Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Pathology
UWORLD Round 1 2020
| Question | Answer |
|---|---|
| What organ malignancies tend to be propensity to bony metastasis? | Prostate, Breast, Kidney, Thyroid, and Lungs. |
| How is Malignant back pain clinically presented? | Pain at night, no relief with rest, onset age > 50 years old, and systemic symptoms. |
| How is Cystic Medial degeneration described? | Myxomatous changes with pooling of mucopolysaccharides in the media layer of the large arteries |
| What condition is seen with cystic medial degeneration? | Aortic aneurysms |
| What is the most common cause or condition in which there is cystic medial degeneration in young patients? | Marfan syndrome |
| What are the spinal cord roots of Phrenic nerve? | C3-C5 |
| Which nerve arises spinal cord C3-C5 roots? | Phrenic nerve |
| What is innervated by the Phrenic nerve? | Ipsilateral hemidiaphragm |
| How is compression or damage to the Phrenic nerve clinically presented? | Hiccups and diaphragmatic paralysis with dyspnea |
| What are two extra or less common involvements of a compression to the Phrenic nerve? | 1. Brachial plexus 2. Recurrent Laryngeal nerve |
| What does compression of phrenic nerve affecting the brachial plexus is clinically presented? | Pain along the distribution of C8, T11, and T12 |
| What nerve is often affected by phrenic nerve damage or compression that causes hoarseness of the voice? | Recurrent laryngeal nerve |
| What are the physical or hemodynamic changes seen in the myocardium in response to an acute pulmonary embolism? | Rapid increase in Right Ventricular (RV) pressure ---> RV enlargement and RV dysfunction |
| Why is there no ventricular (RV) wall enlargement in acute pulmonary embolism? | There is NO TIME for compensatory hypertrophy, to respond to the sudden increase in pressure load |
| In which setting, chronic or acute, pulmonary embolism, is there wall thickening of the ventricle? | Chronic overload of the heart |
| What is seen in wall of the ventricles with a chronic overload of the heart? | Ventricular wall thickening |
| What is Primary Myelofibrosis? | Myeloproliferative disorder associated with the clonal expansion of megakaryocytes |
| What feature in Primary Myelofibrosis accounts for the majority of its clinical presentation? | Bone marrow fibrosis |
| What are some clinical features of 1 Myelofibrosis? | Hepatosplenomegaly, cytopenias, and PBS shows Dacrocytes |
| What type of RBCs are seen in primary Myelofibrosis? | Dacrocytes |
| Bone marrow aspiration in Primary Myelofibrosis | Dry tap |
| What is seen in Bone marrow bx in a patient with Primary Myelofibrosis? | Marked fibrosis with occasional clusters of atypical megakaryocytes |
| What is Gallstone ileus? | Mechanical bowel obstruction caused when a large gallstone erodes into the intestinal lumen (small intestine MC) via fistula |
| What is a key or feature imaging finding in Gallstone ileus? | Pneumobilia |
| What is Pneumobilia? | Air in the biliary tract |
| What condition is seen with Pneumobilia? | Gallstone ileus |
| What type of symptoms are seen with Gallstone ileus? | Small obstruction symptoms such as abdominal distension, tenderness, and high-pitched (tinkling) bowel sounds |
| What condition is often associated with high-pitched bowel sounds? | Small intestine obstruction (gallstone ileus) |
| What does nRBC (nucleated RBCs) refer to? | Refers to precursor cells of the red blood cell lineage which still contain a nucleus; they are also known as erythroblasts or – obsolete – normoblasts. |
| The appearance of nRBCs most likely indicate? | In healthy adults and older children, nRBC can only be found in blood-building bone marrow where they mature. |
| What rare form of red blood cell is present in healthy individuals at times of blood-building bone marrow? | nRBC |
| What is Erythema multiforme? | A target-shaped, inflammatory skin lesion that typically arises in the setting of infection, particular with HSV or Mycoplasma pneumoniae |
| Target-shaped, inflammatory skin lesion seen after HSV or M. pneumonie infection? | Erythema multiforme |
| What causes the development of E. multiforme? | Deposition of infection antigens in keratinocytes leading to a strong cell mediated (cytotoxicT-cell) immune response |
| What cells are affected in the development of Erythema multiforme? | Keratinocytes |
| What type of hypersensitivity is seen with Erythema nodosum? | Delayed-hypersensitivity reaction |
| What is Erythema nodosum? | Delayed-type hypersensitivity reaction causing inflammatory nodules in the subcutaneous fat |
| What tissue is directly affected by Erythema nodosum to develop? | Subcutaneous fat |
| Subcutaneous fat affection by antigens, lead to E. multiforme or E. nodosum? | Erythema nodosum |
| What is a very common cause of Portal Hypertension? | Portal Vein thrombosis |
| What are the symptoms seen in Portal Vein thrombosis? | Portal hypertension, splenomegaly, and varicosities of portocaval anastomosis |
| What leads to vomit of blood in Portal Vein thrombosis? | Portal hypertension leads to development of Esophageal varices |
| Which liver condition is often seen without any changes to the Hepatic parenchyma? | Portal Vein thrombosis |
| What type of hypertension is more common to develop "ascites"? | Sinusoidal portal hypertension |
