate into wall of stomach
Krukenberg tumor A Krukenberg tumor refers to a malignancy in the ovary that metastasized from a primary site, classically the GI
Virchow's (sentinel) node Left Supraclavicular adenopathy associated with a malignancy often on left side, associated with GI and pelvic malignancies
How does mechanical obstruction of intestine show on x-ray? Step-ladder or staircase appearance due to air-fluid levels
Which congenital abnormality can lead to volvulus? Intestinal malrotation
What are the locations of volvulus? sigmoid colon (occurs in redundant sigmoid cole and elderly) and small bowel (iatrogenic, surgery)
How can volvulus be twisted Sigmoid (sigmoidoscopy, no surgery). Small bowel (surgery)
What is description of intussusception during palpation? What type of stool forms? Sausage-shaped mass & currant-jelly stool
Celiac sprue Hypersensitivity to gluten (and gliadin), leading to loss of small bowel villi and malabsorption. Gluten is in fiber
Which antibody and condition is celiac sprue associated with? IgA. Associated with Dermatitis Herpatiformis
What are the genetic predisposition to celiac sprue? HLA-B8, DR3 and DQ
What is treatment of Tropical sprue? Antibiotics, vitamin B12 and folate
Whipple's disease Infectious disease involving, small bowel, pancreas, joints, lungs, heart, liver, spleen & CNS.
Which gender does whipple's disease affect? ONLY males
What is the causative agent of Whipple's disease? Tropheryma whipplei
Where does crohn disease usually occur? Mostly distal ileum, but also any where in GI
What is characteristic of barium test in crohn's disease? String sign, due to narrow lumen caused by crohns
What are the characteristics of crohn's disease lesion? cobblestone appearance, skip-lesions, creeping fat, thickened bowel wall, linear fissures,noncaseating granulomas: could mimic appendicitis
Which group of people commonly get crohn's and ulcerative colitis? Crohn's-- Young Jewish females UC-- Young white females
What's age distribution of crohn's disease and ulcerative colitis? Crohn's -- bimodal; age 10-30 and 50-70 UC -- 20-30yrs
What is the difference in stool between ulcerative colitis and crohn's disease? UC-- blood diarrhoea. CD --mucus stool
Which inflammatory bowel disease causes perianal fistulas and which causes pseudopolyps?? Crohn's disease-- Perianal fistula Ulcerative colitis-- pseudopolyps (grows above ulceration)
How can UC and CD be easily differentiated microscopically? CD- noncaseating granulomas UC-- crypt abscesses (will have neutrophils in glands of lumen at the base, called crypts)
What are the complications of UC Toxic megacolon
What is the depth of lesions of UC and CD? UC--limited to mucosa and submucosa CD-- Transmural
Which areas of GI does ischemic bowel disease usually affect? Watershed areas (such as splenic flexure)
Angiodysplasia? Where does it occur? This is arteriovenous malformation of the intestine. Occurs in the cecum and right colon
What is angiodysplasia associated with? Osler-Weber-Rendu disease and CREST syndrome
Melanosis coli Caused by laxative abuse, leading to black mucosa. Mimics colitis, hence the name coli. Blackness is due to macrophage filled with laxative pigment
What is description of pseudomembranous colitis lesion? What is cause? Mushroom-shaped inflammatory lesions. Broad base antibiotic
Which organism can cause acute appendicitis in infants and children? Pin worm
Meckel's diverticulum A true diverticulum, involves all 3 layers. Outpouching is due to remnant of the viteline (omphalomesenteric) duct
Mecke's diverticulum rules of 2s 2% of population, 2ft from ileocecal valve, 2cm long, 2 tissue types in meckels (stomach & pancreatic), 2yrs older or younger during diagnosis, 2% of carcinoid tumors occurs in meckel's.
Why does meckel's diverticulum mimic appendicitis?
Colonic diverticulosis Extremely common. Pseudodiverticula; involves only mucosa & submucosa. Risk factor includes old age & low fiber diet.
Left-sided appendicitis? This is description for colonic diverticulosis; since it involves the sigmoid colon
What are the 2 forms of Adenomatous colonic polyp? Tubular & villous. Villous is more dysplastic. Tubular has dysplastic part in head. A mixture of the 2 is called Tubulovillous adenoma
What is the genetic association of Familial Adenomatous Polyposis? APC gene on chromosome 5q21
How is FAP (polyposis) diagnosed? Discovery of more than 100 adenomatous polyps on endoscopy
What is complication of FAP if not removed? By age 40, virtually 100% will develop an invasive adenocarcinoma and increase risk of duodenal adenocarcinoma & adenocarcinoma of papilla of vater
Gardner's syndrome FAP with extraintestinal manifestations: Sebaceous cysts, osteomas (tumors of skull and mandible region and long bones), desmoid tumors due to mutation of APC gene in 5q21
How can Gardner's syndrome be diagnosed? >100 polyps + osteomas
Turcot's syndrome >100 polyps + tumors of CNS; mostly glioblastoma multiforme. Turcot's syndrome is a variant of FAP
What is the most common familial cancer syndrome of the large intestine? Hereditary Nonpolyposis Colorectal Cancer: Autosomal Dominant
Peutz-Jeghers syndrome Multiple harmatomatous polyps in GI + melanin pigmentation leading to hyperpigmentation of face, genitalia, mucosa + increased risk of pancreas, lung, uterus, breast cancers.
What are the differences between right and left sided cancers of the GI? Right-- polypoid mass, occult blood in stool, Fe-deficiency anemia. However, both right & left will be adenocarcinoma Left-- circumferential growth (napkin-ring), apple core appearance of lesion in barium test, constipation/diarrhoea, obstruction
How can colonic adenocarcinoma be diagnosed? Hemoccult positive stool
CEA tumor marker It is NOT used for diagnosis, but rather used to check or monitor patient after treatment of colonic adenocarcinoma
Which stage of the Modified Dukes Staging system of colonic carcinoma means metastasis? Stage D
What kind of cells do carcinoid tumors arise from? Neural crest cells
Carcinoid syndrome Symptoms which are secondary to carcinoid tumors. Includes flushing and diarrhea, and, less frequently, heart failure and bronchoconstriction. It is caused by endogenous secretion of mainly serotonin, kallikrein, hormones
Most common location of carcinoid tumor? Other locations? Appendix (most common), then terminal ileum. Other locations-- GI, hepatobiliary tract, pancreas and lung
What type of tumor is a gastrinoma? Carcinoid tumor
What can trypsin activate? Activation of other pancreatic enzymes, Activation of clotting cascade, activation of kinin system
What are the clinical presentations of acute pancreatitis? Back pain, jaundice (if gallstones), hyperglycemia, Ca2+ influx into pancreas, hypocalcium, shock
Lab test for acute pancreatitis? Elevated amylase (not specific), elevated lipase after 24-48hrs
What are complications of acute pancreatitis? ARDS/DIC, shock, pseudocyst, calcification, hypocalcemia, chronic pancreatitis
How is diabetes mellitus diagnosed? >126mg/dl on at least 2 separate occasions or a positive glucose tolerance test (75g glucose) after 2hrs. >200mg/dl means diabetic
Which virus can trigger diabetic mellitus in a person who is susceptible? Coxsackie B virus; will trigger autoimmune reaction
Diabetic nephropathy Includes Renal artery arterosclerosis, Hyaline arterioscelerosis, Nodular glomerulosclerosis (Kimmelstiel-Wilson; nephrotic, thick BM, PAS+), Diffuse glomerulosclerosis (nephrotic), pyelonephritis & necrotizing papilitis
Diabetic neuropathy Peripheral nephropathy (Glove & stockings peripheral neuropathy), neurogenic bladder, sexual impotence
What type of syndrome can islet cell tumors cause? Carcinoid syndrome; this is because, islets are made up of neural crest cells
What is themost common type of islet cell tumor? Insulinoma
Whipple's disease? In which condition does it occur? Occurs in insulinoma. 1) causes attacks precipitated by fasting or exertion; glucose level <50mg/dl. 2 symptoms are relieved by glucose. 3. Patient is symptomatic ; diaphoretic, fainting
How can hypoglycemia due to insulinoma be differentiated from factitious hypolglycemia C-peptide. C-peptide will be decreased if hypoglycemia is factitious
Glucagonoma? alpha-cell tumor. Produces glucagon. Causes hyperglycemia, anemia and skin rash, diabetes-like conditions
Which syndrome is associated with VIPoma? VIPoma produces vasoactive intestinal peptide. Causes WDHA syndrome: Watery diarrhoea, Hypokalemia and Achlorhydria
What is the risk factor of pancreatic carcinoma? Smoking
Which pancreatic function does pancreatic carcinoma affect? EXOCRINE pancreas
Which parts of pancreas can pancreatic carcinoma affect? Head-- painless jaundice; high conjugated bilirubin and alkaline phosphatase Body/tail-- spreads to vertebral column, stomach, transverse colon, liver. Metastasize before diagnosed. Body/tail is worse prognosis
Trousseau's syndrome This is migratory thrombophlebitis seen in setting of malignancy (carcinomas) Pancreatic carcinoma is classic cancer associated with migratory thrombophlebitis
Which tumor markers are for pancreatic carcinoma? CEA & CA19-9
2 types of cholelithiasis Cholesterol & Pigment stones
Risk factors of cholesterol cholelithiasis (cholesterol monohydrate) Female, fat, fertile, contraceptive (oral), Hormone replacement therapy, Genetic: Native American Pima & Navajo Indians
Risk factors of pigmented bilirubinate stones chronic hemolygic anemia, cirrhosis, bacteria, parasite (Ascaris or Clonorchis (opisthorcis) sinensis)
Symptoms of biliary colic Upper quadrant pain due to impacted stones Pain radiate to right shoulder or tip of right scapula
Choledocholithiasis Calculi within biliary tract
Murphy's sign This shows acute cholecystitis. This is right upper quadrant tenderness on palpation and during INSPIRATION while palpating gallbladder. Pain is due to bile trying to pass obstruction
Dystrophic calcification Normal calcium level but tissue damage due to fibrosis
Rokitansy-Aschoff sinuses Small outpouching of gallbladder mucosa that may penetrate into and thru muscle wall. Occurs in chronic cholecystitis
What is a late complication of chronic cholecystitis? Porcelain gallbladder
What kind of organism can cause ascening cholangitis Gram-negative enteric bacteria
Cholesterolosis Accumulation of cholesterol-laden macrophage in mucosa (lamina propria) of gallbladder wall.
Strawberry gallbladder This is description for gallbladder with cholesterolosis. There is yellow speckling of red-tan mucosa. Strawberry is not due to colour but yellow flux on it. Colour is yellow.
