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Block 10 Flashcards

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1
Q

What are the 5 cardinal signs

A 
Rubor
Calor
Dolor
Tumor
Functio laesa
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2
Q

Neutrophils are present in what inflammation

A

Acute

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3
Q

Where are neutrophils found

A

50% in circulation

50% in marginating pool

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4
Q

What is neutrophil distribution influenced by

A

Cytokines

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5
Q

What is the process of neutrophils adhesion

A
  1. IL-1 and TNF increas expression of selection
  2. Neutrophils weakly bin to selections and roll on surface
  3. Neutrophils express ligands for cellular adhesion molecules
  4. Neutrophils adhere firmly to ICAMS and VCAMS
  5. Neutrophils emigrate and migrate through tissues, phagocytize and kill what has been eaten
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6
Q

Where are a vast majority of mast cells found

A

Skin and lungs

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7
Q

What are chemical mediators of inflammation

A

Histamine
Serotonin
Kinins

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8
Q

What is histamine produced by

A

Basophils, platelets, and mast cells

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9
Q

What is release of histamine triggered by

A

IgE
Anaphylatoxins
IL-1

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10
Q

How is bradykinin made

A

Coag factor 7 converts prekallikrein to kallikrein

Which is then cleaved into bradykinin

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11
Q

What are the affects of bradykinin

A 
Vasodilation
Pain
Increased vascular permeability
Bronchoconstriction
Pain
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12
Q

What is made in the COX pathway

A

TXA2: made by platelets and causes vasoconstriction and platelet aggregation
Prostaglandin E2: causes pain and fever and vasodilation

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13
Q

What is made in the LOX pathway

A

Leukotrienes

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14
Q

What step in the arachidonic acid pathway is stopped by aspirin

A

COX (TXA2)

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15
Q

What are leukotrienes bad for

A

Asthma

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16
Q

What do IL1 and TNF do

A

Activate endothelial cell adhesion molecules

Initiate PGE2 synthesis in hypothalamus

Fever

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17
Q

What does IL6 act on

A

The liver to produce APR, ferritin, fibrinogen, CRP

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18
Q

What does IL-8 do

A

PMN chemotaxis

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19
Q

What are the 4 outcomes of acute inflammation

A

Complete resolution with regeneration

Complete resolution with scarring

Abscess formation

Transition into chronic inflammation

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20
Q

What are the causes of chronic infection

A

Persistent infections

Infections with recalcitrant organisms

Autoimmune disease

Response to foreign material

Response to malignant tumor

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21
Q

Where are macrophages circulating

A

In the blood

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22
Q

What are some macrophages

A 
Histiocytes (connective tissue)
Pulmonary alveolar macrophages (lung)
Kupffer (liver)
Osteoclasts (bone)
Microglia (brain)
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23
Q

