Pathology Dr. Guy's
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What is hypertrophy?
An increase in the size of the cells of an organ
What is hyperplasia?
An increase in the number of cells of an organ
What is aplasia?
The failure of cell production resulting in lack of development of an organ or tissue
What is agenesis?
Aplasia during fetal development resulting in the absence of an organ or tissue
What is hypoplasia?
A decrease in cell production
What is atrophy?
Decrease in the mass of pre-existing cells of an organ, wasting
What is metaplasia?
The replacement of one differentiated tissue by another because of chronic irritation or inflammation, seen in smokers
What is a common example of metaplasia?
squamous replacement of columnar epithelium in the cervix
What is anaplasia?
Complete disorganization of cells
What is dysplasia?
Change in shape, size or function of cells
What causes ischemic cell injury?
anoxia or hypoxia caused by an obstruction, anemia, CO poisoning, poor oxygenation of blood
What is pyknosis?
Condensation of nucleus, shrinking of cells through degeneration, occurs with necrosis
What is karryohexis?
Fragmentation of nucleus, occurs with necrosis
What is karyolysis?
Destruction of the nucleus, occurs with necrosis
What is coagulative necrosis? What organs is it seen in?
- Necrosis from sudden cut-off of blood supply (infarct) to an organ, characterized by preservation of tissue structure
- Heart, kidney, adrenal glands
What is liquefactive necrosis?
- Characterized by digestion of tissue
- Most often occurs from ischemic injury to CNS
- "Wet brains"
What is caseous necrosis?
- cheese-like consistency
- "cheesy TB"
What is gangrenous necrosis?
Caused by interruption of blood supply to an extremity or bowel
What is wet gangrene?
Accompanied by liquefactive necrosis secondary to bacterial infextion
What is dry gangrene?
accompanied by coagulative necrosis due to arterial obstruction of an extremity
What is fatty necrosis?
- enzymatic necrosis
- a complication of acute hemorrhagic pancreatitis where pancreatic enzymes begin to digest the parenchymal cells of the pancreas
What is wallerian degeneration?
The way peripheral nerves die when severed
What is zenker's necrosis?
degeneration in hyaline cartilage and/or skeletal muscle
Where are fatty changes seen? Examples?
- liver, hear, kidney during degeneration
- fatty liver secondary to alcoholism, diabetes, obesity, anemia
What are the 4 many endogenous pigments that can accumulate in cells?
- Hemosiderin (contains iron)
What occurs if there is too little melanin?
What can cause bilirubin to accumulate? where does it accumulate?
- hemolytic anemia, biliary obstruction, liver disease
- skin, sclera and organs (jaundice)
What are the two iron accumulating pathologies?
- Hemosiderosis - accumulates in macrophages, benign
- Hemochromatosis - accumulates in parenchymal cells resulting in tissue damage, scarring and organ dysfunction
What is lipofuscin? Where does it accumulate?
- yellowish breakdown product of lipids
- wear and tear pigment
- liver, skin and heart of elderly
What is brown atrophy?
combination of organ atrophy and lipofuscin deposits
What is metastatic calcification caused by?
hypercalcemia due to hyperparathyroidism, excess vitamin D or milk-alkali syndrome (excess calcium intake)
Where is dystrophic calcification found?
prevsiously damaged tissue (note: calcium levels are normal)
What is amyloidosis? Causes?
- accumulation of insoluble fibrous protein (amyloid) in sufficient amounts to impair fucntion
- primary amyloidosis is idiopathic
- secondary from TB, Osteomyelitis, leprosy
- Affects the heart, skin, liver, kidneys, spleen, lung, ect.
What is inflammation? What are the cardinal signs of inflammation?
- a vascular response to injury
- Rubor (redness)
- Dolor (pain)
- Calor (heat)
- Tumor (swelling)
- Function laesa (loss of function)
What five things occur in acute inflammation?
- Increased capillary permeability --> edema
- Margination --> WBCs localize to outer margins
- Pavementing --> WBCs adhere to endothelium
- Emigration --> chemotaxis attracts neutrophils and macrophages
- Phagocytosis by neutrophils and macrophages/monocytes
What is diapedesis?
What is the difference between macrophage and monocyte?
- macrophage - tissue
- monocyte - circulation
What are the 4 main vasoactive substances?
- Arachidonic acid
What is histamine produced by? What does it do? How long does it last?
- mast cells, basophils and platelets
- increased vascular permeability, vasodilation
- decreases within an hour after onset
What is serotonin produced by? What does it do?
