PTG 105

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  1. What type of cells are the anterior horn cells?
    Nerve cells of the CNS
  2. What type of paralysis do Poliomyelitis patients suffer from?
    Flaccid paralysis
  3. Describe the condition of a person with poliomyelitis:
    • Flaccid paralysis of the arms and legs
    • Difficulty breathing
  4. What is ALS?
    Amyotrophic lateral sclerosis
  5. What is Amyotrophic lateral sclerosis?
    Serious neurological disease that limits voluntary movement
  6. How does Amyotrophic lateral sclerosis begin?
    Muscle twitching/weakness in the arm/leg and slurring of speech
  7. Is there a cure for Amyotrophic lateral sclerosis?
  8. How long do people with Amyotrophic lateral sclerosis live usually?
    3-5 years after first symptoms
  9. Describe progressive stages of Amyotrophic lateral sclerosis:
    • Inability to move muscles needed for eating, speaking, moving and breathing
    • Last stages = difficulty breathing
  10. Describe Myasthenia Gravis:
    • Autoimmune
    • AB destroy neuromuscular junctions
  11. What is the presentation of Myasthenia Gravis?
    Muscle weakness that increases during activity and improves during rest
  12. What disease is marked by Muscle weakness that increases during activity and improves during rest?
    Myastheina Gravis
  13. Describe the immune that leads to Myasthenia Gravis:
    • AB bind (and destroy) ACh receptors on skeletal muscle
    • AutoABs seen in 90% of patients
  14. Do all Myasthenia Gravis patients have autoantibodies?
    No, but 90% do
  15. What type of atrophy is seen with Myasthenia Gravis?
    Disuse atrophy
  16. 2/3 of Myasthenia Gravis patients have_______ and 15% have _______.
    Hyperplasia Thymoma
  17. What What specific muscles are characteristically affected in Myasthenia Gravis?
    • Ocular
    • Causes drooping eyelids and double vision
  18. Describe the presentation of Myasthenia Gravis:
    • Drooping eyelids
    • Double vision
    • Slurred speech
    • Diff. chewing, swallowing
    • Some respiratory/general skeletal muscles maybe effected
  19. What are the two types of treatment for Myasthenia Gravis?
    • Increases Ach at neuromuscular junction
    • Suppress production of abnormal Abs
  20. For Myasthenia Gravis, In what ways can the production of abnormal ABs be thwarted?
    • Thyectomy
    • Plasmapheresis
  21. What is Plasmapheresis?
    Removes autoantibodies
  22. What is Thyectomy?
    Removal of the Thymus
  23. What is the prognosis for pateints with Myasthenia Gravis?
  24. Describe Polymyositis and Dermomyositis:
    • Lymphocytic Inflammatory Autoimmune myopathies
    • Cause symmetrical muscle weakness in large trunk, neck and limbs
  25. What disease is a Lymphocytic inflammatory autoimmune myopathy that effects large muscles of the trunk, neck and extremities?