What are modified into epithelioid cells in granluomas

A

Macrophages

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24
Q

What do eosinophils play a role in

A

Parasitic and allergic reactions

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25
What s contained in eosinophils granules
Major basic protein, which is toxic to parasites
26
Basophils and masts release
Histamine
27
What is a granuloma
An epithelioid mass surrounded by lymphocytes
28
What is produced in necrosis
Exudate, pus that is filled with proteins and neutrophils
29
What are the 2 processes of necrosis
1. Enzymatic digestion of the cell | 2. Desaturation of proteins
30
What are the 4 types of necrosis
Coagulative Liquefaction Caseous Fat
31
What is coagulative necrosis
Dues to ischemia or infarction | It is aseptic
32
Can regeneration occur in coagulative necrosis
It may if enough viable cells are present
33
What kind of necrosis is casused by ischemia is the brain
Liquefactive because there is very little structural framework in neural tissue
34
What is liquefactive necrosis
Leaves pus and fluid remains forms an abscess Associated with bacterial or fungal infections
35
What is caseous necrosis
Most often observed in TB | Cheesy proteinaceous dead cell mass
36
What is fat necrosis
Death in adipose tissue Small white lesions are formed Due to trauma
37
What is apoptosis
Well organized cell death Critical in fine tuning the retina and in fetal development 70% of ganglion cells die
38
What is Type 1 hypersensitivity
Anaphylactic
39
What is the 2 hypersensitivity
Cytotoxic
40
What is type 3 hypersensitivity
Immune complex
41
What is type 4 hypersensitivity
Delayed
42
What are early mediators of anaphylaxis
Histamine Heparin Eosinophils Neutrophils chemotaxic factor (IL8)
43
What are the late mediators of anaphylaxis
Prostaglandins Thromboxanes Leukotrienes SRS-A
44
Leukotrienes are _____ more potent than histamine
1000X
45
What does IL4 do
Drives IgM to IgE
46
What does IL5 do
Activate eosinophils
47
IL-13 does
Massive IgE production
48
What is the initial phase of type 1 driven by
Histamine
49
What is the last phase of Phase 1 driven by
Prostaglandins and leukotrienes
50
Leuoktrienes are _______X more potent than histamine
1000
51
What are some clinical manifestations of r Type 1 reaction
``` Anaphylaxs Atopy Asthma Allergic rhinitis Urticaria Angioedema ```
52
What are some triggers for Type 1 reaction
Food Drugs Stinging insects
53
How does IgE act in parasitic infection
Fab portion is bound to the worm. The Fc portion is free floating. Eosinophils have Fc epsilon receptors that will collide with the parasite that has IgE on it and it will release Major basic proline and cause tissue damage
54
Hoe does IgE work with antigens
On mast cells the IgE is already docked and it waits for the antigen to bind
55
What is the mechanism of Type 2 reaction
1. Ab bind to cell membrane 2. Cellular destruction leads to activation of complement and NK killing 3. Cellular dysfunction causes abnormal activation or blocking
56
What are some destructive examples of type 2 reactions
``` Autoimmune hemolytic anemia ITP Transfusion Hyperacute transplant rejection Rheumatic fever ```
57
Classical rejection is mediated by what hypersensitivity
4
58
Cornelia transplant rejections are mediated by what
2
59
What is an example of abnormal activation in Type 2
Graves
60
What is an example of blocking in type 2
MG
61
What is Coombs serum
Anti human IgG
62
What does direct Coombs test look for
Antibodies on RBCs
63
What does indirect Coombs test look for
Free plasma antibodies that could bind RBC and cause lysis
64
What is the mechanism of Type 3 reaction
1. Circulating Ig/GIgM complexes get lodged in vessels and tissues 2. Complement is activated, tissue is damaged
65
What is a local manifestation of type 3 reaction
Arthus
66
What s arthus
It is a type 3 reaction Common after vaccinations Arm will get red
67
What are some systemic examples of type 3 reactions
Serum sickness Rheumatoid arthritis Lupus
68
What is the process of immune complexe-mediated complement activation
1. Mast cell degranulation via anaphylotoxins 2. PMN chemotacis 3. Stimulates release of lytic enzymes from PMNs
69
Type 1,2,3 are ______ driven
Ab
70
Type 4 is ____ driven
Cell
71
Type 1 is Ig____ driven
E
72
Types 2-3 are Ig_ and Ig__ driven
G and M
73
What is the mechanism of type 4 reactions
1. Antigen binds to sensitized CD4 cell 2. CD4 releases cytokines that attract macrophages 3. Tissue damage
74
Are antibodies involved in Type 4 reactions
NO
75
What are som e examples of Type 4 reactions
Contact dermatitis TB test Corneal transplant recreation Autoimmune
76
What are the key cells in type 4 reactions
T helper cells | Macrophages
77
What is phlyctenular keratoconjunctivitis
