Midterm 2 Pathology Flashcards

Question

What are 2 examples of effusion?

Answer 1

1. Pleural effusion | 2. Ascites: massive peritoneal space fluid in liver failure

Answer 2

Clots or other material that block blood flow and can lead to infarcts. Main clinically relevant emboli that are hard to diagnose b/c of nonspecific symptoms

Answer 3

1. pulmonary thromboembolus: clot from deep vein lower leg got stuck in main pulmonary artery and block blood flow to lung 2. air emobli 3. other foreign material 4. Tumors (renal and liver)

Answer 4

low blood pressure from low cardiac output or low vascular resistance; blood flow less than body needs

Answer 5

1. hypovolemic: low blood volume from bleeding/dehyrdation 2. cardiogenic: arrhythmic, heart infarct/failure, pulmonary emobli) 3. septic shock: generalized infection --> vasodilation, high permeability, poor cardiac pump, increased metabolism)

Answer 6

high blood pressure from high cardiac output or high vascular resistance

Answer 7

1. Tachycardia (rapid heart beat >100 2. cardiohypertrophy (increase cell size in hear) 3. increase in STROKE VOLUME b/c increase end diastolic volume (FRANK-STARLING MECHANISM) 4. increase catecholamine activity leading to positive ionotropic effect (strengthen heart beat) 5. redistribution of blood flow (kidneys)

Answer 8

1. Hypertension 2. cause by ischemic heart disease, aortic/mitral valve disease, cardiomyopathy or myocarditis 3. leads to pulmonary edema and breathing problems (paroxysmal nocturnal dyspnea) leads to orthopnea (dyspnea lying down) leads to reduced blood perfusion to organs ex. kidney.

Answer 9

1. lung disease 2. Cor Pulmonale- abnormal enlargement of right side of the heart OR right sides heart valve disease OR consequence of left sided failure OR myocarditis/cardiomyopathy 3. lead to hepatomegaly; pools in the liver (ascites) Liver chronic congestion Spleen congestive splenomegaly kidney congestion and hypoxia subcuatneous peripheral edema pleural effusions brain venous congestion

Answer 10

1. retrosternal pain 2. dyspnea 3. diaphoresis (sweating) 4. nausea/ vomiting 5. palpitations 6. anxiety 7. can be asymptomatic or sudden death

Answer 11

with at least 2 of these! 1. Ischemic type chest pain for > 20 minutes 2. acute EKG changes 3. Rising, then falling serum cardiac biomarkers (troponin, CK)

Answer 12

infarct due to aneurysm in heart wall

Answer 13

1. involves full thickness of heart from endocardium to epicardium 2. involves LV ant/post free wall OR septum with extension in to RV wall 3. correlates with the STEMI (ST segment elevation) on EKG 4. more severe than MI

Answer 14

1. due to hypotension and global ischemia 2. multifocal or diffuse areas of necrosis confined to INNER 1/3-1/2 of LV wall 3. not necessarily in distribution of one coronary artery 4. correlates with NSTEMI (non ST segment elvation MI) on EKG 5. less severe but still potentially lethal

Answer 15

1. No symptoms 10-20% 2. Arrhythmias 3. Congestive heart failure 4. Pulmonary edema (60%) 5. Pericarditis (50%) 6. Mural Thrombus (40%) 7. Extension of the infarct

Answer 16

related to aortic where valve won't open and prevents forward flow

Answer 17

1. postinflammatory scarring from Rheumatic heart disease 2. senile calcific arotic stenosis 3. . calcification of bicuspid aortic valve

Answer 18

1. Pathogenesis post infective endocarditis or rheumatic fever 2. common in congential bicuspid valvues or normal valves of old people 3. fibrosis and cacification that obliterate sinuses of Valsalva and valve leaflets

Answer 19

1. Pressure overload of left ventricle 2. stenosis is the main cause of PREDICTABLE PAIN with exertion like angina and caludication 3. can lead to thrombosis and cause infarct!

Answer 20

can't close completely and allows reverse flow

Answer 21

``` Post inflammatory scarring syphilitic aortitis ankylosing spondylitis rheumatoid arthritis Marfan's syndrome ```

Answer 22

Postinflammatory scarring from Infective endocarditis carcinoid disease Phen/fen medication Rupture of papillary muscle or chordae tendinae Mitral valve prolapse

Answer 23

large leaflets, long chordae tenineae, myxomatous change within leaflets (posterior!) Unknown etiology, hereditary, Marfans Clinically? 2-3% of population susceptible to endocarditis

Answer 24

LV dilation and calcification of mitral ring

Answer 25

1. Rheumatic Fever 2. Infective endocarditis (strep or staph 70% mortality) 3. often a pre-injured valve

Answer 26

``` a systemic disease causing: polyarthritis of large joints carditis subcutaneous nodules erythema marginatum of skin sydenham's chorea ``` *UNCOMMON b/c strep throat abx

Answer 27

aortic= mitral > tricuspid, posthesis > congential defect

Answer 28

friable vegetations containing RBC, fibrin, inflammatory cells and organisms

Answer 29

Stpah aureus, Strep, Pseudomonas, HACEK, Polymicrobial

Answer 30

Fever and murmur are common predisposing heart damage often present get blood cutures and echo Mortality is 70% if Staph!!

