Cell Biology & Pathology

Q0001:Three cell types with regard to cell cycle
Permanent; Stable; Labile

Q0002:Rough Endoplasmic Reticulum rich cells
-Mucus-secreting goblet cells of small intestine;-Antibody-
secreting plasma cells;(ie lost of secretory protein)
Q0003:Cell cycle: Permanent cells
Remain in G0. If they regenerate; they regenerate from stem
cells.
Q0004:Cell cycle: Stable cells
Enter G1 from G0 when stimulated
Q0005:Cell cycle: Labile cells
Never go to G0; divide rapidly with a short G1
Q0006:Smooth Endoplasmic Reticulum: Functions
-Steroid synthesis;-Detoxification of drugs and poisons
Q0007:Permanent cells: cell types
-Neurons;-Skeletal and cardiac muscle;-RBCs (regenerate from
stem cells)
Q0008:Stable cells: cell types
-Hepatocytes;-Lymphocytes
Q0009:Smooth Endoplasmic Reticulum rich cells
-Liver hepatocytes;-Steroid hormone-producing cells of the
adrenal cortex
Q0010:Labile cells: cell types
-Bone marrow;-Gut epithelium;-Skin;-Hair follicles;(think
about chemotherapy side effects)
Q0011:Rough Endoplasmic Reticulum: Functions
-Synthesis of secretory (exported) proteins;-N-linked
oligosaccharide addition to many proteins
Q0012:Neurons: name of Rough Endoplasmic Reticulum and
its function
Nissl bodies sytnhesize enzymes (eg ChAT) and peptide
neurotransmitters.
Q0013:6 functions of Golgi apparatus
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-6-
phosphate to proteins designated for lysosome;5.
Proteoglycan assembly from core proteins;6. Sulfation of
sugars in proteoglycans and of selected tyrosine on proteins
Q0014:I-cell disease: Presentation
-coarse facial features;-clouded corneas;-restricted joint
movement;-high plasma levels of lysosomal enzymes;-fatal in
childhood
Q0015:3 types of vesicular trafficking proteins
COPI; COPII; and Clathrin
Q0016:COPI: Function
Retrograde Intracellular transport: cis-Golgi to RER
Q0017:COPII: Function
Anterograde Intracellular transport: RER to cis-Golgi
Q0018:Clathrin: Function
Extracellular/lysosomal transport;-lysosome: trans-Golgi to
lysosome ;-trans-Golgi to plasma membrane to endosomes
(for receptor mediated endocytosis)
Q0019:Microtubules: Diameter
24 nm
Q0020:Microtubules: Structure
13 dimers of alpha/beta tubulin per circumference (each dimer
bound to GTP); repeated in helical configuration
Q0021:Microtubules: Found in ?
-Flagella;-Cilia;-Mitotic spindles;-Slow neuronal axoplasmic
transport
Q0022:Microtubules: Speed of growth and collapse
Grows slowly and collapses quickly
Q0023:Microtubules: Affected by which drugs?
-Mebendazole/thiabendazole (antihelminthic);-Taxol (anti-
breast cancer);-Griseofulvin (anti-fungal);-
Vincristine/Vinblastine (anti-cancer);-Colchicine (anti-gout)
Q0024:Microtubule polymerization defects: Found in what
syndrome
Chediak-Higashi syndrome
Q0025:Chediak-Higashi syndrome
Microtubule polymerization defect resulting in decreased
phagocytosis
Q0026:Cilia: Structure
-9+2 arrangement of microtubule doublets;-The 9 peripheral
doublets are linked by dynein atpase
Q0027:Cilia: Mechanism
The 9 peripheral doublets are linked by dynein atpase; which
causes bending of cilium by differential sliding of doublets
Q0028:Molecular motors and direction of transport in cell
Dynein: retrograde (DIES back towards nucleus);Kinesin:
anterograde (MOVES kinetically forward)
Q0029:Kartagener's syndrome: Defect
Dynein arm defect causing immotile cilia
Q0030:What is phosphatidylcholine also known as?
lecithin
Q0031:Kartagener's syndrome: Presentation
-Male infertility (immotile sperm);-Female infertility
(immotile fallopian cilia);-Bronchiectasis and recurrent
sinusitis (bacteria and particles not pushed out);-Situs
inversus
Q0032:What syndrome is situs inversus associated with?