- Platelets, mast cells
- Increase vascular permeability
What is bradykinin produced by? What does it do?
- coagulation pathway
- vasodilator, stimulates pain receptors
What is arachidonic acid released by? What does it produce?
- phospholipids of cell membranes
- prostoglandins, leukotriences, and other mediators of inflammation
What are the possible outcomes of acute inflammation?
- Abcess (cavity filled with pus)
- Keloid (tumorlike scar)
- Fistula (abnormal communication between two organs)
- "ASK FU what inflammation can do"
What occurs in chronic non-specific chronic inflammation?
- Immune response - lymphocytes, plasma cells, macrophages
What are granulomas? What causes them?
- collections of specialized macrophages surrounded by a rim of lymphocytes
- macrophages successfully phagocytosed the injurious agent but it survives inside them
- macrophages aggregate in the area of injury
What is neoplasia?
uncontrolled, disorderly proliferation of cells resulting in a benign or malignant tumor (neoplasm)
What is metastais?
spread of a malignant tumor to a non-contigous site, defining characteristic of malignant tumor (benign tumors do not metastasize)
What is a carcinoma?
a malignant tumor of epithelial origin
What is a papilloma?
a benign tumor of epithelial origin
What is a adenocarcinoma?
carcinoma of glandular epithelium such as breast, pancreas, prostate
What is an adenoma?
benign tumor of glandular epithelium
What is a sarcoma?
Malignant tumor of mesenchymal origin such as osteosarcoma (bone), rhabdomyosarcoma (skeletal muscle), leiomyosarcoma (smooth muscle) and liposarcoma (fat)
What is a teratoma?
Germ cell tumor, derived from multiple tissue types (all three germ cell layers), can contain skin, bone, cartilage or even teeth. They usually occur in ovaries or testes, they can be benign or malignant
What is a harmartoma?
not a neoplasm, it is a tumor-like overgrowth of normal tissue types such as a hemangioma (irregular accumulation of blood vessels, responsible for port-wine stain birthmarks)
What is a carcinoma in situ?
invasive carcinoma that is limited to the layers of the epithelium
What is Burkitt's lymphoma?
malignancy of B-cells (starry sky appearance), associated with Epstein-Barr virus
What is Hodgkin's disease?
malignancy of lymphoid tissue diagnosed by the presence of Reed-Sternberg cells, presents as painless lymphadenopathy
What is Non-hodgin's disease?
Similare to Hodgkin's but no RS cells
What is Wilm's tumor?
- occurs in children 2 to 4
- huge palpable flank mass around kidney
What is Krukenburg's tumor?
- ovarian cancer that has spread from the stomach
- ovarian cells are replaced by signet-ring cells
What is a uterine leiomyoma?
fibroid tumor, most common neoplasm of women, uterine smooth muscle present in 10 to 20 % of women, usually 20 to 40 years of age
What is Virchow's node?
- Sentinel or signal node
- enlarged, firm, supraclavicular lymph node, usually on the left side
- indicates a visceral malignancy, often gastric carcinoma
What is a pancoast tumor? What symptoms does it cause?
- adenocarcinoma of the lung apex
- pain and tingling over the ulnar nerve distribution, constriction of the pupil and paralysis of the levator palpebrae due to pressure on the brachial plexus
- often associated with Horner's syndrome (ptosis, meiosis, anhydrosis)
What is leukemia?
- group of malignancies of either lymphoid (lymphocytic) or hematopoietic (myeloid) origin
- bone marrow is filled wiht abnormal cells resulting in anemia, infection or hemorrhage
What are the 4 types of leukemia and who do they occur in?
- ALL - children
- AML - all ages
- CLL - elderly men
- CML - adult men
Which leukemia is associated with the philidelphia chromosome?
What is Down's syndrome?
- Trisomy 21 - part of the chromosome 21 is repeated 3 times the normal
- associated with increased age of the egg
- severe mental retardation, epicanthal folds, simian crease, protruding tongue and congenital heart disease
What is Cri du chat syndrome?
- deletion of the short arm of chromosome 5
- severe mental retardation, microencephaly and an unusual cat-like cry
- "cry of the cat"
What is Edwards syndrome?
- trisomy 18
- premature infant
- hypoplasia of muscle
- mental retardation
What are the four autosomal dominant diseases boards is most likely to ask about?