Blisters on eye | Causes by bacteria: staphylococcus aureus
78
What is a macula
A flat lesion I.e. Freckle
79
What is a patch
It is a bigger macule I.e. Birthmark
80
What is a Papule
Elevated skin lesion I.e mole, acne
81
What is a plaque
Larger than a papule I.e psoriasis
82
That is a vesicle
A large fluid filled blister I.e shingles
83
What is a bulla
A large fluid filled blister
84
What is a pustule
A vesicle filled with pus
85
What is a wheal
A transient smooth papule or plaque | I.e hives
86
Is lupus chronic or acute?
Chronic
87
Why is lupus the "great imitator?
It can affect virtually every organ system
88
Who does lupus affect
Primarily women of child bearing age
89
What s the classic triad of lupus?
Fever Joint pain Malar (butterfly) rash
90
What is lupus often misdiagnosed with
Arthritis
91
What is the cause of lupus
Unknown But we know it Type 3, immune complex related (ANAs)
92
What is the ratio of lupus in women to men
10:1 Men usually get more severe
93
What are the common causes of death in lupus
Cardiovascular disease Renal failure Infections
94
What is a test you can do to look for lupus
ANAs Anti-dsDNA Ab Anti smith Ab
95
Is ANA test exclusive to Lupus
NO
96
What is the most common form of lupus
Systemic lupus erythematosis (SLE)
97
What is discoid lupus
Only affects the skin (10%) It never goes internal
98
What is drug induced lupus
10% | Signs/symptoms resolve upon cessation of the drug
99
What is the ANA test
Sensitive and not specific
100
What is the Anti-dsDNA Ab test
Specific, poor prognosis
101
What is the anti-Smtih Ab test
Specific, poor prognosis
102
What are the SLE ocular findings
``` 20% Dry eye Recurrent episcleritis Peripheral keratitis Photosensitivity Uveitis Central retinal artery occlusion ```
103
What test can Lupus cause a false positive in
RPR/VDRL FTA/ABS to confirm
104
What are some drugs that are associated with with drug induced lupus?
Quinidine Isoniazid Hydralazine Procainamide Mnemonic: Quietly Induce Harmful Pathology
105
How will the drugs that cause drug induced lupus show up in the blood
Transient ANA (no anti-Sm antibodies)
106
What is vasculitis
Inflamed vessel walls that can occlude
107
What is giant cell arteritis
Affects large and medium arteries In eye and aorta
108
What is the presentation of giant cell arteritis
HA Scalp necrosis Jaw claudication Blindess
109
What is the treatment for giant cell arteritis
Steroids
110
What is polyarteritis nodosum
Focal or segmental lesions of small and medium arteries Causes joint pain, retinal vein occlusion, cotton wool spots
111
What is scleroderma
Excessive fibrosis throughout the body Occurs in 30-35 year old women Ususually affects the skin, but it can go in to the body and scar organs (fatal in the lungs)
112
ANA positive in _____% of patients with scleroderma
95
113
What is diffuse scleroderma
It can go to many organs of the body Rapid progression to organs 20% 10 year survival Pursed lips
114
What si limited scleroderma
Affects the skin, fingers, and face Benign course CREST syndrome
115
What is CREST syndrome
Calcinosis (calcium deposits under skin) Raynaud phenomenon (vasospasm in digits (white-blue-red) Esophageal Dysmotility Sclerodactyly (thickening and tightening of skin and fingers and toes (claw fingers)) Telangiectasia (small, dilated vessels near the skin or mucus membrane surface, spider veins)
116
What is the test for scleroderma (systemic)
ANA Anti-Scl-70 Ab Anti-centromere Ab
117
You have a positive Anti-scale-70 Ab test, what do you have
Diffuse/bad scleroderma
118
You have a positive anti-centromere Ab test, what do you have
Limited/benign scleroderma
119
What are the ocular implications of scleroderma
May involve lacrimal glands
120
What is Sjögren's syndrome
Autoimmune destruction of exocrine glands | They cant spit or sweat
121
What it's eh triad of sjogrens
Dry mouth Dry eyes Arthritis
122
What is the lab test for sjogrens
ANA/RF positive Anti-Ro Anti-La
123
What is arthritis
Inflammation of the joints
124
What sit eh most common cause of arthritis
Osteoarthritis
125
What is osteoarthritis
Affects 27 mil in US Involves weight bearing joints Due to loss of cartilage Not systemic
126
What is rheumatoid arthritis
Systemic inflammation disease of synovial membranes and joints of hands, feet, wrists (Also heart, lung, liver, skin, vessels)
127
What is the primary mechanism of Rheutatoid arthritis
Starts as type 4 | Goes to type 3
128
What do we use to diagnosis rheumatoid arthritis
Rheumatoid factor It is an autoantibody (IgM) that is specific to cartilage collagen It is an Anti-IgG Ab Make Ab to our own IgG
129
What are the ocular manifestations of rheumatoid arthritis
``` In 25% of patients Keratoconjunctivitis sicca Scleromalacia perforans Choroiditis Retinal vasculitis Retinal detachments Macular edema Peripheral corneal ulceration ```
