Pathology: Knowledge Compilation and Notes

I. Drug-Induced Lung Injury

• Risk factors:

• Age > 60

• Preexisting lung disease (interstitial pneumonia)

• Decreased respiratory function

• History of lung resection

• Oxygen therapy

• Radiation exposure

• Renal impairment

• Smoking

• Note:

• Drug-induced lung injury is a serious concern that can lead to respiratory failure and even death.

• Close monitoring of patient’s respiratory function during drug use is crucial.

• Healthcare professionals should stay updated on the respiratory side effects of drugs, particularly new ones.

• The website [www.pneumotox.com](www.pneumotox.com) provides comprehensive information about drug-induced lung injury.

• Drugs causing cardiogenic pulmonary edema:

• Diltiazem

• Propanolol

• Albumin

• Non-cardiogenic pulmonary edema:

• Aspirin

• Methotrexate

• Lung injury due to Methotrexate:

• Risk factors:

• Diabetes mellitus

• Low albumin

• Older age

• Pleural effusion due to rheumatic fever

• Mechanism:

• Allergic reaction

• Cough due to angiotensin-converting enzyme (ACE) inhibitors:

• More common in women > men

• Latency period up to 15 months

II. Pulmonary Embolism

• Risk factors:

• Estrogen-containing medications (contraceptives)

• Antipsychotic medications

III. CO2-induced Myasthenia

• Drugs causing myasthenia:

• Aminoglycosides (Amikacin)

• Penicillin A

• Procainamide

IV. Jaundice

• Pre-jaundice:

• Duration of 1 week

• Mild fever, not associated with colds

• Flu-like symptoms

• Jaundice:

• Duration of 2-6 weeks

• Increased jaundice, dark yellow urine

• Fever subsides, no fever

• Routes of transmission of hepatitis virus:

• HAV: fecal-oral route

• HBV, HCV, HDV: blood, skin and mucous membrane contact, sexual intercourse, mother to child

• HEV: fecal-oral route

V. Liver Failure

• Classification:

• Fulminant hepatic failure: < 7 days

• Acute hepatic failure: 8-28 days

• Subacute hepatic failure: 4 weeks – 28 weeks

• Acute hepatitis AST, ALT:

• Cirrhosis: AST/ALT > 1

• Alcoholic hepatitis: AST/ALT > 2

VI. Hepatocellular Failure Syndrome

• Symptoms:

• Sleep, digestion, and clotting disorders

• Jaundice, yellow eyes

• Spider angiomas

• Erythema, palmar erythema

• Bilateral leg edema

• Ascites

• Decreased albumin, cholesterol

• Increased globulin, bilirubin

VII. Portal Hypertension Syndrome

• Symptoms:

• Ascites

• Splenomegaly

• Portal-systemic shunt

• Hemorrhoids

• Gastrointestinal bleeding

• Hypersplenism

VIII. Iron Overload and Copper Overload

• Iron overload:

• Skin pigmentation

• Copper overload (Wilson):

• No specific symptoms

IX. Diagnosis of Cirrhosis

• Gold standard: liver biopsy

X. Classification of Hepatitis

• Based on clinical and paraclinical features (hepatocellular failure, portal hypertension)

• Stage diagnosis based on gastrointestinal bleeding, jaundice, ascites, infection, hepatic encephalopathy (compensated – decompensated)

• None: shrunken liver

XI. Urinalysis

• False positive: myoglobinuria

• False negative: urine contains ascorbic acid, nitrites, high protein, pH < 5

• Sample collection: first urine of the morning, midstream

XII. Proteinuria

• Not causing proteinuria: minimal change glomerulonephritis

XIII. Red Blood Cell Casts

• Suggestive of: renal tuberculosis

XIV. Hematuria

• Not causing hematuria: bilirubin, porphyrin, myoglobin, hemoglobin

• Causing hematuria: bilirubin, porphyrin, myoglobin, hemoglobin

XV. Important Tests in Renal Edema

• Proteinuria

XVI. Blood Pressure Grading

• >= 18 years old:

• Primary chronic hypertension

• Not using antihypertensive medications

• No acute disease

XVII. Calcium Channel Blockers (Blood Pressure)

• Used for elderly patients (along with thiazides):

• Side effects: facial flushing, palpitations, leg edema, nocturia

XVIII. Beta Blockers

• Caution:

• Abrupt discontinuation of medication

• Bradycardia

• Patients with asymptomatic hypoglycemia

XIX. Effective Volume Depletion

• Causes:

• Heart failure

• Infection

• Ascites

• Acute pancreatitis

• Third-space loss

XX. True Volume Depletion

• Causes:

• Gastrointestinal-intestinal inflammation

• Chronic diarrhea

• Excessive diuretics

• Poor nutrition

XXI. Prevention of Drug-Induced Nephrotoxicity from Contrast Media

• Use:

• Lowest dose

• No additional imaging for 24-48 hours

• Do not use NSAIDs or diuretics for at least 24 hours

• Check kidney function 24-48 hours

XXII. Acute Tubular Necrosis

• Drugs causing necrosis:

• Aminoglycosides

• Amphotericin B

XXIII. Drugs causing hemolysis

• Drugs causing hemolysis:

• Colchicine

• Ciprofloxacin

• Paracetamol

XXIV. Chronic Interstitial Nephritis

• Risk factors:

• Use of acetaminophen, aspirin > 1g > 2 years

XXV. Risk Factors for Acute Kidney Injury from Contrast Media

• > 60 years old:

• Diabetes mellitus

• Heart failure

• Infection

• Reduced circulatory volume

• Underlying kidney disease > 60 ml/min

XXVI. Prevention of Drug-Induced Kidney Damage

• Use:

• Measure drug concentration

• Use substitute drugs if possible

• Adjust risk factors if possible

• Supplement fluids before and during treatment

• Assess kidney function before treatment (MDRD)

• Monitor and adjust drug dosage (Cockroft-Gault)

• Avoid combining nephrotoxic drugs

XXVII. Drugs that exacerbate hypertension

• NSAIDs:

• Erythropoietin

• Cyclosporine

• Ergotamine

• Estrogens

• Corticosteroids

• Alcohol

• Cocaine

• Anticholinergics

XXVIII. Risk factors for increased peptic ulcer disease in Hp-infected individuals

• CagA & Vac A bacterial infection:

• High salt intake

• Canned food consumption

• NOT a risk factor: alcohol

XXIX. Acute Myocardial Infarction

• Classification:

• ST-segment elevation MI

• Non-ST-segment elevation MI

• Unstable angina

XXX. Causes of Coronary Artery Disease

• Atherosclerosis:

• Takayasu’s disease, Kawasaki disease

• Hyperthyroidism

• Thrombosis, embolism

• Hypercoagulability disorders

XXXI. Risk factors for coronary artery disease

• Increased LDL:

• Decreased HDL

• HbA1c

• Systolic blood pressure

• Smoking

XXXII. Classification of MI

• 5 types:

• Type 1: occurs naturally (primary)

• Type 2: secondary MI due to myocardial oxygen imbalance

• Type 3: sudden death MI

• Type 4a: MI related to intervention, procedures

• Type 4b: MI related to stent intervention

• Type 5: MI related to coronary artery bypass surgery

XXXIII. Optimal aspirin dose for coronary artery disease

• 75-150 mg

XXXIV. Most sensitive test for coronary artery disease

• Exercise electrocardiogram

XXXV. Drug group improving prognosis for patients with chronic coronary artery disease

• Statins:

• Aspirin

• ACEi, ARB

XXXVI. Drug group improving symptoms of coronary artery disease

• Beta blockers:

• Calcium channel blockers

• Nitrate group

XXXVII. Mechanism of Diarrhea

• Osmotic diarrhea:

• Secretory diarrhea

• Inflammatory diarrhea (exudative diarrhea)

• Diarrhea due to intestinal motility disorders (IBS, hyperthyroidism, adrenal insufficiency) -> chronic diarrhea

XXXVIII. Causes of acute diarrhea

• Infection:

• Toxic infection

• Food poisoning, medication

XXXIX. Dysentery

• Blood and mucus in stool:

• Amoebic dysentery – parasite: no fever

• Bacillary dysentery – bacteria (Shigella): fever

XL. Pathogenesis of Constipation

• Slowed transit in the colon:

• Defecation disorder

• False perception of bowel habits

XLI. Causes of Constipation

• Tumors, inflammation, irritable bowel syndrome:

• Pregnancy

• Hypothyroidism

• Diabetes mellitus

• Hypokalemia

• Lead poisoning

XLII. Helicobacter pylori (Hp)

• Gram-negative spiral bacterium:

• Has flagella

• Located beneath the mucous layer of the gastric mucosa

• Secretes urease enzyme that hydrolyzes urea into NH3 & CO2, neutralizing acid

XLIII. Classification of Hp

• Toxic – moderately toxic – non-toxic:

• Cag (+): toxic

• Cag (-): non-toxic

• pH > 7 transforms from spiral bacterium -> coccus (inactive form)

XLIV. Factors to be noted in the diagnosis of cirrhosis

• Cause:

• Complications

• Child Pugh classification

• EXCLUDING: prognosis

XLV. The underestimation of drug-induced lung injury is due to

• There are too many drugs that cause TDP on the respiratory system

XLVI. How to stay updated on TDP drugs on the respiratory system?

• www.pneumotox.com

XLVII. The reason why UT drugs are more likely to cause TDP on the lungs

• The symptoms of the disease are easily mistaken for TDP from the drug

XLVIII. The most common lung injury caused by drugs

• Bronchospasm

XLIX. Factor that cannot cause coronary artery disease

• Increased supply, decreased demand

L. Ischemic colitis cannot occur in patients with

• Hypercoagulability state

LI. Symptoms of colitis

• Pain decreases after defecation:

• Abdominal pain on rectal examination

• Defecation multiple times when the entire colon is inflamed

LII. Mild ulcerative colitis

• Defecation < 4 times

LIII. Pseudomembranous colitis

• After taking antibiotics for 7-10 days

LIV. History of chronic kidney disease, which antibiotic is contraindicated?

• Gentamycin

LV. Patient with chronic kidney disease, gout is contraindicated?

• Paracetamol (NSAIDs)

LVI. Classification of albuminuria AER

• A1 < 30:

• A2 30-300:

• A3 > 300:

LVII. Classification of eGFR

• 1 > 90:

• 2 60-89:

• 3A 45-59:

• 3B 30-44:

• 4 15-29:

• 5 < 15:

LVIII. Description of rheumatoid arthritis

• The most common chronic inflammatory arthritis:

• Leaves many sequelae

• Manifests in joints and extra-jointly

• Peak incidence 25-55 years old

• 0.5-1% of the population

• Women > men (2-3:1)

LIX. Pathophysiology of rheumatoid arthritis

• Interaction of environment, genetics, and immunity:

• Exact mechanism unknown

• Macrophages secrete cytokines

LX. Organ damage in rheumatoid arthritis

• Mental disorders:

• Reproductive dysfunction

• Coronary artery disease

• NO: pericardial effusion

LXI. Patient with red urine, what test needs to be done to confirm the diagnosis?

• Microscopic examination of urine sediment with centrifugation

LXII. Drugs that worsen congestive heart failure

• Corticosteroids:

• Class 1 antiarrhythmics

• Carbenoxolone

• Verapamil, Diltiazem

• Alpha blockers

• NO: Losartan, Spironolactone

LXIII. Drugs toxic to cardiomyocytes

• Doxorubicin:

• Mitomycin

• Mitoxantrone

• Paclitaxel

• NO: Enalapril

LXIV. How do NSAIDs cause congestive heart failure?

• Retention of salt and water leading to increased circulatory volume

LXV. Factors suggestive of constipation due to serious medical conditions

• Weight loss:

• Continuous and worsening progression

• Family history of colorectal UT

• Age > 40

• NO: straining and using fingers to remove stool

LXVI. In chronic colitis, endoscopy helps to

• Rule out malignancy

LXVII. Characteristic of the acute phase of rheumatoid arthritis

• VS & CRP

LXVIII. Which joints are commonly affected in rheumatoid arthritis?

• Wrist, finger metacarpophalangeal, proximal interphalangeal joints

LXIX. Effect of immunosuppressive and immunomodulatory drugs in rheumatoid arthritis

• Helps improve prognosis

LXX. Chronic phase of rheumatoid arthritis

• Should: perform physical therapy; use braces, appropriate devices, exercise

• SHOULD NOT: put patients on complete bed rest

LXXI. The earliest criterion for detecting kidney damage

• Urine volume

LXXII. Conditions that increase urea more than normal

• Patients with gastrointestinal bleeding

LXXIII. Prevalence of chronic kidney disease in the community

• 10%

LXXIV. Which urine sample is used for Addis sediment?

• Urine sample kept for 3 hours

LXXV. The most common cause when a patient with acute kidney injury is in an emergency

• Acute tubular necrosis

LXXVI. The most accurate assessment of proteinuria from the glomeruli

• 24-hour urine protein test

LXXVII. Indication for kidney biopsy

• Hematuria with kidney failure:

• Primary corticosteroid-resistant nephrotic syndrome

• Microscopic hematuria + red blood cell casts

• Hematuria with proteinuria > 1g/24 hours

• NO: gross hematuria with blood clots

LXXVIII. Generalized edema

• Bilateral symmetrical edema of the body, must occur in at least 2 places on the body

LXXIX. Hematuria in glomerulonephritis lasting

• About 1 year after the disease is cured

LXXX. Neurological symptoms in high blood urea syndrome

• Restless legs syndrome, cramps:

• Memory and sleep disorders

LXXXI. Criteria for acute interstitial nephritis syndrome

• White blood cell casts

LXXXII. Oral asthma rescue medication

• Short-acting beta-2 agonist inhaled:

• Formoterol/Budesonide

• Ipratropium

• Magnesium sulfate

LXXXIII. Risk factors for acute asthma attacks

• Previous history of intensive care unit admission, intubation due to acute asthma attack:

• Having >= 1 severe asthma attack in the past 12 months

• Uncontrolled asthma

• Having psychological or socioeconomic problems

• Incorrect inhaler technique

LXXXIV. Functional symptoms suggestive of asthma

• Wheezing for about 1-2 hours in the morning

LXXXV. Risk of fixed airway obstruction

• Not using inhaled corticosteroids:

• Continued smoking, exposure to chemicals, pollution

• Increased sputum production

• Increased blood eosinophils

• NO: increased blood IgE

LXXXVI. Cells that do not participate in the pathogenesis of asthma

• IgG

LXXXVII. Goals of asthma management

• Symptom control:

• Maintain normal active function

• Reduce risk of exacerbations, risk of fixed obstruction

• Reduce drug side effects

LXXXVIII. The most common test to assess kidney function

• Blood creatinine

LXXXIX. Acute glomerulonephritis syndrome consists of symptoms

• Hematuria:

• Increased blood creatinine

• Generalized edema

• Hypertension

• NO: positive renal percussion

XC. Nephrotic syndrome completely recovers with corticosteroids when

• 3 consecutive negative urine dipstick tests

XCI. Paraclini

cal features consistent with average post-streptococcal acute glomerulonephritis

• Anti-Streptolysin O positive

XCII. Colitis management

• Cancer surveillance when the disease lasts longer than 8 years

XCIII. Ulcerative colitis is colitis caused by

• Unknown etiology

XCIV. Ulcerative colitis care

• Gastrointestinal nutrition:

• Treatment with monoclonal antibodies

• Contraindicated: antidiarrheal drugs

XCV. Acute interstitial nephritis symptoms

• Fever:

• Rash

• Joint pain

XCVI. The most common lung injury from heroin

• Cardiogenic pulmonary edema

XCVII. Side effect of dry cough from ACE inhibitors

• Occurs in 5-25%:

• Appears 1 week – 15 months after taking medication

• Women > Men

• Stop medication -> cough stops in 1 week – 3 months

XCVVIII. Lung injury from Amiodarone

• Phospholipid accumulation in cells:

• Chest X-ray shows lung lesions that are less dense than the surrounding tissue

XCIX. Triad that helps identify aspirin-induced asthma

• Asthma – allergic rhinitis – nasal polyps

C. Nitrofurantoin lung injury

• Due to hypersensitivity reaction:

• Immune-mediated damage

• 2/3 of cases have cough

CI. Cells that DO NOT participate in inflammation of the joints

• Smooth muscle cells

CII. Acute interstitial nephritis caused by agents

• Acyclovir

CIII. Fanconi Syndrome

• Tenofovir:

• Antiviral drugs

• Expired tetracyclines

CIV. Iron deficiency microcytic hypochromic anemia

• Give the patient iron supplements

CV. Patient with unmeasurable blood pressure, lethargy, low urine output

• Pre-renal cause

CVI. Which factor is included in the MDRD formula for calculating glomerular filtration rate?

• Race

CVII. Minimum tests to diagnose chronic kidney disease

• Blood creatinine, urinalysis, kidney ultrasound

CVIII. Drugs that cause tachycardia

• Pseudoephedrine hydrochloride:

• Diuretics

• Minoxidil

• Theophylline

• Thyroxine (thyroid hormone)

• Anticholinergic antagonists

CIX. Drugs that prolong QT

• Quinidine:

• Procainamide

• Haloperidol

• Macrolides

• Phenothiazines

General Notes:

• All information above is for reference only and does not replace medical advice from a healthcare professional.

• Contact your doctor for advice and timely treatment if you have any health problems.

• Keep up-to-date on information about diseases and medications to enhance your own knowledge.

Hope this information is helpful!