- Familial hypercholesterolemia
- Huntington's disease
- Marfan's syndrome
What is familial hypercholesterolemia?
high LDL, early onset atherosclerosis, xanthoma
What is huntington's disease?
age 30 to 40 onset, progressive atrophy of the caudate nuclei and putamen, results in choreiform movements and progressive dementia
What is Marfan's sydrome?
- defect of connective tissue
- elongated arms and legs
- arachnodactyly (spider-like fingers)
- dislocation of the lens
- ligamentous laxity
- cardiovascular defects (aortic aneurysm and mitral valve prolapse)
- "Abe Blinkin"
What is neurofibromatosis?
- von Recklinghausen's disease of the nerves
- acoustic neuromas
- cafe au lait spots
- skeletal disorders
- elephant man's disease
What is cystic fibrosis?
- Inborn error of metabolism (autosomal recessive)
- malfunction of pancreas that destorys the lungs
- mucous becomes viscous --> steatorrhea, malabsorption, chronic pulmonary disease, salty sweat
- most common lethal genetic disease in caucasians
What is Klinefelter's syndrome?
karyotype 47, XXY (male) --> male hypogonadism, atrophic testes, gynecomastia, tall stature
What is turner's sydrome?
Karyotype 47, X (female), female hypogonadism, primary amenorrhea and short stature
What is XYY syndrome?
Karyotype 47, male, tall, severe acne, possibly violent behavior
What is fragile X syndrome?
Fragile area on the X chromosome, 2nd only to Down's syndrome as a cause of hereditary mental retardation, in males it is characterized by bilateral macro-orchidism (enlarged testes)
Who carries X-linked recessive diseases? Who inherits them? What are the two most common?
- Females carry
- Males inherit
- (passed mother to son)
- Classic hemophilia
- Christmas disease
What is classic hemophilia?
- Hemophilia A
- Deficiency of factor VIII
- hemorrhage from minor wounds
- recurrent hemarthrosis (bleeding into joints)
- crippling deformities
What is Christmas disease?
- Hemophilia B
- Deficiency of factor IX
- Same symptoms as hemophilia A
What are the three most common lysosomal storage diseases?
- Tay Sachs disease
- Gaucher's disease
- Nieman-Pick disease
What is Tay-Sachs disease?
- accumulation of ganliosides in the neurons
- CNS degeneration, mental deterioration, blindness and death before the age of 4
- "Tayke the Gang shopping at Sacks"
What is Gaucher's disease?
- accumulation of glucocerebrosides in the monocytes
- Hepatomegaly, erosion of the long bones and anemia
What is Nieman-Pick disease?
accumulation of sphingomyelin lipidosis in RE cells
What are glycogen storage diseases? What is the most common?
- defect in synthesis or degradation of glycogen leading to a build up of glycogen in certain tissues
- von Gierke's disease - defeiciency of glucose-6-phosphatase
What are the two most prevalant amino acid diseases?
What is phenylketonuria?
- enzyme deficiency prevents phenylalanine from being converted to tyrosine in the liver
- phenylalanine accumulates resulting in cerebral demyelination
- mental retardation, typically evidenced by age 1
- PKU can be controlled by diet
What is Alkaptonuria?
- enzyme deficiency prevents phenylalanine and tyrosine from being completely broken down leading to a build up of homogenistic acid
- urine turns dark, then black upon sitting
- ochronosis (dark pigmentation of fibrous tissue and cartilage)
- "Al the Kaptin is a Homo, Oh No!"
What is cerebral palsy?
- motor function and coordination are lost
- spastic syndrome
- sometimes accompained by athetoid movements
- hemi or paraplegia, due to UMNL
- scissor's gait
What is sprengel's deformity?
congenital elevation of the scapula sometimes accompained by an omovertebral bone
What is Klipple-feil syndrome?
multiple congenital fusions of cervical vertebrae, may be accompained by Sprengel's deformity and brain stem abnormalities
What is Hirschsprung disease?
congenital megacolon (blockage of colon) caused by the absence of nerve plexus and ganglions
What is arnold-chiari malformation?
malformed cerebellum/medullary structures (below foramen magnum) causing hydrocephalus and possibly spina bifida
What is spina bifida? What are the types?
- localized absence of the vertebral arches
- occulta - present but not apparent, no protrusion of the cord or meninges
- manifesta - apparent, may or may not have protrusion
- cystica - associated with a cyst containing the meninges (meningocele), spinal cord (myelocele) or both (meningomyelocele)
What is hydrocephalus? What are the types?