| What is the MC type of Portal hypertension? | Sinusoidal portal hypertension |
| What condition is most often associated with Sinusoidal Portal hypertension? | Cirrhosis |
| What is the result of Postsinusoidal portal hypertension? | Result of disrupted or congested hepatic venous outflow |
| What common condition is seen with Postsinusoidal portal hypertension? | Budd-Chiari syndrome |
| What is the most common cause of Presinusoidal Portal hypertension? | Portal Vein thrombosis |
| Right sided heart failure is seen with Post or Pre-sinusoidal Portal hypertension? | Postsinusoidal portal hypertension |
| What are the 3 main etiologies of Portal hypertension? | 1. Post-hepatic 2. Intrahepatic 3. Pre-hepatic |
| What are the 3 types of Intrahepatic Portal hypertension? | 1. Pre-sinusoidal 2. Sinusoidal 3. Post-sinusoidal |
| What parasitic infection is known to cause intrahepatic presinusoidal portal hypertension? | Schistosomiasis |
| What is Uremic Platelet disorder? | Abnormal bleeding in patients with UREMIA due to qualitative platelet disorder |
| How are the hemodynamic and hematologic values of Uremic platelet disorder? | Prolonged BT, and normal PC, PT, and aPTT |
| Which hematologic value is prolonged in a patient with Uremia? | Bleeding time |
| Renal dysfunction leading to accumulation of uremic toxins, which cause an excessive bleed, with increased BT. Dx? | Uremic Platelet dysfunction |
| What is the best treatment option for Uremic platelet dysfunction? | Dialysis |
| What are "Fatty streaks"? | Earliest lesions of atherosclerosis, and often seen as early as the second decade of life |
| What common atherosclerotic early sign may be in a young 22 year old patient? | Fatty streaks |
| What is the histochemical composition of Fatty streaks? | Collection of lipid-laden macrophages (foam cells) in the intma that can eventually progress to atherosclerotic plaques |
| What part of the vessel is seen with Foam cells? | Intima |
| What causes Vesicoureteral reflux? | Retrograde urine flow from the bladder into the ureter |
| Retrograde urine flow form the bladder into the ureter | Vesicoureteral reflux |
| What parts of the kidney are most likely affected in Vesicoureteral reflux? | Upper and Lower poles of kidney |
| How do the upper and lower poles of kidney appear in vesicoureteral reflux? | Dilated calyces with overlaying renal cortical scarring |
| What is Henoch-Schonlein Purpura (HSP)? | An IgA-mediated leukocytoclastic vasculitis that commonly cause lower extremity palpable purpura, abdominal pain (+/-) GI bleed, renal disease, and joint pain |
| Is there arthralgia associated with HSP? | Yes |
| What are the general signs of Renal Cell Carcinoma (RCC)? | Hematuria, an abdominal mass, flank pin, and weight loss |
| What are the 2 most commonly associated Paraneoplastic syndromes of RCC? | 1. Hypercalcemia 2. Erythrocytosis |
| Paraneoplastic syndrome in RCC that cause elevated serum calcium is due to: | Increased PTH-related protein |
| Paraneoplastic syndrome associated with RCC leading to Erythrocytosis, is due to: | Increase ectopic EPO production |
| What is Lipofuscin? | Product of lipid peroxidation, accumulating in aging cells |
| What type of conditions are often seen with increased levels of Lipofuscin? | Malnutrition and cachexia |
| What metabolic process leads to production of Lipofuscin? | Lipid peroxidation |
| Increase lipid peroxidation activity will also lead to increased production of: | Lipofuscin |
| What is the single most important risk factor for development of Aortic dissection? | Hypertension |
| Hypertension leading to intimal tears, leads to development of: | Aortic dissection |
| What are some risk factors for Aortic aneurysm? | Hypertension, smoking, diabetes mellitus, and hypercholesterolemia |
| What is the MCC of Renal infarctions? | Cardioembolic disease |
| What is the greatest risk factor for renal infarction due to cardioembolic disease? | AFIB |
| What are the clinical features of Renal infarctions? | Flank pain, nausea, vomiting, low-grade fever, and hypertension |
| What causes hypertension in Renal infarction? | Increased release of Renin from hypoxic tissue |
| What is the Gross pathology description to Renal infarcted tissue? | Demarqued, yellow-white, wedge-shaped areas with surrounding hyperemia |
| The gross examination of a kidney with white, wedge-shaped areas surrounded by red tissue (hyperemia). Dx? | Renal infarction |
| What are some labs seen with Renal infarction? | 1. Elevated Lactate dehydrogenase 2. Hematuria 3. Mild leukocytosis |
| What lab value increase often indicate cell necrosis? | Elevated Lactate dehydrogenase |
| What is Abetalipoproteinemia? | Inherited inability to synthesised Apolipoprotein B, an important component of chylomicrons and VLDL |
| What cholesterol forms have Apolipoprotein B as an essential component? | Chylomicrons and VLDLs |
| What protein is the person with Abetalipoproteinemia unable to synthesize? | Apolipoprotein B |
| What is the pathogenesis of Abetalipoproteinemia? | Lipids absorbed by the small intestine cannot be transported into the blood and accumulate nt intestinal epithelium, resulting in enterocytes with clear or foamy cytoplasms |
| What cells are seen with clear or foamy cytoplasm in Abetalipoproteinemia? | Enterocytes |
| What causes the clear cytoplasm of enterocytes in Abetalipoproteinemia? | Accumulation of lipids in the intestinal epithelium of the small intestine |