Kartagener's
Q0033:Plasma membrane: composition
-Cholesterol (~50%);-Phospholipids (~50%);-Sphingolipids;-
Glycolipids;-Proteins
Q0034:What is lecithin also known as?
phosphatidylcholine
Q0035:Plasma membrane: melting temperature association
High cholesterol or long saturated fatty acid content means
increased melting temperature
Q0036:Where is phosphatidylcholine found?
Major component of;1. RBC membranes;2. myelin;3. bile;4.
surfactant (DPPC- dipalmitoyl phosphatidylcholine)
Q0037:Drugs that inhibit the sodium-potassium pump
-Ouabain;-Cardiac glycosides (digoxin; digitoxin)
Q0038:Ouabain: Mechanism
Inhibits Na-K atpase by binding to K site.
Q0039:What process uses phosphatidylcholine?
Esterification of cholesterol with LCAT (lecithin-cholesterol
acyltransferase)
Q0040:Cardiac glycosides: Mechanism
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;-Sialyl-
LewisX 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
Q0182:Neoplasm associated with: Post surgical gastric
remnants
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 non-
Hodgkin'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
Neoplasia type II
oncogene ret
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
(what type of gene): BRCA1
Tumor suppressor gene on 17q: Breast and ovarian cancer
(what type of gene): BRCA2
Tumor suppressor gene on 13q: Breast and ovarian cancer
(what type of gene): p53
Tumor suppressor gene on 17p: Most human cancers and Li-
Fraumeni Syndrome
(what type of gene): p16
Tumor suppressor gene on 9p: Melanoma
(what type of gene): APC
Tumor suppressor gene on 5q: Colorectal cancer
(what type of gene): WT1
Tumor suppressor gene on 11q: Wilm's tumor
(what type of gene): NF1
Tumor suppressor gene on 17q: Neurofibromatosis type 1
(what type of gene): NF2
Tumor suppressor gene on 22q: Neurofibromatosis type 2
(what type of gene): DPC
Tumor suppressor gene on 18q: Pancreatic cancer
(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
Tumor suppressor gene WT1: Wilm's tumor
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 Li-
Fraumeni syndrome
Tumor suppressor genes BRCA1 (Breast and ovarian cancer)
and NF1 (Neurofibromatosis type 1)
Tumor suppressor genes DPC (Pancreatic cancer) and DCC
(Colon cancer)
Tumor suppressor gene NF2: Neurofibromatosis type 2
Q0258:Gene and matching chromosome associated with:
Retinoblastoma
Tumor suppressor gene Rb on chromosome 13q
Osteosarcoma
Tumor suppressor gene Rb on chromosome 13q
Breast cancer
Tumor suppressor genes BRCA1 (17q) and BRCA2 (13q)
Ovarian cancer
Tumor suppressor genes BRCA1 (17q) and BRCA2 (13q)
Most human cancers
Tumor suppressor gene p53 on chromosome 17p
Q0263:Gene and matching chromosome associated with: Li-
Fraumeni syndrome
Melanoma
Colorectal cancer
Tumor suppressor gene APC on chromosome 5q
Wilms' tumor
Tumor suppressor gene WT1 on chromosome 11q
Neurofibromatosis type 1
Tumor suppressor gene NF1 on chromosome 17q
Neurofibromatosis type 2
Tumor suppressor gene NF2 on chromosome 22q
Pancreatic cancer
Tumor suppressor gene DPC on chromosome 18q
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
Q0302:Tumor marker for: Paget's disease of bone
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
Q0309:Cancer associated with: HCV
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 B-
cell 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)
associated with: Squamous cell lung carcinoma
Causes;-PTH-related peptide;-TGF-beta;-TNF-alpha;-IL-
1;Effect: Hypercalcemia
associated with: Renal cell carcinoma
Cause: Erythropoietin;Effect: Polycythemia;Causes;-PTH-
related peptide;-TGF-beta;-TNF-alpha;-IL-1;Effect:
Hypercalcemia
associated with: Breast carcinoma
