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Q0001:Three cell types with regard to cell cycle

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Permanent; Stable; Labile

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Q0002:Rough Endoplasmic Reticulum rich cells

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-Mucus-secreting goblet cells of small intestine;-Antibodysecreting plasma cells;(ie lost of secretory protein)

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Q0003:Cell cycle: Permanent cells

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Remain in G0. If they regenerate; they regenerate from stem cells.

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Q0004:Cell cycle: Stable cells

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Enter G1 from G0 when stimulated

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Q0005:Cell cycle: Labile cells

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Never go to G0; divide rapidly with a short G1

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Q0006:Smooth Endoplasmic Reticulum: Functions

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-Steroid synthesis;-Detoxification of drugs and poisons

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Q0007:Permanent cells: cell types

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-Neurons;-Skeletal and cardiac muscle;-RBCs (regenerate from stem cells)

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Q0008:Stable cells: cell types

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-Hepatocytes;-Lymphocytes

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Q0009:Smooth Endoplasmic Reticulum rich cells

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-Liver hepatocytes;-Steroid hormone-producing cells of the adrenal cortex

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Q0010:Labile cells: cell types

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-Bone marrow;-Gut epithelium;-Skin;-Hair follicles;(think about chemotherapy side effects)

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Q0011:Rough Endoplasmic Reticulum: Functions

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-Synthesis of secretory (exported) proteins;-N-linked oligosaccharide addition to many proteins

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Q0012:Neurons: name of Rough Endoplasmic Reticulum and its function

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Nissl bodies sytnhesize enzymes (eg ChAT) and peptide neurotransmitters.

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Q0013:6 functions of Golgi apparatus

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1. Distribution center;--Input: Proteins and lipids from endoplasmic reticulum;--Output: Plasma membrane; lysosomes; secretory vesicles;2. Modifies N-oligosaccharides on asparagine;3. Adds O-oligosaccharides to serine and threonine residues (on protein);4. Addition of mannose-6phosphate to proteins designated for lysosome;5. Proteoglycan assembly from core proteins;6. Sulfation of sugars in proteoglycans and of selected tyrosine on proteins

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Q0014:I-cell disease: Presentation

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-coarse facial features;-clouded corneas;-restricted joint movement;-high plasma levels of lysosomal enzymes;-fatal in childhood

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Q0015:3 types of vesicular trafficking proteins

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COPI; COPII; and Clathrin

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Q0016:COPI: Function

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Retrograde Intracellular transport: cis-Golgi to RER

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Q0017:COPII: Function

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Anterograde Intracellular transport: RER to cis-Golgi

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Q0018:Clathrin: Function

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Extracellular/lysosomal transport;-lysosome: trans-Golgi to lysosome ;-trans-Golgi to plasma membrane to endosomes (for receptor mediated endocytosis)

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Q0019:Microtubules: Diameter

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24 nm

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Q0020:Microtubules: Structure

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13 dimers of alpha/beta tubulin per circumference (each dimer bound to GTP); repeated in helical configuration

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Q0021:Microtubules: Found in ?

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-Flagella;-Cilia;-Mitotic spindles;-Slow neuronal axoplasmic transport

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Q0022:Microtubules: Speed of growth and collapse

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Grows slowly and collapses quickly

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Q0023:Microtubules: Affected by which drugs?

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-Mebendazole/thiabendazole (antihelminthic);-Taxol (antibreast cancer);-Griseofulvin (anti-fungal);Vincristine/Vinblastine (anti-cancer);-Colchicine (anti-gout)

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Q0024:Microtubule polymerization defects: Found in what syndrome

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Chediak-Higashi syndrome

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Q0025:Chediak-Higashi syndrome

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Microtubule polymerization defect resulting in decreased phagocytosis

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Q0026:Cilia: Structure

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-9+2 arrangement of microtubule doublets;-The 9 peripheral doublets are linked by dynein atpase

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Q0027:Cilia: Mechanism

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The 9 peripheral doublets are linked by dynein atpase; which causes bending of cilium by differential sliding of doublets

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Q0028:Molecular motors and direction of transport in cell

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Dynein: retrograde (DIES back towards nucleus);Kinesin: anterograde (MOVES kinetically forward)

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Q0029:Kartagener's syndrome: Defect

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Dynein arm defect causing immotile cilia

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Q0030:What is phosphatidylcholine also known as?

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lecithin

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Q0031:Kartagener's syndrome: Presentation

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-Male infertility (immotile sperm);-Female infertility (immotile fallopian cilia);-Bronchiectasis and recurrent sinusitis (bacteria and particles not pushed out);-Situs inversus

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Q0032:What syndrome is situs inversus associated with?

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Kartagener's

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Q0033:Plasma membrane: composition

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-Cholesterol (~50%);-Phospholipids (~50%);-Sphingolipids;Glycolipids;-Proteins

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Q0034:What is lecithin also known as?

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phosphatidylcholine

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Q0035:Plasma membrane: melting temperature association

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High cholesterol or long saturated fatty acid content means increased melting temperature

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Q0036:Where is phosphatidylcholine found?

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Major component of;1. RBC membranes;2. myelin;3. bile;4. surfactant (DPPC- dipalmitoyl phosphatidylcholine)

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Q0037:Drugs that inhibit the sodium-potassium pump

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-Ouabain;-Cardiac glycosides (digoxin; digitoxin)

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Q0038:Ouabain: Mechanism

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Inhibits Na-K atpase by binding to K site.

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Q0039:What process uses phosphatidylcholine?

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Esterification of cholesterol with LCAT (lecithin-cholesterol acyltransferase)

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Q0040:Cardiac glycosides: Mechanism

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Inhibits Na-K atpase; increasing cardiac contractility

Q0041:True or False: Collagen is not the most abundant protein in the body?

False; it is. (25% of all protein in the human body is collagen)

Q0042:True or False: Collagen is the most abundant protein in the body?

True. (25% of all protein in the human body is collagen)

Q0043:Collagen types and their primary locations

Be (So Totally) Cool; Read Books;1. (90% of all collagen) Bone; Skin; Tendon (bONE);2. Cartilage (carTWOlage);3. (Reticulin)-blood vessels;4. Basement membrane

Q0044:Collagen Type I locations

Be (So Totally) cool; read books;-Bone (bONE);-Skin;Tendon;-dentin;-fascia;-cornea;-late wound repair

Q0045:Collagen Type II locations

be (so totally) COOL; read books;-Cartilage (carTWOlage);vitreous body;-nucleus pulposus

Q0046:Collagen Type III locations

be (so totally) cool; READ books;(Reticulin);-blood vessels;skin;-uterus;-fetal tissue;-granulation tissue

Q0047:Collagen Type IV locations

be (so totally) cool; read BOOKS;-basement membrane or basal lamina;(four under the floor)

Q0048:Collagen synthesis: list of events and locations

Intracellular;1. Synthesis (Rough Endoplasmic Reticulum);2. Hydroxylation (Endoplasmic Reticulum);3. Glycosylation (Golgi);4. Exocytosis;Extracellular;5. Proteolytic processing;6. Cross-linking

Q0049:Collagen production step 1: Synthesis

-In rough endoplasmic reticulum;-translation of collagen alpha chains (aka preprocollagen)

Q0050:Composition and other name of collagen alpha-chains

-Gly-X-Y (where X and Y are proline; hydroxyproline; or hydroxylysine);-aka preprocollagen

Q0051:Composition and other name of preprocollagen

-Gly-X-Y (where X and Y are proline; hydroxyproline; or hydroxylysine);-aka collagen alpha-chains

Q0052:Collagen production step 2: Hydroxylation

-In endoplasmic reticulum;-Hydroxylation of specific proline and lysine residues (using vitamin C)

Q0053:Collagen production step for which vitamin C is required

Hydroxylation of Gly-X-Y chains to form hydroxyproline or hydroxylysine

Q0054:Collagen production step 3: Glycosylation

-In Golgi apparatus;-Glycosylation of preprocollagen lysine residues and formation of procollagen (triple helix of three collagen alpha chains)

Q0055:Composition of procollagen

Triple helix of three collagen alpha chains (aka three preprocollagen chains)

Q0056:Osteogenesis Imperfecta: Pathophysiology

Cannot take glycosylated alpha-chains and form procollagen (triple helix)

Q0057:Collagen production step 4: Exocytosis

Exocytosis of procollagen

Q0058:Collagen production step 5: Proteolytic processing

Cleavage of terminal regions of procollagen; transforming it into insoluble tropocollagen

Q0059:Composition of tropocollagen

Procollagen (triple-helix) with terminal regions cleaved

Q0060:Collagen production step 6: Cross-linking

Reinforcement of many staggered tropocollagen molecules by covalent lysine-hydroxylysine cross-linkage to make collagen fibrils

Q0061:Enzyme which performs collagen cross-linking (final step)

Lysyl oxidase

Q0062:Ehlers-Danlos syndrome: Pathophysiology

Nonfunctioning lysyl oxidase resulting in lack of collagen fibrils (linked tropocollagen molecules)

Q0063:Ehlers-Danlos syndrome: Presentation

-Hyperextensible skin;-Tendency to bleed/easy bruising;Hypermobile joints

Q0064:Ehlers-Danlos syndrome: # of types

10

Q0065:Ehlers-Danlos syndrome: Inheritance

Varies

Q0066:Ehlers-Danlos syndrome: Most frequently affected collagen type and result

Type III collagen resulting in blood vessel instability

Q0067:Osteogenesis Imperfecta: Types

-Abnormal collagen type I (bONE);--Most common;-Autosomal-dominant;-Type II;--Fatal in utero or neonatal period

Q0068:Osteogenesis Imperfecta: Presentation

1. Brittle bone disease: Multiple fractures with minimal trauma (often during birth);2. Blue sclearae (due to translucency of connective tissue over the choroid);3. Hearing loss (abnormal middle ear bones);4. Dental imperfections due to lack of dentition

Q0069:Multiple fractures in a child: Differential Diagnosis

-Child abuse;-Osteogenesis Imperfecta

Q0070:Osteogenesis Imperfecta: Incidence

1:10;000

Q0071:Immunohistochemical stain for: Connective tissue

Vimentin

Q0072:Immunohistochemical stain for: Muscle

Desmin

Q0073:Immunohistochemical stain for: Epithelial cells

Cytokeratin

Q0074:Immunohistochemical stain for: Neuroglia

GFAP (Glial fibrillary acid proteins)

Q0075:Immunohistochemical stain for: Neurons

Neurofilaments

Q0076:Vimentin stains for:

Connective tissue

Q0077:Desmin stains for:

Muscle

Q0078:Cytokeratin stains for:

Epithelial cells

Q0079:GFAP (Glial fibrillary acid proteins) stains for:

Neuroglia

Q0080:Neurofilaments stain for:

Neurons

Q0081:Elastin: Description and Location

Stretchy protein within lungs; large arteries; elastic ligaments

Q0082:Elastin and Collagen: Peptide composition difference

Both: Proline and lysine rich;Collagen: Hydroxylated forms;Elastin: Non-hydroxylated forms

Q0083:Elastin: Structure

Tropoelastin with fibrillin scaffolding (fibrillin defect in Marfan's syndrome)

Q0084:Elastin: Conformations

Relaxed and stretched

Q0085:Elastase: function

Break down elastin

Q0086:Elastase inhibitor

alpha-1-antitrypsin

Q0087:Elastase excess: Found where

Found in emphysema

Q0088:Association of emphysema with elastase

Excess elastase activity can cause emphysema

Q0089:Apoptosis: Characteristics

1. Cell shrinkage;2. Chromatin condensation;3. Membrane blebbing;4. Formation of apoptotic bodies which are then phagocytosed

Q0090:Apoptosis: Events which initiate it

-Embryogenesis;-Hormone induction (menstruation);-Immune cell-mediated death;-Injurious stimuli (eg radiation; hypoxia);Atrophy

Q0091:Necrosis: Definition

Enzymatic degradation of a cell resulting from exogenous injury

Q0092:Necrosis: Characteristics

1. Enzymatic digestion;2. Protein denaturation;3. Release of intracellular components;4. Inflammatory process.

Q0093:Necrosis: Types and where they are found

1. Coagulative (heart; liver; kidney);2. Liquefactive (brain);3. Caseous (Tuberculosis);4. Fat (Pancreas);5. Fibrinoid (blood vessels);6. Gangrenous (limbs; GI tract)

Q0094:Reversible or irreversible cell injury: Cellular swelling

Reversible

Q0095:Reversible or irreversible cell injury: Nuclear chromatin clumping

Reversible

Q0096:Reversible or irreversible cell injury: Decreased ATP synthesis

Reversible

Q0097:Reversible or irreversible cell injury: Ribosomal detachment

Reversible

Q0098:Reversible or irreversible cell injury: Glycogen depletion

Reversible

Q0099:Reversible or irreversible cell injury: Plasma membrane damage

Irreversible

Q0100:Reversible or irreversible cell injury: Lysosomal rupture

Irreversible

Q0101:Reversible or irreversible cell injury: Calcium influx leading to oxidative phosphorylation

Irreversible

Q0102:Reversible or irreversible cell injury: Nuclear pyknosis

Irreversible

Q0103:Reversible or irreversible cell injury: Karyolysis

Irreversible

Q0104:Reversible or irreversible cell injury: Karyorrhexis

Irreversible

Q0105:Reversible or irreversible cell injury: Mitochondrial permeability

Irreversible

Q0106:Inflammation: Classic signs

-Rubor (redness);-Dolor (pain);-Calor (heat);-Tumor (Swelling);-Functio lassa (Loss of function)

Q0107:Characteristics of Inflammation: Fluid exudation

1. Increased vascular permeability;2. Vasodilation;3. Endothelial injury

Q0108:Characteristics of Inflammation: Leukocyte activation

1. Emigration;2. Chemotaxis;3. Phagocytosis and killing

Q0109:Characteristics of Inflammation: Fibrosis

1. Fibroblast emigration and proliferation;2. Deposition of extracellular material

Q0110:Characteristics of Acute Inflammation

Mediated by;1. Neutrophils;2. Eosinophils;3. Antibodies

Q0111:Characteristics of Chronic Inflammation

Mediated by mononuclear cells;-Characterized by persistant destruction and repair;-Granulomas: nodular collections of macrophages and giant cells

Q0112:Characteristics of Inflammation: Resolution

1. Restoration of normal structure;2. Granulation tissue;3. Abscess;4. Fistula;5. Scarring

Q0113:Granulation tissue: histologic characteristics

-highly vascularized;-fibrotic

Q0114:Abscess: histologic characteristics

fibrosis surrounding pus

Q0115:Fistula: characteristics

abnormal communication

Q0116:Scarring: histologic characteristics

Collagen deposition resulting in altered structure and function

Q0117:Steps in leukocyte emigration

1. Rolling;2. Tight binding;3. Diapedisis;4. Migration

Q0118:Leukocyte emigration step characteristics: Rolling

Binding between;-E-selectin on vascular endothelium;-SialylLewisX on the leukocyte

Q0119:Leukocyte emigration step characteristics: Tight binding

binding between;-ICAM-1 on vascular endothelium ;-LFA-1 on leukocyte

Q0120:Leukocyte emigration step characteristics: Diapedesis

leukocyte travels between endothelial cells and exits blood vessel

Q0121:Leukocyte emigration step characteristics: Migration

Leukocyte travels through interstitium to the site of injury or infection guided by chemotactic signals

Q0122:Chemotactic signals

1. Bacterial products;2. Complement;3. Chemokines

Q0123:Free radical injury: Initiated by what?

1. Radiation exposure;2. Metabolism of drugs (phase I);3. Redox reactions;4. Nitric oxide;5. Transition metals;6. Leukocyte oxidative burst

Q0124:Free radical injury: Mechanism

-Membrane lipid peroxidation;-Protein modification;-DNA breakage

Q0125:Free radical injury: Stopped by what?

-Spontaneous decay;-Antioxidants;--Vitamin E;--Vitamin A;Enzymes;--Catalase;--Superoxide dismutase;--Glutathione peroxidase

Q0126:Major cause of injury after thrombolytic therapy

Free-radical production induced by reperfusion after anoxia

Q0127:Hyperplasia: definition

reversible increase in number of cells

Q0128:Metaplasia: definition

Reversible substitution of one cell type for another.

Q0129:Metaplasia: When found?

Often secondary to irritation and/or environmental exposure (eg squamous metaplasia in trachea and bronchi of smokers)

Q0130:Dysplasia: definition

Reversible abnormal growth with loss of cellular orientation; shape and size in comparison to normal tissue maturation

Q0131:Dysplasia: When found?

In paraneoplastic syndromes

Q0132:Anaplasia: definition

abnormal cells lacking differentiation; like primitive cells of same tissue.

Q0133:Anaplasia: When found?

Undifferentiated malignancies

Q0134:Neoplasia: Definition

A clonal proliferation of cells that is uncontrolled and excessive

Q0135:Difference between hyperplasia and dysplasia

Can occur together;1. hyperplasia - increase in number;2. dysplasia - abnormal proliferation of cells with loss of size; shape; and orientation

Q0136:Appearance of cancerous cells

-High nuclear/cytoplasmic ratio;-Clumped chromatin

Q0137:How does carcinoma invade a basement membrane?

-Collagenases;-Hydrolases

Q0138:Seed and soil theory of metastasis

Seed: Tumor embolus;Soil: Target organ

Q0139:Tumor grade: definition

Degree of cellular differentiation based on histologic appearance of tumor

Q0140:Tumor stage: definition

Degree of localization/spread based on site and size of primary lesion; spread to regional lymph nodes; and presence of metastases

Q0141:Tumor grade vs stage: Quick characterization

grade: character of tumor itself;stage: spread of tumor in a specific patient (Stage=Spread)

Q0142:Tumor grade vs stage: Which has more prognostic value?

Stage

Q0143:TNM staging system

Tumor size;Node involvement;Metastases

Q0144:Benign tumors of cell type: Blood cells

Does not exist. The malignant blood cells are automatically metastasizing.

Q0145:Benign tumors of cell type: Blood vessels

Hemangioma

Q0146:Benign tumors of cell type: Smooth muscle

Leiomyoma

Q0147:Benign tumors of cell type: Skeletal muscle

Rhabdomyoma

Q0148:Benign tumors of cell type: Bone

Osteoma

Q0149:Benign tumors of cell type: Fat

Lipoma

Q0150:Benign tumors of cell type: >1 cell type

Mature teratoma (women)

Q0151:Benign tumors of cell type: Epithelium

-Adenoma;-Papilloma

Q0152:Malignant tumor of cell type: Epithelium

-Adenocarcinoma;-Papillary carcinoma

Q0153:Malignant tumor of cell type: Blood cells

-Leukemia;-Lymphoma

Q0154:Malignant tumor of cell type: Blood vessels

Angiosarcoma

Q0155:Malignant tumor of cell type: Smooth muscle

Leiomyosarcoma

Q0156:Malignant tumor of cell type: Skeletal muscle

Rhabdomyosarcoma

Q0157:Malignant tumor of cell type: Bone

Osteosarcoma

Q0158:Malignant tumor of cell type: Fat

Liposarcoma

Q0159:Malignant tumor of cell type: >1 cell type

Immature teratoma; Mature teratoma (men only)

Q0160:Name the cell type: Adenoma

Epithelium

Q0161:Name the cell type: Papilloma

Epithelium

Q0162:Name the cell type: Adenocarcinoma

Epithelium

Q0163:Name the cell type: Papillary carcinoma

Epithelium

Q0164:Name the cell type: Leukemia

Blood cells

Q0165:Name the cell type: Lymphoma

Blood cells

Q0166:Name the cell type: Hemangioma

Blood vessels

Q0167:Name the cell type: Angiosarcoma

Blood vessels

Q0168:Name the cell type: Leiomyoma

Smooth muscle

Q0169:Name the cell type: Leiomyosarcoma

Smooth muscle

Q0170:Name the cell type: Rhabdomyoma

Skeletal muscle

Q0171:Name the cell type: Rhabdomyosarcoma

Skeletal muscle

Q0172:Name the cell type: Osteoma

Bone

Q0173:Name the cell type: Osteosarcoma

Bone

Q0174:Name the cell type: Lipoma

Fat

Q0175:Name the cell type: Liposarcoma

Fat

Q0176:Name the cell type: Teratoma

>1 cell type

Q0177:Neoplasm associated with: Down syndrome

ALL (we ALL fall Down); AML

Q0178:Neoplasm associated with: Xeroderma pigmentosum

Melanoma and basal/squamous cell carcinomas of the skin

Q0179:Neoplasm associated with: albinism

Melanoma and basal/squamous cell carcinomas of the skin

Q0180:Neoplasm associated with: Chronic atrophic gastritis

Gastric adenocarcinoma

Q0181:Neoplasm associated with: Pernicious anemia

Gastric adenocarcinoma

Q0182:Neoplasm associated with: Post surgical gastric remnants

Gastric adenocarcinoma

Q0183:Neoplasm associated with: Tuberous sclerosis (facial angiofibroma; seizures; mental retardation)

Astrocytoma and cardiac rhabdomyoma

Q0184:Neoplasm associated with: Actinic Keratosis

Squamous Cell Carcinoma of skin

Q0185:Neoplasm associated with: Barrett's esophagus

Esophageal adenocarcinoma

Q0186:Neoplasm associated with: Plummer-Vinson syndrome (atrophic glossitis; esophageal webs; anemia; all due to iron deficiency)

Squamous Cell carcinoma of the esophagus

Q0187:Neoplasm associated with: Cirrhosis (alcoholic; hepatitis B and C)

Hepatocellular carcinoma

Q0188:Neoplasm associated with: Ulcerative colitis

Colonic adenocarcinoma

Q0189:Neoplasm associated with: Paget's disease of bone

Secondary osteosarcoma and fibrosarcoma

Q0190:Neoplasm associated with: Immunodeficiency states

Malignant lymphomas

Q0191:Neoplasm associated with: AIDS

Aggressive malignant lymphomas (non-Hodgkin's) and Kaposi's sarcoma

Q0192:Neoplasm associated with: Autoimmune diseases

Benign/malignant thymomas

Q0193:Neoplasm associated with: Acanthosis nigricans (hyperpigmentation and epidermal thickening)

Visceral malignancy (stomach; lung; breast; uterus)

Q0194:Neoplasm associated with: Dysplastic nevus

Malignant melanoma

Q0195:Condition associated with: ALL

Down syndrome (we ALL fall Down)

Q0196:Condition associated with: AML

Down syndrome

Q0197:Condition associated with: Melanoma

Xeroderma pigmentosum and albinism;If malignant; dysplastic nevus

Q0198:Condition associated with: Basal cell carcinoma of skin

Xeroderma pigmentosum and albinism

Q0199:Condition associated with: Squamous cell carcinoma of skin

Actinic keratosis; Xeroderma pigmentosum and albinism

Q0200:Condition associated with: Gastric adenocarcinoma

1. Chronic atrophic gastritis;2. Pernicious anemia;3. Postsurgical gastric remnants

Q0201:Condition associated with: Astrocytoma

Tuberous sclerosis (facial angiofibroma; seizures; mental retardation)

Q0202:Condition associated with: Cardiac rhabdomyoma

Tuberous sclerosis (facial angiofibroma; seizures; mental retardation)

Q0203:Condition associated with: Esophageal adenocarcinoma

Barrett's esophagus

Q0204:Condition associated with: Squamous cell carcinoma of esophagus

Plummer-Vinson syndrome

Q0205:Plummer-Vinson syndrome: Presentation

-Atrophic glossitis;-Esophageal webs;-Anemia

Q0206:Plummer-Vinson syndrome: Cause

Iron deficiency

Q0207:Condition associated with: Hepatocellular carcinoma

Cirrhosis due to;1) alcohol;2) hepatitis B or C

Q0208:Condition associated with: Colonic adenocarcinoma

Ulcerative colitis

Q0209:Condition associated with: Secondary osteosarcoma

Paget's disease of bone

Q0210:Condition associated with: Fibrosarcoma

Paget's disease of bone

Q0211:Condition associated with: Malignant lymphomas

Immunodeficiency states

Q0212:Condition associated with: aggressive malignant nonHodgkin's lymphoma

AIDS

Q0213:Condition associated with: Kaposi's sarcoma

AIDS

Q0214:Condition associated with: Benign thymoma

Autoimmune diseases (eg Hashimoto's thyroiditis; myasthenia gravis)

Q0215:Condition associated with: Malignant thymoma

Autoimmune diseases (eg Hashimoto's thyroiditis; myasthenia gravis)

Q0216:Condition associated with: Visceral malignancy

Acanthosis nigricans

Q0217:Acanthosis nigricans: Presentation

-Hyperpigmentation;-Epidermal thickening

Q0218:Tumor associated with this gene: abl

CML

Q0219:Tumor associated with this gene: c-myc

Burkitt's lymphoma

Q0220:Tumor associated with this gene: bcl-2

Follicular and undifferentiated lymphomas (inhibits apoptosis)

Q0221:Tumor associated with this gene: erb-B2

Breast; ovarian; and gastric carcinomas

Q0222:Tumor associated with this gene: ras

Colon carcinoma

Q0223:Tumor associated with this gene: L-myc

Lung tumor (L for Lung)

Q0224:Tumor associated with this gene: N-myc

Neuroblastoma (N for Neuroblastoma)

Q0225:Tumor associated with this gene: ret

Multiple endocrine neoplasia types II and III

Q0226:Gene associated with this tumor: CML

oncogene abl (philadelphia chromosome)

Q0227:Gene associated with this tumor: Burkitt's lymphoma

oncogene c-myc

Q0228:Gene associated with this tumor: Follicular lymphoma

oncogene bcl-2 (inhibits apoptosis)

Q0229:Gene associated with this tumor: Undifferentiated lymphoma

oncogene bcl-2 (inhibits apoptosis)

Q0230:Gene associated with this tumor: Breast carcinoma

oncogene erb-B2

Q0231:Gene associated with this tumor: Ovarian carcinoma

oncogene erb-B2

Q0232:Gene associated with this tumor: Gastric carcinoma

oncogene erb-B2

Q0233:Gene associated with this tumor: Colon carcinoma

oncogene ras

Q0234:Gene associated with this tumor: Lung tumor

oncogene L-myc (L for Lung)

Q0235:Gene associated with this tumor: Neuroblastoma

oncogene N-myc (N for neuroblastoma)

Q0236:Gene associated with this tumor: Multiple Endocrine Neoplasia type I

oncogene MEN1 encoding menin on chromosome 11q

Q0237:Gene associated with this tumor: Multiple Endocrine Neoplasia type II

oncogene ret

Q0238:Gene associated with this tumor: Multiple Endocrine Neoplasia type III

oncogene ret

Q0239:Chromosome and tumor associated with this gene (what type of gene): Rb

Tumor suppressor gene on 13q: Retinoblastoma; osteosarcoma

Q0240:Chromosome and tumor associated with this gene (what type of gene): BRCA1

Tumor suppressor gene on 17q: Breast and ovarian cancer

Q0241:Chromosome and tumor associated with this gene (what type of gene): BRCA2

Tumor suppressor gene on 13q: Breast and ovarian cancer

Q0242:Chromosome and tumor associated with this gene (what type of gene): p53

Tumor suppressor gene on 17p: Most human cancers and LiFraumeni Syndrome

Q0243:Chromosome and tumor associated with this gene (what type of gene): p16

Tumor suppressor gene on 9p: Melanoma

Q0244:Chromosome and tumor associated with this gene (what type of gene): APC

Tumor suppressor gene on 5q: Colorectal cancer

Q0245:Chromosome and tumor associated with this gene (what type of gene): WT1

Tumor suppressor gene on 11q: Wilm's tumor

Q0246:Chromosome and tumor associated with this gene (what type of gene): NF1

Tumor suppressor gene on 17q: Neurofibromatosis type 1

Q0247:Chromosome and tumor associated with this gene (what type of gene): NF2

Tumor suppressor gene on 22q: Neurofibromatosis type 2

Q0248:Chromosome and tumor associated with this gene (what type of gene): DPC

Tumor suppressor gene on 18q: Pancreatic cancer

Q0249:Chromosome and tumor associated with this gene (what type of gene): DCC

Tumor suppressor gene on 18q: Colon cancer

Q0250:Gene and associated tumor on chromosome: 5q

Tumor suppressor gene APC: Colorectal cancer

Q0251:Gene and associated tumor on chromosome: 9p

Tumor suppressor gene p16: melanoma

Q0252:Gene and associated tumor on chromosome: 11q

Tumor suppressor gene WT1: Wilm's tumor

Q0253:Gene and associated tumor on chromosome: 13q

Tumor suppressor genes Rb (Retinoblastoma; Osteosarcoma) and BRCA2 (Breast and Ovarian cancer)

Q0254:Gene and associated tumor on chromosome: 17p

Tumor suppressor gene p53: Most human cancers and LiFraumeni syndrome

Q0255:Gene and associated tumor on chromosome: 17q

Tumor suppressor genes BRCA1 (Breast and ovarian cancer) and NF1 (Neurofibromatosis type 1)

Q0256:Gene and associated tumor on chromosome: 18q

Tumor suppressor genes DPC (Pancreatic cancer) and DCC (Colon cancer)

Q0257:Gene and associated tumor on chromosome: 22q

Tumor suppressor gene NF2: Neurofibromatosis type 2

Q0258:Gene and matching chromosome associated with: Retinoblastoma

Tumor suppressor gene Rb on chromosome 13q

Q0259:Gene and matching chromosome associated with: Osteosarcoma

Tumor suppressor gene Rb on chromosome 13q

Q0260:Gene and matching chromosome associated with: Breast cancer

Tumor suppressor genes BRCA1 (17q) and BRCA2 (13q)

Q0261:Gene and matching chromosome associated with: Ovarian cancer

Tumor suppressor genes BRCA1 (17q) and BRCA2 (13q)

Q0262:Gene and matching chromosome associated with: Most human cancers

Tumor suppressor gene p53 on chromosome 17p

Q0263:Gene and matching chromosome associated with: LiFraumeni syndrome

Tumor suppressor gene p53 on chromosome 17p

Q0264:Gene and matching chromosome associated with: Melanoma

Tumor suppressor gene p16 on chromosome 9p

Q0265:Gene and matching chromosome associated with: Colorectal cancer

Tumor suppressor gene APC on chromosome 5q

Q0266:Gene and matching chromosome associated with: Wilms' tumor

Tumor suppressor gene WT1 on chromosome 11q

Q0267:Gene and matching chromosome associated with: Neurofibromatosis type 1

Tumor suppressor gene NF1 on chromosome 17q

Q0268:Gene and matching chromosome associated with: Neurofibromatosis type 2

Tumor suppressor gene NF2 on chromosome 22q

Q0269:Gene and matching chromosome associated with: Pancreatic cancer

Tumor suppressor gene DPC on chromosome 18q

Q0270:Gene and matching chromosome associated with: Colon cancer

Tumor suppressor gene DCC on chromosome 18q

Q0271:Oncogenes: gain or loss of function QUICK

onco: gain

Q0272:tumor suppressor genes: gain or loss of function QUICK

tumor suppressor: loss

Q0273:Oncogenes: one or two alleles need to be damaged QUICK

One (gain of function)

Q0274:Tumor suppressor genes: one or two alleles need to be damaged QUICK

Two (loss of function)

Q0275:Association for tumor marker: PSA

Screening for Prostatic Carcinoma

Q0276:Association for tumor marker: CEA

-Carcinoembryonic antigen;-In ~70% of colorrectal and pancreatic cancers;-Also produced by gastric and breast carcinomas;-Very nonspecific

Q0277:Association for tumor marker: alpha-fetoprotein

-Hepatocellular carcinomas;-Nonseminomatous germ cell tumors of the testis (eg yolk sac tumor)

Q0278:Association for tumor marker: beta-hCG

-Hydatidiform moles;-Choriocarcinomas;-Gestational trophoblastic tumors

Q0279:Association for tumor marker: CA-125

Ovarian malignant epithelial tumors

Q0280:Association for tumor marker: S-100

-Melanoma;-Neural tumors;-Astrocytomas

Q0281:Association for tumor marker: Alkaline phosphatase

-Metastases to bone;-Obstructive biliary disease;-Paget's disease of bone

Q0282:Association for tumor marker: Bombesin

-Neuroblastoma;-Lung cancer;-Gastric cancer

Q0283:Association for tumor marker: TRAP

-Tartrate-resistance acid phosphatase;-Found in hairy cell leukemia

Q0284:What type of cell is found in hairy cell leukemia?

B-cells

Q0285:Association for tumor marker: CA-19-9

Pancreatic adenocarcinoma

Q0286:Tumor marker for: Prostatic carcinoma

-PSA;-Prostatic acid phosphatase

Q0287:Tumor marker for: Colorectal cancer

CEA - Carcinoembryonic antigen;-Produced by 70% of colorectal cancers

Q0288:Tumor marker for: Pancreatic cancer

CEA - Carcinoembryonic antigen;-Produced by 70% of pancreatic cancers;CA-19-9;-Produced in pancreatic adenocarcinoma

Q0289:Tumor marker for: Gastric carcinoma

-CEA - Carcinoembryonic antigen;-Bombesin

Q0290:Tumor marker for: Breast carcinoma

CEA - Carcinoembryonic antigen

Q0291:Tumor marker for: Hepatocellular carcinoma

alpha-fetoprotein

Q0292:Tumor marker for: Nonseminomatous germ cell tumors of the testis

alpha-fetoprotein

Q0293:Tumor marker for: Hydatidiform moles

beta-hCG

Q0294:Tumor marker for: Choriocarcinoma

beta-hCG

Q0295:Tumor marker for: Gestational Trophoblastic tumors

beta-hCG

Q0296:Tumor marker for: Malignant ovarian epithelial tumors

CA-125

Q0297:Tumor marker for: Melanoma

S-100

Q0298:Tumor marker for: Neural tumors

General: S-100;Neuroblastoma: Bombesin

Q0299:Tumor marker for: Astrocytomas

S-100

Q0300:Tumor marker for: Metastases to bone

Alkaline phosphatase

Q0301:Tumor marker for: Obstructive biliary disease

Alkaline phosphatase

Q0302:Tumor marker for: Paget's disease of bone

Alkaline phosphatase

Q0303:Tumor marker for: Neuroblastoma

Bombesin

Q0304:Tumor marker for: Lung cancer

Bombesin

Q0305:Tumor marker for: Hairy cell leukemia

TRAP (Tartrate-resistant acid phosphatase)

Q0306:Tumor marker for: Pancreatic adenocarcinoma

CA-19-9

Q0307:Cancer associated with: HTLV-1

HTLV=Human T-Lymphotropic Virus;Adult T-cell leukemia

Q0308:Cancer associated with: HBV

Hepatocellular carcinoma

Q0309:Cancer associated with: HCV

Hepatocellular carcinoma

Q0310:Cancer associated with: EBV

-Burkitt's lymphoma;-Nasopharyngeal carcinoma

Q0311:Cancer associated with: HPV

-Cervical carcinoma (with HPV 16;18);-Penile/anal carcinoma

Q0312:Cancer associated with: HHV-8

HHV-8 = Kaposi's sarcoma-associated herpes virus;-Kaposi's sarcoma;-body cavity fluid B-cell lymphoma

Q0313:Oncogenic virus associated with: Adult T-cell leukemia

HTLV-1 (HTLV=Human T-Lymphotropic Virus)

Q0314:Oncogenic virus associated with: Hepatocellular carcinoma

-HBV ;-HCV

Q0315:Oncogenic virus associated with: Burkitt's lymphoma

EBV

Q0316:Oncogenic virus associated with: Nasopharyngeal carcinoma

EBV

Q0317:Oncogenic virus associated with: Cervical carcinoma

HPV 16 and 18

Q0318:Oncogenic virus associated with: Penile carcinoma

HPV

Q0319:Oncogenic virus associated with: Anal carcinoma

HPV

Q0320:Oncogenic virus associated with: Kaposi's sarcoma

HHV-8 (aka Kaposi's sarcoma-associated herpesvirus)

Q0321:Oncogenic virus associated with: body cavity fluid Bcell lymphoma

HHV-8 (Human Herpesvirus 8)

Q0322:Organ affected by: Aflatoxins

Liver (hepatocellular carcinoma)

Q0323:Organ affected by: Vinyl chloride

Liver (angiosarcoma)

Q0324:Organ affected by and effects of: CCl4

Liver;-centrilobular necrosis;-fatty change

Q0325:Organ affected by: Nitrosamines

-Esophagus;-Stomach

Q0326:Organ affected by: Cigarette smoke

-Larynx;-Lung

Q0327:Organ affected by: Asbestos

Lung;-Mesothelioma;-Bronchogenic carcinoma

Q0328:Organ affected by: Arsenic

Skin (squamous cell carcinoma)

Q0329:Organ affected by: Naphthalene (aniline) dyes

Bladder (transitional cell carcinoma)

Q0330:Organ affected by: Alkylating agents

Blood (leukemia)

Q0331:Carcinogen associated with: Hepatocellular carcinoma

Aflatoxins

Q0332:Carcinogen associated with: Angiosarcoma

Vinyl chloride

Q0333:Carcinogen associated with: Centrilobular necrosis of liver

CCl4

Q0334:Carcinogen associated with: Fatty change of liver

CCl4

Q0335:Carcinogen associated with: Liver

-Aflatoxins;-Vinyl chloride;-CCl4

Q0336:Carcinogen associated with: Esophagus

Nitrosamines

Q0337:Carcinogen associated with: Stomach

Nitrosamines

Q0338:Carcinogen associated with: Larynx

Cigarette smoke

Q0339:Carcinogen associated with: Lung

-Cigarette smoke;-Asbestos

Q0340:Carcinogen associated with: Mesothelioma of lung

Asbestos

Q0341:Carcinogen associated with: Bronchogenic carcinoma of lung

Asbestos

Q0342:Carcinogen associated with: Skin

Arsenic (squamous cell carcinoma)

Q0343:Carcinogen associated with: Bladder

Naphthalene dyes (transitional cell carcinoma)

Q0344:Carcinogen associated with: Blood

Alkylating agents (leukemia)

Q0345:Paraneoplastic effects: definition

Symptoms not directly related to tumor or hormones of tumor tissue

Q0346:Name/effect and cause of paraneoplastic syndrome associated with: Small cell lung carcinoma

(with intracranial neoplasms);-Cause: ADH;-Effect: SIADH;(without intracranial neoplasms);Cause:ACTH/ACTH-like peptide;-Effect: Cushing's;Cause:Antibodies against presynaptic Ca2+ channels at neuromuscular junction;-Effect: Lambert-Eaton Syndrome (muscle weakness)

Q0347:Name/effect and cause of paraneoplastic syndrome associated with: Squamous cell lung carcinoma

Causes;-PTH-related peptide;-TGF-beta;-TNF-alpha;-IL1;Effect: Hypercalcemia

Q0348:Name/effect and cause of paraneoplastic syndrome associated with: Renal cell carcinoma

Cause: Erythropoietin;Effect: Polycythemia;Causes;-PTHrelated peptide;-TGF-beta;-TNF-alpha;-IL-1;Effect: Hypercalcemia

Q0349:Name/effect and cause of paraneoplastic syndrome associated with: Breast carcinoma

Causes;-PTH-related peptide;-TGF-beta;-TNF-alpha;-IL1;Effect: Hypercalcemia

Q0350:Name/effect and cause of paraneoplastic syndrome associated with: Multiple myeloma

Causes;-PTH-related peptide;-TGF-beta;-TNF-alpha;-IL1;Effect: Hypercalcemia

Q0351:Name/effect and cause of paraneoplastic syndrome associated with: Bone metastasis (lysed bone)

(Though technically not a paraneoplastic syndrome);Causes;PTH-related peptide;-TGF-beta;-TNF-alpha;-IL-1;Effect: Hypercalcemia

Q0352:Name/effect and cause of paraneoplastic syndrome associated with: Hemangioblastoma

Cause: Erythropoietin;Effect: Polycythemia

Q0353:Name/effect and cause of paraneoplastic syndrome associated with: Hepatocellular carcinoma

Cause: Erythropoietin;Effect: Polycythemia

Q0354:Name/effect and cause of paraneoplastic syndrome associated with: Thymoma

-Cause:Antibodies against presynaptic Ca2+ channels at neuromuscular junction;-Effect: Lambert-Eaton Syndrome (muscle weakness)

Q0355:Name/effect and cause of paraneoplastic syndrome associated with: Leukemia

Cause: Hypercalcemia due to excess nucleic acid turnover (ie; cytotoxic therapy);Effects;-Gout;-Urate nephropathy

Q0356:Name/effect and cause of paraneoplastic syndrome associated with: Lymphoma

Cause: Hypercalcemia due to excess nucleic acid turnover (ie; cytotoxic therapy);Effects;-Gout;-Urate nephropathy

Q0357:Paraneoplastic syndrome and neoplasm associated with: ACTH

Paraneoplastic syndrome: Cushing's syndrome;Neoplasm: Small cell lung carcinoma

Q0358:Paraneoplastic syndrome and neoplasm associated with: ACTH-like peptide

Paraneoplastic syndrome: Cushing's syndrome;Neoplasm: Small cell lung carcinoma

Q0359:Paraneoplastic syndrome and neoplasm associated with: ADH

Paraneoplastic syndrome: SIADH;Neoplasm: Small cell lung carcinoma with intracranial neoplasms

Q0360:Paraneoplastic syndrome and neoplasm associated with: PTH-related peptide

Paraneoplastic syndrome: Hypercalcemia;Neoplasms;Squamous cell lung carcinoma;-Renal cell carcinoma;-Breast carcinoma;-Multiple myeloma;-Bone metastasis (lysed bone) (not really a paraneoplastic syndrome for this one)

Q0361:Paraneoplastic syndrome and neoplasm associated with: TGF-beta

Paraneoplastic syndrome: Hypercalcemia;Neoplasms;Squamous cell lung carcinoma;-Renal cell carcinoma;-Breast carcinoma;-Multiple myeloma;-Bone metastasis (lysed bone) (not really a paraneoplastic syndrome for this one)

Q0362:Paraneoplastic syndrome and neoplasm associated with: TNF-alpha

Paraneoplastic syndrome: Hypercalcemia;Neoplasms;Squamous cell lung carcinoma;-Renal cell carcinoma;-Breast carcinoma;-Multiple myeloma;-Bone metastasis (lysed bone) (not really a paraneoplastic syndrome for this one)

Q0363:Paraneoplastic syndrome and neoplasm associated with: IL-1

Paraneoplastic syndrome: Hypercalcemia;Neoplasms;Squamous cell lung carcinoma;-Renal cell carcinoma;-Breast carcinoma;-Multiple myeloma;-Bone metastasis (lysed bone) (not really a paraneoplastic syndrome for this one)

Q0364:Paraneoplastic syndrome and neoplasm associated with: Erythropoietin

Paraneoplastic syndrome: Polycythemia;Neoplasms;-Renal cell carcinoma;-hemangioblastoma;-hepatocellular carcinoma

Q0365:Paraneoplastic syndrome and neoplasm associated with: Antibodies against Ca2+ channels

Paraneoplastic syndrome: Lambert-Eaton syndrome (muscle weakness due to presynaptic channels being destroyed);Neoplasms;-Thymoma;-Small-cell lung cancer

Q0366:Paraneoplastic syndrome and neoplasm associated with: Hyperuricemia due to excess nucleic acid turnover (ie cytotoxic therapy)

Paraneoplastic syndromes;-Gout;-Urate nephropathy;Neoplasms;-Leukemia;-Lymphoma

Q0367:For the following paraneoplastic syndrome; give the causes and associated neoplasms: Cushing's syndrome

Cause: ACTH or ACTH-like peptide;Neoplasm: Small cell lung carcinoma

Q0368:For the following paraneoplastic syndrome; give the causes and associated neoplasms: SIADH

Cause: ADH;Neoplasms: Small cell lung carcinoma with intracranial neoplasms

Q0369:For the following paraneoplastic syndrome; give the causes and associated neoplasms: Hypercalcemia

Causes;-PTH-related peptide;-TGF-beta;-TNF-alpha;-IL1;Neoplasms;-Squamous cell lung carcinoma;-Renal cell carcinoma;-Breast carcinoma;-Multiple myeloma;-Bone metastasis (lysed bone: technically not a paraneoplastic cause)

Q0370:For the following paraneoplastic syndrome; give the causes and associated neoplasms: Polycythemia

Cause: Erythropoietin;Neoplasms;-Renal cell carcinoma;Hemangioblastoma;-Hepatocellular carcinoma

Q0371:For the following paraneoplastic syndrome; give the causes and associated neoplasms: Lambert-Eaton syndrome (muscle weakness)

Cause: Antibodies against presynaptic Ca2+ channels at neuromuscular junction;Neoplasms;-Thymoma;-Small cell lung carcinoma

Q0372:For the following paraneoplastic syndrome; give the causes and associated neoplasms: Gout

Cause: Hyperuricemia due to excess nucleic acid turnover (ie cytotoxic therapy);Neoplasms;-Leukemias;-Lymphomas

Q0373:For the following paraneoplastic syndrome; give the causes and associated neoplasms: Urate nephropathy

Cause: Hyperuricemia due to excess nucleic acid turnover (ie cytotoxic therapy);Neoplasms;-Leukemias;-Lymphomas

Q0374:Primary tumors that metastasize to the brain

Lots of Bad Stuff Kills Glia;-Lung;-Breast;-Skin (melanoma);Kidney (renal cell carcinoma);-GI

Q0375:Primary tumors that metastasize to the liver

Cancer Sometimes Penetrates Benign Liver;By decreasing frequency;-Colon;-Stomach;-Pancreas;-Breast;-Lung

Q0376:Primary tumors that metastasize to bone

Primary Tumors Like Killing Bone;-Prostate (blastic);Thyroid/Testes;-Lung (Lytic);-Kidney;-Breast (Both lytic and blastic);Prostate and bone are most common

Q0377:% of brain tumors from metastases

50%

Q0378:% of liver tumors from metastases

Unspecified; but there are many more metastases than primary liver tumors

Q0379:% of bone tumors from metastases

Unspecified; but there are many more metastases than primary bone tumors

Q0380:Brain metastasis: Morphology

-Multiple;-Well circumscribed;-At gray/white border

Q0381:Incidence and mortality in men of the following cancer: Prostate

Incidence: 32%;Mortality: 13%

Q0382:Incidence in men of the following cancer: Lung

Incidence: 16%;Mortality: 33%

Q0383:Incidence in men of the following cancer: Colon and rectum

Incidence: 12%;Mortality: Unspecified

Q0384:Incidence and mortality in women of the following cancer: Breast

Incidence: 32%;Mortality: 18%

Q0385:Incidence and mortality in women of the following cancer: Lung

Incidence: 13%;Mortality: 23%

Q0386:Incidence and mortality in women of the following cancer: Colon and Rectum

Incidence: 13%;Mortality: Unspecified

Q0387:Type of necrosis found in: Kidney

Coagulative

Q0388:Type of necrosis found in: Brain

Liquefactive

Q0389:Type of necrosis found in: Tuberculosis

Caseous

Q0390:Type of necrosis found in: Pancreas

Fat

Q0391:Type of necrosis found in: Blood vessels

Fibrinoid

Q0392:Type of necrosis found in: Limbs

Gangrenous

Q0393:Type of necrosis found in: GI tract

Gangrenous

Q0394:receptor: alpha 1; G-protein class?

Gq

Q0395:receptor: alpha 2; G-protein class?

Gi

Q0396:receptor: beta 1; G-protein class?

Gs

Q0397:receptor: beta 2; G-protein class?

Gs

Q0398:receptor: M1; G-protein class?

Gq

Q0399:receptor: M2; G-protein class?

Gi

Q0400:receptor: M3; G-protein class?

Gq

Q0401:receptor: D1; G-protein class?

Gs

Q0402:receptor: D2; G-protein class?

Gi

Q0403:receptor: H1; G-protein class?

Gq

Q0404:receptor: H2; G-protein class?

Gs

Q0405:receptor: V1; G-protein class?

Gq

Q0406:receptor: V2; G-protein class?

Gs

Q0407:receptor: alpha 1; f(x)?

increase vascular smooth muscle contraction

Q0408:receptor: alpha 2; f(x)?

decrease sympathetic outflow; decrease insulin release

Q0409:receptor: beta 1; f(x)?

increase HR; increase contractility; increase renin; increase lipolysis; increase aqueous humor formation

Q0410:receptor: beta 2; f(x)?

vasodilation; bronchodilation; increase glucagon release

Q0411:receptor: M1; f(x)?

CNS

Q0412:receptor: M2; f(x)?

decrease HR

Q0413:receptor: M3; f(x)?

increase exocrine gland secretions

Q0414:receptor: D1; f(x)?

relaxes renal vascular smooth muscle

Q0415:receptor: D2; f(x)?

modulates transmitter release; especially in brain

Q0416:receptor: H1; f(x)?

increase nasal and bronchial mucus production; contraction of bronchioles; pruritus; and pain

Q0417:receptor: H2; f(x)?

increase gastric acid secretion

Q0418:receptor: V1; f(x)?

increase vascular smooth muscle contraction

Q0419:receptor: V2; f(x)?

increase H2O permeability and reabsorption in the collecting tubules of the kidney

Q0420:interphase

Gi; S; G2;precedes mitosis

Q0421:G1 (gap) phase

12 hrs. avg;cell growth: synthesis of carbs; proteins; lipids

Q0422:G0

LONG G1 state (almost stops cycling!);ex: muscle; nerve cells

Q0423:mitochondria + centrioles divide during ____ phase

S phase;(both contain DNA)

Q0424:cells perform their differentiated functions during ____ phase

G1/G0

Q0425:during G1; cells are _n

2n (diploid)

Q0426:during G2; cells are _n

4n (tetraploid)

Q0427:S

6-8 hrs avg;ALLDNA synthesis + chr replication happens here;also RNA synthesis rate increases; cell prepares for mitosis

Q0428:G2

3-4 hrs avg;resembles G1 except cell now TETRAPLOID (4n)

Q0429:in mitosis; cell goes from _n to _n

4n to 2n

Q0430:6 phases of mitosis

preprophase;prophase;metaphase;early anaphase;late anaphase;telophase

Q0431:preprophase

chr condense (recognizable);centrioles (barrel-like) visible in cytoplasm

Q0432:prophase

2 copies of each chromosome separated into single chromosome called CHROMATIDS;mitotic spindle forms;centrioles begin to separatre; microtubules assemble b/w them;near end; nuclear envelope starts to rupture

Q0433:metaphase

nuclear envelope + nucleolus disappear;spindle moves to where nucleus was;chr move to mid-spindle + attach to MT

Q0434:early anaphase

CHROMATIDS split longitudinally + migrate to cell poles;*note: after chromatids split; they are called chromosomes again

Q0435:late anaphase

chr aggregate at poles;CLEAVAGE FURROW begins to form (beginning of cytokinesis)

Q0436:chromatids/chromosomes

until ANAPHASE; each chromosome contains 2 sister chromatids;after ANAPHASE each chromatid = separate chromosome

Q0437:during G2; each chromosome consists of _________

2 sister chromatids; connected at centromere

Q0438:telophase (cytokinesis)

nucleolus forms;nuclear envelopes form around each set of daughter chromosomes;condensed chromatin expands again + begins to reappear;cytoplasm divides by deepening cleavage furrow until --> 2 daughter cells

Q0439:cells entering meiosis are called ________

primary gametes (spermatocytes or oocytes);have same DNA content as cell entering mitosis

Q0440:cells entering meiosis II are called ________

secondary gametocytes;contain 23 chromosomes (each consisting of 2 sister chromatids)

Q0441:meiosis occurs in______

germ cells (sperm; ova);2 parts; cell division in each resembles mitosis; but no DNA replication during either

Q0442:meiosis reduced chromosome # by ______

half

Q0443:genetic recombination occurs in

meiosis;exchange of chr segments;occurs b/w chr within tetrad;changes allelic linkages; does NOT change gene sequence

Q0444:stages of Meiosis I

prophase I;metaphase I;anaphase I;telophase I

Q0445:stages of meiosis II

prophase II;metaphase II;anaphase II;telophase II

Q0446:during meiosis II; _______ separate

sister chromatids (of the 23 chromosomes)

Q0447:recombinbation occurs b/w

chromatids within a tetrad

Q0448:meiotic prophase occurs in _ steps

3 (A;B;C)

Q0449:meiotic prophase A

chromosomes condense (visible); homologous chromosomes pair (except X;Y chr; centromeres of homologues don't pair)

Q0450:meiosis prophase step B

homologous chromosome pairing complete;4 chromatids appear (= tetrad)

Q0451:meiosis prophase step C

RECOMBINATION/CROSS-OVER

Q0452:recombination

chromatid segments exchanged b/w 2 paired homologous chromosomes

Q0453:chiasma

pt of exchange during recombination; shaped like an X

Q0454:cells resulting from meiosis II

spermatids;OR;ova (plus polar body)

Q0455:meiotic metaphase I

paired chromosomes line up on mitotic spindle;2 chromosomes of each homologous pair attach to MT going to opposite poles of cell

Q0456:meiotic anaphase I

both chromatids migrate to same end of cell

Q0457:meiotic telophase I

each daughter gets 1 part of each chromosome pair;each gets total 23 chromosomes

Q0458:2nd meiotic division

similar to meiotic division except NO PRIOR DNA SYNTHESIS;23 chromosomes divide at centromere;each new daughter cell gets 23 chromatids (HAPLOID)

Q0459:5 causes of tissue hypoxia

ischemia; hypoxemia; ETC block; uncoupled ETC; AV shunts

Q0460:Ultimate effects of tissue hypoxia

No O2 to accept electrons in ETC; no production of ATP. Na/K pump fails and cell swells (reversible change). Ribosomes fall from RER. Disruption of cell membrane and mitochondria induces apoptosis.

Q0461:Effects of low ATP in cell

Increased glycolysis to support ATPase pump. Anaerobic glycolysis produces lactate with decreased intracellular pH which denatures proteins (coagulation necrosis); cell swelling; entry of calcium and apoptosis

Q0462:Pathophysiology of cell injury in hypoxia

ETC fails due to lack of oxygen; 2. No ATP production in ETC increases anaerobic glycolysis (high citrate and AMP activate PFK-1); 3. increased lactate decreases cell pH which denatures proteins and produces coagulation necrosis; 4. ATPase fails and cell swells with fall off of ribosomes from RER; 5. disruption of cell membrane with entry of Ca activates phspholipase (lipid peroxidation); complement activation; nuclear enzymes with pyknosis and destruction of mitochondria and apoptosis

Q0463:What is methhemoglobin?

Hemoglobin with oxidized (Fe3+) iron that cant bind O2. Decreases SaO2 and produces cyanosis. Caused by nitro/sulfa compounds. Rx.: methylene blue

Q0464:Increased PACO2; decreased PaO2; decreased O2 content; decreased SaO2

Respiratory acidosis

Q0465:Normal PaO2 and SaO2; decreased Hb

Anemia

Q0466:Normal Hb; PaO2; decreased SaO2; decreased O2 content

CO poisoning or methhemoglobinemia

Q0467:CO poisoning tissue hypoxia

Decreased O2 content and SaO2; normal PaO2; left shift of dissociation curve and cytochrome oxidase inhibition all cause hypoxia. Produced by car exhaust; heaters; smoke inhalation; wood stoves. Rx.: 100% O2. First symptom: headache

Q0468:Factors that left-shift O2 dissociation curve and decrease P50

Decreased 2;3BPG; CO; MetHb; HbF; hypothermia; alkalosis

Q0469:Factors that right-shift O2 dissociation curve and increase P50

Increased 2;3BPG; fever; acidosis

Q0470:Causes of hypoxia with normal O2 content

Ischemia; cyanide poisoning; ETC uncouplers (alcohol; salicylates; dinitrophenol)

Q0471:Free radical metabolism

NADPH oxidase and spontaneous superoxide; Superoxide dismutase makes H2O2 from superoxide. Catalase breaks down H2O2. Gluthathione reductase and GSH peroxide breakdwon H2)2 using reduced GSH and NADPH from G6PDH in HMP shunt

Q0472:Causes of free radical injury

Aging process produces lipofuscin which peroxidates membrane; MPO system; O2 free radicals; ionizing radiation; acetaminophen (treat with acetylcyteine); CCl4 poisoning

Q0473:Features of apoptosis

Eosinophilic cytoplasm; pyknotic nucleus; no inflamatory infiltrate

Q0474:Physiologic examples of apoptosis

Thymus involution; Mullerian and Wolffian structure involution; gravid uterus

Q0475:Pathologic examples of apoptosis

Councilman bodies in viral hepatitis; psammoma bodies; cancer

Q0476:Coagulation necrosis

Denaturing and coagulation of proteins in cytoplasm (infarction). Pale Vs. hemorrhagic infarcts

Q0477:Liquefactive necrosis

Neutrophil destruction with hemolytic enzymes. Abesesses; wet gangrene; brain; pancreas

Q0478:Caseous necrosis

Combination of coagulation and liquefaction necrosis. Cheeselike material; casseating granulomas with macrophages

Q0479:Fat necrosis

Lipases on fatty tissue. Pancreas. Chalky-white appearance

Q0480:Fibrinoid necrosis

Histologically resembles fibrin. Eosinophilic mitral valve vegetations; immunocomplexes

Q0481:Fatty liver change

In alcoholics - liver stores excess tryglycerides because increased NADH produces glycerol 3P and increased acetate (acetyl CoA) increases FA synthesis. In kwashiorkor; no apolipoproteins for VLDL

Q0482:Regulation of apoptosis

Genes bcl-2 (inhibits apoptosis) prevents release of cytochrome C and binds protease activating factor (Apaf-1); p53 stimulates apoptosis. Mediated by caspases. Stimulated by cell injury; lack of hormones; Fas and TNF

Q0483:Rb suppressor gene and Rb protein

Located on chromosome 13. Produces unphosphorylated Rb protein which stops cell from entering S phase. Phosphorylation by cyclin D/cdk complex allows it to enter S phase. Mutation of Rb gene produces cancer

Q0484:cdk/cyclin D complex

When activated it phosphorylates Rb protein allowing cell to enter S phase

Q0485:p53 suppressor gene

Located on chromosome 17. Produces a protein that inactivates cyclin D/cdk complex preventing Rb protein phosphorylation which keeps cell in G1

Q0486:Name 5 characteristics of the metabolic syndrome

central obesity;atherogenic lipid patterns;hypertension;insulin resistance or diabetes;pro-inflammatory state; ie C-reactive protein

Q0487:Describe stable angina

Chest pain precipitated by exertion; relieved by rest or vasodilators.

Q0488:Describe unstable angina

Chest pain that is prolonged or recurrent at rest.

Q0489:Describe Prinzmetal angina

Intermittent chest pain at rest; usually caused by vasospasm.

Q0490:The two patterns of myocardial ischemic necrosis? Describe them.

Transmural: entire ventricular wall from endo- to epicardium;Subendocardial: limited to interior one third of ventricular wall

Q0491:Name 6 complications of myocardial infarction.

Arrhythmia: common cause of death in first hours after MI;Heart failure: depends on MI size;Myocardial rupture: risk highest 4-7 days after MI;Papillary muscle rupture;Mural thrombosis: forms over infarct in heart; can embolize;Ventricular aneurysm

Q0492:Timeline of GROSS morphological changes in acute myocardial infarction?

< 12 hrs: no gross changes;24 hrs: swelling; pale or red brown infarct with surrounding hyperemia;7 days: yellow infarcted area with red border;10 days: red vascular connective tissue gradually replaces necrotic tissue;5 weeks: pallor of infarct due to fibrosis;3-6 months: gray-white scar

Q0493:Timeline of MICROSCOPIC morphological changes in acute myocardial infarction?

< 6hrs: none;12-24hrs: nuclei disappear; striations lost; neutrophils infiltrate; coagulative necrosis apparent;3 days: macrophages replace neutrophils; phagocytose debris;7 days: growth of fibroblasts and new vessels in the lesion;2-4 weeks: collagen and matrix synthesis;>5 weeks: progressive fibrosis replaces lesion

Q0494:When do LDH; troponin; and CK-MB each peak in acute myocardial infarction?

LDH peaks at 3 days and persists;Troponin peaks at 24 hours and persists;CK-MB peaks at 24 hours and tapers to zero.

Q0495:Rheumatic fever: etiology

Immunologic disease. Streptococcal antigens elicit an antibody response that is reactive to human heart and other tissues.

Q0496:Rheumatic fever: name and characteristics of the classic histologic lesion?

Aschoff body;Focal interstitial myocardial inflammation with collagen; fibrinoid material; multinucleated giant cells; and large myocytes.

Q0497:Rheumatic fever: how long after what infection? What lab sign indicates recent infection?

1-4 weeks after Group A beta hemolytic streptococcus infection. Elevated anti-streptolysin (ASO) indicates recent infection.

Q0498:Rheumatic fever: non-cardiac manifestations

Fever; malaise; elevated ESR; arthralgias/arthritis/migratory polyarthritis; subcutaneous nodules; erythema marginatum; Sydenham chorea.

Q0499:Rheumatic fever: cardiac manifestations

Pancarditis (all 3 layers);Non-friable mitral and aortic vegetations; which after healing cause fibrosis; calcification; and deformation of the values. Chordae tendineae are also thickened and shortened.

Q0500:Organisms causing acute vs subacute bacterial endocarditis

Acute: staph aureus (also beta hemolytic strep and pneumococcus);Subacute: strep viridans (also enterococcus; HACEK organisms)

Q0501:Complications of infective endocarditis?

Distal embolization to brain or other tissues can lead to septic infarcts;Renal glomeruli involvement due to immune complex disease or septic emboli.

Q0502:Suspect what if tricuspid valve is involved in infective endocarditis?

IV drug use. 50% of cases of endocarditis in this population have tricuspid involvement.

Q0503:Risk factors for infectious endocarditis?

Congenital heart disease;Preexisting valvular heart disease;Artificial valve;IV drug use

Q0504:What is nonbacterial thrombotic endocarditis associated with? What are its complications?

Metastatic cancer and other wasting disorders;Valve deposits are sterile and made of fibrin; as a result emboli are sterile; not septic.

Q0505:What is Libman-Sacks endocarditis?

Occurs in SLE; is characterized by small fibrin vegetations forming on either or both sides of the valve leaflets.

Q0506:What is endocarditis of the carcinoid syndrome?

Caused by secretory products of carcinoid tumors such as serotonin and other vasoactive peptides and amines. They cause endocarditis resulting in thickened endocardial plaques; usually in the RIGHT of the heart because these substances are inactivated in the pulmonary circulation.

Q0507:Most common valvular lesion?

Mitral prolapse (7% of population)

Q0508:Characteristic sound of mitral prolapse?

Systolic murmur with midsystolic click.

Q0509:Causes of mitral stenosis?

Almost always rheumatic heart disease.

Q0510:Causes of aortic stenosis?

Age related calcific stenosis;Congenital bicuspid valve;Rheumatic valve

Q0511:Causes of aortic regurgitation?

Nondissecting aortic aneurysm;Rheumatic heart disease;Syphilitic aortitis with dilation of valve ring

Q0512:Coarctation of aorta is more common in what syndrome?

Turner's syndrome (monosomy X)

Q0513:Congenital rubella syndrome includes what fetal defects?

Cardiovascular (PDA and others);Microcephaly;Deafness;Cataracts;Growth retardation

Q0514:What drug keeps PDA open? what drug closes it?

Prostaglandin keeps it open;Indomethacin closes it.

Q0515:Name three conditions associated with dilated cardiomyopathy.

Alcoholism; thiamine deficiency; prior myocarditis.

Q0516:What is a common cause of restrictive cardiomyopathy?

Cardiac amyloidosis.

Q0517:what are the morphological changes seen in hypertrophic cardiomyopathy?

hypertrophy of all chamber walls especially the ventricular septum;Disoriented tangled and hypertrophied myocardial fibers;Left ventricular outflow obstruction.

Q0518:What is the inheritance of hypertrophic cardiomyopathy?

Usually autosomal dominant

Q0519:what is the most common cause of myocarditis?

Coxsackievirus

Q0520:what is the most common tumor of the heart?

Atrial myxoma

Q0521:What is cor pulmonale? Name one common cause.

Cor pulmonale is right ventricular hypertrophy or dilation secondary to lung disease or primary disease of pulmonary vasculature such as primary pulmonary hypertension;Emphysema is a common cause.

Q0522:pansystolic murmur at LLSB radiating right towards midclavicular line that is medium pitched; has a blowing quality; increases on inspiration; S3; incr. JVP and "v" wave

tricuspid regurg. The S3 sound is from the overdistended RV

Q0523:harsh; shrill; midsystolic crescendo-decrescendo murmur; sometimes S4

aortic stenosis

Q0524:soft; blowing; pansystolic murmur; S3; elevated left atrial pressures;

mitral regurg

Q0525:immediate diastolic murmur in a middle-aged guy who has always had some problems keeping up

bicuspid aortic valve

Q0526:asymptomatic adult with prominant RV impulse; midsystolic ejection murmuer heard in pulmonic area and along the LSB; fixed splitting of S2

classic for ASD

Q0527:systolic ejection murmer on RSB that radiates to jugular

aortic stenosis

Q0528:opening snap and diastolic murmur

mitral stenosis

Q0529:incr. RV pressures --> RVH and PA dilation & crescdecresc murmur if severe; no RA enlargement

pulmonary stenosis

Q0530:child with a harsh systolic murmer and increased oxygen saturation in the RV

VSD

Q0531:Mitral/tricuspid regurgitation

holosystolic; high-pitched 'blowing murmur';mitral: loudest at apex and radiates towards AXILLA;tricuspid: loudest at tricuspid area and radiates to right sternal border

Q0532:Aortic stenosis

crescendo-decrescendo systolic ejection murmur following an ejection click!!;LV>>aortic pressure during systole;radiates to carotids/apex;'pulsus parvus et tardus' - pulses weak compared to heart sounds

Q0533:VSD

holosystolic; harsh-sounding murmur;loudest at tricuspid valve

Q0534:Mitral prolapse

late systolic murmur with midsystolic click (MC);most frequent valvular lesion;loudest at S2

Q0535:Aortic regurgitation

immediate high-pitched 'blowing' diastolic murmur;wide pulse pressure when chronic

Q0536:Mitral stenosis

follows opening snap;secondary to rheumatic fever;delayed rumbling late diastolic murmur;LA>>>LV pressure during diastole;tricuspid stenosis differs because it gets louder with inspiration (more blood flows into RA upon inspiration)

Q0537:PDA

continuous machine-like murmur;loudest at time S2;(aorta --> pulmonary artery;the pressure difference is obscene and thus you have a continuous murmur)

Q0538:Congenital heart defects associated with 22q11 syndrome

truncus arteriosus; tetralogy of fallot

Q0539:Down syndrome heart defects

ASD; VSD; AV septal defect (endocardial cushion defect)

Q0540:Congenital rubella!!!

septal defects; PDA; pulmonary artery stenosis;(microcephaly; mental retardation; deafness; cataracts; growth retardation)

Q0541:Turner's syndrome heart stuff

coarctation of aorta

Q0542:Marfan's syndrome heart stuff

aortic insufficiency (late complication)

Q0543:Offspring of diabetic mother

transposition of great vessels

Q0544:MC arteries affected by Monckenberg arteriosclerosis

Radial and Ulnar arteries

Q0545:Definition;Hyaline thickening of small arteries in Essential HTN and DM

Arteriolosclerosis

Q0546:Dx;"Onionskin" thickening of the arteriolar walls

Hyperplastic Arteriolosclerosis;(Malignant HTN)

Q0547:Definition;Dx specific to an aneurysm of the Ascending Aorta;where does it exert its effect?;what heart problem can it lead to?

Syphillic (Leutic) Anneurysm;effects: Vaso Vasorum;leads to: Aortic valve incompetence

Q0548:what may be confused w/ a MI if it wasn't for the normal serum enzymes?

Dissecting Aneurysm

Q0549:Definition;dilated small vessel surrounded by radiating fine channels and associated w/ hyperestrinism

Spider Telangiectasia

Q0550:Dx;Port-wine stain birthmark

Hemangioma

Q0551:Dx;Hemangioblastomas of the retina; cerebellum and medulla;What can it lead to?;what genetics? gene?

Von Hippel-Lindau Dz;can lead to: Bilateral Renal Cell CA;genetics;Auto Dominant;deletion on VHL gene on chrom 3;(chrom 3 = 3 words in name VHL)

Q0552:Malignant vascular tumor caused by Arsenic exposure

Hemangiosarcoma

Q0553:Dx;fever; weight loss; abd pain; HTN; cutaneous eruptions; arthralgia; vasculitis in arterioles and glomeruli of kidney;What is possible predisposing virus?

Polyarteritis Nodosa;(P-ANCA);;virus: HBV

Q0554:Dx;granulomatous vasculitis w/ eosinophilia and asthma; prominent in pulmonary vasculature

Churg-Strauss syndrome

Q0555:Dx;child w/ previous URI gets hemorrhagic urticaria of extensor surfaces; arthralgia; abd pain; melena

Henoch-Schonlein purpura

Q0556:Dx;necrotizing granulomatous vasculitis in lung and upper airway and necrotizing glomerulonephritis

Wegener's Glanulomatosis;(C-ANCA)

Q0557:Dx;unilateral HA; visual impairment; polymyalgia rheumatica (muscle pain); increased ESR

Temporal arteritis;(Giant cell arteritis)

Q0558:Dx;fever; arthritis; night sweats; myalgia; skin nodules; ocular disturbances; weak pulse in upper extremities; elevated ESR

Takayasu's Arteritis

Q0559:Dx;child w/ fever; congested conjuctiva; changes in lips/oral mucosa; lymphadenitis

Kawasaki Dz

Q0560:Dx;intermittent claudication; nodular phlebitis; cold sensitivity; heavy smoker

Buerger's Dz;(Tx: quit smoking)

Q0561:Dx;marked increase in diastolic BP; retinal hemorrhages; papilledema; "flea-bitten" kidney

Malignant HTN

Q0562:Definition;focal interstitial myocardial inflammation w/ fragmented collagen and fibrinoid material and some mulitnucleated giant cells; seen in Rheumatic fever

Aschoff Body;(w/ Anitschkow's cells)

Q0563:MC coronary artery for MI

LAD

Q0564:Definition;Autoimmune phenomenon resulting in fibrinous pericarditis post-MI

Dressler's syndrome

Q0565:what lab is elevated in Rheumatic Heart Dz?

elevated ASO titer

Q0566:Dx;fever; erythema marginatum; valvular damage; elevated ESR; polyarthritis; Sub-q nodules; chorea

Rheumatic Heart Dz;(mitral = MC valve)

Q0567:MCC of Subacute Endocarditis

Strep Viridians

Q0568:MCC of Acute Endocarditis

Staph Aureus

Q0569:Definiton;Endocarditis secondary to metastasis or renal failure

Marantic endocarditis;(can result in peripheral emboli)

Q0570:(3) congenital Right -> Left shunts

3 Ts;Tetralogy of Fallot;;Transposition of great vessels;;Truncus Arteriosus

Q0571:Dx;Fixed S2 split

ASD

Q0572:Definition;uncorrected VSD; ASD; or PDA leads to progressive pulmonary HTN. With Inc pulm resistance; shunt reverses from L -> R to ;R -> L; causing late cyanosis; clubbing and polycythemia

Eisenmenger's syndrome

Q0573:which congenital heart defect is not compatable with life unless a shunt is present?

Transposition of great vessels

Q0574:Dx;notching of ribs; HTN in upper extremities and weak pulses in lower extremities

Coarctation of Aorta

Q0575:Dx;continuous "machine-like" murmur

PDA

Q0576:what is given to close a PDA?

Indomethacin

Q0577:what is given to keep a PDA open?

Prostaglandins;[PROp it open]

Q0578:Congenital defect with;Congenital Rubella;(2)

Septal defect;;PDA

Q0579:Congenital defect with;Marfan's syndrome

Aortic insufficiency

Q0580:Congenital defect with;offspring of Diabetic mother

Transposition of Great vessels

Q0581:Murmur;systolic High-pitched "blowing"

Mitral Regurg

Q0582:Murmur;Midsystolic Click

Mitral Prolapse

Q0583:Murmur;Wide pulse-pressure

Aortic Regurg

Q0584:MC heart tumor in children

Rhabdomyoma;(w/ Tuberous Sclerosis)

Q0585:which type of emboli can lead to DIC?

Amniotic fluid embloi

Q0586:Dx;low CO; equilibrium of pressures in all 4 chambers; JVD; pulsus paradoxus

Cardiac tamponade

Q0587:(4) causes of Serous Pericarditis

SLE;;RA;;Infection;;Uremia

Q0588:(3)* causes of Fibrinous pericarditis

Fiber in your RUM;Rheumatic fever;;Uremia;;MI

Q0589:(4) signs of Tetralogy of Fallot

PROVe;Pulmonary stenosis;;RVH;;Overriding Aorta;;VSD

Q0590:developmental cause of Tetralogy of Fallot?

Anterosuperior displacement of Infundibular septum

Q0591:Definition;passage of emboli from the venous circulation into the arterial circulation via a R -> L shunt

Paradoxic Emboli

Q0592:True of false: 50% is classified as secondary HTN (usually resulting from renal disease)

false. (90% essential/primary; 10% secondary)

Q0593:read the questioner's mind: HTN predisposes individuals to this disease (the one John Ritter died of)

aortic dissection

Q0594:Pathology changes associated with HTN

hyaline thickening & atherosclerosis

Q0595:This awful term refers to a stiffening of the arteries that invovles the media. Particularly likely to occur at the radial & ulnar arteries.

Monckeberg arteriosclerosis

Q0596:Atherosclerosis: True or false: atherosclerosis is a disease of small sized arteries

false. affects elastic; large & medium muscular arteries.

Q0597:Atherosclerosis: Earliest sign of atherosclerotic disease

fatty streak

Q0598:Atherosclerosis: most likely location

abdominal aorta. (then coronary artery; popliteal artery; and carotid artery)

Q0599:Type of angina resulting from coronary artery spasm

Prinzmetal's variant

Q0600:This coronary artery branch is most commonly implicated in myocardial infarction

LAD (left anterior descending)

Q0601:most common cause of sudden cardiac death

(lethal) arrhythmia

Q0602:Solid tissues like the heart; brain; kidney and spleen have only a single blood supply (not so good collaterals). Therefore infarcts are more likely to be --?

pale

Q0603:2 instances where red infarct is likely

(1) reperfusion (2) loose tissues with good collaterals - like the lungs or intestine

Q0604:Evolution of MI: Rank the following vessels from most to least commonly occluded: RCA; LAD; circumflex

LAD>RCA>circumflex

Q0605:Evolution of MI: Histologic changes on day 1 of an MI?

pallor of infarcted area; coagulative necrosis

Q0606:Evolution of MI: days 2-4?

dilated vessels (hyperemia); neutrophil invasion; extensive coagulative necrosis

Q0607:Evolution of MI: days 5-10?

yellow-brown softening of infarcted region; macrophages present; granulation tissue begins to grow in

Q0608:Evolution of MI: after 7 weeks?

infarct is gray-white; scar complete

Q0609:Diagnosis of MI True or false: ECG is not diagnostic during the first 6 hours following an MI

False; it is the gold standard within this time period

Q0610:Diagnosis of MI What is the test of choice within the first 24 hours?

CK-MB

Q0611:Diagnosis of MI This enzyme is elevated from 4 hours up to 10 days after an MI and is the most specific protein marker

cardiac troponin I

Q0612:Diagnosis of MI on ecg; transmural infarction causes ______

ST elevation; Q wave changes

Q0613:MI complications: Most common (90% of patients)

arryhthmias; esp. 2 days after infarct

Q0614:MI complications: automimmune phenomen several weeks post-MI that results in fibrinous pericarditis

Dressler's syndrome

Q0615:MI complications: high risk of mortality

cardiogenic shock (large infarcts)

Q0616:MI complications: seen about a week after the infarction

rupture of ventricular wall; septum; or papillary muscle

Q0617:Cardiomyopathies Most common

dilated (congestive) cardiomyopathy; heart looks like a ballon on X-ray

Q0618:Cardiomyopathies True or False: substance abuse is a common cause of dilated cardiomyopathy

True; cocaine and alcohol especially

Q0619:Cardiomyopathies These two infectious diseases are associated with dilated myopathy

coxsackievirus B and Chagas' disease

Q0620:Cardiomyopathies True or false: hypertrophic cardiomyopathy causes systolic dysfunction

False; dilated myopathy causes systolic dysfunction; hypertrophic causes diastolic

Q0621:Cardiomyopathies Half of hypertrophic myopathies are inherited as an _________ trait (x-linked; dominant; etc.)

autosomal dominant; major cause of sudden death in young athletes

Q0622:Cardiomyopathies On echo in hypertrophic disease; the LV thickens and the chamber looks how?

like a banana

Q0623:Cardiomyopathies These "-osis" diseases are major causes of restrictive/obliterative cardiomyopathy

sarcoidosis; amyloidosis; hemochromatosis; endocardial fibroelastosis; endomyocardial (Loffler's) fibrosis….also; scleroderma but it's not an -osis

Q0624:Name two causes of holosystolic murmurs

1) VSD; 2) mitral regurg; and 3) tricuspid regurg

Q0625:Widened pulse pressure seen with this diastolic murmur

aortic regurg

Q0626:Describe the murmur associated with the most common valvular lesion

Mitral prolapse; late systolic murmur following mid-systolic click

Q0627:True or false: aortic stenosis causes a decrescendocrescendo murmur following an ejection click

False; ejection click is followed by a crescendo-decrescendo systolic murmur

Q0628:cause of a continuous murmur loudest at time of S2?

patent ductus artieriosis

Q0629:opening snap followed by late diastolic rumbling?

mitral stenosis

Q0630:most common heart tumor?

metastasis

Q0631:primary cardiac tumor in 1) adults and 2) children

adults=myxoma (almost always in left atrium); children=rhabdomyoma

Q0632:fun gross pathologic term for changes in liver with CHF?

nutmeg

Q0633:what are "heart failure cells"?

hemosiderin-laden macrophages in lung

Q0634:dyspnea on exertion; pulmonary edema; and paroxysmal nocturnal dyspnea are symptoms of?

left heart failure

Q0635:patient says "I have to sleep upright." the clinical term for this is?

orthopnea

Q0636:most pulmonary emboli arise from?