130
In RA IgG causes very little activation of complement T/F?
True
131
what is keratoconjunctivitis sicca
Decrease tear production | 15-25%
132
What is scleromalacia perforans
Necrotizing scleritis without inflammation | 15% caused by RA
133
What is juvenile idiopathic Arthritis (JIA)
Common in children ANA positive RF negative in (50%) (if present they will have a worse outcome)
134
JIA is the most Mormon cause of what in children
Uveitis (80%)
135
What are seronegative spondyloarthropathies?
Arthritis without RF
136
What are seronergtive spondyloarthropathies associated with strongly?
HLA-B27 (MHC-I)
137
What are the signs of Seronegative spondyloartropathies
Inflammation in back (worse in morning) Uveitis Rashes GI symptoms Dactylitis (sausage fingers) ``` PAIR P:psoriatic arthritis A: ankylosis spondylitis I: IBD R: Reiters syndrome ```
138
Who is ankylosing spondylitis more common in
Men
139
What would a radiology scan reveal in ankylosing spondylitis
Bamboo spine (vertebral fusion)
140
What is the classic triad of reactive arthritis
Conjunctivitis Urethritis Arthritis Can't see, cant pee, cant climb a tree
141
What is sarcoidosis
A non-rheumatologist autoimmune Inflammatory disease Associated with uveitis and hypercalcmia
142
What is a common sign of sarcoidosis
Non-case acting granuloma skin lesions
143
You do a test and find a high calcium what are you worried about?
Parathyroid Sarcoidosis Lung cancer
144
What is the indicator of impetigo
Honey colored lesions
145
What causes upetigo
Gram positive bacteria
146
What are the 2 gram positive bacteria responsible for impetigo
Staph aureus | Group A beta-hemolytic streptococci
147
What are the 2 types of impetigo
Impetigo contagiosa Impetigo bullosa
148
It impetigo contagious?
Yes, highly
149
How does impetigo contagosa appear
Crusty pustules
150
How does impetigo bullosa appear
Bulla Honey colored Usually called by S. Aureus
151
Where does impetigo occur
Common sites of S. Aureus colonization (nose and face) Secondary infections of dermatomes, breaks in skin, and wounds can occur
152
What accumulates in impetigo
Neutrophils accumulating in stratum cornermen Leads to subcorneal pustule that raptures and crusts
153
What is the pathogenesis of blister formation
Bacteria produce toxin that cleaves desmoglein
154
What Ecthyma (impetigo)
Deeper infection | Results in erosion to dermis
155
What is folliculitis
Staphylococci infection of hair follicles
156
What are the signs and symptoms of folliculitis
Itching and burning
157
What areas can be affected with folliculitis
Any region with hair | Especially axilla, face, legs
158
What is a faruncule
It occurs in the setting of staphylococcal folliculitis Initially a firm nodule that develops an abscess, sometimes with a central pustule
159
What WBC is in furuncule
Neutrophils
160
What is a carbuncle
Composed of multiple, coalescing furuncules Colin's subcutaneous abscesses, superficial pustules And openings draining pus
161
What is erysipelas
A beta hemolytic strep colonize skin and spread along superficial lymphatic vessels Erythematous expanding plaque
162
What is psoriasis
A common infection that infects 1-2% of US It affects all ages
163
Is psoriasis itchy?
NO
164
What is psoriasis often associated with
Psoriatic arthritis Myopathy Enteropathy AIDS
165
What areas of the body are often affected by psoriasis
``` Elbows Knees Scalp Lumbosacral Intergluteal cleft Glans penis ```
166
What is the classic presentation of psoriasis
Well demarcated Pink/salmon colored Silver/white scales
167
Does psoriasis affect the nail
Yes In 30% of cases Has pitting, yellow-brown discoloration
168
What is histologically happening in psoriasis
There is an increase in epidermal cell turnover that leads to acanthosis (epidermal thickening)
169
What mediates Psoriasis
``` T cells It has a strong association with HLA-C CD4+T cells interact with antigen cells in skin CD8+T cells are activated Cytokines released ```
170
What is the rate of occurrence of seborrheic dermatitis
It is more common than psoriasis
171
What is affected in seborrheic dermatitis
Areas with high densities of sebaceous glands Scalp, forehead, external auditory canal, retroauricular area, nasolabial folds, presternal area
172
What causes dandruff
Seborrheic dermatitis
173
How does early seborrheic dermatitis appear
Similar to eczema
174
How does late seborrheic dermatitis appear
Similar to psoriasis
175
What causes follicular lipping in seborrheic dermatitis
Mounds of parakeratosis containing neutrophils and serum
176
What causes seborrheic dermatitis
Unknown
177
How does lichen planus classically appear
Pruritic, purple, polygonal papules Often highlighted by Wickham striae
178
When does lichen planus clear?