Answer 31

1. Very destructive 2. can cause thrombi 3. can destroy valvular tissue and cause perforations 4. very dangerous

Answer 32

High blood pressure thinning of arterial walls local injury atheroscelrosis

Answer 33

"Berry Aneruysm" or Saccular: outpouching and most common cerebral aneurysm (subarachnoid hemorrhage) Fusiform involved mostly in aorta!

Answer 34

1. can cause thrombi 2. increased risk of infective endocarditis 3. wears out valves and leak (develop murmus)

Answer 35

Electrical problems Premature beats usually not dangerous tachyarrhythmias are less common and more serious -- such as fibrillations!

Answer 36

1. Palpitations 2. Syncope (fainting) 3. Sudden cardiac death- usually from arrhytmias often related to atherosclerosis

Answer 37

neurocardiogenic or neuroligc hypotension or low cardiac output w/ arrhythmias are serious and need EKG

Answer 38

1. ischemic heart disease- scarring 2. degenerative changes 3. antiarrhythmic drugs 4. Hyperkalemia (increase in K+) 5. MI 6. Trauma (cardiac surgery) 7. Congenital abnormality

Answer 39

Slowed but reliable impulse propogation, no tx needed

Answer 40

Impulse propagation sometimes fails irregular contraction syncope pacemaker

Answer 41

``` no heart conduction latent pacemakers more P waves than QRS no relationship b/w QRS and Pwaves syncope and risk for sudden cardiac death ```

Answer 42

Premature depolarization events that originate from site other than sinus increase rate of depolarization usually from Latent pacemakers

Answer 43

APD, APB, PACs usually not worrisome or requiring tx one part of atria depolarizes before the sinus node abnormal P wave

Answer 44

VPB, PVC Purkinje fibers initiate the contraction instead of the SA node fairly common but causes an extra beat and can cause tachycardia

Answer 45

rates usually > 100 bpm- including re-entrant circuits- multiple ectopic foci (firing too frequently resulting in a circle/loop firing pattern) in re-entrant waves continue to find excitable tissues Re-entrant has an excitable gap caused by conduction delay w/in the circuit --> allows wave to keep finding excitable tissue!

Answer 46

This it he MOST COMMON sustained arrhytmia ineffective contractions and sustained arrhythmia. Chaotic disorganized activation, due to large number of re-entrant circuits in the atria - at risk for thrombi in atria and embolizing (blood pools in atria)--> accounts for 25% of strokes -often in congestive heart failure, valvular disease or hypertension - 10% > 65 yrs have AF - can lead to scarring - inefficient cardiac output

Answer 47

AF can lead to ventricular fibrillation Ventricular tachycardia = torsade de pointes Heart rate 300-600 bpm and extremely irregular heart rhythm Sudden cardiac arrest often due to fast centricular tachycardia and ventricular fibrillation

Answer 48

1 . accounts for majority of CV related deaths 2 >300,00 victims each year in the US 3. fatal 90% instances 4. brain damage and braine death 4-6 min 5. main cause of CV mortality

Answer 49

>180/100 blood pressure

Answer 50

when it is moderate to severe

Answer 51

primary hypertension- it doesn't have identifiable underlying cause

Answer 52

1. increased Na retention and intravascular volume 2. narrowing of arteries and arterioles (kidney!) 3. increased pressure causes further vessel damage 4. cycle: high pressure, vessel damage, renal signal to retain sodium 5. high dietary sodium 6. older, black, family hx, obesity, high salt diet, lack of physical activity

Answer 53

It is secondary to separate underlying medical conditions such as congestive heart failure

Answer 54

1. Endocrine (steroid, thyroid, pheochromocytoma) 2. drugs (cocaine, amphetamine, and others) 3. Pregnancy 4. Renal Failure 5. Sleep Apnea 6. Renal artery stenosis 7. Pain and stress can cause temporary increase in blood pressure

Answer 55

1. accelerated atherosclerosis due to endothelial injury 2. MI 3. Stroke 4. Peripheral vascular disease 5. aneurysms 6. heart failure (chronic hypertrophy) 7. renal failure 8. hemorrhages

Answer 56

excess lipid/fat in the blood | risk factor for many atheroscleorotic diseases! (high VLDL, LDL)

Answer 57

>240 mg/dl = 13% U.S adults | >200 mg/dL= 50% U.S. adults

Answer 58

``` type far more common Caused by: Diabetes (type 2) Sedentary lifestyle, poor diet, obesity Heavy alcohol use chronic renal disease, hypothyroidism, various drugs ```

Answer 59

.2% of U.S. adults! Caused by 1. interaction of genetic and environmental factors 2. genetic factors are unknown in large majority of cases- AD 3. LDL ranges from 360-500 mg/dL, triblycerides usually normal (~120) 4. Coronary artery disease premature 5. defects in LDL receptors

Answer 60

High Density Lipoprotein 1. Cholesteryl ester 2. deliver lipids from the periphery to liver 3. "reverse cholesterol transport" 4. anti-atherogenic A-1 and A-2