DVT

Q0637:True or false: Amniotic fluid can lead to DIC

TRUE

Q0638:what are the component of virchow's triad?

stasis; hypercoagulability; endothelial damage

Q0639:what is pulsus paradoxus?

greater than 10 mmHg drop in systolic on inspiration

Q0640:what is electrical alternans?

characteristic of tamponade on ECG in which QRS complex height varies beat-to-beat

Q0641:midsystolic cresendo-decrescendo murmur

aortic stenosis

Q0642:high-pitched; blowing murmur at the left sternal border

aortic regurgitation

Q0643:low pitched; mid dyastolic rumble

aortic regurgitation

Q0644:midsystolic murmur at the base

aortic regurgitation

Q0645:late mid-diastolic rumble

mitral stenosis

Q0646:high pitched holosystolic murmur at apex to axilla

mitral regurgitation

Q0647:What valve is usually involved in endocarditis?

Mitral

Q0648:What valve indicated drug use if it is involved?

Tricuspid

Q0649:Can endocarditis be non-bacterial?

Yes. It can be secondary to metastasis; renal failure (maranctic or thrombotic); fungal

Q0650:What type of endocarditis does s. Aureus cause?

rapid onset; high virulence; tends to occur secondary to infection elsewhere

Q0651:What do the vegetations look like

Large.

Q0652:What type of endocarditis does s. viridians cause?

subacute. Tends to have smaller vegetations.

Q0653:What predisposes you to s.viridins endocarditis?

tends to occur on previously damaged valves; so rheumatic fever. It is commonly seen after dental work.

Q0654:What are the 8 sings of endocarditis?

JR=NO FAME Janeway lesions; Roth's spots; Nail-bed hemorrhages; Osler's nodes; Fever; Anemia; Murmur (new); Emboli

Q0655:What do Janeway Lesions look like?

multiple small flat erythematous lesions on palms and soles

Q0656:What are roth spots?

round white spots on the retina surrounded by hemorrhage.

Q0657:What are osler's nodes?

Tender raised lesions on the fingers and toes.

Q0658:What is the etiology of these olser's nodes; roth spots; and janeway lesions?

Bacterial vegetations flipping off the heart valve and lodging in the periphery.

Q0659:What type of bacteria causes rheumatic fever?

Group A beta-hemolytic strep

Q0660:when does it occur?

Children 5-15 years; four weeks after a bacterial infection

Q0661:Is the bacteria responsible for the symptoms?

No. RF is an autoimmune reaction of a cross-reactive protein that is found in the initial bacterial infection.

Q0662:What are the non cardiac clinical signs of rheumatic fever?

FEVERSS - Fever; Erythema marginatum; valve damage; Elevated ESR; Red-hot joints (migratory polyarthritis); Subcutaneous nodules; and St. Vitus dance (chorea)

Q0663:What hear valves are effected?

Mitral (most frequent); Aortic; Tricuspid (5%) - high pressure valves mainly.

Q0664:What is an Aschoff body?

classic histological sign of RF; found in the myocardium; contained fibrinoid material; fragmented collages; surrounded by giant cells.

Q0665:What are the cardiac signs of RF?

Verrucious vegetations on the valve; pancarditis; possible pericardial effusions and myocarditis (most common cause of death)

Q0666:Name four causes of serous pericarditis.

RAIL - Rheumatic Arthritis; Infection; Lupus; and Uremia

Q0667:What is serous pericarditis?

straw colored; protein rich exudates - non-purulent; and acute

Q0668:What are three causes of fibirnous exudates?

MI; Rheumatic fever; and Uremia

Q0669:Cloudy pericardial exudates indicated what?

Bacterial infection

Q0670:What are two causes of Hemorrhagic pericarditis?

malignancy and TB

Q0671:What is hemorrhagic pericarditis?

Bloody and inflammatory exudates

Q0672:What are the clinical signs of pericardial exudates?

pericardial pain; friction rub; decreased heart sounds; ST elevation throughout; and pulses paradoxes (like cardiac tamponade)

Q0673:What are the long term sequela of pericarditis?

chronic adhesive or constrictive pericarditis

Q0674:What is constiricit pericadritis

Fibrous scarring in the pericardium obliterates the space and constrict the right side of the heart (because it is less able to withstand the pressure)

Q0675:What types of pericaditis lead to constrictive pericarditis

TB and pyrogenic staph infections

Q0676:Syphilitic Heart Disease: What part of the heart does syphilis damage?

The vaso vasorum of the aorta

Q0677:Syphilitic Heart Disease: What does this lead to?

Dilation of the aorta and valve ring

Q0678:Syphilitic Heart Disease: What clinical results does this have?

it can cause an aortic aneurysm or valvular incompetence

Q0679:Syphilitic Heart Disease: What parts of the aorta are effected

ascending and arch

Q0680:Syphilitic Heart Disease: What is the appearance or the aorta?

Called a "tree-bark" appearance.

Q0681:Lab findings in PAN

p-anca. HBsAg+ in 30%; anemia; leukocytosis

Q0682:Microscopic features of PAN

Segmental necrotizing vasculitis in three stages: fibrinoid necrosis with neutrophils; fibroblast proliferation; nodular fibrosis with loss of internal elastic lamina

Q0683:Lab findings in PAN

p-anca. HBsAg+ in 30%; anemia; leukocytosis

Q0684:Microscopic features of PAN

Segmental necrotizing vasculitis in three stages: fibrinoid necrosis with neutrophils; fibroblast proliferation; nodular fibrosis with loss of internal elastic lamina

Q0685:Clinical features of PAN

Affects all organs except lungs. Fever; hematuria/renal failure/hypertension; abdominal pain/GI bleeding; myalgia/arthralgia

Q0686:Clinical features of Wegner granulomatosis

Bilateral pneumonitis with nodular and cavitary infiltrates; chronic sinusitis; nasopharyngeal ulcerations; renal disease

Q0687:Microscopic features of Wegner granulomatosis

Necrotizing vasculitis of small vessels (granulomas); necrotizing granulomas of respiratory tract; focal necrotizing glomerulonephritis

Q0688:Lab findings in Wegner granulomatosis

c-anca

Q0689:Treatment of Wegner granulomatosis

cyclophosphimide

Q0690:Clinical features of temporal arteritis

Throbbing unilateral headache; visual disturbances; jaw claudication

Q0691:Microscopic features of temporal arteritis

Segmental granulomatous vasculitis with multinucleated giant cells and fragmentation of the internal elastic lamina with intimal fibrosis and luminal thickening

Q0692:Diagnosis; lab findings and treatment of temporal arteritis

Dx.: biopsy of temporal artery. Lab: increased ESR. Rx.: steroids

Q0693:Clinical features of Takayasu asteritis

Loss of pulse in upper extremities; visual disturbances; neurologic abnormalities

Q0694:Microscopic features of Takayasu arteritis

Granulomatous vasculitis with massive intimal fibrosis; thickening of the aortic arch and narrowing of the major arterial branches

Q0695:Clinical features of Buerger's disease

Severe pain in affected extremity; thrombophlebitis; Raynaud phenomenon; ulceration and gangrene. Associated with heavy cigarette smoking

Q0696:Microscopic features of Buerger's disease

Recurrent neutrophilic vasculitis with microabseses; segmental thrombosis and vascular insuficiency

Q0697:Clinical features of Kawasaki disease

Affects children < 4. Acute febrile illness; conjuctivitis; maculopapular rash; lymphadenopathy; coronary aneurysms in 70% of cases

Q0698:Microscopic features of Kawasaki disease

Segmental necrotizing vasculitis with coronary aneurysms

Q0699:Diseases that feature Raynaud phenomenon

SLE; CREST; Buerger; atherosclerosis

Q0700:Raynaud diseasse

Small artery vasospasm resulting in blanching cyanosis of fingers and toes precipitated by cold temperature and emotions

Q0701:Henoch-Schonlein purpura

IgA-C3 immunocomplexes; IgA nephropathy (Berger disease); palpable purpura on buttocks

Q0702:Major risk factors for atherosclerosis

Hyperlipidemia; hypertension; smoking; diabetes

Q0703:Most common sites for atherosclerosis

Abdominal aorta followed by coronary arteries

Q0704:Complications of atherosclerosis

Ischemic heart disease; abdominal aortic aneurysm; peripheral vascular disease (pain; pulselessness; paresthesia; claudication); TIA (vertebral basilar oclussion); renovascular hypertension (high renin).

Q0705:Pathophysiology of essential hypertension

Retention of sodium and water with increase in stroke volume (systolic pressure). Sodium in smooth muscle opens up calcium channels with vasoconstriction of arterioles (increased diastolic pressure). Low renin hypertension.

Q0706:Complications of hypertension

Concentric ventricular hypertrophy; AMI; hyaline arteriosclerosis; nephrosclerosis and CRF; intracranial bleeds; athersoclerosis

Q0707:Renovascular hypertension

Atherosclerosis of renal artery orifice in males or fibromuscular hyperplasia in women. Severe hypertension; epigastric bruit. High renin hypertension. Screen with captopril.

Q0708:Captopril screening test for renovascular hypertension

In renovascular hypertension there's decreased RPF and high levels of renin and angiotensin II. With captopril (ACE inhibitor); there's loss of negative feedback on renin and exagerated high levels of renin post-stimulation. The test has the potential for renal failure if bilateral renal artery stenosis is present as AII is responsible for maintaining renal blood flow.

Q0709:Ahterosclerotic aneurysms

MC site is abdominal aorta below renal arteries (no vasa vasorum). Pulsitile mass with pain and abdominal bruit

Q0710:Syphilitic aneurysm

Obliterative endarteritis of vasa vasorum with ischemia and atrophy of ascending aorta; aortic insuficiency; airway encroachment and laryngeal nerve involvment (brassy cough)

Q0711:Associated diseases of dissecting aortic aneurysm

Marfan; Ehlers-Danlos; copper deficiency (no lysyl oxidase)

Q0712:Signs and symptoms of dissecting aortic aneurysm

Acute retrosternal severe chest pain; aortic insuficiency and cardiac tamponade

Q0713:Phlebothrombosis Vs. Thrombophlebitis

Phlebothrombosis is venous thrombosis of deep veins without inflamation or infection. Thrombophlebitis is venous thrombosis of superficial veins due to inflamation and infection

Q0714:Signs; symptoms; diagnosis and complications of DVT

Leg swelling; warmth; erythema. Increased venous pressure from deep to superficial veins (which drain in deep veins) produces varicosities in superficial system. Complications are thromboembolism; thrombophlebitis. Dx.: Doppler

Q0715:Signs; symptoms and causes of thrombophlebitis

Palpable cord; pain; induration; warmth; erythema. MCC is superficial varicose veins; phlebothrombosis; catherthers; drug abuse

Q0716:Clinical features of varicose veins

Edema; thrombosis; stasis dermatitis; ulcerations

Q0717:Clinical features of superior vena cava syndrome

Compression of SVN by primary lung cancer. Blue discoloration of the face; arms and shoulders; dizziness; convulsions; visual disturbances; distended jugular veins

Q0718:Clinical features of Kaposi sarcoma

Malignant endothelial cell tumor caused by HHV-8. Multiple red-purple patches; plaques or nodules. Spindle shaped cells

Q0719:What will aspiration of a foreign body result in the lung?

Obstruction atelectasis

Q0720:Presence of fluid; air or tumor in the pleural space results in what type of atelectasis?

Compression atelectasis

Q0721:Contraction atelectasis is due to what cause?

Fibrosis of the lung

Q0722:Causes of patchy atelectasis

Lack of surfactant (hyaline membrane disease of newborn or ARDS)

Q0723:Clinical features of typical pneumonia

Sudden onset; high fever; productive cough; tachypnea; pleuritic chest pain; consolidation on x-ray

Q0724:Clinical features of atypical pneumonia

Insidious onset; low fever; no cough; no consolidation

Q0725:Differential diagnosis of rusty sputum

Strep pneumonia; CHF; mitral stenosis; Goodpasture syndrome

Q0726:Features of sarcoidosis

"GRAIN": gammaglubilinemia; rheumathoid arthritis; ACE increase; interstitial fibrosis; non-casseating granuloma; bilateral lymphadenopathy

Q0727:Causes of restrictive pulmonary disease

Kyphoscoliosis; obesity; pneumoconiosis; ARDS; pulmonary fibrosis; sarcoidosis

Q0728:Causes of obstructive pulmonary disease

Asthma; emphysema; chronic brnchitis; bronchiectasis

Q0729:Lung volumes in obstructive pattern

Increased TLC; FRC and RV. Decreased FEV1; FVC; FEV1/FVC

Q0730:Lung volumes in restrictive pattern

Decreased; TLC; FEV1; FVC; FRC; RV. Increased or normal FEV1/FVC

Q0731:Diagnosis criteria for chronic bronchitis

Persistent cough and copius sputum production for at least 3 months in 2 consecutive years

Q0732:Clinical features of chronic bronchitis

Cough; sputum production; dyspnea; infections; hypoxia; cyanosis; weight gain. "Blue bloater"

Q0733:Microscopic findings in chronic bronchitis

Hypertrophy of bronchial mucous glands; globlet cell hyperplasia; mucus hypersecretion; bronchial metaplasia

Q0734:Complications of chronic bronchitis

Recurrent infections; cor pulmonale; lung cancer

Q0735:Definition of emphysema

destruction of alveolar septa resulting in enlarged air spaces and loss of elastic recoil

Q0736:Etiology of emphysema

Protease/antiprotease imbalance. Proteases are made by macrophages and neutrophils. Antiproteases are alpha-1antitrypsin; alpha-1-macroglubulin and secretory leukoprotease inhibitor

Q0737:Features of centriacinar emphysema

Proximal brnchioles involved; distal brnchioles spared; most common (95%); associated with smoking; worst in apical segments of upper lobes

Q0738:Features of panacinar emphysema

Entire acinus invololved; alpha-1-antitrypsin deficincy; worse in bases of lower lobes

Q0739:Clinical features of emphysema

Progressive dyspnea; pursing of lips and accesory muscles; barrel chest; weight loss; "Pink puffer"'

Q0740:Clinical features of asthma

Wheezing; severe dyspnea; coughing

Q0741:Microscopic features of asthma

Charcot-leyden crystals; mucous plugs; goblet cell hyperplasia and hypertrophy; eosinophils; edema; hypertrophy of smooth muscle; thick basement membranes

Q0742:Clinical features of bronchiectasis

cough; fever; malodorous purulent sputum; dyspnea; dilated bronchi extending out to pleura on x-ray

Q0743:Etiology of bronchiectasis

Bronchial obstruction; necrotizing pneumonia; cystic fibrosis; Kartagener syndrome

Q0744:Definition of acute respiratory distress syndrome

damage of alveolar epithelium and capillaries resulting in respiratory failure that is unresponsive to O2 treatment

Q0745:Causes of ARDS

shock; sepsis; trauma; gastric aspiration; radiation; O2 toxicity; drugs; infections

Q0746:Clinical features of ARDS

dyspnea; tachypnea; hypoxemia; cyanosis; use of accesory respiratory muscles. Bilateral lung opacity on x-ray

Q0747:Microscopic features of ARDS

interstitial and alveolar edema; interstitial inflamation; loss of type I pneumocytes; hyaline membrane formation

Q0748:RDS of newborn

Deficiency of surfactant in prematures (<28 weeks) and sons of diabetic mothers. Dyspnea; tachypnea; nasal flaring and cyanosis. Lecithin:sphyngomyelin < 2. Rx.: surfactant and dexamethasone

Q0749:Causes of pulmonary edema

left heart failure; mitral stenosis; fluid overload; nephrotic syndrome; liver disease

Q0750:Microscopic features of pulmonary edema

Intra-alveolar fluid; engorged capillaries; hemosiderin-ladden macrophages

Q0751:Risk factors and genetics of bronchogenic CA

Cigarette smoking; pneumoconiosis; pollution. Oncogenes: Lmyc (SCC); K-ras (adeno). Suppressor genes: p53 and Rb

Q0752:Clinical features of bronchogenic CA

Cough; sputum production; weight loss; anorexia; fatigue; dyspnea; hemoptysis; chest pain. Obstruction may produce emphysema; atelectasis; bronchiectasis or pneumonia

Q0753:Lung adenocarcinoma

Most common - 35%. More common in women. Peripheral gray mass; scarring and mucin-producing glands

Q0754:Squamous cell carconima

2nd most common - 30%. More common in males; related to smoking. Centrally located. Invasive squamous cells with desmosomes and keratin production; PTH production

Q0755:Small cell carcinoma

20%. More common in males; associated to smoking. Central location. Basophilic neurosecretory granules and paraneoplastic syndromes (ACTH; ADH)

Q0756:Pancoast tumor

Apical tumor causing Horner syndrome (ptosis; miosis; anhidrosis; enopthalmos)

Q0757:Superior vena cava syndrome

Obstruction; distended head and neck veins; plethora; facial edema

Q0758:Effects of lung masses within the thorax structures

Pancoast tumor; superior vena cava syndrome; esopahgeal obstruction; recurrent laryngeal nerve hoarseness; EatonLambert syndrome

Q0759:Sites of metastasis of lung cancer

Adrenals (>50%); liver; brain; bone

Q0760:Eaton-lambert syndrome

auto-antibodies against presynaptic Ca channels in neuromuscular junction

Q0761:Metastasis to the lung

Breast (most common)

Q0762:Clara Cells

found in bronchioles;non-ciliated columnar with secretory granules;secrete part of surfactant; degrade toxins; act as reserve cells

Q0763:Goblet Cells

found from trachea to terminal bronchioles;secrete mucus

Q0764:Pseudocolumar Cells

ciliated cells found from nose to respiratory bronchioles

Q0765:When are lungs mature?

L:S ratio > 2.0

Q0766:Where does aspirant go?

when standing; posterobasal segment of R. lower lobe;when supine; superior segment of R. lower lobe

Q0767:Relation of artery to bronchus?

RALS;on the right; pulmonary artery is anterior to bronchus;on left; pulmonary artery is superior to bronchus

Q0768:At what levels do structures pass through diaphragm?

T8=IVC;T10=oesophagus;T12=aorta; thoracic duct; azygous

Q0769:Causes of neonatal RDS?

prematurity;maternal DM with high insulin (insulin decreases surfactant synthesis);C-section (denies baby of the of stress/cortisol which increases surfactant synthesis)

Q0770:Causes of Right Shift in O2-HgB curve?

CADET face right;CO2;Acid/altitude;DPG;Exercise;Temperature

Q0771:CO poisoning

left shit in O2-HgB curve; decreases O2 binding capacity

Q0772:Innervation of lungs (sensory)

parietal pleura = phrenic (c3;c4;c5) refers to neck/shoulders and by intercostals;visceral pleura = vagus

Q0773:when do you hear fremitus?

lobar pneumonia

Q0774:Paraneoplastic syndromes associated with lung cancer?

squamous cell = PTHrP;small cell = ACTH; ADH; Eaton Lambert

Q0775:Locations of Lung Cancers

central = squamous; small S's;peripheral = adenocarcinoma

Q0776:Relation of Lung Cancer with smoking

all related; but adenocarcinoma the least related;S's

Q0777:What's the difference between small and non-small cell carcinomas?

for small cells; surgery is useless

Q0778:Horner's Symptoms

ptosis (droopy eyelid);miosis (pupil constriction);anhidrosis (lack of sweat)

Q0779:COPD = also known as OLD: obstructive lung disease: why is it called obstructive?

obstruction of AIR FLOW → air trapping in lungs

Q0780:COPD = also known as OLD: obstructive lung disease: what is the major PFT finding?

FEV1 / FVC ration is decreased (hallmark finding)

Q0781:COPD = also known as OLD: obstructive lung disease: name the 4 types of COPD

1) Chronic Bronchitis (Blue Bloater) 2) emphysema (pink puffer) 3) asthma 4) bronchietasis

Q0782:COPD = also known as OLD: obstructive lung disease: what is the definition of Chronic Bronchitis

productive cough for >3 consecutive months in two or more years.

Q0783:COPD = also known as OLD: obstructive lung disease: what do you expect on lung histology?

hypertrophy of mucus-secreting glands in the bronchioles (Reid index of >50%)

Q0784:COPD = also known as OLD: obstructive lung disease: leading cause is smoking: what are the physical findings for Chronic Bronchitis? (name 3)

1)cyanosis 2) wheezing 3) crackles

Q0785:what is the pathophysiological mechanism of EMPHYSEMA?

destruction of fibrous septa/alveolar walls → enlargement of air space and decreased total surface area for gas exchange

Q0786:if the cause is smoking; what kind of emphysema would you see on histo slide?

centri-acinar emphysema

Q0787:what else can cause emphysema: (also may work synergistically with smoking): What kind of findings do you see in lung histo and name another organ affected?

alpha 1-antitrypsin deficiency → panacinar emphysema + liver cirrhosis

Q0788:what causes the emphysema in this disorder?

increased elastase activity to damage lung tissue.

Q0789:name 4 findings of emphysema (in general)

1) dyspnea; 2) decreased breath sounds 3) tachycardia 4) decreased I/E ratio

Q0790:What is mechanism of asthma

BRONCHIAL hypersensitivity/hyperresponsiveness → REVERSIBLE bronchoconstriction

Q0791:name 3 common asthma triggers

1) viral URI 2) allergens 3) stress!!

Q0792:name 7 asthma findings

1) cough 2) wheezing 3) dyspnea 4) hypoxemia 5)decreased I/E ratio 6) tachypnea 7) pulsus paradoxus

Q0793:BRONCHIECTASIS: what is its mechanism??

chronic necrotizing infection of BRONCHI → dilated airways; purulent sputum; recurrent infections; hemoptysis (see Robbins for a good discussion of this)

Q0794:what disorders is bronchietasis commonly associated with?

1) bronchial obstruction 2) cystic fibrosis 3) poor ciliary motility

Q0795:What are classic PFT findings for RLD?

decreased VC decreased TLC ; FEV1/FVC ration > 80%

Q0796:Name the two MAJOR types of RLD

1) poor breathing mechanics (EXTRA-pulmonary) 2) Interstitial lung diseases

Q0797:Name 3 lung volumes that are increased in COPD

increased TLC; increased FRC; increased RV

Q0798:What 2 values are BOTH reduced in COPD and RLD?

1) FEV1 and 2) FVC (think FEV1/FVC ratio) NOTE! in COPD; FEV1 is more dramatically reduced and thus the FEV1/FVC ratio is decreased

Q0799:what is the main pathology resulting from asbestosis?

DIFFUSE; interstitial fibrosis caused by inhaled asbestos Fibers.

Q0800:What cancers are increased in pts with asbestosis?

1) pleural mesothelioma 2) bronchogenic carcinoma (BC)

Q0801:Major finding in lung w/ asbestosis?

Ferruginous bodies: asbestos fibers coated with hemosiderin also 2) ivory white pleural plaques

Q0802:Neonatal respiratory distress syndrome: What is the main cause

surfactant deficiency --> to increased surface tension --> alveolar collapse

Q0803:Neonatal respiratory distress syndrome: surfactant is made by which cells? After when?

type 2 pneumocytes after 35th gestational week

Q0804:Neonatal respiratory distress syndrome: what do you measure? Where do you get this fluid?

lecithin-to-sphingomyelin ratio in the amniotic fluid = measure of lung maturation <1.5 in neonatal distress syndrome

Q0805:Neonatal respiratory distress syndrome: what is surfactant made of (chemical name)

dipalmitoyl phosph-tidyl-choline (DP-PTC)

Q0806:Neonatal respiratory distress syndrome: treatment for poor maturation of lungs

1) before birth = maternal steroids 2) after= artificial surfactant

Q0807:Karta-gener's syndrome: what is this?

immotile cilia due to dynein arm defect

Q0808:Karta-gener's syndrome: results in what in female and male? (4 things)

1) sterility (in male sperm also immotile) 2)bronchietasis 3)recurrent sinusitis (bacteria & particles not pushed out) 4) associated with situs inversus (e.g. dextro-cardia)

Q0809:name the 3 main classes of cancers that affect parts of the lung

1) bronchogenic carcinoma (with different subtypes) 2) carcinoid tumor 3) metastasis

Q0810:list the 5 types of major bronchogenic carcinomas

CENTRAL 1) squamous cell ca 2)small cell ca; PERIPHERAL 3) adenocarcinoma 4) bronchoalveolar ca 5) large cell ca

Q0811:mnemonic: what is meant by SPHERE of symptoms?

S= superior vena cava syndrome; P= pancoast tumor; H= Horner's syndrome; E= Endocrine (paraneoplastic); Recurrent laryngeal / hoarseness; E = Effusions (pleural OR pericardial)

Q0812:What can a CARCINOID tumor cause?

Carcinoid Syndrome = flushing; diarrhea; wheezing; and salivation

Q0813:Metastases to lung is very common; LUNG cancer also prone to metastasize to what other parts?

1) brain (epilepsy) 2) bone (fracture) 3)liver (jaundice + hepatomegaly)

Q0814:What is Pancoast's tumor?

it's a carcinoma of the apex of lung

Q0815:what may Pancoast's tumor affect?

may affect CSP= cervical sympathetic plexus causing Horner's syndrome

Q0816:what is Horner's syndrome?

P.A.M. is Horny = Ptosis; Anhydrosis; Miosis

Q0817:1st AID breaks it down into TYPE/ ORGANISM/ CHARACTERISTICS = cover parts of this table and fill in the blanks

0

Q0818:what causes acute epiglottitis; which may be lifethreatening in young children?

H. influenzae

Q0819:MC nasal and laryngeal tumor

Squamous cell CA

Q0820:Dx;Decreased FEV1/FVC ratio

COPD

Q0821:Dx;Charcot-Leyden crystals; Curschmann spirals; bronchial smooth muscle hypertrophy

Asthma

Q0822:Definition;Productive cough occurring at least 3 consecutive months over at least 2 years;what change occurs w/ cells?

Chronic Bronchitis;;(Inc mucous due to hyperplasia of mucous-secreting glands)

Q0823:Definition;Dilation of air spaces w/ destruction of alveolar walls and lack of elastic recoil

Emphysema

Q0824:Type of emphysema dealing with smoking

Centriacinar

Q0825:Type of emphysema dealing with A-1-A deficiency;what gene is difficient in most severe?

Panacinar;(piZZ - homozygous)

Q0826:Type of emphysema dealing with blebbing or subpleural bullae

Paraseptal

Q0827:Definition;perminant abnormal bronchial dilation caused by chronic infection w/ inflammation and necrosis of the bronchial wall

Bronchiestasis

Q0828:Dx;dilated airways; copious purulent sputum; hemoptysis and recurrent pulmonary infections leading to lung abscess (obstruction)

Bronchiectasis

Q0829:Definition;Diffuse alveolar damage w/ resultant increase in alveolar permeability; causing a leak of protein-rich fluid from the alveoli and formation of intra-alveolar hyaline membrane

Adult Respiratory Distress Syndrome (ARDS)

Q0830:Definition;Group of environmental diseases caused by inhalation of inorganic dust particles

Pneumoconioses

Q0831:Dx;inhalation of carbon dust; marked by carboncarrying macrophages

Anthracosis

Q0832:Dx;progressive massive fibrosis w/ necrotic black fluid and dark macules around bronchioles

Coal Miners Pneumoconiosis

Q0833:Dx;diffuse interstitial fibrosis mainly in the lower lobes w/ ferruginous bodies and dense fibrocalcific plaques of parietal pleura;what can it lead to?

Asbestosis;leads to: Mesothelioma

Q0834:Dx;bilateral hilar lymphadenopathy; hypercalcemia; noncaseating granulomas

Sarcoidosis

Q0835:Dx;localized proliferation of histiocytes that have characteristic inclusions resembling tennis rackets (birbeck granules)

Eosinophilic granulomas

Q0836:Definition;Immune complex Dz w/ progressive fibrosis of the alveolar wall

Idiopathic Pulmonary fibrosis

Q0837:MCC of Pulmonary HTN

COPD

Q0838:MCC of interstitial pneumonia;(2)

Mycoplama Pneumoniae;;Viruses

Q0839:What virus produces a Giant cell pneumonia?

Measles

Q0840:What pneumonia is seen in people working with cattle or sheep?

Rickettsial pneumonia;(Q-fever)

Q0841:Dx;Gohn complex

Primary TB

Q0842:Pulmonary infection;Abscess and sinus tract formation w/ exudate containing sulfur granules

Actinomycosis

Q0843:Tx of Neonatal Respiratory Distress syndrome

Give mother steroids before birth;(or artificial surfactant for infant)

Q0844:MCC of Lobar pneumonia

Pneumococcus

Q0845:Definition;Carcinoma in the apex of the lung that may affect cervical sympathetic plexus

Pancoast tumor

Q0846:what are the (2) lung cancers that are central?;what do they have a causitive link to?

Squamous cell;Small cell (Oat cell);;both: Smoking!

Q0847:Dx;cough; hemoptysis; bronchial wheezing; pneumonic "coin" lesion on x-ray

Lung Cancer

Q0848:Describe the (3) peripheral Lung Cancers

Adenocarcinoma;MC non-smoking; K-RAS oncogene;Bronchoalveolar;Tall columnar cells w/ along alveoli;Large cell;Undifferentiated

Q0849:Dx;lung tumor of major bronchi that may also cause flushing; diarrhea; wheezing and salivation

Carcinoid tumor

Q0850:(5)* complications of Lung tumors

SPHERE;Superior vena cava syndrome;Pancoast tumor;Horner's syndrome;Endocrine (paraneoplastic);Recurrent Laryngeal Sx (hoarsemess);Effusions (pleural or pericardial)

Q0851:Causes of Respiratory sounds;Stridor

Inspiratory sound from narrowing extrathoracic area ;(above glottis)

Q0852:Causes of Respiratory sounds;Wheezing

Narrowing of the intrathoracic airway during expiration

Q0853:Causes of Respiratory sounds;Crackles

Alveoli popping open ;due to;fluid (pneumonia; HF; ARDS) ;or fibrosis

Q0854:Causes of Respiratory sounds;Dullness to Percussion

fluid; pus; tumor or blood absorbing the sound b/t alveoli and chest wall

Q0855:Causes of Respiratory sounds;Hyperresonance

Air under the chest wall;(Pneumothorax)

Q0856:Causes of Respiratory sounds;Fremitus / Egophany

Consolidation;(Pneumonia)

Q0857:Dx;Increased Cold Agglutinin

Mycoplasma pneumonia

Q0858:Dx;laryngeal edema; steeple sign; unusual cough

Parainfluenza;(Croup)

Q0859:Dx;inhaling quartz or talc

Silicosis

Q0860:what is the second MCC of lung CA?

Radon gas

Q0861:Dx;Tracheal deviation towards side of lesion;(one main one possible)

Atelectasis;(Bronchial obstruction)

Q0862:Dx;Tracheal deviation away from the side of lesion;(one main one possible)

Pneumothorax;(Pleural Effusion)

Q0863:Dx;bronchiectasis; recurrent sinusitis; infertility; situs inversus;defect?

Kartagener's syndrome;(Dynein arm defect)

Q0864:What is the most common cause of typical community acquired pneumonia?

Streptococcus pneumoniae

Q0865:What is the most common cause of atypical pnuemonia?

Mycoplasma Pneumoniae

Q0866:Interstitial pneumonia is;

atypical

Q0867:bronchopneumonia is;

typical

Q0868:signs of consolidation; in terms of percussion; egophany; tactile fremitus; whispered pectorliloquy

dullness to percussion;egophany +;increased tactile fremitus;whipsered pectoriliquy +

Q0869:Consolidation indicates atypical or typical pneumonia?

Typical.

Q0870:What is the most common source of nosocomial pneumonia infection?

Respirators.

Q0871:What pathogen is usu responsible for respirator contracted pneumo?

Pseudomonas aeruginosa

Q0872:What three pathogens are associated with nosocomial pneumo?

Pseudomonas aeruginosa; Escheria coli; Staph aureus.

Q0873:Most common cause of the common cold.

Rhinovirus

Q0874:What type of influenzavirus is most often involved?

A

Q0875:2nd most common cause of atypical pneumonia

Chlamydia pneumoniae

Q0876:Case: newborn: afebrile; staccato cough; conjunctivitis; wheezing. Pathogen?

Chlamydia trachomatis

Q0877:Water loving bacteria that causes green sputum

Pseudomonas aeruginosa (respirators!)

Q0878:Most common cause of pneumonia in alcoholics. Then another cause.

Klebsiella pneumoniae or just S. pneumoniae.

Q0879:How do you differentiate between the two common causes of pneumo in alcoholics?

Klebsiella pneumoniae causes thick mucoid sputum; where as S pneumo does not.

Q0880:What bacterial cause of pneumo is associated with water coolers and produce mists?

Legionella pneumophila

Q0881:Case: Pneumo with hyponatremia. Pathogen and pathophys?

Legionella can cause tubulointerstitial disease with JG destruction learing to hyporeninemic hypoaldosteronism with hyponatremia; hyperk; and met acid.

Q0882:What is the most common opportunistic fungal infection and where is it found in the community?

Cryptococcus neoformans; found in pigeon poop.

Q0883:What fungal infection is associated with Ohio/central Mississippi River valley? What 3 animals carry it?

Histoplasma capsulatum. Bats; starlings; chickens. Thus assoc with cave explorers; spelunkers; and chicken farmers.

Q0884:What systemic fungi is associated with the central and southeast US?

Blastomyces dermatidis.

Q0885:SW "Valley fever;" increases after earth quakes (in dust).

Coccidioides immitis.

Q0886:Cave explorer in the Arizona desert with nonproductive cough.

Coccidioides; not Histoplasma. SW! dry!

Q0887:I say pigeons; you say;

Cryptococcus neoformans!

Q0888:What yeast will be phagocytosed by macrophages?

Histoplasma

Q0889:A nasal polyp in a kid is most likely caused by;

Cystic fibrosis.

Q0890:A nasal polyp in an adult is most likely caused by;

Allergies.

Q0891:A woman with chronic pain has asthma. What else?

A nasal polyp caused by NSAID use. Block cyclooxygenase; leave lipoxygenase path open. Leukotrienes C-D-E are increased; causing bronchoconstriction.

Q0892:What is a medically significant A-a gradient?

> 30

Q0893:What causes an increased A-a gradient?

Hypoxemia of pulmonary origin.

Q0894:Calculate and A-a gradient in a pt breathing .3 O2 who has PCO2 of 80 mmHg and PaO2 of 40 mmHg.

PAO2 = 0.3 (713) - 80/0.8 = 114 mmHg;A-a = 114-40 = 74 mm Hg; which is clinically significant

Q0895:Name 3 causes of hypoxemia with a normal A-a gradient.

1. Depression of medullary resp centers;- barbituates; brain injury;2. Upper Airway obstruction;-food block; epiglottitis; croup;3. Muscles of respiration dysfunction;-paralyzed diaphragm

Q0896:Name 3 general causes of hypoxemia with an increased A-a gradient

1. Ventilation defect;2. Perfusion defect;3. Diffusion defect

Q0897:Example of a ventilation defect

Airway collapse in ARDS - impaired O2 deliver to alveoli

Q0898:Example of perfusion defect

Pulmonary emobolus blocks blood flow to alveoli

Q0899:2 Examples of Diffusion defects

Interstitial Fibrosis;Pulmonary Edema;O2 can't diffuse alveoli->capillary

Q0900:What is the most common cause of fever 24-36 hours after surgery?

Resorption atelectasis;Ex: mucus plug obstructs airway; alveoli collapse.

Q0901:On Tension pneumothorax; what side does the trachea deviate to?

Contralateral - pushed by air compressing the lung.

Q0902:With resorption atelectasis; what side does the trachea deviate to?

Ipsilateral - goes where there is space.

Q0903:What cell synthesizes surfactant?

Type II pneumocytes.

Q0904:What increases surfactant synthesis? (2) Decreases? (2)

Increases: cortisol and thyroxine;Decreases: insulin (maternal diabetes); prematurity; c-section (less cortisol)

Q0905:How does surfactant work?

Prevents alveolar collapse on expiration by reducing surface tension.

Q0906:Is Infant RDS a ventilation; perfusion; or diffusion defect?

Ventilation; alveoli collapse.

Q0907:infant RDS treatment

PEEP

Q0908:Free radicals from O2 thrx in infant RDS can cause;(2)

blindness;bronchopulmonary dysplasia

Q0909:What causes hypoglycemia in the newborn?

Excess insulin from response to fetal hyperglycemia in maternal diabetes.

Q0910:What causes hyaline membranes?

proteins leaking out of damages pulmonary vessels

Q0911:What causes ARDS? Pathophys.

Pulmonary edema from acute alveolar capillary damage.

Q0912:What causes capillary damage in ARDS?

Acute damage ->macrophages release cytokines-> chemotactic to netrophils -> neuts transmigrate through pulm capillaries > leave holes -> protein leakage -> hyaline membranes

Q0913:Gram + diplocci on sputum stain = ;How do you treat?

Strep Pneumo. Treat with Penicillin G.

Q0914:How do you prevent Pneumocystis in AIDS pts?

Rx TMP/SMX (trimethoprim-sulfamethxazole) when CD4 is <200.

Q0915:What 3 things can Aspergillus cause?

1. Aspergilloma: fungus ball in old TB site; hemoptysis;2. Allergic reaction;3. Vessel invasion with hemorrhagic infarction and necrotic bronchopnuemo

Q0916:Where do most PE's come from?

Clot in femoral vein; NOT lower leg DVT.

Q0917:Where will an aspiration mass go if you are sitting? supine? right sided? Which is most common?

Sitting = R lower lobe; posterobasal;Supine = R lower lobe; superior seg;*most common;Right side= R upper lobe; superior seg

Q0918:What 2 diagnostic tests are used to diagnose PE? Gold standard?

1. VQ scan - V normal; Q off;2. Gold = pulm angiogram

Q0919:How do you prevent Pneumocystis in AIDS pts?

Rx TMP/SMX (trimethoprim-sulfamethxazole) when CD4 is <200.

Q0920:What 3 things can Aspergillus cause?

1. Aspergilloma: fungus ball in old TB site; hemoptysis;2. Allergic reaction;3. Vessel invasion with hemorrhagic infarction and necrotic bronchopnuemo

Q0921:Where do most PE's come from?

Clot in femoral vein; NOT lower leg DVT.

Q0922:Where will an aspiration mass go if you are sitting? supine? right sided? Which is most common?

Sitting = R lower lobe; posterobasal;Supine = R lower lobe; superior seg;*most common;Right side= R upper lobe; superior seg

Q0923:What 2 imaging diagnostic tests are used to diagnose PE? Gold standard?

1. VQ scan - V normal; Q off;2. Gold = pulm angiogram;NOT spiral CT;D-dimers also useful. Neg rules out PE.

Q0924:Interstitial Fibrosis;Restrictive or Obstructive?;FEV1;FVC;FEV1/FVC;TLC

Restrictive; all V decreased;FVC; TLC down;FEV1/FVC increased - FEV1 up bc of increased elasticity

Q0925:What is Caplan syndrome?

Rheumatoid nodules in lung + restrictive disease like Coal WP or Asbestos disease.

Q0926:What does Coal WP do to TB risk? Cancer risk?

Does not affect TB or cancer risk.

Q0927:What does silicosis do to cancer and TB risk?

Increases risk of cancer and TB

Q0928:What do lung opacities contain in silicosis?

Collagen and quartz. HARD as rocks; as they are made of rocks. Quartz is super fibrogenic

Q0929:What is the most common lesion related to asbestos exposure? What is the most common disease process?

1. Benign plueral plaques;2. Primary bronchogenic carcinoma;Mesothelioma takes longer to show up; thus less common than primary cancer

Q0930:What 2 complications are common in all 3 pneumoconiosis? (silicosis; coalwp; asbetosis)

Cor pulmonale;Caplan syndrome

Q0931:What do roofing and working in shipyards expose you to?

Asbetos

Q0932:What do foundries (casting metal); sandblasting; and mines expose you to?

Quartz / Silicosis

Q0933:What is the most common sxs of Sarcoidosis?

Dyspnea

Q0934:What does sarcoidosis do to the lung?

causes granulomas in interstitium and nodes; contain multinucleated giant cells

Q0935:Name 3 other manifestations of sarcoidosis (outside the lung)

1. Nodular skin lesions;2. Eye lesions;3. Granulomatous hepatitis;4. Enlarged lacrimal glands;5. increased ACE;6. Hypercalcemia

Q0936:What is the likely cause of a pleural effusion in a young woman?

SLE - Lupus;example of serositis

Q0937:Farmer's Lung is caused by;

Moldy hay = saccharopolyspora rectivirgula / thermophilic actinomyces;Type III hypersensitivity - immune complex mediated;Type IV with Chronic exposure -> granuloma

Q0938:In Emphysema; compliance___ and elasticity___.

Compliance increases (inhalation) ;Elasticity decreases (exhalation)

Q0939:What's the difference between a transudate and an exudate?

Transudate: ultrafiltrate of plasma. ex: heart failure;Exudate: protein-rich; cell-rich fluid;ex: pneumonia; infarction; metastasis

Q0940:Pleural fluid protein / serum protein = 0.6;Transudate or exudate?

over 0.5 = exudate ;(more protein in fluid than plasma)

Q0941:Pleural fluid LDH/serum LDH = 0.7;Transudate or exudate?

over 0.6 = Exudate

Q0942:What lung cancer can cause Horner's syndrome and why?

Pancoast tumor of superior sulcus - usu primary sq cell cancer in extreme apex. Can destroy superior cervical ganglion and cause horners (eye lid lag; miosis - pinpoint pupil; anhydrosis - no sweating)

Q0943:What is the most common type of lung cancer?

Metastatic more common than primary;Primary; most common is Adenocarcinoma.

Q0944:Are cancers caused by smoking usually peripheral or central?

Central;However; after filters were installed in cigarettes; the big carcinogens got filtered out. Now; peripheral cancers caused by the small carcinogens are increasing.

Q0945:Which two cancers have the strongest association to smoking?

1. Squamous cell;2. Small cell

Q0946:Is adenocarcinoma related to smoking? Where in the lungs is it usually found.

Adenocarcinoma is not usually associated with smoking; usually found peripherally.

Q0947:What is the most important first step in evaluating a "coin lesion" on a chest x-rays.

Compare size from previous x-rays.

Q0948:What three cancers are most often associated with lung mets?

1. Primary Breast;2. Colon; Renal Cell

Q0949:What is the most common symptom of primary lung cancer? What about metastatic?

Cough for primary; dyspnea for metestatic. (Still have dyspnea in primary.)

Q0950:Where does primary lung cancer metastisize to?

1. Hilar lymph nodes;2. Adrenal gland;3. Liver (50%); brain (20%); bone

Q0951:Name 5 issues associated with CF that are not pulmonary.

1. Malabsorption - pancreatic exocrine def;2. Type 1 diabetes - chronic pancreatitis;3. Male infertility;4. Meconium ileus in bebes;5. 2ary Biliary cirrhosis - bile duct obstruction by thick secretions

Q0952:What is the most common respiratory pathogen in CF?

pseudamonas aeruginosa

Q0953:What is the most common cause of death in CF?

Respiratory infection.

Q0954:Most common cause of bronchiectasis in US? INternational?

US - CF;Int - TB

Q0955:What condition is associated with cupfuls of sputum production?

Bronchiectasis; due to dilation of bronchi and bronchioles that get filled with pus. Ew.

Q0956:Extrinsic asthma is associated with what type of hypersensitivity rxn?

Type 1 - IgE dependent activation of Mast cells.

Q0957:All these things are involved in asthma pathology. Tell me the story of how: Eotaxin; IL4; T cells; eosinophils; mast cells; major basic protein; IL5; histamine; cationic protein; LTC-D-E; Acetylcholine

1. Inhaled allergen sensitizes by stimulating helper T cells (CD4Th2) that release IL 4 and IL 5;IL 4 - IgE production;IL 5 - production and activation of eosinophils;2. Antigens crosslink IgE on mast cells; release histamine + mediators -> bronchoconstriction; mucus; leukocytes;3. Late phase (4-8 hrs later);Eotaxin - chemotactic for eosinophils;Eosinophils release major basic protein and cationic protein; which damage epithelial cells and produce airway constriction;LTC-D-E cause prolonged bronchoconstriction;Acetylcholine causes airway muscle contraction.

Q0958:How are IL4 and IL5 involved in extrinsic asthma?

Released by Tcells;IL4 stimulates isotope switching to IgE production;IL5 stimulated production and activation of eosinophils.

Q0959:Name two causes of emphysema

1. Smoking;2. alpha-1-antitrypin def (AAT)

Q0960:What causes airway collapse in emphysema?

Loss of elastic tissue - loss of radial traction.

Q0961:What causes panacinar emphysema? Centriacinar?

Panacinar = AAT def;Centriacinar = smoking

Q0962:Curschmann spirals and Charcot-Leyden crystals are histologic evidence of what disease?

Asthma.

Q0963:What lung cancer is associated with hypercalcemia?

Squamous Cell

Q0964:What lung cancer is associated with Cushings?

Small Cell

Q0965:(3) branches of the celiac trunk

Left Gastric A;Splenic A;Common Hepatic A

Q0966:(2) branches of the Common Hepatic Artery that supply the stomach

Right Gastric A;Gastroduodenal A

Q0967:trace the Gastroduodenal Artery to the spleen

GDA -> R. Gastroepiploic A ->;L. Gastoepoploic A -> spleen;(Gastroepiploic AA supply blood to Greater curvature of stomach - can also be called Gastro-omenal AA)

Q0968:Name the Veins that you would see varices in w/ portal HTN;(3 sets)

Esophageal;Left gastric -> Azygos;External hemorrhoids;Superior -> Inferior rectal;Caput Medusae;Paraumbilical -> Inferior Epigastric

Q0969:what does the Submucosa portion of the GI contain and control?

Submucosa;meiSSner's plexus;control;Secretions; blood flow and absorption

Q0970:what does the Muscularis portion of the GI contain and control?

Muscularis;Myenteric Auerbach's plexus;control: Motility

Q0971:what is the immunoglobulin of the gut?

IgA

Q0972:Definiton;Secrete alkaline mucous to neutralize acid contents entering the duodenum from the stomach

Brunner's glands

Q0973:what is the name of the structure where the hindgut meets the ectoderm in development?;why is it significant?

Pectinate line;Above line: Internal hemorrhoids;Below line: External

Q0974:Innervation; blood supply and pain level to Internal Hemorrhoids

Nerves: Visceral innervation;Blood: Superior rectal A;Pain: none

Q0975:Innervation; blood supply and pain level to;External Hemorrhoids

Nerves: Somatic innervation;Blood: Inferior rectal (Pudendal branch);pain: Painful

Q0976:what are the objects from lateral to medial in the Femoral Triangle?

NAVEL;Nerve;Artery;Vein;(Empty);Lymphatics

Q0977:what are the top; medial and lateral edges of the Femoral triangle?

Top: Inguinal ligament;Medial: Adductor Longus m;Lateral: Sartorius m

Q0978:What is Hasselbach's triangle made of?

Lateral: Inferior Epigastric A;Medial: Rectus Abdominis;Bottom: Inguinal ligament

Q0979:best landmark to determine of the inguinal hernia is Direct or Indirect

Inferior Epigastric artery;[MDs don't LIe];Medial to artery = Direct;Lateral to artery = Indirect

Q0980:why is the Indirect hernia more common in infants?

failure of Processus Vaginalis to close

Q0981:what is the primary cause of Achalasia?;secondary?

Primary;Failure of LES to relax due to loss of Auerbach's plexus;Secondary;Chagas Dz

Q0982:Dx;"Olive" mass in epigastric region and projectile vomiting at 2 weeks of age

Pyloric stenosis

Q0983:Dx;Infecton of GI causing PAS-positive macros in intestinal lamina propria and mesenteric nodes

Whipple's Dz;(T. Whippelii)

Q0984:Definition;epithelial tumor arising from precursor cells of the enamel origin

Ameloblastoma

Q0985:MC Salivary gland tumor

Pleomorphic Adenoma

Q0986:Dx;newborn w/ copious salivation assoc w/ choking; coughing and cyanosis on attempts at eating

Tracheoesophageal fistula

Q0987:Definiton;Acute gastritis in assoc w/ severe burns

Curling Ulcer

Q0988:Definiton;Acute gastritis in assoc w/ brain injury

Cushing ulcer

Q0989:Definition;focal damage to the gastric mucosa w acute inflammation; necrosis and hemorrhage

Acute (erosive) Gastritis

Q0990:Dx;Autoimmune dz; pernicious Anemia; Achlorhydria;where in stomach?

Chronic (nonerosive) Gastritis Type A (3 As);(Fundal)

Q0991:MC form of Chronic Gastritis;where in stomach?

Type B;H. Pylori-assoc Gastritis;[B = Bug];(Antrum)

Q0992:Dx;Pain greater w/ meals;Ulcer cause?

Gastric;[Gastric = Greater w/ meals];Cause;low mucosal protection vs. acid;(H.pylori and NSAIDs)

Q0993:Dx;Pain Decreases w/ meals;Ulcer cause?

Duodenal ulcer;[Duodenal = Dec w/ meal];Cause: H.pylori

Q0994:MC type of stomach cancer;(2) Extra-GI sites of involvement

Adenocarcinoma;extra sites;Virchow node;;Krukenberg tumor - signet-ring cells in bilateral Ovary

Q0995:Definition;Stomach cancer that is diffusely infiltrative (thickened; rigid appearance)

Linitis Plastica

Q0996:Definition;extreme enlargement of gastric rugae and possible loss of plasma proteins from altered mucosa

Menetrier Dz;(giant hypertrophic gastritis);[MENE large Rugae]

Q0997:Dx;colon inflammation w/ crypt abscesses and pseudopolyps

Ulcerative colitis

Q0998:Definition;twisting of portion of bowel around its mesentary

Volvulus

Q0999:remnant of Embryonic Vitelline duct

Meckel's Diverticulum

Q1000:Dx;inc serotonin; cutaneous flushing; diarrhea; bronchospasm; valvular lesions of right heart; RLQ mass

Carcinoid tumor;(MC place = Appendix)

Q1001:Definition;dilation of the colon due to the absence of ganglion cells;underlying cause?

Hirschsprungs Dz;(colon SPRUNG open);cause: failure of neural crest cells to migrate

Q1002:Dx;trisomy 21 patient w/ chronic constipation early in life

Hirschsprungs Dz

Q1003:MC place for ischemic bowel due to being poorly vascularized regions;(2)

Splenic flexure;Rectosigmoid junction

Q1004:Dx;Unexplained lower bowel bleeding

Angiodysplasia

Q1005:Dx;inflammation of the colon w/ flask-shaped ulcers

Amebic colitis;(E. Histolytica infection)

Q1006:Dx;barrium swallow has "apple core" lesion in lower GI

Colorectal cancer

Q1007:which polyp is benign?;which is most malignant?

Benign: Tubular Adenoma;;most malignant: Villous Adenoma

Q1008:Dx;polyps of the colon and small intestines and melanotic accumulations in the mouth; lips; hands and genitals

Peutz-Jegher syndrome

Q1009:Dx;adenomatous polyps w/ osteomas and soft tissue tumors

Gardner syndrome

Q1010:Dx;adenomatous polyps w/ tumors of the CNS

Turcot syndrome

Q1011:Causes of Micronodular Cirrhosis;(3)

Metabolic insult;Wilsons Dz;;Alcohol;;Hemochromatosis

Q1012:what type of shunt may releive portal HTN?;connecting what vessels?

Portacaval shunt;between Splenic vein and Lt Renal vein

Q1013:Another name for AST in lab

SGOT

Q1014:Dx;swollen; necrotic hepatocytes; PMN infiltrates; intracytoplasmic eosinophilic inclusions; fatty change; sclerosis around central vein

Alcoholic Hepatitis

Q1015:Best tx for staph food poisoning?

Bed rest

Q1016:Bacterial infection from raw oyster?

Cholera

Q1017:What is the antibx of choice for severe cholera?

Tetracycline

Q1018:Tightly knotted ball of nematodes (15 to 35 cm in length); worms have tapered ends without hooks;species?

Ascaris lumbricoides

Q1019:Which Vibrio cholera serogroup is the most common cause of cholera epidemics?

1

Q1020:Celiac disease is associated with which HLAs? Predisposes to which neoplasms?

HLA-B8 and DQW2; predisposes to T-cell lymphoma; and GI and breast cancer

Q1021:The retropharyngeal space is located between which two layers of fascia?

Buccopharyngeal layer of deep cervical fascia and the prevertebral layer of deep cervical fascia

Q1022:Metoclopramide is used to treat;? can antagonize which receptors?

Prokinetic agent used to treat GERD. Can antagonize dopamine receptors.

Q1023:Both pancreatic buds form from evaginations from which part of the duodenum?

Second part

Q1024:Which antibiotic can cause a disulfiram-like reaction when taken with alcohol?

Metronidazole

Q1025:Which vessel gives off the short gastric arteries?

Splenic artery

Q1026:Internal hemorrhoids are produced by varicosities of which vein?

Superior rectal vein

Q1027:Misoprostol is what type of drug? Prophylaxis to prevent;?

Prostaglandin analog to prevent NSAID-induced ulcers

Q1028:Which muscle elevates the lower jaw during chewing? Moves the lower jaw forward? Backward?

Medial pterygoid. Lateral pterygoid. Temporalis

Q1029:Which salivary gland has the greatest % of mucus secreting cells? Serous?

Sublingual. Parotid.

Q1030:Which H2-receptor antagonist is a potent hepatic enzyme inhibitor?

Cimetidine

Q1031:What type of mucosa is normal for the distal esophagus?

Non-keratinized; stratified; squamous epithelium

Q1032:What ligament separates the greater peritoneal sac from the right portion of the lesser peritoneal sac?

Gastrohepatic ligament

Q1033:What type of heterotopia can occur in the small intestine without causing bleeding?

Pancreatic heterotopia

Q1034:The left renal vein drains into;?

IVC

Q1035:The splenorenal ligament contains which vessels?

The splenic artery and vein

Q1036:Mesalamine is indicated for the treatment of;?

Ulcerative colitis.

Q1037:Pseudomembranous colitis produces what kind of diarrhea?

Greenish; foul-smelling watery diarrhea.

Q1038:The right gastroepiploic artery is a branch of;?

Gastroduodenal artery

Q1039:Which anesthetic can cause idiosyncratic hepatic failure?

Halothane

Q1040:Elevated AST and ALT reveal what process in which tissue?

Hepatocellular death

Q1041:CCK is secreted in response to;?

The presence of amino acids and fatty acids in the duodenum

Q1042:Ondansetron selectively antagonizes which receptors?

5HT3 receptors

Q1043:Lipoprotein lipase is located where?

External surface of endothelium of tissues with triglyceride needs such as muscle and lactating breast.

Q1044:What type of stones can be seen in liver fluke infestation?

Bilirubin stones

Q1045:The free edge of the lesser omentum contains which three important structures?

Common bile duct; hepatic artery; and the portal vein

Q1046:What agents are absolutely contraindicated in patients with bowel obstruction?

Prokinetics; such as metoclopramide

Q1047:Gastroschisis? Caused by?

Abdominal viscera protrude from the abdominal cavity at birth. Caused by incomplete fusion of the lateral body folds

Q1048:Motilin is released by;?

Small intestine

Q1049:How does secretin affect the rate of stomach emptying?

Decreases the rate of stomach emptying

Q1050:Inferior rectal nerve is a branch of;?

Pudendal nerve of the sacral plexus

Q1051:Sepsis; hypotensions; and neutrophilia in an infant who has been started on oral foods;?

Necrotizing enterocolitis.

Q1052:Which narcotic is least likely to cause spasm of the sphincter of Oddi? Why?

Meperidine; due to its anti-muscarinic properties.

Q1053:Superior pancreaticoduodenal artery gets it's blood supply from? Inferior?

Celiac trunk by means of the common hepatic artery. SMA.

Q1054:Which tx for GERD could cause torsades de pointes when given with erythromycin?

Cisapride.

Q1055:Disulfiram?

a drug used to support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol.

Q1056:This parasite can cause mild diarrhea; or more aggressive dysentery; peritonitis; or liver abscess formation;

Entamoeba histolytica

Q1057:Microabscesses in mesenteric lymph nodes is associated with which bug?

Yersinia enteritis

Q1058:Enlarged and ulcerated Peyer's patches are associated with which infection?

Salmonella typhii

Q1059:Cholera enterotoxin activates which enzyme?

Adenylate cyclase

Q1060:Megaloblastic anemia can be caused by which parasite?

Diphyllobothrium latum

Q1061:Kid vomits up a cylindrical white worm 30 cm long;How was this organism acquired?

Ingestion of eggs from human feces (Ascaris lumbricoides)

Q1062:Which hepatitis virus is a major cause of epidemics but does not cause significant mortality in pregnant women?

Hepatitis A

Q1063:A patient with dumping syndrome should eat small; frequent meals that are high in;?

Fat

Q1064:What deficiency could cause a decrease in serum calcium and phosphate?

Vitamin D

Q1065:Mini epidemic of pediatric diarrhea;?

Yersinia

Q1066:Traveler's diarrhea - empiric tx?

Ciprofloxacin

Q1067:Undercooked chicken - bloody diarrhea; abdominal pain; and fever;?

Campylobacter jejuni

Q1068:Liver abscesses - what parasite;?

Entamoeba histolytica

Q1069:OOcysts 5-7 microns in diameter;organism? Where does it's sexual phase occur?

Crytosporidiosis - invades the brush border of the intestinal epithelium

Q1070:An obstruction in the common bile duct would affect the urine how?

Increased urine bilirubin - tea-colored urine

Q1071:Oval eggs flattened along one side? Causes anal pruritis?

Enterobius vermicularis (pinworm)

Q1072:Hep B infection causes what in the majority of cases?

Subclinical disease followed by recovery

Q1073:Darkly colored faceted stones with irregular shapes are associated with which infestation?

Opisthorchis sinensis (oriental liver fluke)

Q1074:Rotavirus symptoms in kids?

Watery non-bloody diarrhea; often coupled with nausea and vomiting

Q1075:Norwalk agent usually affects kids older than;?

2

Q1076:A stomach lesion on the lesser curvature with piled up ulcer edges suggests;?

Gastric carcinoma

Q1077:What are predisposing factors for gastric carcinoma?

Pernicious anemia; chronic gastritis; achlorhydria; bacterial overgrowth; and neoplastic polyps

Q1078:Achlorhydria?

Absence of HCl in the stomach

Q1079:Type A gastritis - increased or decreased likelihood of developing gastric carcinoma?

Increased

Q1080:Symptoms of fever; chills; hypotension; and fluidfilled blisters progressing to muscle necrosis;?

Vibrio vulnificus

Q1081:Nonmotile bug; cuases dysentery?

Shigella

Q1082:Plague bug?

Yersinia pestis

Q1083:Hypertrophic pyloric stenosis usually presents when?

Several weeks of age

Q1084:The parasympathetic preganglionic innervation to the internal anal sphincter is provided by which nerve?

Pelvic nerve

Q1085:Courvoisier sign?

Painless distention of the gallbladder

Q1086:Which bug produces exotoxin A?

Staph aureus

Q1087:Which apolipoprotein molecule activates lipoprotein lipase?

CII

Q1088:Supparative cholangitis can occur as a complication of infestation by;?

Roundworm (ascaris lumbricoides) and the liver flukes Clonorchis sinensis and Fasciola hepatica

Q1089:Which damaging agents could cause development of hepatocellular carcinoma in the setting of cirrhosis?

HBV; alcohol; hemochromatosis

Q1090:Loss of villi and intraepithelial lymphocytic infiltration?

Celiac sprue

Q1091:Granular; spherical; thin-walled cysts measuring 10-20 um in diameter;trichrome stains show up to four nuclei in most of the cysts;?

Entamoeba histolytica

Q1092:scleral icterus typically reflects which fraction of biliribuin that binds tissues more avidly;?

Uncojugated bilirubin

Q1093:Which nodes drain the greater curvature of the stomach? The bladder and male internal genitalia? The distal stomach; pancreas and duodenum?

Gastroepiploic nodes. Internal iliac nodes. Subpyloric nodes.

Q1094:What are the most important predictors of a carcinoid's metastatic potential?

Location and size

Q1095:Acute hemorrhagic pancreatitis causes what changes to the pancreas?

Autodigestion; chalky-white 'fat necrosis;' hemorrhagic; edematous

Q1096:Name two polyposis syndromes that do not preispose for colon cancer?

Juvenile polyposis syndrome and Peutz-Jeghers syndrome

Q1097:Glands and sawtooth crypts with a proliferation of goblet and columnar epithelial cells - what type of polyp?

Hyperplastic polyp

Q1098:What is a pancreatic pseudocyst?

Complication of pancreatitis - lined by granulation tissue and collagen; containing pancreatic juices and lysed blood.

Q1099:Acetaminophen toxicity would cause elevation in which enzymes?

AST and ALT

Q1100:This is formed by herniation of the mucosa at a point of weakness at the junction of the pharynx and esophagus in the posterior hypopharyngeal wall…?

Zenker’s diverticulum

Q1101:What is the triad of Plumner-Vinson syndrome?

Esophageal webs; atrophic glossitis; and iron-deficiency anemia

Q1102:Markedly enlarged rugal folds can be seen in several conditions; including…?

Infiltrative cancer; lymphoma; hypersecretory gastropathy; and Menetrier disease

Q1103:What is Menetrier disease?

Men at rear – protein losing enteropathy – marked hyperplasia of mucus-secreting cells.

Q1104:Tuberculosis GI involvement?

Mass lesions and strictures

Q1105:Oral squamous cell carcinoma is most often located;? Which HPV is associated with almost half of all oral cancers?

Floor of the mouth. HPV16

Q1106:Acute gastritis can be seen as a complication of which other conditions?

Alcohol use; NSAIDs; smoking; shock; steroid use; and uremia

Q1107:Which autoimmune disease is associated with atrophic gastritis?

Pernicious anemia

Q1108:Tumor composed of uniform round cells arranged in trabeculae; with a 'salt-and-pepper' chromatin pattern

Carcinoid

Q1109:Cardiac failure; megaesophagus in Brazilian man;?

Chagas

Q1110:One of the most common etiologic agents of infective esophagitis;?

Herpes simplex

Q1111:What parts of the liver are Zones 1; 2; and 3; associated with;?

Zone 1 - periportal;Zone 2 - intermediate;Zone 3 - Central vein

Q1112:Which liver zone contains the P450 oxidase enzyme system?

Zone 3

Q1113:Disease characterized by inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts; producing alternating strictures and dilatation;?

Primary sclerosing cholangitis

Q1114:Usual cause of intestinal amebiasis; with small nuclei with distinctive tiny central karyosomes;?

Entamoeba histolytica

Q1115:Most likely cause of sudden gastrointestinal obstruction?

Intussusception

Q1116:On biopsy; this protozoan appears crescent-shaped;?

Giardia lamblia

Q1117:Tumors from the penis; vagina; and anal canal drain to which lymph nodes?

Medial side of the horizontal chain of the superficial group of inguinal lymph nodes

Q1118:Eosinophilic cytoplasmic inclusions;?

Mallory bodies

Q1119:Predisposing condition to angiosarcoma in the liver?

Vinyl chloride exposure (used in the rubber industry)

Q1120:Liver steatosis would progress to what if the noxious stimulus is removed?

Complete regression

Q1121:Pancreatic calcifications constitute strong radiologic evidence of;?

Chronic pancreatitis

Q1122:T or F? Pernicious anemia is an autoimmune disease associated with atrophic gastritis

True

Q1123:Celiac sprue is located;?

Proximal small bowel

Q1124:Polycythemia vera woman develops progressive severe ascites and tender hepatomegaly;?

Budd-Chiari

Q1125:Definition;intracytoplasmic eosinophilic inclusions;what are they seen in?

Mallory bodies;in: Alcoholic hepatitis

Q1126:Dx;high unconjugated bilirubin w/o hemolysis; decreased UDP-glucuronyl transferase; stress induced; no sx

Gilbert's syndrome

Q1127:Dx;high unconjugated bilirubin w/o hemolysis; absent UDP-glucuronyl transferase; jaundice; kernicterus; CNS damage

Crigler-Najjar syndrome

Q1128:Dx;Increased Conjugated bilirubin; brown to black discoloration of liver

Dubin-Johnson syndrome

Q1129:Dx;hypergammaglobinemia and anti-smooth muscle Ab

Autoimmune Hepatitis

Q1130:Dx;severe obstructive jaundice; itching; hypercholesterolemia; xanthomas

Primary Biliary cirrhosis;(Anti-mitochondrial Ab)

Q1131:Definition;extrahepatic biliary obstruction causing increased pressure in intrahepatic ducts leading to injury and fibrosis; Inc Alk phos; Inc conjugated bilirubin

Secondary Biliary Cirrhosis

Q1132:Dx;tender hepatomegaly; ascites; polycythemia; hypoglycemia;what is elevated in serum?

Hepatocellular CA;(elevated alpha-fetoprotein)

Q1133:Definition;Inadequate hepatic copper excretion and failure of copper to enter circulation; leading to copper accumulation in organs

Wilson's Dz;(Auto Resessive)

Q1134:Dx;asterixis; parkinsonian sx; cirrhosis; low ceruloplasmin; dementia

Wilson's Dz;ABCD;Asterixis;Basal ganglia sx;Copper accumulation/low Ceru;Dementia

Q1135:Dx;occlusion of IVC or hepatic veins w/ centrilobular congestion and necrosis; assoc w/ polycythemia; abd CA; or complication of pregnancy

Budd-Chiari syndrome

Q1136:Hyperbilirubinemia type; urine bilirubin and urine urobilinogen changes for;Hepatocellular jaundice

Conjugated/Unconjugated;Inc Urine Bilirubin;nml/Dec Urobilinogen

Q1137:Hyperbilirubinemia type; urine bilirubin and urine urobilinogen changes for;Obstructive jaundice

Conjugated;Inc Urine Bilirubin;Dec Urobilinogen

Q1138:Hyperbilirubinemia type; urine bilirubin and urine urobilinogen changes for;Hemolytic jaundice

Unconjugated;Absent urine Bilirubin;Inc Urobilinogen

Q1139:Dx;hepatoencephalopathy in young children w/ virus who are given aspirin

Reye's syndrome

Q1140:what is chronic calcifying pancreatitis assoc with?

alcoholism

Q1141:what is chronic obstructive pancreatitis assoc with?

Gallstones

Q1142:Cause of Cholangiocarcinoma

Liver fluke;(C.sinensis)

Q1143:Dx;"Strawberry gallbladder"

Cholesterolosis

Q1144:what causes the GB to become enlarged and distended?

Tumors (not stones)

Q1145:(3) changes in the pancreas w/ Acute Pancreatitis

Hemorrhagic Fat Necrosis;Calcium soaps (leading to HypoC);Pseudocysts

Q1146:Dx;abdominal pain radiating to back; migratory thrombophlebitis; obstructive jaundice w/ palpable GB

Pancreatic Adenocarcinoma

Q1147:Dx;malabsorption problem w/ positive D-xylose test;what CA can it lead to?

Celiac Sprue;;leads to: T-cell lymphoma

Q1148:Diverticuli are blind pouches found in the:

alimentary tract

Q1149:Diverticuli are lined by:

Mucosa; muscularis; and serosa

Q1150:The 4 GI tract locations of diverticuli are:

esophagus; stomach; duodenum and colon

Q1151:Why are most diverticuli termed false?

They lack or have an attenuated muscularis mucosa.

Q1152:Percent of older patients likely to get diverticulosis (many diverticula):

50% of patients >60

Q1153:The reasons for increasing number of diverticula with age are:

Increased intraluminal pressure and focal weaknes in the colonic wall.

Q1154:What type of diet is diverticulosis associated with?

low-fiber

Q1155:Sx of diverticulosis?

usually asymptomatic; sometimes vague discomfort.

Q1156:Diverticulitis commonly presents with pain where?

LLQ

Q1157:Complications of diverticulitis include:

perforation; peritonitis; abcess formation; bowel stenosis

Q1158:What is intussuception?

telecoping of 1 bowel segment into distal segment.

Q1159:Complication of intussusception is:

compromised blood supply.

Q1160:What is volvulus?

Twisting of portion of the bowel around its mesentery.

Q1161:What volvulus lead to?

obstruction.

Q1162:What is the most common type of stomach cancer?

adenocarcinoma

Q1163:Is this cancer aggresive?

Yes; it has early aggressive local spread and node/liver mets

Q1164:Stomach Cancer is associated with what 3 etiologic factors?

dietary nitrosamines; achlorhydria; chronic gastritis

Q1165:What is stomach cancer termed when it is diffusely infiltrative with thickened and rigid appearance?

Linitis plastica

Q1166:What does Virchow's node signify?

involvement of supraclavicular node by stomach mets

Q1167:What is Krukenberg's tumor?

bilateral stomach cancer mets to the ovary

Q1168:What are characteristics of Krukenberg's tumor?

Abundant mucus; "signet ring" cells

Q1169:What is Hirschprung's diease?

congential megacolon

Q1170:What is missing?

enteric nerve plexus (both Auerbach's and Meissner's). Seen on biopsy

Q1171:What is the cause of this disease?

failure of neural crest migration.

Q1172:How does this disease present?

Chronic constipation early in life.

Q1173:Which part of the colon is dilated?

That part proximal to the aganglionic segment - aganglionic portion is constricted.

Q1174:The risk factors for colorectal cancer are:

colorectal villous adenoma; IBD; low-fiber diet; age; FAP; HNPCC; personal and family hx. of colon cancer.

Q1175:What is Peutz-Jeghers; and does it lead to colorectal cancer?

It is a benign polyposis syndrome which is not a risk factor.

Q1176:Who schould be screened for colorectal cancer and how?

People over age 50; screen with stool occult blood test.

Q1177:Cirrho in Greek means:

tawny yellow

Q1178:Cirrhosis is:

diffuse fibrosis of the liver with destruction of norml architecture; nodular regeneration.

Q1179:Cause of micronodular cirrhosis (nodules <3mm; uniform in size) is:

metabolic insult

Q1180:Causes of macronodular cirrhosis (nodules >3mm; varied in size) are?

Significant liver injury leading to hepatic necrosis (postinfectious; drug-induced hepatitis)

Q1181:Cirrhosis is assocated with what type of cancer?

hepatocellular carcinoma

Q1182:The effects of portal hypertension are:

esophageal varices (hemetemesis; melena); peptic ulceration (melena); splenomegaly; caput medusae; ascites; hemmorhoids; and testicular atrophy

Q1183:Portal hypertension may be relieved by what method?

Portacaval shunt between splenic vein ad left renal vein.

Q1184:What are the effects of liver cell failure?

Coma; scleral icterus; fetor hepaticus (breath smells like a freshly opened corpse); spider nevi; gynecomastia; jaundice; loss of sexual hair; asterixis; bleeding tendency; anemia; ankle edema

Q1185:Hepatocytes in alcoholic hepatitis are:

swollen and necrotic

Q1186:Other histologic changes seen in aloholic hepatitis are:

neutrophil infiltration; mallory bodies (hyaline); fatty change; and sclerosis areound central vein

Q1187:SGOT (AST):SGPT (ALT) ratio in alcoholic hepatitis is:

usually more than 1.5 (A Scotch and Tonic: AST elevated)

Q1188:What is Budd-Chiari Syndrome?

Occlusion of the IVC or hepatic veins with centrilobular congestion and necrosis; leading to congestive liver disease

Q1189:The features of congestive liver disease are:

hepatomegaly; ascites; abdominal pain; and eventual liver failure

Q1190:Budd-Chiari Syndrome is associated with what 3 conditions:

polycythemia vera; pregnancy; hepatocellular carcinoma

Q1191:Wilson's disease is?

Copper accumulation; especially in liver; brain and cornea

Q1192:It is due to what?

failure of copper to enter circulation in the form of ceruloplasmin

Q1193:What is another name for Wilson's Disease?

Hepatolenticular degeneration

Q1194:What are the symptoms of Wilson's Disease? (A;B;C6;D)

Asterixis; basal ganglia degeneration (parkinsonian symptoms); Ceruloplasmin decrease; cirrhosis; corneal deposits (kayser-fleischer rings); copper accumulation; carcinoma (hepatocellular); choreiform movements; Dementia

Q1195:Somatotropic adenoma would affect glucose tolerance how?

Impaired glucose tolerance

Q1196:Describe how coma could result from complications of DM II?

Osmotic diuresis + dehydration = severe hyperosmolarity; Osmotic loss of water from neurons can produce coma

Q1197:Even small amounts of insulin are sufficient to prevent;?

Ketosis

Q1198:Beta hydroxybutyrate is a;?

Ketone body

Q1199:An XY fetus with a mutated dysfunctional androgen receptor molecule would develop how?

male sexual development is impaired and female external genitalia are formed;Because the androgen receptor in hypothalamic and pituitary tissue is also defective; normal testosterone suppression of pituitary gonadotrophs is absent

Q1200:How does the pituitary affect the sensitivity of peripheral tissues to the action of insulin?

GH - anti-insulin effects on liver and muscle. ACTH causes increased cortisol = decreased insulin sensitivity in peripheral tissues. TSH also tends to increase blood glucose levels

Q1201:ANP is released when?

When the atria are distended - suppresses the reninangiotensin-aldosterone system

Q1202:Graves is caused by;?

Increased production of thyroid-stimulating immunoglobulins

Q1203:T or F? Hyperthyroidism and hypothyroidism are always associated with increased and decreased radioactive iodine uptake; respectively.

False

Q1204:The sweating and palpitations of hypoglycemia are caused by;?

Epinephrin

Q1205:Link the following: dissecting osteitis and chronic renal failure

Hyperparathyroidism results from decreased serum calcium and increased serum phosphate (sequelae of renal failure). This may lead to osteomalacia and osteitis fibrosa cystica; which is classically associated with dissecting osteitis.

Q1206:Thyrotoxic crisis is most commonly seen in which disease?

Inadequately treated Graves' disease

Q1207:What are the HLA associations of DM I ?

DR3 and DR4

Q1208:What are the two most dangerous hormonal deficiencies?

Glucocorticoids and thyroid hormone

Q1209:Why does mild renal failure cause hyperkalemia?

Deficient renin production by the damaged kidney causes decreased secretion of aldosterone

Q1210:What types of infections are more frequently considered with Addison's?

Tuberculosis; fungal infections

Q1211:How to clinically distinguish primary from secondary adrenocortical insufficiency?

Secondary is not associated with skin hyperpigmentation (which results from increased production of ACTH precursor; which also stimulates melanocytes)

Q1212:Nonenzymatic glycosylation is seen in which disease?

Diabetes mellitus

Q1213:Euthyroid sick syndrome?

After systemic illnesses or stresses; there can be a decrease in 5'-monodeiodinase activity in peripheral tissues. Causes a decreased conversion of T4 to T3

Q1214:Describe how a short-term vs long-term severe Mg deficiency affects PTH?

Short-term - increased PTH;Long-term; severe - decreased PTH

Q1215:Which zones of the adrenal cortex does Addison's affect?

All three

Q1216:Early manifestations of cretinism?

Difficulty feeding; somnolence; failure to thrive; and constipation

Q1217:Chronic thyoiditis is aka.?

Hashimoto's thyroiditis

Q1218:How would a decrease in GH affect IGF-1 release?

Decrease

Q1219:What is testicular feminization?

Androgen insensitivity due to an androgen receptor defect

Q1220:PTH acts on which biochemical pathway?

Increased intracellular cAMP

Q1221:Somatostatin would inhibit the release of what from the pituitary?

GH and TSH

Q1222:Antimicrosomal antibodies are seen in which thyroid condition?

Hashimoto thyroiditis

Q1223:ACTH affects which zones of the adrenal cortex?

Inner two - fasciculata and reticularis

Q1224:When is gynecomastia normal/common?

Adolescent boys during puberty

Q1225:hCG is in the same hormone family as;?

TSH; FSH; and LH

Q1226:T or F? In a patient with DM II; you would expect deactivation of fatty acid synthase

False - fatty acid synthase is rapidly induced in the liver by high glucose and insulin levels

Q1227:What is Chvostek's sign?

Facial muscle contraction on tapping in front of the ear;Detects hypocalcemia

Q1228:Tx for acute hypocalcemia?

Calcium gluconate and cholecalciferol

Q1229:Which metabolite helps to raise serum calcium by increasing proximal intestinal absorption of calcium?

Cholecalciferol (Vit D3; 1;25-OH2-D3)

Q1230:T or F? Hypercalcemia can 'hyperstabilize' excitable tissue membranes and reduce normal responsiveness

True

Q1231:Laron dwarfism?

Congenital absence of growth hormone receptors;detected by an absence of GH binding protein; which is identical to the extracellular portion of the GH receptor

Q1232:T or F? Plasma levels of proinsulin are increased in patients with insulinomas?

True

Q1233:Prolactin has close structural homology with;?

GH

Q1234:Child who develops weight loss despite increased food intake?

Diabetes mellitus

Q1235:Sheehan's syndrome?

Hypopituitarism due to ischemic damage to the pituitary resulting from excessive hemorrhage during parturition

Q1236:T or F? Somatotropes are basophils.

False - they are acidophils

Q1237:Which drugs are antidiabetic agents that increase insulin sensitivity through a variety of mechanisms that result in decreased hepatic gluconeogenesis and increased insulindependent muscle glucose uptake?

Thiazolidinediones

Q1238:Hyperthyroid patient with mononuclear cell infilitrate in thyroid with multinucleated giant cells; follicular disruption; and loss of colloid;?

Subacute thyroiditis (aka granulomatous giant cell; de Quervain thyroiditis)

Q1239:Which syndrome is associated with coarctation of the aorta?

Turner syndrome

Q1240:Elevated anion gap; decreased arterial blood pH; and elevated blood lactate is a rare complication of which drug?

Metformin

Q1241:This disease is characterized among other things by Hurthle cells (oncocytes) and associated with various thymic disorders

Hashimoto thyroiditis

Q1242:Mucosal neuromas in a patient with a marfanoid syndrome is a marker for;?

MEN III

Q1243:Pituitary apoplexy is what? may result after;?

Life-threatening infarction of the pituitary gland. May result after obstetric hemorrhage: Sheehan syndrome

Q1244:How would clonidine affect pancreatic insulin secretion?