Spontaneously after 1-2 years Can leave behind hyperpigmentation May progress into malignancy
179
What is pemphigus
A rare, autoimmune blistering disorder that usually affects people older than 40
180
What is the most common variant of pemphigus
Pemphigus vulgaris
181
How does pemphigus vulgaris occur
Involves mucosa and skin (scalp, face, axilla, groin, trunk, other pressure points)
182
How does pemphigus vulgaris appear
As superficial vesicles and bull are that rupture easily Dried serum, crust
183
What is in the sera of pemphigus vulgaris | How are they deposited
IgG Ab to desmogleins In a fish net pattern
184
Who is affected by bullous pemphigoid
Elderly
185
How does bullous pemphigoid appear
Tense bullae filled with clear fluid They do NOT rupture easily Heal without scarring
186
What areas are affected by bullous pemphigoid
``` Inner thighs Flexor surfaces of forearms Axilla Groin Lower abdomen Oral lesions (30%) ```
187
Is bullous pemphigoid acantholytic
No
188
What antigen causes bullous pemphigoid
Antigens in hemidesmosomes
189
What is acne vulgaris
Adolescent acne It is a disorder of sebaceous follicles Hereditary
190
What causes acne vulgaris
Androgenic hormones cause abnormal keratinization of follicles Sebaceous ducts are blocked Comedone
191
What bacteria causes acne
Propionibacterium acnes
192
How does bacteria cause acne
Bacterial lipases convert lipids to sebum to pro-inflammatory fatty acids
193
How does mild acne appear
Comedones | Occasional papules and pustules
194
How does moderate acne appear
More inflammatory | Lesions may heal with scars
195
How does cystic acne appear
Learner, deeper, more numerous papules or pustules Lesions tend to occur on trunk Not true cysts
196
What does trunk involvement indicate in acne
That treatment will be difficult
197
How does healing occur in severe acne
Atrophic or pitted scars on face Hypertrophic scars or keloids on back Hyperpigmentation
198
What is Rosacea commonly mistaken for
Acne
199
How does acne differ from rosacea
Rosacea does not have comedones Lesions are usually on flush areas, nose, cheeks, forehead, chin
200
What causes rosacea
Idiopathic | No inherited patterns
201
Does rosacea have ocular involvement
Blepharoconjunctivitis
202
What are the precipitating factors for rosacea
Sun exposure Excessive face washing Irritating cosmetics
203
What is rhinophyma
Disfiguring sebaceous hyperplasia It is an enlarged red nose
204
How does pre-rosacea appear
Facial erythema and telangiectasias "rosy cheek" Most patients never develop inflammatory lesions
205
What is vitiligo?
Loss of melanocytes in affected skin
206
What makes vitiligo more prominent
Tanning of surrounding areas
207
What can cause the loss of pigmentation in vitiligo
Infection Dermatitis Chemical irritation Idiopathic
208
What is melasma
Enhanced pigment transfer from melanocytes
209
What is melasma associated with
Pregnancy | Oral contraceptives
210
What accentuates melasma
Sun exposure | It resolves spontaneously or after hormone administration is discontinued
211
What is lentigines
Localized hyperplasia of melanocytes Birthmark Common in infancy or childhood
212
How does lentigines appear
Oval, tan-brown macules or patches Cafe au lait spots
213
How does lentigo differ from freckles
Lentigo does not darken in sunlight
214
What can too many cafe au lait spots be indicative of
Neurofibromatosis type I
215
What is solar lentigines
Develop with age and sun exposure "liver spots"
216
What causes scabies
Sarcoptes scabei
217
How is scabies spread
Person to person | Fomites
218
Where are mites typically found
Between fingers and on wrists
219
Where are the common locations of scabies rash to occur
Buttocks, back, lumbar, elbows, armpits, groin, knees, umbillicus , hands, heel
220
What is the pathognomonic lesion of scabies
Burrow
221
How do burrows form in scabies
Adult female burrows and deposits eggs The egg hatches Larvae molt into nymphs (found in molting pouches) Male will penetrate molting pouch and mating
222
What are nevocellular nevi?
Moles Congenital or acquired Tan/brown, with unform papules and borders
223
What are nevocellular nevi formed from
Melanocytes that have become round Occurs at tips of rete ridges
224
What are junctional nevi
Flat Can grow into dermis and form compound nevi
225
What is a compound nevi
Have cords of nevus cells in dermis Raised, dome shaped Have matured (produce no melanin)
226
What is sporadic dysplastic Nevi
Malignant | Transformation is rare
227
What is familial dysplastic nevi
Precursors of malignant melanoma Heritable Lifetime risk of maligned degeneration is 100%
228
How does dysplastic nevi differ from nevi
Larger than acquired nevi Can occur as hundreds of lesions Any body surface is prone, no just sun exposed regions Coloration not constant
229
What is dysplastic nevi