    Dermatomyositis and Polymyositis
  26. What type of inflammation is found in polymyositis and dermatomyositis?
    Lymphocytic inflammation
  27. What symptom does dermatomyositis have that polymyositis does not?
    Rash on the upper eyelid
  28. What inflammatory muscular disease has a rash on the upprer eyelid?
  29. What symptoms of polymyositis and dermatomyositis be seen on a lab report?
    • Lymphocytic inflammation of the muscle
    • Antinuclear antibodies in the serum
    • Elevated creatine kinase due to muscle injury
  30. Are there lesions of the muscle tissue with dermatomyositis or polymyositis?
  31. Inflammatory myopathies can be caused by dermatomyositis, polymyositis and what else?
    • Viruses: HIV, Influenza
    • Parasitic infections: Trichinosis, Cysticercosis, toxoplasmosis
  32. HIV, Toxoplasmosis, Trichinosis, Cysticercosis and Influenza can all cause what disease?
    Inflammatory myopathy
  33. What are the soft tissues?
    • Fat
    • Muscle
    • Fibrous tissue
  34. What percent of soft tissue tomors are benign?
  35. How do soft tissue tumors present?
    As a Mass
  36. At what age to soft tissue tumors present?
    Any age
  37. What is a malignant soft tissue tumor called?
  38. What is a tumor of the adipose tissue called?
    • Lipoma
    • Liposarcoma
  39. What is a tumor of the smooth muscle called?
    • Leiomyoma
    • Leiyomyosarcoma
  40. What is a tumor of the skeletal muscle called?
    • Rhabdomyoma
    • Rhabdomyosarcoma
  41. What is a tumor of the Fibrous tissue called?
    • Tumor like conditions
    • Fibrosacrcoma
  42. What does Fibrohistiocytic mean?
    Having both fibrous and histocytic properties
  43. What is histocytic?
    A blood disease characterized by abnormal multiplication of macrophages
  44. What is a common etiology osteosarcoma and fibrosarcoma?
  45. What is a common etiology of Angiosarcoma?
    Chemical like PVC
  46. What is a common etiology of Kaposi sarcoma?
    Infection like AIDS
  47. What is a common etiology of fibromatosis?
  48. What tumors can be caused by radiation?
    • Osteosarcoma
    • Fibrosarcoma
  49. What tumors can be caused by AIDS?
    Kaposi sarcoma
  50. What tumors can be caused by PVC?
  51. What tumors can be caused by Genetics?
    Certain fibromatosis
  52. What is Angiosarcoma?
    Blood vessel sarcoma
  53. What age is typical for Rhabdomyosarcoma?
    0-15, incidence tapers into the 30s
  54. What is Synovial Sarcoma most common?
  55. What age is typical of Fibrosarcoma?
  56. What age is typical of Liposarcoma?
    25-55, usually 40+
  57. What age is typical of Malignant schwannoma?
  58. What age is typical of malignant fibrous histcytoma?
  59. What is the incidence of soft tissue tumors of the lower limbs and girdle?
  60. What is the incidence of soft tissue tumors of the upper libs and girdle?
  61. What is the incidence of soft tissue retroperitoneal or intraperitoneal tumors?
  62. What is the incidence of soft tissue tumors of the trunk?
  63. What is the incidence of soft tissue tumors of the Head and neck?
  64. What is the most common soft tussue tumor?
  65. How common is lipoma?
    Most common soft tissue tumor
  66. Describe Lipoma:
    • Benign
    • Subcutaneous
    • Usually trunk and neck (can be anywhere)
  67. Histologically, what do lipomas look like?
    Bright yellow mature adipose tissue with a fine fibrous capsule
  68. Where are Liposarcomas usually found?
    Deeply seated in soft tissue
  69. What is the most common soft tissue sarcoma?
  70. What are the subtypes of Liposarcoma?
    • Pleomorphic
    • Myoxoid
    • Round cell
    • Well-differentiated
    • Dedifferentiated
  71. What is the pathology of a liposarcoma?
    • Well circumscribed
    • Not encapsulated
    • Contains lipoblasts
  72. A well circumscribed, non-encapsulated tumor that contains lipoblasts is most likely what?
  73. What is the prognosis for liposarcoma?
  74. What subtype of liposarcoma has the best prognosis?
    Well-differntiated, myoxoid liposarcoma
  75. What two “tumor like conditions” of the fibrous tissue were discussed in class?
    • Nodular fasciitis
    • Fibromatosis
  76. What age group is affected by nodular fasciitis?
    Young adults
  77. What is Nodular fasciitis commonly misdiagnosed as?
  78. Why is Nodular fasciitis commonly misdiagnosed as sarcomas?
    • Cellularity
    • Mitotic figures
    • Fast growth
  79. What is a nodular fasciitis composed of?
    Plump immature fibroblasts or Myofibroblasts
  80. Where do Nodular fasciitis tumors usually present?
    • Forearm
    • Chest
    • Back
  81. How can the growth of nodular fasciitis be characterized?
    Fast Growth
  82. Are the masses of nodular fasciitis painful?
  83. Describe Fibromatosis:
    Benign proliferation of fibroblast and myofibroblasts
  84. What types of Fibromatosis are there?
    • Superficial
    • Deep
  85. Where is superficial fibromatosis found?
    On the palms and penis
  86. Where are deep type fibromatoses found?
    • Abdomen
    • Trunk
    • Limb muscles
  87. Describe histology/pathology of a fibromatosis:
    • Infiltrating borders
    • Firm
    • White cut surface
    • Large
  88. What is the treatment of fibromatosis?
    Surgery, often reoccurring
  89. Describe the aggressiveness of fibromatosis:
    Locally aggressive, does not metastasize distantly
  90. What does Fibromatosis resemble?
  91. What is a desmoid tumor?
    A deep type fibromatosis
  92. When does deep type fibromatosis of the abdominal wall often occur?
    During pregnancy
  93. How common is Fibrosarcoma?
  94. What is the reoccurrence rate of Fibrosarcoma?
  95. What percent of Fibrosarcomas metastasize?
  96. Where do Fibrosarcomas often develop?
    • Thigh
    • Knee
    • Retroperitoneum
  97. What does a Fibrosarcoma look like histologically?
    • Herringbone Fibroblast growth
    • Nuclear atypia
    • Cellular Peomorphism
    • Mitotic activity
  98. What type of tumor shows Herringbone fibroblastic growth patterns?
  99. What are the three type of Fibohistiocytytic tumors?
    • Fibrous histiocytoma
    • Dermatofibrosarcoma protuberans (DFSP)
    • Malignant fibrous histiocytoma
  100. Is Fibrous histiocytoma malignant?
  101. Is Dermatofibrosarcoma protuberans malignant (DFSP)?
    Borderline malignant
  102. What type of Fibrohistiocytic tumor is Malignant?
    FMalignancy fibrous histiocytoma
  103. What type of Fibrohistiocytic tumor is benign?
    Fibrous Histiocytoma
  104. What type of Fibrous histiocytic tumor is borderline Malignant?
    Dermatofibrosarcoma protuberans (DFSP)