| What are the two main causes of ATN? | 1. Renal ischemia 2. Direct cytotoxicity |
| What are the 3 pahses of ATN? | 1. Initiation (initial insult) 2. Maintenance (oliguric renal failure) 3. Recovery |
| In which phase of ATN does the GFR improve prior to restoration of renal tubular absorptive capacity? | Recovery phase |
| What are some adverse effects that may occur in Recovery phase of ATN as the GFR improves? | Transient polyuria and electrolyte wasting (hypokalemia) |
| What is the MCC of elevated Platelet Count (PC)? | Reactive thrombocytosis |
| What is the most common cause of Reactive thrombocytosis? | High level of inflammatory cytokines (IL-6) which cause the liver to release Thrombopoietin |
| What liver protein is release in order to increase the number of platelets? | Thrombopoietin |
| What are the major or most common conditions that lead to Reactive thrombocytosis? | Chronic infection, rheumatologic disease, and burns |
| What hematological conditions are less commonly seen with Reactive thrombocytosis? | Hemolysis and iron deficiency anemia |
| What CNS cells are affected in HIV-associated dementia? | Macrophages |
| Is HIV-dementia a late or early manifestation? | Late-stage HIV infection |
| Which CNS cells are most commonly used for HIV infection and replication? | Macrophages |
| What is a common complication of Subarachnoid hemorrhage? | Communicating hydrocephalus |
| How is a Communicating hydrocephalus developed? | Blood-induced impairment of absorption of CSF by the arachnoid granulations |
| Blood-induced impairment of absorption of CSF by the arachnoid granulations. Dx? | Communication hydrocephalus |
| What is the cause of Noncommunicating hydrocephalus? | Blockage to the cerebral aqueduct (of Sylvius) |
| What is the type of hydrocephalus seen with intracerebral hemorrhage? | Noncommunicating hydrocephalus |
| A person with a SAH will most likely develop a communicating or noncommunicating hydrocephalus? | Communicating hydrocephalus |
| Irreversible ischemic injury to brain tissue causes tissue digestion by hydrolytic enzymes. | Liquefactive necrosis |
| What type of necrosis is seen in brain tissue? | Liquefactive necrosis |
| How is necrotic brain tissue replaced after infarct? | Cystic Astroglial scar |
| A cystic astroglial scar is seen as a result of: | Infarcted CNS tissue replacement after an ischemic event |
| What is the most common type of necrosis is most organs, except the brain? | Coagulative necrosis |
| Where is the blood accumulated in an Epidural Hematoma? | Between the Bone and Dura mater |
| Head CT shows blood accumulated between the skull (bone) and the dura mater. Dx? | Epidural hematoma |
| What is the MCC of Epidural hematoma? | Tear of the MMA associated with fracture of the pterion region of the skull |
| Which lobe of the skull is the pterion region located? | Temporal lobe |
| A direct blow to the Pterion region in the Temporal lobe, will most likely develop what type of brain hemorrhagic injury? | Epidural hematoma |
| How is an Epidural hematoma clinically presented? | Transient loss of consciousness followed by a lucid interval before increasing ICP leads to neurologic deterioration |
| What is a common cause or association of Zollinger-Ellison syndrome? | Gastrinomas |
| Which organs are the most common locations for Gastrinomas? | Pancreas and Small intestine |
| How is ZES presented? | Peptic ulcers (especially duodenal), heartburn, and diarrhea |
| A person with recurrence of PUD, heartburn, and diarrhea. What is a possible diagnosis? | Zollinger-Ellison syndrome |
| A ZES patient will most likely develop which specific malignancy? | Gastrinomas |
| How is a person with a Gastrinoma present gastrin levels? | Elevated gastrin levels |
| What is the association between Gastrinoma and gastrin levels/secretion? | Elevated gastrin levels atha rise in response to exogenous secrein administration |
| Exogenous administration of Secretin will cause: | Elevated gastrin levels in people with Gastrinoma |
| In healthy individual, no malignancy, how does secretin work? | Inhibits the release of gastrin from normal gastric G cells |
| What substance is secreted by gastric G cells? | Gastrin |
| What is known to inhibit gastrin release by normal gastric G cells? | Secretin |
| What is the most common cause of Temporal lobe epilepsy? | Hippocampal sclerosis |
| What is a common and significant complication of Hippocampal sclerosis? | Temporal lobe epilepsy |
| What is the histological description of Temporal lobe epilepsy? | Atrophy of the hippocampal with neurons with maked reactive gliosis |
| What is reactive gliosis? | Astrocyte proliferation in response to injury |
| A parvo B19 infection is known to cause what in people with Hb disorders? | Aplastic crisis |
| What is a common cause of Aplastic crisis in Sickle cell anemia patients? | Parvovirus B19 infection |
| What are the signs and symptoms of symptomatic anemia? | Exertional dyspnea, fatigue, and low hematocrit |
| What Causes the symptoms in symptomatic anemia? | Inhibition of Erythropoiesis |
| What process is inhibited or stop by ParvoB19 that causes anemia and aplastic crisis? | Infection (virus) inhibits the secretion of erythropoiesis |
| WHat is seen in Bone Marrow biopsy of a patient with Aplastic crisis due to Parvo B19 infection? | Giant Pronormoblasts sith glassy, intranuclear viral inclusions |