What is a palpable gallbladder usually a sign of? Gallbladder cancer. Note tahat cholecystitis or obstructions are usually not palpable
What kind of epithelium is gallbladder lined by? Columnar epithelium
Cholangiocarcinoma This is carcinoma of the intrahepatic bile duct which is found INSIDE the liver
Klatskin tumor This is carcinoma of the bifurcation of the right and left hepatic bile ducts
Risk factors of bile duct carcinoma, cholangiocarcinoma and klatskin tumor Living in China, Clonorchis (Opisthorcis), Sinensis (Chinese liver fluke)
What can of epithelial cells is lined by bile duct? columnar cells
What defines clinical jaundice? Bilirubin levels greater than 2-3mg/dl Normal level is 0.1-1mg/dl
What kind of gallstones are produced when there is increased unconjugated bilirubin? Pigmented bilirubinate gallstones
Gilbert syndrome Common benign inherited disorder; lack of glucuronosyltranferase (UGT). Unconjugated hyerbilirubinemia. Mild or no clinical symptoms
Which drug can cause Gilbert syndrome? Phenobarbital
Crigler-Najjar syndrome Unconjugated hyperbilirubinemia which is more serious than Gilbert syndrome. Deficit of bilirubin glucuronosyltransferase (UGT). Can cause jaundice or kernicterus. Can be induced by phenobarbital
What are the 2 types of Crigler-Najjar syndrome? Type I- more serious. No UGT activity, causes kernicterus. Liver transplant required Type II- moderate deficit of UGT enzyme causes jaundice
Dubin-Johnson syndrome Autosomal recessive disorder. Decreased excretion of conjugated hyperbilirubinemia due to defect in the canalicular cationic transport protein. Causes black pigmentation of liver
Rotor's syndrome Autosomal recessive. Conjugated hyperbilirubinemia. Similar to Dubin-Johnson's but without the pigmentation. Deficit in hepatic uptake and storage of bilirubin. Conjugated bilirubin cannot be transported out of liver
What is colour of stool and urine of patient with biliary tract obstruction Clay-coloured stool & dark urine
What's the lab finding for biliary tract obstruction? Increased conjugated bilirubin, alkaline phosphatase, 5'-nucleotidase
What does antibodies target in the hepatic autoimmune disease of Primary Biliary Cirrhosis? Anti-mitochondria-antibody (AMA)
What are lab findings for Primary Biliary Cirrhosis? Increased conjugated bilirubin, increased alkaline phosphatase, 5'-nucleotide, +AMA, Granulomatous (micro)
Which biliary condition is associated with ulcerative colitis? Primary Sclerosing Cholangitis
What is description of Primary Sclerosing Cholangitis during cholangiogram? Beaded appearance
What kind of nodules are seen in cirrhosis? Regenerative nodules: could be macronodular >3mm or micronodular <3mm
Etiology of Cirrhosis Alcohol, viral hepatitis, Biliary tract disease, Wilson's disease, a1-antitrysin deficiency, hemochromatosis
Which cell causes the fibrosis? Ito cell
Where is estrogen degraded in men? Liver; hence cirrhosis leads to gynecomastia and testicular atrophy. Lack of estrogen breakdown can also cause spider angiomas on head and chest
Hepatorenal syndrome Renal dysfunction secondary to liver dysfunction. Renal biopsy will be normal microscopically. Function is back to normal when liver is treated. HRS is associated with cirrhosis or fulminant liver disease
In viral hepatitis, what kind of bilirubin is elevated? Both conjugated and unconjugated are elevated
Which hepatitis virus is usually associated with drug abusers? Hepatitis B
Councilman bodies vs. Mallory bodies Apoptotic hepatocytes; round, eosinophilic Mallory bodies-- also round and eosinophilic but associated with alcoholic liver disease
Which hepatitis virus can cause chronic viral hepatitis? Hepatitis B,C, and D. Infection for >6months is chronic
In chronic viral, where is the inflammation confined? Portal tracts
Which hepatocyte is associated with Ground glass hepatocytes microscopically? Hepatitis B
Which hepatitis virus is RNA and which is DNA? Only hepatitis B is DNA. All others are A
Which hepatitis virus is associated with hepatocellular carcinoma? Hepatitis B or C or D
Which hepatitis have vaccines? Hepatitis A and B
During window period, which Hep. B marker will be positive if patient is infected? HBcAb; Antibodies to core antigen
Which Hep B marker is positive in acute or recent infection HBsAg; surface antigen HBcAb; Antibody to core antigen
Which Hep B marker indicates transmissibility of virus by patient? HBeAg; indicates that patient can easily transmit. e= e-antigen HBeAb; indicates low transmissibility of virus by patient
How can Hepatitis A recent infection and prior infection/immunization be checked? Recent infection: Anti-HAV IgM Prior infection: Anti-HAV IgG
Which organism can cause amebic liver abscesses? Entamoeba Histolytica: causes abscess formation in liver
What is description of damage done by entamoeba histolytica in the colon? Flask-shaped ulcers
What is the gross description of amebic liver abscess? Necrotic abscess filled with brown paste-like or chocolate-like material. Described as Anchovy paste"
How can entamoeba histolytica be differentiated from Entamoba coli? Entamoeba histolytica eats RBCs, so RBC will be found in them. No RBC is found in Entamoeba coli
Which Hepatitis virus can cause fulminant liver failure? Which is most severe in pregnant women? Hepatitis E virus for both
What of nodules is associated with alcoholic cirrhosis? Micronodular
What kind of filaments is Mallory bodies associated with? Associated with keratin intermediate filaments, which are filaments of hepatocytes. Alcohol damages them and causes them to stick together
Wilson's disease Genetic disease of copper metabolism. Leads to copper accumulation in organs. The low level or problem is with ceruloplasmin; a transporter of Cu2+. Leads to cirrhosis. Autosomal recessive. WD gene (ATP7B) on chr 13
In Wilson's disease, where else can copper accumulate besides in liver? Accumulation in Descemet's membrane of cornea Deposition in basal ganglia, leading to neurological problems
Kayser-Fleischer rings Greenish-yellow pigmented ring encircling cornea just within the corneoscleral margin. Due to copper deposit in Descemet's membrane, as it occurs in Wilson's disease
What does the defective gene of WD (ATP7B) normally code for? Hepatocyte Canalicular Copper-translating ATPase.
How can Wilson's disease be diagnosed? Decreased serum ceruloplasmin, increased copper in liver biopsy, increase urinary copper
How can Wilson's be treated? Copper chelator (D-penicillamine), Liver transplantation
Cause of primary hemochromatosis It's a recessive disorder due to defect of HFE gene on chr 6p. Most common mutation is the C282Y mutation
What are some causes of secondary hemochromatosis? Transfusion in chronic anemia, Ingesting iron supplements
Which tissues can hemochromatosis affect? Liver (increases risk of HCC by 200x), pancreas, skin, bronze diabetes, heart, gonads
How does hemochromatosis affects liver, pancreas, skin, heart and gonads Liver-- leads to hepatocellular carcinoma (200x). Pancreas-- leads to insulin deficiency. Skin-- hyperpigmentation (called BRONZING of skin). Heart-- cardiac arrhythmias & CHF. Gonads-- hypogonadism
Bronze Diabetes This occurs in hemochromatosis. Syndrome where there is Bronzing in skin & insulin insufficiency of pancreas
Genetic defect of a1-antitrypsin deficiency Defect of Pi gene on chr 14. PiM-- normal, PiS-- mildly reduced levels. PiZ-- markedly reduced levels. PiZZ has severe reduction in enzyme levels
What is the disease distribution in a1-antitrypsin deficiency? Liver-- leads to cirrhosis and high risk of HCC. Lung-- Panacinar emphysema
Reye syndrome Fatal disease which occurs in young children with viral illness/infections with VZV and influenza B virus. Treatment with aspirin in children and chicken pox also cause Reye syndrome. Fatty liver change & Encephalopathy
What is the distribution of disease in Reye's syndrome Liver-- microvesicular steatosis; diffuse fatty change Brain-- Cerebral edema/ encephalopathy
Budd Chiari syndrome Hepatic Vein Thrombosis causing occlusion. Associated with polycythemia vera, pregnancy, oral contraceptives, paraoxysmal nocturnal hemoglobinuria, Hepatocellular carinoma, Idiopatic
What is the most common primary tumor in the liver? Hemangioma
Most common cause of Hepatic adenoma Oral contraceptive use. Therefore occurs in young women.
What is micro finding of hepatic adenoma? Hepatic ademona resembles normal liver, but lacks portal tracts
Which group of people is Hepatocellular carcinoma common for? Asians, specifically Japanese
What are the 4 main causes of Hepatocellular carcinoma Hepatitis B, C, Aflatoxin B1 and cirrhosis
What is the tumor marker for HCC? a-Fetoprotein (AFP)
Which form of HCC has better prognosis? Fibrolamella variant: shows one large mass of an HCC
Which toxins usually cause angiosarcoma? Arsenic, Polyvinylchloride (PVC), Thorotrast (ThO2)
What the cause of acute aseptic meningitis (leptomeningeal inflammation) Enterovirus
What is the cause of mycobacterial meningoencephalitis? Mycobacterium Tuberculosis or Atypical mycobacteria
Which is the most common cause of Mycobacterial Meningoencephalitis in AIDS patients? Mycobacterium Avium-Intracellulare
CSF findings in purulent meningitis Decreased glucose, increased protein (since its purulent), increased neutrophils, increased pressure
CSF findings in viral meningitis Normal glucose, increase protein level, slight elevation in pressure, increased lymphocytes (NOT neutrophils)
CSF findings in granulomatous (mycobacterial/fungal) Decreased glucose, increase lymphocytes, increased protein, increased pressure
What are the common features in viral encephalitides Perivascular cuffs, microglial nodules (macrophages of brain), neuron loss, neuronophagia
What are some specific forms of encephalitides? Anthrop-borne, HSV type I, Rabies, HIV and Progressive Multifocal leukoencephalopathy
Cowdry body Intranuclear inclusion seen in herpes virus infection
Negri bodies Occurs in rabies; i.e. virus-infected brain neurons. Eosinophilic cytoplasmic inclusions
What are the causes of Fungal Meningoencephalitides Candida, Aspergillus, Cryptococcus, and Mucor species
Which organism stains with Indian ink? Cryptococcus
Which patients do the following fungi cause meningoencephalidies in: Diabetics, AIDS? Diabetics-- Mucor Cryptococcus neoformans (encapsulated)-- AIDS patients. Stained with Indian Ink
Which fungal infections have tropism for blood vessels? And what do they cause? Mucor and Aspergillus have tropism for vessels: They cause vasculitis, and they rupture blood vessels and cause hemorrhage
Which fungal meningoencephalitides is due to invasion of the Virchow-Robin space? Cryptococcus
What is description of the lesion caused by cyptococcal meningoencephalitis? Soap bubble lesion in brain
Toxoplasmosis is associated with which patients? AIDS patients & pregnant women
What is description of brain lesion caused by Toxoplasmosis? Ring-Enhancing Lesion-- cerebral abscess with central necrosis and chronic inflammation
Rare complication of measles (Rubeola) virus infection? Subacute Sclerosing Panencephalitis
What is the most common transmissible spongiform encephalopathy due to a prion? Symptoms? Creutzfeldt-Jakob Disease (PrP protein)-- Rapidly progressive dementia, memory loss, personality changes and hallucinations
Which medical produces can lead to spongiform encephalopathy? Corneal transplant, Pituitary extract
What is normal conformation of PrPc and what is the diseased conformation? Normal -- alpha-helix (PrPc). Diseased-- B-pleated sheet (PrPs)
Kuru Plaques They are deposits of amyloid of altered PrP protein.