  105. How do most benign fibrous histiocytomas usually present initially?
    Mobile subcutaneous nodule on the extremities
  106. What does a Benign Fibrous histiocytoma look like histologically?
    • Storiform pattern
    • Foamy macrophages
    • Tuton giant cells
  107. What disease has a histological appearance of foamy macrophages/storiform pattern/Tuton giant cells?
    Benign Fibrous histiocytoma
  108. What does Storiform pattern of cells look like?
    Star like clustering
  109. Can Dermatofibrosarcoma protuberans metastasize?
    Can, but rarely
  110. Where are Dermatofibrosarcoma protuberans usually found?
    Trunk and proximal extremities
  111. What characteristically happens with Dermatofibrosarcoma protuberans after excision?
    They regrown
  112. Describe Dermatofibrosarcoma protuberans histology:
    • Similar to Benign fibrous histiocytoma
    • More cellular
    • More atypia
    • More mitotic activity
    • Infiltrative borders
  113. Usually, how old are patients with malignant fibrous histiocytoma?
    50-60 years
  114. How often do malignant fibrous histiocytomas metastasize?
    50% of cases
  115. Where are malignant fibrous histiocytomas usually located?
    • Soft tissues of the extremities
    • Retroperitoneum
  116. Describe the histology of malignant fibrous histiocytoma:
    Highly pleomorphic and atypical cells
  117. What is aRhabdomyoma?
    Benign tumor of skeletal muscle
  118. How common is Rhabdomyoma?
  119. What other disease can rhabdomyoma occur with?
    Tuberous sclerosis
  120. At what stage in life does Rhabdomyosarcoma occur?
    Infancy through first decade
  121. What is the most common sarcoma in children?
  122. Children from 2-8 usually develop Rhabdomyosarcoma in what body areas?
    • Head
    • Neck Genitourinary
  123. Teenagers from 14-18 usually develop Rhabdomyosarcoma in what areas of the body?
    • Abdominal
    • Paratesticular
    • Trunk
  124. What are the three subtypes of Rhabdomyosarcoma?
    • Pleomorphic
    • Aveolar
    • Embryonal
  125. What characteristic indicates Aveolar Rhabdomyosarcoma?
    Chromosomal translocation t(2, 13)
  126. What disease typically shows chromostomal translocation t(2,13)
    Aveolar Rhabdomyosarcoma
  127. What are long thin cells associated with Rhabdomyosarcoma called?
    Strap cells
  128. What cells are often seen on a slide of Rhabdomyosarcoma?
    • Strap cells
    • Myoblasts
  129. What is the name for a benign smooth muscle tumor?
  130. Where are Leiomyomas usually found?
    • Uterus
    • Sometimes subcutaneous
  131. What is the most common neoplasm in women?
  132. What is the histology of Leiomyoma?
    • Blunt ended, elongated nuclei
    • Minimal atypia
    • Minimal mitosis
    • No coagulative tumor necrosis
  133. What type of tumor would you expect to have blunt ended, elongated nuclei, little atypia and mitosis and no coagulative necrosis factor?
  134. What percent of adult soft tissue sarcomas are Leiomyosarcoma?
  135. What sex is more likely to develop Leiomyosarcoma?
  136. Where is a common site for metastasis of Leiomyosarcoma?
    The lung
  137. What are common sites for Leiomyosarcoma?
    • Extremities
    • Lumen of vessels (inferior vena cava, saphenous vein)
  138. What would you expect to see on a slide of Leiomyosarcoma?
    • High mitotic activity
    • High pleomorphism
    • Tumor cell necrosis
  139. What is synovial sarcoma?
    Deep seated tumor around large joints, usually in young adults
  140. Where are most synovial sarcomas located?
    80% at the knee or ankle
  141. What age range is typical for synovial sarcoma?
    20-40 years
  142. How often does synovial sarcoma metastasize?
  143. Where does synovial sarcoma metastasize to?
    • Lung
    • Pleura
    • Bone
    • Regional lymph nodes
  144. What usually causes Synovial sarcoma?
    Chromosomal translocation t(X;18), (p11.2; q11)
  145. What percent of people with synovial sarcoma also have chromosomal translocation?
  146. What is characteristic of the histology of synovial sarcoma?
    • Biphasic
    • Spindle cells stroma and Round epithelial cells that form glands
  147. What type of tumor has a biphasic histological appearance with spindle cells and round epithelial cells mixed as glands?
    Synovial sarcoma
  148. What are the important cell types of the epidermis?
    • Melanocytes
    • Squamous epithelial cells
  149. What is another name for squamous epithelial cells of the epidermis?
  150. What are the major components of the dermis?
    • Blood vessels
    • Hair follicles
    • Sebaceous glands
    • Sweat glands
  151. Describe a Papule:
    Elevated solid area (plaque)
  152. What is an elevated solid area on the skin?
    Papule (Plaque)
  153. What is a Macule?
    Flat area of coloration on the skin
  154. What is the term for a flat area of coloration on the skin?
  155. What is a Nodule?
    A solid area larger than a papule
  156. What is a Weal?
    An itchy, transiently elevated area with variable blanching and erythema
  157. What is the term for an itchy transiently elevated area of the skin with variable blanching and erythema?
  158. What is a vesicle?
    (Bulla), fluid filled raised area
  159. What is the term for a fluid filled raised area?
    Vesicle (Bulla)
  160. What is a Pustule?
    Discrete pus filled raised area
  161. What is the term for a discrete raised pus filled area?
    Vesicle or Bulla
  162. What is another term for hives?
  163. What is another term for Uticaria?
  164. What are Utricaria?
    Red edematous itchy plaques appearing within minutes
  165. What are the common ages to develop uticaria?
  166. What areas are utricaria found?
    Trunk and distal extremities
  167. How long does Uticaria usually last?
    Few hours
  168. What are Uticaria usually from?
    Hypersensitivity Type I (IgE dependant)
  169. What skin disease is usually caused by a type I hypersensitivity (IgE dependant)?
  170. What is an IGE independent cause of Uticaria?
  171. What would you expect to see in a cross section of skin with uticaria?
    Eiosinophils and mast cells
  172. What disease accounts for 1/3 of dermatology visits?
  173. What causes dermatitis or eczema?
    • Drugs
    • Allergens
    • UV light
    • Trauma
  174. What is Dermatitis/Eczema?
    General term for variety of inflammatory skin conditions
  175. What is the term for a general inflammatory skin condition?
    Dermatitis or Eczema
  176. What is a complication of Dermatitis/Eczema?
    Secondary skin infections
  177. What does a typical dermatitis or eczema lesion look like?
    Oozing, crusting, scaling
  178. What type of dermatitis were covered in class?
    • Allergic contact dermatitis
    • Atopic dermatitis
    • Drug-related dermatitis
    • Photoeczematous eruption
    • Primary irritant dermatitis
  179. What is Allergic contact dermatitis?
    • Type IV hypersensitivity reaction
    • Poison IVY, jewelry, cosmetics, etc.
  180. What is Atopic dermatitis?
    • Associated with a personal or family history of eczema, hay fever or asthma
    • Begins in infancy on face and scalp
  181. What type of dermatitis is a Type IV hypersensitivity (i.e. cosmetics, poison ivy, etc.)?
    Allergic contact dermatitis
  182. What type of dermatitis is associated with a personal of family history of hay fever, asthma or eczema and begins at infancy with a face and scalp rash?