| Is Parvo B19 infection seen wht intranuclear or cytoplasmic inclusions in Bone marrow inspection? | Intranuclear viral inclusions |
| What is a common cause of Pericardial effusion? | Malignancy |
| What leads to Pericardial effusion in a person with underlying malignancy? | Slower accumulation of pericardial fluid with compensatory pericardial stretching |
| What is done to confirm diagnosis of Pericardial effusion? | Pericardiocentesis |
| What is Myositis Ossificans? | Formation of lamellar bone in extraskeletal tissues , often triggered by trauma |
| How is Myositis Ossificans clinically presented? | Painful, firm, mobile mass within muscle |
| What is the histologic description of Myositis Ossificans? | Benign metaplastic bone and proliferating fibroblasts without mitotic atypia |
| What occurs due to cerebral hypoperfusion to Watershed areas in the brain? | Global cerebral ischemia and Watershed infarction |
| Where are watershed areas in the brain located? | Borders between areas perfused by the anterior, middle, and posterior cerebral arteries |
| How is gross description of an watershed infarcted area in the brain? | Symmetric, bilateral wedge-shaped strips of necrosis over the cerebral convexity, parallel and adent the interhemispheric fissure |
| How do most carcinogens enter the body, in a active or inactive state? | Inactive state |
| What term is used to describe inactive carcinogens? | Pro-carcinogens |
| What converts pro-carcinogens into active carcinogens once in the body? | CYP450 oxidase system |
| What is an important function of CYP450 oxidase system in association to carcinogens? | It helps turning pro-carcinogens (inactive) into active carcinogens |
| Common Carcinogen | Cytochrome P450 microsomal monooxygenase |
| Irreversible sign of cell injury | Mitochondrial vacuolization |
| A histological examination shows clear and abundant mitochondrial vacuolization. What does it mean? | The cell has suffered irreversible cell injury |
| What does mitochondrial vacuolization cause to cell that is irreversible damage? | Cell's mitochondria are permanently unable to generate ATP |
| The inability to generate ATP is often seen with: | Mitochondrial vacuolization |
| Is Multiple Myeloma (MM) seen with hypo- or hypercalcemia? | Hypercalcemia |
| What are some symptoms and signs that should, if in combination, raise suspicion of Multiple Myeloma? | 1. Hypercalcemia 2. Normocytic anemia 3. Bone pain 4. Elevated gamma gap, 5. Renal failure |
| Old woman with bone pain, elevated gamma immunoglobulin levels, and elevated BUN:Cr ratio. Possible Dx? | Multiple Myeloma |
| What type of anemia is often produced by Multiple Myeloma? | Normocytic anemia |
| What nephrotic condition is associated with Multiple Myeloma? | Light chain cast nephropathy |
| Which hematologic malignancy is associated with Light chain cast nephropathy? | Multiple Myeloma |
| What is Light Chain Cast Nephropathy? | Nephrotic condition associated with large, waxy, eosinophilic casts composed of Bence Jones proteins that are seen in the Tubular lumen |
| What nephrotic proteins are seen in Multiple Myeloma? | Bence Jones proteins |
| What is the MCC of peripheral neuropathy in adults? | Diabetes mellitus |
| How is the distribution of diabetic peripheral neuropathy described? | Stocking-glove distribution |
| How is the Peripheral Neuropathy due to DM? | Paraesthesias and numbness in a stocking-glove distribution and decreased proprioception due to degeneration of large-fiber sensory axons |
| What causes the decrease in proprioception in DM? | Degeneration of large-fiber sensory axons |
| Acute and severe consequence of LV myocardial infarction? | Acute Pulmonary edema |
| Is Left sided heart infarct seen with Pulmonary or Peripheral edema? | Pulmonary |
| What is the pathogenesis of pulmonary edema due to Left Ventricle heart infract? | Elevated hydrostatic pressure in the pulmonary venous system lead to engorged alveolar capillaries with transudation of fluid into the alveoli |
| Transudation of fluid into alveoli due to elevated hydrostatic pressure is often the cause of: | Acute pulmonary edema due to LV heart failure |
| What is a histological finding of chronic lung congestion due to heart failure? | Hemosiderin-laden macrophages |
| Is it expected to observe Hemosiderin-laden macrophages in a person with acute pulmonary edema due the heart failure? | No, they are commonly present in chronic lung congestion |
| What causes Acromegaly? | Excessive production of Growth Hormone (GH), usually due to a pituitary somatotroph adenoma |
| What myocardial manifestation is often produced or associated with Acromegaly? | Left-ventricular hypertrophy |
| What are some musculoskeletal manifestations seen with Acromegaly? | 1. Bony hypertrophy (frontal bossing, enlarged jaw, hands, and feet) 2. Osteoarthritis 3. Left-ventricular hypertrophy |
| Which side and chamber of the heart is seen hypertrophied with Acromegaly? | Left ventricle |
| What is a severe consequence of Left ventricle hypertrophy in Acromegaly? | Heart failure |
| What are classic manifestations of bony hypertrophy in Acromegaly? | Frontal bossing, and enlargement of hands, feet, and jaw. |
| What is the MC ovarian malignancy? | Epithelial Ovarian cancer |