associated with: Multiple myeloma
associated with: Bone metastasis (lysed bone)
(Though technically not a paraneoplastic syndrome);Causes;-
PTH-related peptide;-TGF-beta;-TNF-alpha;-IL-1;Effect:
Hypercalcemia
associated with: Hemangioblastoma
Cause: Erythropoietin;Effect: Polycythemia
associated with: Hepatocellular carcinoma
Cause: Erythropoietin;Effect: Polycythemia
associated with: Thymoma
-Cause:Antibodies against presynaptic Ca2+ channels at
neuromuscular junction;-Effect: Lambert-Eaton Syndrome
(muscle weakness)
associated with: Leukemia
Cause: Hypercalcemia due to excess nucleic acid turnover (ie;
cytotoxic therapy);Effects;-Gout;-Urate nephropathy
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
with: ACTH-like peptide
Paraneoplastic syndrome: Cushing's syndrome;Neoplasm:
Small cell lung carcinoma
with: ADH
Paraneoplastic syndrome: SIADH;Neoplasm: Small cell lung
carcinoma with intracranial neoplasms
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)
with: TGF-beta
with: TNF-alpha
with: IL-1
with: Erythropoietin
Paraneoplastic syndrome: Polycythemia;Neoplasms;-Renal
cell carcinoma;-hemangioblastoma;-hepatocellular carcinoma
with: Antibodies against Ca2+ channels
Paraneoplastic syndrome: Lambert-Eaton syndrome (muscle
weakness due to presynaptic channels being
destroyed);Neoplasms;-Thymoma;-Small-cell lung cancer
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
causes and associated neoplasms: SIADH
Cause: ADH;Neoplasms: Small cell lung carcinoma with
intracranial neoplasms
causes and associated neoplasms: Hypercalcemia
1;Neoplasms;-Squamous cell lung carcinoma;-Renal cell
carcinoma;-Breast carcinoma;-Multiple myeloma;-Bone
metastasis (lysed bone: technically not a paraneoplastic
cause)
causes and associated neoplasms: Polycythemia
Cause: Erythropoietin;Neoplasms;-Renal cell carcinoma;-
Hemangioblastoma;-Hepatocellular carcinoma
causes and associated neoplasms: Lambert-Eaton syndrome
(muscle weakness)
Cause: Antibodies against presynaptic Ca2+ channels at
neuromuscular junction;Neoplasms;-Thymoma;-Small cell
lung carcinoma
causes and associated neoplasms: Gout
Cause: Hyperuricemia due to excess nucleic acid turnover (ie
cytotoxic therapy);Neoplasms;-Leukemias;-Lymphomas
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
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
cancer: Lung
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
Gi
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
decrease HR
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. Cheese-
like 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 & cresc-
decresc 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 decrescendo-
crescendo 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
Q0644:midsystolic murmur at the base
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-1-
antitrypsin; 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: L-
myc (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; Eaton-
Lambert 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
disease: what is the major PFT finding?
FEV1 / FVC ration is decreased (hallmark finding)
disease: name the 4 types of COPD
1) Chronic Bronchitis (Blue Bloater) 2) emphysema (pink
puffer) 3) asthma 4) bronchietasis
disease: what is the definition of Chronic Bronchitis
productive cough for >3 consecutive months in two or more
years.
disease: what do you expect on lung histology?
hypertrophy of mucus-secreting glands in the bronchioles
(Reid index of >50%)
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 life-
threatening 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 carbon-
carrying 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;?