Clonidine; an alpha2-receptor agonist; would inhibit pancreatic insulin secretion

Q1245:T or F? Glucagon; gastrin; secretin; and CCK all stimulate insulin secretion

True

Q1246:Which category of drugs could blunt or prevent the premonitory signs and symptoms of acute episodes of hypoglycemia in a diabetic patient?

Beta adrenergic blockers - such as propnalol

Q1247:Solid balls of neoplastic follicular cells in a thyroid nodule biopsy?

Papillary carcinoma

Q1248:Riedel thyroiditis?

Rocklike stroma; fibrous reaction that may involve adjacent structures

Q1249:Which pancreatic tumor could cause necrotizing skin eruptions on the legs?

Glucagonoma - alpha cell tumor

Q1250:How does propylthioracil work?

Inhibiting the peripheral conversion of T4 to T3

Q1251:Which oncogene are MEN II and III associated with?

Ret oncogene

Q1252:Thyroid gland is enclosed by which fascia?

Pretracheal fascia

Q1253:GIP - how does it affect insulin secretion?

Increases beta cell release of insulin

Q1254:Nortriptyline - what is it; and how could it cause galactorrhea?

A TCA; inhibits dopamine pathways; stimulating prolactin; which causes galactorrhea

Q1255:What is the most reliable indicator of metastatic potential of a pheochromocytoma?

The actual presence of distant metastases

Q1256:How does adult polycystic kidney disease affect aldosterone?

Pressure exerted by the cysts can compromise glomerular blood flow; stimulating increased renin and thus increased aldosterone

Q1257:What is VMA and what is it used for?

Vanillylmandelic acid; a norepinephrine metabolite. Urine levels of this can diagnose pheochromocytoma

Q1258:Which one drains directly into the IVC: left renal vein or right renal vein?

Right renal vein

Q1259:Which thyroid condition frequently develops after a viral infection?

Subacute granulomatous (de Quervain's thyroiditis)

Q1260:Most common pituitary tumor? % of all pituitary tumors?

Prolactinoma with hyperprolactinemia makes up 30% of pituitary tumors.

Q1261:Characteristics of prolactinoma?

Most common pituitary tumor;Chromophobic staining;In women; leads to amenorrhea; galactorrhea;Undergoes dystrophic calcification;Underlying cause for 1/4 cases of amenorrhea

Q1262:Treatment for prolactinoma?

Most commonly bromocriptine: a dopamine receptor agonist that causes the lesion to shrink;Surgery

Q1263:What hypothalamic factors control release of the following pituitary hormones: TSH; PRL; ACTH; GH; FSH; LH?;Is the controlling factor stimulatory or inhibitory for each?

TSH: stimulated by TRH; inhibited by somatostatin;Prolactin: inhibited by dopamine;ACTH: stimulated by CRH;GH: stimulated by GHRH; inhibited by somatostatin;FSH: stimulated by GnRH;LH: stimulated by GnRH

Q1264:Characteristics of somatotropic adenoma?

Second most common pituitary tumor;Acidophilic staining;Causes release of somatomedins by liver (IGF-I; somatomedin C);Causes gigantism if during childhood; acromegaly during adulthood;Causes local compression in sela turcica.

Q1265:Characteristics of corticotropic adenoma?

Hypercorticism (Cushing disease);Basophilic staining;Weight gain; moon facies; thin/atrophied skin; hirsuitism; HTN; hyperglycemia due to insulin resistance

Q1266:Difference between Cushing disease and Cushing syndrome?

"Syndrome" is hypercorticism regardless of cause; "disease" is in the case of corticotropic adenoma of the pituitary.

Q1267:What is pituitary cachexia (Simmonds disease)? What are the 2 most common causes?

Generalized panhypopituitarism leading to marked wasting;Pituitary tumors and Sheehan's syndrome (postpartum pituitary necrosis) are the most common causes.

Q1268:What is Sheehan's syndrome?

Ischemic necrosis of the pituitary during child birth; due to hypoperfusion. The pituitary enlarges during pregancy but its blood supply does not; hence it is suspectible to peripartum blood loss.

Q1269:Symptoms of growth hormone deficiency?

In children: growth retardation;In adults: increased insulin sensitivity with hypoglycemia; decreased muscle strength; and anemia.

Q1270:Symptoms of gonadotropin deficiency?

In children: retarded sexual maturation;In adult men: loss of libido/muscular mass; impotence; decreased body hair;In adult women: amenorrhea; vaginal atrophy

Q1271:Result of TSH deficiency?

Secondary hypothyroidism.

Q1272:How to distinguish between deficiency of ACTH and primary adrenal failure (Addison disease)?

In Addison disease B-melanocyte stimulating hormone is still high leading to hyperpigmentation of skin. Not true in ACTH deficency; where B-MSH is also low.

Q1273:Function of oxytocin?

Induces uterine contraction during labor; ejection of milk from mammary alveoli

Q1274:Most common cause of SIADH?

Small cell carcinoma of lung;Other tumors can also produce ectopic ADH.

Q1275:Causes of ADH deficency (diabetes insipidus)?

Tumors;Trauma;Inflammatory processes;Lipid storage disorders;etc.

Q1276:What is empty sella syndrome?

Pituitary hypofunction due to destruction of all or part of the pituitary.

Q1277:What is Nelson syndrome?

Large pituitary adenomas that develop after bilateral adrenalectomy: due to a loss of feedback inhibition on preexisting pituitary microadenomas.

Q1278:What hormones are released by the neurohypophysis? Is it anterior or posterior?

Oxytocin; ADH;Posterior

Q1279:What hormones are released by the adenohypophysis? Is it anterior or posterior?

TSH; prolactin; ACTH; GH; FSH; LH;Anterior

Q1280:What is a craniopharyngioma?

Benign childhood tumor from remnants of Rathke pouch;Often cystic or calcified;Not a true pituitary tumor; but can have mass effects that cause pituitary hypofunction.

Q1281:What are the symptoms of a nonsecreting pituitary adenoma or other mass lesion in the sella?

Hypopituitarism; headache; visual disturbances (bilateral hemianopsia due to optic chiasm pressure) and palsies (due to cranial nerve compression)

Q1282:What is the most common congenital anomaly of the thyroid? other anomalies?

thyroglossal duct cyst; it does not lead to alterations in thyroid function;Ectopic thyroid tissue may also be found anywhere along the course of the thyroglossal duct. (If removing these; be sure they are not the ONLY thyroid tissue!)

Q1283:what are the causes of goiter?

physiologic enlargement during puberty and pregnancy;iodine deficiency;Hashimoto thyroiditis;goitrogens: substances that suppress synthesis of thyroid hormones;dyshormonogenesis: failure of hormone synthesis due to enzyme defects

Q1284:what is the difference between a hot nodule and cold nodule in the thyroid?

most nodules are hypoplastic and do not take up radioactive iodine (cold);Some nodules are hyperplastic and actively produce thyroid hormone; and take up radioactive iodine (hot);Nonfunctional (cold) nodules are more likely to be malignant compared to functional (hot) nodules.

Q1285:what are the causes and characteristics of myxedema?

Therapy for hyperthyroidism; Hashimoto thyroiditis; idiopathic; iodine deficiency;Clinical characteristics include cold intolerance; weight gain; low voice; mental slowness; menorrhagia; constipation; dry skin; hair loss; puffiness of the face

Q1286:what are the causes and characteristics of cretinism?

Iodine deficiency; thyroid enzyme deficiency; poor thyroid development; failure of fetal thyroid dissent; trans placental transfer of antithyroid antibodies from a mother with autoimmune thyroid disease;Characteristics include severe mental retardation; impaired physical growth and dwarfism; a large tongue; and a protuberant abdomen

Q1287:what are the symptoms of hyperthyroidism (thyrotoxicosis)?

Restlessness; irritability; fatigability; tremor; heat intolerance and sweating; tachycardia; muscle wasting and weight loss; fine hair; diarrhea; menstrual abnormalities; and most importantly greatly increased T4.

Q1288:what is Graves' disease? What is its mechanism? Susceptible individuals?

Hyperthyroidism caused by a diffuse toxic goiter. It occurs more frequently in women than in men; and the incidence is increased in HLA-DR3 and HLA-B8 positive individuals. Exophthalmos is characteristic and unique;Autoimmune disease; with thyroid stimulating immunoglobulin (TSI) and thyroid growth immunoglobulin (TGI) causing hormone production and hyperplasia.

Q1289:what are the three types of thyroiditis?

Hashimoto thyroiditis;subacute granulomatous thyroiditis;Riedel thyroiditis

Q1290:What is Hashimoto thyroiditis?;Who is susceptible?

Autoimmune disorder; common cause of hypothyroidism. Histologically; massive infiltrates of lymphocytes with germinal center formation and Hurtle cells. Autoantibodies are present; including anti-thyroglobulin; antithyroid peroxidase; anti-TSH receptor; and anti-iodine receptor;Associated with increased incidence of pernicious anemia; diabetes mellitus; and Sjogren's syndrome. Associated with HLA-DR5 and HLA-B5.

Q1291:What is subacute granulomatous thyroiditis? What appears to be a common cause?

focal destruction of thyroid tissue and granulomatous inflammation caused by a variety of viral infections; including mumps and Coxsackie virus;Follows a self-limiting course of several weeks duration consisting of a flulike illness; pain and tenderness of the thyroid; and a transient hyperthyroidism.

Q1292:what is Riedel thyroiditis?

Idiopathic replacement of the thyroid by fibrous tissue; can mimic carcinoma.

Q1293:What are the characteristics of papillary carcinoma of the thyroid? Common causes?

the most common thyroid cancer;Histologically: papillary projection into gland-like spaces; empty "orphan Annie" nuclei; calcified spheres;excellent prognosis; even when the adjacent lymph nodes are involved;can be caused by long-term radiotherapy to the neck; or RET-PTC fusion gene

Q1294:List the four types of malignant thyroid tumors. Which has the best prognosis and which has the worst?

papillary carcinoma - best;follicular carcinoma;medullary carcinoma;undifferentiated carcinoma -worst

Q1295:what are the characteristics of medullary carcinoma of the thyroid?

Originates from C-cells in the thyroid; produces calcitonin;histologically: sheets of tumor cells in amyloid stroma;associated with multiple endocrine neoplasia II; III

Q1296:What are the causes of primary hyperparathyroidism? What are the laboratory findings associated with it? What are the clinical manifestations?

Most common cause is parathyroid adenoma. Primary parathyroid hyperplasia and carcinoma are less likely. PTHlike hormone can be produced by bronchogenic squamous cell carcinoma or renal cell carcinoma;Lab findings include hypercalcemia/hypercalciuria; decreased serum phosphorus/increased urinary phosphorus; increased serum alk.phos; and increased serum PTH;Clinical symptoms include cystic bone changes; "metastatic calcification"; renal calculi; peptic ulcer.

Q1297:What are the causes of secondary hyperparathyroidism? What are the lab values and clinical characteristics?

Commonly caused by hypocalcemia in chronic renal disease. Vitamin D conversion by the kidney is impaired; decreasing intestinal absorption of calcium;Lab values include decreased serum calcium; increased serum phosphorus; increased serum alkaline phosphatase; increased serum PTH. Clinical symptoms include osteoclastic bone disease and metastatic calcification;(Personal note: many apparent paradoxes in this disease)

Q1298:What causes hypoparathyroidism? What are the symptoms?

The most common cause is accidental surgical excision during thyroidectomy. Sometimes associated with congenital thymic hypoplasia (DiGeorge syndrome);Resulting in severe hypocalcemia; manifested as increased neuromuscular excitability and tetany.

Q1299:What is pseudo-hypoparathyroidism?

Multi-hormone resistance including PTH; and the pituitary hormones TSH; LH; and FSH;Clinical characteristics include unresponsiveness of the kidney to PTH; shortened fourth and fifth metacarpal and metatarsals; short stature; and other skeletal abnormalities.

Q1300:What are the causes of Cushing's syndrome? What is the difference between Cushing's syndrome and Cushing's disease?

Exogenous corticosteroid medication;Hyper production of ACTH by pituitary adenoma;Adrenal cortical adenoma or carcinoma;Ectopic production of ACTH (by small cell carcinoma of the lung);Cushing's syndrome results from increased circulating cortisol from any source; Cushing's disease refers to only hyper production of ACTH by pituitary adenoma.

Q1301:What is primary hyperaldosteronism?

Conn syndrome; usually due to an aldosterone producing adrenocortical adenoma or carcinoma;Causes hypertension; sodium and water retention; and hypokalemia;Decreased serum renin is present due to negative feedback from hypertension.

Q1302:What is secondary hyperaldosteronism?

Caused by stimulation of the renin angiotensin system. Serum renin is increased in contrast to primary hyperaldosteronism;Usually secondary to renal ischemia; renal tumors; and edema (cirrhosis; nephrotic syndrome; cardiac failure).

Q1303:What is adrenal virilism?

Congenital enzyme defects that lead to diminished cortisol production and compensatory increased ACTH. This leads to adrenal hyperplasia and androgenic steroid production;Deficiencies include 21-hydroxylase deficiency and 11-hydroxylase deficiency;Clinical characteristics include precocious puberty in males and virilism in females.

Q1304:What is Addison disease? Symptoms and labs?

Primary adrenocortical deficiency; usually due to idiopathic adrenal atrophy. Can also be caused by tuberculosis; metastatic tumor; and infection. Characteristics include hypotension; skin pigmentation; low serum sodium; chloride; glucose; bicarbonate and increased potassium.

Q1305:What is Waterhouse-Friedrichsen syndrome?

Catastrophic adrenal insufficiency and vascular collapse due to hemorrhagic necrosis of the adrenal cortex. Often associated with DIC and characteristically due to meningococcal meningitis (Neisseria meningitis).

Q1306:What is a pheochromocytoma?

Adrenal medulla tumor of chromaffin cells. Causes paroxysmal hypertension due to hyperproduction of catecholamines. Increased urinary excretion of catecholamines and metabolites (metanephrine; normetanephrine; vanillylmandelic acid). Can also cause hyperglycemia.

Q1307:What is a neuroblastoma?

A highly malignant catecholamine producing tumor occurring in early childhood. Urinary catecholamines and metabolites are seen as in pheochromocytoma. Hypertension is common. Originates in the adrenal medulla and presents as a large abdominal mass.

Q1308:Epidemiology and etiological factors of type 1 diabetes mellitus?

Usually early in life; less common than type 2 disease. The disease is due to failure of insulin synthesis by beta cells of the pancreatic islets. Cause may be due to genetic predisposition or autoimmune inflammation of the islets. Incidences significantly higher in individuals with a mutation in HLA DQ; and in HLA DR3/HLA DR4 positive individuals.

Q1309:Clinical characteristics of type 1 diabetes?

Without insulin replacement: carbohydrate intolerance with hyperglycemia leading to polyuria; polydipsia; weight loss; ketoacidosis; coma; and death. Ketoacidosis results from increased metabolism of fat leading to production of "ketone bodies".

Q1310:What are etiologies of Cushing’s syndrome? Is ACTH always elevated?

increased cortisol due to: 1. Cushing’s disease (primary pituitary adenoma) increased ACTH 2. Primary adrenal (hyperplasia/neoplasia) decreased ACTH 3. Ectopic ACTH production (ie- small cell lung ca) increased ACTH 4. Iatrogenic; decreased ACTH

Q1311:Describe the clinical picture of Cushings.

HTN; wt gain; moon facies; truncal obesity; buffalo hump; hyperglycemia (insulin resistance); skin change (thinning; striae); osteoporosis; immune suppression

Q1312:T/F Conn’s syndrome is secondary hyperaldosteronism.

False. Conn’s syndrome is primary hyperaldosteronism; caused by an aldosterone-secreting tumor. Results in HTN; hypokalemia; metabolic alkalosis; low plasma renin.

Q1313:Which hyperaldosteronism is associated with high plasma renin?

Secondary hyperaldosteronism. It is due to renal artery stenosis; chronic renal failure; CHF; cirrhosis; or nephrotic syndrome. Kidney perception of low intravascular volume results in an overactive renin-angiotensin sysem.

Q1314:What is the tx for hyperaldosteronism?

Spironolactone; a diuretic that works by acting as a aldosterone antagonist.

Q1315:What characterizes addison’s disease? (which hormones are elevated or deficient)? Is it associated with HTN or hypotension?

Primary deficiency of aldosterone and cortisol due to adrenal atrophy; causing hypotension and skin hyperpigmentation. Adrenal atrophy; absence of hormone production; involves all 3 cortical divisions.

Q1316:T/F In primary insufficiency decreased pituitary ACTH production is characterized by skin hyperpigmentation.

False: increased ACTH causes MSH activity & hyperpigmentation

Q1317:T/F Neuroblastoma is the most common tumor of adrenal medulla in adults.

False. Pheochromocytoma is the most common tumor of adrenal medulla in adults. It is derived from chromaffin cells (arise from neural crest). It is associated with neurofibromatosis MEN types II and III.

Q1318:Where does neuroblastoma occur?

Neuroblastoma is the most common tumor of adrenal medulla in children. It can occur anywhere along the sympathetic chain.

Q1319:Pheochromocytoma: secrete combination of two molecules

epinephrine and norepinephrine

Q1320:Pheochromocytoma: epidemiology (rule of 10's)

10% malignant; 10% bilateral; 10% extra-adrenal; 10% calcify; 10% kids; 10% familial

Q1321:Pheochromocytoma: symptoms - 5 P's

(elevated blood) Pressure; Pain (headache); Perspiration; Palpitations; Pallor/diaphoresis --> relapsing and remittant

Q1322:Pheochromocytoma: elevations in two lab values

urinary VMA and serum catecholamines

Q1323:Pheochromocytoma: association with two other endocrine diseases

MEN II and III

Q1324:Pheochromocytoma: treatment

alpha-antagonists

Q1325:Multiple Endocrine Neoplasia type I (Wermer's syndrome) - 3 P's

Pancreas; Pituitary; and Parathyroid tumors

Q1326:Multiple Endocrine Neoplasia type II (Sipple's syndrome)

medullary carcinoma of thyroid; pheochromocytoma; parathyroid tumor; or adenoma

Q1327:Multiple Endocrine Neoplasia type III

medullary carcinoma of thyroid; pheochromocytoma; oral/intestinal ganglioneuromatosis

Q1328:Hypothyroidism or hyperthyroidism myxedema is prominent in which one

hypothyroidism

Q1329:Hypothyroidism or hyperthyroidism chest pain; palpitations; arrhythmias

hyperthyroidism

Q1330:TSH is (increased/decreased) in primary hyperthyroidism? In primary hypothyroidism?

hyper - decreased; hypo - increased

Q1331:Graves' disease involves autoantibodies with what mechanism of action?

stimulation of TSH receptors

Q1332:three symptoms of Graves'

ophthalmopathy; pretibial myxedema; diffuse goiter

Q1333:Graves' is a type __ hypersensitivity

type II

Q1334:Hashimoto's thyroiditis: thyroid is (enlarged/not enlarged) and (tender/nontender)

enlarged; nontender

Q1335:Hashimoto's thyroiditis: autoimmune antibodies directed against ---

microsomes

Q1336:Hashimoto's thyroiditis: histology shows (type of cell) infiltrate

lymphocytes (with germinal centers)

Q1337:Subacute thyroiditis (de Quervain's): self-limited (hyper/hypo)thyroidism following ---

hypothyroidism following flu-like illness

Q1338:Subacute thyroiditis (de Quervain's): symptoms include

jaw pain; tender thyroid gland; early hyperthyroidism

Q1339:Thyroid cancer: most common; good prognosis; "ground glass" nuclei; psammoma bodies

papillary carcinoma

Q1340:Thyroid cancer: poor prognosis; uniform follicles

follicular carcinoma

Q1341:Thyroid cancer: calcitonin producing (C cells); sheets of cells

medullary carcinoma (MEN II and III)

Q1342:Thyroid cancer: older patients; horrible prognosis

undifferentiated/anaplastic

Q1343:Cretinism: caused by a lack of dietary --- or defect in -- formation

iodine (endemic); T4 (sporadic)

Q1344:Cretinism: symptoms include

pot-belly; paleness; puffy face; protuberant tongue; protruding umbilicus

Q1345:Acromegaly: caused by excess --- in adults

growth hormone

Q1346:Acromegaly: symptoms include

large furrowed tongue; deep voice; large hands and feet; coarse facial features

Q1347:Acromegaly: in children; leads to ---

gigantism

Q1348:Metyrapone stimulation test

Metyrapone blocks 11OHase which stimulates ACTH and 11-deoxycortisol and decreases cortisol. If ACTH increases and 11-deoxycortisol decreases the problem is adrenal insuficiency. If both increase; the problem is pituitary insuficiency. If 11-deoxycortisol or ACTH dont change look for adrenal or ectopic Cushing's.

Q1349:High dose dexamethasone suppression test

Dexamethasone is a cortisol analog and should suppress ACTH and cortisol. If it does suppress cortisol its pituitary Cushing's. If it doenst; its adrenal or ectopic Cushing's

Q1350:Clinical features of hyperthyroidism

Tachychardia; palpitations; atrial fibrillation; systolic hypertension; nervousness; diaphoresis; tremors; diarrhea; weight loss. High free T4 and decreased TSH (if primary) or increased TSH (if secondary)

Q1351:Graves disease

IgG autoantibodies stimulate TSH receptors. Signs and symptoms of hyperthyroidism plus goiter; exophthalmus and pretibial myxedema (due to glycosamynoglycan deposition)

Q1352:Effect of oral contraceptives and anbolic steroids on binding proteins

Contraceptives increase binding proteins and increase toal levels of the hormone with normal TSH or ACTH. Anabolics do the opposite. Increased total T4 or total cortisol with normal TSH or ACTH indicates contraceptives. Decreased total T4 or cortisol with normal TSH or ACTH indicates anabolic steroids.

Q1353:Clinical features of hypothyroidism

Fatigue; cold sensitivity; decreased cardiac output; myxedema; constipation; anovulatory cycles. Low free T4 with high TSH (primary) or low TSH (secondary)

Q1354:Cretinism

Congenital hypothyroidism. Mental retardation; failure to thrive; stunted bone growth.

Q1355:Hashimoto thyroiditis

Anti-microsomal antibodies against thyroid gland produces hypothyroidism. Lymphocytic inflamation with germinal centers

Q1356:Subacute thyroiditis

Preceded by viral illness. Granulomatous inflamation

Q1357:Reidel thyroiditis

Destruction of the thyroid gland by dense fibrosis. Irregular hard thyroid that is adherent to trachea (dyspnea) and esopahgus (dysphagia)

Q1358:Thyroid adenoma

Painless solitary cold nodule that may be functional

Q1359:Papillary thyroid carcinoma

80% of malignant thyroid tumors. Papillary pattern; psammoma bodies; clear "orphan Annie" nuclei. Lymphatic spread to cervical nodes is common

Q1360:Follicular thyroid carcinoma

15% of malignant thyroid tumors. Hematogenous metastasis to bone or lungs

Q1361:Medullary thyroid carcinoma

5% of malignant thyroid tumors. Arises from C cells and produce calcitonin. May be associated with MEN II

Q1362:Anaplastic thyroid carcionoma

Firm enlarging mass that metastasizes to trachea and esophagus and causes dyspnea and dysphagia

Q1363:Primary hyperparathyroidism

Excess PTH with hypercalcemia caused by parathyroid adenoma (80%); hyperplasia (15%) or paraneoplastic syndromes (lung SCC and renal cell carcinoma). High serum Ca+ and PTH; kidney stones; osteoporosis; short QT interval.

Q1364:Secondary hyperparathyroidism

Caused by chronic renal failure (no phosphate excretion increases serum phosphate; decreasing Ca+ and increasing PTH); chronic renal failure also causes deficiency of alpha-1hydroxylase and vitamin D. Vitamin D deficiency and malabsorption

Q1365:Functions of PTH

Increase reabsorption of Ca+ in distal tubule; decreases phosphate reabsorption in proximal tubule; increases alpha-1hydroxylase in proximal tubule; binds to PTH receptor on osteoblast releasing IL-1 (osteoclast activating factor) to activate osteoclast resorption

Q1366:Hypoparathyroidism

Due to surgical removal of glands or DiGeorge syndrome. Hypocalcemia with low PTH; tetany; prolonged QT interval

Q1367:Prolactinoma

Hyperprolactinemia produces galactorrhea; amenorrhea (tumor mass inhibits GnRH) and infertility

Q1368:GH producing adenoma

High GH and somatomedin C (IGF-1) produce gigantism (in children; tall stature with long extremities) or acromegaly (in adults; prominent jaw; flat forehead; enlarged hands and feet; diabetes and visceromegaly)

Q1369:Sheehan syndrome

Ischemic necrosis of pituitary secondary to post partum hypotension results in panhypopituitarism

Q1370:Diabetes insipidus

Hypotonic polyuria; polydipsia; hypernatremia; dehydration. Central DI is due to lack of ADH. Nephrogenic DI is due lack of renal response to ADH.

Q1371:SIADH

Excesive ADH. Oliguria; water retention; hyponatremia; cerebral edema. Due to paraneoplastic syndrome (lung SCC) or trauma

Q1372:Clinical features of Cushing's syndrome

Thin extremeties (protein catabolism); truncal obesity and buffalo hump (hyperglycemia increases insulin with fat deposition); purple stria (low collagen in vessels); hyperlipidemia (hormone-sensitive lipase); hirsutism; hypertension and hypokalemic alkalosis (high aldosterone).

Q1373:Differentiation of Cushing's syndrome

High ACTH with dexamethasone suppression --> pituitary. High ACTH without dexamethasone suppression --> ectopic (lung SCC). Low ACTH --> adrenal. Low ACTH with low cortisol and adrenal atrophy --> steroid therapy (MCC). High ACTH produces skin pigmentation in pituitary and ectopic.

Q1374:Conn syndrome

Adrenocortical adenoma causes hypertension; hypernatremia; hypokalemia; metabolic alkalosis; tetany. High aldosterone and low renin

Q1375:Waterhouse-Friderichsen syndrome

Bilateral hemorrhagic infarction of the adrenals associated with menigococcemia. DIC; hypotension; shock.

Q1376:Addison disease

Autoimmune destruction of adrenal cortex due to abrupt withdrawal of corticosteroids; miliary TB or menincoccemia. Weakness; hyperpigmentation of skin (high ACTH); hypotension; hypoglycemia; poor response to stress

Q1377:Pheochromocytoma

Catecholamine-producing benign tumor of the adrenal medulla. Severe headaches; tachycardia; palpitationss; diaphoresis; anxiety; hypertension. Associated with MEN II. Elevated urinary vanillylmandelic acid (VMA) and catecholamines.

Q1378:MEN I

Tumors of the pituitary (non-functioning); parathyroids (hypercalcemia); and pancreas gastrinoma (zollinger-ellison)

Q1379:MEN II

Medullary carcinoma of thyroid; pheochromocytoma; parathyroid hyperplasia or adenoma

Q1380:Pathophysiology of diabetic ketoacidosis

Hyperglycemia (due to increased glycogenolysis and gluconeogenesis). Ketone bodies (low insulin and high cortisol/epinephrine activate hormone-sensitive lipase; Boxidation and ketogenesis). Osmotic diuresis and volume depletion with loss of potassium. Dilutional hyponatremia due to osmotic effect of hyperglycemia. Low insulin fails to activate lipoprotein lipase leading to hypertriglyceridemia.

Q1381:Pathophysiology of diabetic vascular disease

Non-enzymatic glycosylation and arteriosclerosis produces ischemic injury and diabetic foot. Accelerated atherosclerosis; abdominal aortic aneurysms and MI.

Q1382:Pathophysiology of diabetic ocular disease

Cataracts due to conversion of glucose into sorbitol by aldose reductase in the lens. Retinopathy with microaneurysms (non-proliferative) and neovascularization (proliferative)

Q1383:Pathophysiology of diabetic neuropathy

Destruction of Schwann cells with decreased peripheral sensitivity liads to pressure ulcers on bottom of diabetic foot

Q1384:(4)* functions of T3

4 Bs;Brain maturation;Bone growth;Beta-adrenergic effects;BMR increase

Q1385:what is the cause of increased cortisol w/ low ACTH ;(aside from Cushings)?

Chronic steroid use

Q1386:(2) steps of Dexamethasone test to determine cause of Increased cortisol;(3 causes)

1. Give LOW dose;(result: Lower cortisol = Healthy);(result: Higher cortisol = step 2);2. Give HIGH dose;(result: Lower cortisol = ACTH-producing tumor);(result: Higher cortisol = Cortisone producing tumor)

Q1387:Dx;Low cortisol; High ACTH

Primary Hypocortisol;(Addisons)

Q1388:Dx;Low cortisol; Low ACTH

Secondary Hypocortisol;(no ACTH; no skin pigmentation)

Q1389:Dx;High cortisol; Low ACTH;(2)

Primary Hypercortisol;(Cushings; chronic steroids)

Q1390:Dx;High cortisol; High ACTH

Secondary Hypercortisol;(Tumor)

Q1391:Dx;HTN; hypoK; metabolic alkalosis; low plasma renin

Primary Hyperaldosteronism;(Conn's syndrome)

Q1392:Dx;HTN; hypoK; metabolic alkalosis; high plasma renin

Secondary Hyperaldosteronism;;(CRF; CHF; renal artery stenosis; cirrhosis; anything that stimulates venous pooling)

Q1393:Dx;low aldosterone; low cortisol; hypotension; skin pigmentation; Adrenal Atrophy; Absence of hormones; All 3 cortical divisions affected

Addison's Dz;(Primary Hypoaldosteronism and Hypocortisol)

Q1394:MC tumor of the adrenal medulla in children

Neuroblastoma

Q1395:Dx;elevated Pressure; HA Pain; Perspiration; Palpitations; Pallor

Pheochromocytoma

Q1396:Dx;kidney stones; stomach ulcers; pituitary tumor

MEN I (Wermer's syndrome);3P = Pancreas; Pituitary; Parathyroid

Q1397:Dx;medullary CA of thyroid; pheochromocytoma; parathyroid tumor

MEN II - Sipple syndrome

Q1398:Dx;medullary CA of thyroid; pheochromocytoma; mucosal neuromas

MEN III

Q1399:Dx;Inc ESR; jaw pain; very tender thyroid; hypothyroidism following flu-like illness

Subacute Thyroiditis;(de Quervain's Thyroiditis)

Q1400:MC thyroid anomaly

Thyroglossal duct cyst

Q1401:Dx;Increased TSH at thyroid

Goiter

Q1402:MCC of hypothyroidism

Iodine deficiency

Q1403:Dx;child w/ potbelly; pale; puffy-faced; impaired growth; protruding umbilicus and tongue; mental retardation;what is deficient?

Cretinism;(Iodine deficiency)

Q1404:Dx;hyperthyroidism; nodular goiter; no exophthalamos

Plummer Dz

Q1405:Dx;hypothyroidism w/ massive infiltrates of lymphocytes in germinal center

Hashimoto thyroiditis

Q1406:Dx;previous radiation of neck; "ground-glass" nuclei in thyroid; psammoma bodies

Papillary carcinoma of thyroid;(MC type of thyroid CA)

Q1407:Dx;Increased Calcium; Decreased Phosphorus

Primary Hyperparathyroidism;(Inc PTH)

Q1408:Dx;Decreased Calcium; Decreased Phosphorus

Secondary Hyperparathyroidism;(Dec Vit-D)

Q1409:Dx;Decreased Calcium; Increased Phosphorus

Primary Hypoparathyroidism;(Dec PTH)

Q1410:Dx;Increased Calcium; Increased Phosphorus

Secondary Hypoparathyroidism;(Inc Vit-D)

Q1411:Dx;stones; bones (pain) and groans (constipation)

Primary Hyperparathyroidism

Q1412:Definition;cystic bone spaces filled w/ brown fibrous tissue as a result of the osteoclastic reabsorption in primary hyperparathyroidism;(2 names)

Osteitis Fibrosa Cystica;(von Recklinghausen's syndrome)

Q1413:Definition;bone lesions due to secondary hypoparathyroidism due to renal Dz

Renal Osteodystrophy

Q1414:(2) Physical exam signs of low calcium

tapping facial nerve -> contraction of facial muscles;(Chvostek's sign);occlusion of Brachial artery w/ BP cuff -> carpal spasm;(Trousseau's sign)

Q1415:Dx;Decreased Calcium; Increased Phosphorus; Increased PTH; shortened 4th/5th digits; short stature;what protein is deficient?

Pseudohypoparathyroidism;(Dec Guanine Nucleotide BP)

Q1416:Dx;kussmaul respirations; hyperthermia; N/V; Abd pain; psychosis; dehydration; fruity breath

Diabetic Ketoacidosis

Q1417:Dx;adrenal insufficiency due to hemorrhagic necrosis of adrenal cortex; assoc c/ DIC; due to Meningococcemia

Waterhouse-Friderichsen syndrome

Q1418:Dx;hyperinsulinemia and hypoglycenia; CNS dysfunction; reversal of CSN symptoms w/ glucose administration

Insulinoma

Q1419:Dx;hypresecretion of HCl in stomach; recurrent peptic ulcer Dz; hypergastrinemia

Zollinger-Ellison syndrome

Q1420:Dx;rare tumor w/ watery diarrhea; hypokalemia; achlorhydria

VIPoma;(Inc VIP)

Q1421:Dx;Adrenal hyperplasia; High BP; Low Cortisol; High Androgens

11-Hydroxylase deficiency

Q1422:Dx;Adrenal hyperplasia; Low BP; Low Cortisol; High Androgens

21-Hydroxylase deficiency

Q1423:Dx;Adrenal hyperplasia; High BP; Low Cortisol; Low Androgens

17-Hydroxylase deficiency

Q1424:Dx;Increase in Dilute Urine; Hyposmolar serum

Primary Polydipsia

Q1425:Dx;Increase in Dilute Urine; Hyperosmolar serum

Diabetes Insipidus;(ADH deficiency = Neurogenic);(ADH receptor issue = Nephrogenic)

Q1426:Dx;Increase in concentrated Urine; Hyposmolar serum

SIADH

Q1427:what receptors promote insulin secretion?;inhibit?

promote: Beta receptors;inhibit: Alpha receptors

Q1428:what stimulates both insulin and glucagon?

Amino Acids

Q1429:what hormone is needed for GH to function correctly?

Thyroid hormones

Q1430:Definition;causes the increased synthesis of cartilage in epiphyseal plates of long bones; is a good measure of GH secretion

Insulin-like Growth Factor-1;(IGF-1: a somatomedian)

Q1431:how is GH similar to glucagon?;insulin?

glucagon: Inc blood glucose and fat;Insulin: Inc uptake of AA into cells

Q1432:Calcium change w/ Acidosis

Increased

Q1433:Name bone calcium and phosphate

Hydroxyapatite

Q1434:blood cells which contain;heparin &;histamine

basophil;mast cell

Q1435:type of hypersensitivity reaction?;mast cell

type I

Q1436:fnx of cromolyn sodium

prevents mast cell degranulation;(tx asthma)

Q1437:major basic protein?

in eosinophils for defending against protozoans

Q1438:acute inflammatory response cell

neutrophil

Q1439:40-75% of WBC

neutrophil

Q1440:hypersegmented polys; what diseases

B12 and folate deficiency

Q1441:cell type?;kidney shaped nucleus;frosted glass cytoplasm

monocyte

Q1442:cell type?;CD19 & CD20

B cell

Q1443:cell type?;CD3

T cell

Q1444:gamma interferon affect on macrophage

activation

Q1445:what are the common causes of chronic blood loss?

In the United States: menorrhagia; gastrointestinal bleeding;Worldwide: hook worm disease (necator americanus)

Q1446:What groups are at risk for dietary deficiency of iron?

Premature infants: human milk is low in iron; and newborn iron is depleted within six months. Pregnant women may also require iron supplements;The elderly are also at risk of dietary deficiency.

Q1447:List the common symptoms of anemia as well as the symptoms of severe anemia.

Common: pallor; fatigue; dyspnea on exertion;Severe: angina pectoris; glossitis; gastritis; koilonychia; and Plummer-Vinson syndrome.

Q1448:What are the iron study patterns in iron deficiency anemia?

Serum iron is low;TIBC is elevated;Serum ferritin is low.

Q1449:How do you distinguish iron deficiency anemia from beta thalassemia minor?

In beta thalassemia minor; the alpha-2 hemoglobin is increased.

Q1450:What are the three peripheral blood findings in macrocytic anemias? What is seen in the bone marrow?

pancytopenia; global macrocytosis; hypersegmented neutrophils;the bone marrow shows megaloblastic hyperplasia.

Q1451:Name eight causes of vitamin B12 deficiency megaloblastic anemia.

pernicious anemia; total gastric resection; disorders of the distal Ilium; a strict vegetarian diet; intestinal malabsorption syndromes; blind loop syndrome; broad-spectrum antibiotic therapy; Diphyllobothrium latum infestation (fish tapeworm)

Q1452:How do you distinguish folate deficiency from vitamin B12 deficiency?

There are no neurologic abnormalities in folate deficiency.

Q1453:Name six causes of folate deficiency anemia.

dietary deprivation in alcoholics or dieters;Pregnancy;phenytoin or oral contraceptive therapy;folate acid antagonist chemotherapy;relative deficiency in hemolytic anemia;intestinal malfunction due to sprue or Giardia

Q1454:what are the iron study patterns in the anemia of chronic disease?

Serum iron is low;TIBC is low;Serum ferritin is elevated.

Q1455:what are some causes of aplastic anemia?

Toxic exposure;dysfunction of cytotoxic T cells;radiation exposure;chemicals such as benzene;therapeutic drugs such as chloramphenicol; sulfonamides; gold salts; chlorpromazine; antimalarial drugs; and alkylating agents;Viral infection by parvovirus or hepatitis C.

Q1456:Which antibodies mediate warm antibody autoimmune hemolytic anemia versus cold agglutinin disease?

IgG: warm;IgM: cold

Q1457:cold agglutinin disease is a complication of what diseases?

infectious mononucleosis and mycoplasma pneumonia;it may be a chronic complication of lymphoid neoplasms.

Q1458:What preventative measure can be taken to prevent erythroblastosis fetalis?

administer anti-D IgG antiserum to D negative mothers at the time of delivery of a D positive child. this causes fetal red cells to be removed from maternal circulation.

Q1459:What are the possible causes of erythroblastosis fetalis?

Maternal alloimmunization to fetal Rh antigens;ABO incompatibility.

Q1460:What is the pathophysiology of paroxysmal nocturnal hemoglobinuria?

Defect in the PIG-A gene causes impaired synthesis of the GPI anchor; which fixes CD55; CD59; and CD8 proteins to the cell surface. These proteins protect red cells from compliment mediated lysis.

Q1461:What are the possible molecular defects in hereditary spherocytosis? What is its inheritance?

Spectrin; ankyrin; protein 4.1 or other RBC skeletal proteins;Autosomal dominant.

Q1462:What is the pathophysiology of G6PD deficency? What is its inheritance?

Lack of G6PD reduces the body's ability to deal with oxidative stress. G6PD is an X-linked disorder.

Q1463:What are sources of oxidative stress that can cause an episode of hemolysis in G6PD?

drugs such as primaquine (anti malarial); sulfonamides; other oxidant drugs;fava beans;infection

Q1464:How can you differentiate the presentation of pyruvate kinase deficiency from G6PD deficiency?

In contrast to G6PD deficiency anemia; pyruvate kinase deficiency anemia is chronic and sustained.

Q1465:What is the inheritance of pyruvate kinase deficiency anemia?

autosomal recessive.

Q1466:What percentage of African-Americans carry the hemoglobin S gene? What advantages does the gene confer?

Approximately 7%;The hemoglobin S gene confers resistance to malarial infection (Plasmodium falciparum).

Q1467:Specifically; what is the genetic defect in hemoglobin S disorders?

A point mutation on chromosome 11 in codon six of the beta globin gene results in a substitution of valine for glutamic acid.

Q1468:What are the six symptoms of sickle cell anemia?

severe hemolytic anemia;chronic leg ulcers;vaso-occlusive crises ;auto splenectomy;aplastic crises (parvovirus);infectious complications (salmonella osteomyelitis)

Q1469:What are six clinical and laboratory signs of beta thalassemia?

severe anemia;severe splenomegaly;distortion of skull facial bones and long bones;microcytosis; hypochromia; target cells;increased Hemoglobin F;generalized hemosiderosis

Q1470:What is sickle-cell thalassemia?

Co-inheritance of hemoglobin S and thalassemia of the beta globin gene. Clinically similar to sickle cell anemia but less severe.

Q1471:What are possible causes of mechanical disruption leading to hemolysis? What is seen on the peripheral smear?

aortic valve prosthetics;disseminated intravascular coagulation;thrombotic thrombocytopenic purpura;smear shows schistocytes or helmet cells

Q1472:What is the spectrum of clinical abnormalities in alpha thalassemia according to the number of deletions?

one deletion: no abnormalities;two to three deletions: mild to moderate thalassemic symptoms;four deletions: hydrops fetalis

Q1473:What is hepcidin?

A peptide hormone that decreases both intestinal iron absorption and the release of iron from macrophages. In anemia of chronic disease; proinflammatory cytokines induce hepatic synthesis of hepcidin. This causes serum iron to be low despite normal or even elevated iron stores (ferritin).

Q1474:Anemia of Pregnancy

not really anemia. inc plasma volume => dec Hct; RBC; Hg

Q1475:Causes of anemia

1) decreased production: hematopoietic cell damage (rad; drugs; inf) deficiency in factors (iron for heme; vit b12 + folate for DNA). 2) Inc loss: external blood loss or hemolysis

Q1476:Acute Posthemorrhagic Anemia

initially; no dec in Hct; RBC; Hg b/c parallel loss in volume. Reactive increase in platelet count. Then; hemodilution => detect anemia.

Q1477:Iron deficiency anemia

Causes: chronic blood loss; dietary deficiency; inc requirement. Sx: pallor; fatigue; DOE. Angina if CAD. Severe: glossitis; gastritis; koilonychia; Plummer-Vinson syndrome; pica. Lab: 1) dec Hct 2) smear: hypochromic; microcytic 3) dec serum Fe; inc TIBC 4) dec body iron stores (dec hemosiderin in bone marrow; dec serum ferritin)

Q1478:Chronic blood loss

Iron deficiency anemia (major cause). Menorrhagia; GI bleed (carcinoma; hookworm).

Q1479:Dietary iron deficiency

Iron deficiency anemia. Infants (milk is low in iron). Rarely elderly.

Q1480:Increased iron requirement

Pregnancy. Also; infants and preadolescents can outgrow stores.

Q1481:Koilonychia

spooning of the nails. A/w severe iron defiency

Q1482:Plummer-Vinson syndrome

partially obstructing upper esophageal webs a/w sever iron deficiency

Q1483:Pica

appetite for substances not fit as food or no nutritional value. A/w severe iron deficiency

Q1484:DDx (hypochromic; microcytic)

Anemia of chronic disease (low TIBC); ?-thalassemia (inc HgA2); Sideroblastic anemia

Q1485:Megaloblastic anemia

Def B12 or folate => dec DNA synth => delay divison => nuclear-cytoplasmic asynchrony (loose chromatin) => dec production + ineffective hematopoiesis. Megaloblasts (erythroid precursors) in marrow. Labs: 1) smear: pancytopenia; oval macrocyotsis (MCV > 110); hypersegmented PMN. 2) marrow: megaloblastic hyperplasia. 3) B12 (homocysteine; methyl malonic acid); folate levels. Folate tx will rev B12 anemia but not neuro sx

Q1486:Pernicious anemia

Autoimmune gastritis: Abs vs. IF (and parietal cells) => 1) B12 def 2) achlorhydria 3) inc risk gastric carcinoma. Sx: insidous onset; lemon yellow skin; stomatitis; glossitis; *posterolateral degeneration* (demyelination) =>ataxia; hyperreflexia; impaired vib/proprioception. No neuro w/ folate def. Lab: 1) smear: pancytopenia; macrocytosis; hypersegmented PMN. marrow: megaloblastic hyperplasia. 2) Anti-IF Ab (Anti-parietal cell less specific) 3) Schilling test

Q1487:Schilling test

Give B12 alone and B12+IF. 1) NL abs of b12 => dietary deficiency. 2) Abs corrected w/ IF => pernicious anemia 3) Abs not correct w/ If => malabsoprtion (Crohn's; blind-loop syndrome; giant tapeworm).

Q1488:DDx B12 megaloblastic anemia

Pernicious anemia; total gastric resection (no IF); ileum disorder (B12-IF abs); intestinal malabsoprtion syn; blind loop syn (bacterial overgrowth); broad spectrum abio (bacterial overgrowth); strict vegetarian; *diphyllobothrium latum*

Q1489:Diphyllobothrium latum

giant fish tapeworm. freshwater fish. b12 defiency (megaloblastic anemia)

Q1490:Folate deficiency

No neuro. Causes: dietary def (alcoholics; fad dieters); pregnancy; *phenytoin* (dec folate abs); *OC* (dec folate abs); folate antagonistic chemo; inc demand (hemolytic anemia); malabs (sprue; *Giardia lamblia*)

Q1491:Giardia lamblia

flagellated protozoa. ADEK + folate def (megaloblastic anemia). Campers injest cyst from mnt stream => trophozoite => coats SI => dec fat abs => stinky; greasy diarrhea. Homosexual males. Tx: metro ("flagyl").

Q1492:Anemia of chronic disease

A/w chronic infection; chronic immune disorders (RA); neoplasms; renal dz. Problem releasing iron from storage. IL1; TNF; IFN-g => dec EPO + inc hepcidin. 1) low serum Fe 2) *dec TIBC* (vs. iron def) 3) high storage in macrophages 4) high serum ferritin (reflects high stores). (Normochromic/normocytic or hypochromic/microcytic. Renal dz => macrocytic.)

Q1493:Aplastic anemia

pancytopenia; hypocellular marrow. Autoimmunity (CD8 T); radiation; benzene; *chloramphenicol (rev or irrev)*; sulfonamides; gold salts; chlorpromazine; alkylating agents; parvovirus; hep C (?).

Q1494:Myelophthisic anemia

Replacement of marrow by neoplasm or fibrosis => leukoerythroblastosis

Q1495:Leukoerythroblastosis

smear: small #s of nucleated RBC + immature granulocytic precursors

Q1496:Hemolytic anemia

1) Inc RBC destruction: maximal conjugation => unconjugated bilirubinemia (indirect) (acholruic jaundice); pigmented gallstones; inc urine urobilinogen; hemosiderosis (tx: deferoxamine). if intravascular => hemoglobinemia; hemoglobinuria; no haptoglobin. 2) compensatory inc RBS production: marrow erythroid hyperplasia; reticulocytosis/polychromatophilia (inc MCV)

Q1497:Warm antibody autoimmune hemolytic anemia

Most common immune hemolytic anemia. IgG. 2° to SLE; Hodgkin or non-Hodkin lymphoma. Usual hemolytic anemia fx + spherocytosis (loss of membrane) + positive direct Coombs test.

Q1498:Cold agglutinin disease

Anti-i IgM. Below 30°. 2° to infectious mononucleosis (EBV) or Mycoplasma pneumoniae.

Q1499:Chronic cold agglutinin disease

Anti-i IgM. A/w lymphoid neoplasms; Raynaud's. Chronic hemolytic anemia exacerbated by cold weather. Sometimes: hemoglobinemia; hemoglobinuria.

Q1500:Hemolytic disease of the newborn

Erythroblastosis fetalis. Maternal ab vs. fetal RBC. Maternal alloimmunization (Rh blood group: mom=d; fetus=D). ABO incompatibility. => kernicterus (unconjugated bilirubin in CNS esp basal ganglia); hydrops fetalis (heart failure w/ generalized edema). Prevent: Anti-D IgG to mom at delivery/termination to prevent alloimmunization.

Q1501:Paroxysmal nocturnal hemoglobinuria

Acquired: somatic mutation in PIG-A => impaired GPI achnor synthesis. No CD55; CD59; C8 bp on RBC; granulocytes; platelets => complement-mediated lysis => pancytopenia; venous thrombosis; intravascular hemolytic anemia. Dx: CD59 neg RBC on flow. Old dx: Ham test.

Q1502:Hereditary spherocytosis

AD. Most common inherited intracorpuscular hemolytic anemia in whites. Spherocytes; splenomegaly (sequestered); *MCHC*; osmotic fragility; spectrin deficiency. Causes inc mut in: spectrin; ankyrin; protein 4.1; etc.

Q1503:Hereditary elliptocyosis

AD. Hemolysis; splenomegaly. Often no anemia.

Q1504:G6PD deficiency

XR. Most common enz def hemolytic anemia. Blacks + Mediterraneans. Acute; self-limited episodes of intravascular (Hg-emia; -uria) <= oxidative stress: inf; drugs (primaquine; sulfonamides; etc.) fava beans. => Heinz bodies (precipitated Hg) => Bite cells. R to p. falciparum infection.

Q1505:Pyruvate kinase deficiency

AR. 2nd most common enz def hemolytic anemia. Nonspherocytosis hemolytic anemia. Chronic/sustained (vs. G6PD def)

Q1506:Hemoglobin S

Blacks (R to falciparum infection). Pt mut codon 6 Glu=>Val (lose MstII site: prenatal dx by amnotic or chorionic villus sample). Polymerize @ low O2 tension => sickle => obstruct microvasc.

Q1507:Duffy Fy

a- b- phenotype. R to p. falciparum infection.

Q1508:Sickle cell anemia

Homozygous HbS. HbS polmerize @ low O2 tension => sickle => hemolytic anemia; chronic leg ulcers; painful crises (infection or dehydration); lung + spleen infarct (autosplenectomy => inf w/ encapsulated bact). Parvovirus => aplastic crises. Salmonella osteomyelitis.

Q1509:Sickle cell trait

Heterozygous HbS. No clinical consequence.

Q1510:Hemoglobin C

Blacks. homozygous: mild hemolytic anemia; splenomegaly; target cells; (intraerythrocyte xtals). HbSC ~ HbS.

Q1511:Hemoglobin E

Souteast Asia. Urban US. Clinical: similar to HbC.

Q1512:HbA; S; C on PAGE

HbA- (aspartate). HbS (valine). HbC+ (lysine).

Q1513:? Thalassemia Major

Mediterranean and US. Dec Hb synth + alpha chains aggregate (short life) + ineffective erythropoiesis + relative folate deficiency => anemia. Chronic hemolysis + transfusion => hemosiderosis (Tx: deferoxamine). Splenomegaly. Marrow expansion => skull; facial bones; long bone distortion. Smear: micro; hypo; target cells; anisocytosis; poikilocytosis. Test: inc HbF (alpha2 gamma2)

Q1514:? Thalassemia Minor

Heterozygous. Mild hypochromic microcytic anemia. Inc HbA2 (alpha2 delta2) (vs. iron def; ACD).

Q1515:Sickle cell thalassemia

~ sickle cell anemia (less severe).

Q1516:Alpha thalassemia

Ch 16. Southeast asia. 3a = silent carrier. 2a = a-thal trait. 1a = HbH dz. 0a = hydrops fetalis (Hb Barts: O2 affinity too high; no delivery).

Q1517:Mechnical hemolytic anemas

prosthetic aortic valve or microangiopathic hemolytic anemia (DIC; thrombotic thrombocytopenic purpura): partial occlusion of vessels. Schistocytes; helmet cells.

Q1518:Heterophile+ infectious mononucleosis

EBV invades B lymphocytes via CD21 receptors with atypical CD8 response; lymphocytosis and paracortex hyperplasia Fever; sore throat (gray-white membrane on tonsils) and tender lymphadenopathy

Q1519:Heterophile- infectious mononucleosis

Cytomegalovirus

Q1520:Paul-Bunnell monospot test reaction

IgM (heterophile) antibodies against EBV react with sheep red blood cells - postivie monospot test

Q1521:Characteristics of acute lymphadenopathy

Tender focal lymphadenopathy = bacterial. Generalized tender lymphadenopathy = viral

Q1522:Characteristics of chronic lymphadenopathy

Non-tender follicular hyperplasia (rheumathoid arthritis; toxoplasmosis; leukemia). Non-tender paracortical hyperplasia (viruses; drugs; SLE; leukemia).

Q1523:Leukemoid reaction Vs. leukemia

Leukemoid reaction lacks blast and has elevated leukocyte alkaline phosphatase (LAP) (TB; whooping cough). Chronic myelogenous leukemia has low LAP.

Q1524:General signs and symptoms of leukemia

Normo anemia; thrombocytopenia; leukocytosis or leukopenia; blast cells (>30%=acute); generalized non-tender lymphadenopathy; hepatosplenomegaly; bone pain and fever

Q1525:Pre-B ALL

Age < 15. Tdt+; CALLA+; cytoplasmic mu+

Q1526:Mature B ALL

Age < 15. Surface Igs present

Q1527:B cell CLL

Age > 60. 95% of CLL cases. Differentiated cells are CD19+; CD20+; CD23+; CALLA-

Q1528:T cell CLL

Age > 60. Mature T cell markers and hypogammaglubulinemia. Lymphocytosis and neutropenia

Q1529:Adult T cell leukemia

Caused by HTLV-1 retrovirus. Leukemia sypmtoms and signs wih lytic bone lessions and hypercalcemia (osteoclast activating factor)

Q1530:AML

15-60 years. Myeloblast proliferation. Auer rods are pathognomonic of myeloblasts. T(15;17). Abnormal retinoic acid receptor. Rx.: retinoic acid

Q1531:CML

15-60 years. Pluripotent cell proliferation. Philadelphia chromosome t(9;22). All cells increased with low LAP

Q1532:PRV

Increased erythroid precursors; hematocrit and viscocity. Decreased EPO. Normal SaO2. Increased basophils with histamine release (pruritus; gastric ulcers); plethora and cyanosis.

Q1533:Follicular B-cell lymphoma

MC lymphoma. B lymphocytes. t(14;18); Chr 14 has immunoglobulin heavy chain genes; chr 18 has bcl-2 gene (normally inhibits apoptosis).

Q1534:Burkitt's lymphoma

MC lymphoma in children. Starry-sky. t(8;14). African affects mandible; american affects abdomen

Q1535:Mycosis fungoides

CD4 T-cells. Generalized prutitic erythematous rash. PAS+

Q1536:Histiocytosis X

In children. Histiocytes are CD1+

Q1537:Hodgkin lymphoma

Reed-Sternberg cells are CD15+; CD30+. Fever; night sweats; weight loss; localized lymphadenopathy

Q1538:Multiple myeloma

Neoplasm of plasma cells. Anemia; bone pain; pathologic fractures; hypercalcemia; renal failure; light-chain amyloids (Bence-Jones protein).

Q1539:t(15;17)

AML translocation

Q1540:t(9;22)

CML philadelphia chromosome translocation. Forms a protein with tyrosine kinase activity

Q1541:t(14;18)

Follicular B-cell lymphoma translocation

Q1542:t(8;14)

Burkitt's lymphoma translocation

Q1543:Lymphomas: Hodgkin's Versus NHL: Which one presents with Reed-Sternberg cells?

Hodgkin's

Q1544:Lymphomas: Hodgkin's Versus NHL: Which one is associated with HIV and immunosuppression?

NHL

Q1545:Lymphomas: Hodgkin's Versus NHL: Which one involves multiple; peripheral nodes; with common extranodal involvement?

NHL

Q1546:Lymphomas: Hodgkin's Versus NHL: Which one is localized to a single group of nodes; with contiguous spread and rare extranodal involvement?

HL

Q1547:Lymphomas: Hodgkin's Versus NHL: Which one presents with constitutional signs/symptoms: low-grade fever; night sweats; weight loss?

HL (NHL has few signs/symptoms)

Q1548:Lymphomas: Hodgkin's Versus NHL: Which one presents with mediastinal lymphadenopathy?

HL

Q1549:Lymphomas: Hodgkin's Versus NHL: Which one involves mostly the B cells (except lymphoblastic origin)?

NHL

Q1550:Lymphomas: Hodgkin's Versus NHL: Which one has hypergammaglobulinemia?

neither. Multiple Myeloma has hypergammaglobulinemia; where the excess B cells are in the resting state.

Q1551:Lymphomas: Hodgkin's Versus NHL: Which one has a 50% association with EBV?

HL

Q1552:Lymphomas: Hodgkin's Versus NHL: Which one has bimodal age distribution?

HL (NHL has peak incidence at 20-40 years old)

Q1553:Lymphomas: Hodgkin's Versus NHL: Which one has more common male presentation?

HL

Q1554:Hodgkin's What factors denote a good prognosis?

Increased lymphocytes; decreased RS cells.

Q1555:Hodgkin's Which HL type has the best prognosis?

Nodular sclerosing (65-75%); which has least RS cells and lots of lymphocytes. Lymphocyte-predominant LH also has excellent prognosis.

Q1556:Hodgkin's Which HL type is the most common?

Nodular sclerosing; affecting women more than men and primarily young adults.

Q1557:Hodgkin's What is the prognosis of mixed cellular HL?

Intermediate. There are lots of lymphocytes but also lots of RS cells.

Q1558:Hodgkin's Which HL type has the worst prognosis?

Lymphocyte-depleted; which affects older males with disseminated disease.

Q1559:Hodgkin's Which HL type has the most RS cells?

Mixed cellular.

Q1560:Which NHL type has only B cells?

Small Lymphocytic lymphoma; follicular lymphoma; Burkitt's

Q1561:Which NHL type has a mix of B cells and T cells?

Diffuse large cell ; occurring mostly in elderly but sometimes in children.

Q1562:Which NHL type has only T cells?

Lymphoblastic Lymphoma; which has immature T cells. It is a very aggressive T-cell lymphoma.

Q1563:Which type is associated with a t(8;14) c-myc gene mutation?

Burkitt's Lymphoma; occurring mostly in children. Has a high-grade "starry sky" appearance.

Q1564:Which type is associated with a t(14;18) mutation and overexpression of bcl-2?

Follicular lymphoma; which is difficult to cure but has an indolent course.

Q1565:Which type is associated with EBV infection and is endemic in africa?

Burkitt's

Q1566:Which is the most common childhood NHL?

Lymphoblastic Lymphoma; which also presents with ALL and a mediastinal mass.

Q1567:Which is the most common adult version of NHL?

Follicular lymphoma.

Q1568:Which NHL types occur in adults?

Small lymphocytic lymphoma; follicular lymphoma.

Q1569:Which NHL types occur in children?

Lymphoblastic lymphoma; Burkitt's lymphoma.

Q1570:Which NHL has a distribution of 80% adults and 20% children?

Diffuse large cell lymphoma; which ALSO has an 80% B cells 20% T cell distribution.

Q1571:Which low-grade NHL type presents like CLL?

Small Lymphocytic lymphoma.

Q1572:Leukemias: Peripheral and bone marrow characteristics

Increased circulating leukocytes; bone marrow infiltrates of leukemic cells

Q1573:Leukemias: Consequences of marrrow failure

Anemia (dec. RBC's); infections (dec. WBC's); hemorrhage (dec. platelets)

Q1574:Leukemias: Common organs of infiltration

Liver; spleen; lymph nodes

Q1575:Leukemias: Characteristics of acute leukemias

Blasts predominate; children or elderly; short or drastic course

Q1576:Leukemias: ALL characteristics (4)

Lympholasts (pre-B or pre-T); children; most responsive to therapy; associated with Down's Syndrome

Q1577:Leukemias: AML characteristics (3)

Myeloblasts; adults; auer rods

Q1578:Leukemias: Characteristics of chronic leukemias

More mature cells; midlife age range; longer; less devastating course

Q1579:Leukemias: CLL characteristics - cells

Lymphocytes; non-Ab producing B cells; increased smudge cells on peripheral blood smear

Q1580:Leukemias: CLL - population

older adults

Q1581:Leukemias: CLL - presentation and course

lymphadenopathy; hepatosplenomegaly; few sx; indolent course

Q1582:Leukemias: CLL is similar to?

very similar to SLL (small lymphocytic lymphoma)

Q1583:Leukemias: CLL is associated with?

warm antibody autoimmune hemolytic anemia

Q1584:Leukemias: CML cell characteristics

Myeloid stem cells; increased neutrophils and metamyelocytes

Q1585:Leukemias: CML translocation?

Ph Chromosome; t(9;22); bcr-abl

Q1586:Leukemias: CML acute complications?

blast crisis (AML)

Q1587:what chromosomal translocation? CML

Ph chromosome; t(9;22); bcr-abl

Q1588:what chromosomal translocation? Burkitt's lymphoma

t(8;14); c-myc activation

Q1589:what chromosomal translocation? Follicular lymphomas

t(14;18); bcl-2 activation

Q1590:what chromosomal translocation? AML- M3 type

t(15;17); responsive to all-trans retinoic acid (ATRA)

Q1591:what chromosomal translocation? Ewing's sarcoma

t(11;22)

Q1592:what chromosomal translocation? Mantle cell lymphoma

t(11;14)

Q1593:What are the chronic leukemias associated with Tlymphoblasts?

Sezary Syndrome; CLL-T (both L2)

Q1594:What are the acute leukemias associated with Tlymphoblasts?

ALL-T (L2); ALL-null (L1); ALL-common(L1)

Q1595:What are the chronic leukemias associated with Blymphoblasts?

CLL-B (L3)

Q1596:What are the acute leukemias associated with Blymphoblasts?

ALL-B (L3)

Q1597:What are the chronic leukemias associated with monoblasts?

Chonic monocytic (M5); chronic myelomonocytic (M4)

Q1598:What are the acute leukemias associated with monoblasts?

Acute monocytic (M5); acute myelomonocytic (M5)

Q1599:What are the chronic leukemias associated with myeloblasts?

CML (M1; 2 and 3); Polycythemia rubra vera (M1); myelofibrosis (M1)

Q1600:What are the acute leukemias associated with myeloblasts?

AML (M2 and M1); Promyelocytic (M1)

Q1601:What are the chronic leukemias associated with eosmyeloblasts?

Eosinophilic (rare)

Q1602:What are the chronic leukemias associated with normoblasts?

Chronic erythroid (M6; rare)

Q1603:What are the acute leukemias associated with normoblasts?

acute erythroleukemia (M6)

Q1604:What are the chronic leukemias associated with megakaryoblasts?

Idiopathic thrombocytopenia (M7)

Q1605:What are the acute leukemias associated wwith megakaryoblasts?

acute megakaryocytic leukemias (M7)

Q1606:What type of cell proliferates in MM; and what is its histologic appearance

Monoclonal plasma cell; fried egg appearance

Q1607:Where does MM arise?

bone marrow

Q1608:The 2 most common ab's; in order; are:

IgG (55%); IgA (25%)

Q1609:Common multiple myeloma symptoms are:

lytic bone lesions and hypercalcemia; renal insifficiency; increased suscpetibility to infection; anemia

Q1610:This disease is associated with:

primary amyloidosis

Q1611:Ig light chains are also called:

Bence Jones proteins

Q1612:3 key diagnostic features:

lytic bone lesions on x-ray; M-spike on serum protein electrophoresis; Bence-Jones proteins in urine

Q1613:Red blood cell appearance on peripheral smear:

Rouleaux formation (poker chips)

Q1614:What 2 differences are seen in Waldenstrom's macroglobulinemia?

M-spike is IgM; no lytic lesions

Q1615:Target cells

increased RBC membrane. Hemoglobinopathies; thalassemia; liver disease.

Q1616:Acanthocytes

Irregular spicules on surface. Abetalipoproteinemia

Q1617:Spherocytes

Decreased RBC membrane. No central area of pallor. Spherocytosis

Q1618:Schistocytes

RBC fragments. Microangiopathic hemolytic anemia; trauma

Q1619:Bite cells

RBC with removed bits of cytoplasm. G6PDH deficiency.

Q1620:Sickle cells

Sickle cell anemia

Q1621:Howell-Jolly bodies

Remnants of nuclear chromatin. Severe anemias or patients without spleen

Q1622:Ring sideroblasts

Trapped iron in mitochondria. Prussian-blue stain. Sideroblastic anemia

Q1623:Heinz bodies

Denatured Hb. G6PDH deficiency

Q1624:Basophilic stipling

RNA remnants. Lead poisoning

Q1625:Hypersegmented neutrophil

Megaloblastic anemia

Q1626:EPO stimuli

Low SaO2 (hypoxemia; anemia < 7gm/Dl; left shifted O2 curve

Q1627:Reticulocytes

Immature RBC with no nucleous and bluish color in peripheral blood indicate effective erithropoiesis. Require 24 hours to become mature.

Q1628:Reticulocyte normal and corrected count

Normal reticulocyte count is 1.5%. Corrected count is Hct/45 * reticulocyte count. >3% --> marrow responds well. <3% marrow is not well. If polychromasia (shift cells) divide corrected count by two because shift cells take double the time to mature

Q1629:Signs of anemia

Palpitations; dizziness; angina; pallor; weakness

Q1630:Hypochromic RBCs

Increased central pallor

Q1631:MCV < 80

Iron deficiency; thalassemia; AOD; Sideroblastic

Q1632:MCV 80-100; low reticulocyte count

Marrow failure; aplastic anemia; leukemia; renal failure; AOD

Q1633:MCV 80-100; high reticulocyte count

Sickle cell; G6PDH deficiency; spherocytosis; AIHA; PNH

Q1634:MCV > 100

Folate or B12 deficiency

Q1635:Causes of iron deficiency anemia

Ulcers; menstrual bleeding; left colon cancer; elderly and poor children; malabsorption; gastrectomy; hookworm; PlummerVinson

Q1636:Low serum iron; % saturation and serum ferritin with high TIBC

Iron deficiency anemia

Q1637:Low serum iron; TIBC and % saturation with high serum ferritin

AOCD

Q1638:High serum iron; serum ferritin and % saturation with low TIBC

Sideroblastic anemia

Q1639:AOCD

Iron is trapped in bone marrow macrophages due to high levels of IL-1 and lactoferrin. High ferritin and low TIBC.

Q1640:HbA

alpha 2beta 2

Q1641:HbF

alpha 2gamma 2

Q1642:Hb Barts

gamma 4

Q1643:HbH

beta 4

Q1644:alpha -thalassemia

Carrier has one alpha gene deletion; asymptomatic. ALPHA Thal trait has two deletions. HbH disease three deletions with high HbH and Heinz bodies. Hydrops fetalis; four deletions; lethal; high Hb Barts

Q1645:beta -thalassemia

Minor; asymptomatic; 8% HbA2 and 5% HbF. Major develop symptoms 6 months after birth as HbF declines; jaundice; bilirubin gallstones; secondary hemochromatosis due to life-long transfusions; CHF; crecut skull x-ray; target cells. 90% HbF and HbA2

Q1646:HbA2

alpha 2δ2

Q1647:Lead poisoning anemia

Sideroblastic anemia. Lead denatures ferrochelatase; ALA dehydrse and ribonuclease (coarse basophilic stipling). Ringed sideroblasts and basophilic stipling. Lead colic; peripheral neuropahty; cerebral edema; learning disabilities; bone in epiphysis on x-rays. high serum Pb; high urine δ-ALA; high serum iron; ferritin and %saturation with low TIBC. Risk fators: Pb paint; battery factory; pottery painter.

Q1648:Iron overload anemia

Sideroblastic anemia with ringed sideroblasts. Alcoholism (MCC); pyridoxine deficiency (required by ALA synthase); isoniazid treatment. High serum iron; % saturation; ferritin and decreased TIBC.

Q1649:Factors that induce and prevent sickling

Deoxygenation of Hb/right shifting dissociation curve (acidosis); increasing HbS concentration (dehydration); low O2 tension (altitude and renal medulla). HbF left shifts dissociation curve and prevent sickling (hydroxeurea Rx)

Q1650:Pathophysiology of sickle cell disease

Valine subsitutes glutamic acid in position 6 of beta Hb chain causing sickling and thrombi that occlude vessels (painful crisis); hand-foot swelling; autosplenectomy with HowellJolly bodies and increased risk of infections by encapsulated orgainsms; Salmonella osteomyelitis; parvovirus B19 aplastic crisis.

Q1651:Pathophysiology of G6PDH deficiency

Mutation causes defective protein folding with low G6PDH activity and low levels od reduced gluthathione needed to neutralize ROS. Oxidative stress; oxidative drugs (primaquine; sulfonamides; anti-TB); bacterial infections and fava beans cause red cell damage and hemolysis with Heinz body formation (seen with methylene blue or crystal violet stains)

Q1652:Pathophysiology of spherocytosis

Spectrin defect with decrease in RBC membrane leads to circular RBCs which are removed by macrophages in the spleen (extravascular hemolysis). Triad of anemia; splenomegaly and jaundice with risk of bilirubinate gallstones. Increased osmotic fragility test.

Q1653:Pathophysiology of AIHA

IgG autoantibodies against Rh antigens on RBC with macrophage removal in spleen cause splenomegaly. Differentiate from hereditary spherocytosis with positive direct Coombs test

Q1654:Pathophysiology of PNH

Low levels of decay accelerating factor (DAF) are not able to normally inhibit C3 convertase with increased sensitivity of cells to complement lysis. Slow breathing at night (retains CO2) and exercise produce acidosis which activates the complement system with pancytopenia and increased risk of aplastic anemia; leukemia and venous thrombosis

Q1655:Direct Coomb's test

Detects IgG or C3 on surface of RBCs. Positive in AIHA; negative in hereditary spherocytosis.

Q1656:Indirect Coomb's test

Detects autoantibodies in the serum. Often positive in AIHA

Q1657:Pathophysiology of microangiopathic hemolytic anemia

RBCs are damaged by calcium in stenotic valves (aortic stenosis MCC); fibrin clots in DIC and platelet plugs in ITP and HUS. Presence of schistocytes.

Q1658:Sites for reabsorption of iron; folate and B12

Iron: duodenum (Bilroth II; vitamin c deficiency and malabsorption syndromes produce deficiency). Folate: jejunum (contraceptives and alcohol decrease absorption). B12: terminal ileum (pernicious anemia; Crohn's and terminal ileum resection decrease absorption)

Q1659:Pathophysiology of megaloblastic anemia

Methyl THF is needed to make methylcobalamine to convert homocysteine into methione by methylTHF-homocysteine methyl transferase (requires cobalamine). Methylene THF is required by thymidilate synthetase to make nucleic acids. B12 is needed by methylmalonyl CoA mutase to make succinyl CoA.Tetrahydrofolate is made by dihydrofolate reductase (blocked by methotrexate and trimethropin). Deficiency of folate or B12 produces megaloblastic anemia with hypersegmented neutrophils (no nucleic acid synthesis); homocystinuria and methylmalonic aciduria.

Q1660:Causes of folate deficiency

Alcoholism (not beer); pregnancy; methotrexate; trimetrhoprim; phentoyn; birth control pills; celiac disease; leukemia

Q1661:Causes of B12 deficiency

Pernicious anemia; pure vegan diet; Crohn's disease; chronic pancreatitis (cant cleave R factor from saliva which protects B12); D. latum

Q1662:Schilling's test

Non-radioactive intramuscular B12 to saturate transcobalamin followed by radioactivee oral B12. No radioactive B12 detected in 24h urine confirms B12 absorption deficiency. Correct with intrinsic factor (pernicious anemia); pancreatic enzymes (chronic pancreatitis) or antibiotics (bacterial overgrowth)

Q1663:describe structure of RBC

biconcave;anucleate ;large surface:volume for easy gas exchange

Q1664:how do RBCs derive energy

glucose;90% anaerobic resp;10% HMP shunt

Q1665:survival time of RBC

120 days

Q1666:what does membrane of RBC contain

chloride-bicarb antiprot ;allows RBC to transport CO2 from periphery to lungs for elimination

Q1667:WBC differential from highest to lowest:

Neutrophils Like Making Things Better;Neutrophils;Lymphocytes;Monocytes;Eosinophils;Ba sophils

Q1668:which WBC are granulocytes

BEN ;basophils;eosinophils;neutrophils

Q1669:which WBC are mononuclear cells

monocytes;lymphocytes

Q1670:what are the steps in forming a granulocyte

pluripotent hematopoietic cell;myeloid stem cell;promyelocyte;myelocyte;metamyelocyte;stab cell;granulocyte

Q1671:what are the precursors to monocyte

pluripotent hematopoietic stem cell;myeloid stem cell;monoblast ;monoctye

Q1672:what are the precursors to lymphocytes

pluripotent hematopoietic cell ;lymphoid stem cell;lyphoblasts;B/T cell

Q1673:what are the steps to RBC formation

pluripotent hematopoietic stem cell;proerythroblast;reticulocyte;RBC

Q1674:what are hte steps to platelet formation

pluripotent hematopoietic stem cell;myeloid stem cell;megakaryoblast;megakaryocyte;platelet

Q1675:what are granulocytes; platelets; and monocytes all derived from (what is common precursor)

myeloid stem cell

Q1676:what is contained in the granules of basophils

heparin ;histamine;LTD4;other vasoactive amines

Q1677:when is basophilic stippling seen

thalassemia ;anemia of chronic dz ;iron deficiency anemia;lead poisoning

Q1678:what do eosinophils react to?

helminths and protazoa ;phagocytose ag-ab complexes

Q1679:causes of eosinophilai

NAACP ;neoplastic;asthma;allergies;collagen vascular dz;parasites

Q1680:what is contained in the PMNL granules

hydrolytic enzymes;lysozyme;MPO ;lactoferrin

Q1681:where do B cells go after they are mature?

migrate to peripheral lymphoid tissue (follices of LN; white pulp of spleen; unencapsulated lymphoid tissue)

Q1682:when does B cell --> plasma cell

when it encounters ag

Q1683:appearance of plasma cell

off center nucleus ;abundant RER;well developed golgi

Q1684:causes of DIC

STOP Making New Thrombi;Sepsis (gram -);Trauma;OB complications;Pancreatitis (acute) ;Malignancy;Neoplasm;Transfusion

Q1685:causes of extravascular hemolytic anemia

odd shapes of RBC (spherocytes; target cells; schistocytes; etc) ;autoimmune anemia

Q1686:causes of intravascular hemolytic anemia

destruction via complement and lysis;paroxysmal nocturnal hemoglobinuria;microangiopathic anemia

Q1687:microangiopathic anemia

seen when theres is an occlusion of a small BV; which leads to mechanical disruption of RBC (seen in DIC; TTP/HUS; SLE; malignancy)

Q1688:jaundice in the hemolytic anemias

not seen in intravascular hemolysis normally; b/c the macrophages eat all of the destroyed Hb

Q1689:what is haptoglobin ;levels during hemolysis

a "suicide protein" that carries Hb to the spleen to get broken down ;levels are low

Q1690:treatment for spherocytosis

splenectomy

Q1691:process behind paroxysmal nocturnal hemoglobinuria

acidosis normally develops during sleep; which predisposes cells to destruction via complement; but this is normally inhibited by DAF (which degrades complement); if not enough DAF --> lysis of RBC InTRAVASCULARLY!

Q1692:how to dx G6PD deficiency during acute crisis?

look at blood smear and look for Heinz bodies;when crisis is over; look for enzyme deficiency

Q1693:how to dx autoimmune hemolytic anemia

direct coomb's test (or indirect)

Q1694:some kids can have extremely elevated wbc counts (>50;000) and this is not malignancy; what is it called?

leukemoid reaction

Q1695:why do howell-jolly bodies appear in pts w scd?

if pts had working spleens; they would have been able to remove these abnormal cells

Q1696:what should all SC pts be vaccinated against

s. pneumonia

Q1697:#1 cause of osteomyelitis in SCD;#2 cause?

salmonella;s. aureus

Q1698:why is hydroxyurea effective in treating SCD?

it creates an incresae in HbF; which binds to O2 tighter than adult Hb.

Q1699:what would you do with an african american person who presents with microscopic hematuria; and is asymptomatic and has a normal CBC?

test for SCD!!;there may be sickling in the renal medulla and peritubular capillary (so they might be a carrier of the trait)

Q1700:what does antithrombin III do?;what activates it?

breaks down factors IX; X; XI ;heparin

Q1701:factor V leiden?

factor 5 is resistant to breakdown by APC ;leads to venous clots

Q1702:protein c;what does it require

breaks down factors V and VIII ;requires vit K and protein s

Q1703:protein s

required as a cofactor for APC

Q1704:tPA

activates plasmin; which breaks down fibrin

Q1705:difference between multiple myeloma and waldenstrom's macroglobulinemia

MM: IgG or IgA in high amounts (lytic bone lesions; renal insuff from increased Ig light chains excretion - Bence Jones proteins) ;W<: IgM in large amts (--> hyperviscosicty; no lytic bone lesions) ;both have M spike

Q1706:which form of hodgkin's lymphoma has the worst prognosis

lymphocyte depleted

Q1707:translocation (9;22)

Philadelphia chromosome;CML

Q1708:translocation (8;14)

Burkitt's lymphoma (c-myc activation)

Q1709:translocation (14;18)

follicular lymphoma (bcl2 expression)

Q1710:translocation (15;17)

M3 - AML

Q1711:translocation (11;22)

ewing sarcoma

Q1712:translocation (11;14)

mantle cell lymphoma

Q1713:when is WAIHA seen

chronic anemia seen with;SLE ;CLL ;some drugs

Q1714:when is CAIHA seen

infectious mononucleosis;m. pneumonia

Q1715:which NHLs are seen in children

burkitt's lymphoma;diffuse large cell;lymphoblastic lymphoma

Q1716:smudge cells

cll

Q1717:philadelphia chromosome

cml

Q1718:auer rods

aml

Q1719:how to differentiate cml from leukemoid reaction

cml has low alk-phos levels

Q1720:what is a result of treating aml

cells can release auer rods --> DIC

Q1721:What are they general characteristics of Neoplasia?

Uncontrolled disorderly proliferation of cells resulting in a benign or malignant tumor or neoplasm.

Q1722:What is dysplasia?

1) Reversible change;2) Often precedes malignancy;3) Morphologically manifests by disorderly amturation and spatial arrangement of cells marked variability in nuclear size and shape and increased often abnormal mitosis4) Exemplified by dysplasia of squamous epithelium of the cervix which is often a precursor of malignancy.

Q1723:What are neoplasms?

1) Resemblance to tissue of origin is close the neoplasm is termed WELL DIFFERENTIATED; if little resemblance to teh tissue of origin is seen it is POORLY DIFFERENTIATED2) Neoplasms grow at the expense of finction and vitality of normal tissue without benefit to the host and are largely independent of host control mechanism.

