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Pathology
UWORLD Round 1 2021 Part 3
| Question | Answer |
|---|---|
| What is the first part of the Pupillary Light reflex? | Light enters the retinal en sends a signal via the Optic nerve (CN II) to the Pretectal nuclei |
| Light is shone to an eye and the retina and al signal is sent via the CN II to the Pretectal nuclei. | Afferent limb of the Pupillary Light reflex |
| What is the second or efferent limb of the Pupillary Light reflex? | Oculomotor nerve (CN III) sends signal to the pupil and cause pupillary constriction |
| What does a defect or damage to any part of the CN II or CN III, has on the Pupillary Light reflex? | Prevention of the pupillary constriction |
| What is caused to serum Calcium in cases of low vitamin D intake? | Decreases level of serum Calcium and serum phosphate Increases level of serum PTH |
| What hormone serum level is increased with a decrease in dietary vitamin D intake? | PTH |
| Is serum Calcium decreased or increased by low intake of Vitamin D? | Decreased |
| What condition is suspected in cases of serum Ca2+ and serum phosphate decrease, with a consequential increase in serum PTH? | Poor dietary intake of vitamin D |
| What is the cause of Biliary atresia? | Due to obliteration of the Extrahepatic bile ducts |
| What are the serum lab levels seen with Biliary atresia? | Elevated direct bilirubin, pale stools, dark urine, jaundice, and hepatomegaly |
| Is GGT elevated or decreased in biliary atresia? | Increased |
| What conditions are often found with elevated levels of GGT? | In most diseases that cause damage to the liver or bile ducts |
| What does GGT stand for? | Gamma-Glutamyl Transferase |
| What part of the brain is lesioned in Hemiballismus? | Subthalamic nucleus |
| Are the deficits of Hemiballismus contralateral or ipsilateral? | Contralateral |
| Lesion to the Subthalamic nucleus will cause what condition? | Hemiballismus |
| Where is the lesion if a patient is wild, failing movements of the right upper limb? | Left Subthalamic nucleus |
| A lesion to the right subthalamic nucleus will produce: | Hemiballismus with left deficits |
| Rare movement disorder that results in wild, flailing movements of the limbs. | Hemiballismus |
| What are Leiomyosarcomas? | Malignant neoplasms of the smooth muscle of the uterus that histologic findings at atypia and high degree of mitosis |
| What is the histologic description of Leiomyosarcomas? | Atypia and high degree of mitosis |
| What should raise suspicion of neoplasm of the genitourinary tract ? | Vaginal bleeding in a post-menopausal women |
| What is the MC primary brain malignancy in children? | Pilocytic astrocytoma |
| Where in the brain are Pilocytic astrocytomas mostly found? | Posterior fossa |
| What are some histologic features and/or findings of Pilocytic astrocytomas? | 1. Astrocyte origin ---> (+) GFAP stain 2. Rosenthal fibers -- eosinophilic corkscrew fibers |
| Which brain childhood malignancy is (+) GFAP and with Rosenthal fibers under histological examination? | Pilocytic astrocytoma |
| What is Amyloidosis? | Refers to the deposition of abnormally aggregated insoluble proteins (B-pleated sheets) in specific organs |
| Which are common organs affected by amyloid deposition (amyloidosis)? | Heart, kidney, liver and the ANS |
| List of common types of amyloidosis: | 1. Primary amyloidosis (AL) 2. Secondary amyloidosis (AA) 3. Dialysis-related amyloidosis (B2-microglobulin) 4. Familial/senile (ATTR) |
| How is Amyloid cardiomyopathy manifested and characterized? | Manifested with heart failure and characterised by dyspnea and edema with decreased EF percentage |
| Is the Ejection Fraction affected in Amyloid cardiomyopathy? | Yes, it is decreased |
| What is the MCC Aortic Stenosis (AS)? | Calcific degeneration of the trileaflet aortic valves |
| What is the description of the aortic valve? | Trileaflet valve |
| Which cardiac valve is described as a "trileaflet"? | Aortic valve |
| Calcification of the trileaflet aortic valve. Dx? | Aortic stenosis |
| Which is Aortic Stenosis best heard when auscultated? | Second right intercostal space |