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 fluid-
filled 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;?
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;?
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
urobilinogen changes for;Obstructive jaundice
Conjugated;Inc Urine Bilirubin;Dec Urobilinogen
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 (post-
infectious; 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;C-
6;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 renin-
angiotensin-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 insulin-
dependent 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
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. PTH-
like 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-1-
hydroxylase 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-1-
hydroxylase 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; B-
oxidation 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
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
Q1423:Dx;Adrenal hyperplasia; High BP; Low Cortisol; Low
Androgens
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
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
presents with constitutional signs/symptoms: low-grade
fever; night sweats; weight loss?
HL (NHL has few signs/symptoms)
presents with mediastinal lymphadenopathy?
HL
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
bimodal age distribution?
HL (NHL has peak incidence at 20-40 years old)
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 T-
lymphoblasts?
Sezary Syndrome; CLL-T (both L2)
Q1594:What are the acute leukemias associated with T-
lymphoblasts?
ALL-T (L2); ALL-null (L1); ALL-common(L1)
Q1595:What are the chronic leukemias associated with B-
lymphoblasts?
CLL-B (L3)
Q1596:What are the acute leukemias associated with B-
lymphoblasts?
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)
myeloblasts?
CML (M1; 2 and 3); Polycythemia rubra vera (M1);
myelofibrosis (M1)
myeloblasts?
AML (M2 and M1); Promyelocytic (M1)
Q1601:What are the chronic leukemias associated with eos-
myeloblasts?
Eosinophilic (rare)
normoblasts?
Chronic erythroid (M6; rare)
normoblasts?
acute erythroleukemia (M6)
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; Plummer-
Vinson
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
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 Howell-
Jolly 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
Burkitt's lymphoma (c-myc activation)
follicular lymphoma (bcl2 expression)
M3 - AML
ewing sarcoma
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 promoter-
induced 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
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.
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.
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 anti-
oncogene 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 c-
myc;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
osteomyelitis in sickle cell anemia patients
Salmonella organisms
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-Schuller-
Christian 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
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
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
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
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
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
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 weight-
bearing 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; anti-
Smith; 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 drug-
induced 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 Henoch-
Schonlein 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 Henoch-
Schonlein 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
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
can often lead to bell's palsy if impinging on the CN VII
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 end-
stage 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
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?
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 HCO3-
generation;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?
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
Urine osmolality <350; Urine Na >20; Fe(Na) >2% and
BUN/Cr <15. Where is the problem
Renal
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
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
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
Increased CO2 by decreased respiration
Vomiting; hyperaldosteronism (increased H+ secretion); loop
or thiazide diuretics (volume contraction)
Q2693:What is the primary disturbance in respiratory
alkalosis?
A drop in CO2
increased excretion of bicarb by the kidney
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
Lacks muramic acid
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;Ataxia-
telangiectasia - 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; estrogen-
replacement 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
Q2884:Which thyroid cancer?;From parafollicular "C cells"
Medullary carcinoma of the thyroid
Q2885:Which thyroid cancer?;Produces calcitonin
Q2886:Which thyroid cancer?;a/w MEN types II & III
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
Q2901:What drug class?;Glyburide
Second generation sulfonylurea
Q2902:What drug class?;Glimepiride
Q2903:What drug class?;Glipizide
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
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
Q2915:What diabetes drug type is;Chlorpropamide
Q2916:What diabetes drug type is;Glyburide
Q2917:What diabetes drug type is;Glimepiride
Q2918:What diabetes drug type is;Glipizide
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
Q2923:What diabetes drug type is;Miglitol
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
Q2970:Which ovarian tumor;Can cause endometrial
hyperplasia/carcinoma in adults
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
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 25-
menopause
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
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
Q3005:What penile tumor?;Becomes invasive SCC in <10%
of cases
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 blood-
filled 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
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; rough-
surfaced 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-and-
mouth 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 sun-
exposed areas of the head or neck
Q3114:What skin cancer is microscopically characterized by
nests of palisading cells
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
Q3117:Which neoplasm is microscopically characterized by
nest of atypical squamous epithelial cells and keratin
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
Q3119:Actinic keratosis lesions may transform into what
type of skin cancer if left untreated
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 dark-
skinned 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; rough-
looking or velvety skin in the axilla or on the back of the neck
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 Ehlers-
Danlos 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
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
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 mucosa-
associated 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 well-
differentiated 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 gram-
negative 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. Right-
sided 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 spoon-
shaped. 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 2-
cm 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 C-
peptide 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?