Answer 61

Low density lipoportein 1. Choleterol ester 2. delivers lipids from liver to periphery 3. Atherogenic B-100

Answer 62

Very low density lipoprotein 1. triglyceride 2. delivers lipids from liver to periphery 3. B-100 atherogenic

Answer 63

Triglyceride | delivers lipids from gut to liver

Answer 64

Lipids induce atherosclerosis Plaque in aorta have higher cholesterol concentration increased number of apo-B particles (VLDL, LDL) Lipids leak into vessel intima --> induce macrophage response and inflammation --> induces smooth muscle cels in intima, fibrosis, calcification --> atheroma can rupture into lumen and cause thrombus (infarct and death)

Answer 65

1. lipid deposits/plaques (atheromas) in arteries. most common kind of arteriosclerosis! 2. aortic and coronary arteries 3. at risk of thrombus 4. hardening of arteries.

Answer 66

Atherosclerosis --> causes 80% of heart disease *also main cause of peripheral vascular disease, stroke, 30% all death

Answer 67

if slow then causes stable angina | if fast then causes thrombus/embolus!

Answer 68

causes complicated lesion (thombosis), and causes most infarcts

Answer 69

``` Aorta Coronary arteries Legs (iliac, femoral, popliteal) Carorid/circle of willis Kidney Pulmonary ```

Answer 70

1. usually hit below the renal arteries 2. aneurysm 3. can rupture 4. ulcerated plaques can embolize especially to lower part of the body

Answer 71

1. causes 80% of heart disease: angina, infarct, chronic, ischemic heart disease 2. most common in Left anterior descending (LAD) and Left circumflex (LCX), enitre lenght of right coronary artery 3. cause thrombosis and occlusion (rupture plaque/thrombus - 2/3, erosion plaque/thrombus = 1/3)

Answer 72

Peripheral Artery Disease! Claudication (ache, pain, fatigue w/ exertion) --> ulcers and GANGRENE! CAD and PAD usually both present risk with diabetes!

Answer 73

Erosion of plaque = thrombus (main cause of stroke!) | associated w/ hypertension, hypercoaguability, old age (less with hyperlipidemia)

Answer 74

1. Hyaline arteriosclerosis --> hyaline in arteriole 2. proliferative arteriosclerosis --> malignant hypertension and scleroderma 3. fibrinoid necrosis or "onion skin"

Answer 75

1. Main pulmonary arteries fatty streak 2. small pulmonary artery thickening and fibrosis (arteriosclerosis and not atherosclerosis) marker of and cuase of pulmonary hypertension 3. cor Pulmonale-- pulmonary hypertension and RV hypertrophy

Answer 76

1. increasing age (>45 male, >55 female) 2. smoking ( endothelial injury, increase coag, free radicals) 3. diabetes and metabolic syndrome 4. hypertension (endothelial injury) 5. dyslipidemia (lipid deposition in vessels) 6. Family hs/ genetics 7. male or postmenopausal female (lose estrogen) 8. lifestyle: obesity, inacvtivity, poor diet) 9. inflammatory markers 10. periodontal disease?? not clear that it is causal

Answer 77

Thrombosis (NOT STABLE STENOSIS!) is main cause in areas of mild/moderate stenosis tHIS IS ABRUPT STENOSIS

Answer 78

Stenosis (not thrombosis)

Answer 79

1. endothelial dysfunction: smoking, hyertension, diabetes, inflammation 2. lipids deposit in vessel wall intima 3. inflamation 4. fibrosis in smooth muscle --> fibroatheroma with slow stenosis (angina or claudication) 5. plaque rupture --> thrombosis --> MI, gangrene...

Answer 80

75%, increases resistance 16 fold

Answer 81

Cerebral infarct most common cause, others are hemorrhagic

Answer 82

1. coronary artery stenosis | 2. atheroma types

Answer 83

paroxysmal attacks of chest pain. substernal or precordial can radiate myocardial ischemia!

Answer 84

1. pain 2-5 min w exertion, relieved w/ rest and vasodilators 2. cause: coronary stenosis (>70-75% cross section) 3. subendocardial ischemia , ST segment depression in EKG

Answer 85

at rest, bried (like stable angina) | reversible spasm with ST segment elevation or depression

Answer 86

Most dangerous!!! prolonged pain or pain at rest new or worsening angina ST-segment depression Cause: acute plaque change

Answer 87

Pale area in recent infarct- softer than normal pericardium Old infarct is white firm scar Aneurysm with thrombus! Pallor --> Pallor and hyperemia --> Hyperemic border with central yellowing --> maximally yellow with soft vascular margins --> white fibrosis

Answer 88

unexpected death within 1 hour of cardiac event | high grade coronary stenosis + ventricular electrical instability and arrhythmia

Answer 89

inadequate expansion of airspaces and gives rise to hypoxia

Answer 90

aspiration pneumothorax pleural fibrosis

Answer 91

progression of acute injury and damage from activated neutrophils

Answer 92

Congestive obstructive pulmonary disease mainly caused by cigarette smoke: emphysema, astham, bronchietasis Very Common!

Answer 93

emphysema, chronic bronchitis, and asthma

Answer 94

destruction of alveolar walls and permanent enlargement of airspaces

Answer 95