| Which is the "aortic area" in auscultation? | Second right intercostal space |
| Where is Aortic Stenosis murmur radiation? | Carotid arteries |
| Which known murmur radiates to the Carotid arteries? | Aortic stenosis |
| What is the description of Aortic stenosis murmur sound? | Harsh, ejection-type systolic murmur |
| Aortic stenosis is a diastolic or systolic murmur? | Systolic murmur |
| Harsh, ejection-type systolic murmur radiating to the carotid arteries | Aortic stenosis |
| Besides a S2 sound, what is often found as well in Aortic stenosis? | S4 |
| What causes the S4 in Aortic stenosis? | Decreased compliance of the Hypertrophic myocardium |
| How is Stasis dermatitis characterized? | Chronic erythema, fibrosis, and reddish-brwon discoloration due to deposition of hemosiderin |
| What causes the discoloration of the skin in Stasis dermatitis? | Hemosiderin deposition |
| What provides the Hemosiderin this is deposited in skin to give that reddish-brown skin discoloration in Stasis dermatitis? | Breakdown of extravasated red cells |
| How are the symptoms of Stasis dermatitis? | Bilateral and often worse at the level or above the ankles |
| What are complication seen with Stasis dermatitis? | Poor wound healing, weeping, and ulceration |
| What are some common clinical manifestations of Chronic Venos Insufficiency? | 1. Varicose veins (legs) 2. Warm, thick inducatede skin 3. Bronze-brown skin pigmentation 4. Ulcer 5. Edema |
| What are histological findings of Psoriasis? | Hyperkeratosis and confluent Parakeratosis of the Stratum corneum |
| What dermatological condition is seen with silvery scales on gross anatomy, diffuse epidermal hyperplasia, and elongated clubbed rete ridges? | Psoriasis |
| What are common complications of Psoriasis? | 1. Psoriatic arthritis 2. Nail changes 3. Ocular (eye) changes |
| What are the common ocular changes seen with Psoriasis? | Conjunctivitis, blepharitis, and uveitis |
| What condition is often seen with development of colitis after therapy with antibiotics? | C. difficile infection |
| What is a pathognomonic finding of C. difficile infection? | Pseudomembrane n the colonic mucosa |
| How is the Pseudomembrane seen with C. difficile infection described am composed? | Colonic mucosa yellowish plaque membrane, composed of fibrin and inflammatory cells |
| What is the role of the 2 toxins secreted or produced by C. difficile? | Penetrate the colonic epithelial cells leading to watery diarrhea, abdominal cramping, and colitis |
| How many toxins are produced by C. difficile infection? | 2 toxins |
| Anaerobic, gram positive, spore-forming bacillus. | C. difficile |
| What is the name of the condition due to Vitamin C deficiency? | Scurvy |
| What causes development of Scurvy? | Vitamin C deficiency |
| What are the associated clinical manifestation of Scurvy? | Coiled hair, perifollicular keratosis, hemorrhage, easy bruising, bleeding gums, and loose teeth |
| How are the levels of PT, PTT, and PC in Scurvy? | Normal |
| In a patient with vitamin C deficiency, the levels of PT/PTT and PC, are expected to be: | Normal |
| How is Epidimyditis presented? | Acute testicular pain, tenderness, and pyuria |
| What gives rise to Epididymitis? | Retrograde passage of organisms fro the urethra into the ejucalatory duct and vas deferens |
| Retrograde passage of organisms from the urethra into the ejaculatory duct and vas deferens. Dx? | Epididimitis |
| What Is the MCC of Epididymis n men of 25 years of age or younger? | STIs |
| What is the MCC of Epididymitis in men over the age of 35? | Gram-negative colonic flora |
| What nerve is often affected leading to development of Hyperacusis? | Facial nerve |
| What ist is hyperacusis? | Increased sensitivity to sound |
| A patient presents with increased sensitivity to sound, it raises suspicion to damage to which cranial nerve? | Facial nerve |
| Where in the nerve is the facial nerve damage to cause hyperacusis? | Close to its origin from the brainstem |
| What is the most common motor neuron disease? | Amyotrophic Lateral Sclerosis (ALS) |