A type of Creutzfeldt-Jakob Disease associated with eating monkey's brain? Kuru; specific to Fore Tribe of Papau New Guinea
What condition is common for all prion diseases? Subacute Sclerosing PanEncephalitis
Lacunar infarcts These are infarcts usually seen around the basal ganglia and typically from a branch from the middle cerebral artery
How would CSF fluid in an intracerebral hemorrhage differ from that of arachnoic hemorrhage? Intracerebral hemorrhage will have clear CSF. Arachnoic hemorrhage will be bloody
What is the most frequent cause of subarachnoid hemorrhage? Ruptured Berry Aneurysm
Which kidney disease is associated with Berry aneurysm? Polycystic kidney disease
What condition does subarachnoid hemorrhage mimic? Meningitis; due to headaches and nuchal rigidity
What are symptoms of subarachnoid hemorrhage? Nuchal rigidity, headached, stupor, neurological deficits
Which layers of blood vessel do Berry aneurysm affect? Intima & Adventitia
Where is the most common location of Berry aneurysm? Anterior circle of willis at branching points
Which 3 disorders are associated with Berry's aneurysm? Marfan's syndrome, Ehlers Danlos type 4, Adult Polycystic Kidney Disease
WHere is the usual site of a contusion? Crests of orbital gyri in frontal and temporal poles
Plaque Jaune These are remote contusion lesions
What are the 3 types of cerebral herniations? Subfalcine (cingulate gyrus), Transtentorial (Uncal), Cerebellar tonsillar
Which vessel does a subfalcine herniation compress? Anterior cerebral artery
What is compressed by a Transtentorial (uncal) herniation? CN III-- Oculomotor; causing ipsilateral opthalmoplasia, and contralateral hemiplegia Compression of pons and midbrain
What type of hemorrhage can a serious Tentorial herniation lead to? Duret Hemorrhage; compression of pons and midbrain, leading to hemorrhage
What is compressed in a cerebellar tonsillar herniation? Compression of the medulla oblongata; can cause respiratory arrest or respiratory depression
Which deficiency leads to neural tube defect? Folate
Which conditions can a neural tube defect of the spinal cord cause? Spina Bifida occulta, meningocele, meningomyelocele, myelocele
What is treatment for acute and chronic attacks of multiple sclerosis? Acute-- High dose steroids Chronic--Interferon B and copolymer 1 (Copaxone)
Band cells During leukocytosis, early neutrophils released are called band cells
Dohloe bodies Found in neutrophils during severe bacterial infectionThese are blue-gray, oval, basophilic leukocyte inclusions located in the peripheral cytoplasm of neutrophils. They are remnants of RER
In which conditions will monocytosis occur? Collagen vascular disease, inflammatory bowel disease, Granulomas, TB infections
Which reaction is used for the monospot test? Paul-Bunnel reaction
What are the symptoms of monocytosis? Fever, sore throat, cervical lymphandenitis (posterior auricular nodes), Hepatosplenomegaly
What are the complications of monocytosis? Hepatic dysfunction, splenic rupture, rash if ampicillin is used
What can cause decreased eosinophils? Increased cortisol, cushing's syndrome, exogenous corticosteroids. Causes eosinophils to sequester in lymph nodes
When tumors metastasize to lymph nodes, where do they first go? Subcapsular sinus
Where does leukemia first begin? Bone marrow, then spills out into the peripheral smear
What is the difference between lymphoma and leukemia in terms of location? Leukemia-- starts in bone marrow and spills into peripheral blood Lymphoma-- cancer of lymphoid tissues and typically stay in lymph nodes or travel to bone marrow
How can acute leukemia be diagnosed? Bone marrow biopsy. >30% blasts in biopsy indicates leukemia
What are markers for Acute Lymphoblastic Leukemia? TDT, PAS, acid phosphatase
What are the prognostic factors for Acute Lymphoblastic Leukemia? Hyperploidy-- >50 chr is good prognosis Patients with Philadelphia chr-- 9-22 translocation is worse
What is the most common type of ALL? Early pre B-ALL
How does ALL present? Anemia, neutropenia, low platelet count, lymphadenopathy and ABDOMINAL MASS in child
What is a young male with mediastinal mass lymph node most likely to have? Lymphoblastic lymphoma
Which lymphoma is similiar to CLL (chronic lymphocytic leukemia)? SLL (small lymphocyctic lymphoma) is similar to CLL. SLL is in lymph node. CLL is in periphery
Which leukemia is the most indolent (slow growing)? CLL - Chronic lymphoblastic leukemia
Which kind of autoimmune disease is CLL associated with? Autoimmune Hemolytic Anemia (AIHA)
Which leukemia is smudge cell associated with? Chronic lymphoblastic leukemia
Which group of people is Hairy cell leukemia common in? Middle-aged caucasian men
What kind of infection is Hairy Cell leukemia associated with? HLTV-1
What are the 3 types of HTLVs associated with? HLTV-1 -- Hairy cell leukemia HLTV-2 -- Adult T-cell leukemia or lymphoma HLTV-3 is actually HIV
What is the diagnostic stain for Hairy-cell leukemia? TRAP-- Tartrate resistant acid phosphatase
What is treatment for Hairy cell leukemia? 2-Chlorodeoxyadenosine (2-CDA or Cladribine)-- inhibits ADA and increases levels of toxic deoxyadenosine
What is the most common form of Non-Hodgkin's lymphoma? Follicular lymphoma
What is origin of all Follicular lymphoma? Derived from B-cells
What does follicular lymphoma normally transform to? Diffuse large cell lymphoma
What are the subtypes of Diffuse Large B-cell lymphoma? Immunonodeficiency-Associated B-cell lymphoma Body-Cavity Large B-cell lymphoma
What is the most aggressive cancer? Burkitt's lymphoma
Which cancer has a starry-sky appearance? Burkitt's lymphoma: The macrophage represents the stars while the malignant burkitt represents the night sky
What is the translocation for Burkitt's lymphoma? T(8:14)-- Chr14 has immunoglobulin heavy-chain genes Chr8-- has oncogene c-myc
What is the lab finding for Multiple Myeloma? M spike; monoclonal Ig spike (most common is IgG, then IgA)
Multiple Myeloma Malignant neoplasm of plasma cells
What symptoms will an adult with multiple myeloma present with? Lower back pain
What is the description of RBCs in multiple myeloma? Rouleaxu stack of coins: Increased Ab production causes RBCs to stick together
What explains the multiple lytic bone lesions that occur during multiple myeloma? Plasma cells secrete Osteoclastic Activating Factor; leading to hypercalcemia
What renal disease result from multiple myeloma? Myeloma nephrosis
Increase in which interleukin is associated with poor prognosis for multiple myeloma? IL-6
When plasmacytoma is outside bone, where is it usually found? Upper respiratory tract
Which 2 inclusions will be present in lymphoplasmacytic lymphoma? Russell bodies (cytoplasmic immunoglobulin) and Dutcher bodies (intranuclear immunoglobulin)
Which syndrome is associated with lymphoplasmacytic lymphoma? Hyperviscosity syndrome: Visual abnormality, neurologic symptoms, Bleeding and cryoglobulinemia
Which lymphoma is part of the wastebasket diagnostic category? Peripheral T-cell lymphoma
What is the microscopic description of Adult T-cell leukemia/lymphoma? Hyperlobated 4-leaf clover lymphocytes in peripheral blood
Mycosis Fungoides Malignant T-cell disorder with better prognosis than ATLL. It's CUTANEOUS, hence looks like fungal infection. Rash will have a rash which will not go after antifungal medication
Sezary syndrome Occurs in cutaneous forms of T-cell lymphoma (such as Mycosis Fungoides). Associated with generalized exfoliative skin rash. The cells start in skin but can get to blood.
Reed-Sternberg Cell Associated with Hodgkin's lymphoma. They are B-cells and diagnostic. Have bilobed nucleus with prominent large inclusion-like nucleolus in each lobe.
Which infection will produce cells with Owl's eye appearance? Cytomegalovirus
What are the 5 classes of Hogkin's lymphoma? Lymphocyte-rich, Lymphocyte predominant, Mixed cellularity, Lymphocyte depleted, Nodular sclerosis (more common in females)
Which form of Hodgkin's is associated with EBV? Lymphocyte-rich
How can myeloblasts be differentiated from lymphoblasts? Myeloblasts have granules. Lymphoblasts have no granules
Auer rods These are intracytoplasmic rods in myeloblasts. They are abnormal lysosomes. Found mostly in M3 AML
What stains Auer rods? MPO (myeloperoxidase) or Sudan-black B stain
Which system is used to classify AML? French-American-British system
What is the translocation of M3 AML? T(15:19), 15 has the PML gene and 17 has the RAR-a gene
Di Guglielmo's disease This occurs in M6 Erythroleukemia. It's an abnormal erythroid precursor (binucleate and megablastic changes
Myelodysplastic syndrome Dysplastic changes which include Pelger-Huet cells (aviator glasses nuclei), ring sideroblasts, nuclear budding and pawn hall megakaryocytes. MDS patients have increased risk of developing acute leukemia
What is treatment for Chronic Myelogenous Leukemia? Imatinib
What are the 3 clinical presentations of Langerhan's cell histiocytosis? Letter-Siwe, Hand-Schiller-Christina and Eosinophilic granuloma
What stains Mast cells? Toluidine Blue
What are the diseases of mast cells? Solitary Mastocytoma, Urticaria pigmentosum, Systemic mastocytosis
Genital warts is also known as? Condyloma acuminatum
What is the cause of condyloma acuminatum? HPV serotypes 6 and 11: 6 and 11 are benign
Which HPV serotypes are benign? Which are malignant? 6 and 11- benign. 16 and 18-- malignant
Papillary Hidradenoma Benign tumor of modified apocrine sweat glands of the labia majora or interlabial folds
What are the risk factors of squamous cell carcinoma of the vulva? Symptoms? HPV 16, smoking, Immunedeficiency (AIDS). Bleeding and itching vulva. Note that SCC is associated with keratin pearls
What is marker for melanoma? S-100 positive
What is the most common pathogen for Bartholin gland abscess? Neisseria gonorrhoeae
Lichen Sclerosis Occurs in elderly postmenopausal women. Presents as WHITE PATCH or pale skin with sclerosing of skin
Vaginal Adenosis and Clear Cell Adenocarcinoma Occurs in young girls of mothers who were exposed to Diethystilbesterol (an abortion drug). Vaginal Adenosis is a precursor of clear cell adenocarcinoma
Embryonal Rhabdomyosarcoma (Sarcoma Botryoides) Occurs in children below 4yrs. Cancer of skeletal muscle CT. There is polypoid grape-like soft tissue mass protruding from vagina. Botryoides means grape-like. Poor prognosis
What is marker for Embryonal Rhabdomyosarcoma? Desmin
What does persistence of mesonephri (Wolffian) duct remnant cause? Gartner's duct cyst. Cyst in laterl wall of vagina
Rokitansky-Kuster-Hansen syndrome Congenital absence of upper part of vagina and uterus. Primary amenorrhea
What are the classic causes of Pelvic Inflammatory Disease (PID) & salpingitis Chlamydia & Gonorrhoea
PID is an ascending infection. How does it ascend? Begins in cervix to endometrium (endometritis), fallopian tubes (salpingitis & fallopian tube scarring) and pelvic cavity (peritonitis & pelvic abscess)
Fitz-Hugh-Curtis Syndrome? Also known as? Also known as Perihepatitis. Characterized by violin-string adhesions between the fallopian tube and liver capsule. Associated with chlamydia and gonorrhoea
What are complications of PID Tubo-ovarian abscess, Tubal scarring; leading to increased risk of infertility and ectopic tubal pregnancy. Intestinal obstruction, secondary to fibrous adhesions
What is the 1st, 2nd and 3rd most commom cancers of the female genital tract? Endometrial cancer, Ovarian cancer and Cervical cancer
What is the 1st, 2nd and 3rd cancers with the highest mortality? Ovarian, Endometrial and cervical cancer
Incidence of cervical cancer has decreased because of...? PAP smear
Which infection and which oncogene are responsible for cervical carcinoma? HPV 16, 18, 31 and 33. E6 (binds p53) and E7 (binds Rb) oncogenes
What are the risk factors of cervical carcinoma? HVP, E6 & E7 oncogene mutations, early age of first intercourse, multiple sex partners, multiple pregnancies, oral contraceptive use, smoking, STDs, immunosuppression
What is the precursor lesion for cervical cancer? Cervical Intraepithelial Neoplasia (CIN); dysplastic
Where does cervical intraepithelial neoplasia usually occur? Occurs at the SQUAMOCOLUMNAR JUNCTION
Which is the progression of cervical carcinoma? CIN I, CIN II, CIN III, CIS, Invasive squamous cell carcinoma
Microscopically, what will be seen in cervical cancer? It's a squamous cell carcinoma, so keratin pearls will be seen
Which 2 methods can be used to diagnose cervical cancer? Papanicolaou test. Colposcopy with biopsy
What is the cause of the more serious form of chronic cervicitis called folliculuar cervicitis? Chlamydia Trachomatis
What does a neonate born out of a cervix affected with chronic cervicitis (follicular cervicitis get? Neonatal conjunctivitis & pneumonia
What is acute endometritis associated with? Pregnancy & Abortion
What is chronic endometritis associated with? IUDs, & PID
Which infection is associated with IUDs? Actinomyces (grows as molar teeth on agar). Actinomyces is associated with sulfur granules
Endometriosis Endometrial tissue and glands and stroma outside the uterus; causing GI and bladder problems
Which group of people usually get endometriosis? Females of reproductive age who do not have children right away; med students, law students etc.