- excessive accumulation of CSF
- obstructive - when caused by obstruction of the third or fourth ventricle
- communicating - when caused by blockage of the absorption via the arachnoid granulations
What is congenital syphilis?
Hutchinson's teeth and saddle nose
What is ventricular septal defect?
failure of the interventricular foramen to close, leaving communication open between the left and right ventricles
What is patent ductus arteriosus?
failure of the vessel connecting the left pulmonary artery to the descending aorta to close, this is usually convereted into a fibrous cord (ligamentum arteriosum) by two months after birth. Frequently associated with rubells infection in utero
What is atrial septal defect?
failure of the foramen ovale to close, leaving the two atria communicating
What is the tetralogy of fallot?
- most common cyanotic congenital anomaly "blue babies"
- Dextrarotation fo aorta
- Right ventricular hypertrophy
- Interventricular septal defect
- Pulmonary stenosis
What is coarctation of the aorta?
congenital narrowing of the aorta distal to the ligamentum arteriosum, resulting in hypertension of the head and upper extremeties and hypotension of the legs and abdomen
What is type 1 hypersensitivity?
- anaphylaxis, allergies, asthma
- IgE response
- mast cells or basophils release histamine, prostagladins and chemotactic factors (to alert phagocytic cells)
What is type 2 hypersensitivity?
- Antibody-antigen reactions cause cell destruction and lysis
- complement system --> lysis
- transfusion reactions, Rh incompatibility, hemolytic anemia
What is type 3 hypersensitivity?
- immune complex
- large antibody-antigen complexes cause platelet aggregation, clotting activation and inflammation
- serum sickness (arthus reaction)
- RA, SLE, GMN (glomularnephritis)
What is type 4 hypersensitivity?
- delayed type (cell-mediated)
- delayed overreaction (because no Ab is involved) because of sensitized T-cells containing a specific antigen
- tuberculin skin test (PPD)
How to remember the types of hypersensitivity?
What are the 5 immunoglobulins? How is each unique?
- G-most numerous
- M-1st to go up
- E-last to go up, allergies, parasites
What are autoimmune diseases caused by? Who do they occur in? What are the 6 most common?
- IgG and IgM
- Sjrogren syndrome
- Goodpasture's syndrome
- Myasthenia gravis
- Hasimoto's thyroiditis
What is systemic lupus erythematosus (SLE)?
- most often affects women
- butterfly rash on face
- Raynaud's phenomenom of hands and feet
- Arthritis and arthralgia
- glomerular changes in the kidney
- Libman-sachs endocarditis (severe SLE)
- diagnosed by ANA test and dsDNA
What is sjrogren syndrome?
- Triad of symptoms:
- xerostomia (dry mouth)
- xerophthalmia (dry eyes - actually keratoconjunctivitis)
- plus one of the following: RA (most common), SLE, Scleroderma or Hashimoto's thyroiditis
What is Goodpasture's syndrome?
Glomerulonephritis and hemoptysis due to autoimmune complexes forming on the glomerular basement membrane and in the lungs
What is myasthenia gravis?
- antibodies act on the acetylcholine receptors at neuromuscular junctions
- muscle weakness upon exertion
- facial (mainly eye muscles) and extremity muslces are primarily affected
What is scleroderma?
- Progressive systemic sclerosis (PSS)
- CREST syndrome:
- Raynaud's phenomenon
- Esophageal dysfunction
- Sclerodactyly (claw hands)
- Telagiectasia (dilation of small vessels)
What is Hashimoto's disease?
anti-thyroglobulin antibodies, affects the thyroid follicles resuling in hypothyroidism (myxedema)
What are the four immunological disorders we need to know about?
- Bruton's agammaglobulinemia
- DiGeorge's syndrome
- Wiskott-Aldrich syndrome
What is Bruton's Agammaglobulinemia?
- X-linked disorder present in male infants characterized by absence of B-cells and thus immunoglobulins
- T-cells are unaffected
- leads to recurrent bacterial infections
What is DiGeorge's syndrome?
- congenital T-cell deficiency due to hypoplasia of the thymus leading to lymphopenia
- B-cells are unaffected
- leads to recurrent viral and fungal infections
What is Wiskott-Aldrich syndrome?
Immunodeficiency accompanied by eczema and thrombocytopenia
What is AIDS?