| What is distinctive in clinical manifestation with ALS? | Disease causes both upper and lower motor neuron lesions |
| What is the LMN neuron lesion of ALS? | Loss of neurons of the anterior horns of the Spinal Cord |
| The loss of neurons of the anterior horns of the spinal cord represent what in ALS? | LMN lesion |
| What represents the UMN lesion of ALS? | Demyelination of the Lateral Corticospinal tract |
| What are the clinical manifestation of UMN lesion in ALS? | Spasticity and hyperreflexia |
| In ALS, the demyelination of the lateral corticospinal tract represents? | UMN lesion |
| What is the best treatment option for Amyotrophic Lateral Sclerosis (ALS)? | Riluzole |
| What conditions treated with Riluzole? | Amyotrophic Lateral Sclerosis (ALS) |
| What is the mode of action of Riluzole? | Decrease Glutamate release |
| Which medication works by decreasing the release of glutamate? | Riluzole |
| What motor cranial nerve nuclei are affected in ALS? | CN V, IX, X, and XII |
| Demyelination of Lateral Corticospinal tracts and loss of neurons of the anterior horns o f the Spinal cord, leads to development of what condition? | Amyotrophic Lateral Sclerosis (ALS) |
| What is a commonly tested Hemangioma? | Cavernous hemangioma |
| What is a Cavernous hemangioma? | Vascular malformations composed of abnormally dilated capillaries separated by thin connective tissue septa |
| What vascular malformation is due to dilated capillaries separated by thin connective tissue septa? | Cavernous hemangioma |
| What is a potential complication or risk of Hemangiomas, especially a Cavernous hemangioma? | Due to lack of structural support, these tend to bleed an cause neurologic deficits and seizures |
| What is referred with Wallerian degeneration? | Process of axonal degeneration and breakdown of the Melin sheath that occurs distal to a site of injury |
| Why does Axonal regeneration does not occur in the CNS? | Due to persistence of myelin debris, secretion of inhibitory factors, and development of dense glial scarring |
| Does Axonal regeneration occur in the CNS, PNS, or both? | Only in the PNS |
| Which process occurs in the CNS : Wallerian degeneration or Axonal regeneration? | Wallerian degeneration |
| The presence of Glial scar and persistence of myelin debris after ischemic stroke, what is a process that cannot occur in the CNS? | Axonal regeneration |
| Common Prion disease | Creutzfeldt-Jakob disease |
| What is Creutzfeldt-Jakob disease? | Prions disease characterized by rapidly progressive dementia, myoclonus, and death within a year of symptom onset |
| What condition is due to the accumulation of an abnormally folded protein ath is resistant to protease and trigger similar conformational changes in other proteins? | Creutzfeldt-Jakob disease |
| What protein or by product is highly associated with development of hepatocellular cancer? | Aflatoxins |
| What is the associated DNA nucleotide change (mutation) associated with increased risk for HCC development? | G:C --> T:A transversion |
| A G : C -----> T: A transversion is associated with what malignancy? | Hepatocellular carcinoma |
| What foods are often associated with Aflatoxins synthesis? | Corn, soybeans, and peanuts |
| What areas of the worlds oar often associated with higher levels or chances of developing Aflatoxins leading to HCC? | African and Asian countries |
| Important and common antioxidant: | Superoxide Dismutase |
| What is "superoxide dismutase"? | Antioxidant that neutralizes reactive oxygen species prevent cell injury |
| What is the role of Superoxide dismutase? | Antioxidant that neutralizes ROS preventing cell injury |
| Why does a pos-ischemic reperfusion is often seen with ischemic injury? | The antioxidants are not sufficient to neutralize the oxidative stress and ROS production by reperfusion leading to cell death and damage |
| What transcription factor has a critical role in inflammation as a immune response to infection? | Nuclear factor-kappa B (NF-kB) |
| NF-kB is an: | Transcription factor with a critical role in immune response to infection and inflammation |