What are common sites of endometriosis? Pouch of Douglas, ovary/ovarian and uterine ligaments, serosa of bowel and urinary bladder, peritoneal cavity
What is description of gross appearance of endometriosis? Red-brown serosal nodules (powder burns), chocolate cysts in ovary
What is the most common benign tumor of the female genital tract? Leiomyoma (fibroids)
Which affects the size or increase in growth of leiomyomas? Estrogen
What is description of gross appearance of leiomyoma? White-tan mass, whorl-like trabeculated appearance
Which layers are leiomyomas found and which is the most common location of a leiomyoma? Subserosal (on periphery), Intramural (in muscle; most common), submucosal. Intramural is the most common location
What is the malignant form of leiomyoma? Leiomyosarcoma. Note that leiomyoma does NOT progress to leiomyosarcoma
Which stage in a woman's life is endometrial carcinoma most common? Postmenopausal
What is the clinical presentation of endometrial carcinoma? Postmenopausal vaginal bleeding
Which therapy and drug predisposes a woman to endometrial cancer? Estrogen replacement therapy & Tamoxifen
What makes prognosis of endometrial cancer bad? Invasion into myometrium
What are clinical presentations of Polycystic Ovarian Disease? Oligomenorrhea or secondary amenorrhea, hirsutism (due to testosterone), infertility (due to estrogen), obesity (duet to estrogen)
What is lab finding for Polycystic Ovarian Disease? Elevated LH, Low FSH and Elevated testosterone
What is treatment for Polycystic Ovarian Disease? Oral contraceptives; Provera (progesterone-only contraceptive)
What is the most common benign ovarian tumor? Cystadenoma
What will patient with cystadenoma present with? Adnexal (next to uterus) tenderness or mass
What are the micro findings of cystadenoma? Serous tumors (cells will have cilia on them) or Mucin tumors
What can cause Pseudomyxoma Peritonei? Cystadenocarcinoma; when the mucin type becomes malignant, it will secrete mucin into the abdomen causing pseudomyxoma peritonei
What is the micro findings of a serous cystadenocarcinoma? Psammoma bodies
What is tumor marker for cystadenocarcinoma? CA-125
Meigs's (not meig's) syndrome Fibroma + Ascities + Pleural Effusion (FAPE). Associated with ovarian fibroma
Which hormone does a Granulosa cell tumor secrete? What are the complications of this secretion? Estrogen-producing tumor. Endometrial hyperplasia, altered menstrual cycle, leiomyomas, endometrial carcinoma
What kind of therapy is Dysgerminoma and semimoma sensitive to? Radiosensitive
What are the clinical presentations of Granulosa cell tumor? Prepubertal-- precocious puberty. Reproductive age-- irregular menses. Postmenopausal-- vaginal bleeding
What are the micro findings of granulosa cell tumor? Polygonal tumor mass, Call-Exner bodies (diagnostic)
What is the difference between teratomoa adult and immature/primitive looking cells? Adult-looking; benign. Immature/primitive looking; malignant
Androblastoma is aka...? Sertoli-Leydig cell Tumor; produces androgens
What is the difference between sertoli-leydig cell tumor in male and female? In male, they are seen together. In females, they are separate
What is complication of Sertoli-Leydig cell tumor? Risk of female pseudohermaphrodite
Where are the primary sites of tumors that metastasize to ovary? Breast cancer, colon cancer, Endometrial cancer, gastric cancer (signet ring cell, Linitis Plastica) krukenberg tumor
Complete hydatidiform mole Ferlization of sperm with egg which has lost all of its chromosomal material. Hence all chromosomal material is derived from sperm. 90% is 46XX (all paternal). 10% is 46XY. Will have more proliferation of trophoblast. Hence there will be high B-HCG amount
What is USG finding of hydatidiform mole? Snow-storm pattern or snowy pattern and hydropic villi or grape-like lesions
What is a partial hydatidiform mole? Fertilization of an egg without chr material with by 2 sperms: one will be 23x and another will be 24x. Results in triploidy: 69chr. Material is from both parents
What are presentations of hydatidiform mole? Uterine enlargement, high B-HCG, passage of edematous grapelike soft tissue/lesions
What is treatment of hydatidiform mole? Endometrial curettage and B-HCG levels
In terms of the presence of fetal tissue, what is the difference between complete and partial? Complete will have NO fetal tissue. Partial will have some fetal tissue
Choriocarcinoma Malignant germ cell tumor derived from trophoblast. Grossly, there is necrotic and hemorrhagic mass
What are the 2 types of trophoblasts? Which one makes B-HCG? Cytotrophoblast & Syncytiotrophoblast. Syncytiotrophoblast makes B-HCG
What are the risk factors of placental abruption? Cocaine, cigarettes, hypertension, older maternal age
What is a complication of placental abruption? DIC, retroplacental hemorrhage or hemorrhage on placenta
Placental accreta & Placental previa Previa-- Placenta overlying cervical os. Accreta-- placenta implanting on myometrium rather than on endometrium; hence no resiudal in between
What is acute mastitis associated with? Lactation & breast feeding
Which organism is the most common cause of acute mastitis? Staphylococcus aureus (will cause purulent discharge)
Why is there cancer associated with fibrocystic change/disease? There is collection of benign breast tissue changes with nonproliferative components and proliferative components that increase risk of breast cancer
What is the most common lesion of the breast? Where is it usually located? Fibrocystic change. Usually located at the upper outer quadrant of breast
What is description of the cysts of nonproliferative fibrocystic change? Blue-domed cyst
What are the 3 features of a nonproliferative fibrocystic change Apocrine metaplasia (from blue to reddish colour), cysts (blue-domed), microcalcification. No risk of cancer
What are the 3 features of a proliferative fibrocystic change Ductal hyperplasia, sclerosing adenosis, small duct papilloma. Risk of cancer
How does a fibroadenoma feel during palpation? Palpable, round, moveable, RUBBERY (will slip away from fingers)
Phylloides tumor is also known as... Cystosarcoma phylloides
Which best lesion presents with bloody nipple discharge? Intraductal papilloma; involves the lactiferous ducts or sinuses
What is the most common cancer in females? Breast cancer
What is the 2nd most common cause of death in women? Breast cancer
What are the hereditary risk factors of breast carcinoma? BRCA1 on chr 17q21. BRCA2 on chr 13q12-13. p53 germ mutation, associated with Li Fraumeni syndrome
What is mammographic finding in a malignant breast cancer? Mammogroaphic calcification (small fine microcalcification) or architectural distortion
What are clinical presentation of breast cancer? solitary painless mass, fixed mass (at least 2cm), nipple retraction or skin dimpling, fixation to chest wall, most common in upper outer quadrant
Which 3 breast tumors have better prognosis invasive? mucinous carcinoma, tubular carcinoma, medullary carcinoma
How is prognosis for breast cancer determined? Invasion to even one axillary lymph node is is poor prognosis. Size of tumor (palpable only if more than 2cm), grade, ER/PR receptor status, aneuploidy
Why are African-Americans like to have worse breast cancer prognosis? Present at a later stage. They have negative estrogen receptor status
Which genes make breast cancer prognosis worse? HER2/neu
What are the treatments for local and metastatic breast cancer? Local-- mastectomy/lumpectomy with radiation, axillary dissection Metastatic-- Tamoxifen, chemotherapy; ie. if patient has positive receptors and premenopausal
What are micro findings in Paget Disease of the nipple PAS positive, intraepidermal spread of tumor cells (paget cells), clear halo around nucleus
Which 3 conditions can cause gynecomastia? Patients with liver cirrhosis or failure, spirolactone use, marijuana
How can gynecomastia be differentiated from normal breast tissue microscopically? Presence of ducts in gynecomastia, and absence of lobules
How does spironolactone cause gynecomastia? Blocks androgen production by inhibiting enzymes in the testosterone synthetic pathway (i.e. 17a hydroxylase and 17-20-desmolase), Also block receptor-binding of testosterone and DHT. Also displaces estradiol from SHBG, increasing free estrogen levels
What is the most common congenital anomaly seen in males? Hypopadiasis
What is the cause of epispadias and hypospadias? What complications can they cause? Undescended testes. Can cause infertility and UTIs
What is condyloma acuminatum associated with in males? HPV serotypes 6 and 11
Which cancer is high in uncircumcised males? Squamous cell carcinoma
What are 3 precursors of squamous cell carcinoma in penis? Bowen disease (SSC in situ), Bowenoid papulosis (SSC in situ), Erythropolasia of Queyrat (penile Bowen disease)
What are the causes of priapism? Sickle cell anemia, Trauma, Trazadone
Which medications can cause erectile dysfunction? Leuprolide, methyldopa, psychotropic medications
What is the most common cause of scrotal enlargement? What is causes it? Hydrocele; i.e. fluid in within the tunica vaginalis.
How can hydrocele be be diagnosed? Transluminating light thru it. It's positive if light comes out of it.
Spermatocele Dilated EFFERENT DUCT in the epididymus, containing sperm. Associated with trauma
What is the age distribution and causes of acute epididymitis? <35, associated with STDs; Neisseria gonorrhea, Chlamydia trachomatis >35, Associated with E.coli & pseudomonas
What is the cause of chronic epididymitis? TB
What is the cause of orchitis? Viral mumps
What are complications of undescended testes? Infertility,testicular atrophy, risk of inguinal hernia, risk of seminoma or cancer
How can prolactinoma affect sperm? Cause low sperm count
What are the 2 forms of testicular cancer? Seminoma & Nonseminomatou tumors (may have widespread metastasis
What is description of testicular cancer on USG? Hypoechoic intratesticular mass
What can a nonseminomatous tumor consist of...? Embryonal, yolk sac, choriocarcinoma, teratoma
What are the differences between seminomas and nonseminomatous germ-cell tumors? Seminoma-- radiosensitive, late metastsis, excellent prognosis. Both sensitive to chemo Nonseminomatous--not radiosensitive, early metastasis to retroperitoneal node, more aggressive
What is tumor marker for seminoma? Placental Alkaline Phosphatase PALP
What are tumor markers for Embryonal carcinoma (nonseminomatous)? a-Fetoprotein (AFP) & B-HCG
Tumor marker for choriocarcinoma and Yolk sac tumor? Choriocarcinoma-- B-HCG Yolk sac tumor-- a-Fetoprotein
What is the most common germ-cell tumor in children and adults? Children-- Yolk sac tumor (endodermal sinus tumor). Adult-- Seminoma
What is micro finding in a Yolk sac tumor? Schiller-Duval bodies
Teratocarcionma Teratoma + Embryonal carcinoma
What kind of hormone does a leydig cell tumor produce? Both androgens and estrogens
What is the micro finding of leydig cell tumor? Wrinkly-crystalloids
What kind of hormone does a sertoli cell tumor produce? Androgens and estrogens
What kind of lymphoma is a Testicular lymphoma? Non-Hodgkin's lymphoma
What kind of occupation is associated with scrotal squamous cell carcinoma? Chimney sweeping; soot
Which hormone plays an important role in BPH? Androgen; Dihydrotestosterone (DHT). Testosterone is converted to DHT via 5a-reductase
How can growth in BPH be stopped? 5a-reductase inhibitor
Which renal and bladder complications can result from BPH? Bilateral hydronephrosis, diverticula of bladder and obstruction of urethra
What is difference between PSA in BPH and prostatic carcinoma? BPH is not as highly elevated as it is in prostatic carcinoma
What are the various methods of treating BPH? TURP (Transurethral Resection of Prostate), Finasteride (Proscar), Terazosin, Prozosin
What is the most common male cancer in the US? Prostate adenomacarcinoma
What is the 1st and 2nd most common cause of cancer death in men? Lung cancer-- #1. Prostate cancer-- #2
Which part of prostate is prostatic adenocarcinoma usually found? Posterior aspect of the peripheral zone, hence easy to palpate
What is the difference between BPH and Prostatic adenocarcinoma in terms of palpation? BPH-- rubbery Prostate adenocarcinoma-- Hard
What does it mean when urinary symptoms begin in a prostatic adenocarcinoma patient? Means that cancer has now spread forward to glands and has metastaized: called Late Urinary Symptoms of Prostatic Adenocarcinoma
How can prostate adenocarcinoma be detected? Digital rectal exam (induration), serum PSA levels, Transrectal ultrasound and biopsy
Which system is used to grade prostatic adenocarcinoma? Gleason Grading System
Where does prostatic adenocarcinoma usually metastasize to? Obturator and pelvic lymph nodes. Osteoblastic bone, lumbar spine (hence classic presentation is lower back pain)
What is differential for male with back pain? Multiple myeloma, Prostatic cancer, Triple A (Abdominal Aortic Aneurysm)
What will be elevated in prostatic cancer and why? Alkaline phosphatase; this is because, there is metastasis to osteoblastic bone, which makes Alkaline phosphatase. PSA will also be elevated
How can prostatic cancer be treated? Local disease; prostectomy and/or external beam radiation. Metastatic: orchiectomy, to cut off testosterone. Will lead to gynecomastia due to high estrogen.