Q1724:What is Carcinoma?

Malignant tumor of epithelial origin

Q1725:What is Squamous cell carcinoma?

1) Originates from stratified squamous epithelium of for example the skin mouth esophagus and vagina as well as from areas of squamous metaplasia as in teh bronchi or the squamocolumnar junction of the uterine cervix2) marked by the production of keratin.

Q1726:What is transitional cell carcinoma?

Arises from the transitional cell epithelium of the urinary tract.

Q1727:What is adenocarcinoma?

Carcinoma of the glandular epithelium and includes amlignant tumors of the GI mucosa endometrium and pancreas2) Often associated with desmoplasia tumor-induced proliferation of non-neoplastic fibrous CT particularly in adenocarcinoma of the breast pancreas and prostate.

Q1728:Wht is sarcoma?

1) malignant tumor of mesenchymal origin2) Often used with a prefi that denotes the tissue of origin of the timor as in osteosarcomaa rhabdomyocarcoma leiomyosarcoma and liposarcoma.

Q1729:What are eponymically named tumors?

1) Burkitt lymphoma;2) Hodgkin disease;3) Wilms tumor

Q1730:What is a teratoma?

1) neoplasm derived from all three germ cell layers which may contain structures such as skin bone cartilage teeth and intestinal epithelium2) May be either malignant or benign;3) Usually arises in the ovaries or testes.

Q1731:Describe Benign Tumors.

1) Usually well differentiated and closely resemble teh tissue of origin;2) Do not metastasize and grow slowly. They can be harmful if their growth compresses adjacent tissues. For example benign intracranial tumors can be more lethal than some malignant skin tumors3) Tend to become encapsulated4) Denoted by the suffix -oma as in lipoma and fibroma5) Don't confuse this with some malignant neoplams as hepatoma melanoma lymphoma and mesotheliuma as well as several non-neoplastic swelings including granuloma and hematoma.

Q1732:What is a papilloma?

1) Papilloma is a benign neoplasm most often arrising form surface epithelium such as squamous epithelium of the skin larynx or tongue2) Consists of delicate finger-like epithelial processes overlyig a core of connective tissue stroma that contains blood vessels3) May also develop from transitional epithelium of the urinary bladder ureter or renal pelvis.

Q1733:What is an adenoma?

Benign neoplasm of glandular epithelium that occurs in several variants like papillary cystadenoma and fibroadenoma.

Q1734:What is papillary cystadenoma?

Characterized by adenomatous papillary processes that extend into cystic spaces as in cystadenoma of the ovary.

Q1735:What is a fibroadenoma?

Marked by proliferation of CT surrounding neoplastic glandular epithelium; for example fibroadenoma of the breast.

Q1736:What are benign tumors of mesenchymal origin?

1) Most often named by the tissue of origin; for example leiomyoma rhabdomoma lipoma fibroma and chondroma2) Include the most common neoplasm of women the uterine leiomyoma or fibroid tumor.

Q1737:What is Choristoma?

Small non-neoplastic area of normal tissue misplaced within another organ sucha as pancreatic tissue within the wall of the stomach.

Q1738:What is a Hamartoma?

Non-neoplastic disorganized tumor-like overgrowth of cell types that are regularly found within the affected organ; hemangioma an irregular accumulatoin of blood vessels is an example.

Q1739:What is monoclonality?

1) Denotes origin from a single precursor cell;2) Characteristic of most neoplasms; in contrast polyclonal proliferations are almost always non-neoplastic3) Assessed by a variety of approaches.

Q1740:What do Glucose-6-phosphate dehydrogenase isoenzyme studies do?

1) Offering compelling evidence for monoclonality of tumors; because of X inactivation in early embryonic life tissues of females heterozygous for G6PD isoenzymes consist of a mosaic of cell types with random cells expressing one or the other of the two isoenzymes2) monoclonal tumors express only one of the isoenzymes;3) Polyclonal cellular proliferations exhibit both isoenzymes.

Q1741:How are immunoglobulins involved as indicators of monoclonality in malignancies of B cell origin?

1) Produced by B cell malignant tumors and are demonstrable as cytoplasmic or surface immunoglobulin or in the case of multiple myeloma are secreted and are demonstrable in the serum2) Monoclonal the resultant mixture of immunoglobulin molecules will exhibit either kappa or lambda chain specificity but not both a characteristic finding in neoplastic B cell proliferations3) B cell or plasma cell proliferations are polyclonal they result in the production of heterogeneous immunoglobulin molecules some of which express kappa specificity and others that express lambda specificity.

Q1742:What is immunoglobulin gene rearrangement in regards to being an indicator of monoclonality in malignancies of B cell origin?

1) Characteristic of B cell maturation. The number of possible combinations achieved by rearrangement is almost countless; it can be assumed that each normal B cell is marked by a unique rearrangement pattern. Neoplastic proliferation results in large numbers of cells all demonstrating the same pattern of immunoglobulin gene rearrangement denoting their common origin form a single cell3) Assessed by molecular diagnostic techniques;4) Because immunoglobulin heavy chain rearrangement is limited to B cells this approach also demonstrates teh B cell origin of a tumor.

Q1743:How are surface antigens idicators of monoclonality in malignancies of T cell origin?

1) demonstrable as T cells mature; they may be characteristic of either the stage of maturation or functional subclass. Cellular proliferations in which large numbers of T cells share surface markers in common are suggestive of monoclonality2) In addition to many others include the CD4 antigen marking T helper cells and the CD8 antigen marking T suppressor and cytotoxic cells.

Q1744:What is T cell receptor gene arrangement and how is it involved as an indicator of monoclonality in malignancies of T cell origin?

1) Analogous to immunoglobulin gene rearrangement and is used in a similar manner to demonstrate both the T cell origin of a tuor and its monoclonality.

Q1745:What is invasion of a tumor cell?

1) Aggressive infiltration of adjacent tissues by a malignant tumor2) Often extends into lymphatics and blood vessels with the formation of tumor emboli that may be carried to distal sites. not all tumor emboli results in metastatic tumor implants and the presence of tumor cells withing blood vessels or lymphatics indicates only the penetration of basement membranes and is not synonymous with metastasis.

Q1746:What are the six steps of metastasis?

1) Growth and vascularization of the primary tumor;2) Invasiveness and penetration of basement membranes into lymphatics or blood vessels3) Transport and survival of tumor cells in the circulation4) Arrest of tumor emboli in the target tissue and passage again across basement membranes;5) Overcoming of target tissue defense mechanisms;6) Development of successful metastatic implants.

Q1747:What are the preferential routes of metastasis?

1) Vary with specific neoplasms;2) Carconomas tent to metastasize via lymphatic spread3) Sarcomas tend to invade blood vessels early resulting in widespread blood-borne dissemination4) Notable exceptions include renal cell and hepatocellular carcinoma which are market by early venous invasion and hematogenous dissemination.

Q1748:What are the target organs of metastasis?

1) Most commonly the liver lungs brain adrenal glands lymph nodes and bone marrow2) Rarely include skeletal muscle or the spleen.

Q1749:What is tumor progression in regards to metastasis?

1) Characterized by the accumulation of successive cytogenetic or molecular abnormalities2) Exemplified by the progression of changes from normal colonic epithelium to adenoma to carcinoma to metastasis with parallel changes in APC K-ras DCC p53 and possibly other genes3) Individual neoplastic cells within a tumor may have varying metastatic potential.

Q1750:What is Cachexia and wasting?

1) Origin is complex; it is characterized by weakness weight loss anorexia anemia infection and hyprmetabolism2) May be mediated in part by cachectin (TNF-alpha) a product of macrophages that promotes catabolism of fatty tissue.

Q1751:What are the endocrine abnormalities of malignance?

1) Caused by tumors of endocrine gland origin which may actively elaborate hormones leading to a variety of syndromes2) Pituitary abnormalities;3) Adrenocortical abnormalities;4) Ovarian abnormalities;5) Trophoblastic tissue abnormalities

Q1752:What are pituitary abnormalities of malignancy?

1) Prolactinoma leading to amenorrhea infertility and some times galactorrhea2) Somatotropic (acidophilic) adenoma leading to gigantism in children and acromegaly in adults3) Corticotropic (most often basophilic) adenoma leading to Cushing disease (adrenal hypercorticism of pituitary origin)

Q1753:What are the adrenocortical abnormalities of malignancy?

Include adrenogenital syndrome Conn syndrome and Cushing syndrome of adrenal origin resulting from adrenal cortical tumors.

Q1754:What are ovarian abnormalities of malignancy?

1) Granulosa-theca cell tumor leading to hyperestrinism;2) Sertoli-Leydig cell tumor leading to excess androgen production.

Q1755:What are trophoblastic tissue abnormalities of malignancy?

Include hyperproduction of human chorionic gonadotropin from hydatiform mole or choriocarcinoma.

Q1756:List 6 endocrinopathies.

1) Cushing syndrome;2) Inappropriate secretion of ADH;3) Hypercalcemia;4) Hypoglycemia;5) Polycythemia;6) Hyperthyroidism

Q1757:What is Cushig syndrome in regards to paraneoplastic syndrome?

Caused by production of ACTH-like substances by small cell carcinoma of the lung.

Q1758:What is Inappropriate secretion of ADH in regards to paraneoplastic syndrome?

Comes form a variety of tumors most commonly small cell carcinoma of the lung.

Q1759:What is hypercalcemia as a paraneoplastic syndrome?

Caused by metastatic disease in bone secretion of a substance similar to parathormone by squamous cell bronchogenic carcinoma or secretoin of a substance similar to osteoclast activating factor by the malignant plasma cells of multiple myeloma

Q1760:What is Hypoglycemia in regards to paraneoplastic syndrome?

Caused by secretion of insulin-like substances by hepatocellular carcinomas mesotheliomas and some sarcomas

Q1761:What is Polycythemia in regards to paraneoplastic syndrome?

Caused by elaboration of erythropoietin by renal tumors and other neoplams.

Q1762:What is hyperthyroidism in regards to paraneoplastic syndrome?

Caused by production of substances like thyroid-stimulating hormone by hydatidiform moles choriocarciomas and some lung tumors

Q1763:What are neorologic abnormalities of paraneoplastic syndromes?

1) May occur in the absence of metastatic disease;2) Include degenerative cerebral changes with dementia cerebellar changes with resultant gait dysfunction and peripheral neuropathies

Q1764:What are skin lesions related to paraneoplastic syndromes?

1) May be associated with visceral malignancies;2) Include acanthosis nigricans and dermatomyositis.

Q1765:What coagulation abnormalities are associated with paraneoplastic syndromes?

1) Include migratory thrombophlebitis associated with carcinoma of the pancreas and other visceral malignancies (Trousseau phenomenon) and disseminated intravascular coagulation associated with various neoplasms.

Q1766:What are oncofetal antigens?

1) Proteins normally expressed only in fetal or embryonic life; their expression by neoplastic cells is considered a manifestation of dediffrentiation;2) The undifferentiated neoplastic cells tend to resemble their embryonic counterparts3) Include carcinoembryonic antigen (CEA) which is associated with colon cancer and other cancers and preneoplastic processes and alpha-fetoprotein (AFP) which is associated with hepatocellular carcinoma and many germ cell tumors. AFP is also iincreased in fetal anencephaly and other neural tube defects.

Q1767:What are direct-reacting carcinogens?

Do not need to be chemically altered to act.

Q1768:What are indirect-reacting carcinogens?

Require metabolic conversion form procarcinogens to active ultimate carcinogensFor example a mucosal glucuronidase in the urinary bladder converts to beta-napthylamine glucuronide to the carcinogen beta-naphthylamine.

Q1769:What are the stages of chemical carcinogenesis?

Initiation and Promotion

Q1770:What is Initiation?

The first critical carcinogenic event and it is usually a reaction between a carcinogen adn DNA. Two or more agents may act together as cocarcinogens

Q1771:What is promotion?

Induced by a stimulator of cell proliferation and enhances the carcinogenic process. A promoter not a corcinogenic in itself enhances other agents' carcinogenicityFor example phorbol esters react with membrane receptors stimulating cell replication. This may enhance clonal selection resulting in cells with increasingly deleterious DNA changes.

Q1772:How does exposure to UV radiation contribute to carcinogenesis?

1) In the form of sunlight is clearly related to the frequency of skin cancers such as squamous cell and basal cell carcinomas and melanomas2) Thought to act by inducing dimer formation between neighboring thymine pairs in DNA. In most cases such dimers are successfully repaired by enzymatically mediated mechanisms. That skin cancer may be induced by such dimer formation is suggested by the greatly increased incidence of skin tumors seen in Xeroderma pigmentosum an autosomal recessive disorder characterized by failure of DNA excision repair mechanisms.

Q1773:What is ionizing radiation and how is it carcinogenic?

1) Classic cause of cancer exemplified by the increased incidence of cancers in those exposed to radiation2) skin cancer and myeloid leukemias in radiologists3) Lung cancer in uranium miners;4) Thyroid cancer in patients who have received head and neck radiation therapy;5) Acute and chronic myeloid (but not lymphoid) leukemias in survivors of atomic blasts6) Osteosarcoma in radium watch-dial workers.

Q1774:How do DNA viruses contribute to carcinogenesis?

1) Integrate viral DNA into host genomes perhaps resultig in host cell expression of viral mRNA coding for specific proteins;2) Include haman papillomavirus EVB hepatitis B virus as prominent suspects that play a role in human carcinogenesis.

Q1775:How do retroviruses contribute to carcinogenesis?

1) Marked by transcription of viral genomic RNA sequences into DNA by action of viral reverse transcriptase2) In the case of retroviruses that are tumorigenic in experimental animals are frequently characterized by substitutions of genomic sequences known as viral oncogenes.

Q1776:What are viral oncogenes?

1) named with a three-seter abreviation preceded by v for viral;2) exhibit homology for DNA sequences of man and other eukaryotic species; these eukaryotic DNA sequences are called proto-oncogenes or cellular oncogenes and are identified with the same three-letter abbreviations preceded by c for cellular.

Q1777:What are the characteristics of Ras and G proteins?

1) Located at the plasma membrane and have GTP binding and GTPase activities. GTPase hydrolytically converts active ras-GTP to ras-GDP2) Inactivated by ras-GTPase mediated by GTPase-activating protein (GAP);3) GTP activation of ras can stimulate or depress adenylate cyclase activity altering intracellular cAMP levels thus affecting cellular behavior.

Q1778:Describe the mutation of the ras gene.

1) Usually occurs at codon 12;2) Results in an aberrant p21 protein product with intact GTP binding but with a loss of GTPase activity. Mutant ras proteins can be activated by GTP binding but cannot be inactivated by GTPase activity3) ras is mutated in 25%-30% of malignancies.

Q1779:What is growth factor or GF receptor activity in regard to oncogenesis?

alterations in expression or structural changes in oncogene products may result in inappropriate activvation of receptor proteins or their oncogenic analogs thus mimicking the actions of growth factors2) On stimulation with the appropriate growth factor receptor proteins often demonstrate tyrosine kinase activity of their cytoplasmic domains3) Significant homologies occur between several oncogenes and the genes for cellular growth factors and their receptorsa) v-sis and the gene for beta chain of PDGF;b) v-erb and the gene for EGF receptor;c) v-fms and the gene for CSF-1 receptor;d) c-neu and the gene for EGF receptor

Q1780:What are nuclear proteins in regard to oncogenesis?

Some oncogene products including the protein products of myc fos and myb are confined to the cell nucleus.

Q1781:What is promoter insertion in regard to oncogenes?

1) Insertion of retroviral promoter or enhancer sequences into the host genome can lead to increased expression of a nearby oncogene2) This mechanism is similar to the promoterinduced hyperexpression associated with translocations characteristic of several human leukemias and lymphomas.

Q1782:What are point mutations in regard to oncogenes?

Exemplified by a single nucleotide changes in codon 12 of the ras family of genes associated with a number of human tumors.

Q1783:What are chromosomal translocations in regard to oncogenes?

Frequent association with malignancy seen in these genetic rearrangements has been clarified by demonstrating that important genes are situated at the sites of chromosomal breaks

Q1784:What is 8;14 translocation?

Burkitt lymphoma;c-myc proto-oncogene on chromosome 8 is translocated to a site adjacent to the imunoglobulin heavy chain locus on chromosome 14. Major regulatory sequences within the immunoglobulin gene are thought to increase the expression of c-myc

Q1785:What is 14;18 translocation?

Follicular lymphoma;Immunoglobulin heavy chain locus on chromosome 14 si transposed to a site adjacent to bcl-2 an oncogene on chromosome 18. This results in enhanced expression of bcl-2 thus inhibiting apoptosis.

Q1786:What is 9;22 translocation?

Chronic myeloid leukemia (CML);1) c-abl proto-oncogene on chromosome 9 is transposed to a site adjacent to bcr an oncogene on chromosome 222) The union of bcr adn abl results in a hybrid or chimeric bcr-abl fusion gene that codes for a protein with increased tyrosine kinase activity3) Altered chromosome carrying this hybrid gene the Philadelphia chromosome can be demonstrated by cytogenetic techniques in hematopoietic cells of patients with CML.

Q1787:What is 15;17 translocation?

Acute proyelocytic leukemia (FAB M3 AML);1) The translocation involves the PML gene on chromosome 15 and the retinoic acid receptor (RAR) alpha gene on chromosome 172) Therapy wiht the retinoic acid analogue all-trans retinoic acid can result in maturation of these leukemic cells and clinical remission.

Q1788:Describe gene amplification.

1) Reduplication of the gene with multiple resultant genomic DNA copies and can sometimes result in a thousand or more copies of the amplified gene2) Extensive amplification can result in small free chromosome-like bodies called double minute chromosomes or in band-like structures within chromosomes called homogeneously staining regions (HSRs) which are both demonstrable cytogenetically

Q1789:Name two neoplasms associated with gene amplification.

Neuroblastoma and some Breast Cancers.

Q1790:What is amplified in neuroblastoma?

N-myc; correlates inversely with the degree of differentiation of the neuroblastoma cells.

Q1791:What is amplified in some breast cancers?

HER-2/neu oncogene; such amplification is associated with poor prognosis.

Q1792:What are cancer suppressor genes (anti-oncogenes)?

In contrast to oncogene mechanisms cancer suppressor genes promote cellular proliferation when the gene is inactivated (most often by deletion). A single residual copy of the antioncogene suppresses tuor formation but homozygous inactivation promotes the expressoin of the neoplastic phenotype.

Q1793:Describe the anti-oncogene process using retinoblastoma.

1) An intraocular childhood tumor caused by inactivation of the Rb gene. The two hit hypothesis of Knudson holds that two mutagenic events are requird to induce alterations on both chromosomes2) In the familial forms of retinoblastoma the gene on one chromosome in teh germline is inactivated or deleted and the gene on the other chromosome is affected by a somatic mutation3) In sporadic nonfamilial cases of retinoblastoma both deletions occur as somatic mutations.

Q1794:What is the p53 tumor suppressor gene?

1) Mutated in over 50% of all malignant tumors2) Has been called teh "guardian of the genome";3) In the seting of DNA damage causes cell cycle arrest in G1 providing time for DNA repair4) If repair is successful cells re-enter the cell cycle5) If not successful p53 product causes cell death by apoptosis6) Familial loss causes the Li-Fraumeni syndrome which is characterized by a wide variety of tumors: breast soft tissue sarcomas brain tumors and leukemias.

Q1795:What are WT-1 and WT-2 tumor suppressor genes?

1) Are located on chromosome 11;2) Inactivation or deletion of either is associated with Wilms timor the most common renal neoplasm of children.

Q1796:What is the APC tumor suppressor gene?

Inactivation is common in familial polyposis coli and adenocarcinoma of the coon as well as a few other tumors; gastric and esophageal.

Q1797:What is the BRCA-1 tumor suppressor gene?

Inactivation is associated with familial propensity to breast and ovarian carcinomas.

Q1798:What is the BRCA-2 tumor suppressor gene?

Inactivation is associated with breast cancer.

Q1799:What is von Recklinghausen neurofibromatosis type 1 and NF-1?

1) Characterized by multiple benign neurofibromas cafe au lait spots iris hamrtomas and an increased risk of developing fibrosarcomas2) Caused by mutations in the NF-1 tumor suppressor gene (which functions as a GAP protein that inactivates ras)

Q1800:What is multiple endocrine neoplasia type II?

1) Familial occurence of the combination of medullary thyroid carcinoma bilateral pheochromocytomas and hyperparathyroidism due to hyperplasia or tumor2) Caused by mutations of teh ret proto-oncogene that are transmitted i the germline. Thus demonstration of a ret mutation in a patient with medullary thyroid carcinoma would indicate the need for surveillance for the development of pheochromocytoma or hyperparathyroidism.

Q1801:What is hereditary nonpolyposis colon cancer (HNPCC or Lynch syndrome)?

1) Caused by an inherited mutation in certain DNA repair genes resulting in genomic instability2) Predisposes to mutations in other genes more diretly related to transformation.

Q1802:What is Xeroderma pigmentosum?

1) An autosomal recessive disorder;2) Manifest by an increased incidence of skin cancers (basal cell carcinoma squamous cell carcinoma malignant melanoma) caused by hypersensitivity to ultraviolet light3) Involves defects in genes that function in nucleotide excision repair which is required for repair of ultraviolet-induced pyrimidine (often thymine) dimers (cross-linked pyrimidine residues).

Q1803:Describe the grading of cancer.

Histopathologic evaluation of the lesion based on teh degree of cellular differentiation.

Q1804:Describe the staging of cancer.

1) Clinical assessment of the degree of localization or spread of the tumor2) Generally correlates better with prognosis than does histopathologic grading. However both approaches are useful3) Exemplified by teh generalized TNM system which evaluates the size and the extent of the tumor (T) lymph node involvement (N) and metastasis (M)4) Sometimes oriented toward specific tumors as exemplified by teh Dukes system for colorectal carcinoma and teh Ann Arbor system for Hodgkin disease adn non-Hodgkin lymphomas.

Q1805:down syndrome associated neoplasm

Acute Lymphoblastic Leukemia;we ALL go DOWN together

Q1806:xeroderma pigmentosum assoc neoplasm

squamus cell and basal cell carcinoma of skin

Q1807:chronic atrophic gastritis pernicious anemia and postsurgical gastic remnants assoc neoplasia

gastric adenocarcinoma

Q1808:tuberculosis scerlosis (facial angiofibroma seizures mental retardation) assoc neoplasms

astrocytoma and cardiac rhabdomyoma

Q1809:actinic keratosis assoc neoplasm

squamous cell carcinoma of skin

Q1810:barret's esophagus assoc neoplasm

esophageal adenocarcinoma

Q1811:plummer-vinson syndrome (atrophic glossitis esophageal webs anemia all due to iron deficiency) assoc neoplasms

squamous cell carcinoma of esophagus

Q1812:cirrhosis assoc neoplasm

hepatocellular carcinoma

Q1813:ulcerative colitis assoc neoplasm

colonic adenocarcinoma

Q1814:paget's disease of bone assoc neoplasm

2ndary osteosarcoma and fibrosarcoma

Q1815:aids associated neoplasom

aggressive malignant lymphomas (non hodgkins) and kaposi's sarcoma

Q1816:acanthosis nigricans (hyperpigmentation and epidermal thickening) assoc neoplasm

visceral malignancy (stomach lung breast uterus)

Q1817:dysplastic nevus assoc neoplasm

malignant melanoma

Q1818:tumor associated w/ oncogenes gain of function;1 cmyc;2 bcl-2;3 erb-B2;4 ras

1 burkitt's lymphoma;2 follicular and undifferentiated lymphomas (inhibits apoptosis);3 breast ovarian and gastric carcinomas;4 colon carcinoma

Q1819:tymor and chromosome associated w/ homozygous loss of fx of tumor suppressor genes1 Rb;2 BRCA1 and 2;3 p53

1 13q retinoblastoma osteosarcoma;2 17q 13q Breast and ovarian cancer;3 17p most human cancers li-fraumeni syndrome

Q1820:tumors assiciated w/ tumor markers1 PSA;2 CEA;3 AFP;4 beta-hCG;5 CA-125;6 S-100;7 alkaline phosphatase

1 prostatic carcinoma;2 carcinoembryonic antigen. produced by 70% colorectal and pancreatic cancers also by gastric and brast carcinomas;3 normally made by fetus. hepatocellular carcinomas. nonseminomatous germ cell tumors of the testis (i.e. ylk sac tumor);4 hydatiform moles choriiocarcinomas and gestational trophoblastic tumors;5 ovarian malignant epithelial tumors;6 melanoma neural tumors astrocytomas;7 metastases to bone obstructive biliary disease paget's disease of bone

Q1821:tumors associated with Oncogenic viruses1 HTLV-1;2 HBV HCV;3 EBV;4 HPV;5 HHV-8

1 adult t cell leukemia;2 hepatocellular carcinoma;3 burkitt's lymphoma nasopharyngeal carcinoma;4 cervical carcinoma (16 18) penile/anal carcinoma;5 kaposi's sarcoma

Q1822:chemical carcinogens and affected organs1 aflatoxins vinyl chloride;2 nitrosamines;3 asbestos;4 arsenic;5 CCl4;6 Napthalene dyes

1 Liver;2 esophagus stomach;3 lung (mesothelioma and bronchogenic carcinoma);4 skin (squamus cell);5 liver (centrilobular necrosis fatty change);6 bladder (transitional cell carcinoma)

Q1823:Definition;when the resemblance to the tissue of origin is close

Well-differentiated

Q1824:(4) signs of Malignant Cancer

Hyperchromatism;;Anaplasia (poor differentiation);;Inc Nuclear/cytoplasmic ratio;;prominent Nucleoli

Q1825:the (3) types of CA from Epithelial origin

Epithelial = "Carcinoma";Squamous Cell CA;;Adenocarcinoma;;Transitional Cell CA

Q1826:Definition;reversible pre-neoplastic growth with loss of cellular orientation shape and size in comparison to normal tissue

Dysplasia

Q1827:Definition;a clonal proliferation of cells that is uncontrolled and excessive

Neoplasia

Q1828:Order of the "-plasias" in severity;(5)

normal cells -> Hyperplasia ->;Metaplasia or Dysplasia >;Anaplasia -> Neoplasia (Carcinoma in situ) ->;Metastasis

Q1829:what cancer type is often associated w/ Desmoplasia (proliferation of fibrous tissue)?;name (3) main sites

Adenocarcinoma;sitesBreast;Pancreas;Prostate

Q1830:Definition;Neoplasm derived from all (3) germ layers;where is it usually seen?

Teratoma;;MC in ovaries and testis

Q1831:Definition;benign neoplasm often arising from surface or transitional epithelium;what does it look like?

Papilloma;;(finger-like projections)

Q1832:Difference b/t Choristoma and Hamartoma

Chroistomanormal tissus misplaced w/i another organ;Hamartomabenign tumor-like overgrowth of cells regularly found w/i the infected organ

Q1833:Definition;denotes origin from a single precursor cell;what is opposite?

Monoclonal;(neoplastic);oppositePolyclonal;(non-neoplastic)

Q1834:what type of metastatic tumors are via Lymphatic spread?;spread in blood?

Carcinoma = Lymphatic;;Sarcoma = Blood

Q1835:Pituitary tumor Dx;amenorrhea infertility

Prolactinoma;(sometimes galactorrhea)

Q1836:Pituitary tumor Dx;gigantism in children and acromegaly in adults

Somatotropic (Acidophilic) adenoma

Q1837:Pituitary tumor Dx;causes Cushings disease ;(secondary adrenal hypercorticism)

Corticotropic (Basophilic) adenoma

Q1838:Paraneoplastic effect;Inc ACTH -> Cushing's syndrome

Small cell CA of lung

Q1839:Paraneoplastic effect;Inc ADH -> SIADH;(2)

Small cell CA of lung;;intracranial neoplasms

Q1840:Paraneoplastic effect;PTH-related peptide -> Hypercalcemia;(5)*

Some Really Breaks My Bones;Squamous cell CA of lung;;Renal cell CA;;Breast CA;;Multiple Myeloma;;Bone metastasis

Q1841:Paraneoplastic effect;TSH -> Hyperthyroidism;(2)

Hydatiform moles;;Choriocarcinoma

Q1842:Paraneoplastic effect;EPO -> Polycythemia;(2)

Renal cell CA;;Hemangioblastoma

Q1843:Paraneoplastic effect;Hyperuricemia -> Gout;(2)

Leukemias;;Lymphomas

Q1844:Order of primary tumors that metastasize toBrain;(5)*

Lots of Bad Stuff Kills Glia;Lung;Breast;Skin (melanoma);Kidney;GI

Q1845:Order of primary tumors that metastasize toLiver;(5)*

Cancer Sometimes Penetrates Benign Liver;Colon;Stomach;Pancreas;Breast;Lung;(from bottom -> up)

Q1846:Order of primary tumors that metastasize toBone;(5)*

Bone Problems Likely to Kill;Breast;Prostate;Lung;Thyroid / Testis;Kidney

Q1847:Tumor marker seen in 70% of colorectal and pancreatic cancers

CEA

Q1848:Malignancy w/ Chemical Carcinogen;Vinyl Chloride

Angiosarcoma of Liver

Q1849:Malignancy w/ Chemical Carcinogen;Cigarette smoke;(2)

CA of Lung;CA of Larynx

Q1850:Malignancy w/ Chemical Carcinogen;Alkylating agents

Acute Leukemia

Q1851:Malignancy w/ Chemical Carcinogen;Asbestos;(3)

Mesothelioma;;Lung bronchogenic CA;;GI cancers

Q1852:Malignancy w/ Chemical Carcinogen;Smoked fish w/ Nitrosamines;(2)

Adenocarcinoma of stomach;;Esophageal CA

Q1853:Malignancy w/ Chemical Carcinogen;Alcohol;(2)

Mouth CA;;Esophageal CA

Q1854:Malignancy w/ Chemical Carcinogen;Arsenic

Squamous cell CA

Q1855:Malignancy w/ Chemical Carcinogen;High-fat diet

Breast CA

Q1856:Malignancy w/ Chemical Carcinogen;Naphthalene (Aniline) dyes aromatic amines

Transitional CA of bladder

Q1857:Malignancy w/ Chemical Carcinogen;Benzene

Acute Leukemia

Q1858:Malignancy w/ Chemical Carcinogen;Diethylstilbestrol (DES)

Clear cell CA of vagina

Q1859:Malignancy w/ Chemical Carcinogen;Nickel Chromium Uranium

Lung CA

Q1860:Dx;atrophic glossitis esophageal webs anemia low iron;what CA does it lead to?

Plummer-Vinson syndrome;CASquamous cell CA of Esophagus

Q1861:Dx;facial angiofibromas seizures mental retardation;what CA does it lead to?;(2)

Tuberous Sclerosis;CAAstrocytoma;Cardiac Rhabdomyoma

Q1862:what is a common skin presentation seen in malignancies of the stomach lung breast and uterus?

Acanthosis Nigracans

Q1863:Oncogene assoc tumor;abl

CML

Q1864:Oncogene assoc tumor;c-myc

Burkitt's lymphoma

Q1865:Oncogene assoc tumor;bcl-2

Follicular lymphoma

Q1866:Oncogene assoc tumor;erb-B2;(3)*

BOG;Breast;;Ovarian;;Gastric CA

Q1867:Oncogene assoc tumor;ras

Colon CA

Q1868:Oncogene assoc tumor;L-myc

Lung CA;[L = Lung]

Q1869:Oncogene assoc tumor;N-myc

Neuroblastoma;[N = Neuro]

Q1870:Oncogene assoc tumor;ret;(2)

MEN types 2 & 3

Q1871:Tumor assoc w/ Supressor gene;Rb;(2);Chromosome?

Retinoblastoma;;Osteosarcoma;chrom: 13q

Q1872:Tumor assoc w/ Supressor gene;BRCA1 and 2;(2);Chromosome?

Breast CA;Ovarian CA;chrom: 17q 13q

Q1873:Tumor assoc w/ Supressor gene;p53;Chromosome?

Most cancers;(Li-Fraumeni syndrome);chrom: 17p

Q1874:Tumor assoc w/ Supressor gene;p16;Chromosome?

Melanoma;;chrom: 9p

Q1875:Tumor assoc w/ Supressor gene;APC;Chromosome?

Colorectal CA;;chrom: 5q;(5 letters in "polyp")

Q1876:Tumor assoc w/ Supressor gene;WT1;Chromosome?

Wilms Tumor;;chrom: 11q

Q1877:Tumor assoc w/ Supressor gene;NF1;Chromosome?

Neurofibromatosis type 1;(Von Recklinghausen);chrom: 17q;(17 letters in Von Recklinghausen)

Q1878:Tumor assoc w/ Supressor gene;NF2;Chromosome?

Neurofibromatosis type 2;;chrom: 22q;(type 2 = 22)

Q1879:Tumor assoc w/ Supressor gene;DPC;Chromosome?

Pancreatic CA = PC;;chrom: 18q

Q1880:Tumor assoc w/ Supressor gene;DCC;Chromosome?

Colon CA = CC;;chrom: 18q

Q1881:Tumor marker;alpha-fetoprotein;(2)

Hepatocellular CA;;Germ cell tumor of testis;(yolk sac tumors)

Q1882:Tumor marker;beta-hCG;(3)

HCG;Hydatidiform moles;;Choriocarcinoma;;Gestational Trophoblastic tumor

Q1883:Tumor marker;CA-125;(2)

Ovarian CA;;malignant Epithelial tumors

Q1884:Tumor marker;S-100;(3)*

MAN;Melanoma;;Astrocytoma;;Neural tumors

Q1885:Tumor marker;Alkaline phosphatase;(3)*

MOP;Metastasis to Bone;;Obstructive Biliary Dz;;Paget's Dz of bone

Q1886:Tumor marker;Bombesin;(3)

Neuroblastoma;;Lung CA;;Gastric CA

Q1887:(4)* tumors w/ Psammoma Bodies

PSaMMoma;Papillary Thyroid;Serous Papillary Cystadenocarcinoma of Ovary;;Meningioma;;Mesothelioma

Q1888:Virus assoc tumors;HTLV-1

Adult T-cell Leukemia

Q1889:Virus assoc tumors;HBV HVC

Hepatocellular CA

Q1890:Virus assoc tumors;EBV;(2)

Burkitt's lymphoma;;Nasopharyngeal CA

Q1891:Virus assoc tumors;HPV;(3)

CAP it;Cervical CA (16 18);;Anal CA;;Penile CA

Q1892:Virus assoc tumors;HHV-8

Karposi's sarcoma

Q1893:where is person most likely to have cancer?

Skin;(skin has highest incidence but unable to quantify)

Q1894:top (3) MCC of CA in male and female

MaleProstate;Lung;Colorectal;FemaleBreast;Lung;Colorectal

Q1895:top (2) MCC of death from CA;in male and female

MaleLung;Prostate;FemaleLung;Breast

Q1896:What is osteogenesis imperfecta

A group of heritable diseases characterized by abnormal type I collagen

Q1897:How many types of osteogenesis imperfecta are there

4 (types I to IV)

Q1898:What is the usual clinical presentation of osteogenesis imperfecta

Multiple fractures; often with minimal trauma

Q1899:Besides bone; what else is affected in osteogenesis imperfecta

Teeth; skin; eyes

Q1900:What are the characteristic eye findings in osteogenesis imperfecta

Blue sclerae

Q1901:What are the radiographic findings in osteogenesis imperfecta

Thin and osteopenic bones; often with many foci of fracture callus

Q1902:What is osteopetrosis

An inherited disorder characterized by abnormally dense bone

Q1903:What causes osteopetrosis

Failure of osteoclastic cells by an unknown mechanism

Q1904:What are 2 other names for osteopetrosis

Marble bone disease;Alber-Schonberg disease

Q1905:Why the name “marble bone” disease for osteopetrosis

Bones look short and block-like; and are radiodense; like marble

Q1906:What is the common clinical presentation of osteopetrosis

Multiple fractures

Q1907:Why are multiple fractures common in osteopetrosis

Although bone is hyperdense; it is intrinsically disorganized. Consequently; it is weaker

Q1908:What are 2 common conditions associated with osteopetrosis

Anemia due to decreased marrow space;Blindness; deafness; and other cranial nerve involvement due to narrowing of neural foramina

Q1909:What are the 2 genetic variants of osteopetrosis

AR and AD

Q1910:What variant of osteopetrosis is most severe

The AR variant is fatal in infancy

Q1911:What is osteoporosis

A decrease in bone mass

Q1912:What causes osteoporosis

Impaired synthesis or increased resorption of bone matrix

Q1913:Name 5 states with which osteoporosis is associated

Postmenopause;Physical inactivity;Hypercorticism;Hyperthyroidism;Calcium deficiency

Q1914:Describe the pathophysiology associated with osteoporosis of the elderly

A continuous loss of bone occurs at the trabecular and cortical layers due to increased resorption

Q1915:What commonly prescribed drug induces osteopenia

Steroids

Q1916:What commonly results from osteopenia

Fractures

Q1917:What are the calcium and phosphorus levels in the blood in patients with osteoporosis

Normal

Q1918:What is seen radiographically in patients with osteoporosis

Diffuse radiolucency of bone

Q1919:What is the treatment for osteoporosis

No cure. Calcium supplements; exercise; and estrogen therapy (in some patients) help reduce the risk; however

Q1920:What is the effect of PTH on bone

It stimulates the active phase of bone remodeling

Q1921:What are the two main causes of hyperparathyroidism

Parathyroid hyperplasia and parathyroid adenoma

Q1922:What are the two clinical features of hyperparathyroidism

Bone pain and hypercalcemia

Q1923:What are the significant laboratory values in hyperparathyroidism

Calcium >11.5 mg/dl; Phosphorus <2.0 mg/dl

Q1924:What is seen on bone histologic examination in hyperparathyroidism

An increased number of osteoclasts

Q1925:After bone is resorbed; what replaces it

Fibrous tissue

Q1926:What abnormality is often seen in the fibrous tissue of resorbed bone

Hemosiderin pigment

Q1927:What are the fibrous tissue lesions seen in resorbed bone called

Brown tumors

Q1928:How is hyperparathyroidism treated

By removal of the parathyroid lesion

Q1929:How does hypoparathyroidism affect bone

It decreases the turnover rate

Q1930:What is the most common reason for hypoparathyroidism

Surgical removal of parathyroid glands

Q1931:What are the clinical signs of hypoparathyroidism

Signs of hypocalcemia; including soft tissue ossification and calcification; abnormal dentition; and otoscleorosis

Q1932:What is seen on bone histologic examination in hypothyroidism

Active osteoblasts and lack of osteoclasts

Q1933:What is the treatment for hypoparathyroidism

Administration of PTH or vitamin D

Q1934:What is osteomalacia

A bone abnormality caused by defective calcification of osteoid matrix

Q1935:What causes osteomalacia

Vitamin D deficiency

Q1936:In what age group does osteomalacia typically occur

Adults

Q1937:What can osteomalacia mimic radiographically

Osteoporosis

Q1938:How is osteomalacia diagnosed

By bone biopsy

Q1939:What is the treatment for osteomalacia

Correct vitamin D deficiency

Q1940:What is osteomalacia called when secondary to renal disease

Renal osteodystrophy

Q1941:Define rickets

Bone abnormality caused by defective calcification of osteoid matrix and increased thickness of epiphysial growth plates

Q1942:What causes rickets

Vitamin D deficiency

Q1943:Describe the difference between rickets and osteomalacia

Osteomalacia occurs in adults; rickets in children. Because bone growth is not complete in patients with rickets; skeletal deformities are common

Q1944:What are six clinical manifestations of rickets

Craniotabes—thickening and softening of occipital and parietal bones;Late closing of fontanelles;Rachitic rosary— costochondral swelling;Harrison groove—depression of insertion site of diaphragm into rib cage;Pigeon breast— protrusion of sternum;Short stature caused by spinal deformity

Q1945:What is the treatment for rickets

Correction of vitamin D deficiency

Q1946:Define scurvy

Bone abnormality characterized by impaired osteoid matrix formation

Q1947:What causes scurvy

Vitamin C deficiency

Q1948:How does vitamin C deficiency lead to impaired bone formation

Failure of praline and lysine hydroxylation required for collagen synthesis

Q1949:Name three clinical characteristics of scurvy

Subperiosteal hemorrhage;Osteoporosis;Epiphysial cartilage not replaced by osteoid

Q1950:Why does subperiosteal hemorrhage occur with scurvy

Because of increased capillary fragility

Q1951:What is seen on bone histologic examination in scurvy

Decreased trabecular bone mass and abnormal osteoblasts

Q1952:What is the treatment for scurvy

Correction of vitamin C deficiency

Q1953:What is pyogenic osteomyelitis

Infection of the medullary and cortical portions of the bone; including the periosteum

Q1954:What bones are commonly affected by pyogenic osteomyelitis in children

Long bones

Q1955:What bones are commonly affected by pyogenic osteomyelitis in adults

Vertebrae

Q1956:What is the usual causative organism of pyogenic osteomyelitis in children

Staph aureus

Q1957:What are the usual causative organisms (2) of pyogenic osteomyelitis in newborns

Group B beta -hemolytic strep;E coli

Q1958:What is the usual causative organism of pyogenic osteomyelitis in sickle cell anemia patients

Salmonella organisms

Q1959:What is the usual causative organism of pyogenic osteomyelitis in IV drug abusers

Pseudomonas organisms

Q1960:How do the causative bacteria of pyogenic osteomyelitis spread in the body

Hematogenously

Q1961:In adults; what is the usual cause of pyogenic osteomyelitis

Complications from surgery and compound fractures

Q1962:What portion of the bone is most commonly involved initially in pyogenic osteomyelitis

Metaphysis

Q1963:Name 3 reasons for persistent pyogenic osteomyelitis

Necrotic bone acting as a locus for persistent infection;Pyogenic exudate compressing vascular supply of bone;Inflammation in relatively avascular areas of bone

Q1964:Name 2 clinical symptoms of pyogenic osteomyelitis

Fever; local bone pain

Q1965:What are significant laboratory test values in pyogenic osteomyelitis

Marked leukocytosis; fever; and increased sedimentation rate

Q1966:What is a localized bone infection surrounded by granulation tissue called

Brodie abscess

Q1967:How is a Brodie abscess treated

Drain or debride the abscess;Administer antibiotics

Q1968:How frequently do flare-ups occur with chronic osteomyelitis

It varies; with intervals of months to years

Q1969:What is tuberculous osteomyelitis

Bone infection due to spread of tuberculous organisms

Q1970:How are tuberculous organisms spread

Hematogenously

Q1971:What is tuberculous osteomyelitis with spinal involvement called

Pott disease

Q1972:What bones does tuberculous osteomyelitis affect

Spine;Hip;Long bones;Bones of the hands and feet

Q1973:What happens to bone affected by tuberculous osteomyelitis

Progressive destruction; with little ossification

Q1974:What is histiocytosis X

A group of disorders affecting other organs systems in addition to bone. It is characterized by proliferation of histiocyte cells

Q1975:Histiocyte cells are similar to what epidermal cells

Langerhans cells

Q1976:What are characteristic markers of histiocytic cells

Birbeck granules

Q1977:What do Birbeck granules look like

Tennis rackets

Q1978:Name 3 variants of histiocytosis X

Eosinophilic granuloma;Hand-Schuller-Christian disease;Letterer-Siwe disease

Q1979:What is characteristic of eosinophilic granuloma

Histiocytic proliferation with inflammatory cells; including many eosinophils

Q1980:What is the clinical presentation of eosinophilic granuloma

Solitary bone lesion

Q1981:Does extraskeletal involvement occur in eosinophilic granuloma

Yes; commonly in the lung

Q1982:What is the prognosis in eosinophilic granuloma

Best of all variants of histiocytosis X. Lesions sometimes heal without treatment

Q1983:What is characteristic of Hand-Schuller-Christian disease

Histiocyte proliferation with inflammatory cells

Q1984:What is affected in Hand-Schuller-Christian disease

Bone;Liver;Spleen;Other tissues

Q1985:What population is affected by Hand-SchullerChristian disease

Children less than 5 years old

Q1986:List the classic triad of Hand-Schuller-Christian disease

Skull lesions;Diabetes insipidus;Exophthalamos

Q1987:What is the prognosis in Hand-Schuller-Christian disease

Better than Letterer-Siwe; worse than eosinophilic granuloma

Q1988:What is characteristic of Letterer-Siwe disease

Widespread histiocyte proliferation

Q1989:What population is affected by Letterer-Siwe disease

Infants

Q1990:What are 5 clinical findings in Letterer-Siwe disease

Hepatosplenomegaly;Lymphadenopathy;Pancytopenia;Pulm onary involvement;Recurrent infections

Q1991:What is the course of Letterer-Siwe disease

Aggressive and fatal

Q1992:What is another name for unicameral bone cyst

Solitary bone cyst

Q1993:What is the cause of unicameral bone cyst

Unknown

Q1994:What population is affected by unicameral bone cysts

Young males

Q1995:What portion of bone is affected by unicameral bone cysts

Distal ends of long bones

Q1996:Name 3 clinical signs of unicameral bone cysts

Pain;Soft tissue swelling;Occasional fractures

Q1997:What is seen on radiography of unicameral bone cysts

Radiolucent area with smooth; thin cortex

Q1998:What is the appearance of unicameral bone cysts on gross pathology

Multiloculated cavity

Q1999:What is the treatment for unicameral bone cysts

Curettage with insertion of bone chips

Q2000:What is the prognosis with unicameral bone cysts

Excellent; with few recurrences

Q2001:What population is affected by aneurysmal bone cysts

Females in 2nd to 3rd decade of life

Q2002:What portion of bone is usually affected with aneurysmal bone cysts

Metaphysis of long bones;Vertebrae

Q2003:Name the 2 clinical signs of aneurysmal bone cysts

Pain;Soft tissue swelling

Q2004:What is seen on radiography of aneurysmal bone cysts

Circumscribed zone of rarefaction; with extension into soft tissues

Q2005:What is the size range of aneurysmal bone cysts

Up to 20 cm

Q2006:What is the gross pathology of aneurysmal bone cysts

Bone is greatly distorted with irregular outlines. It appears spongy; with cystic spaces of various sizes

Q2007:Give 2 histologic differential diagnoses of aneurysmal bone cysts

Giant cell tumor of bone;Telangiectatic osteosarcoma

Q2008:How are aneurysmal bone cysts treated

Removal of entire lesion with insertion of bone chips

Q2009:What is the prognosis with aneurysmal bone cysts

Recurrences occur 20% to 30% of the time

Q2010:Fibrous dysplasia most commonly affects what bones

Ribs; femur; tibia; maxilla

Q2011:Is fibrous dysplasia monostotic or polyostotic

80% monostotic; 20% polyostotic

Q2012:Polyostotic lesions are part of what syndrome

Albright syndrome

Q2013:What bone complications occur in fibrous dysplasia

Deformity secondary to repeated fractures

Q2014:Describe the radiographic appearance of fibrous bone dysplasia

Well-defined zones of rarefaction surrounded by narrow rims of sclerotic bone

Q2015:Describe the major histologic feature of fibrous dysplasia

Proliferation of fibroblasts; which produce a dense collagenous matrix

Q2016:What is the treatment for monostotic bone lesions

Curettage or local resection

Q2017:What is the treatment for polyostotic bone lesions

Conservation (nonsurgical); because lesions stop growing after puberty

Q2018:What is another name for osteochondroma

Exostosis

Q2019:Define osteochondroma

Bony growth covered by a cartilaginous cap

Q2020:What is osteochondroma’s claim to fame

Most common benign tumor of bone

Q2021:Where does osteochondroma originate

In the metaphysis

Q2022:What are the 2 most frequent locations for osteochondroma

Distal femur;Proximal tibia

Q2023:What population is most commonly affected by osteochondroma

Males under 25 years of age

Q2024:Does osteochondroma undergo transformation to a malignant tumor

Rarely

Q2025:Describe the clinical symptoms of osteochondroma

Pain and compression of adjacent structures

Q2026:What is the prognosis of osteochondroma

Excellent. Resection is usually curative

Q2027:What is giant cell tumor

Benign tumor characterized by multinucleated giant cells and fibrous stroma

Q2028:Where does giant cell tumor originate

Epiphysis of long bones

Q2029:What are the 2 most frequent locations of giant cell tumor

Distal femur;Proximal tibia

Q2030:How does giant cell tumor appear radiographically

Soap bubble appearance

Q2031:What population is most commonly affected by giant cell tumor

Females 20 to 40 years old

Q2032:What is the course of giant cell tumor

Although benign; it is locally aggressive

Q2033:What is the prognosis of giant cell tumor

Frequently recurs after local curettage

Q2034:What is enchondroma

Benign intramedullary cartilaginous neoplasm

Q2035:Where does enchondroma most frequently occur

Hands and feet

Q2036:What population is most commonly affected by enchondroma

All age groups

Q2037:What is osteoma

Benign tumor of mature bone

Q2038:What are the 2 most frequent locations of an osteoma

Skull;Facial bones

Q2039:What population is most commonly affected by osteoma

Males of any age

Q2040:Osteoma occurring as multiple lesions; with intestinal polyps and soft tissue tumors; is known by what name

Gardner syndrome

Q2041:What are the clinical features of osteoma

It is asymptomatic; unless drainage of paranasal sinus is blocked

Q2042:What is the prognosis of osteoma

Excellent. Resection is curative

Q2043:What is osteoid osteoma

Neoplastic proliferation of osteoid and fibrous tissue

Q2044:What are the most frequent locations of osteoid osteoma

Ends of diaphysis of femur or tibia

Q2045:What population is most commonly affected by osteoid osteoma

Males less than 25 year old

Q2046:What are the clinical features of osteoid osteoma

Increasing pain; worse at night; relieved by aspirin

Q2047:How does osteoid osteoma appear radiographically

Central radiolucent area surrounded by sclerotic bone

Q2048:What is the central radiolucent area in an osteoid osteoma called

Nidus

Q2049:What is the nidus of osteoid osteoma; microscopically

Osteoblasts; calcification; and multinucleate giant cells

Q2050:What is the prognosis for osteoid osteoma

Excellent. Resection of nidus and sclerotic bone is curative

Q2051:Name the 2 most frequent locations of osteoblastoma

Vertebrae and long bones

Q2052:What population is most commonly affected by osteoblastoma

Males under 30

Q2053:What are the clinical features of osteoblastoma

Usually none

Q2054:Radiographically; how does osteoblastoma appear

Well-circumscribed lesion surrounded by sclerotic bone

Q2055:What treatment for osteoblastoma allows the best prognosis

Results are excellent when the lesion is removed by curettage

Q2056:Give another name for osteosarcoma

Osteogenic sarcoma

Q2057:State osteosarcoma’s claim to fame

Osteosarcoma is the most common primary malignant tumor of bone

Q2058:Define osteosarcoma

Malignant osteoid and bone-producing neoplasm

Q2059:What causes osteosarcoma

The cause is unknown

Q2060:Name the 2 most frequent locations of osteosarcoma

Distal femur and proximal tibia

Q2061:What population is most commonly affected by osteosarcoma

Males 10-20 years old

Q2062:What are the clinical features of osteosarcoma

Pain; swelling; and pathologic fractures

Q2063:What are the significant laboratory values of osteosarcoma

A 2-3 fold increase in alkaline phosphatase levels

Q2064:Radiographically; elevation of periosteum is called what

Codman triangle

Q2065:How does osteosarcoma spread

Hematogenously

Q2066:Name the 4 factors predisposing to osteosarcoma

Paget disease;Ionizing radiation;Bone infarcts;Familial retinoblastoma

Q2067:How does osteosarcoma appear on gross pathology

Large necrotic and hemorrhagic mass

Q2068:What is the microscopic appearance of osteosarcoma

Malignant stroma containing osteoid and bone

Q2069:How is osteosarcoma treated

Surgical amputation of affected limb; and adjunctive chemotherapy

Q2070:What is the prognosis for osteosarcoma

Poor; 5 year survival rate is 5% to 20%

Q2071:What is chondrosarcoma

Malignant cartilaginous neoplasm

Q2072:Name the 4 most frequent locations of chondrosarcoma

Proximal femur; proximal humerus; pelvis; spine

Q2073:What population is most commonly affected by chondrosarcoma

Males 30-60 years old

Q2074:Name three clinical features of chondrosarcoma

Pain; swelling; and presence of mass for several years

Q2075:Radiographically; how does chondrosarcoma appear

Cortical destruction with occasional medullary involvement

Q2076:From what two preexisting cartilaginous tumors can chondrosarcoma arise

Multiple familial osteochondromatosis;Multiple enchondromatosis

Q2077:How does chondrosarcoma appear on gross pathology

Lobulated white or gray mass; with mucoid material and calcification

Q2078:What is chondrosarcoma’s microscopic appearance

Poorly developed cartilage cells with anaplastic cells

Q2079:What is the treatment for chondrosarcoma

Total resection; if possible

Q2080:What is the prognosis for chondrosarcoma

Chondrosarcoma is slow growing; but has a high tendency to recur; 10 year survival rate is 50-60%

Q2081:What is Ewing sarcoma

Undifferentiated round cell malignant tumor

Q2082:In what 4 areas does Ewing sarcoma occur most often

Long bones; pelvis; scapula; ribs

Q2083:What population is most commonly affected with Ewing sarcoma

Males less than 15 years

Q2084:What are the clinical features of Ewing sarcoma

Pain; swelling; and presence of mass for several years

Q2085:How does Ewing sarcoma appear radiographically

Destructive appearance

Q2086:What does subperiosteal reactive new bone resemble

Onion skin

Q2087:The early phase of Ewing sarcoma mimics what other disease

Acute osteomyelitis

Q2088:What genetic defect is present in Ewing sarcoma

11;22 translocation

Q2089:Where does Ewing sarcoma arise

Undifferentiated mesenchymal cells of the medullary cavity

Q2090:How does Ewing sarcoma appear on gross pathology

Hemorrhagic and necrotic destruction of medullary cavity

Q2091:Microscopically; what is seen with Ewing sarcoma

Undifferentiated small round cells in sheets or cords

Q2092:How is Ewing sarcoma treated

Amputation of limb; possibly chemotherapy

Q2093:What is the prognosis with Ewing sarcoma

Poor. Malignant course with early metastases; the 5 year survival rate is 0-12%

Q2094:Give another name for osteitis deformans

Paget disease of the bone

Q2095:Define osteitis deformans

Bone disease characterized by abnormal bony architecture with increases in osteoblastic and osteoclastic activity; and a “ high turnover rate”

Q2096:Name the five most common locations of osteitis deformans

Spine; pelvis; skull; femur; and tibia

Q2097:What population is most commonly affected with osteitis deformans

Elderly persons

Q2098:What causes osteitis deformans

Cause is unknown; an infectious nature is postulated

Q2099:Describe the clinical features of osteitis deformans

Pain; fracture; and skeletal deformities; deafness when skull is involved; short stature when spine is involved

Q2100:Is osteitis deformans monostotic or polyostotic

Both

Q2101:Microscopically; how does osteitis deformans appear

Marked medullary fibrosis; disorganization of normal trabecular pattern

Q2102:What is the treatment for osteitis deformans; and why?

Calcitonin or one of the diphosphonates. They decrease resorption; and thus decrease the high turnover rate

Q2103:What is avascular necrosis

Necrosis of bone; usually the femoral head; caused by infarction

Q2104:Give 3 possible causes of avascular necrosis

Emboli;Decompression syndrome (the bends);Sickle cell anemia

Q2105:Radiologically; what is seen with avascular necrosis

Reparative foci replacing necrotic bone

Q2106:With what other conditions is avascular necrosis commonly associated

Alcoholism;Corticosteroid treatment;Hyperuricemia;SLE;Trauma

Q2107:What is the treatment for avascular necrosis

Hemiarthroplasty

Q2108:When avascular necrosis occurs in the femoral head of children; what is it called

Legg-Calve’-Perthes disease

Q2109:What disease is characterized by pain in weightbearing joints; is worse after use; has crepitation with motion; no signs of inflammation; and is seen in the middle-aged population

Osteoarthritis; aka degenerative joint disease

Q2110:What are signs of osteoarthritis on x-ray

Joint space narrowing; osteophytes

Q2111:What are Herberden’s nodules

Palpable DIP joints with osteophytes

Q2112:What are Bouchard’s nodules

Palpable PIP joints with osteophytes

Q2113:What are some treatments of osteoarthritis

NSAIDs and weight reduction to reduce strain on joints

Q2114:A 4 year old boy presents with arthralgias; soft hyperextensible skin; corneal and scleral abnormalities; joint laxity; and easy bruising. Diagnosis?

Ehlers-Danlos syndrome

Q2115:A 32 year old female presents to your office complaining of morning stiffness for greater than 1 hour; pain in joints bilaterally; with fatigue and hand deformations over time. Diagnosis?

Rheumatoid arthritis

Q2116:Which joints are most commonly involved in RA

Wrists; PIP; and metacarpophalangeal

Q2117:What are some common findings with RA

Fever;Malaise;Pericarditis;Pleural effusions;Uveitis;Subcutaneous nodules

Q2118:Which lab test should you order when you suspect RA

Rheumatoid factor

Q2119:What is rheumatoid factor

Immunoglobin M antibody to fragment crystallizable (Fc) portion of IgG

Q2120:What is the name for the chronic inflammation of cartilage found in RA

Pannus

Q2121:What disease would be expected in a young woman that suffers with RA-like symptoms (polyarthritis); leukopenia; leg ulcers; and splenomegaly?

Felty’s syndrome

Q2122:What disease is similar to RA (bilateral joint pain; fever) but is seen in children; along with rash and hepatosplenomegaly

Still’s disease (juvenile RA);*Kids can’t sit Still when their joints hurt

Q2123:What is different about pediatric RA

It is often RF negative

Q2124:A 5 year old child presents with complaints in two joints. Which disease is this

Pauciarticular juvenile RA

Q2125:What is a child with pauciarticular RA at risk for

Iritis (do slit-lamp test)

Q2126:A 43 year old male presents to your clinic with a history of falling on his knee two days ago. Since then; the knee has become red; swollen; and warm. Diagnosis?

Septic joint

Q2127:How can you diagnose septic joint

Arthrocentesis with high white blood cells/ neutrophil count and Gram’s stain

Q2128:What is the most common causative organism of septic joint

Staphylococcus aureus

Q2129:What are some common organisms that are found uniquely in the joints of infants and young children

Group B streptococci;Haemophilus influenzae

Q2130:What are some common organisms associated with implantable devices and prosthetics

Staph aureus;Staphylococcus epidermidis;Gram-negative bacilli

Q2131:A 23 year old male; sexually active college student arrives at your clinic complaining of a swollen red knee and urethritis. What organism is the most likely

Neisseria gonorrhoeae

Q2132:How is the diagnosis made in a patient with gonorrhea

Urethral swab

Q2133:How do you treat gonorrhea

Ceftriaxone

Q2134:Which organism should be suspected in a patient with diabetes and osteomyelitis

Pseudomonas

Q2135:Which organism should be suspected in a sickle cell patient with osteomyelitis

Salmonella

Q2136:A 65 year old white male presents to clinic with a 2 hour history of sudden onset of extreme pain in his great toe. What disease should be suspected in this patient

Gout

Q2137:What is podagra

Gout of the metatarsophalangeal joint of the big toe

Q2138:What other findings should be looked for in a patient with gout

Tophi; subcutaneous deposits of uric acid crystals

Q2139:How do tophi appear on x-ray

“Punched out” lesions

Q2140:What lab tests help to diagnose gout

Uric acid level;Joint fluid aspiration of needle-shaped crystals with negative birefringence

Q2141:What are contributing factors for gout

Thiazide diuretics;Lesch-Nyhan syndrome;Diets with high protein and alcohol

Q2142:What is the treatment for gout

Acute—Colchicine; NSAIDs;Maintenance—Allopurinol

Q2143:What diseases are associated with pseudogout

Hyperparathyroidism;Hemochromatosis

Q2144:A 12 year old presents with migratory polyarthritis; rash; fever; and general malaise. She recalls having a sore throat about 3 weeks ago but did not get treatment. Diagnosis?

Acute rheumatic fever

Q2145:What are the Jones criteria of rheumatic fever

Fever;Erythema marginatum;Verrucous valvular vegetations;Erythrocyte sedimentation rate increase;aRthritis;Subcutaneous nodules;Chorea (Sydenham’ s);Preceded by Streptococcus infection;*FEVERS and Chorea preceded by a Streptococcus infection

Q2146:What is the distinctive inflammatory heart lesion associated with rheumatic fever

Aschoff’s bodies

Q2147:What is the causative organism of the sore throat in rheumatic fever

Group A beta -hemolytic streptococci

Q2148:What is the actual cause of rheumatic fever

Hypersensitivity—cross reaction antibodies against M protein of Streptococci

Q2149:Which titers are elevated with rheumatic fever

Antistreptolysin O titer; ESR

Q2150:Which hematologic disease is associated with avascular necrosis of the femoral head

Sickle cell anemia

Q2151:A patient presents with urethritis; conjunctivitis; arthritis; and happens to be HLA-B27 positive. Diagnosis?

Reiter disease;*Can’t pee; can’t see; can’t kick with your knee

Q2152:Previous exposure to which bacteria can precipitate Reiter disease

Chlamydiae;Shigella;Salmonella;Campylobacter;Yersinia species

Q2153:A 35 year old white male presents with diffuse red/purple plaques with silver scale on extensor surfaces and scalp. What disease is suspected

Psoriasis

Q2154:What other symptoms are common with psoriasis

Nail pitting;Psoriatic arthritis with sausage digits

Q2155:What is the most common form of psoriatic arthritis

Asymmetric arthritis in fingers or toes

Q2156:What is the phenomenon that describes the development of a psoriatic plaque in an area of previous trauma

Koebner phenomenon

Q2157:What is the name of the sign that occurs when a small amount of scale is removed from a psoriatic plaque; leaving small bleeding points behind

Auspitz sign

Q2158:What can precipitate an outbreak of psoriasis

Infection;Stress;Sunburn;Drugs— beta -blockers; lithium; and antimalarials

Q2159:What is used to treat psoriasis

Psoralen ultraviolet A (PUVA);Retinoids;Methotrexate;Cyclosporin

Q2160:What HLA type is associated with psoriatic arthritis

HLA-B27

Q2161:A 28 year old African-American female presents to the clinic with new onset of fatigue; weight loss; joint pain; and Raynaud’s phenomenon. On exam; she is found to have a malar rash. Diagnosis?

SLE

Q2162:What are the official criteria for the diagnosis of SLE

Oral ulcers;Renal disorder;Photosensitivity;Hematologic (anemias; cytopenias);Arthritis (nonerosive synovitis);Neurologic (seizures; psychosis);Serositis;Malar rash;Antinuclear antibody;Immunologic (anti-DNA; antiSmith; false positive rapid plasma reagin/Venereal Disease research Laboratory [RPR/VDRL]);Discoid rash;*The ORPHAN’S MAID has Lupus;*Need 4/11 criteria for diagnosis

Q2163:In which sex and race is SLE most common and severe

Black females

Q2164:What cardiac lesion is associated with SLE in the adult and consists of nonbacterial verrucous valvular vegetations

Libman-Sacks endocarditis

Q2165:What are some causes for chest pain in a patient with SLE

Pleuritis;Pericarditis

Q2166:A 30 year old white male presents with new onset of SLE-like symptoms. Which drugs can cause these

Hydrazine;INH;Procainamide;Phenytoin;*You won’t be HIPP with drug-induced Lupus

Q2167:Which antibody system is associated with druginduced Lupus

Antihistone

Q2168:How are the manifestations of SLE in the kidney classified

Type I—appears normal by light microscopy;Type II— mesangial lupus glomerulonephritis;Type III—focal proliferative glomerulonephritis;Type IV—diffuse proliferative glomerulonephritis;Type V—membranous glomerulonephritis

Q2169:What are wire-loop lesions in the kidney and what do they represent

Thickening of the capillary wall found in diffuse proliferative glomerulonephritis; indicate a poor prognosis with SLE

Q2170:Which neoplasm is associated with SLE and myasthenia gravis

Thymoma

Q2171:Which antibody is sensitive but not specific for the diagnosis of SLE

Antinuclear antibody

Q2172:Which two antibodies are very specific for SLE

Anti-Smith;Antidouble-stranded DNA

Q2173:A black female with SLE delivered an infant with bradycardia; which is later found to have AV-block. What autoantibody could have caused this congenital heart block

Anti-Rho antibodies which cross the placenta

Q2174:Which two HLA types is SLE linked to

HLA-DR2 and HLA-DR3

Q2175:An 18 year old female patient presents with a 5 week history of arthritis; fever; 15lb weight loss; and diarrhea. What diseases should be considered

Inflammatory bowel disease—Crohn’s and ulcerative colitis

Q2176:On physical exam; a patient is found to have a right lower quadrant abdominal mass and positive fecal occult blood. Radiographic studies show a thickened terminal ileum; skip lesions; and areas of stricture. Diagnosis?

Crohn’s disease

Q2177:What are systemic symptoms of Crohn’s disease

Aphthous ulcers;Erythema nodosum;Uveitis

Q2178:What is the cause of Crohn’s disease

Idiopathic;Associated with HLA-B27

Q2179:What findings would be expected on gross examination of a biopsy taken for a small bowel with Crohn’s disease

Sharp demarcation of diseased bowel (skip lesions); Linear ulcers; Cobblestone mucosa; Sinus tract/fistula formation; Creeping fat around the bowel surface; *The old Crohn skips down the cobblestone tract

Q2180:What findings would be expected histologically in Crohn’s disease

Transmural inflammation of bowel wall; Noncaseating granulomas; Mucosal damage; Ulceration

Q2181:What are treatment options for Crohn’s disease

Sulfasalazine; Corticosteroids; Bowel rest; Surgery (fistulas; obstruction); B12 supplements for malabsorption

Q2182:A 22 year old white female presents with a 2 week history of migratory polyarthritis; 15 lb weight loss; and grossly bloody mucoid diarrhea. Diagnosis?

Ulcerative colitis

Q2183:What features are characteristics of ulcerative colitis

Continuous involvement beginning at rectum; Microabscesses; Pseudopolyps; Superficial ulceration

Q2184:A patient with established ulcerative colitis presents to the ER with high fever and symptoms of shock and abdominal distention. What must be suspected

Toxic megacolon

Q2185:What systemic illnesses do patients with ulcerative colitis exhibit

Toxic megacolon; Colon cancer; Primary sclerosing cholangitis; Pyoderma gangrenosum; Uveitis; Erythema nodosum

Q2186:What are the major differences that separate UC from Crohn’s

No skip lesions; no granulomas; no fistulas/sinuses in ulcerative colitis

Q2187:A 45 year old white female presents with a 3 month history of diarrhea; fatty white stools; and a rash that was diagnosed as dermatitis herpetiformis. What is her probable diagnosis

Celiac sprue

Q2188:What causes celiac sprue

Antigliaden antibody (IgA antiendosomal)

Q2189:What pathology would be seen in biopsy of celiac sprue

Blunting of villi; Lymphocytes in the lamina propria

Q2190:What dietary recommendations should celiac sprue patients follow

Avoid all foods containing gliadin (gluten); including wheat and beer

Q2191:A 33 year old white male complains of joint pain. He mentions that he has noticed an increase in pigmentation along with frequent urination and a strange tendency to set off metal detectors. Diagnosis?

Hemochromatosis

Q2192:What are the symptoms for hemochromatosis

Bronze diabetes; Congestive heart failure; Micronodular cirrhosis

Q2193:What type of cancer are patients with hemochromatosis at risk of

Hepatocellular cancer

Q2194:What is the cause of the symptoms of hemochromatosis

Increased iron deposition

Q2195:Besides increased iron supply; what are other important lab findings in hemochromatosis

Increased ferritin;Increased transferrin;Positive Prussin blue stain

Q2196:What is the inheritance pattern of primary hemochromatosis

Autosomal recessive

Q2197:What is the cause of hemochromatosis as a secondary disorder

Chronic blood transfusions

Q2198:What are treatment options for hemochromatosis

Phlembotomy; Deferoxamine

Q2199:An 18 year old football player complains of joint pain; bruising; and somewhat limited range of motion. He reports that he has always been a free bleeder. Diagnosis?

Hemarthroses associated with hemophilia

Q2200:A 15 year old boy scout complains of a 2 week history of flu-like illness and joint pain which started in his left knee; and now is in his right knee. It all began after a camping trip in Connecticut. Diagnosis?

Lyme disease

Q2201:What causes Lyme disease

Borrelia burgdorferi; which is transmitted by Ixodes tick bites

Q2202:A boy scout with Lyme disease recalls a strange bull’s eye rash that appeared and then disappeared before he could get an appointment. What is the rash called

Erythema chronicum migrans

Q2203:What cardiac complications are possible with Lyme disease

First-degree AV-block

Q2204:What are the treatments for Lyme disease

Tetracycline; Doxycycline

Q2205:A 34 year old abstinent Asian patient presents with a several year history of arthritis; recurrent genital and oral ulcers; and a painful rash over the pretibial areas. Diagnosis?

Behcet’s disease

Q2206:An 18 year old man presents with migratory arthritis; currently in his ankle; a rash; and pain with urination. A Gram ’s stain of urethral discharge shows gram-negative cocci. Diagnosis?

Gonococcal arthritis

Q2207:A 24 year old man recently diagnosed and treated for chlamydia complains of persistent joint pain with tender Achilles’ tendons and eye irritation. Diagnosis?

Reiter’s reactive arthritis

Q2208:A 28 year old male presents with a 2 week history of joint pain; fever; malaise; as well as a new rash all over his body including his palms and soles. Diagnosis?

Secondary (disseminated) syphilis

Q2209:A patient with syphilis describes two papular lesions on his penis that are gray-white. What are these lesions

Condylomata lata of the secondary stage of syphilis

Q2210:A patient with syphilis admits that initially he had a red; firm; painless sore on his penis 6 weeks ago; but it disappeared. What is the lesion called

Chancre—the primary stage of syphilis

Q2211:What is the best way to diagnose syphilis in the primary stage

Darkfield exam

Q2212:Which serologic test detects syphilis the earliest; is the most specific; and stays positive even after treatment

Fluorescent treponemal antibody absorption test (FTA-ABS)

Q2213:Which serologic tests are used for presumptive diagnosis of syphilis

VDRL and RPR

Q2214:What are treatment options for syphilis in primary and secondary stages

Penicillin G—intramuscular

Q2215:What is the classic reaction hours after treatment for syphilis that involves shaking chills; sore throat; myalgia; and malaise

Jarisch-Herxheimer reaction

Q2216:If a patient with secondary syphilis is not treated; what are some outcomes in the following years

One third of patients get tertiary syphilis (1-40 years after infection); Two thirds have no further symptoms

Q2217:What are some of the findings in tertiary syphilis

Iritis (Argyll Robertson pupil); Aortitis; Neurosyphilis (tabes dorsalis; paresis); Gummas

Q2218:A 20 year old black male presents with a 1 month history of worsening back pain that is worse in the morning and improves with exercise. What is the suspected diagnosis

Ankylosing spondylitis

Q2219:What are some associated findings with ankylosing spondylitis

Positive family history; Uveitis; Anemia

Q2220:What clinical test for ankylosing spondylitis should be performed in the office

Schober test—decreased angle of anterior flexion of the back; eliciting pain

Q2221:What is the genetic association of ankylosing spondylitis

AR; HLA-B27

Q2222:What is classic sign of ankylosing spondylitis on radiographs

Bamboo spine

Q2223:A 45 year old male smoker complains of cold sensitivity and pain in his fingers. Some fingers have signs of gangrene. What is he suffering from

Buerger’s disease (smoking and thromboangiitis obliterans)

Q2224:What are the signs and symptoms of Buerger’s disease

Intermittent claudication of small vessels; Raynaud’s phenomenon; Nodular phlebitis

Q2225:What HLA types are increased in patients with Buerger’s disease

HLA-A9 and HLA-B5

Q2226:What is the treatment for Buerger’s disease

Stop smoking

Q2227:A 22 year old Asian female presents to your office with arthritis; fevers; night sweats; change in vision; and skin nodules. On physical exam; she is found to have weak and uneven pulses in the upper extremities. What disease should be ruled out

Takayasu’s arteritis (pulselessness disease)

Q2228:What vessels does Takayasu's arteritis affect

Medium and large arteries

Q2229:What lab test is usually abnormal in Takayasu’s arteritis

ESR (elevated)

Q2230:What imaging test should be done to confirm Takayasu’s arteritis

Angiogram

Q2231:In Takayasusu’s arteritis; what would an angiogram reveal

Thickening (granulomatous inflammation) of the aortic arch and proximal vessels

Q2232:What are some complications of Takayasu’s arteritis

Pulmonary hypertension; Stroke

Q2233:A 4 year old Japanese female presents to the ER with a 5 day history of fever above 102; arthritis; bright red lips; swollen hands and feet; and swollen lymph nodes. Diagnosis

Kawasaki disease (mucocutaneous lymph node syndrome)

Q2234:What are the criteria for a diagnosis of Kawasaki disease

Fever >5 days; Lymphadenopathy; Bilateral conjunctival injection; Mucosal changes (fissuring; injection; strawberry tongue; erythema); Extremitiy changes (edema; erythema); Rash (truncal; may be desquamative); Arthritis (may be present)

Q2235:What are the major complications of Kawasaki disease

Myocardial infarction and coronary artery aneurysms

Q2236:What autoantibodies are found in Kawasaki disease

Antiendothelial antibodies

Q2237:Which vessels does Kawasaki disease typically affect

Large; medium; and small arteries

Q2238:What should be done if Kawasaki disease is suspected

Treat with aspirin and IV immunoglobuliins

Q2239:Why is Kawasaki disease one of the only indications for using aspirin in children

Reye’s syndrome limits the use of aspirin in children; except in the treatment for Kawasaki disease

Q2240:A 7 year old boy presents with arthritis; lower extremity palpable purpura; abdominal pain; and blood in the stool and urine. Diagnosis?

Henoch-Schonlein purpura

Q2241:What are two common histories with HenochSchonlein purpura

Post-streptococcal infection or upper respiratory infection; History of insect bites

Q2242:What types of immune complexes are found in tissue biopsy of Henoch-Schonlein purpura

IgA dominant

Q2243:Which vessels are mainly affected in HenochSchonlein purpura

Small vessels (capillaries; venules; and arterioles)

Q2244:A young man presents with arthritis; asthma; allergy; weight loss; fever; and vasculitis. What disease is suspected

Churg-Strauss syndrome

Q2245:What are some laboratory findings of Churg-Strauss syndrome

Blood eosinophilia; Increased IgE

Q2246:Which vessels are affected in Churg-Strauss syndrome

Small and medium sized vessels

Q2247:Which autoantibody groups are associated with Churg-Strauss

Antineutrophil cytoplasmic antibody (ANCA); Antimyeloperoxidase

Q2248:A 65 year old female presents with increasing headache; vision changes; scalp pain; and jaw pain. She also complains of a few previous months of aching joints and muscles. What should immediately be suspected

Temporal (giant cell) arteritis

Q2249:What should be done immediately when temporal (giant cell) arteritis is suspected

Start high-dose steroids

Q2250:What is the major complication of temporal arteritis that prompts administration of steroids

Blindness

Q2251:Which lab test is elevated in temporal arteritis

ESR

Q2252:What is the diagnostic test that confirms temporal arteritis

Temporal artery biopsy

Q2253:What would a biopsy of temporal arteritis show

Granulomatous arteritis

Q2254:What other disease is strongly associated with temporal arteritis

Polymyalgia rheumatica

Q2255:A 42 year old male presents with chronic sinusitis; hemoptysis; necrotizing granulomas of the nose and palate; and a previous diagnosis of crescentic glomerulitis. Diagnosis?