Compound nevi with abnormal growth Nevus cells are enlarged and fused Hyperchromasia (parallel bands of fibrosis)
230
What is the clinical presentation of acanthosis Nigricans
Thickened hyperpigmented skin Sometimes skin tags Occurs in armpit, neck, groin, anogenital
231
What is acanthosis nigricans an important marker for
Malignant conditions 80% benign (obesity/insulin dependents, endocrine, drug admin) Malignant (tumors produce factors that promote epidermal growth)
232
What is the clinical presentation of keratoacanthoma
Single lesion Grows rapidly (3-4 was) Ulcer forms a lesion center (crater) center has keratin mass Sunexposed skin(face, ears, back of hands and arms) Resolves in 3-4wks with an irregular scar Can progress in to squamous cell carcinoma (may be removed)
233
What is the clinical presentation of seborrheic keratosis
After 3040 yo Trunk, shoulder, face, scalp Begin small, yellow/tan plaque that increases in thickness and developers a greasy crust Black or brown with sharp demarcation Verruous surface May be removed
234
What should you be aware of in seborrheic keratosis
Development of multiple legions Can be a sign of Leser-Trelat (malignancy)
235
What is the clinical presentation of actinic keratosis
Occurs on exposed fair older skin Chronic UV exposure Ill defined erythematous macules or papules with a scaly surface Premalignant (can progress to squamous cell carcinoma in not treated)
236
What can actinic keratosis be a source of
Cutaneous horns
237
What is the clinical presentation of squamous cell carcinoma
Red/scaling plaques Nodular, tan hyperkeratotic lesions that can ulcerate Oder (60y.o)
238
What are the risk factors for squamous cell carcinoma
``` Sun exposure Fair complexion Carcinogens Old burns Arsenic ingestion Chronic ulcers and draining osteomyelitis Chewing tobacco (oral) Xeroderma pigmentosa ```
239
When is squamous cell carcinoma usually discovered
When small and respectable (5% metastasized)
240
What can be associated with squamous cell carcinoma
Cutaneous horns Leukoplakia when oral mucosa is involved
241
SCC Squamous epithelium extends beyond basement membrane into dermis In ALL layers of epidermis
Know this
242
What is the clinical presentation of basal cell carcinoma (BCC)
``` Common Slow growing Aggressive Pearly papules with telangiectasias Occurs in sun exposed, hair bearing areas ``` Rare to metastasize
243
What is rodent ulcer in reference to BCC
When it loses its distinct border but continues to grow across the skin
244
What are the risk factors for BCC
Chronic sun exposure Fair complexion Immunosuppression Xeroderma pigmentosum
245
What is the clinical presentation of malignant melanoma
40-70 Males: upper back Females: back and legs Asymptomatic (can itch) Usually >1cm
246
What are in the important clinical signs of malignant melanoma
Asymmetry Border irregularity Color Diameter >1cm
247
What are the risk factors for malignant melanoma
Intermittent sun exposure Bad sunburns in past Fair skin Dysplastic nevus syndrome (50% at age 60)
248
What re prognostic indicators of malignant melanoma
Depth of invasion Tumors that have horizontal growth have best prognosis Vertical growth: BAD
249
What are some horizontal growth patterns of malignant melanoma
Lentigo malignant melanoma Superficial spreading melanoma Acral -lentiginous melanoma
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Lentigo maligna melanoma
Usually on face or neck | Best prognosis
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Superficial spreading melanoma
Most common for Caucasians Stays in situ for months
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Acral lentiginous melanoma
Most common in dark skin | Hands, feet, subungal area
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What melanoma growth has the worst prognosis
Vertical growth
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Tumor growth <0.76 mm vertical tells you that.....
Metastasis is unlikely
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What is the cause of carotid stenosis
Build up of atherosclerotic plaque in the lumen of the common carotid near the bifurcation
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What effect does stenosis have on vessels
Reduces blood flow (Can be symptomatic if mild) Can lead to thrombosis at stenotic site or formation of emboli which occlude major arteries Drop in BP
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What are the major arteries that can be affected by Carotid stenosis
Middle cerebral artery * Anterior cerebral artery Ophthalmic Artery
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What s amaurosis fugax?
Transient/acute monocular blindness
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What can be found in a physical exam that is associated with carotid stenosis