| How is NF-kB normally found? | Normally found in the cytoplasm, in a latent, inactive state bound to inhibitor protein, IkB. |
| Inactive NF-kB is found bound to: | IkB |
| What inhibitory protein keeps NF-kB inactive in the cytoplasm? | IkB |
| How can liposaccharides initiate the transcription of free NF-kB? | Lipopolysaccharides destroy IkB, leaving free (unbounded) NF-kB to be translocated to the nucleus, leading to initiation of inflammation, immunity and cell proliferation |
| Once free NF-kB is translocated to nucleus and activated it indicates which responses: | Inflammation, immunity, and cell proliferation |
| What can destroy IkB and leads to activation of latent NF-kB? | Lipopolysaccharides |
| What is the most common appearance of Pulmonary infarcts? | Hemorrhagic (red) and wedge-shaped in the periphery of the lung |
| Where in the long, centrally or peripherally, are pulmonary infarcts often seen? | Periphery of the lung |
| A wedge-shape and red lesion in the periphery of a lung most likely indicates what pathologic condition? | Hemorrhagic pulmonary embolism |
| What population is often at higher risk of developing pulmonary infarct due to involvement of the tricuspid valve? | IV drug users |
| What is the cause (pathologic) of Pulmonary embolism in IV drug users? | Embolization of the Tricuspid valve vegetation fragments |
| What condition is often seen with IV drug users? | Tricuspid valve endocarditis |
| What is a severe consequence of Tricuspid valve endocarditis? | Embolization of TV vegetation fragments leading to hemorrhagic pulmonary infarction. |
| How does BPH increase risk of developing UTIs? | The residual urine can act as growth medium for pathogenic bacteria leading to increased UTIs |
| What is a consequence of residual urine in patient with BPH? | Increased chances of developing an UTI |
| What are some urinary manifestations of BPH? | Increase resistance to urine flow in the urethra and lead to incomplete bladder emptying during micturition |
| What common male condition is often seen with incomplete bladder emptying, which then increases risk of UTI development? | Benign Prostatic Hyperplasia (BPH) |
| What is a common cause of acute renal failure in children? | HUS |
| What is the triad associated with HUS? | 1. Microangiopathic hemolytic anemia, 2. Thrombocytopenia 3. Actúe kidney injury |
| What bacterial are often associated with development of HUS in children? | E. coli O157:H7 and Shigella dysentery, as these produce Shiga-toxin |
| What is Rickets? | Condition characterized by an excess of Unmineralized Osteoid matrix and epiphyseal cartilage due to vitamin D deficiency |
| Which vitamin is deficient in Rickets? | Vitamin D |
| What are the effects on bone n Rickets? | Excess unmineralized osteoid matrix and epiphyseal cartilage |
| What cartilage "type" is in excess in patient with Rickets? | Epiphyseal cartilage |
| Excess unmineralized osteoid matrix and epiphyseal cartilage, with low vitamin D serum level. Dx? | Rickets |
| What are common clinical manifestations of Rickets? | Frontal bossing, craniotabes, costochondral junction deformity, and bowed legs |
| What condition is often seen with bowed legs and "rachitic rosary" X-ray view of the thorax? | Rickets |
| What is referred by x-ray description of an "rachitic rosary"? | Costochondral junction deformity in Rickets |
| What is synovitis? | Condition characterized by pain, erythema, swelling, and reduced range of motion in a joint |
| What B7 (+) condition is often seen with Synovitis? | Septic arthritis |
| Besides common clinical manifestations of synovitis, what other symptoms often accompany a patient with acute synovitis? | Fever and Leukocytosis |
| What synovial fluid and histological findings strongly suggest Bacterial joint infection? | High synovial fluid leukocyte count (>100, 000) and absent crystals on microscopic examination |
| What conditions require treating Septic arthritis with antibiotics, in order to prevent them from developing? | Joint destruction, osteomyelitis, and sepsis |
Created by:
rakomi
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