smoking alpha 1 antitrypsin deficiency (imblance of proteases and antiproteases) air pollution

Answer 96

1. barrel chest with hyperinflation 2. long expiratory phase with pursing of lips --> clinically apparent after 1/3 lung destroyed --> dyspnea w/ cough and wheezing

Answer 97

persisten cough > 3 months in 2 consecutive years cause by smoking and air pollution

Answer 98

hypersecretion of mucus by airways; infection often present

Answer 99

obstruction of bronchi and persisten necrotizing infections destruction of elastin and muscles in bronchial walls-- congenital expression often caused by cystic fibrosis

Answer 100

Persisten productive cough (often foul smelling) hemoptysis if widespread hypoxemia with obstructive ventilator defects

Answer 101

reactive airway disease and narrowing of airways- hyperreactivity): hyperinflated lungs, thick mucus plugs in airways, smooth muscle hypertrophy

Answer 102

Atopic: childhood onset often with allergic rhinitis non-atopic: non-immune, occupational exposures

Answer 103

restricitve lung disease: stiff lung and hard to expand lungs

Answer 104

collagen vascular diseases such as rheumatoid arthritis

Answer 105

restrictive eg. mineral dust induced, silicosis, asbestosis [mesothelioma]) ranges from asymptomatic nodules to progressive massive fibrosis

Answer 106

restrictive disease- abnormal connective tissue and reduced elastic properties; multi-organ involvement)

Answer 107

non caseating granulomas in lung and mediastinal lymph nodes african americans have 10x greater risk

Answer 108

1. can cuase sudden death if in pulmonary artery 2. origin from deep veins in legs 3. causes: prolonged bed rest, surgery, congestive heart failure

Answer 109

Causes: heart disease, recurrent thrmobemboli Cor Pulmonale- right ventricular failure

Answer 110

cause by fibrosis or chest wall abnormalities; gas exchange impaired; difficulty inhaling and expanding lungs

Answer 111

Gas exchange impaired by obstruction or hemorrhage; may be abrupt or insidious

Answer 112

blocked airways; gas exchange through septal walls not impaired; unable to exhale

Answer 113

1. caused by mycobacterium tuberculosis 2. usually lungs but can affect other organs 3. flourishes in crowded, impoverished areas 4. non-contagious during long period of dormancy 5. problems with multidrug antibiotic resistance 6. forms necrotizing granulomas

Answer 114

Histoplasmosis causes acute pulmonary infection, chronic granulomatous lung infection OR disseminated military disease

Answer 115

micro-organisms including from normal flora OR CMV (cytomegalo virus) -- common! causes owls eye histology

Answer 116

Lung tumors! 95% primary lung caners are carcinomas (adeno and squamous cell [contains keratin] types most common) smokers 10-55x more likely to develop than general population

Answer 117

1. Hypertension 2. Aterionephrosclerosis 3. Diabetes 4. Chronic Glomerulonephritis (acute or chronic)

Answer 118

caused by hypertension or diabetes where hyaline thickening or arterioles

Answer 119

Congential and have horse shoe kidney

Answer 120

1. multiple cysts, cartilage | 2. urinary tract dysfunction

Answer 121

1. Genetic 2. Renal insufficiency 3. Linked to intracranial aneruysm 4. other organs also have cysts 5. enlarged kidneys

Answer 122

1. 3 weeks of complete obstruction causes permanent damage 2. get dilated ureter and hydronephrosis 3. if distal to bladder can get dilated bladder with a thickening of the bladder wall

Answer 123

Part of urinary obstruction where unable to concentrate the urine

Answer 124

1. Anuria 2. polyuria 3. bladder distention 4. sometimes asymptomatic

Answer 125

must do chemistry to determine type!

Answer 126

1. Renal colic 2. Hematuria (blood in urine) 3. pyelonephritis (infection of kidney) 4. sometimes asymptomatic

Answer 127

1. calcium oxalate (75% of stones!) 2. magnesium ammonium phosphate (15% stone) = alkaline urine 3. Uric acid- half are associated with gout 4. cystine

Answer 128

10-20% kidney failure inflammation of the kidney due to infection -can be acute or chronic (more scarring)

Answer 129

1. Retrograde spread from cystitis, due to hematogenous spread 2. common with urinary obstruction, stenosis 3. diabetes and immunocompromised (diabetes is the most common cause! --> papilllary necrosis)

Answer 130

1. flank pain 2. fever 3. 10-20 % chornic renal failure 4. kidney scarring 5. symptom of cystitis

Answer 131

1. 80-90% of renal malignancies- most frequent 2. most common in males > 40 yer and smokers 3. analgesic users (NSAIDS) 4. obesity!

Answer 132

1. often asymptomatic (and not discovered until large) 2. hematuria 3. dull flank pain 4. fever 5. fatigue

Answer 133

lungs or bone and sometimes to regional lymph nodes

Answer 134

1. clear cell | 2. papillary

Answer 135

Wilms Tumor or nephroblastoma

Answer 136

Infection of the bladder from urethra, aka UTI 1. stones 2. catheters 3. short female urethras 4. obstructions