    Atopic dermatitis
  183. What type of dermatitis disappears when a drugs is removed?
    Drug-related dermatitis
  184. What is Photoeczematous eruption?
    Dermatitis on exposed skin
  185. What is Primary irritant dermatitis?
    Dermatitis following repeated trauma like rubbing
  186. What type of dermatitis follows repeated trauma like rubbing?
    Primary irritant dermatitis
  187. What is Impetigo?
    Superficial bacterial infection of the face
  188. What is usually the cause of impetigo?
    Staph or strep infection
  189. Is impetigo infectious?
    Yes, especially children in crowded spaces
  190. What part of the body is usually infected by impetigo?
  191. What does Impetigo look like?
    Oozing, crusting and pus forming blister on the face (usually)
  192. How is Impetigo treated?
  193. What is Acne?
    Nodules and pustules on the face and upper back
  194. When is Acne most common?
    Puberty through adulthood
  195. What causes Acne?
    Blockage of sebaceous glands and hair follicle by lipids and keratin
  196. What is the etiology of Acne (6)?
    • Fatty acids
    • Hereditary
    • Hormonal (androgens)
    • Emotions
    • Corticosteroids
    • Propionibacterium
  197. What causes inflammation associated with acne?
    Fatty acids
  198. What bacteria can live in a plugged hair follicle?
  199. What are the possible treatments for Ance?
    • Clindamycin
    • Erythromycin
    • Benzoyl peroxide
    • Salicylic acid
  200. What antibiotics would you use to treat acna with?
    • Erythromycin
    • Clindamycin
  201. What must be done to cause Erythema Multiforme to heal?
    Nothing, self-limiting
  202. What is Erythema multiforme?
    • Multiple forms of lesions on the skin (macules, papules,etc.)
    • Hypersensitivity reaction
  203. What is the characteristic lesion of Erythema multiforme?
    Targetoid lesions
  204. What disease is indicated by targetoid lesiosn?
    Erythema multiforme
  205. What type of skin lesion would you expect with herpes simplex?
    Erythemia Multiforme
  206. What etiologies does Erythemia Multiforms have?
    • Herpes Simplex
    • Drugs: Sulfonamides, penicillin
    • Malignant disease
    • Collagen vascular disease
  207. What type of skin lesion is found with Sulfonamide and penicillins?
    Erythemia Multifomre
  208. What type of skin lesion is found with Collagen vascular disease?
    Erythemia Multiforme
  209. What type of skin lesion is associated with malignant diseases?
    Erythemia Multiforme
  210. What is Stevens-Johnson syndrome?
    • Erythemia Multiform of the the entire body and mucus membranes
    • Extensive and febrile EM
  211. What is the name for an extensive and febrile form of Erythemia Multiforme?
    Stevens-Johnson syndrome
  212. What are two chronic inflammatory skin conditions?
    • Psoriasis
    • Lichen planus
  213. What type skin of diseases are Lichen planus and Psoriasis?
    Chronic inflammatory diseases
  214. What is Psoriasis?
    • Demarcated pink plaques with silver scales on knees, elbows, scalp and glans penis
    • Probably an immune disorder
  215. What is the etiology of Psoriasis?
    Immune disorder
  216. What percent of psoriasis sufferers have nail issues as well?
  217. What areas of the body does psoriasis usually affect?
    The elbow, knees, nails, skin, scalp and glans penis
  218. What is the term for new Psoriasis lesions developing at the site of trauma?
    Koebner phenomenon
  219. What is Koebner phenomenon?
    New lesions of psoriasis developing at a site of trauma
  220. What percent of the population of affected by Psoriasis?
  221. What ages are most effected by psoriasis?
    All ages
  222. What do psoriasis lesions look like?
    Pink demarcated plaques covered in shiny, silvery scales that bleed when they break away
  223. What is the Auspitz sign?
    Bleeding points of psoriasis plaques when the scales pull away
  224. What type of nail changes would you expect with psoriasis?
    • Pitting
    • Thickening
  225. What is Lichen Planus?
    Itchy purple papules of the skin and mucus membranes, usually symetrically distributed
  226. Where are Lichen planus lesions located?
    • Skin = knee, write and elbow
    • Oral
  227. What percent of Lichen Planus patients have oral lesions?
  228. What is the etiology of Lichen Planus?
    • Immune disorder
    • Linked to Hep C
  229. What is the most distressing symptoms of Lichen planus?
  230. What skin disease includes itchy purple papules an skin and mucus membranes?
    Lichen planus
  231. If a person has Lichen planus on one hand, where else would you expect to find it?
    On the other hand (lichen planus = symmetrical)
  232. What is Seborrheic Keratosis?
    Benign dark colored plaques (keratin cysts) that appear "stuck on"
  233. What age group usually gets Seborrheic Keratosis?
    Middle aged to older
  234. Where are Seborrheic Keratosis lesions found?
    Head, neck, trunk and extremities
  235. What disease is characterized by keratin cysts that appear stuck on to the skin?
    Seborrheic Keratosis
  236. What is a Keratoacanthoma?
    Dome shaped Benign proliferation of the keratanocytes
  237. What other disease does Keratoacanthoma mimic?
    Squamous cell carcinoma
  238. Why does Keratoacanthoma mimic squamous cell carcinoma?
    It is fast growing
  239. What group is Keratoacanthoma common in?
    Men over 50
  240. What areas of the body is Keratoacanthoma common?
    Face, sun exposed areas
  241. What is a Keratoacynthoma composed of?
    Dome shaped nodule with keratin filled plug
  242. What disease presents as a domed shaped nodule with a keratin filled plug?
  243. What is another term for Verrucae?
  244. What is another term for warts?
  245. What group is Verrucae common in?
    Children/adolescents (though any age)
