Micro/Path: Disorders and Inflammation Flashcards
1
Q
- increased melanin pigmentation is seen in?
2. decreased melanin pigmentation is seen in? (2)
A
- Addison’s Disease
2. Albinism and Vitiligo
2
Q
Melanin is the only endogenous __ colored pigment
A
brown-black
3
Q
what enzyme catalyzes the oxidation of tyrosine ==> dihydroxyphenylalanine in melanocytes?
A
tyrosinase
4
Q
Homogentistic acid is a __ pigment that occurs in patients with ___ = a rare metabolic disease
A
black, alkaptonuria
5
Q
Ochronosis __
A
is the syndrome caused by the accumulation of homogentisic acid in connective tissues: skin, cartilage, CT = alkaptonuria
6
Q
occurs when melanocytes, the cells responsible for skin pigmentation, die or are unable to function
A
Vitiligo
7
Q
the normal major pigment found in bile
A
Bilirubin
8
Q
- Bilirubin is derived from ___
2. does it contain iron
A
- Hemoglobin
2 no
9
Q
is bilirubin normal function and excretion vital to health
A
yes
10
Q
excess ___ causes jaundice
A
bilirubin
11
Q
hemosiderin
A
hemoglobin derived, yellow to brown pigment that serves as one of the major storage forms of iron
12
Q
under normal conditions small amounts of hemosiderin can be seen in
A
mononuclear phagocytes of bone marrow, spleen and liver which are actively engaged in RBC break down
13
Q
Local excess of Hemosiderin is seen when there is
A
hemorrhages in tissues.
Hemosiderin is most commonly found in macrophages and is especially abundant in situations following hemorrhage, suggesting that its formation may be related to phagocytosis of red blood cells and hemoglobin.
14
Q
- best example of localized hemosiderosis is a
2, when there is SYSTEMIC overload of iron, hemosiderin may be deposited in organs and tissues. this is called
A
- bruise
2. hemosiderosis
15
Q
an inherited condition of extreme accumulation of iron and is associated with the liver, heart, and pancreatic damage, resulting in liver fibrosis, heart failure, and DM
A
hemochromatosis
16
Q
Gout = defect in metabolism = overproduction of
A
uric acid
or reduced ability of kidney to eliminate the uric acid
17
Q
is gout inherited?
A
yes
may also develop in pp with DM, sickle cell anemia, kidney disease, or drug therapy that interferes with uric acid excretion
18
Q
gout is a disorder of _ metabolism and predominantly in men/women
A
purine
men
19
Q
monosodium urate crystals
A
gout
20
Q
hyperuricemia causes deposition of ___ into joints of people w gout
A
monosodium urate crystals
21
Q
gout occurs most frequently in which joint
A
metatarsophalangeal joint of the big toe
22
Q
podagra
A
acute gouty arthritis in big toe is called
23
Q
tophi
A
= large aggregates of urate crystals seen in chronic gouty arthritis
24
Q
most individuals with chronic gout also develop
A
urate nephropathy
25
Primary gout is the most common form = means
hyperuricemia without evident cause: most common in middle aged men and family predisposition
26
secondary gout is much less common. this is hyperuricemia with causes like
leukemia, multiple myeloma, myeloproliferative syndromes,
27
Lesch-Nyhan syndrome
hyperuricemia w severe neurological manifestations.
28
calcium pyrophosphate dihydrate crystal depostions caused by
pseudogout = elicits inflammatory reaction in cartilage. resembles gout clinically
29
acute cholecystitis
sudden inflammation of the gallbladder = severe abdominal pain.
30
90% of acute cholecystitis is caused by
gallstones (cholelithiasis) in the gallbladder
31
What kind of bacteria is isolated in ACUTE cholecystitis 80% of the time?
enteric bacteria
32
acute cholecystitis causes __ to become trapped in the gallbladder. this build up = irritation and pressure in gallbladder that can lead to bacterial infection and perforation of the organ
bile
33
___cholecystitis is thickening of the gallbladder wall occurring as a result of extensive fibrosis. it is frequently complicated by gallstones and bacteria can be cultured 30% of the time
chronic
34
Gallstones (cholelithiasis) occur more freq in men/women
women
35
Gallstones (cholelithiasis) associated w/_ and _ in women
obesity and multiple pregnancies
36
Gallstones (cholelithiasis) become more common in both sexes with increasing
age
37
What ethnicity have a higher rate of Gallstones (cholelithiasis)
native americans
38
Urinary stones are typically classified by their location in the
1. (nephrolithiasis),
2. (ureterolithiasis)
3. (cystolithiasis),
4. (cholelithiasis)
1. kidney stone
2. ureter
3. bladder
4. gallblader
39
3 types of cholelithiasis:
1. cholesterol stones
2. pigment stones
3. mixed stones
which one is most common
mixed stones (80%)
40
this type of cholelithiasis is made of cholesterol and calcium salts
mixed stones
| most common
41
type of cholelithiasis resulting from precipitation of excess insoluble UNCONJUGATED BILIRUBIN
pigment stones
42
type of cholelithiasis that is usually solitary and too large to enter the cystic duct or common bile duct
cholesterol stones
43
this type of cholelithiasis is associated with hemolytic anemia and bacterial infection
pigment stones
44
small yellow cholesterol flecks that are highlighted against a red background in the lining of the gallbladder
strawberry gallbladder aka Cholesterolosis
45
small finger like out pouchings of the gallbladder lining that develops as a person ages. may cause inflammation and require gallbladder removal
diverticulosis of the gallbladder
46
gallstones that block the __ duct result in obstructive jaundice (yelloo skin bc bile pigment deposited in skin)
common bile duct
47
inadequate secretion of thyroid hormones during fetal life or early infancy
cretinism
| congenital deficiency in the secretion of the hormone thyroxine from thyroid gland
48
cretinism is a condition of ___ growth and impaired __development
stunted body growth and impaired mental development
49
In cretinism, the mandible is ___ developed
the maxilla is ___ developed
the eruption of primary AND permanent teeth are
1. mandible is underdeveloped
2. maxilla overdeveloped
3. delayed
50
baby has open mouth that drools, swollen face and tongue, umbilical hernia, coarse, dry skin
cretinism
51
1. Myxedema
| 2. more common in
hypothyroidism in adults (or underactivity of thyroid)
| women
52
puffiness of face, eyelids, swelling of tongue and larynx, dry rough skin, hair becomes sparse, mentally and physically sluggish. obesity, over 50y/o, women, xray/radiation treatment, thyroid surgery are risk factors
myxedema (hypothyroid)
53
the secretion of T3 (triiodothyronine) and T4 (thyroxine) is controlled by the __ and __ in the brain
pituitary and hypothalamus
54
majority of T3 is formed in __ tissues by
peripheral, conversion of secreted T4
55
Hematemesis
associated with?