- caused by the human immunodeficiency virus (HIV), a retrovirus
- targets CD4 T-cells (helper cells)
- replicated by reverse transcriptase
- lymphadenopathy, chronic diarrhea, fever and weight loss, late stages --> dementia
What opportunistic infections are associated with AIDS? What cancers?
- Pneumocystis carinii pneumonia, CMV and fungal infections (candida, toxoplasmosis and histoplasmosis)
- Kaposi's sarcoma and non-hodgkin's lymphoma
What are the two main malnutrition disorders?
Marsmus and Kwashiorkor
What is Marasmus?
- Protein and calorie malnutrition
- retarded growth and loss of muscle tissue "waste away", NO edema
- "Mars bars are high in protein and calories"
What is Kwashiorkor?
- Protein deficiency with adequate calories
- severe edema, anemia, and fatty liver (swollen belly)
What does toxicity of water soluble vitamins cause? Deficiency?
- Toxicity is rare because extra is peed out
- Deficiency leads to glossitis, dermititis and diarrhea
What is vitamin B1? What can cause a vitamin B1 defiency? What are the symptoms of deficiency?
- Alcoholism, fat diets
- Wet Beriberi - peripheral neuropathy plus congestive heart failure
- Dry Beriberi - peripheral neuropathy resulting in atrophy of muscles of extremities
- Wernicke-Korsakoff syndrome - confusion, ataxia and opththalmoplegia (paralysis of one or more ocular muslces) - occurs in alcoholics
What is vitamin B2? What does a deficiency cause?
- Cheilosis, glossitis, seborrheic dermatitis
What is vitamin B3? What does a deficiency cause?
- Dementia, dermatitis, diarrhea, death
What is vitamin B6? What does a deficiency cause?
- Cheilosis, glossitis, and seborrheic dermatitis
What is vitamin B9? What does a deficiency cause?
- Folic acid
- Caused by lack of folic acid in diet, rarely malabsorption
- Often seen in pregnancy due to increased demand for RBC production
- Megaloblastic anemia
What is vitamin B12? What does a deficiency cause?
- Usually from malabsorption
- Pernicious anemia (lack of intrinsic factor due to chronic gastritis)
- Megaloblastic anemia - large amount of erythrocyte precrusor cells in the bone marrow (maturation is decreased) --> PLS (posterolateral sclerosis) or combined systems disease
What does a vitamin C deficiency cause?
poor collagen formation from impaired wound healing and abnormal bleeding (fragile capillaries)
Why do deficiencies of fat soluble vitamins usually occur? Which fat soluble vitamins are commonly taken in toxin doses?
- poor absorption of fat leads to deficiency
- vitamins A and D
What occurs in vitamin A deficiency? Toxicity?
- Deficiency: Nyctalopia (night blindness), xerophthalmia (dry eyes), Keratomalacia (corneal softening), squamous metaplasia of trachea and bronchi
- Toxicity: Alopecia and liver damage
What is vitamin D? What does a deficiency cause? Toxicity?
- Deficiency: Rickets (children), osteomalacia (adults)
- Toxicity: Growth retardation (children), hypercalcuria, nephrocalcinosis and renal calculi
What is vitamin E?
What does a deficiency of vitamin K cause? Toxicity?
Deficiency: "Hemorrhagic disease of the newborn" and abnormal bleeding in adults, no toxicity
What is Wilson's disease?
disorder of copper metabolism, copper accumulates in liver, kidneys and lenticular nuclues of the brain (heptolenticular degeneration), Kayser-Fleisher ring (yellow-greenish ring encircling the cornea)
What does an iodine deficiency result in?
myxedema and goiter in adults, creatinism in children (primary hypothyroidism)
What does a chromium deficiency result in?
- impairs the function of insulin --> diabetes
- chromium is found in Glucose Tolerance Factor (GTF)
What does zinc do? Deficiency? Toxicity?
- assists enzymes in all organs and cells
- deficiency causes growth retardation with sexual immaturity in children
- toxicity has been linked to atherosclerosis
What does a deficiency of magnesium cause?
hallucinations, inability to survive a mild heart attack
What does fluoride do? Toxicity?
- stabilizes bones and makes teeth resistant to decay
- excess flouride discolors teeth and makes them brittle
What is Reflex Sympathetic dystrophy?
- Regional osteoporosis, sudek's atrophy or causalgia
- follows a trivial trauma
- progressive onset of pain, stiffness and swelling distal to the site of injury, local osteoporosis
What is osteoporosis?