Answer 137

Infection from snails that is the leading cause of squamous cell carcinoma in bladder - primarily in middle east - shistosomoiasis eggs deposited in bladder

Answer 138

1. Most often in MALES >50 years old 2. associated with smokeing, carcinogens (eg. dyes, pain, etc) 3. Most common urothelial malignancy

Answer 139

Infection of the prostate often caused by bacteris such as cystitis 2. causes enlarged and tender prostate can cause obstruction 3. most common in older men

Answer 140

1. very common in older men; 95% > 75 yrs old 2. serious sequelae less common 3. cause not well know; perhaps has to do with androgens or even estrogens 4. urinary obstruction is common bladder can't empty completely 5. 10 % require surgery to relieve

Answer 141

1. most common malignancy (except skin cancers) in OLDER MEN; 60% of men > 80 yrs old 2. most often detected by rectal exam 3. many small and not clinically significant 4. most metastasize to bone and occasionally to regional lymph nodes 5. can be deadly in some patients, especially in younger men

Answer 142

1. only associated w/ prostate tissue 2. >4-6 mg/ml is abnormal (usually higher with age) 3. rapidly increasing PSA means higher risk for cancer 4. the more PSA bound to alpha-1 antichymotrypsin, the greater the risk of cancer

Answer 143

1. prostatecetomy (affects bladder function) 2. radiation 3. hormonal; block androgen receptors- affects male functions 4. chemotherapy or bisphosphnate

Answer 144

1. diabetes 2. hypertension 3. chronic glomerulonephritis

Answer 145

Factors to cause adhesion for plateles ie. coagulate

Answer 146

1. Anucleated 2. lifespan ~10 days 3. circulating platelets do not adhere- during stasis, adhesion occurs

Answer 147

1. typically initiated by injury 2. adherence to subendothelium by interacting with von Willebrand factor 3. aggregate with other platelets and form surface for coagulation cascade

Answer 148

1. coagulation cascade (factors mostly from liver( 2. cascade of activating enzymatic conversions 3. fibrin and platelet aggregates form stable clot a. factors 2, 7, 9, 10 are vitamin k dependent necessary for calcium binding sites activating coagulation cascade b. for final step thrombin catalyzes fibriongen (soluble) to fibrin (insoluble) *thrombin acts at other levels of cascade* --> fibrin cross-links under the influence of Facto XIII

Answer 149

1. natural anticoagulants: Protein C, prevent growth of clot 2. Fibrinolysis- breaks down clot

Answer 150

1, Platelet count (part of CBC- complete blood count) 2. Coag cascade: - > prothrombin time PT (12-15 sec. extrinisc and common pathways through factor VII - -> partial thromboplastin time- PTT measures INTRINSIC and common pathways and icludes factors XII, XI, X, VIII (12, 11, 10, 8) 3. Fibrinolysis 4. Prolonged coagulation tests may be due to deficiency or inhibitor of a coagulation factor

Answer 151

pathological clotting

Answer 152

Hemostasis

Answer 153

1. Virchow's Triad- things that cause pathological clotting: - endothelial injury - abnormal blood flow - hypercoagulability (acquried/inherited factors)- usually reflects abnormalities of cascade

Answer 154

1. surgery/trauma 2. limb immobilization 3. bedridden 4. long distance air travel 5. pregnancy 6. advancing age 7. oral contraceptives

Answer 155

1. some aspect of cascade abnormal 2. FACTOR V LEIDEN- single nucleotide point mutation in coagulation factor V that interferes with an anticoagulant facor, thus increasing formation of fibrin and becoming "prothrombic"

Answer 156

1. Abnormal vessels 2. decreased platelets/dysfunction 3. abnormal factors

Answer 157

Mucocutaneous bleeding (petechiae on mucosal surface)

Answer 158

thrombocytopenia, von Willebrand Disease interfered with von willebrand factor preventing clot from adhering to endothelium and clot formation

Answer 159

1. Decreased bone marrow production 2. hemodilution due to multiple transfusions 3. immune reaction due to platelet autoantibodies directed as platelet surface proteins

Answer 160

1. platelet count

Answer 161

1. Von willebrand disease ~1% (associated with factor VIII- get increased bleeding) 2. hemophilia A (Factor VIII) and B (Factor IX- christmas disease)

Answer 162

have prolonged PTT and normal PT and platelet count; sever hemorrhaging internally/organs and soft tissue or into joints

Answer 163

1. liver disease | 2. vitamin K deficiency

Answer 164

Complete blood count- automated hematological evaluation- included RBC, WBC and platelets

Answer 165

1. Iron deficiency 2. medications 3. alcohol 4. infections 5. gender 6. pregnancy

Answer 166

1. High WBC an fever probably mean infection 2. leukocyte count include all nucleated hematopoietic cells expcept red blood cells 3. important to evaluate infections, some drug effects (cytotoxic or antimicrobial), radiation therapy

Answer 167