| What are the main types of Epithelial Ovarian malignancies? | 1. Serous cystadenocarcinoma 2. Mucinous cystadenocarcinoma |
| What are the histological findings of Epithelial ovarian malignancy? | Anaplasia of epithelial cells with invasion into the stroma, along with multiple papillary formations with cellular atypia |
| What serum marker is strongly associated with Epitelial ovarian malignancies? | CA-125 |
| Elevated levels of CA-125 strongly indicaties? | Epithelial ovarian cancer |
| What are 3 main categories of Malignant Ovarian Neoplasms? | 1. Epithelial 2. Germ cell 3. Stroma (sex cord) |
| What are some characteristic of Serous cystadenocarcinoma ovarian cancer? | 1. Histo --> Psammoma bodies 2. Bilateral 3. MC type |
| Characteristics associated with Ovarian mucinous cystadenocarcinoma? | 1. Pseudomyxoma peritonei 2. Mucin-producing epithelial cells |
| What malignancy is associated with Pseudomyxoma peritonei? | Mucinous cystadenocarcinoma of the ovary |
| What are the two main Ovarian Germ cell tumors? | Dysgerminoma and Endodermal sinus (yolk sac) |
| Ovarian dysgerminoma is characterized with: | 1. Elevated b-hCG 2. Adolescents 3. Histo --> "fried-egg" appearance |
| Which ovarian germ cell tumor is seen with elevated AFP? | Endodermal sinus (yolk sac) |
| What are some features of Endodermal sinus (yolk sac) tumor of the ovaries? | Elevated AFP Aggressive Schiller-Duval bodies that resemble glomeruli |
| Which is the key histological finding of ovarian Endodermal sinus tumor? | Schiller-Duval bodies |
| Schiller-Duval bodies resemble _____________. | Glomeruli |
| What are the two main types of Stroma (sex cord) ovarian tumors? | 1. Granulosa cell 2. Sertoli-Leydig cell |
| What hormones are excessibly secreted in Ovarian Granulosa cell cancer? | Estrogen and Inhibin |
| Histological finding in Granulosa ovarian cell tumor | Call-Exner bodies and coffee bean nuclei |
| What hormones are elevated in Sertoli-Leydig ovarian malignant cancer? | Androgens |
| What is Non-Bacterial Thrombotic Endocarditis? | From of non-infectious endocarditis characterized by valvular deposition of sterile platelet-rich thrombi |
| Which endocarditis is seen with sterile platelet-rich thrombi deposition in heart valves? | Non-Bacterial Thrombotic Endocarditis |
| What pathological conditions are associated with development of non-bacterial thrombotic endocarditis? | 1. SLE 2. Advanced malignancy |
| A woman with advance mucinous adenocarcinoma is at increased risk of developing what cardiac condition? | Non-Bacterial Thrombotic Endocarditis |
| What causes development of nonbacterial thrombotic endocarditis? | Valvular damage due to inflammation cytokines in the setting of an underlying hypercoagulable state |
| What are the results of Ionizing radiation? | Cellular and DNA damage primarily through generation of reactive species, which can trigger progressive inflammation and tissue damage |
| GI tract ionizing radiation manifestations occur after approximately: | Several weeks after radiotherapy |
| What is the most important determination for tumor prognosis? | Tumor stage |
| Which is more important in regards to cancer prognosis, tumor stage or tumor grade? | Tumor stage |
| Tumor staging is based on: | Depth of invasion (penetration) and metastatic spread (lymph involvement) |
| Important complication of Thiamine deficiency: | Wernicke Encephalopathy |
| How is Wernicke encephalopathy due to Vitamin A deficiency clinically presented? | Encephalopathy, ataxia, and oculomotor dysfunction |
| What type of patients most often tend to develop Thiamine deficiency? | Chronic alcoholics |
| What is way in which Wernicke encephalopathy due to thiamine deficiency may be precipitated? | Infusion of glucose-containing fluids |
| What are common neuroimaging findings of Wernicke encephalopathy due to vitamin A deficiency? | Focal hemorrhage or atrophy of the mammillary bodies |
| What are Migraines? | Episodic neurological disorder that results in severe, unilateral, throbbing headaches, often associated with photophobia, phonophobia, nausea and vomiting |
| How long do migraines typically last? | 4-72 hours |
| How much (percentage) of patients with migraines develop auras? | 25% |
| What is a common finding of 1/4 patients with migraines? | Aura |
| How is a migraine commonly described? | Severe, unilateral, throbbing headache, associated with photo-, phonophobia, and N/V |
| What is an aura? | Focal, reversible neurologic symptoms that precede or accompany the migraine (headache) |
| Are migraines usually bilateral or unilateral? | Unilateral |
| Severe, unilateral, throbbing headache, 10 hours duration, occuring every day. Dx? | Migraine |
| How do Paraneoplastic syndromes occur? | Due to the production of hormone-like substances from tumor cells |
| What are the main causes of Paraneoplastic syndromes? | 1. Production of hormone-like substances by tumor cells 2. Reaction to tumor cells that cross-react with normal cells, causes dysfunction and/or damage to healthy organs and tissues |
| What is the associated phenomenon type of Neurologic paraneoplastic syndrome? | Autoimmune |
| What is a common Neurologic paraneoplastic syndrome | Paraneoplastic cerebellar degeneration |
| What are the associated malignancies of Paraneoplastic cerebellar degeneration? | 1. Small cell lung cancer 2. Breast, Ovarian, and Uterine cancer |