When should PSA levels checked after prostectomy due to cancer? 6 months after
During which stages of life can goiter occur? Puberty and pregnancy; due to increased demand of the thyroid
What can Multinodular Goiter (nontoxic goiter) lead to later? Plummer syndrome: TOXIC multinodular goiter
What is lab finding in a multinodular goiter? Normal TSH, T3 and T4
What kind of hypersensitive reaction is Graves disease? Type II hypersensitivity; IgG on TSH receptors
In which condition is pretibial myxedema present? Hyperthyroidism (Grave's disease)
What is the typical triad for Goiter? Diffuse goiter, Exophthalmus & Pretibial myxedema
What is description of micro findings in Grave's disease? Moth-Eaten Appearance of scalloped colloid
What is the most sensitive test in thyroid disease? TSH
What are 2 types of transient hyperthyrodism? Hashimoto & Subacute thyroiditis: There is first hyperthyroidism, which is followed by hypothyroidism
What is lab finding in hypothyroidism? low T4 and T3. Primary hypothyrodism: High TSH. 2ndary Hypothyroidism: low TSH
What is the most common cause of hypothyroidism in the US? Iatrogenic hypothyroidism; Thyroidectomy & Radioactive iodine treatment
In which areas may there be iodine deficiency? Alps, Malaysia and the Himalayas
What is the difference between Grave's and Hashimoto thyroiditis? Graves-- autoimmune against TSH receptor, causes hyperthyroidism Hashimoto thyroiditis--Autoimmune, against thyroid gland or TSH receptor (BLOCKS it) and causes hypothyroidism. However, there is transient hyperthyroidism
What is micro finding of Hashimoto's thyroiditis? Lymphocytic inflammation with germinal centers Epithelial changes to HURTLE CELL; a large eosinophilic cell with granular cytoplasm
What can Hashimoto's lead to & why? Large cell lymphoma (Non-Hodgkin B-cell lymphoma). If lymphocytic infiltrations stay in thyroid long enough, they become malignant
What is history of a patient with subacute thyroiditis? Viral infection. Patient will have fever, Transient hyperthyroidism with subsequent hypothyroidism
What is micro finding of subacute thyroiditis? Granulomatous thyroiditis
Riedel thyroiditis Characterized by destruction of the thyroid gland by dense fibrosis and fibrosis of surrounding structures (trachea & esophagus)
Which drug can cause Riedel thyroiditis? Methysergide (migraine medication); also causes fibrosing of retroperitoneal
What is the most common cancer of thyroid? Papillary carcinoma
What are the micro findings of papillary carcinoma? Papillary pattern; i.e. finger-like projections. Occasional psammoma bodies. Typical nucleus will be VESICULAR, CLEAR, DEVOID of CHROMATIN; called ORPHAN ANNIE EYE
What does follicular carcinoma of thyroid most commonly metastasize to? Hematogenous metastasize to bones or lungs. Hematogenous spread makes follicular worse than papillary which is lymphatic spread
Where does medullary carcinoma of thyroid arise from, and what does it secrete? C (parafollicular) cell; secretes calcitonin
What kind of syndromes are associated with medullary carcinoma of thyroid? MEN II and III sydnromes
What is micro findings of medullary carcinoma of thyroid? Which stain can be use? Polygonal cells in amyloid stroma. Amyloid, so congo red can be used or apple-green birefringens under polarized light
Which syndrome is Parathyroid Adenoma associated with? MEN I
How can parathyroid adenoma be differentiated from parathyroid hyperplasia? Adenoma-- only 1 gland is enlarged. The other 3 will be normal. Hyperplasia-- All 4 will be enlarged
In paraneoplastic syndrome, which carcinomas secrete PTH-like substances and cause hypercalcemia? Squamous cell carcinoma of lung & renal cell carcinoma
Which pathologic bone fractures or conditions result from hyperparathyroidism? Osteoporosis & Osteitis Fibrosa cystica
Which condition is called Brown tumor and associated with hyperparathyroidism? Osteitis Fibrosa Cystica
What is Ca2+ in primary and secondary hyperparathyroidism? Primary-- Ca2+ will be elevated Secondary-- Ca2+ will be normal or low. Will NOT be elevated
What are the etiology of secondary hyperparathyroidism? Chronic renal failure, Vit. D deficiency, Ca2+ malabsorption, any disease that causes hypocalcemia
Cause of DiGeorge syndrome Dysgenesis of both thymus and parathyroid glands. They both come from the 3rd and 4th pharyngeal pouch
What is effect of hypocalcemia on ECG? prolonged QT interval
What are signs of hypocalcemia? Peri-oral numbness and tingling, Prolonged QT interval on ECG, neuromuscular excitability and tetany, psychiatric disturbances, Positive Chvostek & Trousseau sign
In pituituary adenoma, which nerve is affected? Optic chiasm; causing Bilateral Temporal Hemianopsia
What are 2 type of functional pituitary adenoma? Prolactinoma & Growth-hormone producing Adenoma
What will patient with prolactinoma present with? Female: Galactorrhea, amenorrhea, infertility. Male: hypogonadism, decreased libido, gynecomastia and impotence
What is lab finding for GH-producing adenoma? Elevated GH, elevated somatomedin C (insulin-like growth factor 1). GH acts on liver and other tissues, leading to increased production and release of somatomedins (esp. IGF-1)
What is the most common reason for death in acromegaly? Internal organ enlargement, esp. cardiac enlargement, leading to cardiac failure
In females, what is first sign of hypopituitarism? Amenorrhea
What is a patient with BIPOLAR disease also most likely to have and why? Nephrogenic Diabetes insipidus (not central); this might be due to lithium toxicity which makes nephrons insensitive to ADH
How can central and nephrogenic diabetes insipidus be differentiated? Deprived patient of water and give ADH. If patient respond to ADH; it's central. If patient does not, it's nephrogenic
Which carcinoma can secrete ADH and cause SIAHD? Carcinoma of lung
Craniopharyngioma Benign pituitary tumor derived from Rathke Pouch Remnants. Can undergo calcification
What is the most common cause of hypopituitarism in children? Craniopharyngioma
Microscopically, what does craniopharyngioma look like? Tumor looks like enamel of the tooth; Adamantinoma
What are the classic presentations of cushing's? Moon facies, purple striae, trunkal obesity, hypertension, diabetes, osteoporosis
What is the most common cause of cushing's? Exogenous steroids
What is the most common endogenous cause of cushing's Pituitary adenoma or cushing's disease
How can cushing's be diagnosed? 24hr urine free cortisol test
What is a cause of secondary hyperaldosteronism (Conn's)? Renal artery stenosis, leading to ischemia of kidney. Results in increase in renin and hypertension
Adrenogenital syndrome Adrenal disorder characterized by excess production of androgens and virilzation. Causes clitomegaly and hypotension
What are the causes of Adrenogenital syndrome? Adrenocortical adenoma/carcinoma, congenital adrenal hyperplasia, 11 and 17-hydroxylase deficiency
What enzyme deficiency is associated with congenital adrenal hyperplasia? What does this deficiency also lead to/ 21-hydroxylase deficiency. Leads to hypotension and virilization
What is 11 and 17 hydroxylase deficiency associated with? Hypertension
Which pathogen can cause Waterhouse-Friderichsen syndrome? Neisseria meningitides
Waterhouse-Friderichsen syndrome Acute adrenal insufficiency. Bilateral hemorrhagic infarction. Causes purpura on skin, bilateral hemorrhage into adrenal gland
What is another name for hemorrhage into adrenal glands besides Waterhouse-Friderichsen? Adrenal Apoplexy
Which lung disease can also cause Addison's disease? Tuberculosis
In which type of Addison's disease is there hyperpigmentation; primary or secondary? Primary Addison's disease will cause hyperpigmentation
Which adrenal tumor is also called Dark/Dusky coloured tumor? Pheochromocytoma
What is the rule of 10's? In which condition does it apply? Pheochromocytoma... 10% occur in children, 10% are bilateral, 10% are outside of adrenal gland, 10% are malignant, 10% are familial (MEN II & III)
What are diagnostic markers for pheochromocytoma Elevated urinary Vanillylmandelic acid. Elevated catecholamines
MEN I and IIa are also known as... Werner syndrome & Sipple syndrome
Tumors in which organs are associated with MEN I (Werner syndrome)? 3P's-- Pituitary gland, Parathyroid, & Pancreas (gastrinoma & ZES)
Which genes are defective in MEN I and II/III (IIb)? MEN I-- MEN I gene. MEN II/III-- RET proto-oncogene
MEN IIa syndrome AKA Sipple syndrome; features medullary carcinoma of the thyroid, pheochromocytoma, and parathyroid hyperplasia or adenoma. Patient will have hypercalcemia
MEN IIb/III Medullary carcinoma of thyroid, Pheochromocytoma & Mucocutaneous neuromas + MARFANOID HABITUS (tall and thin individual)
What type of collagen is in bone? Type I collagen
What are osteoblasts receptors to? Which enzyme do they produce? Receptor to parathyroid hormone. Produces Alkaline Phosphatase
What is an osteoblast surrounded by osteocyte called? Osteocyte
Which enzymes do osteoclasts contain? Where do they resorb bone? Acid phosphatase and collagenase. Resorb bone in Howship's lacunae
Which hormones affect bone? Parathyroid hormone, calcitonin, Vitamin D, estrogen, thyroid, cortisol and Growth hormone
Which bones in body undergo intramembranous bone growth? Cranial, clavicle, vertebrae, wrist and ankle
Which markers are elevated in bone formation? Alkaline phosphatase & Osteocalcin
What is the most common cause/form of inherited dwarfism? Achondroplasia
What is the mutation in Achondroplasia? Fibroblast growth factor receptor 3 on chr 4. FGFR-3 inhibits cartilage synthesis at epiphyseal plate & causes premature ossification of growth plates
What is absent in Osteogenesis Imperfecta? Type I collagen
What is absent in Osteogenesis Imperfecta (Brittle bone disease)? Absence of type I collagen
What defect occurs in the eye when patient has osteogenesis Imperfecta? Thin sclera with Blue hue; due to lack of collagen needed for the sclera
What other pathologies are associated with osteogenic imperfecta? Thin blue sclera, Dentinogenesis imperfecta (due to lack of dentin), thin dermis susceptible to bruising, hearing loss
All 4 types of osteogenic imperfecta are Autosomal dominant, except...? Type II or Type III which can be both autosomal dominant or recessive
Osteogenesis Imperfecta Type II Child will be stillborn or die; due to fractures in utero
What is a unique feature about Type IV osteogenesis imperfecta besides multiple fractures? NO blue sclera. Sclera will be normal
Osteopetrosis Decreased osteoclast function; leads to decreased resorption and thick sclerotic bones. Causes fracture, even though the bone is thick
What blood condition must be associated with Osteopetrosis for diagnosis? Anemia-- this is because, there will be Myelophthisic tissue which is replacement of hematopoietic tissue in BM with abnormal tissue. Leading to ANEMIA & extramedullary hematopoiesis
What is compressed in osteopetrosis and what are the consequence? Compression of cranial nerves; results in blindness, deafness, facial nerve palsies. Hydrocephalus occurs due to blockage of CSF
What is x-ray finding in osteopetrosis? Generalized osteosclerosis. Long bones have broadened metaphyses called ERLENMEYER FLASK-SHAPED DEFORMITY
Which osteopetrosis type is benign and which is malignant? Autosomal recess-- malignant. Autosomal dominant-- benign (associated with CN impingement
What is treatment of osteopetrosis? Bone marrow transplantation
Patient complaining of not fitting his hat any longer most likely have... and why? Paget's diseae (Osteitis Deformans); there is bone remodelling disorder due to osteoblastic activity
Which pathogen can cause Paget disease? Paramyxovirus
What are the 2 forms of Paget disease? Monostotic (15%)-- involves one bone. Polystotic (85%): involves multiple bones
What is micro finding in Paget's disease? Haphazard arrangment of cement lines, creating mosaic pattern of lamellar bone
When facial bone is involved in Paget's disease, what feature is formed? Lion-like facies
What are lab findings in Paget's disease? Elevated alkaline phosphatase, Elevated urinary hydroxyproline
What are complications of Paget's disease? AV-shunts with marrow, resulting in high-output cardiac failure. Paget disease can cause osteosarcoma or other sarcomas
Which race is mostly affected by osteoporosis? Postmenopausal Caucasian women