Bruit
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How do you define the severity of carotid stenosis
By the degree of narrowing of the lumen
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What is carotid endarterectomy?
Surgical removal of the atherosclerotic buildup | High risk
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What are some alternative treatments for patients with carotid stenosis if carotid endarterectomy is too risky
Angioplasty | Stenting
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What can patients with carotid stenosis develop
Carotid occlusion
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What is carotid occlusion
Complete filling collusion of a long segment of the internal carotid They are functionally intact due to compensation through collateral blood flow via circle of Willis Thrombi can form at distal end of occlusion (endarterectomy too risky)
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What is a carotid/vertebral dissection?
Trauma-induced tear in the inner lining of a vessel | Creates a flap of tissue in the lumen that can occlude the vessel
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T/F the patient could hear popping at time of tear in dissection
True
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What is the complication what can occur with carotid/vertebral dissection
Thrombosis along the dissection flap and then occlusion occurs
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What is the presentation of carotid/vertebral occlusion
Pain in distribution areas Transient ischemic attack signs Infarct Horners syndrome ipsilaterally
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What is vasculitis
Inflammatory disease in large arteries (elastic lamina) | Can lead to ischemia distal to origin site
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What arteries can be involved in vasculitis
Superficial temporal Vertebral Ophthalmic Posterior ciliary (Small) Extramural arteries
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What is temporal arteritis
Risk of secondary ischemia due to occlusion or significant narrowing Ischemia in CNS Transient of ongoing visual loss
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Is temporal arteritis an emergency?
YES They can develop blindness Treat with glucocorticoids
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What is the presentation of temporal arteritis
Visible blood loss perfusion in affected side of face ``` Fever, ache, pain, scalp tenderness, HA Jaw claudication Weight loss Anemia Can be associated with peripheral neuropathies White swelling around the optic disc ```
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Who gets temporal arteritis
Rare under 50 Common over 70 Women White peoples
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How o you disgnose temporal arteritis
Biopsy of temporal artery | Angiogram
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What is Graves' disease
Autoimmune | Common origin for orbital disorder in adults
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What causes Graves' disease
Ab target TSH receptors, Increase T3/4 Can produce toxicity to thyroid tissue
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What causes orbital signs in Graves' disease
Lymphocytic infiltration
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What is the presentation of hyperthyroid disease
Goiter Tachycardia Fatigue, weight loss, anxiety, heat intolerance, sweating, increased appetite
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What are the orbital signs associated with graves
``` Periocular swelling Lid retraction Bulging eyes Diplopia Disconjugate gaze Oculomotor deficits Foreign body sensation Pain during eye movements ```
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What is craniopharyngeal carcinoma
Invades intracranial if it spreads to cranial sinuses
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What is nasopharyngeal carcinoma
Invade intracranially if it spreads to the sinuses
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What is laryngeal carcinoma
Common in smokers, presents with hoarseness Cervical lymphadenopathy Less likely to invade CNS
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What is salivary carcinoma
Common form from parotid gland Can invade toward CNS along facial nerve Less likely to invade to lead to visual oculomotor system disturbances
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What is lymphoma
CNS essential lacks lymphatic vessels and nodes Primary CNS lymphoma (rare from glial cells) Chronic: in lymph vessels /nodes. Benign

Pathology (4 decks)

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