Wegener’s granulomatosis

Q2256:Which vessels are usually affected in Wegener’s granulomatosis

Medium and small vessels of the respiratory tract and kidneys

Q2257:Which antibody is found in Wegener’s

Cytoplasmic-ANCA (c-ANCA); predominantly antiproteinase 3

Q2258:What deformity is associated with Wegener’s

Saddle nose deformity

Q2259:Besides Wegener’s; what is the other disease that involves both the respiratory tract (hemoptysis) and kidney (renal failure)

Goodpasture’s syndrome

Q2260:What is the antibody associated with Goodpasture’s syndrome

Antiglomerular basement membrane

Q2261:What does immunoflorescence of affected tissue in Goodpasture’s syndrome show

Linear deposits of IgG and C3 in the glomerular basement membrane

Q2262:A 40 year old black female present with increasing shortness of breath; polyarthritis; change in vision; fevers; and malaise. On chest x-ray; there is bilateral hilar lymphadenopathy. What is the most likely diagnosis

Sarcoidosis

Q2263:What electrolyte abnormality is common with sarcoidosis

Hypercalcemia

Q2264:On biopsy of affected tissue; what is the classic finding in sarcoidosis

Noncaseating granulomas

Q2265:What skin findings are associated with sarcoidosis

Erythema nodosum; Lupus pernio

Q2266:A 26 year old white male presents with malaise; fever; weight loss; hypertension; ab pain; and melena. He has a history of hepatitis B and drug use. What disease is suspected

Polyarteritis nodosa (PAN)

Q2267:How is a diagnosis of polyarteritis made

Tissue biopsy showing transmural necrotizing arteritis of medium-sized arteries

Q2268:What is the treatment for polyarteritis nodosa

Steroids and cyclophosphamide

Q2269:What is the disease that is a variation of polyarteritis nodosa; which affects smaller arterioles; capillaries; and venules rather than the larger vessels

Microscopic polyangiitis (leukocytoclastic vasculitis)

Q2270:What clinical symptoms do patients with microscopic polyangiitis have

Hemoptysis; Hematuria; Abdominal pain/blood in stool; Skin findings (purpura)

Q2271:Which antibody is microscopic polyangiitis most closely associated with

p-ANCA

Q2272:A 50 year old man presents with fever; arthralgias; and palpable purpura on the lower extremities after starting several new medications. What is the most likely diagnosis

Hypersensitivity angiitis

Q2273:How is the diagnosis of hypersensitivity angiitis made

Skin biopsy showing infiltration of dermal capillaries

Q2274:A 55 year old white female presents with polyarthritis; dysphagia and reflux esophagitis; pulmonary fibrosis; and hypertension. On exam; her face appears tight and masklike and she has swelling of the hands and thickening of the skin. What is the most likely diagnosis

Scleroderma (systemic scleroderma)

Q2275:What is the autoantibody that is most closely associated with scleroderma

Anti-DNA topoiosomerase I (anti-Scl-70)

Q2276:What is the more limited version of scleroderma

CREST syndrome

Q2277:What are the characteristics of CREST syndrome

Calcinosis (subcutaneous); Raynaud phenomenon; Esophageal dysfunction; Sclerodactyly; Telangiectasia

Q2278:What antibodies are most closely associated with CREST syndrome

Anticentromere antibody

Q2279:A 50 year old white female presents with very dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca). She reports that she has several dental caries filled recently. What is the most likely syndrome

Sjogren’s disease

Q2280:What are some GI symptoms commonly associated with Sjogren’s

Constipation and pancreatic insufficiency due to gland destruction

Q2281:How is Sjogren’s disease diagnosed

Lip biopsy; Schirmer’s test (showing decreased lacrimation)

Q2282:What autoantibodies are associated with Sjogren’s disease

Antinuclear antibody (ANA) (nonspecific) and antinucleoprotein antibodies (SS-A[Ro] and SS-B)

Q2283:What are patients with Sjogren’s at risk for developing

Lymphoma

Q2284:A 23 year old white female presents with a 6 month history of weight loss; muscle weakness; palpitations; diarrhea; and fine tremor. Tachycardia and exophthalmos are present. What do you suspect

Graves’ disease (diffuse toxic goiter)

Q2285:What autoantibody causes Graves disease

Thyroid-stimulating hormone (TSH)-receptor antibody

Q2286:A 23 year old white female develops limb weakness; ptosis; diplopia; and difficulty chewing. Weakness improves after rest. Sensation and reflexes remain intact and normal. What disease is suspected

Myasthenia gravis

Q2287:How is the diagnosis of myasthenia gravis confirmed

Edrophonium challenge temporarily improves muscle strength

Q2288:What is edrophonium

Anticholinesterase inhibitor

Q2289:What causes myasthenia gravis

Antiacetylcholine-receptor antibody

Q2290:What HLA type is associated with myasthenia gravis

HLA-DR3

Q2291:What diseases are associated with myasthenia gravis

Thymoma; Thyrotoxicosis

Q2292:What treatments are available for myasthenia gravis

Anticholinesterase drugs; Corticosteroids; Thymectomy; Plasmapheresis

Q2293:A 55 year old white woman presents with 1 month history of proximal muscle weakness and pain; increasing fatigue; and malaise. What disease should be ruled out

Polymyositis

Q2294:What lab finding support the diagnosis of polymyositis

Increased ESR; Increased CPK; Increased aldolase; Increase LDH; Antinuclear may be positive; Abnormal electromyography

Q2295:What is the only specific test that provides a definitive diagnosis of polymyositis

Muscle biopsy showing lymphoid inflammation

Q2296:What disease is characterized by symptoms and lab values similar to polymyositis; but also has a lilac edematous rash on the eyelids

Dermatomyositis

Q2297:What is the name of the rash on the eyelids found in dermatomyositis

Heliotrope rash

Q2298:What are patients with dermatomyositis and polymyositis at an increased risk of developing

Ovarian cancer

Q2299:What is the treatment for dermatomyositis and polymyositis

High-dose steroids

Q2300:A 55 year old white female complains of 3 months of neck stiffness; pelvic and pectoral girdle weakness; and pain; fatigue; and malaise. What is the most likely diagnosis

Polymyalgia rheumatica

Q2301:What lab values would be abnormal in polymyalgia rheumatica

Elevated ESR

Q2302:With what disease is polymyalgia rheumatica associated

Temporal arteritis

Q2303:A 45 year old white woman presents with a 2 month history of decreased sleep and several (>11) very tender points on her anterior and posterior torso and neck that produce extreme pain with palpation. She has a history of anxiety disorder and depression. Diagnosis?

Fibromyalgia

Q2304:What lab values should be evaluated in fibromyalgia

CBC—normal; ESR—normal

Q2305:How should a patient with fibromyalgia be treated

NSAIDs and antidepressants

Q2306:Dx;autosomal dominant trait leading to the failure of longitudinal bone growth; causing short limbs

Achondroplasia

Q2307:Dx;Pannus formation in joints

Rheumatoid Arthritis

Q2308:Dx;increased bone resorption due to decreased estrogen levels

Osteoporosis (type 1);(type 2 is men and women >70)

Q2309:(2) common fractures due to Osteoporosis

Vertebral crush fractures;;Collies distal Radius Fx

Q2310:Definition;failure of normal bone resorption leading to thick; dense bones due to abnormal function of Osteoclasts; no labs elevated; "marble bone Dz"

OsteoPETrosis

Q2311:Definition;increase in oseteoblastic and osteoclastic activity; all labs normal except great increase in Alk Phos

Padget Dz of the Bone

Q2312:Dx;bone replaced w/ fibroblasts and collagen (PFD) in unilateral bones; precocious puberty; unilateral pigmented skin

Albright's syndrome

Q2313:Definition;pain and stiffness in shoulders and hips; often w/ fever and weight loss in pt >50yo;what is it assoc w/?

Polymyalgia rheumatica;;assoc w: Temporal (giant cell) arteritis

Q2314:what joint problem can be caused by G6PD deficiency?

Gout

Q2315:Dx;painful MTP joint; formations on external ear or achilles tendon;test?

Gout;(Tophus formations are on ear and achilles);Test: joint aspiration;(Needle-shaped Negatively birefringement)

Q2316:Dx;calcium crystals in the knee;test?

Pseudogout;Test: joint aspiration;(Basophilic; rhomboid; Positively Birefringement)

Q2317:Dx;Gammaglobinemia; RA; ACE increase; Interstitial lung fibrosis; Noncaseating granulomas

Sarcoidosis;"GRAIN"

Q2318:(2) types of Seronegative spondyloarthropathies ;(arthritis w/o rheumatoid factor)

Ankylosing Spondylitis;Reiter's syndrome

Q2319:Dx;chronic inflammatory dz of spine and sacroiliac joints; uveitis and aortic regurg

Ankylosing Spondylitis

Q2320:Dx;Urethritis; conjunctivitis and anterior uveitis and arthritis

Reiter's syndrome;(Can't see; can't pee; can't climb a tree)

Q2321:Dx;an acquired loss of melanocytes in descrete areas of skin that appear as depigmented white patches

Vitiligo

Q2322:Definition;epidermal hyperplasia and hyperpigmentation most often in flexural areas and a marker of visceral malignancy

Acanthosis Nigricans

Q2323:Dx;port-wine stain on the face; ipsilateral glaucoma; vascular lesions of ocular tissue; extensive hemangiomatous involvement of meninges

Sturge-Weber syndrome

Q2324:Dx;pruitic eruption; commonly on the flexor surfaces;(2 names)

Atopic Dermatitis;(Eczema)

Q2325:Dx;Epidermal hyperplasia w/ parakeratotic scaling especially on knees and elbows;what layer of skin is increased?;Decreased?

Psoriasis;;Inc Spinosum;Dec Granulosum

Q2326:Definition;Pruritic papules and vesicles associated w/ Celiac sprue

Dermatitis Herpetiformis

Q2327:Dx;Pruitic; purple; polygonal papules; infiltrate of lymphocytes at the dermalepidermal junction

Lichen Planus;[Lymphocytes = Lichen]

Q2328:Definition;assoc w/ infections; drugs; CA and autoimmune Dz; presents w/multiple types of lesions including macules; papules; vesicles and Target lesions

Erythema Multiforme

Q2329:Dx;erythema multiforme; high fever; bulla formation and necrosis; ulceration of skin; high mortality rate

Stevens-Johnson syndrome

Q2330:Dx;common benign flat pigmented squamous epithelial proliferation of keratin-filled (horn) cysts that look pasted-on

Seborrheic Keratosis

Q2331:Definition;subepidermal blistering w/ characteristic inflammatory infiltrate of eosinophils in the surrounding dermis;auto Ab against epidermal BM

Bullous Pemphigoid

Q2332:Dx;Blistering of oral mucosa with extensive skin involvement following; breakdown of cell-to-cell junctions w/ sparing of basement layer; auto Ab against epidermal cell surface

Pemphigus Vulgaris

Q2333:Dx;skin cancer of face and hands w/ keratin "pearls"

Squamous cell CA

Q2334:Dx;skin cancer in sun-exposed areas of body; pearly papules w/ "palisading" nuclei

Basal cell CA

Q2335:Dx;skin CA that can metastasize;what characteristic correlates to increased risk of metastasis?

Melanoma;;(Inc Depth of tumor = Inc Mets)

Q2336:what is common w/ all primary metatastic bone tumors?

they are all "Sarcomas"

Q2337:Dx;epiphyseal tumor at end of long bone (usu at knee) w/ spindle-shaped cells and "soap bubble" or "double bubble"

Giant cell Tumor;;(MC female bone tumor)

Q2338:Dx;bone growth covered by a cap of cartilage; usu in men < 25yo

Osteochondroma

Q2339:Dx;benign neoplasm of intermedullary bone usu in fingers and toes and w/o pain

Endochondroma

Q2340:Dx;replacement of intermedullary bone w/ fibrous tissue; "ground-glass" appearance on x-ray; "Chinese character" w/o osteoblasts

Fibrous Displasia

Q2341:Definition;;Giant cell-like bone tumor of metaphysis or vertebrae; pain and swelling; hemorrhagic cysts w/ giant cells

Aneurysmal Bone Cyst

Q2342:Dx;males < 25yo w/ central "nidus" of osteoid surrounded by a shell; painful (wake from sleep); responsive to aspirin

Osteoid Osteoma

Q2343:Dx;boys < 15yo w/ tumor of pelvis or shaft of long bones; small round blue cell tumor; PAS+; "Onionskin" look to bone;what translocation?

Ewing Sarcoma;[eWINGS and Onion rings];t(11;22)

Q2344:Dx;bone tumor w/ osteoid spindle cells; usu the knee; painful and aggressive; Inc Alk Phos; elevation of periosteum ;(Codman's triangle)

Osteosarcoma;(MC primary bone malignancy)

Q2345:Dx;malignant cartilaginous tumor in the central skeleton; painful and slow-growing; bluish-white appearance w/ sectioning

Chondrosarcoma

Q2346:Dx;weakness in proximal muscles of extremities; later compensatory hypertrophy of distal site (calf) and eventual pseudohypertrophy; Inc serum CK; death from weak resp muscles;genetics?

Duchenne Muscular Dystrophy;(frameshift deletion of Dystrophin)

Q2347:Definition;similar to DMD; but less severe; segmental deletions in Dystrophin

Becker muscular dystrophy

Q2348:Dx;Inability to relax muscles once contracted; weakness; cataracts and testicular atrophy

Myotonic Dystrophy;(CTG repeats - Auto Dominant)

Q2349:Dx;weakness of extraocular and facial muscles; muscle weakness w/ use and recovery w/ rest; difficult chewing; swallowing; resp failure; more common in women

Myasthenia Gravis;(Ab to ACh receptor)

Q2350:Definition;paraneoplastic syndrome w/ clinical manifestations similar to those of myasthenia gravis

Lambert-Eaton syndrome;(MC w/ Small cell CA of Lung)

Q2351:Dx;pigeon breast; string-of-beads in costochondrial junction; depression along line of insertion of diaphragm to rib cage (Harrison groove); High-output Cardiac failure

Rickets;(Vit D deficiency)

Q2352:Achondroplasia?

mutation of fibroblast growth factor receptor 3

Q2353:What happens with the mutation of FGFR3?

results in the reduction of the proliferation of chondrocytes on growth plate

Q2354:Morphology of Achondroplasia?

zones of proliferation and hypertrophy are narrowed and disorganized and contain clusters of large chondrocytes instead of well-formed columns

Q2355:Osteogenesis Imperfecta?

deficiency in synthesis of type 1 collagen

Q2356:deficiency in synthesis of type 1 collagen?

incorporation of defective alpha2 chains that cause instability and degradation of the triple helix

Q2357:Osteogenesis Imperfecta Type II

fatal in utero or during the perinatal period;fetus is still within the womb

Q2358:Findings for Osteogeness Imperfecta?

extreme skeletal fragility;blue sclerae caused by a decrease in collagen content; exposing the coridal veins;hearing loss related to both a sensorineural deficit and impeded conduction owing to abnormalities in the bones of the middle and inner ear;dental imperfections due to a deficiency of dentin;

Q2359:Mucopolysaccharidoses

caused by deficiencies in the enzymes

Q2360:Deficient enzymes in Mucopolysaccharidoses

that degrade dermatan sulfate; heparan sulfate; and keratan sulfate

Q2361:Mucopolysaccharidoses

abnormalities in hyaline cartilage

Q2362:Signs of Mucopolysaccharidoses

patients are frequently of short stature and have chest wall abnormalities and malformed bones

Q2363:Hunter's syndrome

associated with increased tissue stores and excretion of dermatan sulfate and heparan sulfate

Q2364:Senile Osteoporosis

continuous loss of bone at both the trabecular and cortical layers; which become thinner by internal resorption

Q2365:Steroid-induced Osteoporosis

catabolic effect of corticosteroids may affect trabecular bone; producing a decrease in bone formation

Q2366:Effects of Steroids on Caclium absorption

steroids also decrease intestinal absorption and renal resorption of calcium; so that less calcium reaches the bone

Q2367:Post-menopausal osteoporosis

most common after the fifth decade of life;decreased remodeling and decreased amount of bone deposited by osteoblasts;b/c lack of estrogen

Q2368:Immobilization osteoporosis

confinement of bed results in a loss of 30% of initial bone volume;lack of exercise seems to be the cause;

Q2369:anorexia nervosa and osteoporosis

anorexia nervosa leads to osteoporosis in women b/c of loss of menstrual period;reduction in bone mass with normal bone mineralization

Q2370:Osteopetrosis

Marble bone disease; Albers-Schonberg disease

Q2371:Osteopetrosis

osteoclast dysfunction;stonelike quality of the bones; however; the bones are abnormally brittle and fracture like a piece of chalk

Q2372:Osteopetrosis xray findings

Erlenmeyer flask

Q2373:Deficiency seen in Osteopetrosis

carbonic anhydrase II deficiency

Q2374:Morphology of Osteopetrosis

osteoclasts lack the usual ruffled borders and show decreased functioning

Q2375:Clinical features of Osteopetrosis

fractures; anemia; hydrocephaly are often seen;

Q2376:Paget Disease (Osteitis Deformans)

haphazard arrangement of cement lines

Q2377:Paget Disease (Osteitis Deformans)

can often lead to bell's palsy if impinging on the CN VII

Q2378:Paget Disease (Osteitis Deformans)

predilection for the skull; pelvis; tibia; and femur

Q2379:Paget Disease (Osteitis Deformans) Lab findings

serum alkaline phosphatase level is markedly elevated/increased levels of urinary hydroxyproline;

Q2380:X ray findings ofr Pagets

bone lysis and reformation are characteristic;

Q2381:Pathology of Pagets

"mosaic" pattern of osteoclasts;so termed b/c of cement like material forms narrow boundaries

Q2382:Cancer associated with Pagets Disease

often associated with Osteosarcoma

Q2383:Treatment for Pagets

administration of calcitonin; which decreases the resorption

Q2384:Signs and Symptoms of Pagets

bone pain; fractures; and deformities;deafness when skull is affected;height distortion due to vertebral compression

Q2385:Osteonecrosis (AvascularNecrosis)Differential Diagnosis

1) mechanical vascular interruption (fracture);2) corticosteroids;3)thrombosis and embolism (nitrogen bubbles in dysbarism)4) vessel injury (vasculitis; radiation therapy)5) increased intraosseous pressure with vascular compression;6) venous hypertension

Q2386:Osteonecrosis course

chronic pain that is initially associated only with activity but then becomes progressively more constant until finally it is present at rest

Q2387:MCC bilateral segmental osteonecrosis or avascular necrosis (AVN) of the femoral head

systemic steroid therapy

Q2388:Osteomyelitis

inflammation of the medullary and cortical portions of bone; including the periosteum

Q2389:Osteomyelitis bones affected; child vs adult

children; the long bones are most often affected; in adults; the vertebrae

Q2390:Osteomyelitis Pathogenesis

1) Most commonly; the hematogenous spread of bacteria from a distant focus of sepsis;2) Invasion of bone from adjacent septic arthritis or soft tissue abscesses;3) Penetrating trauma;4) Complication of fractures;5) Complications of surgery

Q2391:Osteomyelitis increased risk

pts with sickle cell disease; hemodialysis patients; patients with bone or joint prostheses; and intravenous drug abusers

Q2392:Pyogenic Osteomyelitis caused by

Staphylococcus aureus is responsible for 80% to 90% of the cases

Q2393:What are in utero manifestations of complete/bilateral renal agenesis? How common is this?

Oligohydramnios occurs because the renal system is not excreting fluids swallowed by the fetus;This results in the oligohydramnios sequence: multiple fetal abnormalities including hypoplastic lung; defects in extremities; etc.

Q2394:What are the clinical manifestations of the nephrotic syndrome?

Massive proteinuria: >4 g per day;Hypoalbuminemia: <3 g per deciliter;Generalized Edema;Hyperlipidemia and Hypercholesterolemia: due to increased hepatic lipoprotein synthesis

Q2395:What is Minimal Change Disease?

Prototypical nephrotic syndrome. Most often in young children but can occur in older individuals;Light microscopy shows normal glomeruli;Electron microscopy is normal except for effacement of epithelial foot processes;Responds well to steroid therapy;Pathogenesis may be related to mutations in nephrin.

Q2396:What is focal segmental glomerulosclerosis?

Like the name: focal; involving only a subset of glomeruli; segmental; involving only a portion of the glomerular tuft;Symptoms include nephrotic syndrome or non-nephrotic proteinuria. Like minimal change disease; there is a loss of foot processes. There is also sclerosis -- collapse of the basement membranes; increase in matrix; and hyalinosis of the capillary wall with possible obstruction;Responds poorly to steroids.

Q2397:What is membranous glomerulonephritis?

An immune complex disease of unknown etiology that causes the nephrotic syndrome and azotemia;Light microscopy shows thickened capillary walls due to a five to 10 fold thickening of the basement membrane. Epimembranous (subepithelial) deposits with a spike and dome appearance. Granular pattern on immunofluorescence.

Q2398:What is diabetic nephropathy?

Dramatic thickening of the entire glomerular basement membrane; seen by electron microscopy;Other changes include an increase in mesangial matrix in both a diffuse and nodular (Kimmelstiel-Wilson nodules) pattern.

Q2399:What is renal amyloidosis?

Presents with nephrotic syndrome; due to subendothelial and mesangial amyloid deposits;Often caused by chronic inflammatory diseases such as rheumatoid arthritis or plasma cell disorders such as multiple myeloma.

Q2400:What are the five patterns of lupus nephropathy?

Type 1: no observable renal involvement;Type 2: mesangial cell and matrix proliferation; with slight proteinuria and minimal hematuria;Type 3: focal proliferative -- not all glomeruli involved; but some severely damaged;Type 4: diffuse proliferative -- all glomeruli involved with inflammation; thromboses; mesangial proliferation; and scarring. Also see wire loop abnormalities; endothelial cell proliferation; and subendothelial immune complex deposition;Type 5: membranous form -- same as primary membranous glomerulonephritis

Q2401:What are the characteristics of the nephritic syndrome?

Oliguria; azotemia; hypertension; hematuria with red cell casts. Patients often report having "smoky brown urine".

Q2402:What is poststreptococcal glomerulonephritis?

Prototype of the nephritic syndrome. Immune complex disease due to GAS infection. 95% show complete recovery; but a small minority develops rapidly progressive glomerulonephritis;Causes an inflammatory reaction with renal surface petechiae; enlarged; hypercellular glomeruli; normal basement membrane thickness; subepithelial bumps; and "lumpy bumpy" immunofluorescence.

Q2403:What is rapidly progressive (crescentic) glomerulonephritis (RPGN)?

Nephritic syndrome that progresses to renal failure within weeks or months. Crescents are formed by fibrin deposition in Bowman space and proliferation of epithelial cells;Type I: anti-GBM disease;Type II: poststreptococcal (50%);Type III: pauci-immune; associated with ANCAs

Q2404:What is Goodpasture's syndrome?

Nephritic syndrome; pneumonitis with hemoptysis; and RPGN crescentic glomerulonephritis due to anti-glomerular basement membrane antibodies;Fluorescent antibody staining demonstrates a linear pattern.

Q2405:What is focal glomerulonephritis?

Focal and segmental inflammatory changes (contrast to sclerotic changes in focal segmental glomerulosclerosis);Due to immune complexes; often secondary to SLE; subacute bacterial endocarditis; polyarteritis nodosa; Goodpasture's syndrome; Wegener granulomatosis; and IgA nephropathy. Can also be idiopathic.

Q2406:What is Alport syndrome?

Hereditary nephritis associated with nerve deafness; and ocular disorders (lens dislocation; cataracts);Due to a mutation of the Alpha-5 chain of type IV collagen; often causes endstage renal disease by 30 years of age;Microscopically; irregular glomerular basement membrane thickening/thinning with foci of splitting of the lamina densa.

Q2407:ureter crosses anterior to the origin of what artery to enter the pelvis?

external iliac

Q2408:ovoid; PAS-positive hyaline masses

Kimmelstiel-Wilson nodule - most specific lesion of diabetic glomerulosclerosis

Q2409:nephrotic syndrome in IV drug user or HIV nephropathy

focal segmental glomerulosclerosis

Q2410:renal pathology associated with DIC?

diffuse cortical necrosis

Q2411:Potter's syndrome?

bilateral renal agenesis - oligohydraminos; limb & facial deformities;pulmonary hypoplasia

Q2412:cause of Potter's syndrome?

malformation of ureteric bud

Q2413:why do kidneys stay low in abdomen in horseshoe kidney?

get trapped under IMA

Q2414:RBC casts in urine

glomerular inflammation (nephritic syndromes); ischemia; or malignant hypertension

Q2415:WBC casts in urine

tubulointerstitial disease; acute pyelonephritis; glomerular disorders

Q2416:granular casts in urine

acute tubular necrosis

Q2417:waxy casts in urine

advanced renal disease/CRF

Q2418:hyaline casts in urine

nonspecific

Q2419:LM: glomeruli enlarged and hypercellular; neutrophils; lumpy-bumpy; EM: subepithelial humps; IF: granular pattern

acute postreptococcal glomerulonephritis

Q2420:LM and IF: crescent moon shape

rapidly progressive (crescentic) glomerulonephritis

Q2421:finding on immunofluorescence in Goodpasture's?

linear pattern; anti-GBM IgG Abs

Q2422:IF and EM findings in Berger's disease?

mesangial IgA deposits (Berger's also known as IgA nephropathy)

Q2423:split basement membrane with nerve deafness and lens dislocation or cataracts

Alport's syndrome

Q2424:mutation in Alport's? characteristic findings?

collagen IV; nerve deafness and ocular disorders

Q2425:hematuria; hypertension; oliguria; azotemia

nephritic syndrome

Q2426:findings in nephrotic syndrome

massive proteinuria; hypoalbuminemia; peripheral and periorbital edema; hyperlipidemia

Q2427:LM: diffuse capillary and BM thickening; IF: granular pattern; EM: spike and dome

membranous glomerulonephritis

Q2428:findings in minimal change disease/lipoid nephrosis?

LM: normal glomeruli; EM: foot process effacement

Q2429:LM: segmental sclerosis and hyalinosis

focal segmental glomerular sclerosis - most severe disease in HIV patients

Q2430:findings in diabetic nephropathy

LM: Kimmelstiel-Wilson lesions; basement membrane thickening; glomeruli appear like golf balls

Q2431:findings in membranous glomeruloneprhitis in SLE

wire-loop lesion with subepithelial deposits

Q2432:most common type of kidney stones?

calciium oxalate; calcium phosphate; or both

Q2433:second most common type of kidney stone; can form staghorn calculi that can be nidus for UTIs

ammonium magnesium phosphate (struvite)

Q2434:infection with what type of organism leads to struvite kidney stones?

urease-positive bugs - proteus vlugaris; staph; klebsiella

Q2435:kidney stones often seen as a result of diseases with increased cell turnover; such as leukemia and myeloproliferative disorders

uric acid

Q2436:types of radiolucent kidney stones?

uric acid and cystine

Q2437:gene association with renal cell carcinoma?

deletion of VHL gene on chromosome 3

Q2438:where does renal cell carcinoma originate?

renal tubule cells (polygonal clear cells)

Q2439:renal cell carcinoma is associated with what syndromes?

paraneoplastic (ectopic EPO; ACTH; PTHrP; and prolactin)

Q2440:gene association with Wilm's tumor?

deletion of tumor suppressor WT1 on chromosome 11

Q2441:WAGR complex?

Wilm's tumor; Aniridia; genitourinary malformation; and mental-motor retardation

Q2442:most common tumor of the urinary tract system?

transitional cell carcinoma

Q2443:transitional cell carcinoma is associated with what?

problems in your Pee SAC;phenacetin; smoking; analine dyes; and cyclophosphamide

Q2444:white cell casts in urine are pathognomonic for what?

acute pyelonephritis

Q2445:chronic pyelonephritis clinical manifestations?

coarse; asymmetric corticomedullary scarring and blunted calyces; tubules can contain eosinophilic casts (thyroidization of the kidney)

Q2446:most common cause of acute renal failure?

acute tubular necrosis

Q2447:what is acute tubular necrosis associated with?

renal ischemia (e.g. shock); crush injury (myoglobinuria); toxins

Q2448:when does death most often occur in ATN?

during initial oliguric stage

Q2449:what is renal papillary necrosis associated with?

diabetes; acute pyelonephritis; chronic phenacitin use; sickle cell anemia

Q2450:what is uremia?

clinical syndrome marked by increased BUN and creatinine and associated symptoms

Q2451:metabolic consequences seen in renal failure?

1. Anemia (decreased EPO);2. Renal osteodystrophy (failure of active vitamin D production);3. Hyperkalemia;4. metabolic acidosis due to decreased acid secretion and decreased HCO3generation;5. Uremic encephalopathy;6. Sodium and H2O excess --> CHF and pulmonary edema;7. Chronic pyelonephritis;8. Hypertension

Q2452:low serum chloride concentration is caused by what?

is secondary to metabolic alkalosis; hypokalemia; hypovolemia; increased aldosterone

Q2453:high serum chloride concentration is secondary to what?

non-anion gap acidosis

Q2454:most common cause of nephrotic syndrome in adults?

membranous glomerulonephritis

Q2455:Obese male aged 50-70 years; smoker; with hematuria and palpable mass; fever; weight loss. what is diagnosis?

Renal cell carcinoma

Q2456:loop diuretic indicated for the treatment of edema associated with CHF; cirrhosis; and renal disease?

furosemide (also HTN and hypercalcemia)

Q2457:two principal causes of rapidly progressive glomerulonephritis?

anti-glomerular basement membrane and primary systemic vasculitis

Q2458:drugs implicated in the pathogenesis of acute interstitial nephritis?

NSAIDs; beta-lactam antibiotics (penicillins and cephalosporins); sulfonamides; diuretics (furosemide and thiazides); phenytoin; cimetidine; methyldopa

Q2459:EM: subendothelial humps; mesangial proliferation (splits BM)

membranoproliferative glomerulonephritis

Q2460:What does the presence of casts in the urine indicate?

hematuria/pyuria is of renal origin

Q2461:What do RBCs in urine with no casts indicate?

Bladder cancer

Q2462:What does WBCs in urine with no casts inddicate?

Acute cystitis

Q2463:This nephritic syndrome is most frequently seen in children and presents with peripheral and periorbital edema

Acute poststreptococcal glomerulonephritis. resolves spontaneously

Q2464:Outcome of Membranoproliferative glomerulonephritis?

slowly progresses to renal failure

Q2465:outcome of Rapidly progressive glomerulonephritis?

rapid course to renal failure. number of crescents indicates prognosis

Q2466:this is a common cause of recurrent hematuria in young patients

IgA nephropathy (Berger's disease)

Q2467:Immunofluorescent congo red stain of glomeruli show apple-green birefringence. What is the diagnosis?

Amyloidosis

Q2468:Amyloidosis is associated with what conditions?

multiple myeloma; chronic conditions; TB; rheumatoid arithritis

Q2469:Which conditions may lead to hypercalciuria and stones?

hypercalcemic conditions: cancer; increased PTH; increased vitamin D; milk-alkali syndrome

Q2470:child aged 2-4 presents with huge; palpable flank mass; hemihypertrophy. The mass contains embryonic glomerular structures. What is the tumor?

Wilms' tumor

Q2471:What causes diffuse cortical necrosis?

likely due to a combination of vasospasm and DIC. Associated with obstetric catastrophes and sepsis

Q2472:acute interstitial renal inflammation with fever; rash; eosinophilia and hematuria beginning 2 weeks after taking what drugs?

Drug-induced interstitial nephritis; penicillins; NSAIDS; diuretics

Q2473:Patient presents with acute renal failure. labs show Urine osmolality >500; Urine Na <10; Fe(Na) <1% and BUN/Cr >20. Where is the problem

Prerenal

Q2474:Patient presents with acute renal failure. labs show Urine osmolality <350; Urine Na >20; Fe(Na) >2% and BUN/Cr <15. Where is the problem

Renal

Q2475:Patient presents with acute renal failure. labs show Urine osmolality <350; Urine Na >40%; BUN/Cr >15. What is the cause?

post-renal; generally outflow obstruction due to stones; BPH or neoplasia

Q2476:What is Fanconi's syndrome? What are its complications?

Defect in proximal tubule transport. Complications include rickets; osteomalacia; hypokalemia; metabolic acidosis

Q2477:patient presents with flank pain; hematuria; hypertension; urinary infection and progressive renal failure. US shows multiple; large; bilateral renal cysts. What is the underlying cause?

APKD from AD mutation in APKD1 gene

Q2478:low serum Na causes what?

disorientation; stupor; coma

Q2479:high serum Na causes what?

neurologic: irritability; delirium; coma

Q2480:low serum K causes what?

U waves on ECG; flattened T waves; arrhythmias; paralysis

Q2481:high serum K causes what?

peaked T waves; wide QRS; arrhythmias

Q2482:low serum Ca causes what?

tetany; neuromuscular irritability

Q2483:high serum Ca causes what?

delirium; renal stones; abdominal pain; not necessarily calciuria

Q2484:low serum Mg causes what?

neuromuscular irritability; arrhythmias

Q2485:high serum Mg causes what?

delirium; decreased DTRs; cardiopulmonary arrest

Q2486:low serum PO4 causes what?

low-mineral ion product causes bone loss; osteomalacia

Q2487:high serum PO4 causes what?

high-mineral ion product causes metastatic calcification; renal stones

Q2488:mechanism of mannitol?

osmotic diuretic; increased tubular fluid osmolarity; producing increased urine flow. works in PCT

Q2489:mannitol contraindications?

anuria; CHF

Q2490:mechanism of acetazolamide?

Carbonic anhydrase inhibitor. Acts in PCT. depletion of HCO3

Q2491:major toxicity of acetazolamide?

hyperchloremic metabolic acidosis

Q2492:mechanism of furosemide?

loop diuretic. inhibits Na/K/Cl cotransport in thick ascending limb. reduces hypertonicity of medulla preventing concentration of urine in the collecting tubule. also promotes loss of Ca due to decreased electrochemical gradient

Q2493:major toxicity of furosemide?

OH DANG!;Ototoxicity; Hypokalemia; Dehydration; Allergy (sulfa); Nephritis (interstitial); Gout

Q2494:mechanism of ethacrynic acid

loop diuretic blocks Na/K/Cl cotransporter; reduces ability to concentrate urine

Q2495:major toxicity of ethacrynic acid

gout

Q2496:mechanism of hydrochlorothiazide

thiazide diuretic. inhibits NaCl reabsorption in early distal tubule; reducing diluting capacity of nephron. decreases Ca excretion

Q2497:toxicities of hydrochlorothiazide

hypokalemic metabolic acidosis; hypercalcemia; sulfa allergy

Q2498:What are the K sparing diuretics?

Spironolactone; Triamterene; Amiloride; eplerenone

Q2499:Mechanism of spironolactone?

competitive aldosterone receptor antagonist in cortical collecting tubule

Q2500:mechanism of Triamterene and amiloride?

block Na channels in CCT

Q2501:toxicity of K-sparing diuretics?

hyperkalemia; antiandrogenic effects

Q2502:mechanism of ACE inhibitors?

inhibit ACE; reducing angiotensin II and preventing inactivation of bradykinin. Results in increased renin release

Q2503:major toxicities of ACE inhibitors?

cough; increased renin; hyperkalemia

Q2504:What are the ACE inhibitors?

Captopril; Enalapril; Lisinopril

Q2505:mechanism of Losartan

angiotensin II receptor inhibitor (does not produce cough)

Q2506:What are podocytes?

visceral epithelial cells

Q2507:What are the spaces between the podocytes called?

split pores

Q2508:Which cells synthesis the glomerular BM?

visceral epithelial cells (podocytes)

Q2509:What keeps albumin out of urine?

strong negative charge of Glomerular BM

Q2510:What is responsible for charge of GBM?

Heparan Sulfate (strong negative charge)

Q2511:damage to visceral epithelial cell results in what?

damage to BM and leaking of albumin into urine --> nephrotic syndrome

Q2512:linear pattern outlining BM on Immunofluorescence

goodpasture syndrome

Q2513:subendothelial immune complex deposits in glomeruli on EM (granular)

lupus

Q2514:subepithelial immune complex deposits in glomeruli EM (granular)

post-strep glomerulonephritis

Q2515:only glomerulonephritis one can diagnose with IF

IgA glomerulonephritis

Q2516:granular pattern on IF. what does it mean?

immunocomplex type III disease

Q2517:anti BM antibodies is what type of immune complex disease?

Type II

Q2518:RBC casts in urine is unique to what class of diseases

nephritic syndromes

Q2519:serum ANA shows rim pattern. what does that mean?

anti-DNA --> lupus

Q2520:crescentic glomerulonephritis is most commonly seen in what syndrome?

goodpasture's syndrome

Q2521:cholesterol casts in urine that when polarized look like maltese crosses. what is the diagnosis?

nephrotic syndrome

Q2522:why does lipoid nephrosis occur (Minimal change disease)?

loss of negative charge of GBM

Q2523:Nephrotic syndrome associated with HIV

FSGS

Q2524:glomerular problem in HBV

diffuse membraneous glomerulonephritis

Q2525:glomerular problem in HCV

Membranoproliferative glomerulonephritis

Q2526:vasculitis associated with HBV

polyarteritis nodosa

Q2527:large golf-ball appearing glomeruli on H&E

diabetic nephropathy

Q2528:what happens to the GFR and creatinine clearance in early diabetic nephropathy?

hyalinization of efferent arterioles; so Cr clearance and GFR increase. Also nonenzymatic glycosylation of BM cause microalbuminuria

Q2529:ACE inhibitors do what to glomerular arterioles?

less angiotensin II dilates efferent arteriole

Q2530:mesangial cells split BM on EM. C3 deposited adjacent to but not within dense deposits. serum C3 is very low. what is the diagnosis?

Type II membranoproliferative glomerulonephritis

Q2531:properties of BUN

blood urea nitrogen - secreted and reabsorbed in PCT

Q2532:properties of Creatinine

end-product of creatine - only filtered in kidney; neither reabsorbed nor secreted in kidney (can be in other places in very high levels)

Q2533:normal BUN and Cr levels

BUN - 9-10;Cr - 1 mg/dl

Q2534:normal BUN/Cr

10

Q2535:pre-renal azotemia

normal kidneys; but reduced Cardiac Output (e.g. CHF); ergo; GFR decreases. BUN/Cr >15

Q2536:renal failure (oliguria; renal tubular casts)

affects BUN and Cr equally (increased BUN and Cr in equal proportion) BUN/Cr normal (10/1)

Q2537:most common cause of acute renal failure

ischemic acute tubular necrosis

Q2538:Cardiac output decreases and oliguria; what do you worry about most?

ischemic acute tubular necrosis

Q2539:most common cause of ischemic acute tubular necrosis

not treating pre-renal azotemia

Q2540:BUN:Cr ~ 10:1 with oliguria and renal tubular casts

acute tubular necrosis

Q2541:Why does acute tubular necrosis have such a bad diagnosis?

ischemic cause also destroys basement membrane --> loss of structure --> can't regenerate renal tubular cell w/o BM. Even if one recovers; can never recover normal function

Q2542:What parts of nephron is most susceptible to ischemia?

straight portion of proximal tubule and thick ascending limb (medullary part). Affects Na/K/Cl co-transport

Q2543:Nephrotoxic drugs;what are they and where do they affect? prognosis?

gentamicin (aminoglycocides); dye from IV pyelograms; damages proximal tubule. prognosis good because they don't damage BM.

Q2544:How do you separate pyelonephritis from low UTIs?

acute pyelonephritis is infection of kidney proper and has fever with flank pain (CVA tenderness) and WBC casts

Q2545:what is the mechanism of all UTIs

ascending infection from introitus of urethra.

Q2546:scarred kidney with blunted calyces (beneath scarring)

chronic pyelonephritis

Q2547:fever with rash; oliguria; eosinophiluria after starting drug

acute drug-induced interstitial nephritis (methicillin)

Q2548:what kinds of hypersensitivity are associated with acute drug-induced interstitial nephritis?

combination of type I and type IV hypersensitivities

Q2549:empty space on IV pyelogram

analgesic nephropathy from acetaminophen and aspirin combo therapy long-term

Q2550:what is the mechanism of analgesic nephropathy?

acetaminophen --> produces free radicals that damage tubular cells of medulla;aspirin blocks PGE2 so Angiotensin II is unopposed and peritubular capillaries have decreased blood flow causing ischemia in renal papillaries

Q2551:causes of renal papillary necrosis

aspirin/acetaminophen long-term; diabetes; sickle-cell disease; acute pyelonephritis (from abscess formation)

Q2552:BUN/Cr >10 for more than 3 months. what is the diagnosis?

Chronic renal failure

Q2553:results of chronic renal failure

anemia; anion-gap metabolic acidosis; osteoporosis; osteomalacia; secondary hyperparathyroidism

Q2554:uncontrolled essential hypertension (over ten years) causes what?

nephrosclerosis --> hyaline arteriolosclerosis (cobblestone appearance of kidney)

Q2555:person with uncontrolled HTN; wakes up with bad HA; dizzy; blurred vision; BP 240/140; papilledema and flamed hemorrhages; hard and soft exudates; BUN/Cr 80/8. what is diagnosis?

malignant hypertension (shows petechia visible on surface of kidney)

Q2556:Treatment of malignant hypertension?

IV nitroprusside

Q2557:pale; depressed-looking lesions on gross examination of kidney. what do you see on LM?

pale infarction --> coagulation necrosis

Q2558:causes of pale infarcts in kidneys in a patient with irregular irregular pulse?

A-fib; causes thromboemboli

Q2559:little white dots and microabscesses on gross exam of kidneys probably caused by what?

pyelonephritis

Q2560:hydronephrosis and increased pressure have what affect on renal cortex and medulla?

compression atrophy

Q2561:staghorn calculi; alkaline urine and smells of ammonia; what is the cause?

urease (+) bacteria: proteus; klebsiella; staph

Q2562:most common cause of compression atrophy?

stone

Q2563:what is the composition of staghorn calculi

magnesium ammonium phosphate

Q2564:mass in kidney adult what is it?

renal adenocarcinoma

Q2565:mass in kidney in kid with hypertension?

wilm's tumor

Q2566:cause of renal adenocarcinoma?

derived from proximal tubule; most common cause is smoking

Q2567:what are results of renal adenocarcinoma?

produce ectopic EPO; PTH-like peptide; and like to invade renal vein

Q2568:why hypertension in kid with Wilm's tumor?

the tumor makes renin

Q2569:findings in Wilm's tumor?

embryonic kidney structures; aniridia and hemi-hypertrophy of an extremity --> sign that Wilm's tumor has genetic basis

Q2570:genetic abnormality in Wilm's tumor?

WT-1 tumor-suppressor gene on chrom 11. AD

Q2571:most common organism in cystitis?

E. coli

Q2572:patient with increased urinary frequency; has positive leukocyte esterase; dysuria; neutrophils in urine; negative bacterial culture; negative nitrites. what is diagnosis?

Chlamydia

Q2573:causes of sterile pyuria?

chlamydia; TB

Q2574:most common cause of transitional cell carcinoma of bladder?

smoking

Q2575:cyclophosphamide is used to treat what?

Wegener's

Q2576:cyclophosphamide toxicity is prevented by what?

Mesna

Q2577:hypospadias is caused by what?

failure of closure of urethral folds

Q2578:most common cancer of penis is what? What is most common cause?

squamous cell carcinoma due to lack of hygiene in uncircumcised penis. (shmegma)

Q2579:what are two phases of testicular descent?

tans-abdominal migration caused by mullerian inhibitory factor; and shortening of gubernaculum due to testosterone and dihydrotestosterone

Q2580:undescended testicles before 2 years increased risk for what?

seminomas in both testicles (even if appears normal)

Q2581:streak ovaries put woman at risk for what?

dysgerminomas

Q2582:epididymitis at age <35 due to what?

neisseria gonorrhea; chlamydia

Q2583:epididymitis at ages >35 due to what?

pseudomonas; E. coli

Q2584:vericocoeles on what side and why?

left; due to the spermatic vein on left is connected to left renal vein.

Q2585:most common cause of male infertility

vericocoele

Q2586:what would happen if you block left renal vein?

increases pressure on spermatic vein and causes vericocoele.

Q2587:torsion of spermatic cord causes what?

shortens the cord; so the testicle ascends into inguinal canal; pain; loss of cremasteric reflex

Q2588:what is cremasteric reflex?

scratching of scrotum causes the cremaster muscle to contract

Q2589:hydrocoele is what?

persistence of tunica vaginalis

Q2590:painless enlargement of testicle has what on it's differential?

cancer; cancer; cancer; cancer

Q2591:most common cause of testicular cancer

seminoma --> highly responsive to radiation

Q2592:where do seminomas metastacize?

para-aortic LNs

Q2593:most common testicular tumor in kid? what's the tumor marker?

yolk sac tumor (Alpha fetoprotein)

Q2594:25 y/o male presents with unilateral gynecomastia and dyspnea. X-ray of lung shows numerous nodular masses. Where is the primary tumor and what kind?

choriocarcinoma of testicle

Q2595:why do choriocarcinomas develop gynecomastia?

B-HCG is a leutinizing hormone analog --> acts like leutenizing hormone; so stimulates progesterone and causes duct growth in breast tissue

Q2596:most common cause of testicular cancer in older men?

malignant lymphoma metastaces

Q2597:where in prostate gland does hyperplasia occur?

periurethral area

Q2598:where in prostate gland is cancer located?

periphery (that's why you can feel it with your finger on rectal)

Q2599:75 y/o man has urinary retention and massive bladder with dribbling urine. what is cause?

BPH.

Q2600:what hormone is totally responsible for prostate?

dihydrotestosterone

Q2601:BPH and prostate cancer is under the control of what hormone?

dihydrotestosterone

Q2602:how do you treat prostate cancer and BPH

5-alpha-reductase inhibitor

Q2603:most common cancer in men?

prostate cancer

Q2604:What is prerenal azotemia?

selective rise in BUN during early renal failure

Q2605:Define segmental. (kidney pathology)

involving part of the glomerular tuft

Q2606:hematuria; hypertension; oliguria; azotemia = ?

Nephritic Syndrome; "I" = inflammation

Q2607:LM findings in post-strep glomerulonephritis?

lumpy bumpy and hypercellular w/ neutrophils

Q2608:EM findings in post-strep glomerulonephritis?

subepithelial humps (from deposition of cationic antigen)

Q2609:IF findings in post-strep glomerulonephritis?

granular

Q2610:Goodpasture's is what type of hypersensistivity?

type II (IgG binding directly to BM)

Q2611:Goodpasture's IF?

linear

Q2612:Symptoms of Goodpasture's?

hemoptysis; hematuria

Q2613:Membranoproliferative glomerulonephritis EM?

subendothelial humps; "tram track"

Q2614:Course of crescentic glomerulonephritis?

rapid (the Red Crescent is the Islamic Red Cross; an organization that provides relief during emergencies; like crescentic glomerulonephritis)

Q2615:Course of Membranoproliferative glomerulonephritis?

slow

Q2616:IgA nephropathy IF and EM?

mesangial deposits of IgA (Mes"A"ngium)

Q2617:Which can be post infectious; IgA nephropathy or Goodpasture's?

IgA nephropathy

Q2618:Signs of nephrotic syndrome?

massive proteinuria; hypoalbuminemia; generalized edema; hyperlipidemia (think "erotic" = an erection(edema) and ejaculate(massive proteinuria)

Q2619:LM of membranous glomerulonephritis?

diffuse capillary and basement membrane thickening

Q2620:IF of membranous glomerulonephritis?

granular

Q2621:EM of membranous glomerulonephritis?

spike and dome ("if you have a spike in your dome; you must be insane in the "membran"e;" -Chirag)

Q2622:Minimal change disease EM?

foot process effacement

Q2623:Most common cause of childhood nephrotic syndrome?

minimal change disease

Q2624:Focal segmental glomerular sclerosis LM?

segmental sclerosis and hyalinosis

Q2625:Diabetic nephropathy LM?

Kimmelstiel-Wilson lesions

Q2626:SLE (5 patterns of renal involvement) LM?

wire-loop appearance w/ extensive granular BM depsits in membranous glomerulonephritis pattern

Q2627:What is the most common kidney stone?

Calcium (with either oxalate of phosphate)

Q2628:What kidney stone is associated with a bacterial infection?

Ammonium magnesium phosphate (struivte) stones are associated with urase positive bugs that make ammonium

Q2629:What are the two most common stone-forming bacteria?

proteus vulgaris and Staph.

Q2630:What stones are associated with gout?

Uric acid stones

Q2631:What else can cause uric acid stones?

Any disease with high cell turnover (remember that uric acid is a by-product of DNA formation); so leukemia and myeloproliferative disease

Q2632:What stones are associated with cystineuria?

cystine stones

Q2633:What two stones are radiolucent?

Uric acid and cystine (the two purely metabolic causes)

Q2634:What are the complications of stones?

Hydronephrosis and pyelonephritis

Q2635:What causes calcium stones?

Anything that increases calcium in the blood; so high PTH; malignancy (bone breakdown; PTH production); vitamin D overdose.

Q2636:Renal Cell Carcinoma: Is this a common renal cancer?

Yes; the most common

Q2637:Renal Cell Carcinoma: Who is prone to this?

males; ages 50-70; smokers; gene deletions on chromosome 3

Q2638:Renal Cell Carcinoma: This is a cancer of what cell type?

renal tubule cells; histologically they appear clear.

Q2639:Renal Cell Carcinoma: What are the clinical signs of this cancer?

flank pain; fever; hematuria; palpable mass; secondary polycythemia

Q2640:Renal Cell Carcinoma: How does it spread?

It invades the renal veins and IVC; to spread hematogenously

Q2641:Renal Cell Carcinoma: What hormones can it produce?

ACTH; prolactin; Parathyroid-like hormone; gonadotropins and renin.

Q2642:Wilm's Tumor: Who gets this cancer?

Children 2-4 years

Q2643:Wilm's Tumor: Is it common?

The most common renal cancer in children

Q2644:Wilm's Tumor: What is the chromosomal abnormality that leads to this?

deletion of tumor suppressor gene WT1 on chromosome 11

Q2645:Wilm's Tumor: What tetrad is it associated with?

WAGR - Wilm's; Anirida (lack of an iris); Genitourinary malformation; and Retardation

Q2646:Wilm's Tumor: How does it present?

huge palpable mass and hemihypertrophy

Q2647:Wilm's Tumor: What is the histological appearance?

mixed - with stromal; mesenchymal; tubular; glomerular and fibrous elements

Q2648:Transitional Cell Carcinoma: Where does this cancer occur?

Urinary spaces (tract; calyces; pelvis; bladder)

Q2649:Transitional Cell Carcinoma: Does it recur?

yes; often

Q2650:Transitional Cell Carcinoma: How does it spread?

Local invasion

Q2651:Transitional Cell Carcinoma: What can predispose you to it?

Pee SAC toxins - Phenacetin; Smoking; Aniline dye (benezenes); and Cyclophsophimide.

Q2652:Transitional Cell Carcinoma: How does it present?

Hematuria

Q2653:Dx;Bilateral renal Agenesis; limb deformities; facial deformities; pulmonary hypoplasia; oligohydraminos

Potter's syndrome;[Potters can't Pee in utero]

Q2654:where does a horseshoe kidney fuse?;what does it get trapped under?

Fuse: Inferior poles;trapped under;Inferior Mesenteric Artery

Q2655:Cast in urine;RBC cast;(3)

Nephritic syndromes;;Ischemia;;Malignant HTN

Q2656:Cast in urine;WBC casts

Acute Pyelonephritis

Q2657:Cast in urine;Granular casts

Acute Tubular Necrosis

Q2658:Cast in urine;Waxy cast

Chronic Renal Failure

Q2659:what is seen in urine w/ acute cystitis?;Bladder CA?

Cystitis = WBCs;;Bladder CA = RBCs

Q2660:Definition;Hypoalbuminemia; Edema; Hyperlipidemia; massive Proteinuria

Nephrotic syndrome

Q2661:(6) Nephrotic syndromes

Membranous Glomerulonephritis;Minimal change;Focal Segmental Glomerular sclerosis;Diabetic Nephropathy;Renal amyloidosis;SLE nephropathy

Q2662:Definition;Oliguria; Azotemia; HTN; hematuria; RBC casts

Nephritic syndromes

Q2663:Nephritic syndrome;"lumpy-bumpy" LM; subepithelial humps; granular pattern

Acute Poststrep Glomerulonephritis

Q2664:Nephrotic syndrome;granular pattern w/ "spike and dome" on EM

Membranous GN

Q2665:Nephritic syndrome commonly seen in children w/ pre-orbital and peripheral edema

Acute Poststrep GN

Q2666:MC type of kidney stone

Calcium

Q2667:Radiopaque Kidney stone caused by infection and cause staghorn calculi;(3) bugs causing stones

Ammonium Magnesium Phosphate;(Struvite stones);Bugs;Proteus;Staph;Klebsiella

Q2668:Kidney stone seen w/ leukemia and myeloproliferative disorders

Uric acid stone

Q2669:Dx;nephritis; nerve deafness; lens dislocation or cataracts

Alport syndrome

Q2670:Nephritic syndrome;splitting of the lamina densa

Alport syndrome

Q2671:(3) causes of renal Papillary Necrosis

Diabetes;Acute Pyelonephritis;Chronic Phenacetin/NSAID use

Q2672:when is the most critical time for Acute Tubular necrosis?;why?

Initial Oliguric phase;can cause cardiac arrest from HyperK

Q2673:(3) causes of Acute Tubular Necrosis

Renal Ischemia;Crush injury;Toxins

Q2674:Dx;PCT reabsorption defect leading to protein and glucose in the urine w/ systemic acidosis

Falconi syndrome

Q2675:Definition;Impaired tubular reabsorption of Tryptophan leading to Pellagra-like symptoms

Hartnup Dz

Q2676:Dx;coarse and asymmetric corticomedullary scarring of kidney; interstitial fibrosis; tubular atrophy; thyroidization; eosinophilic casts

Chronic Pyelonephritis

Q2677:(3) tests to look for to determine patient has Pre-Renal ARF;(and results)

Urine Osmolality;(>500);Urine Na;(<10);FeNa;(<1%)

Q2678:What test is good to Dx Intrarenal ARF?

BUN/creatinine ratio < 15

Q2679:(2) tests to help Dx Post-renal ARF

Urine Na;(>40);FeNa;(>4)

Q2680:Dx;flank pain; palpable mass; hematuria

Renal cell CA

Q2681:what cell has cancer in Renal cell CA?;what ectopic hormones can be produced?;(4)

Polygonal Clear Cell;hormones;EPO; ACTH; PTH; Prolactin

Q2682:(4)* causes of Transitional cell CA of bladder

Pee SAC;Phenacetin;;Smoking;;Anline dyes;;Cyclophosphamide

Q2683:Dx;child with Aniridia; GU malformation; Retardation; flank mass

Wilms Tumor - MC kidney tumor of kids;(WT1 on chrom 11);WAGR complex

Q2684:What is the primary disturbance in Metabolic acidosis?

a decrease in bicarbonate

Q2685:What is the compensation?

A drop in CO2 by hyperventilation

Q2686:What are common causes?

diabetic ketoacidosis (production of ketone acids); diarrhea (loss of GI bicarb); salisylate overdose; acetazoleamide (diuretic) OD; lactic acidosis; renal failure (can't excrete organic acids); ethylene glycol ingestion

Q2687:What is the primary disturbance in respiratory acidosis?

A build-up in CO2

Q2688:What is the compensation?

Increased bicarb reabosrobtion from the kidney

Q2689:What are some common causes?

COPD; airway obstruction; opiates and sedatives; guillan-barr or ALS;

Q2690:What is the primary disturbance in metabolic alkalosis?

increased bicarbonate

Q2691:What is the compensation?

Increased CO2 by decreased respiration

Q2692:What are some common causes?

Vomiting; hyperaldosteronism (increased H+ secretion); loop or thiazide diuretics (volume contraction)

Q2693:What is the primary disturbance in respiratory alkalosis?

A drop in CO2

Q2694:What is the compensation?

increased excretion of bicarb by the kidney

Q2695:What are some common causes?

hyperventilation; high altitude; pneumonia and pulmonary embolus (hypoxemia causes hyperventilation_

Q2696:What is the Henderson Haselbach equation?

pH = pKa + Log (HCO3-)/(.03*pCO2)

Q2697:Is there an awesome graph on page 277 that you should know?

Yes

Q2698:Low pH; low pCO2 (low HCO3-)

metabolic acidosis

Q2699:Low pH; high pCO2 (high HCO3-)

chronic respiratory acidosis

Q2700:High pH; low pC02 (low HC03-)

acute respiratory alkalosis

Q2701:High pH; high pCO2 (high HCO3-)

metabolic alkalosis

Q2702:pH < 7.4

acidosis

Q2703:pH > 7.4

alkalosis

Q2704:Within acidosis: P (CO2) > 40

Respiratory acidosis

Q2705:Within acidosis: Hypoventilation or Hyperventilation

HYPO

Q2706:Within acidosis: Causes

chronic lung disease; Acute lung disesae; Drugs (opioids; narcotics; sedatives); Weakening of Resp. muscles

Q2707:Within acidosis: P (CO2) < 40

Metabolic acidosis with compensation

Q2708:Within acidosis: What should you do next?

Check Anion Gap

Q2709:Within acidosis: What is the normal anion gap?

8-12 mEq/L

Q2710:Within acidosis: Increased Anion Gap - 4 Causes

Renal Failure; Lactic acidosis; Ketoacidosis; Aspirin ingestion

Q2711:Within acidosis: Normal anion gap (4)

Diarrhea; Sniffin' Glue; Renal Tubular acidosis; Hyperchloremia

Q2712:pH > 7.4 pH > 7.4

alkalosis

Q2713:pH > 7.4 pCO2 < 40

Respiratory alkalosis

Q2714:pH > 7.4 Causes (2)

HYPERventilation; aspirin ingestion (early)

Q2715:pH > 7.4 pCO2 > 40

metabolic alkalosis w/ compensation

Q2716:pH > 7.4 Causes (4)

vomiting; diuretic use; antacid use; hyperALDOsteronism

Q2717:Anion gap acidosis: How do you calculate it

Na - Cl - HCO3

Q2718:Anion gap acidosis: What is normal?

8-12 mEq/L

Q2719:Anion gap acidosis: What is the mnemonic

MUD PILES

Q2720:Anion gap acidosis: M

Methanol

Q2721:Anion gap acidosis: U

Uremia

Q2722:Anion gap acidosis: D

DKA

Q2723:Anion gap acidosis: P

Paraldehyde or Phenformin

Q2724:Anion gap acidosis: I

Iron tablets or INH

Q2725:Anion gap acidosis: L

Lactic Acidosis

Q2726:Anion gap acidosis: E

Ethanol; Ethylene Glycol

Q2727:Anion gap acidosis: S

Salicylates

Q2728:Acid Base Compensations: Metabolic acidosis

pCO2 = 1.5(HCO3) + 8 +/- 2

Q2729:Acid Base Compensations: Metabolic alkalosis

pCO2 increases 0.7 mm Hg per 1 mEq/L HCO3 increase

Q2730:Acid Base Compensations: Respiratory acidosis (acute)

HCO3 increases by 1 mEq/L for every 10 mmHg increase of pCO2

Q2731:Acid Base Compensations: Respiratory acidosis (chronic)

HCO3 increases by 3.5 mEq/L for every 10 mmHg increase of pCO2

Q2732:Acid Base Compensations: Respiratory alkalosis (acute)

HCO3 decreases by 2 mEq/L for every 10 mmHg decrease of pCO2

Q2733:Acid Base Compensations: Respiratory alkalosis (chronic)

HCO3 decreases by 5 mEq/L for every 10 mmHg decrease of pCO2

Q2734:The deep inguinal ring lies lateral or medial to the inferior epigastric artery?

Lateral

Q2735:What is unusual about Chlamydia's cell wall?

Lacks muramic acid

Q2736:Symptoms of congenital CMV infection?

Hepatosplenomegaly; periventricular brain calcification; petechial hemorrhages; and hydrops;Sensorineural deafness

Q2737:Induction of hemolytic anemia in G6PD deficient patients are most often caused by which medications? (make a mnemonic)

Sulfonamides; nitrofurantoin; dapsone; primaquine; and quinine

Q2738:What is unusual about Chlamydia's cell wall?

Lacks muramic acid

Q2739:What is unusual about Chlamydia's cell wall?

Lacks muramic acid

Q2740:Induction of hemolytic anemia in G6PD deficient patients are most often caused by which medications? (make a mnemonic)

Sulfonamides; nitrofurantoin; dapsone; primaquine; and quinine

Q2741:Intranuclear inclusion bodies surrounded by halos?

CMV - "owl eyes"

Q2742:Symptoms of congenital CMV infection?

Hepatosplenomegaly; periventricular brain calcification; petechial hemorrhages; and hydrops;Sensorineural deafness

Q2743:What is located about 1/2 inch above the midpoint of the inguinal ligament?

Deep inguinal ring

Q2744:Toxoplasma gondii is capable of crossing the placenta in which stage of it's lifecycle?

Tachyzoite

Q2745:What are important causes of post-gonococcal urethritis?

Chlamydia; mycoplasma; and ureaplasma

Q2746:Frothy yellow vaginal discharge

Trichomonas

Q2747:Incomplete fusion of the processus vaginalis in males leads to?

Hydrocele of the spermatic cord

Q2748:Pleomorphic gram-negative rods in parallel short chains causing painful ulcer on penis?

Haemophilus ducreyi

Q2749:This space contains the sphincter urethrae muscle and the bulbourethral gland in the male?

Deep perineal space

Q2750:Granulomatosis infantiseptica?

Lysteria monocytogenes in pregnancy

Q2751:Which STD organisms induce endocytosis by epithelial cells?

Neisseria gonorrhoeae and Chlamydia

Q2752:The vagina of prepubertal girls and postmenopausal women is colonized by?

Colonic and skin bacteria; including staph epidermidis

Q2753:Herpes simplex virus 2 lays dormant in which cells?

Neurons of the sacral ganglia

Q2754:The filamentous gram-positive rod produces yellow granular deposits (sulfur granules) in the areas of its tissue invasion?

Actinomyces israelli

Q2755:Testes determining factor does what?

Causes the indifferent gonad to develop into a testis with Sertoli cells; which secrete MIF; suppressing the paramesonephric ducts; thus preventing the formation of femal internal reproductive organs

Q2756:Males with hyperprolactinemia have what affect on sexual function?

interference with testosterone production causing a decrease in sperm count

Q2757:Hydatiform mole progresses to choriocarcinoma at a rate of?

2%

Q2758:What is adenomyosis?

Presence of endometrial glands within the myometrkjm of the uterus in addition to their normal location in the endometrium

Q2759:Most spontaneously aborted fetuses in the first trimester are due to?

chromosomal abnormalities

Q2760:Ovarian metastasis of a mucin-producing adenocarcinoma?

Krukenberg tumor

Q2761:Hydatiform moles produce high levels of?

hCG

Q2762:Which type of breast cancer has the best progrnosis?

Tubular carcinoma

Q2763:XY male born with feminized external genitalia; testes retained within the abdominal cavity and otherwise normal male internal reproductive tracts;what could cause this?

5 alpha reductase deficiency

Q2764:How to diagnose chronic abacterial prostatitis?

>10 leukocytes per high-power field;no bacteria are isolated from cultures of prostatic secretions

Q2765:Flutamide? Mechanism?

Chemo;Antiandrogen; inhibits the actions of androgens in target tissues. Used in prostate cancer

Q2766:Ovarian tumor - Cystic sac containing thick mucinous fluid within a thin wall;Epithelial lining shows malignant features in the absence of stromal invasion?

Borderline mucinous tumor

Q2767:Presence of individual adenocarcinoma cells within the squamous epithelium of the skin near the nipple?

Paget disease

Q2768:Uterine tumor - Well demarcated borders and a whorled pattern on cut surface

Leiomyoma

Q2769:Classical presentation of a germ cell tumor in a 23 year old man?

Non-painful swelling of the testis

Q2770:T or F? Condyloma acuminatum contains koilocytes?

T

Q2771:Most common cause of acute bacterial prostatitis?

Escherichia

Q2772:This drug acts by inhibiting 5 alpha reductase to treat BPH

Finasteride

Q2773:T or F? Maturation of germ cells within the seminiferous tubules occurs in a concentric pattern with the less mature spermatogonia near the tubule center and the mature forms near the basal lamina

FALSE - the opposite

Q2774:Mature teratoma;aka?

Dermoid cyst

Q2775:Most common causes of maternal death in preeclampsia?

Cerebral hemorrhage and ARDS

Q2776:Sclerosing adenosis?

A type of proliferative fibrocystic disease that is often seen with other variants of fibrocystic disease. Proliferation of small ducts; distorts glands and lobules into a whorled pattern. Increased risk for breast cancer

Q2777:Type of endometrium bearing long; narrow; coiled glands lined by a single layer of columnar epithelium showing regular; uniform; small nuclei and clear apical vesicles

Secretory endometrium

Q2778:Tumor with endodermal sinuses that resemble primitive glomeruli?

Yolk sac tumor

Q2779:Differentiation of the male external genitals is dependent on?

Dihydrotestosterone (via action of 5 alpha reductase on testosterone)

Q2780:Key differences between seminomas in men and dysgerminomas in women?

1. Seminomas are most common in the fourth decade; dysgerminomas in the third decade;2. Seminomas are relatively common; while dysgerminomas are rare

Q2781:These agents induce the formation of surfactant lipids in the prevention of RDS in preterm babies;

Corticosteroids

Q2782:Pseudomyxoma peritonei is a potential complication of this tumor?

Mucinous cystadenoma

Q2783:T or F? Elevation of LDH is common in seminomas.

True

Q2784:Koilocytotic atypia is commonly observed with infection with?

HPV

Q2785:Most cases of male pseudohermaphrodites are due to?

Testicular feminization syndrome

Q2786:Most common variant of breast adenocarcinomoa?

Invasive ductal carcinoma

Q2787:Which phase accounts for most of variability in the length of the menstrual cycle?

Follicular phase

Q2788:T or F? Basal body temperature falls precipitously a few days prior to menstruation

True

Q2789:Intraductal papillomas - describe the favorable pathology?

Presence of fibrovascular core; and both epithelial and myoepithelial cells in thepaipllary fronds

Q2790:Alpha fetoprotein is a good marker for which cancers?

Non-seminomatous germ cell tumors of the testes; endodermal sinus (yolk sac) ovarian tumors; hepatocellular carcinomas

Q2791:Malignant mixed mullerian tumor?

Tumor with 2 components (stromal and epithelial (endometrial glands)

Q2792:Maternal blood levels of ; are dependent on a viable fetus?

Estrioll

Q2793:This tumor; in combination with ascites and hydrothorax; is referred to as Meigs' syndrome

Thecoma-fibroma

Q2794:Serous paipllary cystadenocarcinomas of the ovaries express which marker?

CA-125

Q2795:Three stages of spermatogenesis?

Spermatocytogenesis; meiosis; and spermiogenesis

Q2796:What are two types of ovarian tumors that can produce large amounts of steroid hormones?

Sertoli-Leydic cell tumors (testosterone); and granulosa cell tumors (estrogen)

Q2797:36 y/o man with painless enlargement of right testis. Biopsy - Round nests of cells with conspicuous nucleoli and clear cytoplasm; nests are separated by delicate fibrous septa containing numerous lymphocytes;

Seminoma

Q2798:Causative organism of lymphogranuloma venereum?

Chlamydia

Q2799:Bright reddish-pink; acellular ring around the ovum?

Zona pellucida

Q2800:Forms of penile carcinoma in situ?

Bowen's disease; Bowenoid papulosis; and erythroplasia of Queyrat

Q2801:Describe the lesions of Bowenoid paulosis?

Multiple reddish-brown pauplar lesions

Q2802:Most cases of dysfunctional uterine bleeding are due to?

Anovulatory cycles

Q2803:Histology of inflammatory breast cancer?

Dermal lymphatic invasion by cancer cells; can cause orange peel appearance

Q2804:Koilocytic?

The characteristic nuclear and cytoplasmic changes shown by squamous epithelial cells infected by HPV

Q2805:Name the mutations of the following syndromes: LiFraumeni; Cowden; and ataxia-telangiectasia

LiFraumeni - p53;Cowden - gene of chromosome 10;Ataxiatelangiectasia - ATM gene

Q2806:Gynecomastia; golden-brown testicular tumor; large uniform cells with indistinct cell borders; and rod-shaped crystals

Leydig cell tumor (crystals of Reinke)

Q2807:Struma ovarii?

Monodermal teratomas can develop an appearance of mature thyroid tissue

Q2808:T or F? Ductal carcinoma in situ can produce Paget disease?

True

Q2809:The first set of lymph nodes to which lymph from the testes drain?

Para-aortic nodes; near where the testicular artery arises

Q2810:First event in preeclampsia is thought to be?

Placental ischemia

Q2811:Condyloma acuminatum

Verrucous wartlike lesions on vulva; perineum; vagina and cervix associated with HPV serotypes 6 and 11

Q2812:Pelvic inflammatory disease

Vaginal discharge (cervicitis); vaginal bleeding (endometritis); bilateral lower abdomainal and pelvic pain (salpingitis). Caused by n. gonorrhea and/or chlamydia. Complications: tubo-ovarian abscess; tubal scarring (granulomatous inflamation) with infertility and ectopic pregnancies

Q2813:Cervical cancer risk factors

Early age of first intercourse; multiple sexual partners; multiple pregnancies; oral contraceptives; smokking

Q2814:Cervical cancer clinical features

45 years old. Asymptomatic or postcoital bleeding; dyspareunia (painful intercourse); malodorous discharge. Caused by HPV types 16; 18; 31 and 33. Precursor lesion is cervical intraepithelial neoplasia

Q2815:Endometriosis

Presence of endometrial glands and stroma outside the uterus in ovaries; ligaments and pouch of Douglas. Presents with chronic pelvic pain; dysmenorrhea; dyspareunia (painful intercourse); rectal pain; constipation; infertility

Q2816:Endometrial carcinoma risk factors

Early menarche; late menapause; nulliparity; hypertension; diabetes; anovulation; estrogen-producing tumors; estrogenreplacement therapy; endometrial hyperplasia

Q2817:Endometrial carcinoma clinical features

55 year old with postmenopausal vaginal bleeding

Q2818:Polycystic ovarian disease

Females of reproductive age; oligomenorrhea; hirsutism; infertility. Lab: elevated LH; low FSH; high testosterone. Predisposes to endometrial cancer

Q2819:Ovarian cystadenocarcinoma

65 year old with malignant bilateral ovarian enlargement. Risk factors: BRCA-1. Marker: CA125

Q2820:Metastatic tumors to the ovary primary sites

Breast; colon; endometrial; gastric "signet-cell" Krukenberg tumor

Q2821:Hydatidiform mole

Tumor of placental trophoblastic tissue/ Excessive uterine enlargement; vaginal bleeding; high B-HCG. Complete mole: fertilization of an ovum without chromosomes. Partial mole: fertilization by two sperms (one 23X; one 23Y)

Q2822:Choriocarcinoma

Malignant germ cell tumor derived from the trophoblast

Q2823:Fibrocystic change presentation

Bilateral painful mass in young woman with menstrual variation

Q2824:Fibroadenoma

Movable mass that changes with mentrual cycles

Q2825:Breast carcinoma risk factors

BRCA-1; BRCA-2; p53; prior breast cancer; old age; nulliparity; obesity

Q2826:Breast carcinoma clinical features

Solitary painless mass in old woman with nipple retraction or skin dimpling or fixation to chest wall. Calcification on mamogram. MC variation is invasive ductal carcinoma

Q2827:Benign prostatic hyperplasia

Decreased caliber and force of stream; urgency; frequency; nocturia; dysuria. PSA is elevated. Rx.: 5-alpha reductase inhibitor

Q2828:Prostate cancer

Asymptomatic or lower back pain secondary to metastasis. High PSA. Metastasis to pelvic lymph nodes and lumbar spine with high alkaline phosphatase

Q2829:The Adrenal cortex derives from what embryonic tissue?

Mesoderm

Q2830:The Adrenal medulla derives from what embryonic tissue?

Neural creast

Q2831:The Adrenal Zona Glomerulosa produces what?

Aldosterone

Q2832:The Adrenal Zona Fasciculata produces what?

Cortisol; and some sex hormones

Q2833:The Adrenal Zona Reticularis produces what?

Sex hormones (androgens)

Q2834:The Adrenal Medulla produces what?

Catecholamines (Epinephrine and Norepinephrine)

Q2835:What do beta islet cells produce?

Insulin

Q2836:What do alpha islet cells produce?

Glucagon

Q2837:What do delta islet cells produce?

Somatostatin

Q2838:What is the neurohypophysis?

Posterior pituitary

Q2839:What is the adenohypophysis?

Anterior pituitary

Q2840:What is the posterior pituitary derived from?

Neuroectoderm

Q2841:What is the anterior pituitary derived from?

Oral ectoderm

Q2842:What anterior pituitary cells are acidophils?

The ones that produce GH or prolactin

Q2843:What anterior pituitary cells are basophils?

"B-FLAT";The ones that produce FSH; LH; ACTH; TSH

Q2844:What hormones share a common alpha-subunit?

TSH; LH; FSH and hCG

Q2845:What regulates TSH release?

Increased by TRH;Decreased by Somatostatin

Q2846:What regulates Prolactin release?

Increased by TRH;Decreased by Dopamine

Q2847:What regulates ACTH release?

Increased by CRH

Q2848:What regulates GH release?

Increased by GHRH;Decreased by Somatostatin

Q2849:What regulates FSH release?

Increased by GnRH

Q2850:What regulates LH release?

Increased by GnRH

Q2851:What is the most common form of congenital adrenal hyperplasia?

21-beta-hydroxylase deficiency

Q2852:How many carbons do mineralocorticoids have?

21 carbons

Q2853:How many carbons do glucocorticoids have?

21 carbons

Q2854:How many carbons do androgens have?

19 carbons

Q2855:How many carbons do estrogens have?

18 carbons

Q2856:Where is PTH secreted from?

Chief cells of parathyroid

Q2857:What is the active form of Vitamin D

1;25-(OH)2 vitamin D

Q2858:What is the inactivated form of Vitamin D

24;25-(OH)2 vitamin D

Q2859:How is Vitamin D activated?

The liver converts Vitamin D to 25-OH Vitamin D(storage form) and the kidney then converts it to 1;25(OH) Vitamin D

Q2860:What is the storage form of Vitamin D?

25-OH Vitamin D

Q2861:Where is calcitonin secreted from?

Parafollicular cells(C cells) of thyroid

Q2862:What is the role of calcitonin?

Oppose the actions of PTH;Secreted when serum Ca increases and it decreases bone resorption of calcium

Q2863:What hormones are steroid hormones?

"PET CAT";Progesterone; Estrogen; Testosterone; Cortisol; Aldosterone; Thyroxine and T3

Q2864:Secretion and cell type of;Somatotrope cells

Secretes GH;Acidophil

Q2865:Secretion and cell type of;Mammotrope cells

Secretes Prolactin;Acidophil

Q2866:Secretion and cell type of;Corticotrope cells

Secretes ACTH;Basophil

Q2867:Secretion and cell type of;Gondadotrope cells

Secretes LH & FSH;Basophil

Q2868:Secretion and cell type of;Thyrotrope cells

Secretes TSH;Basophil

Q2869:What is the main form of thyroid hormone secreted by the thyroid?

T4-Tetraiodothyronine

Q2870:What is the most active form of thyroid hormone?

T3-Triiodithyronine

Q2871:What condition leads to increased Thyroxine-binding globulin(TBG)?

Pregnancy;Increased estrogen leads to increased TBG

Q2872:What condition leads to decreased Thyroxine-binding globulin(TBG)?

Hepatic failure

Q2873:What is Conn's syndrome?

Primary hyperaldosteronism- an aldosterone secreting tumor

Q2874:What is the most common tumor of the adrenal medulla in adults?

Pheochromocytoma

Q2875:What is the most common tumor of the adrenal medulla in children?

Neuroblastoma

Q2876:What is a/w pheochromocytomas?

Neurofibromatosis; MEN types II & III

Q2877:What is Wermer's syndrome?

MEN type I

Q2878:What is Sipple's Syndrome?

MEN type II

Q2879:Which type of MEN?;Pancreatic; parathyroid & pituitary tumors

MEN type I

Q2880:Which type of MEN?;Medullary carcinoma of the thyroid; pheochromocytoma & parathyroid tumors

MEN type II

Q2881:Which type of MEN?;Medullary carcinoma of the thyroid; pheochromocytoma; & oral & intestinal ganglioneuromatosis

MEN type III

Q2882:Which thyroid cancer?;Most common

Papillary carcinoma of the thyroid

Q2883:Which thyroid cancer?;"Ground-glass" nuclei

Papillary carcinoma of the thyroid

Q2884:Which thyroid cancer?;From parafollicular "C cells"

Medullary carcinoma of the thyroid

Q2885:Which thyroid cancer?;Produces calcitonin

Medullary carcinoma of the thyroid

Q2886:Which thyroid cancer?;a/w MEN types II & III

Medullary carcinoma of the thyroid

Q2887:Which thyroid cancer?;usually only in older patients

Undifferentiated/anaplastic cancer of the thyroid

Q2888:Which thyroid cancer?;a/w Hashimoto's thyroiditis

Lymphoma of the thyroid

Q2889:ret gene mutations are a/w what?

MEN types II & III

Q2890:Type I or Type II DM?;Viral or Immune destruction of beta-cells

Type I DM

Q2891:Type I or Type II DM?;a/w HLA-DR3 & DR4

Type I DM

Q2892:Type I or Type II DM?;Ketoacidosis more common

Type I DM

Q2893:Type I or Type II DM?;"Classic" symptoms of Diabetes more common

Type I DM;Classic symptoms-polyuria; polydipsia; thirst; weight loss

Q2894:Type I or Type II DM?;a/w obestity

Type II DM

Q2895:Type I or Type II DM?;Strong genetic predisposition

Type II DM

Q2896:What drug class?;Lispro

Insulin- short acting

Q2897:What drug class?;NPH

Insulin-intermediate acting

Q2898:What drug class?;Lente

Insulin-long acting

Q2899:What drug class?;Tolbutamide

First generation sulfonylurea

Q2900:What drug class?;Chlorpropamide

First generation sulfonylurea

Q2901:What drug class?;Glyburide

Second generation sulfonylurea

Q2902:What drug class?;Glimepiride

Second generation sulfonylurea

Q2903:What drug class?;Glipizide

Second generation sulfonylurea

Q2904:What drug class?;Metformin

Biguanides

Q2905:What drug class?;Pioglitazone

Glitazones

Q2906:What drug class?;Rosiglitazone

Glitazones

Q2907:What drug class?;Acarbose

alpha-glucosidase inhibitors

Q2908:What drug class?;Miglitol

alpha-glucosidase inhibitors

Q2909:What diabetes drug type is;Lispro

Short-Acting Insulin

Q2910:What diabetes drug type is;Insulin

Short-Acting Insulin

Q2911:What diabetes drug type is;NPH

Intermediate-Acting Insulin

Q2912:What diabetes drug type is;Lente

Long-Acting Insulin

Q2913:What diabetes drug type is;Ultralente

Long-Acting Insulin

Q2914:What diabetes drug type is;Tolbutamide

First generation sulfonylurea

Q2915:What diabetes drug type is;Chlorpropamide

First generation sulfonylurea

Q2916:What diabetes drug type is;Glyburide

Second generation sulfonylurea

Q2917:What diabetes drug type is;Glimepiride

Second generation sulfonylurea

Q2918:What diabetes drug type is;Glipizide

Second generation sulfonylurea

Q2919:What diabetes drug type is;Metformin

Biguanide

Q2920:What diabetes drug type is;Pioglitazone

Glitazones

Q2921:What diabetes drug type is;Rosiglitazone

Glitazones

Q2922:What diabetes drug type is;Acarbose

alpha-glucosidase inhibitors

Q2923:What diabetes drug type is;Miglitol

alpha-glucosidase inhibitors

Q2924:What structure contains the ovarian vessels?

Suspensory ligament of ovaries

Q2925:What structure contains the uterine vessels?

Transverse cervical(cardinal);ligament

Q2926:What structure contains the round ligament of the uterus & the uterine tubules & vessels

Broad ligament

Q2927:What does the acrosome of sperm derive from?

Golgi apparatus

Q2928:What is the food supply of sperm?

Fructose

Q2929:What kind of DNA do Spermatogonium have?

2N diploid

Q2930:What kind of DNA do Primary spermatocyte have?

4N diploid

Q2931:What kind of DNA do Secondary spermatocyte have?

2N haploid

Q2932:What kind of DNA do Spermatid have?