| What are the antibodies associated with Paraneoplastic Cerebellar degeneration? | Anti-YO, anti-P/Q, and anti-Ho antibodies |
| What are the major risk factors for Urothelial cancer of the bladder? | 1. Age > 60 2. Cigarette smoking 3. Occupational exposure to rubber, plastics, or aromatic amine-containing dyes 4. Cyclophosphamide therapy |
| Treatment with cyclophosphamide increases the risk of developing which malignancy? | Urothelial cancer of the bladder |
| What are some labs and symptoms seen with Urothelial cancer of the bladder? | Intermittent, PAINLESS hematuria, and (+) urine cytology |
| What is seen in cytology of Urothelial cancer of the bladder? | Erythematous, flat, or papillary lesions |
| What is often seen and is characteristic of Urothelial cancer of the bladder histologically? | Frequent mitotic figures |
| What are mitotic figures? | Spindle-shaped figure presented during mitosis. |
| What is the main cause for Hepatic neoplasms? | Metastatic disease for a distant site |
| What is the MCC of hepatic metastases? | Colorectal cancer |
| Why is colorectal cancer the MCC of hepatic metastases? | Due to direct blood flow from the colon and superior rectum to the liver via the Portal venous circulation |
| What specific blood circuit allows for hepatic metastases from Colorectal cancer? | Portal venous circulation |
| What is the MCC of nephrotic syndrome during childhood? | Minimal change disease (MCD) |
| What causes the massive loss of protein in urine in MCD? | Increased Glomerular Capillary permeability |
| What is the result of Hypoalbuminemia in Minimal Change Disease (MCD)? | Reduces Plasma Oncotic pressure, which causes a fluid shift into the interstitial space leading to edema |
| A low oncotic pressure may cause: | 1. Fluid shift into interstitial space --> Edema 2. Increased lipoprotein production in the liver |
| What is an Starling force change causing increased lipoprotein production in the liver? | Low Oncotic pressure |
| What is Diverticulitis? | Inflammation of the Colonic diverticula |
| Which abdominal quadrant is seen affected in Diverticulitis? | Lower Left quadrant (LLQ) |
| What are some clinical features of Diverticulitis? | - Low-grade fever and Leukocytosis - Tender mass in the LLQ |
| What causes the palpable mass in LLQ in patients with Diverticulitis? | Inflammation or abscess formation |
| What is a common and severe GI tract risk factor for ARDS? | Pancreatitis |
| Why does Pancreatitis represent a major risk factor for ARDS? | Due to release of large amounts of inflammatory cytokines and pancreatic enzymes, which lead to activation of neutrophils into the alveolar tissues |
| How is the alveoli characterized in the initial phase of ARDS? | The inflammation and fibrin deposition causes alveoli to become lined with waxy, hyaline membranes |
| What increases the stage of a tumor? | Increasing tumor penetration/invasion |
| What is the 2nd MC childhood brain neoplasm? | Medulloblastoma |
| Where do Medulloblastomas in children often are located? | In the cerebellum, of at the vermis |
| What do Medulloblastomas in children consist of? | Sheets of small, blue cells |
| What does the involvement of a medulloblastoma in the cerebellum account for deficits in? | Gait instability and limb ataxia |
| What is caused by Medulloblastoma location in the vermis? | Signs of elevated ICP |
| What are some common symptoms of elevated ICP? | Morning headaches, vomiting, and lethargy |
| What is the most common location for an Ectopic pregnancy? | Fallopian tubes |
| Embryo implant in an extrauterine location, most common the Fallopian tube. Dx? | Ectopic pregnancy |
| What are some associated risk factors for Ectopic pregnancy? | 1. Tubal scarring due to PID or prior pelvic surgery 2. Tobacco use 3. In vitro fertilization |
| What is the result of complete obstruction of mainstem bronchus? | Prevention of ventilation of an entire lung, leading to Obstructive Atelectasis and complete lung collapse |
| What are the CXR findings of Obstruction of mainstem bronchus? | 1. Unilateral pulmonary Opacification 2. Deviation of mediastinum toward the Opacified lung |
| What renal condition is unable to be diagnosed in neonates by abdominal ultrasound? | ADPKD |
| What causes ADPKD patient to develop symptoms? | As the cysts enlarge, they compress the renal parenchyma and cause symptoms |
| Are neonatal kidneys of patient with ADPDK normal or abnormal in size and shape? | Normal |
| What causes ARDS? | Injury of the Pulmonary epithelium and/or endothelium, most often due to sepsis or pneumonia |
| Description of pathology of ARDS? | Cytokines recrutineutophils to the lung tissue, which cause capillary damage and leakage of protein-reich fluid into the alveoli |
| What are the late results of ARDS? | Cellular proliferation and collagen deposition leading to irreversible pulmonary fibrosis |
| GERD is due to: | Gastroesophageal junction incompetence and associated with extraesophageal symptoms |
| What is often and extraesophageal symptoms of GERD, which is mostly present in the absence of Heartburn? | Nocturnal cough |
| What causes or produces GERD characteristic histologic findings? | The acidic contents irritate the esophageal mucosas causing the histological changes |
| What are the classic histological findings of GERD? | Basal zone hyperplasia, elongation of lamina propia papillae,a and scattered eosinophils |