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
Turners syndrome
Coarctation of aorta
offspring of a diabetic mother
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 occiput-
diagnosis + 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
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 antigen-
antibody 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
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 left-
sided 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
artery luminal narrowing; symptom occurrence during
exertion; ST segment depression on ECG?
Stable angina
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
markers. (Some may have more than one answer.);? CA-125
Ovarian cancer
markers. (Some may have more than one answer.);? CA-19.9
and CEA
Pancreatic cancer
markers. (Some may have more than one answer.);? alpha-
Fetoprotein
Hepatoma and nonseminomatous testicular germ cell tumors
markers. (Some may have more than one answer.);? Calcitonin
markers. (Some may have more than one answer.);? PSA and
prostatic acid phosphatase
Prostate cancer
markers. (Some may have more than one answer.);? Placental
alkaline phosphatase
Seminoma
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
enzyme deficiencies?;? Muscle phosphorylase
McArdle's syndrome
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?
In neonates?
Streptococcus agalactiae
In patients with sickle cell disease?
Staphylococcus aureus (but they are more prone to salmonella
infections)
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)
the following?;? Medullary carcinoma of the thyroid;
pheochromocytoma; and parathyroid adenomas (or
hyperplasia)
MEN IIa (or Sipple syndrome)
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
Opening pressure 450 mm H2O; 5 WBCs (90%
lymphocytes); normal glucose and protein levels
Brain abscess
Opening pressure 100 mm H2O; 120 WBCs (90%
lymphocytes); normal glucose levels; protein 17
Viral meningitis
Opening pressure 250 mm H2O; WBCs 250 (90%
lymphocytes); glucose 35; protein 100
TB meningitis
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?
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
Aromatic amines and azo dyes
Arsenic
Squamous cell carcinoma (skin; lung) and angiosarcoma of the
liver
Asbestos
Mesothelioma and bronchogenic carcinoma
Naphthylamine
Bladder cancer
Benzenes
Leukemias
Vinyl chloride
Angiosarcoma of the liver
Chromium and nickel
Bronchogenic carcinoma
Polycyclic aromatic hydrocarbons
Bronchogenic carcinoma
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
hypoglycemia; sweating; hunger; confusion; and increased C-
peptide 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)
immunofluorescent staining;? Smooth and linear pattern of
IgG and C3 in the GBM
Goodpasture disease
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-to-
right 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
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
Vasodilation
PGD2; PGE2; and PGF 2
Pain and fever
PGE2
Vasoconstriction and platelet aggregation produced by
platelets
TXA2
Chemotactic for neutrophils
LTB4
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
the following occupations or materials?;? Aerospace industry;
nuclear reactors
Berylliosis
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; Milk-
alkali 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
examples;? Uremic pericarditis
Fibrinous exudates
examples;? Parasitic infection
Eosinophilic exudates
examples;? Diphtheria infection
Pseudomembranous exudates
examples;? Meningococcal infection
Purulent exudates
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?
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?
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?
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)
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)
the following properties;? IgG or IgM Abs against a specific
target cell or tissue; complement-dependent or ADCC.