- Loss of bone quantity while quality is normal (decrease in bone mass)
- postmenopausal and senile types, most women
- kyphosis is often presnet along with compression fractures, increased radiolucency (after 30 to 50% bone loss), cortical thinning, altered trabecular pattern --> vertebra plana (pancake vertebra) and fish vertebra (biconcave)
What is osteitis fibrosa cystica?
- von Recklinghausen's disease of the bone
- caused by primary or secondary hyperparathyroidism
- widespread osteolytic lesions and brown tumors (cystic spaces filled with fibrous material and brownish blood)
What is osteomalacia?
loss of bone quality caused by vitamin D deficiency in adults, mimics osteoporosis on x-ray, pseudofractures (Milkman's syndrome or loser's lines) are often present
What is rickets?
Vitamin D deficiency in children, causes late closing of fontanelles, long bone deformities, rachitic rosary, pigeon breast
What is Paget's disease?
- Osteitis deformans
- affects spine, pelvis, skull
- increased bone density and thick trabecular patterns
- monostotic - affects one bone
- polyostotic - affects many bones
What is achondroplasia?
autosomal dominant disorder characterized by short limbs with a normal size head and trunk
What is Fibrous dysplasia?
- replacement of portions of bone with fibrous tissue
- can result in spontaneous fractures
- can be monostotic or polyostotic
- cobb webb appearance on x-ray
What is avascular necrosis?
interruption of blood supply to bone from trauma, embolism, "the Bends" (caisson's disease) or sickle cell anemia, in children: Legg-Calve-Perthes disease (involves head of femur)
What is charcot's joint?
- Neurogenic or neuropathic joint
- destroyed joint because of diminished proprioception
- seen in tertiary syphilis (tabes dorsalis, neurosyphilis), diabetic neuropathy and syringomyelia
What is osteogenesis imperfecta?
multiple fractures involving minimal trauma (brittle bone disease) due to defective collagen synthesis, blue sclera (note: if undiagnosed parents may be accused of child abuse)
What is osteopetrosis?
- Albers Schonberg disease
- increased density fo the skeleton due to failure of the osteoclastic activity resulting in anemia, blindness, deafness and cranial nerve invlovement
What is suppurative osteomyelitis?
- acute pyogenic infection of the bone, usually affects the metaphysis of distal femur, proximal tibia, proximal humerus
- caused by infection elsewhere, complication of a compound fracture or from intravenous drug use
- Staph aureus is the most common
- sequestrum (ischemic necrosis of part of bone) is surrounded by a sleeve of bone (involcrum)
What is a brodie's abscess?
- granulation tissue surrounding a bone infection such as osteomyelitis
- most common in male children
- pain worse at night, relieved by asprin
What is osteochondritis dessicans?
small segment of subchondral bone dies and remains in the joint, usually secondary to trauma in the femoral condyles of the knee, most common in male children
What is an osteochondroma? What age are they found in?
Benign exostosis (bony growth covered by a cap of cartilage), any age
What is an giant cell tumor? What age are they found in?
benign, soap-bubble epiphyseal lesion containing giant cells, age 25
What is an aneurysmal bone cyst? What age are they found in?
benign eccentrally located bone tumor, runs from metaphysis to diaphysis, under 20
What is an unicameral bone cyst? What age are they found in?
Benign, centrally located bone tumor, runs from metaphysis to diaphysis, under 20
What is an enchondroma? What are multiple enchondroma's called?
benign cartilaginous tumor of the hands and feet (most often), multiple --> Ollier's disease
What is an osteoma? What age are they found in?
benign tumor of dense, mature bone, most common in males of any age, in their skull or fascial bones (often protruding into a paranasal sinus)
What is an osteoid osteoma? What age are they found in?
- benign painful diaphyseal bone tumor which begins with a nidus, pain is worst at night and dramatically relieved by aspirin (like brodie's), usually surgically removed
- most common in males 10 to 25, diaphysis of femoral neck, distal femur and proximal tibia
What do increased ALP and AcP indicate for bone?
- Alkaline phosphatase indicates bone growth
- Acid phosphatase indicates bone disease
What are the four primary bone malignancies?
- Multiple myeloma
- Ewing's sarcoma
What is multiple myeloma? What are the lab findings? X-ray findings? Most common age?
- malignancy of the plasma cells with abnormal accumulations in the bone marrow cavity
- M protein (blood), bence-jones protein (urine), anemia, increased susceptibility to infection, hypercalcemia, kidney disease
- bone lesions in the skull and axial skeleton, "punched-out lesions", osteopenia
- over 55
What is osteosarcoma? X-ray findings? Most common age and location?