  246. What causes Verrucae?
    DNA virus =HPV
  247. What does a Verrucae look like?
    raised horny lesions
  248. How is Keratoacanthoma treated?
    Is not, because it is self limiting
  249. How are Verrucae treated?
    Self limiting
  250. What are the four types of Verrucae?
    • Verruca vulgaris
    • Verruca plana
    • Veruca plantaris
    • Condyloma acuminata
  251. What is Verruca vulgaris?
    Common wart on hands and feet
  252. What is Verruca plana?
    Flat wart
  253. What is Verruca plantaris?
    Soles of feet
  254. What is Condyloma acuminata?
    Veneral warts
  255. What is the term for Common wart on hands and feet?
    Verruca vulgaris
  256. What is the term for Flat wart?
    Verruca plana
  257. What is the term for Soles of feet?
    Verruca plantaris
  258. What is the term for Veneral warts?
    Condyloma acuminata
  259. What type of wart makes cauliflower like masses on the skin?
    Verruca Vulgaris
  260. What is actinic keratosis?
    Age related change due to many years of sun exposure
  261. What group is actinic keratosis found in?
    Fair skinned
  262. What is the major concern of actinic keratosis?
    • Pre-malignant and may develop into squamous cell carcinoma
    • approx. 25%
  263. What does Actinic keratosis look like?
    Multiple brown lesions on the skin with rough surface
  264. Where is Actinic keratosis most commonly found?
    On sun exposed areas
  265. What is the pathology of actinic Keratosis?
    Squamous dysplasia with elastasis (sun damage)
  266. Describe Squamous cell carcinoma?
    • tumor in sun exposed areas that can metastasize
    • Good prognosis
  267. What is the prognosis of squamous cell carcinoma?
  268. Where does squamous cell carcinoma metastasize to?
    regional lymph nodes
  269. What are the etiological agents of Squamous cell carcinoma 8?
    • UV light DNA damage
    • tar and oils
    • arsenical
    • radiation
    • tobacco chewing
    • immune suppression/chemo
    • burn scar
    • chronic ulcers
  270. What is the most common skin cancer?
    Basal cell carcinoma
  271. What percentage of skin cancer is basal cell carcinoma?
  272. Does Basal cell carcinoma metastisize?
  273. Where is most basal cell carcinoma found?
  274. What does basal cell carcinoma look like?
    Pearly papules
  275. Describe the treatment for basal cell carcinoma?
    Indolent course, no treatment
  276. How deep does basal cell carcinoma go into the skin?
    Usually shallow, can go deep
  277. What is the name for a deep rooting basal cell carcinoma?
    Rodent ulcer
  278. What is another term for a Nevi?
  279. What is another term for a Mole?
  280. What is a Nevi/mole?
    A benign proliferation of melanocytes in the skin
  281. Do nevi disappear?
  282. When do nevi develop?
  283. What is the relative risk of melanoma from nevi?
    Very small
  284. What type of nevi is a precursor to malignant melanoma?
    Dysplastic nevi
  285. What is a Dysplastic nevi?
    A nevi with atypia (that may lead to malignant melanoma)
  286. Describe how Nevi grow?
    • proliferate at dermal-epidermal junction
    • The grow into dermis
    • then reside in the dermis only
  287. What is a junctional nevi?
    One that resides at the dermal-epidermal junction
  288. What is a compound nevi?
    One that has grown from the dermal-epidermal junction into the dermis
  289. What is a intradermal nevi?
    One that resides entirely in the dermis
  290. What is a flat or slightly raised pigmented lesion also known as?
  291. Where is the most common site for male melanoma?
    Trunk 35%
  292. Where is the most common site for female melanoma?
    Leg 56%
  293. What is the most dangerous type of skin cancer?
    Malignant melanoma
  294. What percent of malignant melanoma patients die of metastatic disease?
  295. Where does Malignant melanoma metastasize to?
    Anywhere...brain, lungs, lymph nodes, et.c
  296. What is an acral melanoma?
    Nail melanoma
  297. How does malignant melanoma grow?
    • Horizontally within the epidermis
    • Vertically within the dermis
  298. What type of skin disease grown horizontally in the epidermis and vertically in the dermis?
    Malignant melanoma
  299. How is probability of metastases determined in malignant melanoma?
    by the length of vertical growth into the dermis
  300. What are the meninges?
    The coverings of the brain
  301. How many meninges are there?
  302. What are the three meninges from external to internal?
    • Dura mater
    • Arachnoid mater
    • Pia mater
  303. What is meningitis?
    Inflammation of the brain coverings
  304. What are the four types of intracranial bleeding?
    • Intracerebral
    • Subarachnoid
    • subdural
    • extra dural
  305. What is Cerebrospinal fluid analysis?
    • culture and gram stain
    • look for increased antibodies (as for MS)
  306. What is Computerized axial tomography and what is it used for?
    • CT scan
    • Used to see mass lesions
  307. What is magnetic resonance imaging used for?
    Mass lesions
  308. What is Electrocephalogram used for?
  309. What is Angiography used for?
    Vascular lesion (i.e aneurysm)
  310. What is cerebral edema?
    Increased water content on the brain
  311. What is the term for increased water on the brain?
    Cerebral edema
  312. What are the two types of cerebral edema?
    Vasogenic and Cytotoxic
  313. What is Vasogenic cerebral edema?
    Cerebral edema caused by disruption of the cerebral capillaries and blood brain barrier