source?
vomiting of blood. The source is the upper gastrointestinal tract. associated with esophageal varices common in alcoholics, or peptic ulcers
56
hemoptysis
| associated with?
(coughing up blood) = in minor upper respiratory infections or bronchitis, TB, pneumonia, bronchiogenic carcinoma, idiopathic pulmonary hemosiderosis (iron in the lungs)
57
blood in urine usually caused by
Urinary tract and kidney diseases
58
in women, blood seen in urine may be coming from
vagina and not the urine
59
in men the urethra carries both urine and semen out of the body. if it is not urinary bleeding that causes blood in urine it could be a
prostate problem = bloody ejaculation
60
causes for blood in urine for children?
coagulation disorders: hemophilia, sickle cell, renal vein thrombosis, thrombocytopenias
61
idiopathic pulmonary hemosiderosis (iron in the lungs) main symptom is
hemoptysis (coughing up blood)
62
glucosuria
| common in
glucose (sugar) in urine
| DM
63
Ketonuria
| common in
ketones in urine
| produced by starvation, uncontrolled DM, occasionally alcohol intoxication
64
proteinuria
| sign of
protein in urine
| kidney disease
65
which vessels are particularly prone to tearing along their course thru the subdural space and are a source of bleeding in most cases of subdural hematoma
a. middle meningeal artery
b. middle cerebral artery
c. berry aneurysm in the circle of Willis
d. bridging veins
bridging veins
66
epidural hematomas usually occur from
skull fractures and laceration of middle meningeal artery
67
subdural hematomas usually occur from
bridging veins tearing from deceleration injury from a fall or motor vehicle accident but RARELY a fracture
68
subarachnoid hemorrhages usually occur from
Berry aneurism in circle of willis
69
immediate and temporary disturbance of brain functions - dizziness, cold perspiration visual disturbance and loss of consciousness
brain concussion
| most pp recover completely within a few hours/days
70
one complication of a brain concussion is
postconcussion syndrome
71
meningioma - tumor arising from __
arachinoid
72
mnemonic for hematomas and hemorrhages?
```
EDH = epidural hematomas = MMA (middle menigeal artery) or fracture
SDH = subdural hematomas = BV (bridging vein) tear, fall or deceleration accident. RARELY a fracture
SAH = subarachnoid hemorrhages= BA (berry aneurism)in circle of willis (berry aneurism)
```
73
clinical deficiency in vitamin A?
night blindness
74
vitamin a is called
retinol
75
Fat soluble vitamins
ADEK
76
Vitamin _ is involved in blood clotting. if there is a defect = coagulation defects
K
77
Vitamin _ is an antioxidant. Defects = neurological disorders, ex ataxia
E (tocopherol)
78
Vitamin _ is essential in bone formation. deficiency = Rickets in children and osteomalacia in adults
D (cholecalciferol)
79
This vitamin helps maintain normal body growth and health of specialized tissues especially the retina. it produces_____
Vitamin A (retinol) produces rhodopsin (photopigment)
80
vitamin A def causes
night blindness, keratomalacia, xerophthalmia, follicular hyperkeratosis
81
Xerophthalmia
| cause?
the eye fails to produce tears
| lack of Vit A
82
Nyctalopia
night blindness
83
1. Pathologic calcification is the abnormal tissue deposition of?
calcium salts together with smaller amounts of iron, magnesium and other mineral salts
84
1. Pathologic calcification: when deposition occurs LOCALLY IN DYING TISSUE it is known as ___(dystrophic/metastatic calcification)?
2. What's special about this is that it occurs despite?
1. dystrophic calcification = dying (D =D)
| 2. despite NORMAL levels of calcium and in the ABSENCE of derangements in calcium metabolism.
85
1. Pathologic calcification: when deposition occurs NORMAL TISSUE it is known as ___(dystrophic/metastatic calcification)?