What is the most common bone disorder? Osteoporosis
Lack of which hormone can result in osteoporosis? Estrogen
Which congenital condition can lead to osteoporosis? Turner syndrome
Which endocrinopathies can lead to osteoporosis? Cushing's & thyrotoxicosis
Which medication can be administered for osteoporosis? Biphosphonate (Alendronate)
What is treatment for osteomalacia & rickets? Vitamin D and calcium
What is description of knobbing at the costochondrial junction of bone in a ricket patient Rachitic rosary
What are features in a child with rickets? Rachitic rosary, pectus carinatum, lumbar lordosis, bowing of leg
Which conditions cause bow legging? Rickets & scurvy
How can scurvy be differentiated from rickets? Both will have bowing of legs, however, scurvy will not have pectus carinatum &rachitic rosary
What are lab findings in osteomalacia? Low calcium, low phosphorous. High alkaline phosphatase
What is the most common cause of osteomyelitis? Pyogenic osteomyelitis
Which part of bone does osteomyelitis often affect? Metaphyses
What is the most common cause of osteomyelitis? Staph aureus
Which bacteria is sickle cell most prone to? Which pathogen is the most common cause of osteomyelitis in sickle cell patients? Salmonella. Staph aureus
Which pathogen will most likely cuase osteomyelitis in a diabetic or in an IV drug abusers? Pseudomona
What is x-ray finding in osteomyelitis X-ray normal for up to 2wk. After, may show periosteal elevation, which is lytic focus with surrounding scelerosis
What are complications of osteomyelitis? Fractures, osteogenic sarcoma (rare), Tuberculous osteomyelitis, secondary amyloidosis, sinus tract formation
Which part of bone is mostly affected by avascular necrosis? Head of femur; because head of femur is poorly vascularized
What is appearance of bone (colour) in avascular necrosis? Yellowish appearance
Osteitis Fibrosa Cystica Excessive parathyroid hormone (hyperparathyroidism), causing osteoclast activation and generalized bone resorption
Brown tumors in Osteitis Fibrosa Cystica Brown mass produced by cystic enlargement of bone with areas of fibrosis & organized hemorrhage. Hence brown tissues are associated with hemorrhage into cystic space
Which type and which part of bone does Hypertropic Osteoarthropathy affect? Ends of long bone; fingers, wrist, elbow, knees, ankle
Which lung condition and other condition is associated with hypertrophic osteoarthropathy? Bronchogenic carcinoma, IBD, cyanotic congenital heart disease, chronic lung diseases
Osgood-Schlatter disease Common cause of knee pain in adolescent, due to stress from quads during rapid growth causing inflammation of the proximal tibial apophysis at the insertion of the patellar tendon
What is description for Fibrous dysplasia at the head of femur? Shepherd Crook's deformity
What syndromes are associated with multiple bone involvement of fibrous dysplasia? Albright syndrome or McCune-Albright syndrome; cafe-au-lait spots on skin and precocious sexual development
In which 2 conditions can cafe-au-lait spots seen? Neurofibromatosis & Albright syndrome
What is description of bone spicule formed in fibrous dysplasia? Chinese letters
Which syndrome is osteoma associated with? Gardner's syndrome
Which bones are usually affected by osteoma? Skull and facial bones, especially mandible
Hyperostosis Frontalis Interna Osteoma that extends into orbit or sinuses
Osteoid Osteoma Benign painful growth of the diaphysis of a long bone, often the tibia or fibula. There is osteoid-like lesion surrounded by mature bone
What can osteoid osteoma be treated with? Which time of day is pain worse? Pain is worse at night, due to elevation of prostaglandin at night. Aspirin will block the cyclooxygenase pathway and inhibit prostaglandin
What is x-ray description of osteoid osteoma? Central radiolucency surrounded by sclerotic rim. Lesion size of less than 2cm
What is difference between osteoid osteoma and osteoblastoma? Osteoblastoma is larger (greater than 2cm) and often involves the vertebrae
Endochondroma Benign cartilaginous growth within medullary cavity of bone, usually involving hands and feet
What treatment is used for endochondroma? No treatment
Ollier disease Multiple enchondroma in hands and feet
Maffucci's syndrome This is Ollier disease with hemangiomas. It's enchondromatosis associated with ovarian carcinoma, and brain gliomas
What is x-ray finding in osteoclastoma (Giant-cell tumor of bone) Soup bubble appearance
What is gross appearance of bone in osteoclastoma? Red-brown mass with cystic degeneration
Which bone does osteosarcoma affect? Knee; therefore, there will be knee pain and swelling
What disease is osteosarcoma associated with? Familial retinoblastoma; Rb gene
What are classic x-ray finding in osteosarcoma? Codman's triangle (periosteal elevation), Sunburst pattern, bone destruction
Where does osteosarcoma usually metastasize to? Lung
What is genetic defect in E-wing sarcoma (PNET tumors) Translocation (11:22) producing EWS-FL/1 fusion protein
What are the common sites of E-wing sarcoma? Femur, pelvis an tibia
What is micro and x-ray finding in E-wing? Micro-- blue-cell tumors & PAS positive, Homer Wright Pseudorosettes X-ray- onion skin
What is the most common cancer in males and what does it metastasize to? Prostate; metastasize to bone. It's osteoblastic, so lesion will be dense
What is the most common cancer in female and what does it metastasize to? Breast cancer; to bone
What is the most common type of arthritis? Osteoarthritis
Why is osteoarthritis a misnomer? There is no true inflammation. Injury is due to wear-and-tear and degeneration of articular cartilage. So common in older people.
What is the difference osteoarthritis and rheumatoid arthritis? Osteoarthritis-- wear-and-tear, unilateral, affects weight-bearing joints. RA-- Autoimmune, bilateral, synovial proliferation
What will a patient with Rheutamoid arthritis be positive for? Rheumatoid factor & Rheumatoid nodule
What are the 2 nodes found in osteoarthritis? Osteophytes are found inside fingers. There are 2 types; Heberden nodes-- osteophytes at distal interphalangeal (DIP) joints and Bouchard nodes-- osteophytes at proximal interphalangeal joints
What is genetic predisposition for Rheumatoid arthritis? HLA-DR4 and DR1
What type of hypersensitivity is rheumatoid arthritis? Type III
Diffuse Proliferative Synovitis Synovial hyperplasia _ inflammation leads to the synovitis
Bone fusing in rheumatoid arthritis is called...? Ankylosis
In rheumatoid arthritis, what is description of radial deviation of wrist and ulnar deviation of fingers? Swan neck: hyperextension of PIP and flexion of DIP joints. Boutonniere (button hole): flesion of PIP and extension of DIP joints. Baker cysts: this is synovial cyst in popliteal fossa
What are lab findings in rheumatoid arthritis? Elevated sedimentation rate (due to inflammation), hypergammaglobulinemia, rheumatoid factor (RF)-- IgM against Fc; Type III hypersensitivity
What kind of necrosis occurs as a result of rheumatoid arthritis? Fibrinoid necrosis
Which syndromes are associated with rheumatoid arthritis? Felty sydnrome-- RA + splenomegaly + neutropenia (RSN). Caplan syndrome -- pneumoconiosis + RA. Sjogren's syndrome
In rheumatoid arthritis, how can ankylosis (fusing of bones) be prevented? Exercise fingers and toes
How should RA be treated? Exercise of fingers and toes-- prevents Ankylosis. NSAIDS-- prevents pain & inflammation. Steroids-- Autoimmune
How can RA be treated? Exercise of fingers & toes-- to prevent ankylosis. NSAIDS-- to prevent inflammation. Steroids-- Autoimmune
Which joint pathology is associated with HLA-B27? Ankylosing Spondylitis, Reiter syndrome, Enteropathic arthritis, Psoriatic arthritis
Which joints are usually affected in Ankylosing Spondylitis? Sacroiliac joint and spine
What is description of appearance of spine on x-ray for ankylosing spondylitis? Bamboo spine
Reiter syndrome Associated with HLA-B27. Classic triad of conjunctivitis, urethritis, arthritis. Arthritis affects ankles and knees
Which 2 diseases does onset of arthritis usually follow? Veneral disease & Bacillary dysentery
Enteropathic arthritis is associated with which IBD? Ulcerative colitis
What is appearance of psoriatic arthritis? silvery salmon pink scales
What are causes of secondary gout? Excessive cell breakdown (leukemia), renal disease, Lesch-Nyhan syndrome, HGPRT deficiency
What is distribution of disease in gout? Great toe (podagra), ankle, heel, wrist
During joint aspiration, what kind of birefringent will be observed in gout? Negative birefringent
What is treatment for gout? NSAIDS, colchicine, probenicid, allopurinol
Chondrocalcinosis Aka pseudogout; deposition of calcium pyrophosphate crystals in joints, leading to inflammation
What form of calcium deposits in chrondocalcinosis? Calcium pyrophosphate (NOT oxalate)
Which metabolic diseases are associated with chondrocalcinosis? Diabetes, hypothyroidism, ochronosis
Which pathogens cause lyme disease? Borrelia Burgdorferi (spirochete), Arthropod-borne disease (deer ticks; i.e. Ixodes Dammini)
What are symptoms of lyme disease? Erythema chronic migrans (skin rash), migratory arthritis (knees, shoulders and elbow), CNS & cardiac involvement
Charcot Joint (Neuropathic arthropathy) Joint damage secondary to impaired joint innervation, leading to inability to sense pain
What is the most common cause of neuropathic arthropathy? What is normally affected? Diabetes; usually affects tarsometatarsal joint in mid foot
What are causes of neuropathic arthritis? Diabetes mellitus (tarsometasal joint), syringomyelia (shoulder, elbow, wrist joint), Tabes dorsalis (neurosyphilis; damages hip, knee and ankle joints leading to SNAPPING gaits)
What type of metabolism is used by slow and fast twitch muscles? Aerobic (including kreb's cycle)-- Slow twitch Anaerobic (only glycolysis)--Fast twitch muscle
What is clinical presentation of patient with polymyositis? Bilateral proximal muscle weakness
Dermatomyositis Connective tissue disorder + inflammation of skeletal muscle and skin
What is micro finding in Inclusion body myositis? Cytoplasmic vacuoles with basophilic granules and amyloid
What kind of hypersensitivity reaction is Myasthenia Gravis? Type II hypersensitivity; autoantibodies against ACh receptors
Which thyroid conditions are myasthenia gravis associated with? Thymic hyperplasia & Thymoma
What is treatment for myasthenia gravis? Anticholinesterase agents, steroids, thymectomy
Eaton-Lambert syndrome Disease of neuromuscular junction associated with paraneoplastic process with proximal muscle weakness that improves with repetitive stimulation. It's also a paraneoplastic syndrome of small cell lung cancer
How is Eaton-Lambert different from Myasthenia Gravis, in terms of mechanism? MG-- autoantibodies against Ach receptors Eaton-Lambert-- autoantibodies against Ca2+ channels of neuromuscular junction
Eaton-Lambert syndrome Disease of neuromuscular junction associated with paraneoplastic process with proximal muscle weakness that improves with repetitive stimulation. It's also a paraneoplastic syndrome of small cell lung cancer
Pseudohypertrophy of calves in Duchenne dystrophy Muscle first degenerates, and then there is infiltration of fat and CT into weakened calf.
Pseudohypertrophy of calves in Duchenne dystrophy Muscle first degenerates, and then there is infiltration of fat and CT into weakened calf.
What normally leads to death in Duchenne muscular dystrophy? Respiratory & cardiac failure. Lose of accessory muscles such as serratus, diaphragm
How is Eaton-Lambert different from Myasthenia Gravis, in terms of mechanism? MG-- autoantibodies against Ach receptors Eaton-Lambert-- autoantibodies against Ca2+ channels of neuromuscular junction
What is genetic inheritance of Duchenne muscular dystrophy? X-linked recessive (males); Dystrophin gene on x-chromosome (Xp21. Makes dystrophin protein, an important structural muscle protein
What is the most common and severe form of muscular dystrophy? Duchenne muscular dystrophy
What is lab finding for Duchenne muscular dystrophy? Increased serum creatine kinase
Gower sign Associated with Duchenne dystrophy, movements child makes before being able to stand
Pseudohypertrophy of calves in Duchenne dystrophy Muscle first degenerates, and then there is infiltration of fat and CT into weakened calf.