| How is Renal Papillary necrosis classically presented? | Gross hematuria, acute flank pain, and passage of tissue fragment in urine |
| What hematologic pathologies are most likely to be seen with Renal Papillary necrosis? | Sickle cell disease or trait patients |
| What are some pathologies often associated with development of Renal papillary necrosis? | 1. Sickle cell disease or trait 2. Diabetes mellitus 3. Analgesic nephropathy 4. Severe obstructive pyelonephritis |
| How is PAN characterized? | Segmental, transmural, necrotizing inflammation of medium-sized muscular arteries |
| How do manifestation for PAN arise? | Due to tissue ischemia from arterial lumen narrowing /thrombosis or bleeding from microaneurysms |
| Which organ or systems are most affected by PAN? | Kidneys, skin, peripheral nerves, and GI tract |
| Which vessels are often spared in PAN? | Pulmonary |
| Which organ is often NOT involved in the pathogenesis of PAN? | Lung |
| What are Craniopharyngiomas? | Suprasellar tumors found in children and composed of calcified cysts containing cholesterol crystals |
| Which brain tumor in children is associated with "cholesterol crystals"? | Craniopharyngiomas |
| Where do Craniopharyngiomas arise from? | Remnants of Rathke's pouch, an embryonic precursor of the anterior pituitary |
| Cholesterol crystals are associated with what type of brain neoplasm? | Craniopharyngiomas |
| What is the MCC of baby abusive head trauma? | Vigorous baby shaking |
| What are the clinical consequences of abusive head trauma? | Subdural hemorrhage and Retinal hemorrhages |
| What are clinical signs and/or symptoms that raise suspicion of abusive head trauma? | 1. Subdural hemorrhage 2. Retinal hemorrhages 3. Posterior rib fractures |
| What kind of consolidation is often seen with Aspiration pneumonia? | Dependent lung consolidation |
| Which type of people are at greater risk of developing Aspiration pneumonia? | Elderly patients with dementia or hemiparesis may have dysphagia |
| Emotional, neurological, and/or physical condition that may lead to dysphagia, it also increases risk of developing: | Aspiration pneumonia |
| Depending lung consolidation areas while supine: | 1. Superior region of the lower lobes 2. Posterior region of the upper lobes |
| What are the lung dependent location while upright? | Basilar segments of the lungs |
| What are Acute Phase Reactants (APRs)? | Proteins whose serum concentrations change by equal or more 25% during periods of inflammation |
| What is a unique APR? | Procalcitonin |
| What is Procalcitonin? | Unique APR that can rise or fall depending on the etiology of the infection |
| High levels of Procalcitonin indicate | Bacterial infectious source |
| Low level of Procalcitonin indicate | Viral infectious source |
| What is a common complication of acute pancreatitis? | Pancreatic pseudocyst |
| What is a Pancreatic pseudocyst? | Collection of fluid rich in enzymes and inflammation debris |
| How are the Pancreatic pseudocyst wall lined with? | Granulation tissue and fibrosis |
| What is a key difference between pseudocyst and true cyst? | True cysts are lined with epithelium |
| If a cyst is not lined with epithelium, it is better termed as: | Pseudocyst |
| What causes a Dupuytren contracture? | Progressive fibrosis of the superficial palmar fascia due to excessive fibroblast proliferation |
| What is pathognomonic of Dupuytren contracture? | Fibrotic nodules and cords form along the flexor tendons, limiting the extension of the affected digits |
| What are the endocrine complication seen with Hereditary Hemochromatosis? | 1. Diabetes mellitus 2. Secondary hypogonadism (hypothyroidism) |
| How does hemochromatosis cause secondary hypogonadism? | Deposition of iron in the Pituitary gland, resulting in decreased gonadotropin secretion |
| Besides DM, what is another endocrinological manifestation of Hereditary hemochromatosis? | Secondary hypogonadism |
| Adults or Neonates. Cherry hemangiomas? | Adults |
| Adults or Children. Strawberry hemangiomas? | Children |
| Cherry or Strawberry hemangioma. Spontaneously regress? | Strawberry hemangioma |
| Does a Cherry or Strawberry hemangioma is most commonly in aging adults and increase number with increasing age? | Cherry hemangioma |
| What is the LM description of Cherry hemangioma? | Proliferation of capillaries and post-capillary venules in the papillary dermis |
| What is the common name of Eosinophilic Granulomatosis with Polyangiitis? | Churg-Strauss syndrome |
| What is Eosinophilic granulomatosis with polyangiitis? | Small to medium vessel vasculitis characterized by late-onset asthma, rhinosinusitis and eosinophilia |
| What is a neurological deficit associated with Churg-Strauss syndrome? | Mononeuritis Multiplex |
| What condition is associated with Mononeuritis multiplex? | Churg-Strauss syndrome |
| What is Mononeuritis Multiplex? | Involvement of the epineural vessels of peripheral nerves |
| What is an example of Mononeuritis Multiplex in Churg-Strauss syndrome? | Wrist drop |
| What antibody is (+) in Churg-Strauss syndrome? | p-ANCA |
| What is Melanoma? | Highly aggressive malignancy of the skin that often metastasizes early in the disease course |
| Histology of Melanoma | Cellular atypia with cell containing brown pigment (melanin granules) |
| What are two melanocytic markers that stain (+) by immunostaining? | S-100 and HMB-45 |