2. almost always results from
1. metastatic calcification
| 2. hypercalcemia secondary to some disturbance in calcium metabolism
86
dystrophic/metastatic calcification = normal tissues whenever there is hypercalcemia.
metastatic
87
dystrophic/metastatic calcification = encountered in areas of necrosis, and in necrosis of fat
dystrophic
88
4 principal causes of hypercalcemia
1. increased PTH secretion = increases bone resorption
(hyperPTH)
2. destruction of bone tissue (bone tumors/bone marrow)
3. vitamin D disorder
4. renal failure = retention of phosphate leading to secondary hyperparathyroidism
89
sialolith
stone in salivary duct (salivary calculus)
90
sialolithiasis
formation of sialolith = stone in salivary duct (salivary calculus) = can cause swelling/pain
91
___ occurs as a result of precipitation of calcium and phosphate salts around a nidus of mucous or bacterial debris
sialolithiasis
92
Most sialoliths are found in the __ duct and gland
submandibular duct (Wharton's duct) and gland
93
Stenson's duct belongs to which gland
parotid
94
Wharton's duct belongs to which gland
submandibular
95
the smallest, most diffuse, and the only unencapsulated major salivary gland
sublingual gland
96
ducts of Rivinus belongs to which gland
sublingual
97
1. sublingual glands lie ___ to the submandibular gland inferior to the tongue, as well as beneath the mucous membrane of the floor of the mouth.
2. Each gland is effectively palpated on the floor of the mouth posterior to which teeth?
3. can you palpate them?
1. anterior
2, each mandibular canine
3. yes Placing one index finger intraorally and the fingertips of the opposite hand extraorally, the compressed gland is manually palpated between the inner and outer fingers
98
calcinosis
calcification that occurs under the skin. scleroderma, dermatomyositis, multiple miliary osteomas are examples
99
__ is required for porphyrin synthesis, is associated with anemia and cheilosis, glossitis, and synthesis of niacin from tryptophan
vitamin B6 = pyridoxine
100
which vitamins are water soluble?
B1, B2, B3, B5, B6, B12, folic acid and C
101
a deficiency in this vitamin causes defective wound healing
C
102
a deficiency in this vitamin causes Scurvy
C
103
a deficiency in this vitamin causes Pellagra
B3 niacin (Don't confuse with Podagra = gout in big toe!)
104
a deficiency in this vitamin causes wet and dry beriberi
Vitamin B1 thiamine
105
a deficiency in this vitamin causes cheilosis, gossitis, and dermatitis
B2 riboflavin
106
a deficiency in either of these 2 vitamins causes megaloblastic anemia
Folic acid and B12 (cobalamine)
107
a deficiency in this vitamin causes megaloblastic anemia AND NEUROLOGIC DYSFUNCTION
B12(cobalamine)
108
deficiency in this vitamin causes megaloblastic anemia AND NOOOO NEUROLOGIC DYSFUNCTION
Folic acid
109
a deficiency in this vitamin causes WERNICKE-KORSAKOFF SYNDROME
B1 thiamine
110
this vitamin is a component of FAD and FMN and is essential for oxidation reduction processes
B2 riboflavin
111
this vitamin is required for transamination, porphyrin synthesis, synthesis of niacin from tryptophan
B6 pyridoxine
112
this vitamin is a component of NAD and NADP, essential to glycolysis, TCA, and oxidation reactions
B3 niacin
113
these 2 vitamins are 1 carbon transferers
B12 (cobalamine) and folic acid.
114
this vitamin is required for the hydroxylation of proline and lysine, which are essential for collagen synthesis, and hydroxylation of dopamine in synthesis of norepinephrine
Vitamin C
115
deficiency in this vitamin causes cheilosis, glossitis and anemia
B6 pyridoxine
116
this vitamin is required for folate synthesis and FH4 activation
B12 cobalamine
117
Trachoma is an ___ infection caused by what bacteria
eye
| chylamydia trachomatis
118
conjunctivitis
pink eye = inflammation of conjunctiva (the tissue that lines the INSIDE of the eyelids
119
most common and treatable eye infection is
conjunctivitis
| pink eye
120
conjunctivitis can be caused by virus, bacteria, irritating substances (shampoo/dirt/smoke/pool chlorine), allergens or STDs. Pink eye caused by which one can be spread from person to person
bacteria, virus, Std
121
conjunctivitis COMMON features
soreness redness discharge, visual acuity is good
122
if a neonate has conjunctivitis we must ensure
that there has been no maternal STD association with it
123
Trachoma is an eye infection caused by __
chylamydia trachomatis
124
__ is the most common cause of preventable blindness in underdeveloped areas of the world
chylamydia trachomatis
| Trachoma
125
toxicity of therapeutic oxygen, most often administered because of neonatal respiratory distress syndrome that lead to blindness
retinopathy of prematurity = retrolental fibroplasia
126
diabetic retinopathy is a major cause of
blindness
127
hereditary night blindness with progressive loss of central vision caused by early loss of rods and later loss of cones
retinitis pigmentosa
128
macular degeneration of the aged (senile macular degeneration) is a major cause of impaired vision in the __ and is often bilateral
elderly
129
glaucoma has two forms:
open angle and angle closure
130
most common form of glaucoma
open angle glaucoma
131
this type of glaucoma = narrow anterior chamber angle and increase in intraocular pressure on dilation of pupil
angle closure glaucoma (less common)
132
this type of glaucoma = gradually increasing ocular pressure leading to visual impairment and eventually blindness
open angle glaucoma (most common form)
133
a malignant retinal tumor of childhood
retinoblastoma
134
pt in emergency room w/severe mid abdominal pain. Dr thinks its acute pancreatitis and orders a blood test. lab values show elevated serum lipase. to confirm the diagnosis which other enzyme would likely be elevated?
a. alkaline phosphate
b. amylase
c. glucose-6-phosphatase
d. acid phosphatase
amylase.