  314. What type of cerebral edema is caused by disruption of the capillaries and blood brain barrier?
  315. What is Cytotoxic cerebral edema?
    Cerebral edema second to brain cell damage
  316. What type of cerebral edema is second to brain cell damage?
  317. Under what conditions would vasogenic cerebral edema be seen?
    • trauma
    • tumors
    • late stage cerebral ischemia
    • inflammation
  318. Under what conditions would you expect to find Cytotoxic cerebral edema?
    • Intoxications
    • Hypothermis
    • Reyes syndrome
    • Early ischemia
  319. What types of intoxifications cause Cytotoxic cerebral edema?
    • dinitrophenol
    • hexachlorophene
  320. How does the Blood brain barrier restrict access to the brain?
    tight junctions and metabolic barriers
  321. What is the rate limiting factor in determining permeability of the a drug into the brain?
    The blood brain barrier
  322. What is the blood brain barrier?
    Specialized network of capillaries that limit what passes into the brain
  323. What is the result of Cerebral edema?
    • Increased intracranial pressure
    • Can lead to brain damage
  324. What are symptoms of cerebral edema?
    • Vomiting
    • Change in consciousness
    • Headache
  325. Whatis the most catastrophi cevernt associated with cerebral edema?
    • Coning/Brain herniation
    • Where the brain pushes through the base of the skull
  326. What is the treatment for cerebral edema?
    • Remove lesion
    • Corticosteroids to stabilize the membranes
    • Osmotherapy to reduce edema (such as mannitol and carbonic anhydrase)
  327. What would you use to reduce a cerebral edema?
    Osmotherapy such as mannitol or carbonic anhydrase
  328. Why would you use carbonic anhydrase to treat cerebral edema?
    Stabilize the membranes
  329. What does the brain look like after cerebral edema?
    Widened Gyri with a flattened surface and narrowed sulci
  330. A brain that has widened gyri, narrowed sulci and a flattened surface most likely suffered from what?
    Cerebral edema
  331. What is Hydrocephalus?
    Accumulation of fluid in the Ventricle system of the brain
  332. What are the two main causes of Hydrocephalus?
    • Overproduction of CSF
    • Blockage of CSF circulation
  333. What is the most common cause of Hydrocephalus?
    Congenital defects in CSF circulatory pathway development
  334. What disease other than congenital defects commonly cause hydrocephalus?
    • Meningitis
    • Hemorrhage of tumors (that block CSF)
  335. Where is CSF produced?
    In the Ventricles of the brain
  336. What is the purpose of the Ventricle system of the brain?
    • Protect the brain from impact
    • Remove waste
  337. How is waste from the Ventricle system eliminated?
    Through the blood stream
  338. What are the manifestations of Hydrocephalus?
    In babies: increased size of head and mental retardation
  339. What are three vascular disorders that effect the brain?
    • Infarct
    • Stroke
    • Cerebrospinal accident
  340. What is a brain vascular disorder?
    Local interruption of the blood flow to the brain
  341. What is the outcome of brain vascular disorders?
    Brain death within minutes
  342. What are the risk factors for brain vascular disorders (10)?
    • Hyperlipidemia
    • Hypertension
    • Atherosclerosis
    • cerebral aneurysm
    • berry aneurysm
    • diabetes
    • heart disease
    • smoking
    • male sex
    • Age
  343. What are the main types of stroke?
    • Ischemic
    • Hemorrhagic
  344. What is Ischemic stroke?
    Loss of blood supply
  345. What is the most common type of stroke?
  346. What are the two type of Ischemic stroke and their relative incidence?
    • Atherothrombotic (25-30%)
    • Emboli stroke (35-40%)
  347. What is Hemorrhagic stroke?
    • Intracerebral hemorrhage
    • Or
    • Rupture of saccular aneurysm/vasular malformation
  348. What percent of strokes are Hemorrhagic?
  349. What often causes atrial thrombus in an ischemic strok?
    rheumatic carditis
  350. What often causes thrombus from the heart in ischemic stroke?
    myocardial infarct
  351. What type of stroke is caused by atrial thrombus or a thrombus from the heart?
    Embolic Ischemic stroke
  352. What is a rare stroke type discussed in class?
    Hypoperfusion infarct
  353. How common is Hypoperfusion infarct?
  354. What is Hypoperfusion infarct?
    Inadequate arterial blood supply due to hypotension
  355. What is the term for inadequate arterial blood supply to the brain due to hypotension?
    Hyoperfusion infarct
  356. What is a mini stroke called?
    • Transient ischemic attacks (TIAs)
    • Occurs when blood supply is briefly interrupted
  357. What are the manifestations of stroke?
    • sudden paralysis
    • Dysphagia/Aphasia
    • Confusion or loss of conciousness
  358. How is stroke diagnosed?
    • MRI
    • CT
    • Angiography
  359. What are the outcomes and their associated proportions for stroke?
    • 1/3 die
    • 1/3 live with serious defects
    • 1/3 recover
  360. What does stroke prognosis depend on?
    Amount and site of brain involved
  361. What are the symptoms of stroke?
    • Sudden numbness or weakness of the face, arms or legs
    • Sudden inability to see in one or both eyes
    • Sudden speech issues
    • Sudden trouble with balance
    • Sudden severe headache
  362. Which is more common, arterial thrombosis or venous thrombosis of the brain?
    Arterial (100:1)
  363. What is the best treatment for stroke?
  364. What is the treatment for Ischemic strokes?
    Tissue plasminogen activator (t-PA)
  365. What would you treat with tissue plasminogen activator?
    Ischemic stroke
  366. What is the window of opportunity to treat a stroke?
    3 hours
  367. What can be done to treat dead brain tissue?
    Little, basically just physical therapy
  368. What is a TIA due to?
    • Atherosclerotic narrowing of the blood vessel
    • Small emboli that temporarily lodge
  369. How long do TIA attacks last?
    minutes to hours
  370. What are symptoms of TIA?
    • visual disturbances
    • transient paresis
    • sensory loss
  371. The blood deficit involved in a TIA usually resolves in what time period?
    24 hours
  372. What do TIAs indicate?
    • Future stroke
    • Serve as a warning for cerebrovascular accidents
  373. Where is a subarachnoid hemorrhage located?
    Beneath the arachnoid and above the pia mater
  374. What is the most common type of brain hemorrhage?
    Intracerebral hemorrhage
  375. What percent of hemorrhages are subarachnoid, subdural or extradural?
  376. Describe a Saccular aneurysm or a subarachnoid hemorrhage?
    Ruptured cerebral aneurysm that causes a stroke
  377. What type of hemorrhage can be described as a ruptured cerebral aneurysm that causes a stroke?
    • Saccular aneurysm
    • Subarachnoid hemorrhage
  378. What percent of the population has subarachnoid hemorrhage or saccular aneurysm?
  379. What is a predisposing condition for Saccular aneurysm and Subarachnoid hemorrhage?
    • Polycystic kidney disease
    • Can run in families
  380. What are symptoms of Saccular aneurysm and Subarachnoid hemorrhage?
    • Sudden:
    • severe headache
    • nausea
    • vomiting
    • neck stiffness
    • body weakness in certain areas
    • dysphagia
    • coma
    • death
    • loss of consciousness
  381. What is the death rate for Saccular Aneurysm and Subarachnoid hemorrhage?
    50% within hours to days
  382. How is Subarachnoid hemorrhage or Saccular aneurysm treated?
    If caught on time, clip the bleeding vessels surgically
  383. What is Epidural Hematoma?
    • Hemorrhage between the skull and the top layer of Dura
    • Due to middle meningeal artery damage
    • Secondary to skull fracture in temporal area
  384. What type of brain hematoma is secondary to skull trauma in the temporal region?
    Epidural Hemorrhage
  385. What is the presentation of Epidural hematoma?
    Lucid interval followed by progressive loss of consciousness
  386. What characteristic is special to epidural hematoma?
    Lucid period
  387. Describe the "lucid period" associated with Epidural hematoma:
    • Loss of consciousness or confusion is followed by a temporary improvement in condition then regression
    • Lasts minutes to hours
  388. How long does the lucid period of an epidural hematoma last?
    minutes to hours
  389. What are epidural hematomas caused by?
    Tears in the arteries of the brain, usually the middle meningeal arteries
  390. What is a subdural hematoma?
    Bleeding between the dura and the arachnoid mater
  391. What is the cause of Subdural Hematoma?
    Tears in veins that cross the subdural space
  392. What brain issue is caused by tears in the veins that cross the subdural space?
    Subdural Hematoma
  393. What are the predisposing factors for Subdural hematoma?
    • Very young or old
    • Use of blood thinners like Coumadin
    • Alcoholism
    • Alzheimer's or narcolepsy
  394. An acute subdural hematoma usually presents with symptoms during what time?
    The first 24 hours
  395. A subacute subdural hematoma usually present with symptoms within what time period?
    2-10 days
  396. What are the symptoms of Subdural hematoma?
    • nausea
    • Headache
    • Confusion
    • Decreased consciousness
    • Dysphasia
    • Seizures
    • Coma
  397. What can be done to treat subdural hematoma?
    • Reduce ICP
    • Surgery
    • Respiratory and Circulatory support
  398. What is a Concussion or contusion?
    Injury to the brain due to trauma
  399. What is a Concussion?
    • transient loss of consciousness and widespread paralysis
    • Sometimes w/seizures
    • Usually recover w/o sequelae
  400. What is the most minor and common type of brain injury?
  401. What is a Contusion?
    • Hemorrhages in superficial brain tissue by blunt trauma
    • Bruising of the brain
  402. What is Contusion associated with?
    • Skull fracture
    • Baby shaking
    • Forced trauma
  403. What type of injury is baby shaking?
  404. What is a neural tube defect?
    Congenital malformation like anencephaly and Spina bifida
  405. What is spina bifida?
    Defect in neural tube that allows nerves to protrude
  406. What is the time period for surgical correction of spina bifida?
    24 hours
  407. What are complications of spina bifida?
    damaged nerves below the lesion, causing varying degrees of paralysis and incontinence
  408. What is the most severe form of NTD?
  409. What is the life expectancy of Anencephaly?
  410. What is anencephaly?
    • cephalic/head end of neural tube does not develop and brain, skull and scalp missing
    • Infants born without the front part of the brain
  411. What causes NTDs?
    Not enough folic acid during pregnancy
  412. How many cases of bacterial meningitis per year in the U.S.?
  413. What are the two types of meningitis?
    • Bacterial
    • Non-baterial
  414. What s acute purulent meningitis?
    Bacterial meningitis
  415. What are the major bacteria involved in acute purulent memingitis?
    • Staph pneumoniae
    • Haemophilus influenzae
    • Neisseria meningitidis
    • Listeria monocytogenes
  416. What bacteria is associated with epidemic meningitis?
    Neisseria meningitides
  417. What is the most serious type of meningitis?
  418. What are the other terms for non-bacterial meningitis?
    • Aseptic meningitis
    • Acute viral meningitis
  419. What is Aseptic meningitis usually due to?
  420. What are the most common viruses to cause meningitis?
  421. What is Meningismus?
    Stiffening of the neck associated with meningitis
  422. What is photophobia?
    sensitivity to light
  423. What are the symptoms of Meningitis?
    • Fever/chills
    • Severe headache
    • Stiff neck
    • Sensitivity to light
    • Mental status changes
  424. How is Meningitis diagnosed?
    CSF examination
  425. What is another name for CSF examination?
    • Spinal tap
    • Lumbar puncture
  426. What do you look for in the CSF when concerned aboutmeningits?
    • Bacteria
    • Increased lymphocytes and neutrophils
  427. What is the treatment for bacterial meningitis?
  428. What is the treatment for Viral meningitis?
    Fluid balance and seizure control
  429. What is Encephalitis?
    Inflammation of the brain and spinal cord
  430. What is the term for inflammation of the brain and spinal cord?
  431. What is encephalitis usually caused by?
    Viral infection
  432. What viruses can cause encephalitis?
    • Those carried by mosquitos
    • Herpes
    • HIV
    • Rabies
  433. What two type of encephalitis that are caused by a virus carried by mosquitos and cause epidemics in warm months?
    St. Louis and California encephalitis
  434. What time of year has the highest risk of St. Louis and California encephalitis?
    Warm months
  435. How is encephalitis diagnosed?
    • Viral culture
    • Presence of viral antigen in CSF
  436. What are the symptoms of Encephalitis?
    • Irritability
    • Headache
    • Drowsiness
    • Coma
    • Seizures
    • Disordered thought
  437. Can benign brain tumors be fatal?
    Yes, due to pressure on the brain
  438. Are primary brain tumors common?
    No, metastatic brain tumors are more common
  439. What are the signs of a CNS tumor?
    • Increased ICT
    • headache
    • vomiting
    • vision issue
    • seizure
    • Neurological defects
  440. What is a Glioblastoma?
    Most common primary brain tumor
  441. What is the most common primary brain tumor?
  442. What is the prognosis for Glioblastoma?
    • Highly malignant
    • fatal in about one year
  443. What is the second most common primary brain tumor?
    Meninioma = tumor of the meninges
  444. Describe the pathology of a Meningoma:
    • Benign
    • Slow growing
    • No infiltration
  445. What is a medulloblastoma?
    Malignant tumor of the cerebellum
  446. What is the cure rate of medulloblastoma?
  447. What is the treatment for medulloblastoma?
  448. What are the symptoms of medulloblastoma?
    • Lack of coordination
    • Increased ICT
  449. Where is a medulloblastoma located?
    The brain
  450. What is the most common malignant CNS tumor of children?
  451. What is the most common demyelinating disease?
    Multiple sclerosis
  452. what is multiple sclerosis?