| What is mediated by Tumor Necrosis Factor alpha (TNF-a)? | Paraneoplastic cachexia |
| What is cachexia? | Syndrome that encompases anorexia, mailaise, anemia, weight loss, and generalized wasting due to underlying systemic disease |
| What are the 3 main risk factors for Uric acid kidney stones? | 1. Low urine pH (acidic urine) 2. Increased uric acid secretion 3. Increased urine concentration |
| What conditions lead to uric acid kidney stones due to acidic urine? | Chronic diarrhea (GI bicarbonate loss) and Metabolic syndrome/Diabetes mellitus |
| What conditions lead to an increased uric acid secretion? | Gout and Myeloproliferative disorders |
| Which condition lead to concentrated urine? | Hot, arid climate; dehydration |
| What is polycythemia vera? | Myeloproliferative disorder characterized by uncontrolled erythrocyte production |
| What mutation is strongly associated with most cases of Polycythemia vera? | JAK2 |
| What is JAK2? | A non-receptor tyrosine kinase associated with Erythropoietin receptor |
| What condition is often due to a mutation in JAK2? | Polycythemia vera |
| Non-receptor (cytoplasmic) Tyrosine kinase associated with RBC production? | JAK2 |
| What is the most common cause for Congenital Long QT syndrome? | K+ channel protein mutation that contributes to the outward-rectifying K+ current |
| A prolongation in the QT interval predisposes to: | Development of life-threatening ventricular arrhythmias that can cause palpitations, syncope, seizures, or sudden cardiac death |
| What is Multiple Sclerosis? | Autoimmune disorder of the CNS characterized by recurrent episodes of demyelination, leading to reduced saltatory conduction |
| A 25 year old woman with some recurrent vision problems, and calcification in the periventricular white matter. Dx? | Multiple Sclerosis |
| What causes the focal neurologic deficits of Multiple Sclerosis? | Demyelination, leading to reduced saltatory conduction |
| What are the most common ocular manifestations of Multiple Sclerosis? | Internuclear Ophthalmoplegia and Optic neuritis |
| What age group is most commonly affected by Hematogenous Osteomyelitis? | Children |
| What part of the bones is most affected in Hematogenous Osteomyelitis? | Metaphysis of long bones |
| Why are the metaphysis of long bones most affected by Hematogenous Osteomyelitis? | Due to presence of slow-flowin sinusoids that are conductive to bacterial seeding |
| What are common clinical ways a infant present with Hematogenous osteomyelitis, when the infant cannot indicate the location of the pain? | Fever and refusal to bear weight in affected bone |
| What are the two types of Gastric adenocarcinoma? | 1. Intestinal type 2. Diffuse carcinoma |
| Intestinal Gastric adenocarcinoma is: | Solid mass that projects into stomach lumen and is composed of glandular-forming cuboidal or columnar cells |
| Solid mass that projects into the stomach lumen and is composed of glandular-forming cuboidal/columnar cells. Dx? | Intestinal Gastric adenocarcinoma |
| What is another term for Diffuse gastric adenocarcinoma? | Linitis plastica |
| What is the diagnostic histological finding in Diffuse gastric carcinoma? | Signet-ring cells |
| What condition is associated with Signet-ring cells on light microscopy? | Linitis plastica |
| What type of hypersensitivity reaction is Acute Allergic Contact Dermatitis? | Delayed (Type IV) hypersensitivity reaction |
| Gross description of acute allergic contact dermatitis: | Erythematous, papulovesicular, weeping lesions |
| What is the histological feature of Acute Allergic Contact Dermatitis? | Spongiosis |
| What dermatologic condition is associated with Spongiosis upon histological review? | Acute Allergic Contact Dermatitis |
| What is Spongiosis? | Accumulation of edema fluid in the intercellular spaces of the epidermis |
| What are the results of chronic exposure to irritants that cause Acute Allergic Contact Dermatitis? | Lesions becomes less edematous, with thickening of the Stratum Spinosum and Stratum corneum |
| What are UMN lesion characteristics? | Spastic paralysis, hyperreflexia, and (+) Babinski sign |
| What causes the symptoms in UMN lesions? | Loss of inhibition over Lower Motor Neurons in the anterior horn |
| Loss of inhibition over LMN in the anterior horn. | UMN lesion |
| What are some manifestation of LMN damage? | Paralysis, hypotonia, hyporeflexia, muscle atrophy and fasciculations |
| What is considered an UMN lesion? | Damage or lesion above the anterior horn |
| Damage or lesion below the anterior horn, is a UMN or LMN lesion? | LMN lesion |
| What is another name used for Corticospinal tracts? | Pyramidal tracts |
| What is mediated by the Corticospinal tracts? | Voluntary muscle activity |
| If a patient's voluntary muscle activity is deficient, what is the most likely spinal tract affected? | Corticospinal tracts |
| What is a common characteristic of Diabetes Mellitus type 2? | Pancreatic Islet Amyloid deposition |
| DM I or DM II. Pancreatic Islet Amyloid deposition? | DM II |
| What are some strong associations of DM type I? | 1. HLA-II 2. Pancreatic islet infiltration with lymphocytes 3. Antibodies against islet antigens |
| What type of WBC is seen in the pancreatic islet infiltrate of DM I? | Lymphocytes |
| DM I or DM II. Pancreatic islet infiltration with lymphocytes? | DM I |
Created by:
rakomi
Popular USMLE sets