135
pancreatitis is an __ or __ of the pancreas
infection or inflammation
136
pancreas is an elongated tapered gland located behind/in front of the stomach
behind
137
pancreas secretes
digestive enzymes and hormones insulin and glucagon
138
pancreatitis is often caused by the digestion of parts of the organ by pancreatic enzymes that are normally carried to the small intestine within the pancreatic ducts. IN acute pancreatitis, what has occured
obstruction of the normal pathway of pancreatic juice into the intestine. the zymogens of the proteolytic enzymes are converted into their catalytically active form prematurely inside the pancreatic cells. = attack the pancreas itself = painful and serious destruction of the organ = which can be fatal.
139
acute pancreatitis is associated with
alcoholism and biliary disease
140
acute pancreatitis consequences include enzymatic hemorrhagic fat necrosis with __ formation and resultant __
calcium soap
| hypocalcemia
141
cardinal clinical sign of acute pancreatitis is
severe mid-abdominal pain
142
cardinal sign of acute cholecystitis is
severe RUQ or upper abdominal pain
143
cardinal sign of acute appendicitis is
severe RLQ abdominal pain with marked rebound pain to palpation
144
1. severe mid-abdominal pain
2. severe RUQ or upper abdominal pain
3. severe RLQ abdominal pain with marked rebound pain to palpation
1. acute pancreatitis
2. acute cholecystitis
3. acute appendicitis
145
Neurobromatosis type 1 is aka
von Recklinghausen's disease
146
Neurobromatosis type 1 is aka von Recklinghausen's disease is an autosomal __ disorder
dominant
147
```
gliomas of the optic nerve
neurofibromas (plexiform and solitary)
pigmented nodules of the iris (Lisch nodules)
cutaneous hyperpigmented macules
(café-au-lait spots)
are?
```
Neurobromatosis type 1 is aka von Recklinghausen's
148
bilateral eighth nerve schwannomas and multiple meningiomas, gliomas are
Neurobromatosis type 2
149
Neurobromatosis type 1 (von Recklinghausen's disease), Neurobromatosis type 2, Marfan Syndrome, Familial hypercholesterolemia, hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) and Adult polycystic kidney disease are all
autosomal dominant disorders
150
autosomal dominant disease w/anomalies of receptors for low density lipoproteins (LDLs)
Familial hypercholesterolemia
151
autosomal dominant disease characterized by local telangiectases of the skin and mucous membranes and by recurrent hemorrhage of lesions. Common in Mormon families of Utah
hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
152
autosomal dominant disease characterized by defects in skeletal, visual and cardiovascular structures. Patients are tall thin w/abnormally long arms and spider like fingers (archnodactyly) and hyperextensible joints. heart problems: aneurysm of the proximal aorta, mitral valve prolapse and dissecting aneurysm of the aorta
Marfan syndrome
153
autosomal dominant disease characterized by numerous bilateral cysts that replace and destroy the renal parenchyma
Adult polycystic kidney disease
154
T/F the most common cause of hypothyroidism in adults is Grave's disease
false. Most common cause is Hashimoto's thyroiditis (aka chronic thyroiditis or Hashimoto's Disease)
155
T/F hypothyroidism can be caused by iodine deficiency
true
156
The strongest female predilection of any disease known to man
Hashimoto's thyroiditis (most common cause of hypothyroidism)
157
Hashimoto's thyroiditis:
1. onset of disease is __slow/fast
2. thyroid may initially be painlessly enlarged, over time the inflammation leads to __
3. it is associated with various __
4. histologic characteristic = massive infiltrate of __ with germinal center formation
1. slow
2. atrophy of the thyroid
3. autoantibodies: antithyroglobulin, antithyroid peroxidase, anti-TSH receptor, and anti-iodine receptor antibodies.
4. lymphocytes
158
slowed speech, fatigue, cold intolerance, dry skin, coarse hair and puffy face are symptoms of
hypothyroidism
159
in Hashimoto's disease there is a production of antibodies in response to thyroid antigens and the replacement of normal thyroid tissue with
lymphocytes and lymphoid germinal centers
160
primary hyperparathyroidism (HPT) is most often caused by
parathyroid adenoma
161
hypothyroidism (cretinism and myxedema) can be caused by __ deficiency
iodine
162
Grave's disease is the most common cause of endogenous ___
hyperthyroidism
163
1. ___is the most common cause of endogenous hyperthyroidism
| 2. ___ most common cause of hypothyroidism
1. Grave's Disease = 10x more likely in women
2. Hashimoto's Thyroiditis Disease
Note both are autoimmune disease and both women are WAY more likely to get it
164
Grave's disease = multiple autoantibodies form against the
thyroid antigens especially the TSH receptor
165
a somatotropic adenoma with hypersecretion of growth hormone that develops before epiphyseal closure results in
a. cretinism
b. acromegaly
c. gigantism
d. myxedema
c. gigantism
166
anterior pituitary HYPERFUNCTION is usually due to
benign slow growing tumors
167
most common pituitary tumor
Prolactinoma with hyperprolactinemia
168
in women, Prolactinoma with hyperprolactinemia results in
amenorrhea and galactorrhea (inappropriate milk secretion)
169
Second most common pituitary tumor
somatotropic adenoma with hypersecretion of growth hormone
170
somatotropic adenoma with hypersecretion of growth hormone:
1. ___ results if adenoma develops before epiphyseal closure
2. ___ results if adenoma develops AFTER epiphyseal closure
1. gigantism
| 2. acromegaly
171
Deep voice
enlarged tongue
prognathism (mandible protrudes)
excessive perspiration and offensive body odor
gradual marked enlargement of the head, face, hands, feet and chest
gigantism/acromegaly (somatotropic adenoma w/ hypersecretion of GH)
172
corticotropic adenoma with hypersecretion of ACTH causes
hypercorticalism (CUSHING SYNDROME) = elevated glucocorticoid levels
173
the vast majority of Cushings syndrome are the result of exogenous/endogenous glucocorticoids?
exogenous
174
the endogenous cushing's syndrome can be divided into those that are ACTH dependent and those that are ACTH independent. deficiency.