- bone producing neoplasm, can be sclerotic (cumulus cloud appearance) or lytic or both
- Codman's triangle (lifting of periosteum)
- Males 10 to 25
- When associated with paget's, usually over 60
- Distal femur, proximal tibia and proximal humerus
What is chondrosarcoma? Most common age and location?
malignant cartilaginous tumor, often degenerates from a single or multiple enchondromas (but rarely in hands or feet), males 40 to 60, pelvic bones, proximal and distal femur, proximal tibia, ribs, vertebrae
What is Ewing's sarcoma? X-ray? Treatment? Most common age and location?
- Malignant bone tumor which mimics infection
- Fever, increased WBC's and slight anemia, pain and swelling at the site
- Onion-skin periosteal response
- Amputation and chemotherapy
- Males 10 to 25
- Diaphysis of femur, tibia and fibula, innominate bone
What is a comminuted fx?
a fracture in which the bone has broken into three or more pieces
What is a open fx?
compound fracture, skin has been broken by the bone
What is a closed fx?
simple fractue, skin is intact
What is a greenstick fx?
bending of the bone when there is an incomplete fracture on the convex side
What is an avulsion fx?
tearing away of a portion of the bone by forceful muscular or ligamentous pulling
What is a torus fx?
local bulging of bone, usually in children, due to longitudinal compression of soft bone, usually in the radius or ulna or both
What is a jefferson (burst) fx?
a compression fracture of the atlas in which bilateral fractures occur through the anterior and posterior arches
What is a hangman's fx?
bilateral fractures through the pedicles of C2 (axis) with anterior displacement of C2 on C3
What is a clay shoveler's fx?
avulsion fracture of the spinous process of C7 (most common) or C6 or T1
What is colles' fx?
fracture of the distal radius with posterior displacement of the distal fragment, most common fracture of the wrist (associated with osteoporosis --> falls)
What is smith's fx?
a fracture of the distal radius with anterior displacement of the distal fragment
What is pott's fx?
fracture of the lower part of the fibula at the malleolus resulting in outward displacement of the foot
Which autoimmune joint diseases are R factor positive?
Rheumatoid arthritis, Still's disease (juvenille RA)
Which autoimmune joint disease are R factor negative? What test are they positive for? What do they usually have?
Ankylosing spondylitis, Reiter's syndrome, Psoriatic arthritis, HLA B27 positive, usually present with peripheral arthritis and sacroilitis
What is rheumatoid arthritis? Who does it usually affect? Most frequent sites?
- chronic inflammatory autoimmune disorder
- women 20 to 50
- proximal interphalangeal and metacarpophalangeal joints, ulnar deviation is a characteristic sign
How does RA manifest?
- synovitis, acute inflammatory reactions, edema, pannus (granulation
- tissue), erosion of bone, deformity, swelling and stiffness especially
- in the morning or after inactivity
What is Still's disease?
Juvenile RA, acute onset of fever, generalized swollen glands, liver and spleen enlargment
What is Ankylosing spondylitis?
Marie-strumpell disease, chronic condition of the spine and sacroiliac joints leading to rigidity and fixation from ligamentous calcification and bony fusion (ankylosis)
What is Reiter's syndrome?
- conjunctivitis, urethritis, arthritis, often associated with venereal or intestinal disease
- "Can't see, can't pee, can't dance with me"
How often does psoriatic arthritis occur?
occurs in about 10% of patients with psoriasis
What is osteoarthritis?
chronic noninflammatory degenerative joint disease characterized by degeneration of articular cartilage with new bone formation
X-ray evidence of OA?
asymmetrical, from wear and tear, eburnation (ivory bone), osteophyte formation, joint mice, Heberden's nodes (DIP) and Bouchard's nodes (PIP)
What is gout? What body parts does it target?
- hyperuricemia from a defect in purine metabolism leads to deposition of urate crystals causing a very painful arthritis and bursitis
- MTP of great toe (podagra), joints, ear (nodular tophi), achilles tendon
What is pseudogout?