1N haploid

Q2933:What course do sperm take from production to ejaculation?

SEVEN UP;Seminiferous tubules; Epididymis; Vas deferens; Ejaculatory ducts; (Nothing); Urethra; Penis

Q2934:FSH stimulates which cells in the male?

Sertoli cells;Aid in development of sperm

Q2935:FSH stimulates which cells in the female?

Granulosa cells;Aromatization of androgens

Q2936:LH stimulates which cells in the male?

Leydig cells;Testosterone release

Q2937:LH stimulates which cells in the female?

Thecal cells;Produces androgens

Q2938:Which cell; leydig or sertoli; is found in interstitium between seminiferous tubules?

Leydig cells

Q2939:Which cell; leydig or sertoli; is found in the seminiferous tubules at the edge of the basement membrane?

Sertoli cells

Q2940:What converts testosterone to DHT?

5-alpha-reductase

Q2941:What inhibits 5-alpha-reductase?

Finasteride;Blocks conversion of testosterone to DHT

Q2942:What is the most potent androgen?

Dihydrotestosterone(DHT)

Q2943:Which androgen cannot be aromatized to an estrogen?

DHT;Both Testosterone and androstenedione can be converted to estrogens

Q2944:Which is the most potent estrogen?

Estradiol

Q2945:Which estrogen increases the most during pregnancy?

Estriol

Q2946:In what stage of the cell cycle do eggs arrest in for most of their life?

Prophase of meiosis I

Q2947:In what stage of the cell cycle do eggs arrest in after ovulation and until fertilization?

Metaphase of meiosis II

Q2948:How many days after fertilization does hCG become detectable in the urine?

8 days

Q2949:What is a/w Epispadias?

Exstrophy of the bladder

Q2950:What is the genotype of a complete mole?

46; XX w/ all genes coming from the father

Q2951:What is the genotype of an partial mole?

Usually triploid

Q2952:What strains of HPV are a/w cervical dysplasia?

16 & 18

Q2953:Which ovarian tumor;Equivalent to male seminoma

Dysgerminoma

Q2954:Which ovarian tumor;Sheets of uniform cells

Dysgerminoma

Q2955:Which ovarian tumor;Aggresive malignancy in ovaries & sacrococcygeal area of young children

Yolk sac (endodermal sinus) tumor

Q2956:Which ovarian tumor;Large; hyperchromatic syncytiotrophoblastic cells

Choriocarcinoma

Q2957:Which ovarian tumor;90% of ovarian germ cell tumors

Teratoma

Q2958:Which ovarian tumor;Contains cells from 2 or 3 germ layers

Teratoma

Q2959:Which ovarian tumor;May contain struma ovarii

Teratoma;Struma ovarii- contains functional thyroid tissue

Q2960:Which ovarian tumor;20% of ovarian tumors

Serous cystadenoma

Q2961:Which ovarian tumor;50% of ovarian tumors

Serious cystadenocarcinoma

Q2962:Which ovarian tumor;Frequently bilateral & lined w/ fallopian tube-like epithelium

Serous cystadenoma

Q2963:Which ovarian tumor;Multilocular cyst lined by mucus-secreting epithelium

Mucinous cystadenoma

Q2964:Which ovarian tumor;a/w Pseudomyxoma peritonei

Mucinous cystadenocarcinoma

Q2965:Which ovarian tumor;Resembles bladder epithelium

Brenner tumor

Q2966:Which ovarian tumor;Bundles of spindle-shaped fibroblasts

Ovarian fibroma

Q2967:Which ovarian tumor;Part of Meig's syndrome

Ovarian fibroma;Meig's syndrome- triad of ovarian fibroma; ascites & hydrothorax

Q2968:Which ovarian tumor;Can lead to precocious puberty

Granulosa cell tumor

Q2969:Which ovarian tumor;Secretes estrogen

Granulosa cell tumor

Q2970:Which ovarian tumor;Can cause endometrial hyperplasia/carcinoma in adults

Granulosa cell tumor

Q2971:Which ovarian tumor;Call-exner bodies

Granulosa cell tumor;Call-exner bodies- small follicles filled w/ eosinophilic secretions

Q2972:What is Pseudomyxoma peritonei

intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor;a/w Mucinous cystadenocarcinoma

Q2973:What breast condition?;Most common tumor in women under 25

Fibroadenoma

Q2974:What breast condition?;Lump w/ increased size and tenderness w/ pregnancy

Fibroadenoma

Q2975:What breast condition?;Benign tumor of lactiferous ducts

Intraductal papilloma

Q2976:What breast condition?;Presents w/ serous or bloody nipple discharge

Intraductal papilloma

Q2977:What breast condition?;Large; bulky mass of connective tissue & cysts

Cystosarcoma phyllodes

Q2978:What breast condition?;"Leaflike" projections

Cystosarcoma phyllodes

Q2979:What breast condition?;Early malignancy w/o basement membrane penetration

Ductal carcinoma in situ

Q2980:What breast condition?;Worst and most invasive breast cancer

Invasive ductal carcinoma

Q2981:What breast condition?;Cheesy consistency due to central necrosis

Comedocarcinoma

Q2982:What breast condition?;Fleshy; cellular; lymphocytic infiltrate

Medullary carcinoma

Q2983:What breast condition?;Eczematous patches on nipple

Paget's disease of the breast

Q2984:What breast condition?;Large cells w/ clear halo

Paget's disease of the breast;Cells are called paget cells

Q2985:What breast condition?;MCC of breast lumps age 25menopause

Fibrocystic disease

Q2986:What breast condition?;Diffuse breast pain & multiple lesions; often bilateral

Fibrocystic disease

Q2987:What breast condition?;Increased number of epithelial cell layers in terminal duct lobule

Epithelial hyperplasia- Fibrocystic disease

Q2988:What breast condition?;Increased acini & intralobular fibrosis

Sclerosing type of Fibrocystic disease

Q2989:What breast condition?;Hyperplasia of breast stroma

Fibrosis type of Fibrocystic disease

Q2990:What breast condition?;Breast abscess during breast feeding

Acute mastitis

Q2991:What breast condition?;Benign painless lump that forms due to injury to breast tissue

Fat necrosis

Q2992:Risk factors for Breast tumors

Gender; age; early 1st menarche(<12 y.o.); delayed 1st pregnancy(>30 y.o.); late menopause(>50 y.o.); family history of 1st degree relative w/ breast cancer at young age

Q2993:Most common pathogen in acute mastitis

Staphylococcus aureus

Q2994:What testicular tumor?;Painless testicular enlargement

Seminoma

Q2995:What testicular tumor?;Most common testicular tumor

Seminoma

Q2996:What testicular tumor?;Worst prognosis

Embryonal carcinoma of the testicle

Q2997:What testicular tumor?;Reinke crystals

Leydig cell tumor

Q2998:What testicular tumor?;Androgen producing tumor

Leydig cell tumor

Q2999:What testicular tumor?;Causes gynecomastia in men & precocious puberty in boys

Leydig cell tumor

Q3000:What testicular tumor?;Androblastoma from sex cord stroma

Sertoli cell tumor

Q3001:What testicular tumor?;Most common testicular cancer in older men

Testicular lymphoma

Q3002:What is the typical age of presentation of a seminoma?

15-35 years old

Q3003:What penile tumor?;Solitary crusty plaque on shaft or on scrotum

Bowen disease- type of penile carcinoma in situ

Q3004:What penile tumor?;Peak incidence in 5th decade of life

Bowen disease- type of penile carcinoma in situ

Q3005:What penile tumor?;Becomes invasive SCC in <10% of cases

Bowen disease- type of penile carcinoma in situ

Q3006:What penile tumor?;Red velvety plaques; usually involving the glans

Erythroplasia of Queyrat- type of penile carcinoma in situ

Q3007:What penile tumor?;Similar to Bowen disease

Erythroplasia of Queyrat- type of penile carcinoma in situ

Q3008:What penile tumor?;Multiple papular lesions

Bowenoid papulosis- type of penile carcinoma in situ

Q3009:What penile tumor?;Affects a younger age group than other penile tumors

Bowenoid papulosis- type of penile carcinoma in situ

Q3010:What penile tumor?;a/w HPV

Penile squamous cell carcinoma

Q3011:What penile tumor?;Rare in circumcised men

Penile squamous cell carcinoma

Q3012:What are the three layers of the skin

Epidermis; dermis; subcutaneous tissue

Q3013:What types of cells compose the epidermal layer of the skin

Stratified squamous epithelium

Q3014:What are the four layers of the epidermis

Stratum Corneum;Stratum Granulosum;Stratum Spinosum;Stratum Basalis;Cocky Guys Save Babes

Q3015:Hyperkeratosis affects which layer of the epidermis

Stratus corneum

Q3016:What types of cells compose the stratum basalis

Columnar basal cells

Q3017:What is a plaque

Raised area of skin >1cm in diameter

Q3018:What is a papule

Raised area of skin <1cm in diameter

Q3019:What is a macule

Flat; discolored area of skin <1cm in diameter

Q3020:What is a vesicle

A raised; fluid-filled blister measuring <0.5cm in diameter

Q3021:What are the small; encapsulated sensory receptors found in the dermis of the palms; soles; and digits of the skin (Hint: they are also involved in light discriminatory touch of hairless skin)

Meissner’s corpuscles

Q3022:What is the name of tactile disks that mediate light crude touch

Merkel corpuscles

Q3023:What are the large encapsulated sensory receptors found in deeper layers of skin that are involved in pressure; coarse touch; vibration; and tension

Pacinian corpuscles

Q3024:Where are pacinian corpuscles found

Deep layers of skin;Joint capsules;Serous membranes;Mesenteries

Q3025:What structures prevent diffusion across intracellular spaces

Zona occludens (tight junctions)

Q3026:What structures allow adjacent cells to communicate rapidly

Gap junctions

Q3027:What structure connects cells to underlying extracellular matrix

Hemidesmosomes

Q3028:What are structures that join adjacent cells together and provide anchoring points for intermediate filaments

Desmosomes (macula adherens)

Q3029:What is the function of Langerhans cells

Antigen-presenting cells; Main inducers of antibody response

Q3030:From where does the epidermis regrow after trauma or removal

Hair follicles and sweat glands in the dermis

Q3031:What is the term that describes the replacement of one adult cell type by another; often secondary to irritation and/or environmental exposure

Metaplasia (reversible)

Q3032:Which term describes an increased number of cells

Hyperplasia (reversible)

Q3033:What do you call the change of a cell to a less differentiated form

Anaplasia

Q3034:What is the term for abnormal growth with loss of orientation; shape; and size compared to normal cells

Dysplasia (reversible)

Q3035:Which enzymes do malignant cells use to metastasize

Collagenases and hydrolases

Q3036:Which rash is often described as a target lesion that has a red center; pale zone; and a dark outer ring

Erythema multiforme

Q3037:What are common causes of erythema multiforme

Infections;Antibiotics;Radiation;Chemicals;Malignancy

Q3038:What is the term for dilated; superficial blood vessels

Telangiectasia

Q3039:Which test is designed to ascertain whether a skin lesion will blanch as a result of pressure

Diascopy. Used to determine whether a red lesion is bloodfilled or hemorrhagic

Q3040:What are the most common causes of nonscarring alopecia

Telogen effluvium;Androgenic alopecia;Alopecia areata;Tinea capitis;Traumatic alopecia

Q3041:What are the most common causes of scarring alopecia

Cutaneous lupus;Lichen planus;Folliculitis planus;Linear scleroderma

Q3042:What is the easiest and quickest way to determine if a skin condition is fungal

KOH preparation

Q3043:An 8-month old presents with large; easily ruptured flaccid bullae; with large areas of desquamation of skin and a positive Nikolsky’s sign. What is the most likely diagnosis

Staphylococcal scalded skin syndrome

Q3044:What is the infectious agent that causes scalded skin syndrome

Staphylococcus aureus

Q3045:What condition is described as having thin-walled vesicles or pustules that rupture to form golden-yellow crusts (honey crusts)

Impetigo

Q3046:What is the most common bacterial infection of the skin in children

Impetigo

Q3047:What bacteria cause impetigo

Staph aureus or Strep pyogenes

Q3048:What test is helpful to determine the organism involved in impetigo

Culture and catalase tests

Q3049:A sexually active 23 year old patient presents with painful vesicles on his penis and a slight fever. He refers to having the same type of vesicles multiple times a year. Multinucleated giant cells and ballooning of nuclei are seen microscopically. What is the likely diagnosis

Herpes simplex infection

Q3050:What is the treatment for herpes simplex type I

Oral and topical acyclovir;Valacyclovir;Famciclovir

Q3051:What infection causes unilateral; painful vesicles along a dermatome of the face or trunk

Shingles (Herpes Zoster)

Q3052:Which test can be used to assist in the diagnosis of herpes virus infection

Tzank smear

Q3053:Which disease of childhood presents with acute vesicular eruptions that occur in successive crops; so that the rash typically consists of vesicles at different stages of resolution

Varicella or chicken pox

Q3054:A 16 year old presents with multiple dome-shaped; umbilicated; waxy papules on the face and chest. What is the most likely diagnosis

Molluscum contagiosum

Q3055:How does molluscum contagiosum appear microscopically

Epidermal hyperplasia producing a basin with moluscum bodies (Henderson-Patterson bodies)

Q3056:What type of virus causes molluscum contagiosum

Pox virus

Q3057:A 35 year old patient with AIDS presents with multiple brownish/purplish macules on the trunk and lower extremities. What is the most likely diagnosis

Kaposi’s sarcoma (HHV8)

Q3058:A 7 year old present with multiple hard; roughsurfaced papules on his fingers and elbows. Diagnosis?

Verruca vulagris (common wart)

Q3059:What is the causative agent of verruca vulgaris

HPV

Q3060:What is the typical primary syphilis skin manifestation

Painless indurated genital or lip ulcer (chancre)

Q3061:What are the typical secondary syphilis skin manifestations

Cutaneous lesions that are maculopapular or erythematosquamous; lesions on palms and soles; warts (condylomata lata) on anogenital region; and alopecia

Q3062:What HPV serotypes cause the common wart

HPV-1;2;4;7

Q3063:A 24 year old man from the Northeast; visits the physician because of a centrifugally spreading; erythematous lesion on his right leg. The patient noticed the rash after he went hiking. Diagnosis?

Erythema chronicum migrans (Lyme disease)

Q3064:A mother brings her 5 year old son to the physician because she noted her son scratching a pinkish lesion on his neck. Upon examination; the physician notes a ring-shaped scaling plaque with central clearing and elevated borders. Diagnosis?

Tinea corporis (ringworms)

Q3065:How is ringworm acquired

Tinea corporis is not due to a worm but due to a fungal infection

Q3066:Skin infections are typically caused by what bacterium

S. aureus

Q3067:A 22 year old man presents with a rash that first appeared on his palms and soles; and then spread to his face and trunk. Diagnosis?

Rocky Mountain spotted fever

Q3068:What type of rash is seen in spotted fever

An inward or centripetal spreading rash

Q3069:What is used to test for typhus and Rocky mountain spotted fever

Weil-Felix reaction

Q3070:What is the treatment for Rocky mountain spotted fever

Tetracyclines or chloramphenicol

Q3071:A 26 year old female from Texas complains of small hypopigmented spots on her upper back that usually disappear in the winter months. Diagnosis?

Tinea versicolor

Q3072:What is the confirmatory test for tinea versicolor

KOH preparation

Q3073:Which diseases cause hand and foot lesions

Syphilis;Hand-foot-and-mouth disease;Rocky Mountain spotted fever

Q3074:A 25 year old sexually active male presents with a painful; nonindurated genital ulcer; and tender regional lymphadenopathy. Diagnosis?

Chancroid

Q3075:A 35 year old homeless woman visits a shelter physician because of multiple; extremely pruritic papules in her axilla; groin; and finger webs. The patient indicates her husband also has the same lesions. Diagnosis?

Scabies

Q3076:A 15 year old male on the school swim team visits the dermatologist because of itchiness on both his feet. He states he is not on any medication and has not had it before. Upon inspection; the physician notes erythematous; dry scaling lesions on both feet. Diagnosis?

Tinea pedis

Q3077:What is the treatment for tinea pedis

Topical or oral antifungals

Q3078:What is the rapid developing infection of the skin and fascia that may lead to death if not treated quickly

Necrotizing fasciitis

Q3079:What are the organisms responsible for necrotizing fasciitis

Group A streptococci or Clostridium perfringens

Q3080:A 67 year old Caucasian woman visits her dermatologist because of small reddish papules/pustules predominantly on her cheeks; nose; chin; and forehead. She states that her face becomes worse if she uses hot water or is in warm weather. Diagnosis?

Rosacea

Q3081:What is the treatment for Rosacea

Avoid precipitating factors;Topical metronidazole;Sulfur lotions;Oral tetracyclines;Isotretinoin

Q3082:A 12 year old male visits his physician because of a slap-like red mark on his cheek and a rash on his arms that appeared 1 day after the cheek rash. Upon physical examination; the physician notes malar erythema and a maculopapular rash on his extremities. Diagnosis?

Fifth diseas (erythema infectiosum)

Q3083:What causes fifth disease

Parvovirus B19

Q3084:What are the other complications of fifth disease

Nonimmune fetal hydrops (virus infects and destroys fetal red blood cells);More severe anemia in patients with other type of chronic anemia (like aplastic crisis in sickle cell patient)

Q3085:Which bacteria cause erythrasma

Corynebacterium

Q3086:What bacterium causes scarlet fever

S. pyogenes (group A β-hemolytic)

Q3087:What type of rash is seen in typhus

An outward or centrifugal-spreading rash

Q3088:How do the rickettsiae cause severe tissue damage

Organisms infect endothelial cells and cause vascular leakage; which results in hypovolemic shock; pulmonary edema; renal failure; and CNS damage

Q3089:What does disseminated disease of coccidioidomycosis manifest as on the skin

Verrucous plaques (usually on face);Subcutaneous abscesses;Pustular lesions

Q3090:A 23 year old farmhand presents to the dermatologist with multiple red-violaceous nodules on the hand; fever; and history of diarrhea. During the examination; the patient states he is in charge of the cows on the farm. Diagnosis?

Milker’s nodules

Q3091:What causes milker’s nodules

Paravaccinia virus

Q3092:What group is paravaccinia in

Double-stranded parapoxvirus

Q3093:What disease may follow paravaccinia infection

Bullous pemphigoid

Q3094:A 16 year old female complains of fatigue; fever; sore throat; and lymphadenopathy. She leaves with a prescription for medication. Two days later she returns with a cutaneous rash on her face. What did the physician prescribe the patient

Ampicillin

Q3095:What is the most likely diagnosis for a patient who develops a rash after treatment with ampicillin

Mononucleosis

Q3096:What is the etiologic agent for mononucleosis

EBV (HHV 4)

Q3097:What are the classic criteria for diagnosing mononucleosis

Lymphocytosis; presence of at least 10% atypical lymphocytes on peripheral smear; and a positive serologic test for EBV

Q3098:What organism is responsible for tinea versicolor

Malassezia furfur

Q3099:What is used to treat tinea versicolor

Topical miconazole;Selenium sulfide

Q3100:A 45 year old rancher visits a dermatologist because of a black 2-cm lesion on his hand. He states that the lesion was itchy and had a reddish color a day or two ago. What is the most likely diagnosis

Anthrax

Q3101:What is the causative agent of anthrax

Bacillus anthracis

Q3102:A 36 year old migrant worker from Mexico visits the physician because of small disfiguring nodules forming on his ears and hands. The patient also states that he is losing sensation in the affected areas. Diagnosis?

Leprosy

Q3103:What is the causative agent of leprosy

Mycobacterium leprae

Q3104:What agent causes hand-foot-and-mouth disease

Coxsackie virus type A-16

Q3105:What are the signs and symptoms of hand-foot-andmouth disease

Fever and malaise with small oval vesicles along creases of palms; soles; and lips

Q3106:What is the most common type of bacterial infection in burn victims

Pseudomonas aeruginosa infections

Q3107:Dermatophytes include members of which genera

Trichophyton; Microsporum; Epidermophyton

Q3108:An inner-city child is brought to the physician because of patches of hair loss. His mother states that he has had this problem for at least a month. The lesions are painless and have some scaling. Diagnosis?

Tinea capitis

Q3109:What is the most likely etiologic organism of tinea capitis

Trichophyton tonsurans

Q3110:What is the treatment for tinea capitis

Griseofulvin;Terbinafine

Q3111:Which form of M. furfur generally causes disease

Hyphal form

Q3112:What is the most common type of skin cancer

Basal cell carcinoma

Q3113:What is the neoplasm that is often described as a pearly; red macule; papule; or nodule that is found on sunexposed areas of the head or neck

Basal cell carcinoma

Q3114:What skin cancer is microscopically characterized by nests of palisading cells

Basal cell carcinoma

Q3115:Which neoplasm is often described as a red papule; nodule; or plaque that may be hyperkeratotic or ulcerated on sun-exposed skin

Squamous cell carcinoma

Q3116:Arsenic causes which type of skin cancer

Squamous cell carcinoma

Q3117:Which neoplasm is microscopically characterized by nest of atypical squamous epithelial cells and keratin

Squamous cell carcinoma

Q3118:Which type of skin cancer results as a complication of severe burns 20-40 years later and has a higher risk of metastasis compared to its regular skin version

Squamous cell carcinoma

Q3119:Actinic keratosis lesions may transform into what type of skin cancer if left untreated

Squamous cell carcinoma

Q3120:What are some risk factors for squamous cell carcinoma

Sun exposure;Ionizing radiation;Actinic keratosis;Immunosuppression;Arsenic;Industrial carcinogens

Q3121:A 54 year old male visits the dermatologist because of a dark brown-black 5mm freckle in between his third and fourth toe. The patient stated that he noticed the freckle about a year and a half ago. The dermatologist biopsies the lesion and under the microscope; sees atypical confluent melanocytes with asymmetrical proliferation. Diagnosis?

Melanoma

Q3122:Which stains are used to test for melanoma

S-100;HMB-45;MART-1

Q3123:What is the most sensitive stain that could be used to test for melanoma and is almost always positive

S-100

Q3124:Large congenital nevi and dysplastic nevi may be precursor lesions for what type of cancer

Melanoma

Q3125:Which clinical criteria are used to help diagnose melanomas

Aysmmetry;Border irregularity;Color variation;Diameter;ABCDs of melanoma

Q3126:What is the term for a lesion that is a precursor or marker to melanoma

Dysplastic nevus

Q3127:How is dysplastic nevus syndrome inherited

Autosomal dominant inheritance

Q3128:What chromosome is dysplastic nevus syndrome located on

Chromosome 1

Q3129:What are the peak ages for melanoma

40-70 years of age

Q3130:What are risk factors for melanoma

Sunburns;Chronic sun exposure;Fair skin;Dysplastic nevi

Q3131:What is the most common subtype of melanoma

Superficial spreading melanoma

Q3132:Which type of melanoma has the best prognosis

Lentigo maligna melanoma

Q3133:Which type of melanoma has the worst prognosis

Nodular melanoma

Q3134:What is the most common type of melanoma in darkskinned individuals

Acral-lentiginous melanoma

Q3135:What is the most important prognostic parameter for melanoma

Depth (Breslow’s thickness)

Q3136:In what condition would you find cytoplasmic Birbeck granules through electron microscopy

Histiocytosis X (Langerhans cell histiocytosis)

Q3137:In histiocytosis X; proliferations of which cells is usually found in the epidermis

Langerhans cells (macrophages)

Q3138:What term describes full-thickness epithelia atypia with an intact basement membrane in a cancer biopsy

Carcinoma in situ

Q3139:A 40 year old male has rash of scaly red patches on his trunk; face; and extremities. A biopsy is taken and superficial dermal infiltrates of T-lymphocytes and a collection of atypical lymphocytes are seen within the epidermis. Diagnosis?

Mycosis fungoides (cutaneous T-cell lymphomas)

Q3140:What is mycosis fungoides called where there is blood involvement

Sezary syndrome

Q3141:Skin carcinogenesis is thought to be caused by the accumulation of mutations in which tumor suppressor gene

p53

Q3142:What type of carcinoma microscopically resembles metastatic small cell carcinoma from the lung or certain lymphomas

Merkel cell carcinoma

Q3143:Which HPV serotypes cause condyloma acuminatum

HPV 6 and 11

Q3144:What are tan/brown plaques or papules that have a stuck on appearance and may be found anywhere on the body of adults; except the palms and soles

Seborrheic keratosis

Q3145:What is the most common type of collagen in a keloid

Type III collagen

Q3146:What are the risk factors for keloid formation

African-American race; <30 years of age; and increased skin tension in a wound

Q3147:Single or multiple bright red papules measuring a few millimeters in diameter that occur predominantly on the trunks and limbs of patients over 40 years are what type of lesions

Senile angiomas (cherry angiomas)

Q3148:A 59 year old male visits his family physician because of loss of appetite; weight loss; and fatigue. During the physical examination; the physician notes dark; rough-looking skin in the axilla region. What should the physician suspect

Internal cancer or an endocrine disorder

Q3149:What skin condition is described as dark; roughlooking or velvety skin in the axilla or on the back of the neck

Acanthosis nigricans

Q3150:Which autosomal recessive disease is characterized by defective DNA repair and photosensitivity

Xeroderma pigmentosa

Q3151:Patients with xeroderma pigmentosa usually develop which skin lesions

Basal cell carcinoma;Squamous cell carcinoma;Actinic keratosis;Melanoma in childhood

Q3152:Exposure to UV light causes what type of dimmers in the skin

Thymine-thymine dimmers

Q3153:What are the multiple; light-brown; freckle-like lesions found in neurofibromatosis

Café au lait spots

Q3154:Café au lait spots usually grow along what structures

Peripheral nerves

Q3155:Hypopigmented macules or ash-leaf spots on the trunk or lower extremities are associated with what disease

Tuberous sclerosis

Q3156:What is the tuberous sclerosis triad

Mental retardation;Epilepsy;Multiple angiofibromas

Q3157:A unilateral port-wine stain of the forehead and upper eyelid is associated with what condition

Sturge-Weber syndrome (encephalotrigeminal angiomatosis)

Q3158:Which nerve is associated with Sturge-Weber syndrome

Ophthalmic branch of the trigeminal nerve

Q3159:What condition has whitish-red nodules especially on digits and over joints; and is associated with uric acid accumulation

Gout

Q3160:A 39 year old man comes to the physician because he has noted a bluish-black color on his ears; nose; and sclera. The patient also states that his urine is sometimes very dark. Diagnosis?

Alkaptonuria

Q3161:How is alkaptonuria inherited

Autosomal recessive inheritance

Q3162:What accounts for the discoloration of the skin and urine in alkaptonuria

Deposition of homogentisic acid

Q3163:Hemochromatosis has what manifestation in the skin

Hyperpigmented bronze skin

Q3164:Which connective tissue disorder is associated with hyperextensible fragile skin; loose joints; and a tendency toward easy bruising and bleeding

Ehlers-Danlos syndrome

Q3165:What is the cause of death for a patient with EhlersDanlos disease

Arterial or intestinal rupture

Q3166:What is the name of the group of autosomal recessive diseases of premature aging

Progeria

Q3167:Marfan syndrome is due to a defect in which gene

Fibrillin-1 (FBN-1)

Q3168:On which chromosome is the defect for Marfan syndrome

15q21

Q3169:What is the most common cause of death in a Marfan patient

Ascending aortic dissection

Q3170:How is albinism generally inherited

Autosomal recessive inheritance

Q3171:What is lacking in the epidermis of albino patients

Melanin

Q3172:A 35 year old woman visits her physician because she recently noticed multiple small nodules on the back of her ankle. The patient’s vital signs are normal and she has no prior clinical illnesses. A blood test is taken that reveals Na 142; glucose 100; creatinine 1; BUN 17; cholesterol 310; triglycerides 412. What do the small nodules likely represent

Xanthomas

Q3173:What is the most likely cause of xanthomas

Hyperlipidemia

Q3174:A mother brings her 7 year old son to the physician because of two small masses on his right chest. The mother states that the child is adopted and does not know the child’s family history. A 4 and 3 cm mass is palpated on his right pectoral; small tan lesions are seen on his back and right arm; and a small growth is seen on his iris. Diagnosis?

Neurofibromatosis 1

Q3175:On what chromosome is NF type 1 found

Chromosome 17

Q3176:What are other manifestations associated with NF type 1

Optic gliomas;Bone abnormalities;Freckling of the axillary or genital area

Q3177:What is the most common neurocutaneous disorder

Neurofibromatosis

Q3178:What condition is associated with multiple neuromas on the eyelid; lips; distal tongue; and/or oral mucosa

MEN; Type 2b (III)

Q3179:Epidermolysis bullosa acquisita (EBA) is associated with which disease

Inflammatory bowel disease; especially Crohn’s disease

Q3180:What haplotype is frequently found in patients with EBA

HLA-DR2

Q3181:Which drugs cause erythema multiforme or “target” lesions

Aspirin;Penicillin;Sulfonamides;Phenytoin;Corticosteroids;Ci metidine;Allopurinol;Oral contraceptives

Q3182:Which drugs cause Stevens-Johnson syndrome

Sulfa drugs;Carbamazepine;Phenytoin;Valproic acid;Phenobarbital;Quinolones;Cephalosporins;Allopurinol;C orticosteroids;Aminopenicillins

Q3183:Which drugs induce acne

Lithium;Steroids;Androgens;Oral contraceptive pills

Q3184:Which marker is associated with a genetic susceptibility to fixed-drug reactions

HLA-B22

Q3185:A 16 year old male with a clinical history of acne visits his family physician because he has a red rash on his face and various exposed parts. During the exam; he states the rash occurred after he spent a couple of hours outside playing football. What medication is he most likely taking

Tetracyclines

Q3186:A 75 year old female heart patient visits her dermatologist because her skin has begun to turn a light blue color. She is embarrassed to go in public because children say she looks like a “smurf.” What medication did her cardiologist most likely give her

Amiodarone

Q3187:What type of drug is Amiodarone

Class III antiarrhythmic

Q3188:What do you call a symmetrical; hyperpigmented lesion of the forehead and cheeks that occurs in women who are on oral contraceptives or pregnant

Melasma

Q3189:What are some common drugs that are associated with hyperpigmentation

Bleomycin; Minocycline; Miodarone; Chloroquine; Gold; Chlorpromazine; 5-Fluorouracil; Daunorubicin; Busulfan

Q3190:Which groups of patients have an increased risk of adverse drug reaction

Women;Patients with Sjogren’s syndrome;AIDS patients

Q3191:Which drug causes red man syndrome usually during rapid IV infusion

Vancomycin

Q3192:A 24 year old female presents to the dermatologist because of target-like lesions on her right arm. The patient states she is taking some type of antibiotic for a urinary tract infection. What drug class most likely caused the lesions

Sulfonamides

Q3193:What is the most common cause of burns in children

Scalds from hot liquids

Q3194:What is the most common cause of burns in adults

Accidents with flammable liquids

Q3195:Which kind of burn affects only the epidermis

First-degree burn

Q3196:Which kind of burn usually blisters and affects the dermis and adnexal structures

Second-degree burn

Q3197:Which type of burn involves the entire thickness of the skin; including variable amount of underlying fat and causes loss of sensation in affected area

Third-degree burn

Q3198:The scar that follows a deep second and third degree burn is composed of what

Hyalinized collagen

Q3199:Sharply demarcated; silvery-white plaques on a patient’s elbows and knees are most likely what disorder

Psoriasis

Q3200:What conditions can trigger psoriasis

Trauma; Infection; Drugs

Q3201:Which major histocompatibility markers are associated with psoriasis

HLA-CW6;B13;B17;B27

Q3202:What disorder has scaly; thickened plaques that develop in response to persistent rubbing of pruritic sites

Lichen simplex chronicus

Q3203:Which disease results from the deposition of collagen in skin that causes a “hardened” and “thickened” appearance and is associated with Raynaud’s phenomenon

Scleroderma

Q3204:Which antibodies are associated with scleroderma

Scl-70 (diffuse);Anticentromere antibodies (localized)

Q3205:What other conditions are associated with scleroderma

Hypertension;Gastrointestinal disease;Pulmonary fibrosis;Kidney disease

Q3206:Which type of collagen is defective in osteogenesis imperfecta

Type I collagen

Q3207:Which disease is associated with a rash on the face; particularly the malar areas

Systemic lupus erythematosus

Q3208:Atopic dermatitis is associated with what conditions

Asthma and allergic rhinitis

Q3209:Which test is often helpful in the evaluation of patients with chronic contact dermatitis

Patch test

Q3210:What is the most common presentation of contact dermatitis

Hand eczema; most likely due to occupational exposure

Q3211:Contact dermatitis is what type of hypersensitivity reaction

Type IV-delayed hypersensitivity

Q3212:Eruptive forms of what condition may be associated with Reiter syndrome

Psoriasis

Q3213:Touch normal-appearing skin with a sliding motion and having the epidermis layer separated from the basal layer is what skin test

Nikolsky’s sign

Q3214:Which HLA types are increased in frequency in patients with dermatitis herpetiformis

HLA-B8; DR3; DQW2

Q3215:Which rheumatologic disease is associated with a diffuse red rash of trunk; periungual telangiectasis; proximal weakness; myositis on muscle biopsy; and elevated CPK and aldolase

Dermatomyositis

Q3216:Vitiligo is most commonly associated with what conditions

Thyroid disease;Pernicious anemia;Addison’s disease;Diabetes mellitus type 1

Q3217:What are some clinical manifestations of type I hypersensitivity reactions

Anaphylaxis;Urticaria;Exanthema;Angioedema

Q3218:Urticaria is what type of hypersensitivity reaction

IgE-mediated; type I hypersensitivity reaction

Q3219:Autoantibodies to the intercellular junction of epidermal cells are found in which disease

Pemphigus vulgaris

Q3220:Pemphigus vulgaris is associated with which antibody

IgG

Q3221:What do the autoantibodies in pemphigus vulgaris target

Desmocollins and desmogleins (transmembrane desmosomal glycoproteins)

Q3222:Patients with pemphigus vulgaris have an increased incidence of which haplotypes

HLA-DR4; DRw6

Q3223:What do the autoantibodies in bullous pemphigoid target

BP1 and BP2 in basement membrane

Q3224:Bullous pemphigoid is an autoimmune disorder that rarely affects which part of the body in contrast to pemphigus vulgaris; which affects it frequently

Oral mucosa

Q3225:Dermatitis herpetiformis is associated with what condition

Gluten-sensitive enteropathy

Q3226:TB skin test; transplant rejection; and contact dermatitis are what type of hypersensitivity reaction

Delayed type hypersensitivity reaction; type IV

Q3227:What is the most likely vitamin deficiency that manifests as petechiae; echymoses; abnormal hair growth; bleeding gums; and poor wound healing

Vitamin C (scurvy)

Q3228:A 45 year old patient presents with intense hyperpigmentation; areas of epithelial desquamation; diarrhea; and confusion. What is the most likely deficient vitamin

Niacin (nicotinic acid)

Q3229:Which vitamin deficiencies have cutaneous manifestations

Vitamin C;Vitamin A;Nicotinic acid;Riboflavin;Pyridoxine

Q3230:What are some skin manifestations of kwashiorkor

Dry skin;Patches of hypopigmentation;Skin peeling;Peripheral edema;Thin hair shafts

Q3231:What condition would cause an increase in skin glycogen and acid α-glucosidase in cultured fibroblasts

Pompe’s disease (type II)

Q3232:A 3 year old male presents to the physician with a photosensitive rash; cerebellar ataxia; mental disturbances; and aminoaciduria. Niacin levels are within normal range. What is the most likely diagnosis

Hartnup disease

Q3233:How is Hartnup disease inherited

Autosomal recessive inheritance

Q3234:What are the cutaneous manifestations in Whipple’s disease

Hyperpigmentation of scars and sun-exposed skin

Q3235:A 32 year old woman visits her family physician because of rapid weight gain; profuse sweating; sudden abnormal hair growth; and easy bruising. Upon physical examination; the physician notes purplish striae on the abdomen; telangiectasia; thin skin; and an increase of fatty tissue on her back at the level of C6. What is the most likely diagnosis

Cushing’s syndrome

Q3236:Which test is used to diagnose Cushing’s disease

Dexamethasone suppression test and 24 hour urinary measurement for cortisol

Q3237:What is the most common cause of Cushing’s syndrome

Iatrogenic

Q3238:What hormone is increased in Cushing’s syndrome

Cortisol

Q3239:Patients with carcinoid syndrome may have which skin manifestation

Episodes of flushing of the head; neck; and sometimes trunk

Q3240:What are the metabolic causes of hyperpigmentation

Porphyria cutanea tarda;Hemochromatosis;Vitamin B12 deficiency;Folic acid deficiency;Pellagra;Mallabsorption;Whipple’s disease

Q3241:A 56-year-old man experienced chest pain and was admitted to the hospital suffering from an acute myocardial infarction. Five days later; he developed ventricular tachycardia; which progressed to ventricular fibrillation; and could not be resuscitated. The microscopic section shows an area of myocardium between an established infarct and normal myocardium. The myocytes in the figure show ;A. cell injury with undetermined ultimate fate ;B. early coagulation necrosis ;C. early liquefaction necrosis ;D. irreversible injury and will die within hours

Option A (cell injury with undetermined ultimate fate) is correct. The cells show vacuolation due to loss of the ability to synthesize ATP via aerobic respiration. This; in turn; shuts down the Na+-K+ pump of the cell membrane. Sodium is no longer excluded from the cytosol; and water follows it into the cell; causing swelling and vacuolation. This is a reversible process.

Q3242:. A 31-year-old woman has a mass on the right side of the neck lateral to the larynx. The mass is determined to be a well-differentiated tumor containing psammoma bodies. The tumor is most likely classified as a;A. follicular adenoma ;B. follicular carcinoma ;C. papillary adenoma ;D. papillary carcinoma

Option D (papillary carcinoma) is correct. The presence of psammoma bodies is virtually diagnostic of papillary carcinoma; because these bodies are rarely seen in other thyroid neoplasms. Papillary carcinoma occurs most frequently in women between the ages of 20 and 50 years. Papillary carcinoma is the most common thyroid cancer and spreads via the lymphatic system. This type of thyroid cancer is more common in patients with a history of radiation exposure.

Q3243:A total thyroidectomy is performed on a 42-year-old woman with a thyroid mass that appears to be encapsulated. There is evidence of both recent and past hemorrhage and numerous small; follicle-like structures composed of very uniform-appearing cells. Which of the following distinguishing features would suggest that this tumor is malignant?;A. Absence of papillary growth ;B. Absence of psammoma bodies ;C. Extension through the capsule ;D. Microfollicular pattern ;E. Presence of hemorrhage

Option C (extension through the capsule) is correct. Invasion through the capsule of the tumor is one of the core characteristics used to determine if a follicular neoplasm of the thyroid is benign or malignant. Another characteristic is invasion of the tumor into the vasculature.

Q3244:A 61-year-old man with chronic renal failure is being considered for a renal transplant. His serum calcium level is 7.6 mg/dL. Which of the following findings is most likely to be typical in this patient?;A. Bilateral adrenal hyperplasia ;B. Enlargement of all four parathyroid glands ;C. Functional parathyroid adenoma ;D. Hyperplasia of the adenohypophysis ;E. Hyperplasia of the thyroid follicular cells

Option B (enlargement of all four parathyroid glands) is correct. The patient has secondary hyperparathyroidism associated with chronic renal failure. In such cases; the hypocalcemia caused by renal retention of phosphate leads to compensatory hyperplasia of the parathyroid glands. Typically; all four parathyroid glands are enlarged.

Q3245:Two months ago; a 19-year-old man was brought to the emergency department following an automobile accident in which he sustained severe lacerations and a ruptured spleen. He immediately received four units of packed red blood cells. He now has developed mild jaundice. Except for vague symptoms of fatigue; he is generally asymptomatic. Both his ALT (alanine aminotransferase) and AST (aspartate aminotransferase) are 40 U/L. His alkaline phosphatase is within normal limits. Which of the following types of hepatitis is most likely to have caused this infection?;A. Hepatitis A (HAV) ;B. Hepatitis B (HBV) ;C. Hepatitis C (HCV) ;D. Hepatitis D (HDV) ;E. Hepatitis E (HEV)

Option C (hepatitis C) is correct. HCV has become the major cause of transfusion-related hepatitis since adequate screening methods for HBV have been developed. HCV was previously referred to as non-A; non-B hepatitis or chronic active hepatitis.

Q3246:For the past several weeks; a 39-year-old woman has experienced fatigue; weakness; poor appetite; and weight loss. Physical examination shows hyperpigmentation of the skin and dark patches on the mucous membranes. Laboratory studies show her serum sodium level is 125 mEq/dL; and her serum potassium level is 6.0 mEq/dL. Which of the following is the most likely diagnosis?;A. Atrophic adrenals with dense lymphocytic infiltrate ;B. Carcinoid tumor of the vermiform appendix ;C. Functional follicular adenoma of the thyroid ;D. Granulosa cell tumor of the right ovary ;E. Hyperplasia of all four parathyroid glands

Option A (atrophic adrenals with dense lymphocytic infiltrate) is correct. This patient has Addison's disease; as suggested by the fatigue; weakness; poor appetite; and weight loss. Other characteristics include hyperpigmentation of the skin and dark patches on the mucous membranes. In developed countries; the most common cause of Addison's disease is autoimmune destruction of the adrenals; suggested by lymphoid infiltrates in the adrenal glands plus circulating antiadrenal antibodies. In developing countries; tuberculosis would also be a major cause.

Q3247:For the past 6 months; an 18-year-old woman has had diarrhea; a fever; and cramping and left lower quadrant pain. Flexible sigmoidoscopy shows mucosal ulceration in the sigmoid colon. A biopsy shows transmural inflammation with occasional granulomas. Which of the following would differentiate Crohn's disease from ulcerative colitis?;A. History of fever ;B. History of prolonged diarrhea ;C. Involvement limited to the colon ;D. Presence of gross mucosal ulcerations ;E. Presence of transmural inflammation with granular formation

Option E (presence of transmural inflammation with granular formation) is correct. Ulcerative colitis is essentially a disease of the mucosa; whereas Crohn's disease involves all layers of the bowel wall. A biopsy shows that this patient has transmural inflammation with occasional granulomas.

Q3248:A 56-year-old man with a history of gastric ulceration and Helicobacter pylori infection has a lesion involving the stomach wall. A biopsy shows that the lesion is a mucosaassociated lymphoid tissue (MALT) lymphoma. Which of the following is the most likely source of this tumor?;A. B cells ;B. Histiocytes ;C. Natural killer (NK) cells ;D. T cells

Option A (B cells) is correct. Mucosa-associated lymphoid tissue (MALT) lymphomas are low-grade B-cell lymphomas. Gastric MALT lymphoma has a strong association with H. pylori infection.

Q3249:. A 18-year-old woman with mildly icteric sclerae has a total bilirubin of 5.5 mg/dL and a direct bilirubin of 0.4 mg/dL. She has no associated symptoms; and no history of exposure to hepatotoxins; blood products; or persons with known hepatitis. A brother is unaffected; but an uncle has a similar condition. This patient most likely has which of the following congenital hyperbilirubinemias? ;A. Crigler-Najjar syndrome; type I ;B. Crigler-Najjar syndrome; type II ;C. Dubin-Johnson syndrome ;D. Gilbert syndrome ;E. Rotor's syndrome

Option D (Gilbert syndrome) is correct. Patients with this mild; inherited form of conjugated hyperbilirubinemia are healthy and have no functional or structural evidence of liver disease; except for an increase in unconjugated bilirubin.

Q3250:A 51-year-old man with an 8-year history of cirrhosis has a mass lesion in the left lobe of the liver. A needle biopsy determines the lesion is hepatocellular carcinoma (HCC). In the United States; development of HCC is most commonly associated with which of the following?;A. Alcoholism ;B. Exposure to aflatoxin ;C. Hepatitis C (HCV) infection ;D. Microvesicular steatosis ;E. Neonatal hepatitis

Option C (hepatitis C infection) is correct. HCV infection is most commonly associated with hepatocellular carcinoma. There is a marked reduction of cases of hepatitis B (HBV) in the United States due to the screening of blood used for transfusions.

Q3251:A 12-year-old girl has metabolic acidosis and severe ketosis. Her blood glucose level is 460 mg/dL. Serologic studies for antibodies against b cells show a high titer of anti b cell antibodies. Which of the following is most significant concerning the finding of a high titer of these antibodies?;A. Are a serum marker for the destruction of b cells ;B. Are an indication of the development of type 2 diabetes mellitus ;C. Have caused the destruction of the b cells in the pancreatic islets;D. Form a complex with insulin that causes hyperglycemia

Option A (are a serum marker for the destruction of b cells) is correct. It is currently thought that anti b cell antibodies arise from antigens released into the blood by the destruction of b cells; probably by cytotoxic T cells. Thus; they are a marker; not a cause; of b cell injury.

Q3252:A 62-year-old woman with bilateral palpable masses in her abdomen has a creatinine level of 3.7 mg/dL and her blood urea nitrogen (BUN) is 32 mg/dL. During the past year; she has had hematuria with occasional small blood clots in her urine. Which of the following is the most likely diagnosis?;A. Medullary sponge kidney ;B. Nephronophthisis ;C. Polycystic kidney disease; autosomal dominant ;D. Polycystic kidney disease; autosomal recessive ;E. Renal dysplasia

Option C (polycystic kidney disease; autosomal dominant) is correct. This clinical scenario of bilateral palpable abdominal masses and marked increase in creatine and BUN represents a fairly classic presentation of autosomal dominant (adult) polycystic disease.

Q3253:A 24-year-old woman has painful urination with frequency and urgency. A physical examination shows an increase in heart rate and a temperature of 39.2\\'b0C (102.5\\'b0F). She appears ill and somewhat diaphoretic. A urine specimen is grossly red; and red blood cells (RBCs) are seen on microscopic examination. A urinalysis shows bacteria; polymorphonuclear leukocytes; and leukocyte casts. A nitrite test on a urine dipstick is positive. Which of the following is the most likely diagnosis?;A. Acute pyelonephritis ;B. Acute tubular necrosis ;C. Cystitis ;D. Nephrotic syndrome

Option A (acute pyelonephritis) is correct. Leukocyte casts are formed only in the kidneys; and the presence of these casts is ample evidence of an infection of the renal parenchyma; characteristic of acute pyelonephritis.

Q3254:A urinalysis of an asymptomatic 59-year-old man shows microscopic hematuria and mild prostatic hypertrophy. A CT scan of the abdomen shows a large mass in the left kidney. A needle biopsy confirms a diagnosis of renal cell carcinoma; clear-cell type. Radical nephrectomy indicates that the tumor appears to have invaded the man's left renal vein. If the tumor has metastasized; the most likely site of metastasis is;A. adrenal glands ;B. bones ;C. liver ;D. lungs ;E. regional lymph nodes

Option D (lungs) is correct. Renal cell carcinoma is angioinvasive and tends to disseminate via the vascular system early in its history. If metastases occur; the lungs are involved in more than 50% of cases.

Q3255:A 16-year-old girl whose mother was given diethylstilbestrol (DES) during her pregnancy because of threatened abortion wants to be evaluated in anticipation of problems associated with her mother's medical history. Which of the following conditions would represent a risk as a result of maternal use of DES?;A. Adenocarcinoma of the Bartholin's glands ;B. Adenocarcinoma of the endometrium ;C. Adenocarcinoma of the vagina ;D. Squamous cell carcinoma of the cervix ;E. Squamous cell carcinoma of the vulva

Option C (adenocarcinoma of the vagina) is correct. A small percentage of female children born to women treated with DES (< 0.14%) eventually develop adenocarcinoma of the vagina. The tumor is usually detected between 15 and 20 years of age. The tumor cells contain abundant glycogen producing a so-called clear-cell carcinoma.

Q3256:A 30-year-old woman fears that she will develop ovarian cancer because of her family history and is tested for the BRCA1 gene. This gene has a strong association with which of the following ovarian neoplasms?;A. Dysgerminoma ;B. Mixed M\\'fcllerian tumor ;C. Serous cystadenocarcinoma ;D. Yolk sac tumor

Option C (serous cystadenocarcinoma) is correct. In women who are positive for the BRCA1 gene; the vast majority of ovarian tumors are serous cystadenocarcinomas. A woman who has a family history of ovarian cancer would be at risk for carrying the BRCA1 gene.

Q3257:A 50-year-old woman with an infiltrating ductal carcinoma of the breast has a lumpectomy; followed by adjuvant radiation and chemotherapy. Tissue is sent to the laboratory to determine if any prognostic factors might be present in this woman. Which of the following findings would be associated with an extremely poor prognosis for this patient?;A. Estrogen receptors ;B. HER-2 neu amplification ;C. Mutated p53 oncoprotein ;D. Progesterone receptors

Option B (HER-2 neu amplification) is correct. Tumors with oncogene amplification (HER-2 neu) tend to have a less favorable prognosis than those without this factor.

Q3258:A 55-year-old slightly obese woman has had several bouts of intense right upper quadrant pain and now has scleral icterus. A cholecystectomy shows numerous spongy; laminated brown stones in the gallbladder. Brown gallstones are almost always associated with which of the following conditions?;A. Alcoholic cirrhosis ;B. Escherichia coli infection of the gallbladder ;C. History of mild b-thalassemia ;D. Hypercholesterolemia

Option B (Escherichia coli infection of the gallbladder) is correct. Brown gallstones are almost always associated with E. coli cholecystitis. Bacteria may secrete b-glucuronidase; which hydrolyzes conjugated bilirubin to unconjugated bilirubin. The increase in concentration of unconjugated bilirubin is believed to produce the stones.

Q3259:An endometrial biopsy of a 47-year-old woman with a history of irregular vaginal bleeding shows a welldifferentiated adenocarcinoma of the endometrium. A hysterectomy confirms tumor involvement of the corpus of the uterus and the cervix. Which of the following is a known risk factor for the development of endometrial carcinoma?;A. History of anovulatory menstrual cycles ;B. History of cervical human papillomavirus (HPV) infection ;C. Multiple pregnancies ;D. Thin body habitus

Option A (history of anovulatory menstrual cycles) is correct. A history of irregular vaginal bleeding corroborates anovulatory menstrual cycles and is strongly associated with the development of endometrial cancer; probably because of prolonged estrogen stimulation.

Q3260:A 40-year-old woman has enlarged lymph nodes in the axillae; groin; and cervical triangles. Biopsy of an axillary node shows complete effacement of the architecture of the nodes by nodular aggregates of lymphoma cells. Which of the following is the cell line of origin of this type of lymphoma?;A. B cell ;B. CD4+ T cell ;C. CD8+ T cell ;D. Histiocyte ;E. Natural killer (NK) cell

Option A (B cell) is correct. The woman has follicular (nodular) lymphoma; a non-Hodgkin's (NHL) lymphoma that expresses B cell cluster of differentiation (CD) markers. All follicular (nodular) lymphomas are of B cell lineage.

Q3261:A 64-year-old woman with a saccular aneurysm of the ascending aorta has ataxia and loss of joint position sense. She confabulates when the physician attempts to obtain a history. Which of the following organisms is capable of producing this constellation of findings?;A. Chlamydia trachomatis ;B. Haemophilus ducreyi ;C. Neisseria gonorrhoeae ;D. Treponema pallidum ;E. Trichomonas vaginalis

Option D (Treponema pallidum) is correct. An aortic aneurysm with ataxia and impaired proprioception are characteristic of the tertiary stage of syphilis. The primary stage involves a painless genital ulcer and regional lymphadenopathy; and the secondary stage involves skin and mucosal lesions as well as possible meningeal; hepatic; renal; bone; and joint invasion.

Q3262:When asked to speak to a women's group about risk factors for the development of breast cancer; the physician should tell the group that the histopathologic finding that carries the strongest risk factor for developing breast cancer is;A. apocrine metaplasia ;B. atypical lobular hyperplasia ;C. epithelial hyperplasia ;D. sclerosing adenosis

Option B (atypical lobular hyperplasia) is correct. Atypical lobular hyperplasia is a moderate risk factor for the development of breast cancer.

Q3263:A 51-year-old man has adenocarcinoma of the lesser curvature. Which of the following is the most important prognostic factor when evaluating a patient with this type of tumor?;A. Degree of differentiation ;B. Depth of invasion ;C. Gross growth pattern ;D. Histologic subtype of the carcinoma ;E. Presence of Helicobacter pylori

Option B (depth of invasion) is correct. The morphologic feature with the greatest effect on clinical outcome in adenocarcinoma of the lesser curvature is depth of tissue invasion. Patients with carcinoma in the early stages (limited to the mucosa and submucosa) have a far better prognosis (90% survival with surgery) than patients with advanced carcinoma (<10% survival with surgery).

Q3264:Individuals taking phenobarbital may be more susceptible to free radical injury by toxins such as carbon tetrachloride (CCl4). Phenobarbital induces which of the following subcellular changes? ;A. Additional receptor sites for CCl4 on the cell membrane of the hepatocytes;B. Atrophy of the Golgi zone within the hepatocytes ;C. Atrophy of the smooth endoplasmic reticulum (SER) within the;hepatocytes ;D. Increased formation of G proteins within the hepatocytes ;E. Marked hypertrophy of the SER within the hepatocytes

Option E (marked hypertrophy of the SER within the hepatocytes) is correct. Phenobarbital induces hypertrophy of the SER and hence a marked increase in cytochrome p450 activity. The conversion of CCl4 into the toxic free radical CCl3 by the cytochrome p450 system causes the injury.

Q3265:A 67-year-old retired airline pilot slipped on the ice; striking his head on the sidewalk. His history is unremarkable. A CT scan of the head shows no sign of hematoma; but does show atrophy of the cerebral hemispheres. The atrophy is most likely due to;A. decreased daily workload ;B. diminished blood supply ;C. inadequate nutrition ;D. loss of endocrine stimulation ;E. loss of innervation

Option B (diminished blood supply) is correct. Atherosclerosis leads to reduced blood flow to the brain and is thought to be the major culprit in the etiology of cerebral atrophy in the elderly.

Q3266:A 50-year-old man who has smoked two packs of cigarettes a day for 30 years has squamous metaplasia of the respiratory epithelium. His physician tells him that smoking is a major cause of metaplasia; but there are other causes for this change. Which of the following may also cause squamous metaplasia of bronchial mucosa?;A. Deficiency of folate ;B. Deficiency of vitamin A ;C. Excess vitaminB2 ;D. Excess vitamin C ;E. Excess vitamin D

Option B (deficiency of vitamin A) is correct. Vitamin A and retinoids are necessary in maintaining the differentiation of epithelial cells. Deficiency of vitamin A causes squamous metaplasia of the respiratory tract epithelium as well as impaired vision; night blindness; and xerophthalmia.

Q3267:When an acute inflammatory reaction develops in response to an injurious stimulus; endothelial cells and macrophages produce nitric oxide (NO). During acute inflammation; NO functions to ;A. cause pain ;B. induce smooth muscle contraction ;C. opsonize bacteria ;D. produce fever ;E. promote vasodilation

Option E (promote vasodilation) is correct. NO is produced by nitric oxide synthase and is somewhat cytotoxic. NO causes the relaxation of vascular smooth muscle; leading to vasodilation.

Q3268:A 61-year-old woman with a lengthy history of hypertension dies of an acute myocardial infarction (MI). At autopsy; the heart shows gross hypertrophy of the left ventricle. The adaptive mechanism responsible for the increase in the mass of the ventricle is most likely;A. fusion of individual muscle fibers into larger; stronger units ;B. increased cycling of cells out of G 0 ;1 phase ;C. increased individual cell size; with no mitotic activity ;D. increased mitotic rate and the production of more cells ;E. primarily an increase in individual cell size; with normal mitotic activity

Option C (increased individual cell size; with no mitotic activity) is correct. The increase in cardiac and skeletal mass is due to an increase in the size of individual muscle fibers. These cells are not capable of significant mitotic activity.

Q3269:Several weeks after sustaining a gunshot wound; the bullet is surgically removed from the shoulder of a 20-year-old man. Histologically; the lesion resembles a chronic inflammatory infiltrate; with numerous macrophages surrounding the bullet. In the chronic inflammatory response; macrophages are especially important because they are;A. capable of local proliferation ;B. easily recruited from the circulation ;C. involved in the production of numerous biologically active substances ;D. permanently localized to the site of inflammation

Option C (involved in the production of numerous biologically active substances) is correct. Macrophages produce an abundance of biologically active substances (e.g; toxic free radicals; proteases; cytokines; growth factors; and angiogenesis factor); and all are involved in chronic inflammation.

Q3270:A 30-year-old black woman who resides in North Carolina develops increasing shortness of breath. A physical examination shows lymphadenopathy in the axillae and groin. X-ray film of the chest shows a marked degree of hilar lymph node enlargement. A biopsy of an enlarged axillary lymph node shows numerous noncaseating granulomas. No organisms are identifiable; and acid-fast stains are negative. These findings are most likely caused by which of the following?;A. Coccidioidomycosis ;B. Cryptococcosis ;C. Histoplasmosis ;D. Sarcoidosis ;E. Tuberculosis

Option D (sarcoidosis) is correct. Sarcoidosis typically produces noncaseating ("hard") granulomas; rather than lesions characterized by central caseous necrosis. In addition; multisystem involvement; including skin; lungs; lymph nodes; liver; spleen; eyes; and the small bones of the hand and feet; is typical. Sarcoidosis occurs mainly in individuals between the ages of 20 and 40 years; risk is higher in the black population.

Q3271:A 63-year-old man has a history of congestive heart failure due to severe arteriosclerosis of the coronary arteries. He now has pitting edema of the ankles that extends about halfway up the lower part of his legs. The edema in this patient is most likely caused by which of the following mechanisms?;A. Decreased oncotic pressure in the vascular compartment ;B. Impaired lymphatic drainage of the legs ;C. Increased hydrostatic pressure in the vascular compartment ;D. Increased oncotic pressure in the extracellular compartment ;E. Increased vascular permeability

Option C (increased hydrostatic pressure in the vascular compartment) is correct. In this patient; the increased pressure is the main cause of dependent edema. The failing right side of the heart (right atrium and ventricle) has led to an increase in intravascular hydrostatic pressure; which eventually causes a net movement of fluid from the vascular space to the extravascular space.

Q3272:An 18-year-old man scheduled to undergo surgery to repair a hernia has a history of easy bruising and a tendency to bleed for an abnormally long time after an injury. Laboratory studies show prolonged bleeding time; normal prothrombin time; and slightly prolonged partial thromboplastin time. Which of the following is the most specific laboratory test that would confirm the suspected diagnosis of von Willebrand's disease?;A. Clot retraction test ;B. Factor VIII assay ;C. Ristocetin aggregation test ;D. Thrombin time

Option C (ristocetin aggregation test) is correct. Ristocetin binds to platelets; activating von Willebrand's factor (vWF) receptors on the surface. If vWF is present; it forms a bridge between receptors on different platelets; causing platelet aggregation.

Q3273:A 40-year-old man who was involved in an automobile accident is being treated for a fracture of the pelvis. The man is at increased risk of developing pulmonary emboli because of relative stasis of venous flow in his legs. Which of the following most accurately describes these emboli?;A. Most are clinically silent ;B. They are rare ;C. They commonly cause chronic pulmonary hypertension ;D. They typically cause pulmonary infarction ;E. They usually cause immediate death

Option A (most are clinically silent) is correct. The majority of pulmonary emboli (60\\'9680%) are small; thus; they are clinically silent. Autopsy series are the source of most of the data; and the frequency of finding emboli tends to be related to the diligence of the pathologist.

Q3274:A 54-year-old woman with severe right upper quadrant pain; fever; and jaundice is in shock when brought to the emergency department. A blood culture grows Escherichia coli. The presumptive diagnosis is acute cholecystitis. The most likely cause of shock is ;A. anaphylactic reaction ;B. cardiogenic shock ;C. endotoxemia ;D. hemorrhage ;E. neurogenic shock

Option C (endotoxemia) is correct. Endotoxin (lipopolysaccharide); a component of the cell walls of gramnegative bacteria; binds to CD14 receptors. It causes a cascade of events that result in shock; metabolic failure; disseminated intravascular coagulopathy; and eventually multiple organ failure.

Q3275:A 46-year-old woman delivers a newborn with the physical features associated with Down's syndrome (trisomy 21). A FISH (fluorescent in situ hybridization) assay shows the presence of three number 21 chromosomes. The most common mechanism causing trisomy 21 is;A. failure of lyonization ;B. formation of a ring chromosome ;C. meiotic nondisjunction of chromosome 21 in the ovum ;D. mitotic nondisjunction of chromosome 21 early in embryogenesis ;E. robertsonian translocation of the long arm of chromosome 21 to an acrocentric chromosome

Option C (meiotic nondisjunction of chromosome 21 in the ovum) is correct. Down's syndrome typically affects children born of women over 35 years of age; and is of maternal origin but of undetermined etiology. The most common mechanism of trisomy 21 (>90% of cases) involves the meiotic nondisjunction of chromosome 21.

Q3276:A 27-year-old man is a diagnosed with a diffuse large cell lymphoma. Genetic analysis of DNA from the lymphoma cells shows rearrangement of the immunoglobulin genes. Which of the following is the most likely origin of this lymphoma? ;A. B-cell lymphoma ;B. Histiocytic lymphoma ;C. Natural killer (NK) cell lymphoma ;D. T-cell lymphoma

Option A (B-cell lymphoma) is correct. Somatic rearrangement of the immunoglobulin genes marks this lesion as a lymphoma of B cell origin. Lymphoma is a monoclonal lesion; so all of the tumor cells exhibit identical patterns of immunoglobulin gene rearrangement.

Q3277:A 32-year-old woman has a family history of a high incidence of neoplasia involving multiple organ systems. She undergoes genetic screening for several tumor suppressor genes and oncogenes and is found to have Li-Fraumeni syndrome. The genetic defect associated with this syndrome is loss of one allele of which of the following genes?;A. bcl-2 ;B. NF-1 ;C. P53 ;D. RB ;E. WT1

Option C (P53) is correct. Loss of one of the alleles of the P53 gene is the basis of the Li-Fraumeni syndrome. Patients with this syndrome have an increase in the development of malignant neoplasms arising in various anatomic locations. P53; a tumor suppressor gene that also has oncogene-like properties when mutated; produces an abnormal gene product that is not degraded with normal speed. Patients with a mutated or missing P53 gene have an increased risk of developing malignancies in various tissues.

Q3278:The mechanism thought to be responsible for the increasingly aggressive behavior of malignant tumors is that they;A. are genetically labile ;B. cause the production of tumor necrosis factor-a (TNF-a) ;C. induce angiogenesis ;D. produce paraneoplastic syndromes

Option A (are genetically labile) is correct. Malignant tumors are constantly mutating and forming new clones. Many of the clones die; but some will have a selective advantage with regard to growth; invasion; or metastasis.

Q3279:A 32-year-old man has had vague abdominal discomfort; bloating; and diarrhea since returning from a camping trip 2 weeks ago where he routinely drank mountain stream water. Stool smears show triangular-shaped organisms containing two nuclei. Which of the following is the most likely cause of the diarrhea?;A. Balantidium coli ;B. Entamoeba histolytica ;C. Giardia lamblia ;D. Vibrio cholerae

Option C (Giardia lamblia) is correct. G. lamblia is the most prevalent pathogenic intestinal protozoan. It attaches to the mucosa rather than invading it; thus; it tends to cause irregular (intermittent) watery diarrhea rather than dysentery. In some patients; it causes constipation; in others; it causes steatorrhea. Symptoms of giardiasis generally occur 1\\'963 weeks after infection.

Q3280:A 50-year-old woman who has been taking estrogen daily; without interruption; for a long period of time is at significant risk for the development of ;A. endometrial adenocarcinoma ;B. endometrial atrophy ;C. enlarged corpora lutea ;D. ovarian teratoma

Option A (endometrial carcinoma) is correct. The risk for development of endometrial adenocarcinoma is about 1.7\\'962.0 times the normal rate in patients who take unopposed estrogen on a continuous basis; without interruption.

Q3281:A 17-year-old girl with Hodgkin's disease was treated successfully with aggressive chemotherapy; and the disease has been in remission for 2 years. She is now at increased risk for the development of a second malignant tumor. Which of the following changes is most likely caused by antineoplastic agents?;A. Depression of immune surveillance ;B. Depression of the mononuclear phagocyte system ;C. Induction of nonlethal mutations ;D. Induction of telomerase ;E. Promotion of tumor angiogenesis

Option C (induction of nonlethal mutations) is correct. Most antineoplastic agents act on dividing cells at some specific point in the cell cycle. In damaging the reproductive function of the cell; accumulating nonlethal mutations may occur; which may result in the formation of a second neoplasm.

Q3282:An 18-year-old college student who was seen drinking heavily at a party is found in his room completely unresponsive. When he is admitted to the emergency department; his blood alcohol level is 325 mg/dL. In a nonhabituated drinker; this level of blood alcohol is associated with;A. coma and respiratory collapse ;B. congestive cardiomyopathy ;C. development of acute yellow atrophy of the liver ;D. Korsakoff's syndrome ;E. Wernicke's encephalopathy

Option A (coma and respiratory collapse) is correct. Alcohol acts as a central nervous system (CNS) depressant via mechanisms that are still unclear; but possibly by action on GABA receptors. At alcohol levels of 300\\'96400 mg/dL; coma and respiratory collapse are likely. Individuals who chronically abuse the substance will tolerate higher levels.

Q3283:A 47-year-old man is brought to the emergency department after being exposed to an unknown dose of radiation due to malfunction of the industrial radiographic unit he operates. His coworkers think he may have received whole-body radiation exposure. Which of the following would be most sensitive to radiation exposure?;A. Bladder epithelium ;B. Cartilage ;C. Hair follicles ;D. Kidney ;E. Lymphoid tissue

Option E (lymphoid tissue) is correct. Lymphoid tissue; hematopoietic tissue; spermatogonia; and ovarian follicles are all highly sensitive to radiation.

Q3284:A 24-year-old man has a history of fever; weight loss; hypertension; and abdominal pain. Stool and urinalysis are positive for the presence of blood. Several nodular skin lesions are found. A biopsy shows necrotizing arteritis involving medium-sized muscular arteries. This constellation of findings is most suggestive of;A. Kawasaki disease ;B. polyarteritis nodosa ;C. syphilis ;D. systemic lupus erythematosus (SLE) ;E. Takayasu's arteritis

Option B (polyarteritis nodosa) is correct. Necrotizing inflammation of affected arteries is characteristic of polyarteritis nodosa; a disease that typically involves medium-sized muscular arteries. This disease may involve fever and weight loss; and hypertension is common. Gastrointestinal lesions are the source of the abdominal pain. The disease may affect individuals of any age.

Q3285:A 52-year-old man complains of general malaise. Physical examination shows an enlarged liver; and an MRI shows a mass in the left lobe of the liver. A liver biopsy confirms the mass as an angiosarcoma. The patient most likely has been exposed to which of the following toxins?;A. Carbon tetrachloride (CCl4) ;B. b-naphthylamine ;C. Nickel carbonyl ;D. Organophosphates ;E. Polyvinyl chloride

Option E (polyvinyl chloride) is correct. Polyvinyl chloride; a known carcinogen; is associated with the development of hepatic angiosarcoma.

Q3286:A 48-year-old man comes to the emergency department because of severe chest pain. He is 5 ft 8 in tall and weighs about 90 kg (200 lb). He describes the pain as sudden in onset; producing a sensation of "tearing." Nitroglycerin spray provides no relief. An ECG shows no changes suggestive of an acute myocardial infarction (MI). Angiography shows a dissecting aneurysm of the aorta. The most likely antecedent condition associated with development of a dissecting aneurysm is;A. hypertension ;B. Marfan's syndrome ;C. severe atherosclerosis ;D. syphilis ;E. systemic lupus erythematosus (SLE)

Option A (hypertension) is correct. Over 90% of patients who develop a dissecting aneurysm; and who have neither Marfan's syndrome nor a localized connective tissue disorder; are hypertensive.

Q3287:A 29-year-old woman has a soft midsystolic click on auscultation of the heart. Ultrasound examination shows a mitral valve prolapse. The most likely eventual outcome of this condition is ;A. embolism by platelet aggregates ;B. mitral valve incompetence ;C. mitral valve stenosis ;D. normal life

Option D (normal life) is correct. A mitral value prolapse generally is benign. About 97% of female patients with the condition experience no significant untoward effects.

Q3288:As a result of the decreased incidence of patients with chronic rheumatic fever; consequent damage to the cardiac valves has diminished. The most common antecedent condition leading to infectious myocarditis presently is;A. congenital heart disease;B. endocardial trauma;C. hypercoagulable state;D. leukemia;E. mucin-producing adenocarcinoma

Option A(congenital heart disease) is correct. Rheumatic heart disease was once considered the most common condition that could lead to infectious endocarditis. Presently; congenital lesions; particularly those that produce a "jet" effect such as a small ventricular septal defect; are more common and are a risk factor for infective endocarditis.

Q3289:A 63-year-old woman with a history of type 2 diabetes mellitus and an increasing exercise limitation is admitted to the hospital with severe influenza pneumonitis. She subsequently develops adult respiratory distress syndrome (ARDS) and dies 4 days after admission. Autopsy shows the heart encased in a 1-cm dense collagenous scar. Which of the following is the most likely cause of constrictive pericarditis?;A. Cryptococcosis ;B. Histoplasmosis ;C. Idiopathic ;D. Oat cell carcinoma ;E. Tuberculosis

Option C (idiopathic) is correct. A well-defined history of a previous suppurative; hemorrhagic; or caseous pericarditis is often absent in the patient who dies of constrictive pericarditis.

Q3290:A 72-year-old woman complains of feeling weak. Laboratory studies show a hematocrit of 18%; macrocytosis; hypersegmentation of neutrophils; and occasional giant platelets. Her lactate dehydrogenase (LDH) level is 2950 U/L; and her serum vitamin B12 is 27 pg/mL. Which of the following conditions most likely caused the increase in LDH? ;A. Cardiomyopathy ;B. Hypersplenism ;C. Ineffective erythropoiesis ;D. Intravascular hemolysis ;E. Liver failure

Option C (ineffective erythropoiesis) is correct. Patients with vitamin B12 deficiency have hyperplasia of the red blood cell (RBC) elements in the bone marrow; but the developing RBCs are destroyed in the marrow before they can be released into the circulation. When RBCs are destroyed; they release their large quantity of LDH into the plasma.

Q3291:A 22-year-old medical student volunteers for a hematology research project and is found to be lacking one of four a-globin genes. Previously; he had several hematologic studies that were within normal limits. The significance of this unexpected finding suggests that the student;A. has a moderate degree of erythroid hyperplasia in bone marrow ;B. has an abnormal hemoglobin concentration ;C. has numerous target cells in the peripheral blood ;D. is an asymptomatic carrier of a-thalassemia ;E. may develop severe hemolytic anemia if exposed to oxidant drugs

Option D (is an asymptomatic carrier of a-thalassemia) is correct. Deletion of one of the four a-globin genes produces a silent carrier state; and no hematologic abnormalities are evident. One of the chromosome 16 genes carries this deficiency. If such an individual has offspring with another carrier; the children could have the a-thalassemia trait. There are four functional a-globin genes; thus; there are four possible degrees of a-thalassemia (based on the loss or one to four genes). This individual has the mildest form; the most severe form is associated with fetal death in utero.

Q3292:A 36-year-old man has generalized lymphadenopathy. A histologic examination of a lymph node shows a marked degree of follicular hyperplasia. Which of the following findings would best determine that this condition is a benign reactive process rather than neoplastic?;A. Polyclonality on DNA hybridization studies ;B. Presence of broad increase in IgG on high-resolution electrophoresis ;C. Presence of surface IgG on the cell membrane of the proliferating cells ;D. Presence of translocation t (14;18)(q32;q21)

Option A (polyclonality on DNA hybridization studies) is correct. Polyclonality is a sign of a benign process. Lymphoma is the result of monoclonal expansion of a single cell that has become malignant.

Q3293:A patient has vague symptoms of weakness and fatigue and decreased exercise tolerance. Laboratory studies show a leukocyte count of 11;000/mm with 7% blasts on the peripheral smear. Bone marrow aspirate shows 40% myeloblasts. Acute myeloblastic leukemia is suspected. This patient is most likely between the ages of;A. birth to 2 years;B. 2-10 year;C. 10-15 years;D. 15-40 years;E. >40 years

Option D is correct. Acute myeloblastic leukemia (AML) is primarily a disease of young adults.

Q3294:A 67-year-old woman with a 15-year history of severe coronary artery disease and multiple infarcts of the left ventricle and interventricular septum is hospitalized with acute pulmonary edema. Which of the following conditions is the primary physiologic event leading to pulmonary edema?;A. Decreased plasma oncotic pressure ;B. Left-sided congestive heart failure ;C. Lymphatic obstruction ;D. Rightsided congestive heart failure ;E. Volume overload

Option B (left-sided congestive heart failure) is correct. Failure of the left ventricle causes increased pressure in the pulmonary circulation; which leads to a net movement of fluid from the vascular to the extravascular compartment (Starling's hypothesis).

Q3295:A 29-year-old man is brought to the emergency department after sustaining third-degree burns over 60% of his body. Twenty-four hours later; he develops adult respiratory distress syndrome (ARDS). Which of the following physiologic features would suggest a diagnosis of restrictive lung disease in this patient?;A. Decreased PaO2 ;B. Decreased pulmonary elastic recoil ;C. Decreased total lung volume ;D. Increased PaCO2;E. Increased pulmonary blood flow

Option C (decreased total lung volume) is correct. All of the restrictive lung diseases; including ARDS; have a unifying physiologic abnormality\\: reduction in total lung capacity. This is often due to parenchymal lung disease; but it can also be the result of neuromuscular disease; skeletal diseases; pleural disease; and acute trauma such as bilaterally fractured ribs that produce a flail chest.

Q3296:A 12-year-old child develops wheezing and dyspnea after petting a cat. The child is suffering from which of the following forms of asthma?;A. Allergic bronchopulmonary aspergillosis ;B. Atopic asthma ;C. Intrinsic nonreaginic asthma ;D. Intrinsic pharmacologic asthma ;E. Occupational asthma

Option B (atopic asthma) is correct. Atopic; or allergic; asthma involves a type I hypersensitivity reaction. The binding of an inhaled specific allergen; such as cat dander; to IgE on the surface of a mast cell induces an attack of typical atopic asthma.

Q3297:A 17-year-old boy works for a contractor sandblasting painted concrete surfaces during his summer vacation. In a dusty environment such as this; which of the following sizes of potentially inhaled dust particles has the greatest capacity for causing pulmonary injury?;A. <1 mm ;B. 1mm ;C. 5mm ;D. 10mm ;E. >20mm

Option B (1 mm) is correct. Dust particles within the size range of 1mm have great potential for causing pulmonary injury. Bacteria fit nicely into this size range. Shape is also an important factor in considering capacity for pulmonary injury. Although objects such as asbestos fibers are quite long; they can also gain access to the terminal airways and alveoli because they are thin.

Q3298:A 67-year-old woman is admitted to the hospital with symptoms of pleuritic chest pain; cough productive of rusty looking sputum containing innumerable neutrophils; and a temperature of 39.2\\'b0C (102.5\\'b0F). She is an alcoholic. X-ray film of the chest shows that most of the right middle lobe is opacified. Which of the following is the most likely cause of the infection?;A. Haemophilus influenzae ;B. Klebsiella pneumoniae ;C. Mycoplasma pneumoniae ;D. Staphylococcus aureus ;E. Streptococcus pneumoniae

Option E 9Streptococcus pneumoniae) is correct. The x-ray film of the chest shows the presence of an intra-alveolar exudate with lobar or segmental consolidation;S. pneumoniae (pneumococcus) accounts for 90-95% of cases of lobar pneumonia. Alcoholism is a major risk factor for pneumonia and can lead to increased morbidity and mortality.

Q3299:A 69-year-old man sees his physician because of increasing shortness of breath. X-ray film of the chest shows that most of the right lung is encased by a thick layer of moderately dense tissue. Pleural fluid is blood-tinged with numerous atypical cells. The patient is most likely to have a history of occupational exposure to which of the following substances?;A. Asbestos ;B. Formalin ;C. Hematite ;D. Nickel carbonyl ;E. Silica

Option A (asbestos) is correct. About 90% of malignant mesotheliomas are related to occupational exposure to asbestos. Individuals who have been exposed to asbestos have an 8% risk of developing malignant mesothelioma. There is a long latent period; with the tumor appearing from about 20-40 years after exposure to the substance.

Q3300:A 65-year-old woman is undergoing a physical examination when the physician notices her mucous membranes are somewhat pale and her tongue is beefy red to magenta colored. There is slight cracking of the skin around the angles of her mouth; and her fingernails are slightly spoonshaped. She has difficulty swallowing. Laboratory studies show a red blood cell count of 12 mL/kg and a hematocrit of 30%. The most likely cause of this patient's condition is a deficiency of;A. iron ;B. niacin ;C. pyridoxine ;D. riboflavin ;E. vitamin B12

Option A (iron) is correct. The history and physical findings suggest that the woman has Plummer-Vinson syndrome; which is characterized by iron-deficiency anemia; glossitis; cheilosis; and dysphagia due to formation of upper esophageal webs.

Q3301:A 43-year-old woman sees her physician because of a swollen gland on the left side of her neck. Examination shows a firm mass in the left parotid gland. On palpation; the mass does not move with the overlying skin. The most likely diagnosis is;A. acinic cell carcinoma ;B. adenoid cystic carcinoma ;C. mucoepidermoid carcinoma ;D. pleomorphic adenoma ;E. Warthin's tumor

Option D (pleomorphic adenoma) is correct. This benign tumor accounts for about 50% of salivary gland tumors. The location of the tumor (in the left parotid gland) and the sex of the patient (female) increase the likelihood of the tumor being a pleomorphic adenoma.