``` 3500-10,000 cells/microliter : Neutrophils: 1800-6700 (55%) Eosinophils: 0-570 (3%) Lymphocytes: 1400-3900 (35%) *pay attention to both total and percent! ```

Answer 168

WBC> 10,000 caused: - chronic infection or inflammation - exercise - some leukemias

Answer 169

- too few cells - iron deficiency (most often cause by hemorrhaging)- often has glossitis - lead poisoning

Answer 170

- too many cells - liver disease - drugs - vitamin B12 or folate deficiency- often includes neurological findings (paresthesia, weakness, dementia)

Answer 171

Systemically distributed neoplasm of white cells | - can have acute myeloid or chronic myeloid

Answer 172

- no evidence of maturation in blood or marrow >20% blast (immature) cells - can have skin and gum infiltration

Answer 173

Solid tumors of hematopoietic system/neoplasm of lymphoid tissue- lymphadenopathy - lymphomas usually have enlarged, painless lymphadenopathy

Answer 174

1. Non-hodgkins lymphoma = indolent to very aggressive: survival is years to weeks depending on type 2. Hodgkin lymphoma = all types and curable in most - both are clonal expansions at various developmental stages

Answer 175

alcohol use disorder, binge drinking

Answer 176

Female >male

Answer 177

1. Genetics ~50% 2. environment 3. self- administration (stress)

Answer 178

1. Simple molecule 2. depressant 3. barbituate-like 4. affects GABA A receptors (although not an agonist) 5. interacts with other sedative/hynotic drugs in a synergisitc manner and can lead to OD deaths due to respiratory depression 6. increases release of dopamine and endorphins 7. disrupts lipid membranes

Answer 179

1. increases fat deposits and can cause fatty livers in the extreme 2. causes cirrhosis in ~5-10% alcoholic 3. bad combination with ACETAMINOPHEN

Answer 180

1. it is a diuretic

Answer 181

1. irritating to mouth through the intestines- causes inflammation and enhances chances of cancer 2. stimulates gastric secretions 3. food slows its absorption

Answer 182

1. suppresses immune system/perhaps partially due to malnutrition

Answer 183

- Low doses increase HDL- high doses increase hypertension, coronary artery disease, and arrhythmias

Answer 184

Order of effects: Cortex (cognition) --> limbic (emotion and reward) --> cerbellum (motor and balance) --> hypothalamus (endocrine) --> medulla (respiration and CV regulation)

Answer 185

1. ADME aldehyde dehydrogenase (metabolite is aldehyde) | 2. 0 order kinetic- constant rate of metabolism regardless of concentration

Answer 186

1. cancers, including ORAL, GI, LIVER, 2. malnutrition - poor eating habits, high empty calories in alcoholic beverages 3. fetal alcohol syndrome: developmental facial defects, cognitive damage, "no safe" threshold 4. hangover, headache, nausea/vomiting * controversial if it is a withdrawal phenomenon, but relieved by consuming ethanol 5. tolerance and dependence; tolerance does happen; dependence is both physiological and physical - withdrawal can be life threatening seizures- treat symptoms

Answer 187

1. synergism with sedatives/hypnotics 2. many of the interactions due to ethanol effects on liver metabolism. it can both attenuate and enhance metabolism and effects of other drugs. Alcoholics are notorious for drug interactions