What normally leads to death in Duchenne muscular dystrophy? Respiratory & cardiac failure. Lose of accessory muscles such as serratus, diaphragm
What is genetic inheritance of Duchenne muscular dystrophy? X-linked recessive (males); Dystrophin gene on x-chromosome (Xp21. Makes dystrophin protein, an important structural muscle protein
What is lab finding for Duchenne muscular dystrophy? Increased serum creatine kinase
Gower sign/manuever Associated with Duchenne dystrophy, movements child makes before being able to stand. Using hands to help them stand
Becker's muscular dystrophy Milder form of Duchenne, recessive x-linked. Altered form of dystrophin protein
Where does Guillain-Barre syndrome usually begin? Ascending paralysis due to destruction of schwann cells and peripheral nerve demyelination, caused by viral illness. Starts in lower extremities, then move up to thigh, hip etc.
Which reflex is lost in Guillain-Barre? Deep tendon reflex
What is the most common soft-tissue tumor? Lipoma
Where does lipoma usually occur, and what does biopsy show? Trunk, neck or proximal extremities. Biopsy usually show normal adipose cells
What is the most common adult sarcoma and where does it arise from? Liposarcoma;
Where can dermatofibroma (Fibrous Histiocytoma) be found Extremities
In which disease of the penis can fibromatosis be found? Peyronie's disease; also in palmar in palm of hand
What is appearance of fibrosarcoma microscopically? Herring bone pattern
What is most common site for malignant fibrous histiocytoma? Retroperitoneum and thigh
Rhabdomyoma This is benign tumor of striated muscle
Where is common site of rhabdomyoma? Heart, tongue, vagina
What is cardiac rhabdomyoma associated with? Tuberous sclerosis
When a child has rhabdomyoma in heart, what kind of cell is seen microscopically? Spider cells
What is the most common sarcoma in children? Embryonal Rhabdomyosarcoma
What is typical description of embryonal rhabdomyosarcoma? Grape-like necrotic mass protruding from penis or vagina
What is the most common sarcoma of the GI and uterus? Leiomyosarcoma
What kind of appearance does leiomyosarcoma have? Fish flesh or fleshy appearance
Which sarcoma will stain positive with S-100? Neurofibrosarcoma & neurofibromatosis
What murmur is heard in a ASD Loud S1, with wide fixed S2
What is the order of frequency of the causes of late cynosis in congenital heart disease? VAP; VSD > ASP > PDA
Which congenital heart disease causes Eisenmeger syndrome? All 3 left-to-right shunts: i.e. uncorrected VSD, ASD, PDA
What are features seen in baby with Eisenmenger's syndrome or late cyanotic condition? Cyanosis, right ventricular hypertrophy, clubbing and polycythemia
What is cause of Tetralogy of Fallot? Caused by anterosuperior displacement of the infundibulum septum
How do patients with tetralogy of fallot improve symptoms and why? Squatting. Compression of femoral artery, increases pressure, decreases R to L shunt and sends more blood to lungs
What is the cause of Transposition of Great Vessel? Failure of aorticopulmonary septum to spiral
Which type of coarctation of aorta condition has PDA, and which doesn't? Which has RVH and which has LVH? Infantile/Preductal -- PDA and RVH Adult/Postductal-- ligamentum arteriosus and LVH
In terms of cyanosis in extremities, which coarctation of aorta causes cyanosis and which doesn't? Infantile/Preductal-- Cyanosis in lower extremity. Hypertension in upper extremities Adult/postductal-- No cyanosis in lower extremity. Weak pulse in L. ext. Hypertension in upper ext.
Match the following with respective congenital heart defects: Diabetic mother, marfan's syndrome, Turner's syndrome Diabetic mother-- Transposition of great vessels. Marfan's syndrome--Aortic insufficiency (late complication). Turner's syndrome--Coarctation of aorta
What congenital heart defect is associated with rubella? Septal defects, PDA, pulmonary artery stenosis
What congenital heart defect is associated with 22q11 deletion syndrome? Truncus arteriosus, Tetralogy of Fallot
What congenital heart defect is associated with Down syndrome? All septal defects including AVSD (Endocardial cushion defect)
90% of hypertension is related to...? Remaining 10% is related to? 90%-- primary or essential hypertention due to increased CO and increased TPR. 10%-- secondary to renal disease
What are signs of hyperlipidemia? Xanthomas, Corneal arcus, Atheromas, Tendinous xanthomas
Where does tendinous xanthoma usually occur? Achilles tendon
Xanthomas Plaques or nodules composed of lipid-laden histiocytes in skin, especialy in eyelids (xanthelasma)
Monckeberg Sclerosis Calcification in MEDIA of arteries, especially Femoral, radial, ulnar and Tibia. Causes PIPESTEM ARTERIES. Asymptomatic. No blood flow obstruction.
In which conditions can Arterioloscelerosis occur? Essential hypertension, malignant hypertension and diabetes mellitus. Occurs in SMALL ARTERIES due to hyaline thickening
What is associated with complicated plaque of atherosclerosis? Thrombus, ulcerate, hemorrhage, calcify
What is description of complicated plaque due to dystrophic calcification? Brittle eggshell quality
What symptoms or conditions are associated with aortic dissection? CXR feature? Hypertension, cystic medial necrosis (component of Marfan's syndrome). Tearing chest pain radiating to the back. CXR shows mediastinal widening
In atherosclerosis development, which growth factor is involved in smooth muscle cell migration? PDGF and FGF-B
What is the order of prevalence of atherosclerosis in specific vessels? Abdominal aorta > coronoary artery > popliteal artery > carotid artery
In ischemic heart disease, how much must CAD be occluded to cause angina? > 75%
What are ECG characteristics during Stable, Prinzmetal's and Unstable angina? Stable- ST depression. Prinzmetal's- ST elevation. Unstable/crescendo- ST depression
What is time frame for Sudden Cardiac Death to occur? Death within 1hr of onset of symptoms, mostly due to lethal arrhythmia; such as V-fib
Chronic ischemic heart disease Progressive onset of CHF over many years due to chronic ischemic myocardial damage
What is the most common type of MI, in terms of distribution to heart wall? Transmural (>50%). Subendocardial (aka silent MI) is less than 50%
Which isoenzyme of lactate dehydrogenase is associate with MI? Isoenzyme I and II. Normally II > I. In MI, I > II. Called FLIPPED LH. LH is called lazy enzyme bcos it takes 1 day to be released, peaks in 2 days & lasts 2wks.
In MI, when is contraction bands seen? During first 1-4 hrs. This means that there is coagulative necrosis. However, there is no visible change under light microscope
What is gold standard for MI diagnosis during first 6hrs? ECG
Where is CK-MB PREDOMINANTLY found, and where else can it be found in small amount? Predominantly in myocardium. Also found in skeletal muscle
AST is not specific for MI, where else can it be found? Cardiac, liver and skeletal muscle
In MI, what does ST elevation, ST depression and pathologic Q-wave mean? ST elevation--Transmural infarct. ST depression--Subendocardial infarct. Pathologic Q-wave-- Transmural, Occurs after 24-48hrs
Dressler's syndrome Autoimmune; fibrinous pericarditis several weeks post-MI
Etiologies of dilated (congestive) cardiomyopathy? ABCCCD-HP; Alcohol abuse, Beriberi, Cocaine, Chagas, Coxsackie B, Doxorubicin toxicity, Hemochromatosis, Peripartum cardiomyopathy
What murmur is heard for dialated cardiomyopathy? What is x-ray & USG finding? Murmur--S3, X-ray-- balloon appearance, USG-- dilated heart
Friedreich's Ataxia is associated with which cardiomyopathy? Hypertrophic cardiomyopathy
Which murmur is heart for hypertrophic cardiomyopathy? Size of heart,and how can it be treated? Murmur--S4, apical impulses, systolic murmur. Size--normal heart size; but IV septum hypertrophy. Treatment-- B-blockers or non-dihdropyridine calcium channel blockers (eg. verapamil)
Which phase of heart beat becomes dysfunctional in dilated and hypertrophic cardiomyopathy? How are sarcomeres arranged? Dilated-- Systolic dysfunction; eccentric hypertrophy, sarcomeres added in series. Hypertrophic-- Diastolic dysfunction, concentric hypertrophy; sarcomere arranged in parallel
Loeffler's syndrome Endocardial fibrosis with prominent eosinophilic infiltrate
Which 2 cardiomyopathies can hemochromatosis cause? Dilated cardiomyopathy, restrictive cardiomyopathy
Which lung sound may be heard in CHF? Rales
Signs of BACTERIAL endocarditis? Fever, Roth lesions, Osler lesions, Janeway lesion, murmur, splinter hemorrhage on nail bed, anemia, emboli: FROM JANE
Match the pathogens that can cause endocarditis in the following conditions; Colorectal cancer, prosthetic valves Colorectal cancer-- strep bovis. Prosthetic valve-- staph epidermidis. Also HACEK causes culture-negative endocarditis
Which valve is mostly associated with IV drug use? Which pathogens are responsible? Tricuspid-- Don't *TRI* drugs. Staph aureus, Pseudomonas, Candida
Which valve is mostly involved in endocarditis? Mitral valve
What is early lesion and late lesion of rheumatic heart disease? Early lesion-- mitral valve prolapse. Late lesion-- Mitral valve stenosis
What is difference between Aschoff bodies & Anitschkow's cells? Aschoff-- Granuloma with giant cells. Anitschkow's cell-- activated histiocytes
Pulsus Paradoxus Aka Kassmaul's pulse. Exaggerated decrease in amplitude of pulse during inspiration. Occurs in cardiac tamponade, asthma, COPD, obstructive sleep apnea, pericarditis, croup
What conditions cause the following types of pericarditis; Serous, Fibrinous, Hemorrhagic Serous--SLE, RA, viral infection, uremia. Fibrinous: Uremia, Dressler's syndrome (MI), Rheumatic fever. Hemorrhagic: TB, malignancy (melanoma)
In syphilitic heart disease, What is description of calcification of aortic root and ascending aortic arch Tree bark appearance
What are complications of syphilitic aneurysm? Aortic valve incompetence, aneurysm in ascending aorta, & aortic arch
What is the most common primary cardiac tumor in adults? In children? Adult-- myxoma. Children-- Rhabdomyomas
What is rhabdomyoma in children associated with? Tuberous sclerosis
What sign is positive in cardiac tumors? Kussmaul's sign (not Kussmaul's pulse); This is increase in jugular venous pressure on inspiration
What are the 2 most common tumor metastasis to heart? Melanoma & lymphoma
Raynaud's disease vs. Raynaud's phenomenon Raynaud's phenomenon = raynaud's disease secondary to mixed CT disease, SLE, CREST sydnrome, atherosclerosis, Buerger's
What is marker for Wegener's granulomatosis? What kind of casts seen in urine? c-ANCA; Anti-Neutrophil Cytoplasmic Antibodies (autoantibody against proteinase 3), hematuria with red casts
What is treatment of Wegener's granulomatosis? Cyclophosphamide (first) & corticosteroids
In which vasculitis is p-ANCA positive? Microscopic Polyangitis (microscopic polyarteritis nodosa): p-ANCA (perinuclear). Polyangitis is just like Wegener's but no granulomas. Churg-Strauss syndrome- p-ANCA
What is vasculitis limited to kidney called? Primary Pauci-immune crescentic glomerulonephritis
What is the most common form of childhood systemic vasculitis? What are features? Henoch-Schonlein Purpura; skin rash on buttocks & legs (palpable purpura), arthralgia, GI hemorrhage, abdominal pain, melena. Assoc. with IgA nephropathy. Follows URI.