1. A deficiency in growth hormone in children results in __
2. A deficiency in growth hormone in adults results in
1. dwarfism
| 2. increased insulin sensitivity and hypoglycemia, decreased muscle strength and anemia
175
deficiency in gonadotropins:
1. in preadolescent children results in
2. in adults results in
1. retarded sexual maturation
| 2. loss of libido, impotence, loss of muscular mass, and decreased facial hair in men and amenorrhea in women
176
the pathognomonic lesion of erythema multiforme is
a. butterfly rash
b. "target lesion"
c. "pasted on plaque"
d. hill sachs lesion
b. "target lesion" = red macule or papule with a pale, vesicular or eroded center, symmetric lesions. concentric rings of pallor and redness, referred to as iris, or bulls eye shaped
177
erythema multiforme = uncommon disorder = hypersensitivity to certain drugs and infections. an extensive and symptomatic febrile form of the disease which is often seen in children is called
Stevens-Johnson syndrome
178
erythema multiforme = uncommon disorder = hypersensitivity to certain drugs and infections. a variant of this disease called __ results in diffuse necrosis and sloughing of cutaneous and mucosal epithelial surfaces, producing a clinical situation analogous to an extensive burn when both infection and fluid loss are clinical concerns
toxic epidermal necrosis
179
concentric rings of pallor and redness, referred to as iris, or bulls eye shaped, target lesion
erythema multiforme
180
Herald patch
Pityriasis
| spreads along flexural lines. may be of viral origin
181
Large, red nose
Rosacea
182
Vesicles on mucosa
pemphigus
| autoantibodies against intracellular junctions of keratinocytes
183
Irregular pigmentation
Vitiligo
184
Honey colored crust, superficial skin infection
impetigo
| Staph Aureus or Group A beta-hemolytic Strep
185
pemphigoid is like pemphigus but it is
larger bullae on abdomen and groin
186
hyperlipidemia, foamy histiocytes
xanthoma
187
"salmon patches" and stork bites -spontaneously regresses
Capillary hemangioma
188
"Strawberry hemangiomas" =initially grows, later regresses
Capillary hemangioma
189
"Port-wine stain" seen in Sturge Weber syndrome does not resolve spontaneously
Cavernous hemangioma
190
Café-au-lait spots
Neurofibromatosis Type 1 (von Recklinghausen disease) autosomal dominant
191
Impetigo is an infection caused by what 2 bacteria
coagulase positive staphylococcus aureus
| and Group A beta hemolytic strep (strep pyogenes). enter thru damaged skin and transmitted thru direct contact
192
impetigo is a highly infectious skin infection common in __
pre-school aged children (2-5 years old) during warm weather
193
impetigo usually appears on child's
nose and mouth. starts as red sore that quickly ruptures, oozes for a few days and then forms a yellowish-brown crust that looks like HONEY or BROWN SUGAR
194
impetigo is contagious T/F
true = carried in fluid that oozes from the blisters. rarely may form deeper skin ulcerations
195
recurrent peptic ulcers or peptic ulcers in aberrant sites such as the jejunum is suggestive of
a. cushing syndrome
b. acromegaly
c. sipple syndrome
d. zollinger-Ellison syndrome
d. zollinger Ellison syndrome
196
zollinger Ellison syndrome causes ___ in the pancreas and duodenum and ___ in the stomach and duodenum.
tumors
| ulcers
197
peptic ulcers (lesions in the mucosal membrane) can develop in esophagus, stomach, pylorus, duodenum or jejunum. 80% of all peptic ulcers are in
duodenum and in men 20-50
198
___ulcers which affect the stomach mucosa are most common in middle aged and elderly men
gastric
199
__ ulcers are caused by repeated regurgitation of stomach acid (HCl) into the lower part of the esophagus
esophageal
200
except for peptic ulcers of the stomach, peptic ulcers are always associated with hypersecretion of _ and _
gastric acid and pepsin
201
ulceration closely related to gastric ____ which affects all patients with duodenal ulcers and majority of patients with gastric ulcers
Helicobacter pylori infection
202
1. most common symptom of peptic ulcer
2. most common complication of peptic ulcer is
3. malignant change is common/uncommon
1. pain
2. hemorrhage
3. uncommon
203
in extreme cases ulcers can lead to
perforation = hole in GI tract = leads to acute peritonitis = lead to death
204
aspirin, NSAIDs, smoking, Zollinger Ellison syndrome, primary HPT, multiple endocrine neoplasia (MEN) type 1 (Wermer syndrome) associated with
peptic ulcer
205
vasopressin is produced in which location
supraoptic nuclei of hypothalamus
206
the most common disease of man related to anti-diuretic hormone (vasopressin) is
diabetes insipidus (DI)
207
____can arise from two situations:
| Hypothalmic "central" diabetes or Nephrogenic diabetes
diabetes insipidus (DI)
208
deficiency of ADH from the posterior pituitary. causes = head trauma, infections, tumors in hypothalamus
Hypothalmic "central" diabetes (diabetes insipidus (DI) )
209
kidney is unable to respond to ADH = results from kidney disease or mutations in ADH receptor gene
Nephrogenic diabetes = diabetes insipidus (DI)
210
ADH is produced by __ of hypothalamus but secreted by
supraoptic nuclei of hypothalamus
| secreted by posterior pitutiary
211
ADH binds to receptors on cells of the ___ duct of the kidneys
collecting = promotes reabsorption of water back into the circulation.