Answer 188

``` .05% = relax, reduced reflexes .08% = legally impaired to drive .2% = motor impairment and poor judgment .4% = coma >.4 % = death ```

Answer 189

1. closely linked with obesity and fat metabolism (especially type 2 diabetes) 2. causes abnormal glucose management and metabolsim 3. protein catabolism 4. abnormal adipocytes 5. triglycerides in muscle and hepatic tissue 6. increase inflammatory cytokines 7. increase thrombosis and arthritis

Answer 190

Relative or absolute deficiency of insulin, causing glucose intolerance

Answer 191

1. Fasting sugar >126 mg/dL 2. 75 gm glucose tolerance test: glucose >200 mg/dL after 2 hours 3. hbA1c> 6.5% (this determines the extent to which your hemoglobin is glucosylated- it provides a good estimate of the avg level of glucose for the previous 3-4 months:

Answer 192

1. ~3% or the world population 2. 73.000 dies/year in U.S 3. nearly 50 % undiagnosed 4. 14% population is in pre-diabetic state * fasting blood glucose =100-125 mg/gL, or HbA1c is 5.75-6.4%

Answer 193

1. polydipsia (thirst) and polyphagia (hunger) 2. polyuria (dilute urine) 3. unexplained weight loss

Answer 194

1. promote transport of glucose and amino acids through membranes of skeletal/smooth/cardiac muscle cells, fibroblasts, FAT cells; it is an anabolic hormone 2. does not affect glucose uptake in: neurons, kidney, and RBC 3. Insulin and C- peptide (are linked in precursor peptide) are secreted from beta cells in islets of Langerhans (pancreas) in response to glucose

Answer 195

1. Much of mechanism in the liver 2. increase lipolysis resulting in blood ketosis and elevated triglycerides 3. increase glycogenolysis and gluconeogenesis 4. anabolic effect (protein catabolsim of muscle- can cause wasting)

Answer 196

1. Insulin-requiring 2. Young (3-20 yrs old), loss of islet beta cells, 5% of cases, typically thin 3. NO NATURAL INSULIN 4. loss of beta cells an autoimmune process- probably triggered by environment such as a viral infection 5. keoacidosis (ketone bodies such as acetone)- dehydration; deep labored breathing (caused by acidosis); nausea, coma

Answer 197

1. "adult" onset, non-insulin dependent DM 2. 95% diabetics are type 2 3. insulin levels often normal, problem is resistance of insulin receptors to insulin stimulation 4. correlates with excessive visceral fat (80-90% are obese) 5. restricted diet control ~20% of diabetic expression 6. correlates with hypertension and risk for atherosclerosis 7. metabolic syndrome 8. some genetics- likely polygenic autosomal 9. most over 30 yrs old, but increasing number of younger type 1 DM patient due to obesity 10. minimal ketons or acidosis, but very high glucose = hyperosmolar coma- enough insulin to prevent lipolysis, but still have elevated glucose

Answer 198

cause by pancratitis

Answer 199

Gestational (pregnant) diabetes

Answer 200

1. type 2 diabetes-insuline receptors refractory to insulin 2. abnormal lipid metabolism - high triglycerides and LDL, low HDL 3. Hypertension 4. Increased risk for atherosclerosis 5. prothrombic tendency 6. dyslipidemia 7. pro-inflammatory state

Answer 201

1. gestational diabetes- due to stress of pregnancy (3-10% of pregnancies) 2. usually goes away after pregnancy, although type II diabetes can develop later 3. can have problems with placenta and babies are abnormally large with excessive insulin secretion and early hypoglycemia causing fetal malformations (cardiac, CNS, renal and limbs)

Answer 202

1. Ketoacidosis/hyperosmolar coma/urinary tract infections 2. Ophthalmic-swelling, cataracts, retinopathy, neuropathy, glaucoma and blindness 3. Accelerated atherosclerosis, unhealthy cholesterols and negative consequences on heart (e.g., MI), kidneys (e.g., glomerulosclerosis, pyelonephritis, etc.), brain (stokes) 4. Peripheral neuropathies –loss of touch and pain in extremities; gangrene and amputations of feet 5. Autonomic nerve dysfunction: abnormal GI motility; hypotonic bladder, increased UTI 6. More prone to infections, slow healing 7. Elevated HbA1c

Answer 203

1. Increased gingivitis and periodontitis and abscesses 2. Poor wound healing (issue with oral surgery or implants) 3. Abnormal infections such as thrush/candida 4. Xerostomia (increased caries) 5. Hypoglycemic event if patients don’t eat before experiencing the stress of a dental procedure

Answer 204

1. Heart-coronary artherosclerosis and myocardial infarctions 2. Kidney failure—renal nephropathy 3. Brain- stroke 4. Eye-retinopathy, cataracts

Answer 205

1. Infrequent ectopic sites in oral cavity: intralingual and lingual thyroid tissue 2. Release and management controlled by hypothalamic TRH stimulating TSH from pituitary 3. Excessive activation causes hypermetabolic state causing protein catabolism and enhanced sympathetic nervous system activity 4. Most thyroid disease is female dominant

Answer 206

```  Nervousness  Hot and sweating  Weight loss  Muscle weakness/tremor  Palpitations/tachycardia  “thyroid storm” (know symptoms) ```

Answer 207

Fever, congestive heart failure, and coma

Answer 208

(90% cases of hyperthyroidism)-occurs in 2% of the adult females

Answer 209

a. Cause: autoimmune-antibodies function as agonists to thyroid-related receptors-causing excessive thyroid receptor activation b. T-cell related autoimmune reaction c. Find elevated Ab to TSH receptor d. Thryroid gland has a diffuse enlargement (2-3 times normal size) e. Symptoms:  Hyperthyroidism  Exophthalmos, 1/3 of the cases

Answer 210

• Hypometabolic state (result of reduced thyroid activity) • In children, cretinism with reduced mental and physical development -Wide set eyes -Thick, dry and cool skin (cold intolerant) -Sluggish • Enlarged thyroid • Low temperature • Dry coarse skin and hair • Sluggish • Cold intolerance • Modest weight gain

Answer 211

• Autoimmune; usually females --antithyroid peroxidase Ab present • May start as hyperthyroidism followed by permanent hypothyroidism • Thyroid enlarges- then atrophies over years • Most often in females • Radiation may cause • Most common cause of thyroid deficiency • High TSH

Answer 212

 Viral cause (e.g., flu virus)  Painful  Usually self-limited and surgery not advised

Answer 213

* Most common lesion of the thyroid-usually a thyroid enlargement * Rarely associated with hypothyroidism * Not a cancer * Usually associate with deficiency of iodine * Diagnosed with fine needle aspiration (versus biopsy) to determine if have large follicles filled with colloid and relatively few cells * Can be confused with thyroid neoplasm—usually very cellular and little colloid

Answer 214

Low risk and low metastasis

Answer 215

TSH levels

Answer 216

1. B blocker to block increase sympathetic NS action | 2. radioactive iodine to destroy some of the gland

Answer 217

T3 or T4 supplements. The T4 products are prescribed more frequently and have fewer side effects because less potent