    • Debilitating demyelinating disease of the brain and spinal cord
    • Inflammation/damage to myelin sheath and eventually the nerves
  453. How many Americans have MS?
  454. What is the etiology of Multiple sclerosis?
    • Autoimmune
    • Viral infections
    • Genetic factors
    • Environmental factors
  455. What is the outcome of MS?
    Slowed or blocked nerves causing muscle coordination issues
  456. What are the symptoms of MS?
    • Numbness or tingling in face/extremities
    • Impaired vision
    • Muscle stiffness/spasms
    • Weakness
    • Poor coordination
    • Bladder/Bowel issues
    • Forgetfulness
  457. What is the prognosis of MS?
    • Trouble with balance
    • Paralysis of limbs
    • wheelchair bound in 15-20 years
  458. How is MS diagnosed?
    • MRI features in brain
    • CSF shows increased IgG
  459. What is the treatment for MS?
    • Lifestyle changes
    • medication
    • physical therapy
    • mental counseling
  460. What type of medication are used to treat MS?
  461. What is indicated by increased IgG antibodies in the CSF and Brain lesions?
  462. Is dementia a specific disease?
  463. What is dementia?
    Any progressive loss of nerves in the CNS affecting memory and cognitive function
  464. Does having memory loss mean you have dementia?
    No dementia is in two or more areas of brain function
  465. What is the most common dementia disease in elderly?
    Alzheimer's disease
  466. How many people in the US have Alzheimer's?
    4.5 million
  467. What age does Alzheimer's usually begin?
    65 and up
  468. What proportion of people over 85 have Alzheimer's?
    nearly half
  469. What is a risk factor for Alzheimer's disease?
    Increasing age
  470. What area of the brain does Alzheimer's start with?
    The part that controls thought memory and language
  471. What is the rate of onset of Alzheimer's disease?
  472. What is the cure for Alzheimer's?
    No known cure
  473. What is the treatment for Alzheimer's?
    Aricept may slow progression of symptoms
  474. What does Alzheimer's brain look like?
    • large Suculi
    • Small Gyri
    • Large ventricle
    • Brain shrivels up
    • Plaques and neurofibrous tangles
  475. Where is brain shrinking especially severe in AD patients?
  476. What happens to the ventricles in AD?
    They grow larger
  477. What are the most indicative signs of AD?
    Plaques and Neurofibrous tangles
  478. What are Neurofibrous tangles and plaques?
    • Signs of Alzheimer's disease
    • Abnormal clumps and tangled bundles of nerves
  479. What is Parkinson's disease?
    Progressive loss of nerve cell function in brain that controls muscle movement
  480. What is the cause of Parkinson's disease?
    • Neurons that make dopamine die or stop working
    • Reduced dopamine
  481. What does dopamine usually do?
    Signaler for coordination of body movement
  482. What disease is marked by the death or lack of function of Brain neurons that secrete dopamine?
    Parkinson's disease
  483. When does Parkinson's usually begin?
    around age 60
  484. What are the signs of Parkinson's disease?
    • Trembling hands, arms, legs, jaw and face
    • Stiffness of arms, legs and trunk
    • Slow movement
    • Poor balance
  485. What is a characteristic symptom of Parkinson's disease?
    Pill-rolling tremor
  486. How is Parkinson's disease diagnosed?
    By symptoms, no specific test
  487. What is the treatment for Parkinson's disease?
    L-dopa for symptom relief
  488. What is the pathology of the brain in a parkinson's patient?
    • loss of pigment in substantia nigra
    • Intracytoplasmic inclusions called Lewy bodies
  489. If you examined a brain and saw intracytoplasmic inclusions and loss of pigment in the substantia nigra, what would your diagnosis be?
    Parkinson's disease
  490. What is vascular dementia?
    Multiple cortical infarcts from previous sustained strokes
  491. What is another name for Vascular Dementia?
    Mini infarct dementia
  492. What is the second most common form of dementia?
    Vascular dementia
  493. What is the best form of treatment for Vascular dementia?
    Prevention and early detection
  494. What are the risk factors for Vascular dementia?
    • Hypertension
    • Diabetes mellitus
    • Peripheral arterial disease
    • Smoking
  495. What is Huntington's disease?
    Autosomal dominant degeneration of basal ganglia causing dementia and involuntary movements
  496. What is an autosomal dominant disease that affects the basal ganglia andleads to dementia and involuntary movements?
    Huntington's disease
  497. What age is Huntington's disease most common?
  498. How is Huntington's disease aquired?
    Autosomal dominant inheritance
  499. What type of tretments are there for Huntington's disease?
    Only those for signs and symptoms not for prevention of further progression
  500. If one of your parents had huntington's disease, what are your chances of getting it?
  501. What does Chorea mean?
    Dance and refers to quick jerky movements
  502. The basal ganglia of the brain (caudate nucleus, putamen, globus pallidus) change in what ways during Huntington's disease?
  503. What is Creutzfeldt-Jakob disease (CJD)?
    • rapid progressive dementia that is invariably fatal in one year
    • Mediated by a Prion
  504. How do you get Creutzfeldt-Jacob disease?
    By consuming animal products infection with the bovine form of the prion
  505. What is the pathology of Creutzfeldt-Jacob disease?
    Spongiform change in brain tissue
  506. What are the symptoms of CJD?
    • behavior changes
    • failing memory
    • coordination issues
    • vision issues
    • coma
    • blindness weakness
Card Set:
PTG 105
2013-05-05 05:52:37
PTG 105

PTG 105
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