Type II hypersensitivity (cytotoxic)
the following properties;? Reaction-mediated by sensitized T-
cells
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
rheumatic fever?;? Migratory polyarthritis
Major
rheumatic fever?;? Subcutaneous nodules
Major
rheumatic fever?;? Elevated acute phase reactants (e.g; ESR)
Minor
rheumatic fever?;? Arthralgias
Minor
rheumatic fever?;? Pericarditis
Major
rheumatic fever?;? Erythema marginatum
Major
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;? Stevens-
Johnson 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 sun-
exposed sites has a low level of metastasis?
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 Hippel-
Lindau 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
permanent) based on the following examples;? Skeletal muscle
Permanent
permanent) based on the following examples;? Pancreas
Stable
permanent) based on the following examples;? CNS neurons
Permanent
permanent) based on the following examples;? Fibroblasts
Stable
permanent) based on the following examples;? Hematopoietic
cells
Labile
permanent) based on the following examples;? Liver
Stable
permanent) based on the following examples;? Smooth muscle
Stable
permanent) based on the following examples;? Cardiac muscle
Permanent
permanent) based on the following examples;? Mucosal
epithelium
Labile
permanent) based on the following examples;? Kidney
Stable
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
vascular pathologies;? Subdural hemorrhage
Bridging veins draining into the sagittal sinus
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?
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 Dubin-
Johnson 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
the following laboratory values;? Decreased iron; TIBC; and
percent saturation; increased ferritin
Anemia of chronic disease
the following laboratory values;? Decreased iron; percent
saturation; and ferritin; increased TIBC
Iron deficiency anemia
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 right-
sided 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?
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?
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
associated with the following periods?;? Immunization
HBsAb IgG
associated with the following periods?;? Prior infection
HBcAb IgG and HBsAb IgG
associated with the following periods?;? Acute infection
HBcAb IgM; HBV-DNA; HBeAg; HBsAg
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; cottage-
cheese 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 middle-
aged 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
bacterial endocarditis;? Painful subcutaneous nodules on
fingers and toes
Osler nodes
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)
Average mass of the Hgb molecule/RBC
Mean corpuscular hemoglobin (MCH)
Average volume of a RBC
Mean corpuscular volume (MCV)
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; Bence-
Jones 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
hematoxylin or eosin?;? Nucleoli
Hematoxylin
hematoxylin or eosin?;? Cytoplasm
Eosin
hematoxylin or eosin?;? Collagen
Eosin
hematoxylin or eosin?;? RBCs
Eosin
hematoxylin or eosin?;? Calcium
Hematoxylin
hematoxylin or eosin?;? Bacteria
Hematoxylin
hematoxylin or eosin?;? Fibrin
Eosin
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
Immediately after transplantation; seen as a neutrophilic
vasculitis with thrombosis
Hyperacute rejection
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?
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
information;? Enveloped RNA flavivirus
Hepatitis C
information;? Naked capsid RNA calicivirus
Hepatitis E
information;? Enveloped DNA hepadnavirus
Hepatitis B
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.)
oncogenes. (Some may have more than one answer);? c-myc
Burkitt lymphoma
oncogenes. (Some may have more than one answer);? L-myc
Small cell cancer of the lung
oncogenes. (Some may have more than one answer);? hst-1
and int-2
Melanoma; cancer of the stomach and bladder
oncogenes. (Some may have more than one answer);? et
MEN II and III syndromes
oncogenes. (Some may have more than one answer);? Ki-ras
Pancreas and colon
oncogenes. (Some may have more than one answer);? cyclin D
Mantle cell lymphoma
oncogenes. (Some may have more than one answer);? N-myc
Neuroblastoma
oncogenes. (Some may have more than one answer);? CDK4
Melanoma
oncogenes. (Some may have more than one answer);? abl
CML and ALL
oncogenes. (Some may have more than one answer);? hst-1;
int-2; erb-2; and erb-3
Breast cancer
oncogenes. (Some may have more than one answer);? sis
Astrocytoma
oncogenes. (Some may have more than one answer);? Ki-ras
and erb-2
Lung cancer
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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Q0001:Three cell types with regard to cell cycle

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