Q3302:A 54-year-old man with a history of gastroesophageal reflex disease (GERD) is prescribed a proton pump inhibitor. He says he cannot afford the medication and is unable to adhere to the recommended treatment regimen; but instead relies on over-the-counter medications such as antacids and herbal remedies. Brush cytology of the esophagus shows marked reactive changes of the squamous cells as well as the presence of reactive glandular cells consistent with origin in the body of the stomach. This patient is most seriously at risk of developing ;A. adenocarcinoma ;B. esophageal candidiasis ;C. esophageal stenosis ;D. esophageal varices ;E. ulceration of the esophageal mucosa

Option A (adenocarcinoma) is correct. The presence of glandular cells in the esophageal brushing indicates that the patient has glandular metaplasia of the esophageal mucosa; or Barrett's esophagus (metaplastic columnar epithelium); a complication of chronic GERD. Adenocarcinoma of the esophagus is 30-40 times more likely to occur in patients with Barrett's esophagus.

Q3303:A 42-year-old man has a boring midepigastric pain and occasional tarry stools. Over-the-counter antacids relieve the pain; and aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) generally aggravate it. X-ray film of the upper gastrointestinal tract shows the presence of a 1- to 2cm erosion in the duodenal mucosa about 4-cm distal to the pylorus. Which of the following is the most likely cause of this patient's condition?;A. Gastrinoma ;B. Helicobacter pylori infection ;C. Insulinoma ;D. NSAID ingestion ;E. Vitamin B12 deficiency

Option B (Helicobacter pylori infection) is correct. Infection with ;H. pylori causes the development of most duodenal and many gastric ulcers. The mechanism by which the organism causes peptic ulcer disease is not well understood.

Q3304:An autopsy of a 7-year-old boy who died of irreversible heart failure shows a patchy but focally dense infiltrate of chronic inflammatory cells; predominantly lymphocytes; in the myocardium. Cardiac myocytes in the vicinity of the lymphoid aggregates show focal necrosis. No abnormalities of the cardiac vasculature are evident. Light microscopy shows no organisms. Which of the following is most commonly associated with these findings?;A. Chronic toxoplasmosis ;B. Corynebacterium diphtheriae ;C. Lyme disease ;D. Recent acute viral illness ;E. Rubella

Option D (recent acute viral illness) is correct. Infectious myocarditis is most often associated with an acute viral illness of recent occurrence (possibly with the past 5-30 days) involving an organ other than the heart. Offending organisms are typically coxsackievirus; echovirus; poliovirus; and influenza. Diagnosis of the etiologic agent often requires demonstration of a rising titer of antibody against the suspected virus.

Q3305:Meckel's diverticulum is an uncommon congenital malformation that is usually a clinically silent condition. In some cases; Meckel's diverticulum can be confused with appendicitis in the presence of;A. heterotopic gastric tissue ;B. heterotopic pancreatic tissue ;C. obstruction of the small intestine ;D. roundworm infestation ;E. ulcerative colitis

Option A (heterotopic gastric tissue) is correct. Meckel's diverticulum is a congenital malformation of the small intestine; and occurs in about 2% of the population. It is uncommon; but not rare. If the diverticulum contains heterotopic gastric mucosa; it may ulcerate and cause significant bleeding. It can produce symptoms similar to appendicitis (e.g; right lower quadrant pain).

Q3306:A 4-year-old boy develops hemarthrosis of the right knee with no known preceding traumatic episode. He has not shown any previous abnormal bleeding tendencies associated with the usual childhood trauma. The patient's history suggests an X-linked recessive trait on his mother's side of the family. Which of the following studies would most likely be abnormal?;A. Bleeding time ;B. Partial thromboplastin time (PTT) ;C. Prothrombin time (PT) ;D. Thrombin time

Option B (partial thromboplastin time) is correct. PTT is a measure of the intrinsic clotting pathway and is abnormal if factor VIII or factor IX activity is reduced. Although PTT is generally adequate to screen for hemophilia; factor VIII or factor IX assay are required to confirm the diagnosis. Hemophilia A and hemophilia B are not clinically distinguishable.

Q3307:A febrile 23-year-old woman complains of fatigue; right upper quadrant pain; and difficulty swallowing. Physical examination shows exudative tonsillitis; palatal petechia; tender cervical lymphadenopathy; splenomegaly; and tender hepatomegaly. A complete blood cell count shows mild microcytic anemia; lymphocytic leukocytosis with ~20% of the lymphocytes having atypical features; and a mild thrombocytopenia. Which of the following laboratory findings is expected in this patient?;A. Low total iron-binding capacity ;B. Normal serum ferritin ;C. Normal serum transaminases ;D. Positive hepatitis B surface antigen ;E. Positive heterophile antibody test

Option E (positive heterophile antibody test) is correct. The patient most likely has infectious mononucleosis (IM); which is caused by the Epstein-Barr virus (EBV). The virus infects B cells initially by attaching to CD 21 receptors on the cell surface. Circulating T lymphocytes interact with the infected B cells and become antigenically stimulated; resulting in atypical lymphocytosis. The key screening test for IM is the Monospot test; which detects heterophile antibodies in the patient's serum. Heterophile antibodies unique to IM are IgM antibodies directed against horse red blood cells (RBCs). An agglutination reaction against horse RBCs is the basis for a positive Monospot test.

Q3308:A routine physical examination of an asymptomatic; normotensive 21-year-old African American woman is normal; however; a urinalysis shows red blood cells (RBCs) with no casts. The patient says that she occasionally has had blood in her urine in the past. A urine culture is negative. Laboratory studies show;Serum blood urea nitrogen (BUN) 10 mg/dL ;Serum creatinine 1.0 mg/dL ;Hemoglobin 11.0 g/dL ;Mean corpuscular volume 78 ;Reticulocyte count; corrected 2% ;The peripheral smear shows occasional hypochromatic RBCs. Renal ultrasonography is normal. Which of the following is the next best step in the management of this patient?;A. Bone marrow examination ;B. Cystoscopy ;C. Renal biopsy ;D. Sickle cell preparation ;E. No further investigation is necessary

Option D (sickle cell preparation) is correct. The patient most likely has sickle cell trait; which causes recurrent microscopic hematuria. Although the percentage of sickle hemoglobin in sickle cell trait is only ~40%; with the remainder representing hemoglobin A; the oxygen tension in the renal medulla is low enough to induce sickling of the RBCs in the peritubular capillaries. This results in microinfarctions in the renal medulla and the potential for renal papillary necrosis and loss of both concentration and dilution of urine.

Q3309:A 72-year-old man complains of sudden onset of left flank pain and dizziness when he stands up quickly. When he is lying down; his blood pressure is 100/80 mm Hg; and his pulse is 110/min. When he is moved to a sitting position; his blood pressure is 80/60 mm Hg; and his pulse is 160/min. A pulsatile mass is palpated in the abdomen. The pathogenesis of the patient's flank pain and hypotension is most closely attributed to structural weakness of the aorta due to ;A. genetic defect in collagen ;B. genetic defect in fibrillin ;C. immunocomplex-mediated disease ;D. normal changes associated with aging ;E. severe atherosclerosis

Option E (severe atherosclerosis) is correct. The patient has the classic triad of a ruptured abdominal aortic aneurysm: sudden onset of left flank pain; hypotension; and a pulsatile abdominal mass. Atherosclerotic damage of the abdominal aorta weakens the vessel wall; leading to outpouching of the aorta and the potential for rupture as the expansion increases wall stress.

Q3310:An afebrile 35-year-old sheepherder who is living in a Basque community in southern Arizona complains of recurrent right upper quadrant pain. The sheepherder says that he and his dog spend their days together tending the sheep. A complete blood cell count shows a marked increase in the percentage of eosinophils. An ultrasound of his liver shows a cystic mass with calcifications in the lining of the cyst. Which of the following most accurately describes the epidemiology of this patient's liver disease;;A. The dog ate infected sheep ;B. The dog is an intermediate host ;C. The sheep is a definitive host ;D. The sheepherder ate infected sheep ;E. The sheepherder is a definitive host

Option A (the dog ate infected sheep) is correct. The patient has echinococcosis due to the tapeworm Echinococcus granulosis or E. multilocularis. In the normal developmental cycle of the Echinococcus species; adult worms mate and lay eggs that develop into larvae. The larvae mature into adult worms; and the cycle repeats. Hosts containing the larval form are called intermediate hosts; while hosts containing the adult worms are called definitive hosts.

Q3311:A 24-year-old professional weight lifter develops sudden onset of abdominal pain while bench-pressing 550 pounds. Within 10 minutes of the onset of pain; he becomes hypotensive and collapses. During emergency surgery; the surgeon finds clotted and unclotted blood filling the peritoneal cavity. Which of the following best explains the likely origin of the patient's intra-abdominal bleeding?;A. Ruptured abdominal aortic aneurysm ;B. Ruptured cavernous hemangioma of the liver ;C. Ruptured liver cell (hepatic) adenoma ;D. Ruptured splenic artery aneurysm

Option C (ruptured liver cell adenoma) is correct. Professional weight lifters commonly use anabolic steroids to increase muscle mass and strength. One of the complications of anabolic steroids is the development of liver cell (hepatic) adenomas; which are benign tumors arising from hepatocytes. These tumors tend to rupture and produce intraperitoneal hemorrhage. Women taking estrogen-containing medications are subject to the same complication.

Q3312:An 84-year-old man complains of lower back pain and inability to void urine over the past 24 hours. Physical examination shows point tenderness over the lower lumbar vertebrae and an enlarged bladder extending to the level of the umbilicus. The physician suspects metastatic prostate cancer. Which of the following is indicated as the first step in the management of this patient?;A. Digital rectal examination ;B. Prostate-specific antigen (PSA) ;C. Radionuclide bone scan ;D. Serum alkaline phosphatase ;E. Transrectal ultrasound with biopsy

Option A (digital rectal examination) is correct. Prostate cancer is the most common cancer in men. Point tenderness over the vertebral bodies in an elderly patient is highly suggestive of metastatic prostate cancer; especially coupled with clinical evidence of urinary retention. Because prostate cancers develop in the peripheral zone of the prostate; they are palpated easily by digital rectal examination; especially if they have already spread beyond the gland.

Q3313:A 35-year-old pharmacist complains of recurrent episodes of forgetfulness and tiredness. Physical examination is essentially unremarkable. Laboratory studies show a serum glucose level of 20 mg/dL. Additional studies on the same serum sample show a high serum insulin level and a low Cpeptide level. Based on these findings; which of the following is the most likely diagnosis?;A. Benign tumor involving b-islet cells in the pancreas;B. Ectopic secretion of an insulinlike factor ;C. Malignant tumor involving a-islet cells in the pancreas ;D. Surreptitiously injected human insulin

Option D (surreptitiously injected human insulin) is correct. Normally; b-islet cells first synthesize preproinsulin in the rough endoplasmic reticulin. Preproinsulin then is delivered to the Golgi apparatus; where proteolytic reactions generate insulin and a cleavage peptide called C peptide. Hence; C peptide is a marker for endogenous synthesis of insulin. In this case; the patient has been injecting himself with insulin. This increases the serum insulin level; however; serum C peptide is decreased due to suppression of the b-islet cells by the exogenously administered insulin.

Q3314:An autopsy performed on a 40-year-old man with dementia shows atrophy of the frontal and temporoparietal lobes of the brain. Histologic examination shows senile plaques. The pathogenesis of the dementia in this patient is most closely related to which of the following?;A. b-amyloid protein ;B. Decreased dopamine levels ;C. Slow virus disease ;D. Triplet repeat mutation

Option A (b-amyloid protein) is correct. Senile plaques are characteristic of Alzheimer's disease (AD); which is the most common cause of dementia in patients over 65 years of age. Senile plaques contain a core of A-b-amyloid surrounded by neurites. The explanation for the age disparity in this case is that the patient has Down syndrome with three functioning chromosome number 21 (e.g; trisomy 21). Chromosome 21 codes for an Alzheimer precursor protein (APP); part of which is amyloid-b (A- b) protein. This protein is toxic to neurons; hence the extra chromosome 21 codes for more of the protein; which results in AD at an early age.

Q3315:A 30-year-old woman states that she often burns her hands without feeling any pain. Physical examination shows decreased pain and temperature sensation in the upper extremities; atrophy of the intrinsic muscles of the hands; and abnormal deep tendon reflexes in the upper extremities. The pathogenesis of this patient's neurologic problems is most closely associated with which of the following?;A. Autoimmune destruction of myelin ;B. Fluid-filled cavity in the cervical spinal cord ;C. Superoxide free radical destruction of upper and lower motor neurons ;D. Tumor in the cervical spinal cord ;E. Vitamin B12 deficiency

Option B (fluid-filled cavity in the cervical spinal cord) is correct. The patient has syringomyelia; the development of an expanding fluid-filled cavity in the cervical spinal cord. This results in destruction of the crossed lateral spinothalamic tracts (loss of pain and temperature sensation); anterior horn cells (loss of the intrinsic muscles of the hand); and other tracts as the cavity expands. It is often confused with amyotrophic lateral sclerosis (ALS); however; in ALS there are no sensory abnormalities.

Q3316:Common congenital malformations

Heart defects;Hypospadias;Cleft lip;Congenital hip dislocation;Spina bifida;Anencephaly;Pyloric stenosis

Q3317:Congenital malformation associated with projectile vomitting

Pyloric stenosis

Q3318:Right to left shunts (early cyanosis) blue babies name 3 causes

3 T's;Tetralogy of Fallot;Transposition of great vessels;Truncus arteriosus

Q3319:Child may squat to increase venous return - what type of shunt?

Right to left

Q3320:Left to right shunts (late cyanosis) - blue kids - name 3 causes

VSD;ASD;PDA

Q3321:Close with indomethacin

PDA

Q3322:Most common congenital cardiac anomaly

VSD

Q3323:Loud S1; wide; split; fixed S2

ASD

Q3324:Uncorrected VSD; ASD or PDA leads to progressive pulmonary hypertension. As pulmonary resistance increases shunt changes from Lto R to R to L which causes late cyanosis (clubbing and polycythemia);Diagnosis

Eisenmengers syndrome

Q3325:Name 4 parts of tetralogy of Fallot

PROVe;Pulmonary stenosis;Right ventricular hypertrophy;Overriding aorta;VSD

Q3326:What do you see on xray in patient with tetralogy of Fallot

Boot shaped heart due to RVH

Q3327:Cause of tetralogy of Fallot

Anterosuperior displacement of infundibular septum

Q3328:Patient suffers from "cyanotic spells"; x ray shows boot shaped heart - diagnosis?

Tetraology of Fallot

Q3329:Aorta leaves RV (anterior) and pulmonary trunk leaves LV (posterior) --> separation of systemic and pulmonary circulation. Not compatible with life unless a shunt is present to allow adequate mixing of blood (VSD; PDA or patent foramen ovale);Diagnosis?

Transposition of great vessels

Q3330:Cause of transposition of great vessels

Failure of aorticopulmonary septum to spiral

Q3331:Prognosis for transposition of great vessels

Without surgical correction infants die within 1st month of life

Q3332:In infantile type of coarctation of aorta - aortic stenosis is proximal or distal to insertion of ductus arteriosus?

Proximal (preductal);INfantile = IN close to heart

Q3333:In adult type of coarctation of aorta stenosis is distal or proximal to ductus arteriosus

Distal (postductal);ADult= Distal to Ductus

Q3334:This condition is associated with notching of ribs; hypertension in upper extremities and weak pulses in lower extremities

Coarctation of aorta

Q3335:What should you check in physical exam if suspect coarctation of aorta

Femoral pulses

Q3336:Male to female ratio for coarctation of aort

3:01

Q3337:In fetal period shunt is right to left (normal). In neonatal period; lung resistance decreases and shunt becomes left to right with subsequent RVH and failure (abnormal). Associated with a continuous "machine like" murmur - Name condition

Patent ductus arteriosus

Q3338:Patency of ductus arteriosus is maintained by?

PGE synthesis and low O2 tension

Q3339:What drug is used to close PDA

Indomethacin

Q3340:Name drug used to keep PDA open which may be necessary to sustain life in conditions such as transposition of great vessels

PGE

Q3341:Name defect associated with 22q11 syndromes

Truncus arteriosus; tetralogy of Fallot

Q3342:Name congenital cardiac defect associated with Down syndrome

ASD;VSD

Q3343:Name congenital cardiac defect associated with congenital rubella

Septal defects;PDA

Q3344:Name congenital cardiac defect associated with Turners syndrome

Coarctation of aorta

Q3345:Name congenital cardiac defect associated with offspring of a diabetic mother

Transposition of great vessels

Q3346:Most common chromosomal disorder and cause of congenital mental retardation

Down syndrome

Q3347:GI defect associated with Downs

Duodenal atresia

Q3348:Which cancer is in increased risk for patients with Downs

ALL

Q3349:Most common cardiac malformation in patients with Downs - cause?

Septum primum type ASD due to endocardial cushion defects

Q3350:Decreased levels of alpha fetoprotein;Increased beta HCG;Increased nuchal translucency - diagnosis

Downs

Q3351:Mental retardation; flat facial profile; prominent epicantal folds; simian crease - diagnosis?

Downs trisomy 21

Q3352:95% of Downs are caused by _ ;4% ?;1%

Nondisjunction;4% - Robertsonian translocation;1% mosaicism

Q3353:Edwards syndrome is also called?

Trisomy 18 (Election age)

Q3354:Baby is born with severe mental retardation; rocker bottom feet; low set ears; micrognathia (small jaw); congenital heart disease; clenched hands and prominent occiputdiagnosis + prognosis

Edwards syndrome - trisomy 18;Death within 1 year

Q3355:Pataus syndrome is also called

Trisomy 13

Q3356:Baby is born with severe mental retardation; microphthalmia; cleft lip/palate; abnormal forebrain structures; polydactyly; congenital heart disease - diagnosis + prognosis

Pataus trisomy 13;Death within 1 year

Q3357:Klinefelters genotype

XXY

Q3358:Testicular atrophy; eunuchoid body shape; tall; long extremities; gynecomastia; female hair distribution; presence of inactivated X chromosome (Barr body)

Klinefelter syndrome

Q3359:Common cause of hypogonadism see in infertility workup

Klinefelter syndrome

Q3360:Genotype for Turners syndrome

XO

Q3361:Short stature; ovarian dysgenesis (streak ovary); webbing of neck; coarctation of aorta; no Barr body

Turners

Q3362:Most common cause of primary amenorrhea

Turners

Q3363:Phenotypically normal; very tall; severe acne; antisocial behavior; observed with increased freuency among inmates of penal institutions

Double Y males XYY

Q3364:What type of mutation is Duschennes

Frameshift mutation --> deletion of dystrophin gene --> accelerated muscle breakdown

Q3365:Inheritance for Duschennes

X linked

Q3366:Where does weakness begins in patients with Duschennes

Pelvic girdle and moves superiorly

Q3367:5 year old male presents with pseudohypertrophy of calf muscles and cardiac myopathy - name condition and cause

Duschennes - replacement of muscle by fibrofatty tissue

Q3368:7 year old male requires assistance of the upper extremities to stand up (proximal lower limb weakness) name phenomenon and condition

Gowers maneuver - Duschennes muscular dystrophy

Q3369:How do you diagnose muscular dystrophies

By increased CPK and muscle biopsy

Q3370:Disagreement between phenotypic (external genitalia) and gonadal (testes vs ovaries) sex

Pseudohermaphroditism

Q3371:Ovaries are present but external genitalia are virilized or ambiguous - name condition + cause

Female pseudohermaphroditism;Due to excessive and inappropriate exposure to androgenic steroids during early gestation (congenital adrenal hyperplasia or exogenous administration of androgens during pregnancy)

Q3372:Testes present but external genitalia are female or ambiguous - name condition + cause

Male pseudohermaphroditism - androgen insensitivity syndrome (testicular feminization)

Q3373:Both ovary and testicular tissue present; ambiguous genitalia - very rare;Possible genotypes?

True hermaphrodite;46 XX or 47 XXY

Q3374:Defect in androgen receptor resulting in normal appearing female; female external genitalia with rudimentary vagina; uterus and uterine tubes are absent. develops testicular tissue(often found in labia majora; surgically removed to prevent malignancy);Name condition + genotype + what happens to levels of estrogen; testosterone and LH

Androgen insensitivity syndrome;46 XY;Levels of testosterone; estrogen and LH are all high

Q3375:Unale to convert testosterone to DHT; ambiguous genitalia until puberty; when increased testosterone causes masculinization of genitalia;Name condition + what happens to levels of estrogen; testosterone and LH

5 alpha-reductase defficiency;Testosterone and estrogen levels are normal; LH normal or increased

Q3376:Congenital deletion of short arm of chromosome 5 leads to _

Cri-du-chat syndrome

Q3377:Microcephaly; severe mental retardation; high pitched crying/meowing; epicanthal folds; cardiac abnormalities

Cri-du-chat syndrome

Q3378:2nd most common cause of genetic mental retardation

Fragile X

Q3379:X linked defect affecting methylation and expression of FMR1 gene; associated with macro-orchidism (enlarged testes); long face with large jaw; large everted ears and autism

Fragile X

Q3380:What type of mutation is in Fragile X

Triple repeat disorder (CGG) that may show genetic anticipation (germlike expansion in females)

Q3381:Cleft palate;Abnormal facies;Thymic aplasia;Cardiac defects;Hypocalcemia;2 types of disorders

22q11 syndromes - DiGeorge syndrome (thymic; parathyroid and cardiac defects) or velocardiofacial syndrome (palate; facial and cardiac defects)

Q3382:Adult polycystic kidney disease - unilateral or bilateral

ALWAYS bilateral

Q3383:Patient presents with pain; hematuria; hypertension; progressive renal failure; 90% of mutations are due to mutation in APKD1 (chromosome 16)

Adult polycystic kidney disease - massive enlargement of kidneys due to multiple large cysts

Q3384:Name conditions associated with adult polycystic kidney disease

Polycystic liver disease;BERRY ANEURYSMS;Mitral valve prolapse

Q3385:What is the inheritance for adult form of polycystic kidney disease? ;juvenile?

Adult - autosomal dominant;Juvenile - autosomal recessive

Q3386:Patient has high cholesterol (heterozygotes 300; homozygotes - rare- 700); severe atherosclerotic disease early in life and tendon xanthomas (classically in Achilles tendon); MI may develop before age 20;Name disease and cause

Familial hypercholesterolemia (hyperlipidemia type IIa);Elevated LDL owing to defective or absent LDL receptor

Q3387:Cause of Marfans disease

Fibrillin gene mutation -> connective tissue disorders

Q3388:Skeletal abnormalities in Marfans syndrome

Tall with long extremities; hyperextensive joints; and long; tapering fingers and toes

Q3389:Cardiovascular abnormalities in Marfans syndrome

Cystic medial necrosis of aorta --> aortic incometence and dissecting aortic aneurysms;Floppy mitral valve

Q3390:Occular abnormality in Marfans syndrome

Subluxation of the lens

Q3391:Findings in neurofibromatosis type I (von Riecklinghausen disease)

Cafe-au-lait spots;Neural tumors;Lisch nodules (pigmented iris hamartomas);Also marked by skeletal disorders (scoliosis) and increased tumor susceptibility

Q3392:Gene coding for NFT type I (von Riecklinghausen disease) located where?

Long arm of chromosome 17 (17 letters in Recklinghausen)

Q3393:Gene coding for NFT type II is located where?

On chromosome 22

Q3394:Patient presents with bilateral acoustic neuromas; optic pathway gliomas; juvenile cataracts - diagnosis?

Type II NFT

Q3395:Findings: facial lesions (adenoma sebaceum); hypopigmented "ash leaf spots" on skin; cortical and retinal hamartomas; seizures; mental retardation; renal cysts; cardiac rhabdomyomas. Incomplete penetrance; variable presentation

Tuberous sclerosis

Q3396:Findings: hemangioblastomas of retina/cerebellum/medulla; about half of affected individuals develop multiple bilateral renal cell carcinomas and other tumors - name disease; which gene affected and inheritance

Von Hippel Lindau disease;Deletion of VHL gene (tumor suppressor) on chromosome 3 (3p);Autosomal dominant

Q3397:Findings - depression; progressive dementia; choreiform movements; caudate atrophy and decreased levels of GABA and Ach in brain; symptoms manifest between 20 and 50 - name disorder; what type of disorder; inheritance + which chromosome affected

Huntingtons;Triplet repeat disorder;Autosomal dominant;Gene on chromosome 4

Q3398:Colon becomes covered wiith adenomatous polyps after puberty. Progresses to cancer unless resected - name disease and chromosome on which deletion occurs+ inheritance pattern

Familial adenomatous polyposis - deletion on chromosome 5; autosomal dominant

Q3399:Spheroid erythrocytes; hemolytic anemia; increased MCHC - name disease + what is curative + inheritance pattern

Hereditary spherocytosis;Splenectomy is curative;Autosomal dominant

Q3400:Autosomal dominant cell-signalng defect of fibroblast growth factor (FGF) receptor 3. Results in dwarfism; short limbs but head and trunk are normal size - name disease

Achondroplasia

Q3401:Inheritance pattern for cystic fibrosis

Autosomal recessive

Q3402:Inheritance pattern for albinism

Autosomal recessive

Q3403:Inheritance pattern for alpha1-antitrypsin defficiency

AR

Q3404:Inheritance pattern for PKU

AR

Q3405:Inheritance pattern for thalassemias and sickle cell anemias

AR

Q3406:Inheritance pattern for glycogen storage disorders

AR

Q3407:Inheritance pattern for mucopolysaccharidoses ?;EXCEPT - >

AR;EXCEPT Hunters

Q3408:Inheritance pattern for sphingolipidoses- ?;EXCEPT?

AR;EXCEPT Fabrys

Q3409:Inheritance pattern for infant polycystic kidney disease

AR

Q3410:Inheritance pattern for hemochromatosis

AR

Q3411:Infertility in males with cystic fibrosis is due to?

Absence of vas deferens

Q3412:Which vitamins are defficient in patients with cystic fibrosis

Fat soluble ADEK

Q3413:Cystic fibrosis can present as _ in infancy

Failure to thrive

Q3414:Most common lethal genetic disease of Caucasians

Cystic fibrosis

Q3415:Treatment of cystic fibrosis

N-acetylcysteine to loosen mucous plugs

Q3416:Cause of cystic fibrosis + how it presents

Autosomal recessive defect in CFTR gene on chromosome 7. Defective Cl channel -->secretion of abnormally thick mucus that plugs lungs; pancreas and liver --> recurrent pulmonary infections (Pseudomonas and S aureus); chronic bronchitis; bronchiectasis; pancreatic insufficiency (malabsorption and steatorrhea); meconium ileus in newborns

Q3417:Diagnostic test for cystic fibrosis

Increased concentration of Cl ions in sweat

Q3418:Associated with low folic acid intake during pregnancy; elevated alpha fetoprotein in amniotic fluid and maternal serum

Neural tube defects

Q3419:Failure of bony spinal canal to close but no structural herniation; usually seen at lower vertebral levels

Spina bifida occulta

Q3420:Meninges herniate through spinal canal defect

Meningocele

Q3421:Meninges and spinal cord herniate through spinal canal defect

Meningomyelocele

Q3422:Mechanism of fetal alcohol syndrome

Inhibition of cell migration

Q3423:Newborn presents with postnatal developmental retardation; microcephaly; facial abnormalities; limb dislocation and heart and lung fistulas - probable cause?

Fetal alcohol syndrome

Q3424:# 1 cause of congenital malformation in USA

Fetal alcohol syndrome

Q3425:Increase in number of cells (reversible)

Hyperplasia

Q3426:One adult cell type is replaced by another (reversible) - often secondary to irritation and/or environmental exposure

Metaplasia

Q3427:Abnormal growth with loss cellular orientation; shape; and size in comparison to normal tissue maturation; commonly preneoplastic (reversible)

Dysplasia

Q3428:Abnormal cells lacking differentiation; like primitive cells of same tissue; often equated with undifferentiated malignant neoplasms; tumor giant cells may be formed

Anaplasia

Q3429:Clonal proliferation of cells that is uncontrolled and excessive

Neoplasia

Q3430:S-100

Marker for melanoma; neural tumors; and astrocytomas

Q3431:Gastric Adenocarcinoma markers

CEA and bombesin

Q3432:HCC markers

AFP and alpha-1-AT

Q3433:Plummer-Vinson syndrome triad

Dysphagia (due to webs in the upper esophagus); atrophic glossitis; iron-deficiency anemia

Q3434:Pulseless disease

Takayasu arteritis - stenosis of aortic arch and its large branches with ischemia to upper part of the body

Q3435:Trousseau Sign

Migratory thromophlebitis associated with tumors of pancreas; lung; and colon

Q3436:Colon Cancer tumor suppression genes

APC; DCC; p53

Q3437:Pancreatic Cancer tumor suppression gene

DPC

Q3438:Stomach Cancer tumor suppressor gene

DCC

Q3439:Peripheral nerve tumor suppressor gene

NF-1 (neurofibromatosis 1)

Q3440:Inadequate oxygenation is called _

HYPOXIA

Q3441:Most common cause of hypoxia is _

Coronary artery atherosclerosis

Q3442:CO and CN both inhibit _

Cytochrome oxidase

Q3443:How do you treat CO poisoning ?

100% O2

Q3444:Most adversely affected cell in tissue hypoxia _

NEURONS

Q3445:What do you see on ECG in subendocardial ischemia

ST segment depression

Q3446:Cytochrome C activates _

Apoptosis

Q3447:Most common cause of drug induced fulminant hepatitis

ACETAMINOPHEN

Q3448:Reperfusion injury can be caused by ?

O2 and increase in cytosolic Ca

Q3449:What is the difference between dystrophic and metastatic calcification

Dystrophic calcification - calcification of necrotic tissue;Metastatic calcification - calcification of normal tissue

Q3450:Decrease in size of tissue or organ is called _

ATROPHY

Q3451:Increase in cell size is called _

HYPERTROPHY

Q3452:Increase in number of cells _

HYPERPLASIA

Q3453:One cell type replaces another - this is called _

METAPLASIA

Q3454:Disordered cell growth is called _

DYSPLASIA

Q3455:In cerebral infarction - what type of necrosis?

LIUEFACTIVE (NOT coagulative)

Q3456:Most common cause of caseous necrosis

Tuberculosis

Q3457:What type of necrosis in acute pancreatitis

Enzymatic fat necrosis

Q3458:Programmed cell death is called _

Apoptosis

Q3459:Name apoptosis gene

BAX

Q3460:Name anti apoptosis gene

BCL2

Q3461:These cells release preformed histamine

Mast cells

Q3462:Primary leukocytes in acute inflammation

Neutrophils

Q3463:Responsible for "rolling" of neutrophils

Selectins

Q3464:Neutrophil adhesion molecules

Beta 2 integrins

Q3465:Directed migration of neutrophils is called _

CHEMOTAXIS

Q3466:Name 2 opsonins

IgG and C3b

Q3467:In Butons agammogloblinemia there is a defect in _

OPSONIZATION

Q3468:In Chediak Higashi syndrome patient cannot form _

PHAGOLYSOSOMES

Q3469:Most potent microbicidal system

O2 dependent MPO system

Q3470:End product of O2 dependent MPO system

BLEACH

Q3471:In chronic granulomatous disease there is absent _

NADPH OXIDASE AND RESPIRATORY BURST

Q3472:Most important chemical mediator of acute inflammation

HISTAMINE

Q3473:Most common cause of skin abscess

Staph aureus

Q3474:Most common cause of chronic inflammation

INFECTION

Q3475:Primary leukocytes in chronic inflammation

Monocytes and macrophages

Q3476:Granulation tissue is converted to _

Scar tissue

Q3477:Key adhesion glycoprotein in ECM

Fibronectin

Q3478:cell types in granuloma

macrophages and CD4 helper T cells

Q3479:Macrophages activated by gamma interferon from CD4 Th cells are called _

Epithelioid cells

Q3480:Most variable stage in cell cycle

G1

Q3481:Most critical phase in cell cycle

G1 to S

Q3482:Genes controlling G1 to S phases of cell cycle

RB and TP53

Q3483:Key adhesion glycoprotein in basement membrane

LAMININ

Q3484:IN Ehlers Danlos syndrome which collagen is defective

Type I and type III

Q3485:Cofactor in collagenase

Zn

Q3486:Most common cause of impaired wound healing

Infections

Q3487:In which vitamin defficiency is there decreased cross linking of collagen

Vitamin C defficiency

Q3488:Which drugs prevent scar formation

Glucocorticoids

Q3489:In keloids which type collagen is in excess

type III

Q3490:In lung injury which cell is repair cell

TYPE II PNEUMOCYTE

Q3491:What happens in brain with injury

Proliferation of astrocytes and microglial cells

Q3492:With peripheral nerve transection which cell is key cell in reinnervation

Schwann cell

Q3493:Predominant immunoglobulin in acute inflammation

IgM

Q3494:Predominant immunoglobulin in chronic inflammation

IgG

Q3495:Corticosteroid effect in blood

Increased neutrophils;Decreased lymphocytes and eosinophils

Q3496:Marker of necrosis and disease activity

CRP

Q3497:Marker of acute inflammation

IgM

Q3498:Sign of chronic inflammation

Polyclonal gammopathy; increased IgG

Q3499:Large granular lymphocytes in peripheral blood

Natural killer cells

Q3500:When does IgM and IgG synthesis begin

After birth

Q3501:Class I MHC is present on which cells

All nucleated cells

Q3502:Name antigen presenting cells

B cells;Macrophages;Dendritic cells

Q3503:Which HLA protein is associated with ankylosing spondylitis

HLA B27

Q3504:IgE activation of mast cells happens in which type of hypersensitivity

Type I

Q3505:Name potentially fatal type I hypersensitivity reaction

Anaphylactic shock

Q3506:Antibody dependent cytotoxic reactions are what type of hypersensitivity

Type II

Q3507:Activation of compliment by circulating antigenantibody complexes is what type of hypersensitivity

Type III

Q3508:Name antibody activated hypersensitivity reactions

Type I; II; III

Q3509:Which type of hypersensitivity has to do with cellular immunity

Type IV

Q3510:What is the most important requirement for successful transplantation

ABO blood group compatibility

Q3511:Type of transplant with best survival rate

Autograft (self to self)

Q3512:Hyperacute rejection of transplant - is it reversible? what type of hypersensitivity?

Irreversible; type II hypersensitivity

Q3513:Most common type of transplant rejection - what typ of hypersensitivity?

Acute rejection - type IV and type II hypersensitivity

Q3514:Is chronic rejection of transplant reversible

Irreversible

Q3515:What are symptoms and signs of graft versus host reactions

Jaundice;Diarrhea;Dermatitis

Q3516:Most common cardiac finding in SLE

Fibrinous pericarditis with effusion

Q3517:Most common drug associated with drug induced lupus

Procainamide

Q3518:What type of antibodies are present in drug induced lupus

Antihistone antibodies

Q3519:What two tests can confirm SLE

Anti double stranded DNA;Anti Smith antibodies

Q3520:In systemic sclerosis there is excess _

Collagen deposition

Q3521:Most common initial sign of systemic sclerosis

Raynaud phenomenon

Q3522:What type of antibodies are present with systemic sclerosis

Anti-topoisomerase antibodis

Q3523:What does CREST syndrome stand for

Calcinosis;Raynauds phenomenon;Esophageal dysfunction;Sclerodactyly;Telangiectasia

Q3524:In dermatomyositis and polymyositis there is increased _

Serum creatine kinase

Q3525:Im MCTD (mixed connective tissue disease) what kind of antibodies are present

Anti RNP antibodies

Q3526:Most common congenital immunodefficiency

IgA defficiency

Q3527:Most common acquired immunodefficiency disease worldwide

AIDS

Q3528:Pediatric AIDS is mostly due to _ transmission

Vertical (mother to child)

Q3529:HIV is cytotoxic to what type of cells? which immunity is lost?

CD4 T cells;Loss of cell mediated immunity

Q3530:Which protein is detected in ELISA test screen for HIV

anti gp 120

Q3531:Which test confirms HIV

Western blot

Q3532:Which cells are reservoir cells for HIV

Follicular dendritic cells in lymph nodes

Q3533:Most common CNS fungal infection in AIDS

Cryptococcosis

Q3534:Most common malignancy in AIDS

Kaposis sarcoma

Q3535:Most common cause of blindness in AIDS

CMV

Q3536:In hereditary angioedema there is defficiency of what?

C1 esterase inhibitor

Q3537:Which protein exhibits apple green birefringence in polarized light

Amyloid

Q3538:Which protein is associated with Alzheimers disease in Down syndrome

Beta amyloid

Q3539:Major cation of extracellular fluid

Na

Q3540:Major cation of intracellular fluid

K

Q3541:Water movement between extracellular and intracellular fluid compartments is called? What is it controlled by?

OSMOSIS - controlled by serum Na

Q3542:Formula for calculating serum Na

Total body Na/ Total body water

Q3543:What is the sign of volume depletion

Decreased total body Na

Q3544:In which conditions would you see increase in total body Na

Pitting edema;Body cavity effusions

Q3545:What happens to Na in isotonic loss or gain

Serum Na normal

Q3546:What two signs describe hypotonic disorders

Hyponatremia;ICF expansion

Q3547:In which conditions would you see pitting edema

Right sided heart failure;Cirrhosis;Nephrotic syndrome

Q3548:Which signs describe hypertonic disorders

Hypernatremia or hyperglycemia;ICF conraction

Q3549:What happens to Posm and Na in hyperglycemia

Increased Posm;Decreased serum Na

Q3550:What happens to K in alkalosis

Shifts into cell

Q3551:What happens to K in acidosis

Shifts out of cell

Q3552:Most common cause of hypokalemia

Loop and thiazide diuretics

Q3553:What does ECG show in hypokalemia

U wave

Q3554:Most common cause of hyperkalemia

Renal failure

Q3555:What does ECG show in hyperkalemia

Peaked T waves

Q3556:What does PaCO2 have to be to diagnose respiratory acidosis

>45 mm Hg

Q3557:What does PaCO2 have to ne to diagnose respiratory alkalosis

< 33 mmHg

Q3558:What happens in increased anion gap metabolic acidosis

Anions of acid replace HCO3

Q3559:What happens in normal anion gap metabolic acidosis

Cl anions replace HCO3

Q3560:What is the level of HCO3 have to be to diagnose metabolic acidosis

< 22 mE/L

Q3561:Most common cause of metabolic alkalosis

Loop and thiazide diuretics

Q3562:What does HCO3 have to be to diagnose metabolic alkalosis

> 28 mEq/L

Q3563:With _ intoxication there is often mixture of primary metabolic acidosis and primary respiratory alkalosis

SALICYLATE

Q3564:Excess fluid in interstitial space is called _

EDEMA

Q3565:Protein poor and cell poor fluid is called _

TRANSUDATE

Q3566:Protein rich and cell rich fluid is called _

EXUDATE

Q3567:Is there transudate or exudate in pitting edema? What happens to hydrostatic and oncotic pressures?

Transudate;Increased hydrostatic pressure ;Decreased oncotic pressure

Q3568:Most common site for venous thrombosis

Deep vein of lower extremity under knee

Q3569:Name anticoagulants that are used for prevention of venous thrombosis

Warfarin and Heparin

Q3570:Prevents formation of arterial thrombi

Aspirin

Q3571:How do you prevent mixed thrombus

Aspirin + anticoagulant therapy

Q3572:Majority of pulmonary thromboembolism originate in _

Femoral veins

Q3573:Majority of systemic embolisms originate in _

Left side of the heart

Q3574:Most common cause for fat embolism

Fracture of long bones

Q3575:Signs and symptoms of amniotic fluid embolism

Abrupt onset dyspnea;Hypotension;Bleeding (DIC)

Q3576:What happens in decompression sickness

Nitrogen gas bubbles occlude vessel lumens

Q3577:Two serious potential complications of scuba diving

Pneumothorax and pulmonary embolism

Q3578:Most common cause of hypovolemic shock

Blood loss

Q3579:Most common cause of cardiogenic shock

acute MI

Q3580:What happens to cardiac output in hypovolemic shock? Cardiogenic shock? septic shock?

Hypovolemic shock - decreased CO;Cardiogenic shock decreased CO;Septic shock - increased CO

Q3581:What happens to left ventricular end-diastolic pressure in hypovolemic shock? cardiogenic shock? septic shock?

Decreased in hypovolemic and septic shock; increased in cardiogenic shock

Q3582:What happens to peripheral vascular resistance in hypovolemic shock? cardiogenic shock? septic shock?

Increased in cardiogenic and hypovolemic shock; decreased in septic shock

Q3583:Most common cause of death in shock

Multiorgan failure

Q3584:What type of mutation occurs with sickle cell disease/trait

Missense mutation

Q3585:With beta thalassemia major what type of mutation

Nonsense mutation with stop codon

Q3586:In Tay Sachs disease what type of mutation

Frameshift mutation

Q3587:Additional trinucleotide repeats increases disease severity in future generations - this is called _

ANTICIPATION

Q3588:Most common type of mendelian disorder

Autosomal recessive

Q3589:Both parents must have mutant gene - what type of inheritance

Autosomal recessive

Q3590:Enzyme defficiencies disorders usually involve what type of inheritance

AR

Q3591:In PKU what is increased and what is decreased

Phenylalanine increased;Tyrosine decreased

Q3592:What is defficient in Von Gierkes disease

Glucose 6 phosphatase

Q3593:Most common AR disorder

Hemochromatosis

Q3594:Heterozygotes with dominant mutant gene express disease - type of inheritance

AD

Q3595:Individual with mutant gene doesnt express disease this is called

Reduced penetrance

Q3596:Most common AD disorder

Von Willebrand disease

Q3597:Asymptomatic female carrier transmits mutant gene to 50% of sons - what type of inheritance

XR

Q3598:Most common x linked disorder

Fragile X syndrome

Q3599:In which x linked inheritance femaler carriers are symptomatic

XD

Q3600:Number of Barr bodies?

Number of chromosomes - 1

Q3601:Unequal separation of chromosomes in meiosis is called _

Nondisjunction

Q3602:Nondisjunction of chromosomes in mitosis is called _

Mosaicism

Q3603:Which chromosomal defect is present in cri du chat syndrome

Deletion short arm chromosome 5

Q3604:Most cases of Down syndrome occur due to _

Nondisjunction

Q3605:Most common genetic cause of mental retardation

Down syndrome

Q3606:Most important risk factor for bearing offspring with trisomy syndromes

Advanced maternal age

Q3607:45; x caryotype is present in which condition

Turner syndrome

Q3608:Most common genetic cause of primary amenorrhea

Turners syndrome

Q3609:"Menopause before menarche"

Turners syndrome

Q3610:Which hormones are decreased and which are increased in Klinefelters syndrome

Testosterone and inhibin decreased;LH and FSG increased

Q3611:Which chromosome determines genetic sex of individual

Y chromosome

Q3612:Most common cause of pseudohermaphroditism? What is defficient in this disease?

Testicular feminization;Androgen receptors

Q3613:Most common pathogen causing congenital infection

CMV

Q3614:Name TORCH infections

Toxoplasmosis;Other agents;Rubella;CMV;Herpes simplex

Q3615:Most common cause of stillbirth

Abruptio placentae

Q3616:Common cause of spontaneous abortions

Trisomy 16

Q3617:Most common cause for large for gestational age babies

Maternal diabetes

Q3618:Most common cause of neonatal morbidity/mortality

Prematurity

Q3619:Triple marker for Down syndrome

Decreased AFP;Increased hCG;Decrease in unconjugated urine

Q3620:Most important preventable cause of disease and death in US

Smoking

Q3621:Do women or men have less gastric alcohol dehydrogenase and therefore reach hight alcohol levels

Women

Q3622:Most common cause of thiamine defficiency

Alcohol abuse

Q3623:Increased anion gap metabolic acidosis is caused by _

Lactic acid and beta-hydroxybutyric acid

Q3624:Most common systemic complication of intravenous drug use

Hepatitis B

Q3625:Oral contraceptives decrease risk for which cancers

Endometrial and ovarian

Q3626:Most common cause of hypertension in young woman

Oral contraceptives

Q3627:Most common cause of death in burn victims

sepsis caused by Pseudomonas

Q3628:Least sensitive tissue to radiation

Bone

Q3629:First hematological sign of total body radiation

Lymphopenia

Q3630:Most frequent type of cancer caused by radiation

Acute leukemia

Q3631:Which UV light is most damaging and how

UVB - increase in pyrimidine dimers distorts DNA helix

Q3632:Most common UVB related skin cancer

Basal cell carcinoma

Q3633:Where does carbohydrate digestion begin

Mouth

Q3634:Where does protein digestion begin

Stomach

Q3635:Where does fat digestion begin

Small intestine

Q3636:What is characteristic feature of kwashiorkor

Pitting edema

Q3637:What is characteristic feature of marasmus

Extreme muscle wasting

Q3638:Most common cause of death in anorexia nervosa

Ventricular arrythmia

Q3639:What is the complication caused by vomitting in bulimia nervosa

Hypokalemic metabolic alkalosis

Q3640:Which gene is usually defective in obesity

Leptin gene

Q3641:First sign of vitamin A defficiency

Night blindness

Q3642:Most common cause of vitamin D defficiency

Renal failure

Q3643:Vitamin E toxicity causes _

Decreased synthesis of vitamin K dependent coagulation factors

Q3644:Most common cause of vitamin K defficiency in hospital

Broad spectrum antibiotics

Q3645:Rat poison contains _ derivatives

Coumarin

Q3646:People on corn based diets are defficient in _

Tryptophan and niacin

Q3647:Three D's of pellagra

Dermatitis ;Diarrhea;Dementia

Q3648:Most common cause of vitamin B12 defficiency

Perncious anemia

Q3649:Most common cause of folate defficiency

Alcohol abuse

Q3650:Defficiency of ascorbic acid is called _

Scurvy

Q3651:Poor wound healing; poor taste and perioral rash are signs of what defficiency

Zn

Q3652:Iodide defficiency results in _

Multinodular goiter

Q3653:Benign tumors are of what origin

Epithelial or connective tissue

Q3654:Tumor that has derivatives of ectoderm; endoderm and mesoderm is called_

Teratoma

Q3655:Carcinomas derive from?

Squamous;Glandular (adenocarcinoma);Transitional epithelium

Q3656:Sarcoma derives from?

Connective tissue

Q3657:Non neoplastic overgrowth of tissue is called _

Hamartoma

Q3658:Which cancer invades tissue but doesnt metastasize

Basal cell carcinoma of skin

Q3659:Which metastasis have greater prognostic significance nodal or extranodal

Extranodal (liver; etc)

Q3660:Name 3 routes of metastasis

Lymphatic;Hematogenic;Seeding of body cavities

Q3661:2 types of bone metastasis

Osteoblastic (radiodense);Osteolytic (radioluscent)

Q3662:Most common cause of cancer deaths in adults

Lung cancer

Q3663:Precursor of squamous cell carcinoma

Actinic (solar) keratosis

Q3664:How can you reduce risk for developing gastric lymphoma and adenocarcinoma

Treat H pylori

Q3665:Most common type of mutation in cancer

Point mutation

Q3666:Which genes protect from unregulated cell growth? Which are involved in normal growth and repair?

Suppressor genes;Proto- oncogenes

Q3667:What is the most effective host defense against cancer

Cytotoxic CD8 T cells

Q3668:What is the most common cause of death in cancer

Gram negative sepsis

Q3669:What is the most common paraneoplastic syndrome

Hypercalcemia

Q3670:Diet derived triglyceride

Chylomicron

Q3671:Liver derived triglyceride

VLDL

#NAME?

LDL

Q3673:Removes cholesterol from plaques for disposal in the liver

HDL

Q3674:Pathognomonic lesion of atherosclerosis

Fibrous cap

Q3675:Excellent marker of disrupted fibrous plaques

CRP

Q3676:Most common site for atherosclerosis

Abdominal aorta

Q3677:2 conditions associated with hyaline arteriosclerosis

DM;Hypertension

Q3678:Most common aneurysm in men>55 years of age

Abdominal aortic aneurysm

Q3679:Rupture of aneurysm triad

Left flank pain;Hypotension;Pulsatile mass

Q3680:2 conditions of aortic arch aneurysm

Tertiary syphillis;Vasculitis of vasa vasorum

Q3681:Most common cause of death in Marfan syndrome and EDS

Aortic dissection

Q3682:Most common cause of death with aortic dissection

Cardiac tamponade

Q3683:Symptoms and signs of small vessel vasculitis

Palpable purpura

Q3684:Symptoms and signs of medium sized vessel vasculitis

Thrombosis;Aneurysm formation

Q3685:Most common type of hypertension

Essential hypertension

Q3686:Most common cause of secondary hypertension

Renovascular hypertension

Q3687:Ventricular hypertrophy occurs due to_

Increased afterload or increased preload

Q3688:Pulmonary edema is seen in which heart failure

Left

Q3689:First cardiac sign of LHF

S3

Q3690:Increases intensity for left sided heart murmurs and abnormal heart sounds

Expiration

Q3691:Increases intensity of right sided heart murmurs and abnormal heart sounds

Inspiration

Q3692:Inrease in venous hydrostatic pressure occurs in which heart failure

Right

Q3693:Most common manifestation of CAD

Angina pectoris

Q3694:Subendocardial ischemia with ST segment depression is what type of angina

Stable

Q3695:Vasospasm with transmural ischemia and ST segment elevation is what type of angina

Prinzmetals angina

Q3696:Most common cause of death in acute MI

Ventricular fibrillation

Q3697:Most common cause of death in CHF

Ventricular aneurysm

Q3698:Gold standard for diagnosis of acute MI

Cardiac troponin I and T

Q3699:ECG findings in acute MI

Inverted T waves; elevated ST segments; Q waves

Q3700:Stimuli for EPO

Hypoxemia;Left-shifted OBC;High altitude

Q3701:Where is EPO synthesized?

In endothelial cells of peritubular capillaries

Q3702:Measure of effective erythropoiesis; corrected for the degree of anemia

Reticulocyte count

Q3703:Extramedullary hematopoiesis most often occurs where?

In liver and spleen

Q3704:What happens to Hb; Hct and RBC count in thalassemia

Hb; Hct decreased;RBC count increased

Q3705:What happens to RDW in iron defficiency

Increased

Q3706:End product of heme degradation in macrophage

Unconjugated bilirubin

Q3707:What is the main source of energy in mature RBC

Anaerobic glycolysis

Q3708:Serum ferritin is _ in iron defficiency anemia

Decreased

Q3709:Serum ferritin is _ in ACD; iron overload disease

Increased

Q3710:Serum iron is _ in iron defficiency; ACD

Decreased

Q3711:Serum iron is _ in iron overload disease

Increased

Q3712:If serum total iron binding capacity is decreased it means that transferin is _

Decreased

Q3713:In microcytic anemia there is defect in _

Synthesis of Hb (heme + globin chain)

Q3714:Iron defficiency most often caused by _

Bleeding

Q3715:Most common anemia in hospitalized patients

ACD - anemia of chronic disease

Q3716:With sideroblastic anemia there is defect in _

Heme synthesis in mitochondria; ringed sideroblasts

Q3717:Most common cause of sideroblastic anemia

Alcohol

Q3718:Most common cause of pyridoxine defficiency

Isoniazid

Q3719:In lead poisoning where does lead deposit

Epiphyses

Q3720:Most common cause of vitamin B12 defficiency

Pernicious anemia

Q3721:Which drug inhibits intestinal conjugase

Phenytoin

Q3722:Monoglutamate reabsorption is inhibited by _

Alcohol and oral contraceptives

Q3723:Most common cause of folate defficiency

Alcohol

Q3724:McArdle

glycogen storage disease;muscle

Q3725:von Gierke

glycogen storage disease;liver and kidneys

Q3726:Wilson

Copper metabolism #;liver and brain

Q3727:Galactosemia

galactose metabolism #;liver; lens; brain

Q3728:Turcot

CNS: gliomas;GI tract: adenomas

Q3729:Caroli

congenital malformation bile ducts

Q3730:May-White

familial progressive myoclonus epilepsy with lipomas; deafness; ataxia

Q3731:Crigler-Najjar

Unconjugated bili- severe

Q3732:Gilbert

Unconjugated bili- mild

Q3733:Dubin-Johnson

conjugated bili- mild

Q3734:Rotor

conjugated bili- mild

Q3735:Sturge-weber

leptomeningial angiomatosis; port-wine stain; mental retardation; seizures; hemiplegia

Q3736:Von hippel lindau

capillary hemangioblastoma;retinal angiomas;renal ca ;cysts or ang# any organ

Q3737:Gardner

fam. colon ca; and osteomas; epidermal cysts; fibromatosis; abnormal teeth; thyroid ca; duodenal ca; pigmented ocular fundus; desmoid tumors

Q3738:Menkes

copper deficiency -> #collagen crosslinking -> depigmented lusterless hair; facial/ocular/vascular/cerebral #

Q3739:Milroy

congenital lymphatic malformation / lymphedema

Q3740:Wermer

MEN 1;parathyroid (hypercalcemia; kidney stones);pituitary;pancreas (ulcers)

Q3741:Sipple

MEN 2a;pheochromo;parathyroid;thyroid

Q3742:shy-drager

ANS failure -> orthostatic hypotension and parkinsonism

Q3743:Budd-Chiari

IVC or hepatic vein occlusion (caused by malignancy or congenital IVC webs)

Q3744:Bloom's

auto rec = small body size; immunodeficiency; light-sensitive facial erythema; predisp cancer

Q3745:Rett

only females; severe impairment; characteristic hand wringing movements

Q3746:Churg-Strauss

allergic granulomatosis and angiitis -> asthma and eosinophilia and vasculitis

Q3747:Reye

postviral/aspirin -> enlarged distorted mitochrondria -> esp. liver (disruption biochemical pathways -> microvesicular steatosis); brain (edema). 75% mild; 25% coma; liver failure or cns#; incr ammonia

Q3748:Wiskott-Aldrich

thrombocytopenia; eczema; recurrent sinopulmonary infections;low IgM; high IgE; IgG; IgA; defective response to polysaccharide antigens (defect T cells prevents binding to B cells);12% chance of non-hodgkin lymphoma!

Q3749:Chediak-Higashi

no lysosomal enzymes in phagosomes -> giant inclusions -> infections (neutropenia); albinism; nerve deficits; bleeding diathesis

Q3750:Tuberous sclerosis

MR; seizures; hypopigment (!!); angiofibromata (adenoma sebaceum); large cortical hamartomas; renal angiomyolipomas; cardial rhabdomyomas

Q3751:de Quervain

postviral destruction thyroid causing hyper than hypo

Q3752:Nelson

extreme hyperpigmentation after adrenalectomy

Q3753:Eisenmenger

shift from L-R shunt to R-L dus to pulm HT

Q3754:Dressler's

complication MI -> autoimmune fibrinous pericarditis with fever and peripleural chest pain (several weeks after MI)

Q3755:Peutz-jeghers

polyps (complex branching pattern; benign); melanin spots and incr risk breast/pancreas/overy/uterus/lung ca

Q3756:Potter

bilateral renal agenesis -> oligohydramnios

Q3757:Lesch-Nyhan

purine metabolism# (no HGPRT);aggressive; self-mutilation; gout; gouty nephropathy; yellow-orange crystals of uric acid in diaper

Q3758:maple syrup disease

branched chain amino acid #;motor abnormalities and seizures

Q3759:phenylketonuria

aromatic amino acid metabolism #;mental retardation

Q3760:orotic aciduria

pyrimidine metabolism #;retarder growtha nd development and megaloblastic anemia

Q3761:homocystinuria

sulfur containing amino acid #;mental retardation; dislocation of lenses; osteoporosis; thrombosis

Q3762:Binswanger

subcortical leukencephalopathy ;Diffuse loss of deep white matter - ass hypertension

Q3763:Albinism

copper-dependent tyrosinase deficiency -> block production melanin from aromatic amino acid tyrosine

Q3764:Pickwickian syndrome

= obesity hypoventilation syndrome;obesity and sleep apnea

Q3765:What are the risk factors for HTN?

increased age;obesity;diabetes;smoking;genetics;blacks > whites > Asians

Q3766:What does HTN predispose?

atherosclerosis;stroke;CHF;renal failure;retinopathy;aortic dissection

Q3767:Monckeberg atherosclerosis

calcification of the arteries; esp. radial or ulnar;usually benign

Q3768:atreriolosclerosis

hyaline thickening of small arteries in essential HTN;hyperplastic "onion-skinning" in malignant HTN

Q3769:atherosclerosis

disease of elastic arteries and large and medium-sized muscular arteries

Q3770:What are the risk factors in developing atherosclerosis?

smoking;HTN;diabetes mellitus;hyperlipidemia;family history

Q3771:What are the complications of atherosclerosis?

aneurysms;ischemia;infarcts;peripheral vascular disease;thrombus;emboli

Q3772:Where do atherosclerotic plaques tend to form?

abdominal aorta > coronary artery > popliteal artery > carotid artery

Q3773:What is the progression of atherosclerosis?

fatty streaks -> proliferative plaque -> complex atheromas

Q3774:stable angina

most common form of angina;pain precipitated by exertion and is relieved by rest or vasodilators (e.g; nitroglycerine)

Q3775:Prinzmetal's angina

intermittent chest pain at rest;caused by vasospasm

Q3776:unstable/cresendo angina

prolonged or recurrent pain at rest;often indicative of imminent MI

Q3777:Which type of angina has pain that is relieved by rest?

stable angina

Q3778:Which type of angina has pain that gets worse during rest

Prinzmetal's angina;unstable/cresendo angina

Q3779:Which type of angina has intermittent chest pain at rest?

Prinzmetal's angina

Q3780:Which type of angina is caused by vasospasms?

Prinzmetal's angina

Q3781:Which type of angina is relieved by vasodilators?

stable angina

Q3782:Which type of angina is indicative of imminent MI?

unstable/cresendo angina

Q3783:Which type of angina is a result of severe narrowing of atheroscclerotic coronary vessels?

stable angina

Q3784:What is the most common form of angina?

stable angina

Q3785:Where do red (hemorrhagic) infarcts occur?

loose tissue w/ collaterals (e.g; lungs; intestine) or following reperfusion

Q3786:Where do pale infarcts occur?

in solid tissues w/ single blood supply (e.g; brain; heart; kidney; spleen)

Q3787:Which coronary arteries are occluded the most? the least?

LAD > RCA > circumflex

Q3788:When is an MI maximally yellow and soft?

10 days post-MI

Q3789:When are contraction bands visible on an MI?

4 hours post-MI

Q3790:When is ECG the best method of diagnosis of an MI?

w/in the first 6 hours post-MI

Q3791:When does cardiac troponin I begin to rise? How long does it stay elevated?

rises after 4 hours;elevated for 7-10 days

Q3792:What is the test of choice for MI in the first 24 hours post-MI?

CK-MB

Q3793:How long does LDH stay elevated post-MI?

2-7 days

Q3794:Is AST specific for liver?

no;can also be found in cardiac; liver and skeletal muscle cells

Q3795:ST elevation

transmural infarct

Q3796:ST depression

subendocardial infarct

Q3797:Q waves

transmural infarct

Q3798:What are the complications of an MI?

cardiac arrhythmia;LV failure and pulmonary edema;cardiogenic shock;rupture of ventricular free wall; interventricular septum; papillary muscle; cardiac tamponade;thromboembolism - mural thrombus;fibrinous pericarditis (friction fub);Dressler's syndrome (autoimmune pheenomenon resulting in fibrinous pericarditis)

Q3799:What is the most common cardiomyopathy?

dilated (congestive) cardiomyopathy - 90%

Q3800:What type of cardiomyopathy causes systolic dysfunction?

dilated (congestive) cardiomyopathy

Q3801:What type of cardiomyopathy causes diastolic dysfunction?

hypertrophic cardiomyopathy

Q3802:hypertrophic cardiomyopathy

walls of LV are thickened (esp. the ventricular septum) and chamber becomes banana shaped;cause of sudden death in young athletes;50% inheriited as autosomal dominant trait;characterized microscopically by disoriented and tangled myocardial fibers

Q3803:dilated cardiomyopathy

most comon form of cardiomyopathy;characterized by dilation of both ventricles and by both right- and left-sided heart failure

Q3804:restrictive cardiomyopathy

caused by infiltrative processes w/in myocardium that results in stiffening of the heart muscle -> interferes w/ pumping action;exemplified by cardiac amloidosis -> right- and leftsided heart failure

Q3805:mitral regurgitation

holosystolic high-pitched "blowing murmur";loudest at apex

Q3806:aortic stenosis

crescendo-decrescendo systolic ejection murmur following ejection click;LV >> aortic pressure during systole;radiates to carotids/apex

Q3807:VSD

holosystolic murmur

Q3808:mitral prolapse

late systolic murmuc w/ midsystolic click;most frequent valvular lesion

Q3809:aortic regurgitation

immediate high-pitched "blowing" diastolic murmur;wide pulse pressure

Q3810:mitral stenosis

follows opening snap;delayed rumbling late diastolic murmur;LA >> LV pressure during diastole

Q3811:patent ductus arteriosus

continusos machine-like murmur;loudest at time of S2

Q3812:What are the causes of serous pericarditis?

SLE;rheumatoid arthritis;infection;uremia

Q3813:What are the causes of fibrinous pericarditis?

uremia;MI;rheumatic fever

Q3814:What are the causes of hemorrhagic pericarditis?

TB;malignancy

Q3815:What are the findings in hemorrhagic pericarditis?

pericardial pain;friction rub;ECG chances (diffuse ST elevations in all leads);pulsus paradoxus;distant heart sounds

Q3816:syphilitic heart disease

tertiary syphilis disrupts the vasa vasorum of the aorta -> dilation of the aorta and valve ring;"tree bark" appearance of the aorta

Q3817:Buerger's disease;(aka thromboangiitis obliterans)

acute inflammation involving small to medium size arteries of the extremities; extending to adjacent veins and nerves;clearly assoc. w/ smoking

Q3818:What is the treatment for Buerger's disease?

quit smoking

Q3819:Takayasu's arteritis

inflammation and stenosis of medium and large sized arteries w/ freq. involvement of the aortic arch and its branches -> arotic arch syndrome;assoc. w/ elevated ESR;primarily affects young Asian females

Q3820:What are the clinical symptoms of Tayakasu's arteritis?

(FAN ON MY SKIN On Wednesday);Fever;Arthritis;Night sweats;MYalgia;SKIN nodules;Ocular disturbances;Weak pulses in upper extremities

Q3821:Takayasu's arteritis primarily affects what population?

young Asian females

Q3822:Buerger's diease affects what vessels?

small and intermediate vessels of the extremities

Q3823:Takayasu's arteritis involves what vessels?

medium and large arteries w/ frequent involvement of the aortic arch and its branches

Q3824:temporal arteritis;(giant cell arteritis)

most common vasculitis that affects medium and small arteries; usually branches of carotid artery

Q3825:What are the clinical symptoms of temporal arteritis?

unilateral headache;jaw claudication;imparied vision (occlusion of opthalmic artery -> blindness)

Q3826:What population does temporal arteritis affect most?

elderly females

Q3827:Temporal arteritis is associated w/ what lab finding?

elevated ESR

Q3828:polyarteritis nodosa

necrotizing immue complex inflammation of medium-sized muscular arteries; typically involving renal and visceral vessels

Q3829:What is the treatment for polyarteritis nodosa?

corticosteroids;cyclophosphamide

Q3830:Wegner's granulomatosis

characterized by focal necrotizing vasculitis and necrotizing granulomas in the lung and upper airway and by necrotizing glomerulonephritis

Q3831:What is a strong marker for Wegner's granulomatosis?

C-ANCA

Q3832:What is the treatment for Wegner's granulomatosis?

cyclophosphamide and corticosteroids

Q3833:microscopic polyangiitis

similar to Wegner's granulomatosis but lacks granulomas;P- or C-ANCA

Q3834:Churg-Strauss syndrome

granulomatous vasculitis w/ eosinophilia

Q3835:What organs are involved in Churg-Strauss syndrome?

lung; heart; skin; kidneys; nerves

Q3836:Kawasaki's disease

acute; self-limiting disease of infants/kids;acute necrotizing vasculitis of small/medium-sized vessels

Q3837:People w/ Kawasaki's disease may develop what?

coronary aneurysms

Q3838:what does uremia do to the bone marrow?

makes it less responsive to EPO

Q3839:what is hydroxyurea used for?

increases production of fetal hemoglobin HbF

Q3840:what are Howell Jolly bodies?

inclusions of nuclear chromatin remnants seen in RBCs of pts with hypoactive splenic function

Q3841:why should sickle cell patients consider prophylactice cholecystectomy?

70% of sickle cell patients develop symptomatic cholelithiasis

Q3842:why does hepatosplenomegaly develop in thalassemia pts?

increased hemolysis of abnormal RBCs by macrophages in the spleen and liver; extramedullary hematopoiesis

Q3843:where is dietary iron absorbed and in what form?

absorbed in proximal duodenum; we eat Fe+++ and absorb as Fe++

Q3844:why do pts with chronic disease develop anemia?

1. chronic inflammation leads to more cytokines in blood and resulting increase in phagocytic activity destroying RBCs;2. cytokines inhibit renal secretion of EPO;3. lactoferrin released by inflammatory cells binds serum iron and makes it unavailable for erythropoiesis

Q3845:what's the big picture problem in anemia of chronic disease and iron?

high iron stores; but unavailable to the body

Q3846:what does B12 do?

1. catalyzes conversion of homocysteine to methionine;2. catalyzes conversion of methyltetrahydrofolate to tetrahydrofolate;3. converts methylmalonic acid to succinyl CoA

Q3847:what is tetrahydrofolate?

form of folic acid used in DNA synthesis

Q3848:what is G6PD?

the rate-limiting step in HMP pathway for NADPH production

Q3849:what is glutathione?

after reduction by NADPH; it combats oxidatative damage in cells

Q3850:what is primary hemostasis?

production of the temporary platelet plug

Q3851:how does tPA work as a clot buster?

it's an enzyme that activates plasminogen; converting it to plasmin which cleaves fibrin strands

Q3852:how does heparin work?

stimulates antithrombin III; which inhibits thrombin (factor II)

Q3853:what is microangiopathic hemolytic anemia?

hemolytic anemia due to intravascular fracture of RBCs

Q3854:E. coli 0157 and Shigella species are known for causing what heme dysfunction?

TTP or HUS

Q3855:what's the main problem in TTP or HUS?

endothelial damage leads to platelet consumption

Q3856:what does desmopressin acetate (DDAVP) do?

stimulates the liver to produce plasma clotting factors

Q3857:what are 2 common causes of acquired platelet dysfunction?

uremia and NSAIDs

Q3858:how do clopidogrel and ticlopidine work?

these 2 antiplatelet drugs block platelet-ADP receptor activation

Q3859:how do abciximab; eptifibatide and tirofiban work?

inhibit platelet GpIIb-IIIa receptor which mediates aggregation via a "fibrinogen bridge"

Q3860:what anticoagulant can cause thrombocytopenia?

heparin in 1-3% of pts;;can cause 2 syndromes;HITS: heparin induced thrombocytopenia syndrome;HITT: heparin induced thrombocytopenia thrombosis

Q3861:how can ITP be treated?

prednisone to slow the immune-mediated destruction of platelets

Q3862:What is the term for an abnormal amount of collagen type III that produces a large bulging scar; seen primarily in blacks?

Keloid

Q3863:True or false? Klinefelter syndrome cannot be diagnosed until puberty.

True

Q3864:What form of sunlight is the most carcinogenic?

Ultraviolet B (UVB) sunlight

Q3865:What renal pathology involves uniform thickening of the glomerular capillary wall; granular appearance under the microscope; and effacement of foot processes?

Membranous glomerulonephritis

Q3866:What enveloped RNA retrovirus infects CD4 T cells and uses the enzyme reverse transcriptase?

HIV

Q3867:What enzyme is deficient in chronic granulomatous disease of childhood?

NADPH oxidase

Q3868:What rare disorder presents as a large; hard; irregular thyroid gland due to fibrous proliferation of connective tissue in the thyroid gland and extends to adjacent structures?

Riedel thyroiditis

Q3869:Rheumatic fever most commonly follows pharyngeal infections with what bacteria?

Group A beta -hemolytic streptococci

Q3870:What benign cardiac tumor is associated with tuberous sclerosis?

Rhabdomyoma

Q3871:What are the rules of 10 regarding pheochromocytoma?

10% are bilateral; 10% malignant; and 10% familial; 10% in children; 10% outside the adrenal gland; and 10x more likely to be seen on the USMLE than in real life

Q3872:What vascular pathology is associated with HTN in the upper extremities; hypotension in the lower extremities; and a radial-femoral delay?

Postductal coarctation of the aorta (adult)

Q3873:What seronegative spondyloarthropathy is seen in HLA-B27–positive young females and presents with the triad of conjunctivitis; urethritis; and arthritis affecting the knees and ankles?

Reiter syndrome

Q3874:What AD disease involves hyperkeratosis of the palms and soles in association with esophageal carcinoma?

Tylosis

Q3875:A 20-year-old woman who was recently diagnosed with a sexually transmitted disease goes to the ER with a tender; painful; swollen; and erythematous knee (monoarticular). What organism is the likely culprit?

Neisseria gonorrhea (history of STD in patient with monoarticular infectious arthritis: think gonococcus)

Q3876:What vasculitis is characterized by systemic vasculitis in small to medium- size vessels (except the lung); affecting young males; 30% HBsAg-positive; P-ANCA and autoantibodies against myeloperoxidase?

Polyarteritis nodosa

Q3877:What malignant bone tumor is associated with familial retinoblastoma?

Osteosarcoma

Q3878:What bilateral AR disorder seen in infancy as progressive renal failure has multiple small cysts at right angles to the cortical surface?

Polycystic kidney disease of childhood

Q3879:In what syndrome does the patient have angiomatosis; renal cell carcinomas; pheochromocytomas; retinal; cerebellar; medulla; or spinal cord hemangioblastomas; and epidermal cysts?

von Hippel-Lindau syndrome

Q3880:What is the term for hyperextension of the PIP and flexion of the DIP joints in rheumatoid arthritis?

Swan-neck deformities

Q3881:What is the term for white retinal spots surrounded by hemorrhage? In what condition are they seen?

Roth spots; and they are seen in bacterial endocarditis.

Q3882:A 70-year-old man complains of urinary urgency; nocturia; hesitancy; postvoid dribbling; urinary retention; and a PSA result of 6.5 ng/mL. What is your diagnosis?

BPH. Although an argument can be made for prostatic cancer (you should expect a much higher PSA result); these are buzzwords for BPH. Prostatic cancer is usually silent until late in the disease; when obstructive symptoms begin to occur.

Q3883:What triad consists of endothelial injury; changes in laminar flow; and hypercoagulation?

Virchow triad; associated with the formation of a thrombus.

Q3884:What bone cell has receptors for PTH?

Osteoblasts (Remember; they modulate the function of osteoclasts.)

Q3885:What type of peptic ulcer disease is characterized by the onset of burning epigastric pain immediately after eating?

Gastric ulcer

Q3886:What is the term for normal cellular genes associated with growth and differentiation?

Proto-oncogenes

Q3887:Blue sclera is seen in what hereditary bone disorder?

Osteogenesis imperfecta

Q3888:What form of anemia is diagnosed with sucrose lysis test and Ham test?

Paroxysmal nocturnal hemoglobinuria

Q3889:In what rare AR disorder do you see neutropenia; defective degranulation; and delayed microbial killing due to a problem in chemotaxis and migration?

Chédiak-Higashi syndrome

Q3890:What myeloid disorder is characterized by increased hematocrit; blood viscosity; basophils; and eosinophils; intense pruritus; and gastric ulcers due to histamine release from basophils; increased left atrial pressure; and plethora?

Polycythemia vera (Remember; polycythemia vera is a risk factor for acute leukemias.)

Q3891:If you order a V/Q scan for suspected pulmonary emboli; is the filling defect seen on the ventilation or perfusion side?

Ventilation of an unperfused lung segment is highly suspicious for pulmonary embolism.

Q3892:What transports iron in the blood?

Transferrin

Q3893:What hematological malignancy is particularly likely to affect patients with Down syndrome?

ALL (nearly 15–20 times the normal risk)

Q3894:What childhood pathology involves anterior bowing of the tibia; epiphyseal enlargements; and costochondral widening; with the endochondral bones being affected?

Rickets

Q3895:A Japanese man has weight loss; anorexia; early satiety; epigastric abdominal pain; and a palpable left supraclavicular lymph node. On endoscopy you find a large; irregular ulcer with elevated margins on the lesser curvature of the stomach. What is your diagnosis?

Gastric carcinoma

Q3896:What drug causes a sixfold increase in schizophrenia; can impair motor activity; and can cause lung problems?

Marijuana

Q3897:What is the term for neurologic signs consistent with a cerebrovascular accident but lasting 24 hours with full recovery?

Transient ischemic attack

Q3898:What is the name of the tumor when gastric carcinoma spreads to the ovaries?

Krukenberg tumor

Q3899:What condition results from a deficiency in the enzyme hexosaminidase A?

Tay-Sachs disease

Q3900:Which cerebral herniation results in compression of the anterior cerebral artery?

Cingulate gyrus herniation (subfalcine)

Q3901:What pathology involves excessive fibrosis throughout the body via increased fibroblast activity; occurs in women more than men; and is most commonly seen in the third to the fifth decade?

Scleroderma

Q3902:What is the term for the syndrome consisting of hepatomegaly; ascites; and abdominal pain due to hepatic vein thrombosis?

Budd-Chiari syndrome

Q3903:What form of angina is characterized by;? Coronary artery vasospasm; symptom occurrence at rest; ST segment elevation (during episode); and no signs on ECG?

Prinzmetal variant angina

Q3904:What form of angina is characterized by;? Coronary artery luminal narrowing; symptom occurrence during exertion; ST segment depression on ECG?

Stable angina

Q3905:What form of angina is characterized by;? Coronary artery nonocclusive thrombus; symptom occurrence with increasing frequency; duration; intensity; and decreasing activity; frequently at rest?

Unstable (crescendo) angina

Q3906:What skin condition is a localized proliferation of melanocytes presenting as small; oval; light brown macules?

Benign lentigo

Q3907:What is the term for nonneoplastic abnormal proliferation of cell size; shape; and cellular organization?

Dysplasia

Q3908:What diagnosis ensues from finding well-demarcated erythematous plaques with silvery scales on the knees; elbows; and scalp along with nail bed pitting and discoloration?

Psoriasis

Q3909:What renal disease in diabetic patients is seen as a halo of capillaries around the mesangial nodules?

Kimmelstiel-Wilson disease

Q3910:What autoimmune liver disease is characterized by affecting a middle-aged woman with jaundice; pruritus; fatigue; xanthomas; increased direct bilirubin levels; and antimitochondrial Abs?

Primary biliary cirrhosis

Q3911:What cell in chronic inflammation is derived from blood monocytes?

Macrophages

Q3912:True or false? Pancreatic insufficiency results in vitamin B12 malabsorption.

True. Pancreatic enzymes begin the breakdown of vitamin B12-R complex in the duodenum.

Q3913:What neuroendocrine tumor produces excess serotonin; is associated with diarrhea; flushing; bronchospasms; wheezing; and is diagnosed by findings of elevated urinary 5-HIAA levels?

Carcinoid tumor

Q3914:What tumor constitutes 40% of testicular tumors in children?

Teratoma

Q3915:What urinary metabolite is elevated in pheochromocytoma?

Vanillylmandelic acid (VMA)

Q3916:A 25-year-old black woman presents with nonproductive cough; shortness of breath; fatigue; and malaise; she has bilateral hilar lymphadenopathy on chest radiography and elevated ACE levels. What do you diagnose?

Sarcoidosis

Q3917:What are the four reasons for hypochromic microcytic anemia with a low MCV?

1. Sideroblastic anemias (i.e; porphyrin and heme synthesis disorders) ;2. Thalassemia ;3. Iron deficiency ;4. Lead poisoning

Q3918:What is characterized by an intense inflammatory reaction; an increase in the amounts of granulation tissue and wound contraction by myofibroblasts?

Healing by secondary intention

Q3919:What thyroiditis presents as a tender; enlarged; firm thyroid gland; usually preceded by an upper respiratory viral illness?

de Quervain thyroiditis

Q3920:What disorder leads to IgG autoantibodies to the TSH receptor?

Graves disease

Q3921:What intrauterine deficiency leads to failure to thrive; mental retardation; motor incoordination; and stunted growth?

Iodine; resulting in congenital hypothyroidism

Q3922:What pancreatic islet cell tumor is associated with MEN I syndrome?

Gastrinoma

Q3923:What type of PUD is classically described by the onset of burning epigastric pain 1 to 3 hours after eating that is relieved by food?

Duodenal ulcer

Q3924:What disease arises from the adrenal medulla; displaces and crosses the midline; metastasizes early; is the most common solid tumor; and is seen in the 2-to 4-year-old age group?

Neuroblastoma

Q3925:What AD disease associated with chromosome 19 involves a defect in the LDL receptors that leads to skin and tendon xanthomas?

Familial hypercholesterolemia

Q3926:A 20-year-old woman goes to the ER with ptosis; diplopia; weakness in her jaw muscles when chewing; and muscle weakness with repeated use. What is your diagnosis?

Myasthenia gravis

Q3927:What is the term for RBCs with smooth undulations on the surface of their membrane; commonly seen in uremia?

Burr cells (echinocytes)

Q3928:Name the cancer associated with the following tumor markers. (Some may have more than one answer.);? Beta-hCG

Choriocarcinomas and trophoblastic tumors

Q3929:Name the cancer associated with the following tumor markers. (Some may have more than one answer.);? CA-125

Ovarian cancer

Q3930:Name the cancer associated with the following tumor markers. (Some may have more than one answer.);? CA-19.9 and CEA

Pancreatic cancer

Q3931:Name the cancer associated with the following tumor markers. (Some may have more than one answer.);? alphaFetoprotein

Hepatoma and nonseminomatous testicular germ cell tumors

Q3932:Name the cancer associated with the following tumor markers. (Some may have more than one answer.);? Calcitonin

Medullary carcinoma of the thyroid

Q3933:Name the cancer associated with the following tumor markers. (Some may have more than one answer.);? PSA and prostatic acid phosphatase

Prostate cancer

Q3934:Name the cancer associated with the following tumor markers. (Some may have more than one answer.);? Placental alkaline phosphatase

Seminoma

Q3935:Name the cancer associated with the following tumor markers. (Some may have more than one answer.);? CEA

Cancer of the lung; stomach; colon; and breast

Q3936:What seronegative spondyloarthropathy is seen in HLA-B27–positive young men; involves the sacroiliac joints; has no subcutaneous nodules; and has a bamboo spine appearance on radiograph?