What is classic triad for Henoch-Schonlein purpura? Skin, joints, GI
Which vasculitis is associated with strawberry tongue, lymphadenitis, skin rash, fever, conjunctivitis, coronary aneurysm? Kawasaki disease
Which vasculitis could occur in a Hepatitis B patient? Polyarteritis Nodosa
What are symptoms of Takayasu's arteritis Fever, Arthritis, Night sweats, MYalgia, SKIN nodules, Ocular problems, Weak pulse in upper extremities: *FAN MY SKIN Well*
What are the differences between strawberry hemangioma & cherry hemangioma? Strawberry-- infants, regress. Cherry-- elderly, Does NOT regress
Cystic hygroma Cavernous lymphangioma of neck. Associated with Turner's syndrome
Bacillary Angiomatosis Found in AIDS patients. Caused by Bartonella henselae infections. Not to be confused with Kaposi's sarcoma
Lymphangiosarcoma Lymphatic malignancy; associated with persistent lymphedema. E.g. post-radical mastectomy
Kaposi sarcoma Malignancy in skin. Caused by HHV-8 and associated with HIV. Not to be confused with Bacillary Angiomatosis
Which conditions is associated with pyogenic granuloma? Trauma & pregnancy
In which situations are the various casts in urine found? RBC casts--glomerulonephritis, ischemia, malignant hypertension. WBC casts--Tubulointestinal inflammation. Granular (muddy brown)-- ATN. Waxy cast--Advance renal disease/CRF/ chronic glomerulonephritis. Hyaline--nonspecific
What does casts in pyuria & hematuria indicate? Indicates that pyuria and hematuria is of RENAL origin
What is found in urine in acute cystitis, bladder cancer, kidney stones? Bladder cancer--RBC, no casts. Kidney stones--RBC, no casts. Acute cystitis--WBCs, no casts
Primary nephrotic glomerular disorder include...? Minimal change, Membranous GN, Focal segmental GS, MPGN I & II, Mesangial proliferative
Which disease process may result to RPGN Goodpasture syndrome, Wegener's granulomatosis, Microscopic polyarteritis
What is cause for diffuse proliferative GN? SLE or MPGN
What is the most common cause of death in SLE? Diffuse proliferative Glomerulonephritis
Which diseases can present as both nephrotic syndromes and nephritic? SLE, & MPGN I and II
What is difference between nephritic & nephrotic syndrome in terms of proteinuria? Nephritic proteinuria < 3.5g/day. Nephrotic proteinuria > 3.5g/day with FROTHY urine
What is amyloidosis in nephrotic syndrome associated with? Multiple myeloma, chronic conditions, TB, rheumatoid arthritis
What is the most common glomerular diseae in HIV patients? Focal segmental Glomerulosclerosis
What are differences between Type I and II MPGN? Type I; Tram-track, HBV>HCV. Type II: Dense bodies, C3 nephritic factor
What complications of kidneys stones? How can it be treated and prevented? Pyelonephrities, Hydronephrosis. Treat & prevent by encouraging fluid intake.
Tubular failure in oxalate nephropathy can result from... Vitamin C or antifreeze abuse (ethylene glycol)
What is the 2nd most common form of renal stone? Whaat can cause it? Struvite (Mg NH4 PO4)/staghorn calculi- can be caused by Proteus vulgaris, Staphylococcus, Klebsiella)
Which renal stones are radiopaque, and which are radiolucent? Calcium oxalate-- Radioopaque (Oxalate *O* for Opaque). Struvite-- both radiopaque & radiolucent. Urate--radiolUcent. Cystine- slightly radiopaque
How can cystine stone be treated? Cause of cystine stones? What is shape of cystine stones? Which other type of stone can it form? Alkalinization of urine. Cystinuria is cause. Shape is Hexagonal. Rare, but can form cystine staghorn calculi
What is most common renal malignancy? What does it invade? Metastasizes to...? Spreads by which route? Risk factors? Renal cell carcinoma. Invades IVC (& renal vein). Metastasizes to lung, bone. Because spreads by hematogenous route. RF are smoking, obesity
What is shape of renal cell carcinoma cells? Which syndromes is RCC associated with? Chr mutation of RCC? Polygonal clear cells. Assoc. with paraneoplastic syndromes & Von Hippel Lindau. Deletion in chr 3.
What is most common renal malignancy in children? Which 2 syndromes is it associated with? Wilm's tumor (nephroblastoma). WAGR complex & Hemihypertrophy syndrome
What is painless hematuria suggestive of? Bladder cancer
What are causes / risk factor transitional cell carcinoma? Pee SAC: PHENACETIN, Smoking, Aniline dye, Cyclophosphamide
Differences between Acute & Chronic pyelonephritis? Acute- inflammation only in CORTEX, neutrophilic inflammation (WBC), forming WHITE casts in urine. Chronic-- CORTICOMEDULLARY SCARRING, thyroidization of kidney (EOSINOPHILIC CASTS).
What kind of drugs can act as haptens, induce hypersensitivity and cause as a result, cause Drug-induced interstitial nephritis? Diuretis, NSAIDs, penicillin derivatives, sulfonamides, rifampin
What conditions are associated with Diffuse cortical necrosis? Vasospasm and DIC, Obstetric catastrophe (abruptio placentae), & septic shock
Which conditions are associated with ATN? Renal ischemia, crush injury (myoglobulinuria), toxins
Which renal conditions are associated with phenacetin? Chronic pyelonephritis & Chronic phenacetin use
Which renal condition is associated with sickle cell anemia? Renal papillary necrosis
Definition of Acute Renal Failure Abrupt decline in renal function with increase creatinine and increase in BUN over period of several days
How is bone affected during renal failure? Renal osteodystrophy: Failure of vitamin D hydroxylation to occur
Fanconi's syndrome. Causes? Decreased proximal tubule transport of amino acids, glucose, phosphate, urate, protein & electrolytes. Includes Wilson's disease, glycogen storage disease and drugs
Which 2 drugs can cause Fanconi's syndrome? Cisplatin & EXPIRED Tetracycline
What are complications of Fanconi's syndrome? Decreased phosphate reabsorption-- Ricks. Decreased HCO3- reabsorption-- Metabolic acidosis (type 2 RTA). Decreased early Na+ reabsorption-- increased distal Na+ reabsorption, leading to hypokalemia.
Where does Simple cyst occur in kidney? CORTEX ONLY
Polyarteritis nodosa causes systemic vasculitis except where? Except in lungs
What are the 3 pathological stages of polyarteritis nodosa? Acute lesion: fibrinoid necrosis & neutrophils (type III HS). Healing lesions: fibroblast proliferation. Healed lesion: nodular fibosis & loss of internal elastic lamina.
IV users are prone to polyarteritis nodosa because...? They are prone to Hepatitis B, which is associated with polyarteritis nodosa
What lab findings for polyarteritis nodosa (PAN)? Hepatitis B +(30%)& P-ANCA (only in microscopic PAN i.e. capillaries)
What is treatment for polyarteritis nodosa? Corticosteroids & cyclophosphamide
Which vasculitis is a variant of polyarteritis nodosa and occurs in lungs also? Churg-Strauss Syndrome (aka allergic granulomatosis & angiitis): Involves granulomas & Eosinophils
Which lung disease is Churg-Strauss syndrome associated with? Lab finding? Bronchial asthma. P-ANCA positive (just like microscopic PAN)
Which type of vessels are affected by Wegner's granulomatosis? Small-size arteries, veins, capillaries
What kind of renal pathology is caused by Wegner's? Focal Segmental Glomerulonephritis & (Wegner, u need to **RAPIDLY FOCUS**!)
Lab findings for Wegner's? C-ANCA
Which vasculitis is the most common? Temporal Arteritis (aka Giant cell Arteritis); most common in elderly females. Associated with HLA-DR4
What is distribution of disease for Temporal Arteritis? Small & medium-sized arteries, cranial (TEMPORAL, facial, ophthalmic arteries), aortic arch (giant cell aortitis)
What are clinical features of Temporal arteritis? Visual disturbances, facial pain, temporal or throbbing headache, polymalgia rheumatica
Polymyalgia rheumatica Temporal arteritis + systemic flu-like symptoms + joint involvement
Lab findings for Temporal Arteritis? Elevated ESR + granulomatous inflammation
Complication of Temporal arteritis? Blindness due to occlusion of opthalmic artery
Which people are affected by Takayasu arteritis? Which vessel? Young Asian women. Medium and large arteries, aortic arch
How can Takayasu be differentiated from Temporal arteris? Both cause granulomatous vasculitis, so the type of vessels involved should be used. Takayasu-- medium/large arteries. Temporal-- cranial, aortic arch, small arteries, veins, capillaries.
Buerger Disease is a.k.a? Causes claudication so which vessels are involved? Risk factors? aka Thromboangiitis obliterans (literally; thrombus in vessel leading to occlusion). Small/medium arteries & veins and NERVES! ENTIRE NEUROVASCULAR BUNDLE. Smoking, male.
Which vasculitis is associated with microabscesses and Raynaud's phenomenon? Buerger's disease (Thromboangiitis obliterans)
Kawasaki disease is a.k.a? Classic findings in Kawasaki? Which vessels are involved? Mucocutaneous lymph node syndrome. Lymphadenopathy, fever, rash, conjuntctivitis. All arteries + CORONARY BLOOD VESSELS, causing aneurysms
Which group of people get Kawasaki's? US mainland, Hawaii, Japan: only in children
What are the 3 types of Arteriosclerosis? Monckeberg Medial Calcific sclerosis, Arteriolosclerosis, Atherosclerosis
What are the 2 micro findings in arteriolosclerosis and what is each associated with? Hyaline arteriolosclerosis: associated with kidney. Hyperplastic arteriolosclerosis: smooth muscle proliferation- leading concentric wall thickening & narrowing (ONION SKIN)
Berry aneurysm is mostly located on which artery? Dissecting aortic aneurysm? Berry's-- Anterior communicating artery. Dissecting-- Ascending portion of aorta
Which part of smooth muscle does syphilitic aortitis affect? Causes obliterative endarteritis of the vasa vasorum. Associated with TERTIARY syphilis
Syphilitic aneurysm can cause insufficiency of aortic valve causing, heart to enlargen, this is described as...? Cor Bovinum
Tree Barking This is description given to appearance of intima due to syphilitic aneurysm
Why is Aortic dissecting aneurysm considered a false aneurysm? Lumen does not increase in diameter
Risk factors of aortic dissecting aneurysm? Hypertension & Marfan syndrome, tear of intima
X-ray finding in aortic dissecting aneurysm? Widening of mediastinum
Dissecting aneurysm is associated with Beck's triad and cardiac tamponade. What is Beck's triad? JVD + Muffled heart sounds + Hypotension
What is description of a 2nd tear in media in aortic dissecting aneurysm? Double Barrel Aorta
Which head hemorrhage is associated with Berry's aneurysm? How is CSF affected? Subarachnoid hemorrhage, therefore CSF will be bloodyn or xanthochromic (yellowish appearance of CSF)
Risk factors of microaneurysms are...? Hypertension & diabetes
Mycotic aneurysm Cause is secondary to bacterial infection (NOT fungi), particularly salmonella & shigella. Can also occur in brain
Which type of aneurysm are drug abusers prone to? Mycotic aneurysm
Clinical signs of DVT? Unilateral leg swelling, warmth, erythema, Homan sign (increased resistance to passive dorsiflexion of ankle by examiner)
Diagnosis of DVT Doppler "Duplex" ultrasound
Esophageal varices is mostly secondary to...? Portal hypertension (possibly due to cirrhosis)
What is the most common vascular tumor in infants? Where does it occur? Hemangioma: skin, mucous membranes or internal organs
What are the major types of hemangiomas? Capillary hemangiomas: superficial, seen on SKIN & membranes, cause STRAWBERRY marks/birth marks. Cavernous hemangioma: occurs in INTERNAL ORGANS (esp. liver)
Which disease is hemangioblastomas associated with? Von Hippel-Lindau disease; VHL means Renal cell carcinoma + hemangioblastoma
What kind of cells are hemangioblastomas lined by? Blastoma; so lined by primitive endothelial cells
Hemangioblastoma usually consists of multiple tumors involving... Cerebellum, brainstem, spinal cord and retina
Glomus tumor (Glomangioma) Painful tumor of glomus body under nail
What is micro findings in Kaposi sarcoma? Proliferation of spindle-shaped endothelial cells, slit-like vascular spaces, extravasation of RBCs
What are the 4 different forms of Kaposi sarcoma? European form (red purple plaques on low extremities). Transplant-Assoc.-(patient on immunesuppressant for organ transplant), may regress. African form- general lymph spread; in African children & young men. AIDS form- homosexuals; GI, skin, nodes, lungs
Hemangiosarcoma most commonly occurs where? Skin, breast, liver & soft tissues
Liver angiosarcoma is caused by...? PVC, arsenic & thorotrast
Cystic hygroma? Associated with...? Vascular tumor of neck. Cavernous lymphangioma. Associated with Turner syndrome
Which 2 viruses cause Kaposi's sarcoma? HHV8 & HIV
Created by: rakomi



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