212
in absence of ADH the collecting ducts are
impermeable to water = and water flows out as urine
213
diabetes insipidus (DI) is characterized by
polyuria bc kidney cant resorb water properly from urine
214
diabetes insipidus (DI) should not be confused with
Diabetes mellitus = results from insulin deficiency or resistance leading to high blood glucose
215
diabetes insipidus (DI) and DM are unrelated although they can have similar
signs and symptoms, like excessive thirst and urination
216
which is more common DI or DM
DM
217
the most important variable regulating ADH secretion is
plasma osmolarity (concentration of solutes in the blood). osmolarity is sensed by hypothalamus by neurons known as osmoreceptors. those neurons stimulate neurons that produce the ADH
218
What hormone stimulates ADH secretion
Angiotensin II
219
What reduces vasopressin secretion at neurohypohyseal nerve terminals
ethanol
220
ADH is also stimulated by _ in blood pressure and volume, conditions sensed by __
decrease, stretch receptors in the heart and large arteries
221
self-limited disease
a disease process that resolves spontaneously with or without specific treatment
222
infectious mononucleosis is a benign, self limiting disorder caused by
Epstein Barr Virus (EBV) = has affinity for B lymphocytes
223
infectious mononucleosis is a viral/bacterial infection
viral
224
infectious mononucleosis causes
high temp sore throat lymphadenopathy and hepatosplenomegaly
225
EBV (aka human herpesvirus 4 (HHV-4)) transmitted by
close human contact, freq saliva during kissing
226
lymphocytosis with atypical activated T lymphocytes (mononucleosis cells)
infectious mononucleosis
| EBV specific CD8+ cytotoxic T cells and CD16+NK cells in blood
227
acute pharyngitis and tonsillitis, gray-white exudative membrane, enlargement of lymph nodes in neck, palatal petechiae
infectious mononucleosis
228
Heterophil antibodies (hetrophil agglutinins) are ONLY SEEN IN
infectious mononucleosis
229
The monospot test
, a form of the heterophile antibody test, is a rapid test for infectious mononucleosis due to Epstein–Barr virus (EBV).
230
Are antiviral therapy needed for infectious mononucleosis?
no, spontaneous recovery usually occurs in 2-3 weeks.
231
is there a vaccine for EBV (human herpesvirus 4 (HHV-4),)
no ebv vaccine
232
the __ is especially susceptible to traumatic rupture in EBV
spleen
233
EBV is associated with
Burkitt's lymphoma and nasopharyngeal carcinoma and hairy leukoplakia
234
Patients with an __ infectious disease will have a rising antibody titer (acute/chronic)?
acute
235
although asthma can strike at any age, half of all cases occur in
children under 10.
236
wheezing breathlessness chest tightness and cough esp at night and early mornings =
asthma
237
increased airway responsiveness to a variety of stimuli resulting in episodic bronchoconstriction (bronchospasm), increased mucus secretion and inflammation of bronchial walls
asthma
238
atopic asthma
evidence of allergen sensitization,
usually patient with history of allergic rhinitis
eczema
239
non atopic asthma
w/o evidence of allergen sensitization
240
asthmatic bronchitis
smokers
241
in __ bronchial linings overreact to various stimuli causing smooth muscle spasms called bronchospasms = severely constrict the airways
asthma
242
extrinsic allergen inhaled stimulates mast cells in the lung interstitium to release both
histamine and SRS-A (slow reacting substance of anaphylaxis) = cause swelling of bronchial smooth muscle = narrow lumen
243
___ is safe to administer to pp w/asthma and is especially indicated for pt whose asthma is triggered by anxiety
nitrous oxide
244
if patient is taking steroids, and has asthma you should
consult physician to possible augment the corticosteroid drugs (since he shouldn't be having the attacks if he is on the corticosteroids) All forms of corticosteroids reduce inflammation in the airways that carry air to the lungs (bronchial tubes) and reduce the mucus made by the bronchial tubes. This makes it easier for you to breathe
245
Preferred treatment for an ACUTE ASTHMATIC ATTACK
short acting selective beta-2 agonist (albuterol, terbutaline)
246
Status asthmaticus = severe episode of asthma usually requiring hospitalization that does not respond adeq to ordinary therapeutic measures. may lead to death from
respiratory acidosis
247
characterized by a breakdown of self-tolerance to thyroid auto-antigens most importantly the TSH receptor
Grave's disease
| = hyperthyroidism aka thyrotoxicosis
248
1. Primary role of thyroxine is to stimulate
| 2. if in excess =
1. cellular metabolism, growth, and differentiation of all tissues
2. high basal metabolism, fatigue, weight loss, excitability, elevated temp, osteoporosis
249
hyperthyroidism aka thyrotoxicosis oral manifestations are not remarkable but are
premature eruption of teeth and loss of deciduous dentition
250
___ is most common cause of endogenous hyperthyroidism aka thyrotoxicosis
Grave's disease
251
thyroid specific autoimmune disorder, body makes Ab to thyroid stimulating hormone receptor (TSHR), leading to hyperthyroidism, abnormally strong release of hormones from the thyroid gland
Grave's disease
252
what are autoantibodies
An autoantibody is an antibody (a type of protein) by the immune system that is directed against one or more of the individual's own proteins
253
are the autoantibodies made in Grave's disease subject to negative feedback
no, so they continue to be produced and bind to TSHR even when thyroid hormone levels are too high. these antibodies act as antagonists stimulating more hormones to be released
254
insomnia, anxiety, restlessness, weight loss, exophthalmos, irritation and tearing
hyperthyroidism
255
Plummer's disease aka toxic nodular goiter:
1. arises from long-standing __
2. symptoms?