Answer 218

* Secrete parathyroid hormone (PTH) regulated by free calcium in blood-reverse relationship (low calcium increases PTH) * PTH activates osteoclasts and bone resorption and increases serum calcium; also increases tubular reabsorption of calcium, activates vitamin D and increases GI absorption * Usually 4 glands close to thyroid poles

Answer 219

- due to hyperparathyroidism • A very common endocrine disorder; usually an adenoma • Symptoms: osteoporosis (fractures), constipation, nonspecific weakness, anorexia, stones, peptic ulcers, depression, or even coma • Arrhythmias (1) Treatments usually surgical (2) Metastasis and carcinomas are rare

Answer 220

* Intestinal malabsorption of vitamin D or calcium | * Chronic reduction of serum of Ca++ usually a consequence of chronic renal failure

Answer 221

is rare-most often accidental removal at thyroid surgery 1. Symptoms: hypocalcemia, anxiety, depression, decreases PTH, tetany, dental changes in children (poor enamel, brittle teeth, missing teeth)

Answer 222

1. Brain’s endocrine gland, secretes through blood-brain barrier either: • Anterior-portal circulation from hypothalamus (sends “releasing” factors) • Posterior-axons go into systemic circulation

Answer 223

Rathke's pouch from evaginations of roof of mouth

Answer 224

TRH --> Thyroid stimulating hormone TSH in pituitary--> thyroid, T4

Answer 225

CRH--> ACTH in pituitary --> adrenal cortex, cortisol

Answer 226

FSH, LH in pituitary --> reproductive tissues

Answer 227

GH in pituitary --> Liver, IGF-1, and general

Answer 228

Inhibits growth hormone in pituitary

Answer 229

Inhibits prolactin (which usually leads to lactation)

Answer 230

Hypothalamus

Answer 231

ADH secreted for H20 resportion | Oxytocin secreted for nursing

Answer 232

4 types defined by location and effect on specific hormone secretion - Prolactinoma--> affect reproduction function - Growth Hormone --> cause acromegaly in adults and gigantism in children - Null cell --> reduce FSH/LH - Corticotropin --> affect ACTH and causes Cushing's Disease

Answer 233

nonsecretory pituitary adenomas

Answer 234

 Loss of sex characteristics-sterility  Retard growth in children  Hypothyroidism

Answer 235

 Diabetes insipidus –no glucose or insulin involved  Polydipsia  Inappropriate ADH secretion from pituitary  Consequences : alters kidney function-volume (water) expansion, hyponatremia and hemodilution  Causes: metastasized carcinoma, CNS infection

Answer 236

1. Medulla makes and releases catecholamines (epinephrine and norepinephrine) 2. Cortex makes steroids: mineralcorticoids, glucocorticoids and sex steroids

Answer 237

 Weakness  Nausea  Hyponatremia, hyperkalemia  Hypotension  Skin pigmentation (get increase of MSH with the ACTH)  May cause ‘adrenal crisis’- a sudden requirement for increased steroid, which is not available; e.g., ‘Waterhouse-Friderichson syndrome’ caused by hemorrhaging into the adrenal cortex caused by sepsis from meningococcal infection

Answer 238

* Cause: autoimmune * More common in white women * 65% of adrenal insufficiency cases * Adrenals reduced * Increased infection

Answer 239

``` due to hypothalamic or pituitary problem (1). Features; • No hyperpigmentation • Aldosterone usually normal • usually due to exogenous treatment with steroids and their abrupt discontinuation ```

Answer 240

• Autoimmune adrenalitis  Most often in white females  Causes 65% adrenal insufficiency cases • Can be caused by infections such as TB

Answer 241

* Leading cause of hypercortisolism: women 5X more likely * Adrenal hyperplasia * ACTH low, cortisol high * Adrenals act autonomously * Symptoms: moon face, osteoporosis, hypertension, buffalo hump, obesity, thin skin, amenorrhea, muscle weakness, mood changes, poor wound healing (remember: this looks like someone on chronic corticosteroid treatment-e.g., for chronic major arthritis or other inflammatory diseases)

Answer 242

Adenoma causes primary secondary- typically results from renal disease or cirrhosis • Na+ retention and K+ excretion • Suppression of renin-angiotensin system • Women most often

Answer 243

a. Adenomas common (1% prevalence) • Usually nonfunctional b. Carcinomas rare c. Pheochromocytoma (adrenal medulla)

Answer 244

• Tumor of adrenal medulla (usually benign) –increases secretion of catecholamines • Can be episodic or sustain secretion • Effects typically look like increased sympathetic nervous system function  Hypertension  Flushing  Increased urine catecholamines

Answer 245

• Usually children (

Answer 246

Cause not known, but may be triggered by viral infections A. Features:  Common (3-4% Caucasians)- second most frequent bone disease after osteoporosis; chronic  Usually >40 years of age; usually male  Often asymptomatic, can cause bone pain and fractures  Can cause arthritis if near joint  High serum alkaline phosphates  Vertebrae, skull and long bones common sites  Enhances osteoclastic activity—some rebound osteoblastic response; Described as a disorder of bone remodeling.  Often seen patches of radiolucency on radiographs

Midterm 2 Pathology Flashcards

(277 cards)