Ankylosing spondylitis

Q3937:What disorder is associated with decreased platelet count; prolonged PT and PTT; decreased fibrinogen; and increased fibrin split products (D-dimers)?

Disseminated intravascular coagulation (DIC)

Q3938:What spirochete is responsible for Lyme disease?

Borrelia burgdorferi

Q3939:What very aggressive lung cancer metastasizes early and is associated with smoking and paraneoplastic syndromes?

Small cell carcinoma (oat cell)

Q3940:What bone disorder is characterized by brown tumors; bone pain; deformities; and fractures due to excessive PTH?

Osteitis fibrosa cystica (von Recklinghausen disease)

Q3941:What glycogen storage disease is due to the following enzyme deficiencies?;? Lysosomal glucosidase (acid maltase)

Pompe's disease

Q3942:What glycogen storage disease is due to the following enzyme deficiencies?;? Muscle phosphorylase

McArdle's syndrome

Q3943:What glycogen storage disease is due to the following enzyme deficiencies?;? Glucose-6-phosphatase

von Gierke's disease

Q3944:What ovarian disease involves psammoma bodies?

Serocystadenocarcinoma

Q3945:What cystic swelling of the chorionic villi is the most common precursor of choriocarcinoma?

Hydatidiform mole

Q3946:In what condition do you see dimpling on the kidney's surface?

Pyelonephritis

Q3947:What are the most common causes of osteomyelitis;? Overall?

Staphylococcus aureus

Q3948:What are the most common causes of osteomyelitis;? In neonates?

Streptococcus agalactiae

Q3949:What are the most common causes of osteomyelitis;? In patients with sickle cell disease?

Staphylococcus aureus (but they are more prone to salmonella infections)

Q3950:What are the most common causes of osteomyelitis;? In drug addicts?

Pseudomonas

Q3951:What malignant neoplasm of the bone is associated with Homer-Wright pseudorosettes; onion skinning of the periosteum on radiographs of the femur; pelvis; and tibia; and chromosome 11;22 translocation?

Ewing's sarcoma

Q3952:What lymphoma is characterized by CD19; CD20; CD5; CD23-negative; and chromosome 11;14 translocations?

Mantle cell lymphoma

Q3953:What components of the complement cascade form the MAC?

C5b–C9

Q3954:True or false? HPV infection increases the risk of developing squamous cell carcinoma of the penis.

True. HPV serotypes 16 and 18 are risk factors for squamous cell carcinoma.

Q3955:What form of coarctation of the aorta is associated with Turner syndrome?

Preductal (infantile)

Q3956:True or false? An elevated serum osteocalcin level is a marker for increased bone formation.

True. Increased alkaline phosphatase levels also are associated with increased bone formation.

Q3957:What is the most common opportunistic infection of the CNS in HIV?

Toxoplasmosis

Q3958:What hereditary bone disorder is due to decreased osteoclast function; resulting in thick; sclerotic bones that fracture easily?

Osteopetrosis (Albers-Sch?nberg disease)

Q3959:True or false? Pancreatic delta-cell tumors inhibit CCK secretion; leading to gallstones and steatorrhea.

True. Delta-Cell tumors produce excess somatostatin; which inhibits CCK; gastrin (hypochlorhydria); and insulin secretion (diabetes).

Q3960:What is the term for the speckled appearance of the iris in patients with Down syndrome?

Brushfield spots

Q3961:What is the term for the collapse of the vertebral body due to TB?

Pott disease

Q3962:What organ must metastasize for carcinoid heart disease to occur?

Liver

Q3963:Which subset of MEN syndrome is associated with the following?;? Medullary carcinoma of the thyroid; pheochromocytoma; and mucocutaneous neuromas

MEN III (or IIb)

Q3964:Which subset of MEN syndrome is associated with the following?;? Medullary carcinoma of the thyroid; pheochromocytoma; and parathyroid adenomas (or hyperplasia)

MEN IIa (or Sipple syndrome)

Q3965:Which subset of MEN syndrome is associated with the following?;? Parathyroid; pancreatic; and pituitary gland tumors and Zollinger-Ellison syndrome

MEN I (or Wermer syndrome)

Q3966:What X-linked recessive disease involves mental retardation; self-mutilation; choreoathetosis; spasticity; a decrease in HGPRT; and an increase in uricemia?

Lesch-Nyhan syndrome

Q3967:What disorder is associated with spider angiomas; palmar erythema; gynecomastia; testicular atrophy; encephalopathy; abnormalities in clotting factors; and portal HTN?

Cirrhosis

Q3968:What is your diagnosis of a young; thin asymptomatic female with a midsystolic click on cardiac auscultation?

Mitral valve prolapse

Q3969:What infection is associated with ring-enhancing lesions seen on computed tomography (CT) of the brain in an HIV-positive individual?

Toxoplasmosis (although you should rule out cerebral abscess due to other organisms)

Q3970:What is the term for a reversible change in one cell type to another?

Metaplasia (usually to a more protective cell type)

Q3971:What liver tumor is associated with oral contraceptive pill use?

Hepatic adenomas

Q3972:What CNS developmental abnormality is associated with downward displacement of the cerebellar vermis and medulla compressing the fourth ventricle and leading to obstructive hydrocephalus?

Arnold-Chiari malformation type 2

Q3973:What disease involves a lack of both T cell-mediated and humoral immune responses that can be either X-linked or AR?

Severe combined immunodeficiency disease

Q3974:What condition results in the following CSF results?;? Opening pressure 70 to 180 mm H2O; 0–10 WBCs (monocytes); glucose 45 to 85; protein 15 to 45

Normal values

Q3975:What condition results in the following CSF results?;? Opening pressure 450 mm H2O; 5 WBCs (90% lymphocytes); normal glucose and protein levels

Brain abscess

Q3976:What condition results in the following CSF results?;? Opening pressure 100 mm H2O; 120 WBCs (90% lymphocytes); normal glucose levels; protein 17

Viral meningitis

Q3977:What condition results in the following CSF results?;? Opening pressure 250 mm H2O; WBCs 250 (90% lymphocytes); glucose 35; protein 100

TB meningitis

Q3978:What condition results in the following CSF results?;? Opening pressure 400 mm H2O; WBCs 8500 (90% PMNs); glucose 15; protein 120

Bacterial meningitis

Q3979:True or false? Removal of the ileum results in vitamin B12 deficiencies.

True. The ileum is the site where vitamin B12 is absorbed.

Q3980:What is the term for edema that has LDH below 200; protein level 2.5; and a specific gravity below 1.020?

Transudative; exudative has the opposite values and has an elevated cellular content.

Q3981:What is the term for thickened; hyperpigmented skin in the axillae; groin; and skin folds associated with malignancies; obesity; and DM?

Acanthosis nigricans

Q3982:How many grams of protein must be excreted in 24 hours to produce the diagnosis of nephrotic syndrome?

>3.5 g/day of protein; along with generalized edema; hypoalbuminemia; and hyperlipidemia

Q3983:What illicit drug can cause amyloidosis and focal segmental glomerulosclerosis in the kidney?

Heroin

Q3984:What catecholamine-hypersecreting tumor; a secondary cause of HTN; results in headache; diaphoresis; anxiety; tachycardia; and palpitations?

Pheochromocytoma

Q3985:What is the term for flattened nose; low-set ears; and recessed chin seen in patients with bilateral renal agenesis?

Potter facies

Q3986:What type of healing occurs in a clean surgical incision?

Primary intention

Q3987:What are the two most common viral infections in HIV?

CMV retinitis and HSV-2

Q3988:What disorder is defined by inability of the lower esophageal sphincter to relax with swallowing and a bird beak barium swallow result?

Achalasia. (Think Chagas disease if it presents in a person from Central or South America.)

Q3989:Does Cushing syndrome or Cushing disease have elevated ACTH levels and cortisol suppression with dexamethasone?

Cushing's disease (pituitary) has elevated ACTH and cortisol suppression with dexamethasone; whereas Cushing's syndrome (adrenal adenoma) has decreased ACTH and no cortisol suppression with dexamethasone.

Q3990:What CD4 T-cell receptor does the HIV virus bind to?

gp120

Q3991:What is the term for RBC fragments?

Schistocytes

Q3992:What disorder is due to a deficiency in tyrosinase?

Albinism

Q3993:What two Abs are used to diagnose Hashimoto's thyroiditis?

Antithyroglobulin and antimicrosomal Abs

Q3994:What urease-producing gram-negative curved rod is associated with PUD and chronic gastritis?

Helicobacter pylori; which is also associated with an increased risk of gastric carcinoma

Q3995:Name the cancer associated with the following chemical agents. (Some may have more than one answer.);? Alkylating agents

Leukemias and lymphomas

Q3996:Name the cancer associated with the following chemical agents. (Some may have more than one answer.);? Aromatic amines and azo dyes

Hepatocellular carcinoma

Q3997:Name the cancer associated with the following chemical agents. (Some may have more than one answer.);? Arsenic

Squamous cell carcinoma (skin; lung) and angiosarcoma of the liver

Q3998:Name the cancer associated with the following chemical agents. (Some may have more than one answer.);? Asbestos

Mesothelioma and bronchogenic carcinoma

Q3999:Name the cancer associated with the following chemical agents. (Some may have more than one answer.);? Naphthylamine

Bladder cancer

Q4000:Name the cancer associated with the following chemical agents. (Some may have more than one answer.);? Benzenes

Leukemias

Q4001:Name the cancer associated with the following chemical agents. (Some may have more than one answer.);? Vinyl chloride

Angiosarcoma of the liver

Q4002:Name the cancer associated with the following chemical agents. (Some may have more than one answer.);? Chromium and nickel

Bronchogenic carcinoma

Q4003:Name the cancer associated with the following chemical agents. (Some may have more than one answer.);? Polycyclic aromatic hydrocarbons

Bronchogenic carcinoma

Q4004:Name the cancer associated with the following chemical agents. (Some may have more than one answer.);? Nitrosamines

Gastric cancer

Q4005:What are the five conditions associated with normochromic normocytic anemia with a normal MCV and an elevated reticulocyte count?

1. Autoimmune hypersplenism ;2. Trauma ;3. Anemia ;4. Spherocytosis ;5. Sickle cell anemia

Q4006:What pancreatic islet cell tumor is associated with hypoglycemia; sweating; hunger; confusion; and increased Cpeptide levels?

Insulinoma

Q4007:What substance is used to test platelets' response in patients with von Willebrand disease?

Ristocetin

Q4008:What X-linked recessive disorder that is due to an abnormality in the dystrophin gene; has onset by age 5 with progressive proximal muscle weakness; calf pseudohypertrophy; and elevated CPK levels?

Duchenne muscular dystrophy (Remember; Becker's is slower in progress; less severe; later in onset; and lacks cardiac involvement.)

Q4009:What subset of adenocarcinoma arises from the terminal bronchioles and/or alveolar walls?

Bronchioloalveolar carcinoma

Q4010:What estrogen-producing tumor of the female genital tract is characterized by Call-Exner bodies?

Granulosa cell tumor of the ovary

Q4011:What AD syndrome involves 1000 or more edematous polyps; most commonly affects the colorectal area; and is associated with chromosome 5q21?

Familial polyposis coli

Q4012:What is the term for osteophyte formation at the proximal interphalangeal (PIP) joints in osteoarthritis? In the distal interphalangeal (DIP) joints?

Bouchard nodes in the PIP joints; Heberden nodes in the DIP joints.

Q4013:What prostaglandin is associated with maintaining patency of the ductus arteriosus?

PGE (along with low oxygen tension)

Q4014:What is the term for dilated veins within the spermatic cord?

Varicocele

Q4015:What type of hemostasis in an intravascular space consists of fibrin; platelets; RBCs; and WBCs?

Thrombus

Q4016:What is the most common primary malignant tumor in bone?

Osteosarcoma

Q4017:What is the most common infectious agent in HIV?

Pneumocystis carinii

Q4018:What myeloid disorder is characterized by dry bone marrow aspirations; splenomegaly; leukoerythroblastosis; teardrop RBCs; and hyperuricemia due to increased cell turnover?

Myelofibrosis with myeloid metaplasia

Q4019:What disease that involves mental retardation; flat face; muscle hypotonia; and a double-bubble sign on radiograph poses an increased risk of Alzheimer's disease and ALL?

Down syndrome (trisomy 21)

Q4020:What form of anemia is associated with IgG Abs against Rh antigens; positive direct Coombs test; and splenomegaly?

Autoimmune hemolytic anemia

Q4021:What urinary metabolite is increased in patients with carcinoid syndrome?

5-hydroxyindoleacetic acid (5-HIAA)

Q4022:What chronic liver disease has a beaded appearance of the bile ducts on cholangiogram?

Primary sclerosing cholangitis

Q4023:What three LTs are associated with bronchospasms and an increase in vessel permeability and vasoconstriction?

LC4; LD4; and LE 4

Q4024:What are the three Bs of adult polycystic kidneys?

1. Big ;2. Bilateral ;3. Berry aneurysm

Q4025:What AR disease involves a defect in AA 508 on chromosome 7; causing a defect in Cl- transportation that leads to recurrent pulmonary infections and an increase in viscid mucoid secretions along with pancreatic insufficiencies?

Cystic fibrosis. (Parents are usually the first to find out because the baby tastes salty.)

Q4026:What law states that an enlarged; palpable gallbladder is more likely due to cancer than stone obstruction?

Courvoisier's law

Q4027:What is the term for air in the pleural space?

Pneumothorax

Q4028:What disorder of bone remodeling results in thick; weak bones and is associated with high-output cardiac failure?

Paget disease (osteitis deformans)

Q4029:What is the term to describe the increase in organ size due to the increase in cell size and function?

Hypertrophy

Q4030:What slow-growing primary CNS tumor that affects mostly females is associated with psammoma bodies?

Meningioma

Q4031:True or false? Ethyl alcohol induces the cytochrome P-450 enzymes.

True

Q4032:What are the five components of portal HTN?

1. Caput medusae ;2. Esophageal varices ;3. Ascites ;4. Splenomegaly ;5. Hemorrhoids

Q4033:What syndrome results when there is a deletion to paternal chromosome 15? Maternal?

Prader-Willi syndrome and Angelman syndrome; respectively

Q4034:What CNS tumor arises from Rathke's pouch?

Craniopharyngioma

Q4035:What is the triad of Reiter syndrome?

1. Conjunctivitis;2. Nongonococcal urethritis ;3. Peripheral arthritis ;Can't see; can't wee; can't kick with your knee

Q4036:Which of the following is not a risk factor for cholesterol gallstones: pregnancy; OCP use; female gender; hemolytic anemia; cirrhosis; and obesity? (May be more than one answer.)

Cirrhosis and hemolytic anemia; which are risk factors for pigmented gallstones.

Q4037:Name the nephritic disease based on the immunofluorescent staining;? Mesangial deposits of IgA and C3

IgA nephropathy (Berger disease)

Q4038:Name the nephritic disease based on the immunofluorescent staining;? Smooth and linear pattern of IgG and C3 in the GBM

Goodpasture disease

Q4039:Name the nephritic disease based on the immunofluorescent staining;? Granular deposits of IgG; IgM; and C3 throughout the glomerulus

Postinfectious GN

Q4040:What glycoprotein allows platelets to adhere to each other through the use of fibrinogen?

GP IIb/IIIa; which is why GP IIb/IIIa inhibitors are used in the treatment of acute coronary syndromes

Q4041:What virus is associated with body cavity large B-cell lymphomas?

HHV-8

Q4042:What germ cell tumor is seen in the 15-to 35-year-old age group; peaks when the person is 35 years of age; and is a bulky mass that spreads via the lymphatic system?

Seminoma

Q4043:What transmural inflammatory bowel disease can be found from the mouth to anus; has noncaseating granulomas; is discontinuous (skip lesions); and has a cobblestone appearance; thickening of the bowel wall; linear fissures; and aphthous ulcers with normal mucosa between?

Crohn disease

Q4044:Does ELISA or Western blot confirm whether a patient is HIV-positive?

ELISA screens and Western blot confirms the diagnosis.

Q4045:What GN is highly associated with hepatitis B and C infections?

Membranoproliferative glomerulonephritis (MPGN)

Q4046:What is the term for squamous to columnar metaplasia of the distal esophagus secondary to chronic inflammation?

Barrett esophagus has an increased risk of developing adenocarcinoma of the esophagus.

Q4047:What is the term for excessive amounts of granulation tissue that can block re-epithelialization and wound healing?

Proud flesh

Q4048:What is released from the mitochondria to trigger apoptosis?

Cytochrome c

Q4049:How much of a vessel must be stenosed to cause sudden cardiac death?

More than 75% of the vessel

Q4050:Oxidation of Hgb forms what bodies in patients with G-6-PD deficiency?

Heinz bodies

Q4051:What syndrome that is due to an adrenal gland adenoma produces excess aldosterone resulting in HTN; hypokalemia; and low rennin levels?

Conn syndrome (primary hyperaldosteronism)

Q4052:What virus is associated with both nasopharyngeal carcinoma and Burkitt lymphoma?

EBV

Q4053:What normochromic; normocytic AD anemia has splenomegaly and increased osmotic fragility?

Hereditary spherocytosis

Q4054:What does prepubertal hypersecretion of growth hormone lead to?

Gigantism

Q4055:What enzyme is deficient in alkaptonuria?

Homogentisic oxidase

Q4056:What sex cell tumor causes precocious puberty; masculinization; gynecomastia in adults; and crystalloids of Reinke?

Leydig cell tumor

Q4057:Name four major risk factors for atherosclerosis.

DM; hypercholesterolemia; smoking; and HTN are major risk factors. Being male; obesity; sedentary lifestyle; homocysteine elevation; oral contraceptive pills; and genetics are minor risk factors for atherosclerosis.

Q4058:Name the AD disease associated with chromosome 15 in which the patient has long extremities; lax joints; pigeon chest; and posterior mitral leaflet prolapse and is prone to developing dissecting aortic aneurysm.

Marfan syndrome

Q4059:What is the term for a large VSD that leads to pulmonary HTN; RVH; and cyanosis due to right-to-left reversal of the shunt?

Eisenmenger syndrome; which can also occur with any left-toright shunt

Q4060:Eating fava beans can produce the Mediterranean type of what deficiency?

G-6-PD deficiency

Q4061:What form of hemophilia is X-linked recessive and due to a deficiency in factor VIII?

Hemophilia A

Q4062:What leukemia affects a 4-year-old child with 3 months of fever; fatigue; generalized lymphadenopathy; CNS involvement; hepatosplenomegaly; bleeding; and platelet count below 100; 000?

ALL

Q4063:What protein deficiency results in respiratory distress syndrome of newborns?

Deficiency in surfactant

Q4064:What are the three components of amyloid?

1. Fibrillary protein ;2. Amyloid protein ;3. Glycosaminoglycans

Q4065:What autoimmune disorder is due to Abs directed to ACh receptors at the NMJ?

Myasthenia gravis

Q4066:What are the three left-to-right shunts?

1. VSD ;2. ASD ;3. PDA

Q4067:What protein causes fibrinolysis?

Plasmin

Q4068:What pancreatic islet cell tumor is associated with watery diarrhea; hypokalemia; and achlorhydria?

VIPoma

Q4069:True or false? Obesity; DM; HTN; multiparity; early menarche; and late menopause are all risk factors for endometrial carcinoma.

False. They are all risk factors for endometrial carcinoma except multiparity. Nulliparity; estrogen-producing tumors; and estrogen replacement therapy are also risk factors for endometrial carcinoma.

Q4070:What is the term for pigmented iris hamartomas seen in patients with neurofibromatosis type 1?

Lisch nodules

Q4071:What GI pathology is associated with a positive string sign; an increase in the number of bloody stools; RLQ pain; skip lesions; terminal ileum most commonly affected; occurrence in women more than men; and an increased thickness of the bowel?

Crohn disease

Q4072:What is the most common fungal infection in HIV?

Candida

Q4073:True or false? GERD is a cause of asthma.

True. Don't forget this in your differential diagnosis of an asthmatic.

Q4074:Name the product or products of arachidonic acid;? Vasodilation and inhibition of platelet aggregation produced by vascular endothelium

PGI2

Q4075:Name the product or products of arachidonic acid;? Vasodilation

PGD2; PGE2; and PGF 2

Q4076:Name the product or products of arachidonic acid;? Pain and fever

PGE2

Q4077:Name the product or products of arachidonic acid;? Vasoconstriction and platelet aggregation produced by platelets

TXA2

Q4078:Name the product or products of arachidonic acid;? Chemotactic for neutrophils

LTB4

Q4079:Name the product or products of arachidonic acid;? Vasodilation; bronchospasm; and increased vascular permeability

LTC4; LTD4; and LTE4

Q4080:Which hepatitis B Ab indicates low transmissibility?

HBeAb

Q4081:What pneumoconiosis is associated with exposure to the following occupations or materials?;? Miners; metal grinders; and sandblasters

Silicosis;Note: Coal worker's pneumoconiosis is synonymous with black lung disease; an upper lobe occupational disorder

Q4082:What pneumoconiosis is associated with exposure to the following occupations or materials?;? Aerospace industry; nuclear reactors

Berylliosis

Q4083:What pneumoconiosis is associated with exposure to the following occupations or materials?;? Shipyards; brake linings; insulation; and old building construction

Asbestosis

Q4084:What is the term for calcification of the gallbladder seen on radiograph due to chronic cholecystitis or adenocarcinoma of the gallbladder?

Porcelain gallbladder

Q4085:What is the term to describe a decrease in the cell size and function usually associated with disuse?

Atrophy. Disuse can also be due to immobilization; ischemia; aging; and a host of other causes.

Q4086:Which B-cell neoplasm has the following cell surface markers: CD19; CD20; CD5 (T-cell marker); CD23; and are CD10-negative?

CLL (B-cell origin)

Q4087:What disease caused by decompression sickness leads to multiple foci of ischemic necrosis that affect the head of the femur; humerus; and tibia?

Caisson disease

Q4088:What are the four DNA oncogenic viruses?

1. HPV ;2. EBV ;3. Hepatitis B ;4. Kaposi sarcoma

Q4089:Is the AD or AR form of osteopetrosis malignant?

The AR form is malignant and AD is benign.

Q4090:What carcinoma produces hematuria; flank pain; and a palpable mass?

This is the triad of renal cell carcinoma

Q4091:Name at least three causes of metastatic calcification.

Remember the mnemonic PAM SMIDT;P; (hyper) Parathyroid/ Paget disease;A; Addison's disease;M; Milkalkali syndrome/metastatic cancer;S; Sarcoidosis;M; Multiple myeloma;I; Immobilization/idiopathic;D; Vitamin D intoxication;T; Tumors

Q4092:What is the only subtype of Hodgkin's lymphoma that is most commonly seen in females?

Nodular sclerosis

Q4093:What is the leading cause of preventable premature death and illness in the United States?

Smoking

Q4094:What prion-associated CNS pathology produces rapidly progressive dementia with myoclonus; involuntary movements; and death within 6 to 12 months?

Creutzfeldt-Jakob disease

Q4095:What breast malignancy has tumor cells with a halo surrounding the nucleus and is an ulceration of the nipple and areola with crusting; fissuring; and oozing?

Paget disease of the breast

Q4096:What breast pathology involves malignant cells with halos invading the epidermis of the skin?

Paget disease of the breast

Q4097:Macro-ovalocytes in the peripheral blood smear are formed from what cell in the bone marrow?

Megaloblasts

Q4098:Name the type of exudate; given the following examples;? Sunburn

Serous exudates

Q4099:Name the type of exudate; given the following examples;? Uremic pericarditis

Fibrinous exudates

Q4100:Name the type of exudate; given the following examples;? Parasitic infection

Eosinophilic exudates

Q4101:Name the type of exudate; given the following examples;? Diphtheria infection

Pseudomembranous exudates

Q4102:Name the type of exudate; given the following examples;? Meningococcal infection

Purulent exudates

Q4103:Name the type of exudate; given the following examples;? Rickettsial infection

Hemorrhagic exudates

Q4104:What parasite is associated with squamous cell carcinoma of the urinary bladder?

Schistosoma haematobium

Q4105:What malabsorption syndrome produces abdominal distention; bloating; flatulence; diarrhea; steatorrhea; and weight loss shortly after eating bread products?

Celiac sprue (gluten-sensitive enteropathy)

Q4106:What herpes virus is associated with Kaposi sarcoma?

HHV 8

Q4107:What is the term for the copper corneal deposits found in Wilson's disease?

Kayser-Fleischer rings

Q4108:Name the six vitamin K–dependent coagulation factors.

Factors II; VII; IX; and X and proteins C and S.

Q4109:What ovarian carcinoma is characterized by psammoma bodies?

Cystadenocarcinoma

Q4110:A marfanoid patient presents with tearing retrosternal chest pain radiating to her back. What is your first diagnosis?

Dissecting aortic aneurysm. MI is also high on the list; but these are buzzwords to look for dissection.

Q4111:What malignant neoplasm of the skin is associated with keratin pearls?

Squamous cell carcinoma

Q4112:Name four chemotactic factors for neutrophils.

N-formyl-methionine;LTB4;C5a;IL-8

Q4113:What is the term for granuloma at the lung apex in TB?

Simon focus

Q4114:What are the three platelet aggregating factors?

1. ADP ;2. PG ;3. TXA2

Q4115:What syndrome is due to a Neisseria sp. infection in a child resulting in bilateral hemorrhagic infarcts of the adrenal glands?

Waterhouse-Friderichsen syndrome

Q4116:What foci of fibrinoid necrosis are surrounded by lymphocytes and macrophages throughout all the layers of the heart?

Aschoff bodies of rheumatic fever

Q4117:What is the leading cause of primary hyperparathyroidism?

Chief cell adenoma (80%)

Q4118:In what X-linked recessive disease is there a decrease in the HMP shunt; along with Heinz body formation?

G-6-PD deficiency

Q4119:What is the term for a RBC that has a peripheral rim of Hgb with a dark central Hgb-containing area?

Target cell

Q4120:True or false? Raynaud's phenomenon has no underlying pathology.

False. The disease has no associated pathology; the phenomenon is arterial insufficiency due to an underlying disease.

Q4121:What benign solitary papillary growth within the lactiferous ducts of the breast commonly produces bloody nipple discharge?

Intraductal papilloma

Q4122:What form of hemophilia is X-linked recessive and is due to a deficiency in factor IX?

Hemophilia B

Q4123:What are the two reasons for megaloblastic anemia with elevated MCV?

Vitamin B12 deficiency and folate deficiency

Q4124:Is cigarette smoking associated with transitional cell carcinoma of the bladder?

Yes. It is also a cause of cancers of the lung; esophagus; ureter; and kidney; just to name a few.

Q4125:What disease has multiple schwannomas; café-au-lait spots on the skin; and Lisch nodules and is associated with chromosome 17q?

Neurofibromatosis I (chromosome 22q is with neurofibromatosis II and no Lisch nodules)

Q4126:What syndrome is due to Abs directed to presynaptic calcium channels and causes axial and girdle muscle weakness that improves with repeated use?

Eaton-Lambert syndrome

Q4127:In what rare lung malignancy have 90% of patients had an occupational exposure to asbestos?

Malignant mesothelioma

Q4128:What is the term for cytoplasmic remnants of RNA in RBCs; seen in lead poisoning?

Basophilic stippling

Q4129:What is the triad of fat embolism?

1. Petechiae ;2. Hyperactive mental status ;3. Occurrence within 24 to 48 hours of the initial insult (e.g; long bone fracture)

Q4130:Upon seeing negatively birefringent needle-shaped crystals from a joint aspiration of the great toe; what form of arthritis do you diagnose?

Gout

Q4131:What condition is manifested by bilateral sarcoidosis of the parotid glands; submaxillary gland; and submandibular gland with posterior uveal tract involvement?

Mikulicz syndrome

Q4132:What female genital tract disorder is characterized by obesity; hirsutism; infertility; amenorrhea; elevated LH and testosterone levels; and low FSH levels?

Polycystic ovary disease (Stein-Leventhal syndrome)

Q4133:What bronchogenic carcinoma is associated with an elevated level of Ca2+; involves keratin pearls; occurs in men more than women; is associated with smoking; occurs in the major bronchi; and is seen in the central areas of the lung?

Squamous cell carcinoma

Q4134:What disorder is due to a deficiency in the enzyme phenylalanine hydroxylase?

PKU

Q4135:True or false? Being a white male increases your risk factor for testicular cancer.

Oddly enough; it is true. Cryptorchidism; Klinefelter syndrome; testicular feminization; and family history of testicular cancer are all risk factors.

Q4136:Can an acute MI be diagnosed only by looking at an ECG?

No. Remember; tests do not diagnose; they confirm or refute your diagnosis. Also; diagnosis of MI requires two of three criteria: chest pain consistent and characteristic of MI; elevated cardiac enzymes consistent with MI; and ST segment elevation of 2 mm or more in at least two contiguous leads.

Q4137:What autoimmune syndrome is characterized by keratoconjunctivitis; corneal ulcers; xerostomia; and an increased risk of high-grade B-cell lymphomas? What two Ab tests are used in making the diagnosis?

Sj?gren's syndrome; SS-A (Ro) and SS-B (La)

Q4138:True or false? Sickle cell anemia; Caisson disease; chronic steroid use; and Gaucher disease are causes of avascular necrosis of bone.

True. Fractures and trauma; however; are the most common causes.

Q4139:What gene stimulates apoptosis when DNA repair is unable to be done?

p-53

Q4140:Is ulcerative colitis or Crohn disease more commonly associated with primary sclerosing cholangitis?

Ulcerative colitis

Q4141:What test uses p24 protein when diagnosing HIV?

ELISA test

Q4142:How many café-au-lait spots are necessary for the diagnosis of neurofibromatosis type 1?

At least six

Q4143:What is the term for severe and protracted vomiting resulting in linear lacerations at the gastroesophageal junction?

Mallory-Weiss syndrome

Q4144:What is the term for hypercalcemia resulting in precipitation of calcium phosphate in normal tissue?

Metastatic calcification

Q4145:What is the term for a twisting of the bowel around its vascular axis resulting in intestinal obstruction?

Volvulus

Q4146:What form of poisoning is associated with bitter almond–scented breath?

Cyanide

Q4147:Name the type of hypersensitivity reaction based on the following properties;? Circulating Ab-Ag immune complexes deposited in the tissue result in neutrophil attraction and the release of lysosomal enzymes.

Type III hypersensitivity (immune complex)

Q4148:Name the type of hypersensitivity reaction based on the following properties;? IgE-mediated release of chemical mediators from basophils and mast cells; need prior exposure to Ag in the past; eosinophils amplify and continue reaction; can be system or localized.

Type I hypersensitivity (anaphylactic)

Q4149:Name the type of hypersensitivity reaction based on the following properties;? IgG or IgM Abs against a specific target cell or tissue; complement-dependent or ADCC.

Type II hypersensitivity (cytotoxic)

Q4150:Name the type of hypersensitivity reaction based on the following properties;? Reaction-mediated by sensitized Tcells

Type IV hypersensitivity (cell-mediated)

Q4151:What highly undifferentiated aggressive CNS tumor of primordial neuroglial origin develops in children and is associated with pseudorosettes?

Primitive neuroectodermal tumors (i.e; medulloblastomas and retinoblastomas)

Q4152:What syndrome is due to anti-GBM Abs directed against the lung and kidneys?

Goodpasture syndrome

Q4153:What pathway of the coagulation cascade is activated when it is in contact with foreign surfaces?

Intrinsic. The extrinsic pathway is activated by the release of tissue factors.

Q4154:What tumor is seen in the 2-to 4-year-old age group; does not cross the midline; has immature glomeruli; tubules; and stroma; and metastasizes late to the lungs?

Wilms tumor

Q4155:What CNS tumor commonly produces tinnitus and hearing loss?

Schwannoma

Q4156:True or false? Anticentromere Abs are used in diagnosing CREST syndrome.

True. Scl-70 Abs are used in diagnosing diffuse scleroderma.

Q4157:What AR CNS disorder presents early in childhood with gait ataxia; loss of deep tendon reflexes; impaired vibratory sensation; hand clumsiness; and loss of position sense?

Friedreich ataxia

Q4158:What potent platelet aggregator and vasoconstrictor is synthesized by platelets?

TXA2

Q4159:Which type of cerebral herniation is associated with CN III palsy?

Transtentorial (uncal)

Q4160:What form of vasculitis involves the ascending arch and causes obliterative endarteritis of the vasa vasorum?

Syphilitic

Q4161:What is the main type of cell involved in cellular immunity?

T lymphocyte

Q4162:What skin condition has irregular blotchy patches of hyperpigmentation on the face commonly associated with OCP use and pregnancy?

Melasma

Q4163:What is the classic triad of TB?

Fever; night sweats; and hemoptysis

Q4164:True or false? Blood clots lack platelets.

True. A thrombus has platelets; but clots do not.

Q4165:What malignant tumor of the skin is associated with Birbeck granules?

Histiocytosis X

Q4166:What type of anemia is the result of a deficiency in intrinsic factor?

Pernicious anemia (secondary to a lack of vitamin B12 absorption)

Q4167:What cancer is particularly likely to affect English chimney sweeps?

Scrotal cancer; due to the high exposure to polycyclic aromatic hydrocarbons

Q4168:What is the term for a raised fluid-filled cavity greater than 0.5 cm that lies between the layers of the skin?

Bulla

Q4169:What virus is associated with the endemic form of Burkitt lymphoma?

EBV

Q4170:With which pituitary adenoma is an elevated somatomedin C level associated?

GH-producing adenoma

Q4171:What three criteria allow you to differentiate an ulcer from an erosion or carcinoma?

1. Less than 3 cm ;2. Clean base ;3. Level with the surrounding mucosa

Q4172:Name the four right-to-left congenital cardiac shunts.

Truncus (1) arteriosus;Transposition of the (2) great vessels;Tri(3)cuspid atresia;Tetra(4)logy of Fallot;They all begin with T

Q4173:What do low levels of Ca2+ and PO4- along with neuromuscular irritability indicate?

Hypoparathyroidism

Q4174:Does PT or PTT test the extrinsic coagulation pathway?

PT for extrinsic and PTT for intrinsic (remember: wPeT and hPiTT; which means warfarin; extrinsic; PT; heparin; intrinsic; PTT)

Q4175:What leukemia is associated with four-leaf-clover lymphocytes on peripheral blood smear?

Adult T-cell leukemia

Q4176:What ring is a weblike narrowing of the gastroesophageal junction?

Schatzki ring

Q4177:With what disease do you see IgA deposits in small vessels of the skin and the kidneys?

Henoch-Sch?nlein purpura

Q4178:What rapidly progressive and aggressive T-cell lymphoma affects young males with a mediastinal mass (thymic)?

Lymphoblastic lymphoma

Q4179:What is the term for the appearance of the kidney in malignant hypertension (it has petechiae on its surface)?

Flea-bitten kidney (can also be seen in pyelonephritis)

Q4180:True or false? Psammoma bodies are seen in medullary carcinoma of the thyroid.

False. Elevated calcitonin levels are seen in medullary carcinoma of the thyroid. Psammoma bodies are seen in papillary carcinoma of the thyroid and ovaries; as well as meningiomas.

Q4181:What is the lecithin:sphingomyelin ratio in respiratory distress syndrome of newborns?

<2

Q4182:What syndrome has loss of deep tendon reflexes; muscle weakness; and ascending paralysis preceded by a viral illness?

Guillain-Barré syndrome

Q4183:What form of endocarditis do patients with SLE commonly encounter?

Libman-Sacks endocarditis

Q4184:What is the term for black pigmentation of the colon associated with laxative abuse?

Melanosis coli

Q4185:Are the following major or minor Jones criteria of rheumatic fever?;? Fever

Minor

Q4186:Are the following major or minor Jones criteria of rheumatic fever?;? Migratory polyarthritis

Major

Q4187:Are the following major or minor Jones criteria of rheumatic fever?;? Subcutaneous nodules

Major

Q4188:Are the following major or minor Jones criteria of rheumatic fever?;? Elevated acute phase reactants (e.g; ESR)

Minor

Q4189:Are the following major or minor Jones criteria of rheumatic fever?;? Arthralgias

Minor

Q4190:Are the following major or minor Jones criteria of rheumatic fever?;? Pericarditis

Major

Q4191:Are the following major or minor Jones criteria of rheumatic fever?;? Erythema marginatum

Major

Q4192:Are the following major or minor Jones criteria of rheumatic fever?;? Sydenham chorea

Major

Q4193:What gene inhibits apoptosis by preventing the release of cytochrome c from mitochondria?

Bcl-2

Q4194:Which hepatitis strain is a defective virus that can replicate only inside HBV-infected cells?

Hepatitis D

Q4195:What are the three main components of amyloid?

Fibrillary protein; amyloid protein; and glycosaminoglycans (heparin sulfate mainly)

Q4196:What leukemia is characterized by Philadelphia chromosomal translocation (9;22); massive splenomegaly; peripheral leukocytosis (commonly > 100; 00); decreased LAP levels; and nonspecific symptoms of fatigue; malaise; weight loss; and anorexia?

CML

Q4197:What is the difference between a Ghon focus and a Ghon complex?

A Ghon focus is a TB tubercle; whereas a Ghon complex is a focus with hilar lymph node involvement.

Q4198:In what disease do you see horseshoe kidneys; rockerbottom feet; low-set ears; micrognathia; and mental retardation?

Edward syndrome (trisomy 18)

Q4199:What parasitic infection is associated with cholangiocarcinoma?

Clonorchis sinensis

Q4200:What disorder is associated with loss of polarity; anaplasia; pleomorphism; discohesiveness; increase in the nuclear:cytoplasmic ratio; hyperchromasia; and increase in the rate of mitosis?

Malignancy

Q4201:What is the term for telescoping of the proximal bowel into the distal segment presenting as abdominal pain; currant jelly stools; and intestinal obstruction?

Intussusception

Q4202:What mushroom poisoning is associated with fulminant hepatitis with extensive liver necrosis?

Amanita phalloides

Q4203:What type of erythema do you see in;? Ulcerative colitis?

Erythema nodosum

Q4204:What type of erythema do you see in;? Rheumatic fever?

Erythema marginatum

Q4205:What type of erythema do you see in;? StevensJohnson syndrome?

Erythema multiforme

Q4206:What benign bone tumor is associated with Gardner syndrome?

Osteoma

Q4207:What renal calculus is associated with urea-splitting bacteria?

Magnesium ammonium phosphate (struvite)

Q4208:What lymphoma is associated with bleeding and cryoglobulin precipitation at low temperatures; headache and confusion due to hyperviscosity; IgM M-protein spike on serum electrophoresis; and Russell bodies?

Waldenstr?m's macroglobulinemia

Q4209:What type of acute metal poisoning involves stomach and colon erosion and acute tubular necrosis?

Mercury

Q4210:What slow-growing CNS tumor in 30-to 50-year-old patients with a long history of seizures has fried egg cellular appearance in a network of chicken wire?

Oligodendroglioma

Q4211:Goodpasture Ag is a component of what type of collagen?

Type IV collagen

Q4212:If a peripheral blood smear shows schistocytes; reticulocytes; and thrombocytopenia; is it more commonly seen in patients with ITP or TTP?

TTP; thrombocytopenia with megathrombocytes is more characteristic of ITP.

Q4213:After traveling in a plane across the Atlantic Ocean; an obese male goes to the ER with swollen right leg and sudden onset of shortness of breath. What do you immediately diagnose?

Pulmonary embolism due to a DVT; this is not absolute but a classic description.

Q4214:What cell type involves humoral immunity?

B lymphocyte

Q4215:What is the first sign of megaloblastic anemia on a peripheral blood smear?

Hypersegmented neutrophils

Q4216:What is the term for gastric ulcers associated with severely burned or traumatic patients?

Curling ulcers (think curling iron = burn)

Q4217:What syndrome arises from mutation in the fibrillin gene (FBN1) on chromosome 15q21?

Marfan syndrome

Q4218:What AD disorder is characterized by degeneration of GABA neurons in the caudate nucleus resulting in atrophy; chorea; dementia; and personality changes?

Huntington disease

Q4219:What atypical pneumonia can be diagnosed with elevated cold agglutinin titers?

Mycoplasma pneumoniae

Q4220:What is the triad of Felty syndrome?

Neutropenia; splenomegaly; and rheumatoid arthritis

Q4221:What is the term for the unidirectional attraction of cells toward a chemical mediator released during inflammation?

Chemotaxis

Q4222:What is the term for a benign melanocytic tumor associated with sun exposure that presents as tan-to-brown colored and has sharply defined well-circumscribed borders?

Benign nevus (mole)

Q4223:What small- to medium- sized vasculitis is seen in a 35-year-old man who is a heavy smoker presenting with claudication symptoms in the upper and lower extremities?

Buerger disease (thromboangiitis obliterans)

Q4224:What is the term for pelvic inflammatory disease of the fallopian tubes?

Salpingitis

Q4225:What disease with familial mental retardation produces large; everted ears and macro-orchidism?

Fragile X syndrome

Q4226:What type of skin carcinoma occurring on sunexposed sites has a low level of metastasis?

Squamous cell carcinoma

Q4227:What is the tetrad of tetralogy of Fallot?

VSD; RVH; overriding aorta; and pulmonary stenosis

Q4228:What is the term for chronic necrotizing pulmonary infections resulting in permanent airway dilation and associated with Kartagener syndrome?

Bronchiectasis

Q4229:What is an elevated; fluid-filled cavity between skin layers up to 0.5 cm?

Vesicle (e.g; poison ivy)

Q4230:What is the term for panhypopituitarism secondary to ischemic necrosis and hypotension postpartum?

Sheehan syndrome

Q4231:What disease is diagnosed by findings of ANAs and anti-SCL-70 antibodies?

Scleroderma

Q4232:What is the name of the ovarian cyst containing ectodermal; endodermal; and mesodermal elements (i.e; skin; hair; teeth and neural tissue)?

Teratoma (dermoid cyst)

Q4233:What syndrome is seen in iron-deficient middle-aged women with esophageal webs?

Plummer-Vinson syndrome

Q4234:What are the three causes of transudate?

CHF; cirrhosis; and nephrosis

Q4235:A chronic alcohol abuser goes to the ER with weakness; a sore; beefy red tongue; loss of vibration and position sense; arm and leg dystaxia; elevated levels of methylmalonic acid in the urine; and anemia with an MCV above 105 fL. What is your diagnosis; and how will you monitor his response to treatment?

Subacute combined degeneration of the spinal cord is treated with IM vitamin B12 injections. If treatment is working; you will see an increased reticulocyte count on the peripheral smear in about 5 days.

Q4236:What form of GN is characteristically associated with crescent formation?

Rapidly progressive glomerulonephritis (RPGN)

Q4237:What vitamin deficiency may result in sideroblastic anemia?

Vitamin B6

Q4238:What is the term for TB with the cervical lymph node involved?

Scrofula

Q4239:Influx of what ion is associated with irreversible cell injury?

Massive influx of calcium

Q4240:What pathology is associated with elevated levels of Ca2+; cardiac arrhythmias; bone resorption; kidney stones; and metastatic calcifications?

Primary hyperparathyroidism

Q4241:What type of metal poisoning causes mental retardation; somnolence; convulsions; and encephalopathy?

Lead

Q4242:What syndrome is rheumatoid arthritis with pneumoconiosis?

Caplan syndrome

Q4243:True or false? All of the following are risk factors for cervical cancer: multiple pregnancies; early age of intercourse; multiple sexual partners; OCP use; smoking; HIV; and STDs.

True. Don't forget this list; you will be asked.

Q4244:What is the term for precipitation of calcium phosphate in dying or necrotic tissue?

Dystrophic calcification

Q4245:What congenital small bowel outpouching is a remnant of the vitelline duct?

Meckel diverticulum

Q4246:What type of crystals are associated with gout?

Monosodium urate crystals

Q4247:What is the term for transverse bands on the fingernails seen in patients with chronic arsenic poisoning?

Mees lines

Q4248:What is the tumor at the bifurcation of the right and left hepatic ducts?

Klatskin tumor

Q4249:IgE-mediated mast cell release; C3a and C5a; and IL-1 all trigger the release of what vasoactive amine?

Histamine

Q4250:What disease is seen in the 20-to 40-year-old age group; is more prevalent in women than men; involves diarrhea with or without bloody stools; starts in the rectum and ascends without skipping areas; includes pseudopolyps; and has a thickness of the bowel that does not change?

Ulcerative colitis

Q4251:What disorder causes joint stiffness that worsens with repetitive motion; crepitus; effusions; and swelling and commonly affects the knees; hips; and spine?

Osteoarthritis

Q4252:What condition is characterized by a 46XY karyotype; testes present; and ambiguous or female external genitalia?

Male pseudohermaphrodite (dude looks like a lady!)

Q4253:What is the term for RBC remnants of nuclear chromatin in asplenic patients?

Howell-Jolly bodies

Q4254:What is the term for gastric ulcers associated with increased intracranial pressure?

Cushing's ulcers

Q4255:What platelet disorder is characteristically seen in children following a bout of gastroenteritis with bloody diarrhea?

Hemolytic uremic syndrome

Q4256:Are elevated alkaline phosphatase and decreased phosphorus and calcium levels more consistent with osteoporosis or osteomalacia?

Osteomalacia. Osteoporosis has normal levels of calcium; phosphorus; and alkaline phosphatase.

Q4257:What vascular tumor associated with von HippelLindau syndrome involves the cerebellum; brainstem; spinal cord; and retina?

Hemangioblastoma

Q4258:How many segments in a neutrophilic nucleus are necessary for it to be called hypersegmented?

At least 5 lobes

Q4259:Name the type of regeneration (i.e; labile; stable; or permanent) based on the following examples;? Epidermis

Labile

Q4260:Name the type of regeneration (i.e; labile; stable; or permanent) based on the following examples;? Skeletal muscle

Permanent

Q4261:Name the type of regeneration (i.e; labile; stable; or permanent) based on the following examples;? Pancreas

Stable

Q4262:Name the type of regeneration (i.e; labile; stable; or permanent) based on the following examples;? CNS neurons

Permanent

Q4263:Name the type of regeneration (i.e; labile; stable; or permanent) based on the following examples;? Fibroblasts

Stable

Q4264:Name the type of regeneration (i.e; labile; stable; or permanent) based on the following examples;? Hematopoietic cells

Labile

Q4265:Name the type of regeneration (i.e; labile; stable; or permanent) based on the following examples;? Liver

Stable

Q4266:Name the type of regeneration (i.e; labile; stable; or permanent) based on the following examples;? Smooth muscle

Stable

Q4267:Name the type of regeneration (i.e; labile; stable; or permanent) based on the following examples;? Cardiac muscle

Permanent

Q4268:Name the type of regeneration (i.e; labile; stable; or permanent) based on the following examples;? Mucosal epithelium

Labile

Q4269:Name the type of regeneration (i.e; labile; stable; or permanent) based on the following examples;? Kidney

Stable

Q4270:Name the type of regeneration (i.e; labile; stable; or permanent) based on the following examples;? Osteoblasts

Stable;(Labile cells proliferate throughout life; stable cells have a low level of proliferation; and permanent cells as the name states; do not proliferate.)

Q4271:What CNS tumor cells stain positive for glial fibrillary acidic protein (GFAP)?

Astrocytoma

Q4272:True or false? Elevated ASO titers and serum complement levels are associated with poststreptococcal GN.

False. ASO titers are elevated; but serum complement levels are decreased.

Q4273:What glycoprotein allows platelets to adhere to von Willebrand factor?

GP Ib

Q4274:What encephalitis is associated with the JC virus?

Progressive multifocal leukoencephalopathy

Q4275:Hereditary angioneurotic edema (AD) produces local edema in organs (e.g; GI; skin; respiratory tract). What enzyme deficiency causes increased capillary permeability due to a release of vasoactive peptides?

C1 esterase inhibitor (C1INH)

Q4276:Is an anti-HAV IgG Ab associated with immunization or recent infection?

Anti-HAV IgG Abs are associated with immunization or a prior infection. Anti-HAV IgM is associated with acute or recent infection.

Q4277:Which integrin mediates adhesion by binding to lymphocyte function– associated Ag 1 (LFA-1) and MAC-1 leukocyte receptors?

Intercellular adhesion molecule (ICAM) 1

Q4278:Name the cerebral vessel associated with the following vascular pathologies;? Subarachnoid hemorrhage

Berry aneurysm in the circle of Willis

Q4279:Name the cerebral vessel associated with the following vascular pathologies;? Subdural hemorrhage

Bridging veins draining into the sagittal sinus

Q4280:Name the cerebral vessel associated with the following vascular pathologies;? Epidural hemorrhage

Middle meningeal artery

Q4281:True or false? Live vaccines are contraindicated in patients with SCID.

True

Q4282:What is the term for the round intracytoplasmic eosinophilic inclusions containingɑ-synuclein found in the dopaminergic neurons of the substantia nigra?

Lewy bodies

Q4283:In which form of emphysema; panacinar or centriacinar; is the effect worse in the apical segments of the upper lobes?

Centriacinar worse in upper lobes; panacinar worse in base of lower lobes

Q4284:What syndrome results if the enzyme ɑ-1-iduronidase is deficient? L-iduronate sulfatase deficiency?

Hurler syndrome and Hunter syndrome; respectively

Q4285:What percentage of the bone marrow must be composed of blast for leukemia to be considered?

At least 30% blast in the bone marrow

Q4286:What is the term for the heart's inability to maintain perfusion and meet the metabolic demands of tissues and organs?

CHF

Q4287:What syndrome occurs when pelvic inflammatory disease ascends to surround the liver capsule in violin string adhesions?

Fitz-Hugh-Curtis syndrome

Q4288:True or false? Patients with Turner syndrome have no Barr bodies.

True. Remember; the second X chromosome is inactivated; and so is the Barr body. Turner syndrome has only one X chromosome.

Q4289:What is the term for the sign revealed when a psoriatic scale is removed and pinpoint bleeding occurs?

Auspitz sign

Q4290:What type of Hgb is increased in patients with sickle cell anemia who take hydroxyurea?

Hgb F

Q4291:What vasculitis affects a 30-year-old Asian female having visual field deficits; dizziness; decreased blood pressure; and weakened pulses in the upper extremities?

Takayasu arteritis (medium-size to large vessels)

Q4292:A 20-year-old college student has fever; grey-white membranes over the tonsils; posterior auricular lymphadenitis; and hepatosplenomegaly. What is your diagnosis? What test do you order to confirm your diagnosis?

EBV infections resulting in infectious mononucleosis can be diagnosed by the Monospot test. (Remember; it may be negative in the first week of the illness; so retest if you have a high index of suspicion.)

Q4293:What cell type is commonly elevated in asthma?

Eosinophil

Q4294:What pathology is associated with deposition of calcium pyrophosphate in patients older than 50 years?

Pseudogout

Q4295:What thyroid carcinoma secretes calcitonin and arises from the parafollicular C cells?

Medullary carcinoma of the thyroid

Q4296:What illegal drug can cause rhabdomyolysis; MI; cerebral infarct; and lethal cardiac arrhythmias?

Cocaine

Q4297:What AA is substituted for glutamic acid at position 6 on the Beta-chain in patients with sickle cell anemia?

Valine

Q4298:What endogenous pigment found in the substantia nigra and melanocytes is formed by the oxidation of tyrosine to dihydroxyphenylalanine?

Melanin

Q4299:What tumor marker is associated with seminomas?

Placental alkaline phosphatase

Q4300:What type of GN; associated with celiac disease and dermatitis herpetiformis; has mesangial deposits of IgA; C3; properdin; IgG; and IgM?

Berger disease (IgA nephropathy)

Q4301:What AD disease is associated with chromosome 4p; does not present until the person is in his or her 30s; and involves atrophy of the caudate nucleus; dilatation of the lateral and third ventricles; and signs of extrapyramidal lesions?

Huntington disease

Q4302:What pattern of inheritance is G-6-PD deficiency?

X-linked recessive

Q4303:What adenocarcinoma presents with elevated levels of acid phosphatase; dihydrotestosterone; PSA; and bone pain?

Prostatic carcinoma

Q4304:Is Dubin-Johnson or Rotor syndrome associated with black pigmentation of the liver?

Both are AR with conjugated hyperbilirubinemia; but DubinJohnson syndrome is differentiated from Rotor by the black pigmentation of the liver.

Q4305:What oxygen-dependent killing enzyme requires hydrogen peroxide and halide (Cl-) to produce hypochlorous acid?

Myeloperoxidase

Q4306:What condition results in a strawberry gallbladder?

Cholesterolosis

Q4307:What three chemical agents are associated with angiosarcomas of the liver?

Arsenic; thorotrast; and vinyl chloride

Q4308:What is the term for programmed cell death?

Apoptosis (Remember; there is a lack of inflammatory response.)

Q4309:What potentially fatal disease occurs in children who are given aspirin during a viral illness?

Reye syndrome

Q4310:What metal poisoning produces microcytic anemia with basophilic stippling?

Lead poisoning

Q4311:What inflammatory bowel disorder is continuous; with extensive ulcerations and pseudopolyps; and is associated with HLA-B27?

Ulcerative colitis

Q4312:What is the pentad of TTP?

Neurologic symptoms;Renal failure;Thrombocytopenia;Fever;Microangiopathic hemolytic anemia;(Don't forget it. When I was an intern; my senior resident asked me this question more times than I would like to remember.)

Q4313:Which hepatitis B Ag correlates with infectivity and viral proliferation?

HBeAg

Q4314:What disease involves cold skin abscesses due to a defect in neutrophil chemotaxis and a serum IgE level higher than 2000?

Job syndrome

Q4315:What female pathology is associated with endometrial glands and stroma outside the uterus commonly affecting the ovaries as chocolate cysts?

Endometriosis

Q4316:What is the karyotype in Turner syndrome?

45XO

Q4317:What is the term for a congenital absence of the ganglionic cells of the Auerbach and Meissner plexus in the rectum and sigmoid colon?

Hirschsprung disease (aganglionic megacolon)

Q4318:What syndrome is associated with gastrin-producing islet cell tumor resulting in multiple intractable peptic ulcers?

Zollinger-Ellison syndrome

Q4319:What type of collagen is associated with keloid formation?

Type III

Q4320:The "tea-and-toast" diet is classically associated with what cause of megaloblastic anemia?

Folate deficiency (very common in the elderly)

Q4321:What is the term for ascending bacterial infection of the renal pelvis; tubules; and interstitium causing costovertebral angle tenderness; fever; chills; dysuria; frequency; and urgency?

Pyelonephritis

Q4322:How can a deficiency in adenosine deaminase be a bone marrow suppressor?

It causes a buildup of dATP; which inhibits ribonucleotide reductase and leads to a decrease in deoxynucleoside triphosphate; a precursor of DNA; resulting in overall bone marrow suppression.

Q4323:Which phenotype of osteogenesis imperfecta is incompatible with life?

Type II

Q4324:With what is cherry red intoxication associated?

Acute CO poisoning

Q4325:What are the four most common causes of femoral head necrosis?

1. Steroids ;2. Alcohol ;3. Scuba diving ;4. Sickle cell anemia

Q4326:What are the four signs of acute inflammation?

Rubor (red); dolor (pain); calor (heat); tumor (swelling); also sometimes there is loss of function

Q4327:Name the hypochromic microcytic anemia based on the following laboratory values;? Increased iron; decreased TIBC; increased percent saturation; increased ferritin

Sideroblastic anemia

Q4328:Name the hypochromic microcytic anemia based on the following laboratory values;? Decreased iron; TIBC; and percent saturation; increased ferritin

Anemia of chronic disease

Q4329:Name the hypochromic microcytic anemia based on the following laboratory values;? Decreased iron; percent saturation; and ferritin; increased TIBC

Iron deficiency anemia

Q4330:Name the hypochromic microcytic anemia based on the following laboratory values;? Normal iron; TIBC; percent saturation; and ferritin

Thalassemia minor

Q4331:Which form of emphysema is associated with an alpha1-antitrypsin deficiency?

Panacinar

Q4332:An 80-year-old woman presents to you with rightsided temporal headache; facial pain and blurred vision on the affected side; and an elevated ESR. Your diagnosis?

Temporal arteritis (giant cell arteritis)

Q4333:What type of neurofibromatosis is associated with bilateral acoustic schwannomas?

Type 2

Q4334:What disorder is due to a deficiency in the enzyme glucocerebrosidase?

Gaucher disease

Q4335:What is the term for flexion of the PIP and extension of the DIP joints seen in rheumatoid arthritis?

Boutonnière deformities

Q4336:True or false? Atelectasis is an irreversible collapse of a lung.

False. Atelectasis is a reversible collapse of a lung.

Q4337:What viral infection in patients with sickle cell anemia results in aplastic crisis?

Parvovirus B 19

Q4338:What syndrome has elevated FSH and LH levels with decreased testosterone levels and 47XXY karyotype?

Klinefelter syndrome

Q4339:What CNS developmental abnormality is associated with 90% of syringomyelia?

Arnold-Chiari malformation type 2

Q4340:What is the term for fibrinoid necrosis of the arterioles in the kidney secondary to malignant hypertension?

Onion skinning

Q4341:A 30-year-old woman goes to your office with bilateral multiple breast nodules that vary with menstruation and have cyclical pain and engorgement. What is your diagnosis?

Fibrocystic change of the breast. This highlights the distinguishing features from breast cancer; which is commonly unilateral; single nodule; no variation with pregnancy.

Q4342:What disease is X-linked recessive; is associated with eczema thrombocytopenia and an increased chance of developing recurrent infections; involves a decrease in serum IgM and in the T cell-dependent paracortical areas of the lymph nodes; and means that the patient is likely to develop malignant lymphoma?

Wiskott-Aldrich syndrome

Q4343:Which form of melanoma carries the worst prognosis?

Nodular melanoma

Q4344:Patients with sickle cell anemia are at increased risk for infection from what type of organisms?

Encapsulated bacteria

Q4345:How many major and/or minor Jones criteria are required for the diagnosis of rheumatic fever?

Two major or one major and two minor

Q4346:What skin carcinoma is a superficial dermal infiltrate of T lymphocytes seen in males more than 40 years old and presents as scaly red patches or plaques?

Mycosis fungoides (cutaneous T-cell lymphoma)

Q4347:What Hgb-derived endogenous pigment is found in areas of hemorrhage or bruises?

Hemosiderin

Q4348:What is a palpable; elevated solid mass up to 0.5 cm?

Papule

Q4349:True or false? Monocytosis is seen in TB.

True

Q4350:What pathology is associated with podagra; tophi in the ear; and PMNs with monosodium urate crystals?

Gout

Q4351:What GI pathology can be caused by a patient taking clindamycin or lincomycin or by Clostridium difficile; ischemia; Staphylococcus; Shigella; or Candida infection?

Pseudomembranous colitis

Q4352:What do the risk factors late menopause; early menarche; obesity; nulliparity; excessive estrogen; genetic factor p53; and brc-abl characterize?

Breast cancer

Q4353:What thyroid carcinoma is associated with radiation exposure; psammoma bodies; and Orphan Annie eye nuclei?

Papillary carcinoma of the thyroid

Q4354:Name three opsonins.

Fc portion of IgG; C3b; and mannose-binding proteins

Q4355:What chemical can be dangerous if you work in the aerospace industry or in nuclear plants?

Beryllium

Q4356:Which hepatitis B serology markers—HBcAb IgG; HBcAb IgM; HBeAg; HBsAb IgG; HBsAg; HBV-DNA—are associated with the following periods?;? Window period

HBcAb IgM

Q4357:Which hepatitis B serology markers—HBcAb IgG; HBcAb IgM; HBeAg; HBsAb IgG; HBsAg; HBV-DNA—are associated with the following periods?;? Immunization

HBsAb IgG

Q4358:Which hepatitis B serology markers—HBcAb IgG; HBcAb IgM; HBeAg; HBsAb IgG; HBsAg; HBV-DNA—are associated with the following periods?;? Prior infection

HBcAb IgG and HBsAb IgG

Q4359:Which hepatitis B serology markers—HBcAb IgG; HBcAb IgM; HBeAg; HBsAb IgG; HBsAg; HBV-DNA—are associated with the following periods?;? Acute infection

HBcAb IgM; HBV-DNA; HBeAg; HBsAg

Q4360:Which hepatitis B serology markers—HBcAb IgG; HBcAb IgM; HBeAg; HBsAb IgG; HBsAg; HBV-DNA—are associated with the following periods?;? Chronic infection

HBcAb IgG; HBV-DNA; HBeAg; HBsAg

Q4361:Name the type of necrosis;? The most common form of necrosis; denatured and coagulated proteins in the cytoplasm

Coagulative necrosis

Q4362:Name the type of necrosis;? Seen as dead tissue with coagulative necrosis

Gangrenous necrosis

Q4363:Name the type of necrosis;? Seen as dead tissue with liquefactive necrosis?

Liquefaction necrosis

Q4364:Name the type of necrosis;? Due to lipase activity and has a chalky white appearance

Fat necrosis

Q4365:Name the type of necrosis;? Soft; friable; cottagecheese appearing; characteristically seen in TB

Caseous necrosis

Q4366:Name the type of necrosis;? Histologically resembles fibrin

Fibrinoid necrosis

Q4367:Name the three enzymes that protect the cell from oxygen-derived free radicals.

Superoxide dismutase; glutathione peroxidase; catalase

Q4368:What are the rules of 2 for Meckel diverticulum?

2% of population; 2 cm long; 2 feet from ileocecal valve; 2 years old; and 2% of carcinoid tumors

Q4369:What aneurysm of the circle of Willis is associated with polycystic kidney disease?

Berry aneurysm

Q4370:A 20-year-old black woman goes to you with nonspecific joint pain; fever; and a malar rash over the bridge of her nose and on her cheeks. This is a classic example of what autoimmune disease? What are three autoantibody tests you could order to make the diagnosis?

SLE; ANA; anti-dsDNA and anti-Sm (anti-Smith)

Q4371:True or false? Excess lead deposits in the oral cavity.

True. It deposits at the gingivodental line; known as the lead line.

Q4372:What is the term for increased iron deposition resulting in micronodular cirrhosis; CHF; diabetes; and bronzing of the skin?

Hemochromatosis

Q4373:What AR disorder is due to a deficiency in glycoprotein IIb-IIIa; resulting in a defect in platelet aggregation?

Glanzmann syndrome

Q4374:What protein-losing enteropathy has grossly enlarged rugal fold in the body and fundus of the stomach in middleaged males; resulting in decreased acid production and an increased risk of gastric cancer?

Ménétrier's disease

Q4375:What myopathy due to autoantibodies to ACh receptors can present with thymic abnormalities; red cell aplasia; and muscle weakness?

Myasthenia gravis

Q4376:Which subtype of AML is most commonly associated with Auer rods?

M3 (promyelocytic leukemia)

Q4377:What condition results from a 46XX karyotype and female internal organs with virilized external genitalia?

Female pseudohermaphrodite

Q4378:Two weeks after her son has a throat infection; a mother takes the boy to the ER because he has fever; malaise; HTN; dark urine; and periorbital edema. What is your diagnosis?

Poststreptococcal GN

Q4379:What X-linked recessive immune disorder is characterized by recurrent infections; severe thrombocytopenia; and eczema?

Wiskott-Aldrich syndrome

Q4380:What form of arthritis is associated with calcium pyrophosphate crystals?

Pseudogout

Q4381:What is the term for excessive production of collagen that flattens out and does not extend beyond the site of the injury?

Hypertrophic scar

Q4382:What is the term for inflamed; thickened skin on the breast with dimpling associated with cancer?

Peau d'orange

Q4383:What rare vasculitis has the following characteristics: males aged 40 to 60; affecting small arteries and veins; involving nose; sinuses; lungs; and kidneys; C-ANCA and autoantibodies against proteinase 3?

Wegener granulomatosis

Q4384:What retrovirus is associated with adult T-cell leukemia?

HTLV-1

Q4385:What disease is seen in children younger than 5 years of age and is characterized by X-linked recessive cardiac myopathies; calf pseudohypertrophy; lordosis; protuberant belly; an increase then a decrease in CPK; and death commonly in the second decade of life?

Duchenne muscular dystrophy

Q4386:What malignant neoplasm of the bone has a soap bubble appearance on radiograph?

Giant cell bone tumor (osteoclastoma)

Q4387:What nephrotic syndrome has effacement of the epithelial foot processes without immune complex deposition?

Minimal change disease

Q4388:What is the term for tissue-based basophils?

Mast cells

Q4389:What malignant bone tumor is characterized by Codman triangle (periosteal elevation) on radiograph?

Osteosarcoma

Q4390:Is splenomegaly more commonly associated with intravascular or extravascular hemolysis?

Extravascular hemolysis if it occurs in the spleen; if in the liver; it results in hepatomegaly.

Q4391:What cancer of the male genitourinary system is associated with osteoblastic bony metastasis?

Prostatic carcinoma

Q4392:What stromal tumor in males is characterized histologically with crystalloids of Reinke?

Leydig cell tumor

Q4393:What pulmonary disease; most commonly associated with smoking; results in enlarged; overinflated lungs owing to the destruction of the alveolar walls with diminished elastic recoil?

Emphysema

Q4394:What factor gets activated in the intrinsic pathway of the coagulation cascade? Extrinsic pathway?

Factor XII for the intrinsic; factor VII for the extrinsic pathway

Q4395:What chronic systemic inflammatory disease commonly seen in women aged 20 to 50 is a progressive; symmetric arthritis affecting the hands; wrists; knees; and ankles that improves with increased activity?

Rheumatoid arthritis

Q4396:Name the following descriptions associated with bacterial endocarditis;? Retinal emboli

Roth spots

Q4397:Name the following descriptions associated with bacterial endocarditis;? Painful subcutaneous nodules on fingers and toes

Osler nodes

Q4398:Name the following descriptions associated with bacterial endocarditis;? Painless hyperemic lesions on the palms and soles

Janeway lesions

Q4399:What two CD cell surface markers do Reed- Sternberg cells stain positive for?

CD15 and CD30

Q4400:What two lysosomal storage diseases have cherry-red spots on the retina?

Niemann-Pick and Tay-Sachs diseases

Q4401:True or false? Increased leukocyte alkaline phosphatase (LAP) is associated with CML.

False. Increased LAP is seen in stress reactions and helps differentiate benign conditions from CML; which has low LAP levels.

Q4402:What syndrome has multiple adenomatous colonic polyps and CNS gliomas?

Turcot syndrome

Q4403:What is the term for a venous embolus in the arterial system?

Paradoxic emboli most commonly enter the arteries through a patent septal defect in the heart.

Q4404:Are hemorrhagic cerebral infarcts more commonly associated with embolic or thrombotic occlusions?

Embolic

Q4405:What is the name for the following RBC indices?;? The coefficient of variation of the RBC volume

Red blood cell distribution width index (RDW)

Q4406:What is the name for the following RBC indices?;? Average mass of the Hgb molecule/RBC

Mean corpuscular hemoglobin (MCH)

Q4407:What is the name for the following RBC indices?;? Average volume of a RBC

Mean corpuscular volume (MCV)

Q4408:What is the name for the following RBC indices?;? Average Hgb concentration/given volume of packed RBCs

Mean corpuscular hemoglobin concentration (MCHC)

Q4409:What cardiomyopathy is due to a ventricular outflow obstruction as a result of septal hypertrophy and leads to sudden cardiac death in young athletes?

Hypertrophic cardiomyopathy (hypertrophic subaortic stenosis; or IHSS)

Q4410:Which HPV serotypes are associated with condyloma acuminatum?

HPV serotypes 6 and 11

Q4411:Which form of melanoma carries the best prognosis?

Lentigo maligna melanoma

Q4412:What is the term for an increase in the number of cells in a tissue?

Hyperplasia

Q4413:A 60-year-old man has back pain (compression spinal fracture); hypercalcemia; increased serum protein; BenceJones proteinuria; and monoclonal M-spike on serum electrophoresis. What is your diagnosis?

Multiple myeloma

Q4414:What is the term for pus in the pleural space?

Empyema

Q4415:What is flat; circumscribed nonpalpable pigmented change up to 1 cm?

Macule (e.g; a freckle)

Q4416:Name the macrophage based on its location;? Liver macrophages

Kupffer cells

Q4417:Name the macrophage based on its location;? Bone macrophages

Osteoclasts

Q4418:Name the macrophage based on its location;? Brain macrophages

Microglia

Q4419:Name the macrophage based on its location;? Lung macrophages

Pulmonary alveolar macrophages

Q4420:Name the macrophage based on its location;? Connective tissue macrophages

Histiocytes

Q4421:Name the macrophage based on its location;? Epidermal macrophages

Langerhans cells

Q4422:What is the term for a large; immature RBC that is spherical; blue; and without a nucleus?

Reticulocyte

Q4423:What testicular tumor of infancy is characterized by elevated-fetoprotein levels and Schiller-Duval bodies?

Yolk sac tumor

Q4424:Starry sky appearance of macrophages is pathognomonic of what lymphoma?

Burkitt lymphoma

Q4425:In which region of the lung are 75% of the pulmonary infarcts seen?

Lower lobe

Q4426:For what disease are SS-A(Ro); SS-B(La); and R-ANA diagnostic markers?

Sj?gren disease

Q4427:What HPV serotypes are associated with increased risk of cervical cancer?

HPV serotypes 16; 18; 31; and 33

Q4428:Do the following structures pick up stain from hematoxylin or eosin?;? Nuclei

Hematoxylin

Q4429:Do the following structures pick up stain from hematoxylin or eosin?;? Nucleoli

Hematoxylin

Q4430:Do the following structures pick up stain from hematoxylin or eosin?;? Cytoplasm

Eosin

Q4431:Do the following structures pick up stain from hematoxylin or eosin?;? Collagen

Eosin

Q4432:Do the following structures pick up stain from hematoxylin or eosin?;? RBCs

Eosin

Q4433:Do the following structures pick up stain from hematoxylin or eosin?;? Calcium

Hematoxylin

Q4434:Do the following structures pick up stain from hematoxylin or eosin?;? Bacteria

Hematoxylin

Q4435:Do the following structures pick up stain from hematoxylin or eosin?;? Fibrin

Eosin

Q4436:Do the following structures pick up stain from hematoxylin or eosin?;? Thyroid colloid

Eosin

Q4437:What commonly encountered overdose produces headache; tinnitus; respiratory alkalosis; metabolic acidosis; confusion; vomiting; and tachypnea?

ASA (salicylate)

Q4438:What AR syndrome is due to a deficiency of glycoprotein Ib; resulting in a defect in platelet adhesion?

Bernard-Soulier syndrome

Q4439:What AD renal disorder is associated with mutations of the PKD 1 gene on chromosome 16 and berry aneurysms in the circle of Willis and presents in the fifth decade with abdominal masses; flank pain; hematuria; HTN; and renal insufficiency?

Adult polycystic kidney disease

Q4440:Based on the following information; is the renal transplantation rejection acute; chronic; or hyperacute?;? Months to years after transplantation; gradual onset of HTN; oliguria; and azotemia; seen as intimal fibrosis of the blood vessels and interstitial lymphocytes

Chronic rejection

Q4441:Based on the following information; is the renal transplantation rejection acute; chronic; or hyperacute?;? Immediately after transplantation; seen as a neutrophilic vasculitis with thrombosis

Hyperacute rejection

Q4442:Based on the following information; is the renal transplantation rejection acute; chronic; or hyperacute?;? Weeks to months after transplantation; abrupt onset of oliguria and azotemia; seen as neutrophilic vasculitis and interstitial lymphocytes

Acute rejection

Q4443:What type of collagen is abnormal in patients with osteogenesis imperfecta?

Type I (makes sense; since they have a predisposition for fractures and type I collagen is associated with bones and tendons)

Q4444:What coronary artery vasculitis is seen in Japanese infants and children less than 4 years old with acute febrile illness; conjunctivitis; maculopapular rash; and lymphadenopathy?

Kawasaki disease

Q4445:What disease has IgG autoantibodies; occurs in women more than men; and includes exophthalmos; pretibial myxedema; nervousness; heart palpitations; and fatigue?

Graves disease

Q4446:What condition is defined by both testicular and ovarian tissues in one individual?

True hermaphrodism

Q4447:A mother takes her 2-week-old infant to the ER because the baby regurgitates and vomits after eating and has peristaltic waves visible on the abdomen and a palpable mass in the right upper quadrant. What is your diagnosis?

Pyloric stenosis

Q4448:What variant of polyarteritis nodosa is associated with bronchial asthma; granulomas; and eosinophilia?

Churg-Strauss syndrome

Q4449:What component of the basement membrane binds to collagen type IV and heparin sulfate and is a cell surface receptor?

Laminin

Q4450:What B-cell neoplasm is seen in males with massive splenomegaly; produces dry tap on bone marrow aspirations; and stains positive for tartrate-resistant acid phosphatase (TRAP)?

Hairy cell leukemia

Q4451:What form of nephritic syndrome is associated with celiac sprue and Henoch- Sch?nlein purpura?

IgA nephropathy

Q4452:What syndrome is characterized by embryologic failure of the third and fourth pharyngeal pouches resulting in hypocalcemia; tetany; and T-cell deficiency?

DiGeorge syndrome

Q4453:What is the treatment for physiologic jaundice of newborns?

Phototherapy

Q4454:How many months in how many years must a person cough with copious sputum production for the diagnosis of chronic bronchitis to be made?

3 months of symptoms in 2 consecutive years

Q4455:What chronic inflammatory WBC is associated with IgE-mediated allergic reactions and parasitic infections?

Eosinophils

Q4456:What AD syndrome produces hamartomatous polyps in the small intestine and pigmentation of the lips and oral mucosa?

Peutz-Jeghers syndrome

Q4457:What is the term for formation of a stable fibrin– platelet plug to stop bleeding?

Hemostasis

Q4458:True or false? All of the following are risk factors for breast cancer: early menses; late menopause; history of breast cancer; obesity; and multiparity.

False. All except multiparity are risk factors for breast cancer. Nulliparity; increasing age; and family history in first-degree relative are also risk factors. Memorize this list!

Q4459:Is jugular venous distention a presentation of isolated left or right heart failure?

Right-sided

Q4460:Name the hepatitis virus based on the following information;? Small circular RNA virus with defective envelope

Hepatitis D

Q4461:Name the hepatitis virus based on the following information;? Enveloped RNA flavivirus

Hepatitis C

Q4462:Name the hepatitis virus based on the following information;? Naked capsid RNA calicivirus

Hepatitis E

Q4463:Name the hepatitis virus based on the following information;? Enveloped DNA hepadnavirus

Hepatitis B

Q4464:Name the hepatitis virus based on the following information;? Naked capsid RNA picornavirus

Hepatitis A

Q4465:What AR disease involves a decreased amount of sphingomyelinase; massive organomegaly; zebra bodies; and foamy histiocytes and is associated with chromosome 11p?

Niemann-Pick disease

Q4466:What is the term for hypoperfusion of an area involving only the inner layers?

Mural infarct

Q4467:What are the three causes of normochromic normocytic anemia with a normal MCV and a low reticulocyte count?

Marrow failure; cancer; and leukemia

Q4468:Notching of the ribs; seen on chest radiograph in patients with postductal coarctation of the aorta; is due to collateralization of what arteries?

Dilation of the internal mammary arteries results in erosions on the inner surface of the ribs and is seen as notching.

Q4469:What is the physiologic storage form of iron?

Ferritin

Q4470:What is the term for occlusion of a blood vessel due to an intravascular mass that has been carried downstream?

Embolism

Q4471:What AR disorder of copper metabolism can be characterized by Kayser- Fleischer rings; decreased ceruloplasmin levels; and increased urinary copper excretion and tissue copper levels?

Wilson disease. (Remember; patients commonly present with psychiatric manifestations and movement disorders but may be asymptomatic.)

Q4472:Name the cancer associated with the following oncogenes. (Some may have more than one answer);? c-myc

Burkitt lymphoma

Q4473:Name the cancer associated with the following oncogenes. (Some may have more than one answer);? L-myc

Small cell cancer of the lung

Q4474:Name the cancer associated with the following oncogenes. (Some may have more than one answer);? hst-1 and int-2

Melanoma; cancer of the stomach and bladder

Q4475:Name the cancer associated with the following oncogenes. (Some may have more than one answer);? et

MEN II and III syndromes

Q4476:Name the cancer associated with the following oncogenes. (Some may have more than one answer);? Ki-ras

Pancreas and colon

Q4477:Name the cancer associated with the following oncogenes. (Some may have more than one answer);? cyclin D

Mantle cell lymphoma

Q4478:Name the cancer associated with the following oncogenes. (Some may have more than one answer);? N-myc

Neuroblastoma

Q4479:Name the cancer associated with the following oncogenes. (Some may have more than one answer);? CDK4

Melanoma

Q4480:Name the cancer associated with the following oncogenes. (Some may have more than one answer);? abl

CML and ALL

Q4481:Name the cancer associated with the following oncogenes. (Some may have more than one answer);? hst-1; int-2; erb-2; and erb-3

Breast cancer

Q4482:Name the cancer associated with the following oncogenes. (Some may have more than one answer);? sis

Astrocytoma

Q4483:Name the cancer associated with the following oncogenes. (Some may have more than one answer);? Ki-ras and erb-2

Lung cancer

Q4484:Name the cancer associated with the following oncogenes. (Some may have more than one answer);? erb-1

Squamous cell carcinoma of the lung

Q4485:What AD GI neoplasia produces multiple adenomatous polyps; osteomas; fibromas; and epidural inclusion cysts?

Gardner syndrome

Q4486:What disease involves microcephaly; mental retardation; cleft lip or palate; and dextrocardia?

Patau syndrome (trisomy 13)

Q4487:What type of GN occurs most commonly in children after a pharyngeal or skin infection; is immune complex– mediated; and is seen as lumpy-bumpy subepithelial deposits?

Postinfectious GN

Q4488:What are the three most common sites for left-sided heart embolisms to metastasize?

Brain; spleen; and kidney

Q4489:With what two pathologies is a honeycomb lung associated?

Asbestosis and silicosis

Q4490:What AD disorder due to a mutation in fibroblast growth factor receptor 3 results in normal-size vertebral column and skull and short; thick extremities?

Achondroplasia

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