3. Seen in children?
1. simple goiter
2. same as hyperthyroidism but the protruding eyes seen in Grave's disease DO NOT OCCUR.
3. NEVER SEEN IN Children. MOSTLY ELDERLY
256
The 1st WBC on the scene during the acute or early stage of inflammation
Neutrophils
257
most numerous WBC
Neutrophils
258
the primary constituent of pus
Neutrophils
259
Neutrophils attracted to site of inflammation by __ and they can identify the foreign antigen and attach to it, engulf it.
chemotaxis
260
if the infection continues after the Neutrophils arrive, ___ arrive
monocytes = cells with even greater ability to engulf organisms
261
substances that are chemotactic for Neutrophils are
complement proteins C3a and C5a = anaphylatoxins
262
in order to kill its target, Neutrophils use
oxygen dependent killing mechanisms and defensin molecules
263
oxygen dependent killing mechanisms of Neutrophils
superoxide, myeloperoxide, hydrogen peroxide, and NADPH oxidase
264
NADPH oxidase = multi unit enzyme that produces __ and contributes to the killing of internalized pathogens by neutrophils
superoxide radicals
265
a deficiency in any of the NADPH subunits can cause
chronic granulomatous disease = immunodeficiency disease.
266
NADPH is made in __ pathway
pentose phosphate pathway
267
Defensins are antimicrobial peptides 40 amino acids long that can
penetrate membranes and disrupt their integrity
268
abscesses have a central region of mass of necrotic leukocytes and tissue cells. a zone of preserved neutrophils surround this necrotic focus, and outside that is a vascular dilation and parenchymal and fibroblastic proliferation including chronic inflammation and repair. In time the abscess may become walled off and replaced by
CT
269
A ___ is an abnormal sac within body containing fluid or air. lined with epithelium
cyst
270
a tumor composed of granulation tissue that is usually associated with ulcerated infections. epitheloid cells and giant cells are derived from macrophages and characteristic
granuloma
271
1. a tumor is a growth of tissue that forms an abnormal mass. tumors aka
2. caused by abnormal regulation of
3. provide __ function and grow at expense of healthy tissues
1. neoplasm
2. cell division
3. no useful function
272
a local defect/excavation of the surface of an organ or tissue that is produced by sloughing (shedding) of inflamed necrotic tissue.
Ulcer
273
ulceration can occur only when tissue __and __ exist on or near the surface
necrosis and resultant inflammation
274
myonecrosis aka gas gangrene caused by
anaerobic, spore forming gram + Clostridium perfringes = occurs at site of trauma or recent surgical wound, onset is sudden and dramatic
275
crackly sensation when the swollen area is pressed w fingers
gas gangrene = extremely painful
276
gangrene is the death of a tissue usually associated w loss of
blood supply to the area = necrosis combined with putrefaction = rotting and decomposition
277
gas gangrene prevented by
proper wound care
278
systemic symptoms of gangrene
anxiety, sweating, fever, shock-like syndrome, hypotension, renal failure, coma, and finally death
279
clostridia are obligate
anaerobes, gram + and endospore formers
280
clostridia can form many different toxins the most important is the
alpha toxin = lecithinase = damages cell membranes = resulting in hemolysis
281
most basic and most common type of necrosis
coagulation = coagulative necrosis = denaturation of proteins is the dominant process
282
nuclear changes appear in one of 3 patterns, all due to non-specific breakdown of DNA. = ?
karyolyisis, pyknosis, karyorrhexis
283
___necrosis = enzymatic digestion is the dominant process
liquefactive necrosis
284
when larger areas of tissue are dead = called
gangrene
285
a localized area of coagulative necrosis is called
infarct
286
autolysis
source of hydrolytic enzymes is the dying cell's own lysosome
287
heterolysis
hydrolytic enzymes come from other infiltrating cells
288
injured pancreas would cause which kind of necrosis
fat necrosis
289
trauma to adipose tissue would cause which kind of necrosis
fat necrosis
290
most common sites for fat necrosis
pancreas and adipose tissue
291
immune mediated vascular damage would cause which kind of necrosis
fibrinoid
292
most common site for fibrinoid necrosis
arterial walls
293
ischemia would cause which kind of necrosis
coagulative necrosis
294
most common sites (2) for coagulative necrosis
kidneys/heart
295
suppuration, abscesses and ischemic injury to CNS would cause which kind of necrosis
liquefactive necrosis
296
granulomatous infection (ex. TB) would cause which kind of necrosis
caseous necrosis
297
most common site for liquefactive necrosis (2)
brain or spinal cord
298
putrefactive bacteria acting on necrotic bowel or extremities would cause which kind of necrosis
gangrenous = most common in lower extremities or bowel
299
Epithelioid cells are
Epithelioid histiocytes (Epithelioid cells) are activated macrophages resembling epithelial cells
300
Epithelioid cells and giant cells are derived from macrophages and are important in the development of
granulomatous inflammation
301
granulomatous inflammation is a chronic/acute inflammation
chronic
characterized by granulomas = which are nodular collections of specialized macrophages referred to as epitheloid cells. frequently epithelioid cells fuse to form MULTINUCLEATED GIANT CELLS (Langerhans giant cells and foreign body giant cells)
302
TB is a __ disease
granulomatous = mycobacterium tuberculosis
303
Granulomatous inflammation is characteristically associated with areas of ____ necrosis
caseous
304
TB, leprosy, syphilis, cat scratch disease sarcoidosis and Crohns disease are
granulomatous inflammation diseases
305
in response to injury, mononuclear inflammatory cells coupled w/ production of fibrous CT are indicative of
a. acute inflammation
b. chronic inflammation
c. edema
d. gangren
b. chronic inflammation = develops @ site of injury and persists longer than several days. it is more proliferative than exudative.
306
ex of chronic inflammation
chronic hepatitis chronic pyelonephritis, autoimmune disorders. necrosis commonly occurs and recurs
307
granulomatous is a subtype of _ inflammation
chronic
308
acute inflammation is the initial response to tissue injury esp _ infections involving vascular and cellular responses
bacterial
309
3 major occurences in acute inflammation
```
increased vascular permeability w tissue exudate formed
luekocytic infiltration (mainly neutrophils by C3a and C5a), and repair (either by regeneration or replacement
```
310
local signs of acute inflammation
redness (rubor), heat (calor), swelling (tumor), pain (dolor) and loss of function
311
systemic effects of acute inflammation
fever, tachycardia, leukocytosis (esp neutrophils)
312
Macrophages appear late in the cellular phase and represent a transition b/w
acute and chronic inflammation
313
IL-1, prostaglandins and TNF are the mediators that produce what action
fever
314
IL-1, IL-6, TNF-alpha are the mediators that produce what action
acute phase response
315
Bradykinin, prostaglandins are the mediators that produce what action
pain
316
C5a, C3a, IL-8, chemokines, PAF, Leukotriene B4 are the mediators that produce what action
leukocyte chemotaxis
317
LTB4, IL-1, TNF-alpha, and C5a are the mediators that produce what action
Luekocyte adhesion
318
Histamine, protoglandins, PAF, nitric oxide are the mediators that produce what action
vasodilation
319
histamine, bradykinin, C3a, C5a, leukotrienes, PAF, substance P are the mediators that produce what action
increase vascular permeability
320
in response to injury, capillary permeability increases resulting in the formation of
a. plasma
b. serum
c. exudate
d. transudate
exudate
321
the edema fluid resulting from inflammation is called
exudate aka pus
322
the easiest way to see exudate is to puncture a blister. the fluid that escapes is exudate. if the fluid is cloudy or discolored it is a strong indication of the presence of
infection in the wound.
323
exudate is characterized by being
1. protein rich/poor
2. cell rich or poor
3. high/low specific gravity
protein and cell rich with a HIGH specific gravity (greater than 1.02)
324
types of inflammatory exudates
suppurative, purulent, fibrinous, pseudomembranous
325
in addition to water, exudate contains nutrients oxygen antibodies and neutrophils. the FIRST ROLE of exudate is to
flush away the foreign material from site of injury
326
exudate also acts as a carrier medium to bring __
fibrin and other repair materials to site of injury
327
later in inflammatory process exudate acts as a carrier for
leukocytes (PMN) and monocytes and supplies them with oxygen and nutrients while they ingest bacteria and debris in the wound.
328
presence of exudate enables the movement of phagocytic cells, and later in the healing process the nutrients are used b the new tissue to help
in regeneration of granulation tissue
329
finally, the exudate acts as a lubricant to speed up the migration of
epithelial cells across the wound to complete the initial wound repair
330
___ results from increased intravascular hydrostatic pressure or from altered osmotic pressure. This fluid is thin and watery and is characterized by
1. protein rich/poor
2. cell rich or poor
3. high/low specific gravity
1. low protein
2. few cells
3. low specific gravity (less than 1.012)
opposite of exudate!)
331
1. transudates are present in __condition
non-inflammatory conditions (opposite of exudate!)
332
an ultrafiltrate of blood plasma is transudate or exudate?
transudate
333
most common acute inflammatory rxns contain large # of neutrophils and are termed
suppurative = produce purulent matter = result of tissue necrosis, proteolytic enzmes, WBC and tissue fluid build up
334
tissue damage is caused MOSTLY by neutrophils/complement/macrophages
neutrophils in acute inflammation
335
Cox 2 converts arachidonic acid to
prostoglandins
336
5-lipoxygenase converts arachidonic acid to
leukotrienes
337
prostaglandins and leukotrienes mediate _ inflammation
acute
338
which 2 proteins increase rapidly in acute phase?
C-reactive protein (1000x increase in 24-48 hours) and serum amyloid A
339
polymorphonuclear neutrophils (PMNs) are the first defense cell at injured tissue. they engulf matter by phagocytosis. the engulfed matter becomes a __ which combines with lysosomal granules to form a ___ in which digestion of the engulfed particle occurs
phagosome
phagolysosome
340
basophils mast cells and platelets are impt in _ phase of acute inflammation
vascular
341
PMNs predominate in the _ phase of acute inflammation
cellular
342
macrophages appear late in the _ phase of inflammation
cellular
343
___ are the predominant inflammatory cells in allergic reaction and parasitic infections
eosinophils
344
Iron is stored, mostly in the liver, as ferritin or hemosiderin.
which is the major storage form
ferritin is the major form of iron storage.