Chondrocalcinosis, caused by depostition of calcium pyrophosphate dihydrate crystals, resembles gout clinically
What is lyme disease?
infective polyarthritis caused by borrelia burgdorferi (spirochete transmitted by a tick), skin lesion (erthema chronicum migrans - bulls eye lesion)
What is a ganglion cyst?
a small cystic nodule arising in the tendon sheath or joint capsule of the wrist "ganglion cyst on the wrist"
What is muscular dystrophy?
a group of genetically determined (x-linked) disorders characterized by degeneration of skeletal muscle and profound wasting and weakness, differ in a ge of onset and muscle groups affected, all have high levels of serum CPK (CK-MM, CK-3)
What is Duchenne's muscular dystrophy?
most common and most severe type, male children, begins at age 1, dead by 20 due to weak respiratory muscles, pseudohypertrophy of distal muscles (like calf muscle)
What is myasthenia gravis?
autoantibodies to the acetylchline receptors at the neuromuscular junction, muscle weakness upoon exertion, better with rest, affects facial and extremity muscles primarily, cranial nerve muscles affected
What is myositis ossificans? What is a specific type?
- dysplastic disease deposits bone into muscle causing pain and swelling
- myositis ossificans cricumscripta usually follows a trauma, usually to quadriceps
What is dupuytren's contracture?
disease of the palmar fascia resulting in flexion deformity and loss of finger function
What is multiple sclerosis? What age does it effect? How does it present?
- immune or viral disease of scattered demylination in the brain, spinal cord and optic nerve
- 20 to 30
- weakness of the lower extremities with visual and sensory disturbances, scanning speech, intention trmors and charcot's triad of nystagmus
- periods of remisssion then mental deterioration and invalidism
What is syringomyelia?
a fluid-filled cavity within the spinal cord, often puts pressure on cervical pain and temp receptors, resulting in a loss of sensation over the shoulders and back in a "shawl-like" or "cape-like" distribution
What is tabes dorsalis?
tertiary syphilis, progressive sclerosis of the posterior columns of the spinal cord --> locomotor ataxia, anesthesia and/or sharp pains, and atrophy of muscles and joints --> "tabetic" or steppage gait
What is argyll robertson pupil?
loss of direct or consensual light reflex, with normal constriction to convergence "argyll accomodates but does not react", it is present in tertiary syphilis
What is syndenham's chorea?
associated with rheumatic fever, results in involuntary, irregular, jerky movements of the muscles of the head, neck and limbs
What is freidrich's ataxia?
in children, problem wiht the spinocerebellar tract, results in lower limb incoordination followed by paralysis
What is parkinson's disease?
paralysis agitans, occurs after 50, characterized by lewy bodies (cytoplasmic inclusions), damaged substantia nigra possibly from trauma and drugs results in dopamine depletion --> resting tremors ("rest at the park"), expressionless face "mask-like", muscular rigidity, festinating (shuffling) gait
What is alzheimer's disease?
Progressive dementia, loss of recent memory then long-term and other intellectual functions, unknown cause
What is huntington's disease?
30 to 40, progressive atrophy of the caudate nuclei and putamen, results in choreiform movements and progressive dementia
What is amyotrophic lateral sclerosis (ALS)?
Lou gehrig's disease, degeneration of both the upper and lower motor neuron, atrophy of th elateral coluns and anterior horn cells --> muscular atrophy, fasciculations (LMNL), hyperreflexia, spasticity and pathologic reflexes (all 3 UMNL), onset is middle age, death occurs within 1 to 6 years
What is bulbar palsy?
progressive atrophy of tongue, lips, palate, larynx due to cranial nerve degeneration
What is poliomyelitis?
viral disease --> inflammation of the anterior horn cells of the spinal column --> fever, GI disturbances followed up flaccid paralysis and atrophy
What is a glioblastoma multiforme?
astrocytoma, most common primary brain tumor, occurs in late middle age, hgihly malignant
What is a meningioma?
2nd most common primary brain tumor, benign, slow growing, usually arises from arachnoid cells of the meninges
What is acoustic neuroma?
benign tumor of schwann cells, third most common primary brain tumor, on eighth cranial nerve
What is a neuroblastoma?
tumor of the adrenal medulla (increases catecholamines) and/or sympathetic ganglia
What is medulloblastoma?
common in children, highly malignant tumor of the cerebellum and brain stem
What is a retinoblastoma?
malignant, intraocular tumor of children, genetic, enucleation (removal of the eye) will cure if has not spread
What are the most common sources of metastasis to the brain?
lungs (#1) and breat (#2)
What is tic douloureux?
trigeminal neuralgia --> servere, paroxysmal (sudden) bursts of pain in one or more branches of the trigeminal nerve (CN V)
What is bell's palsy?
unilateral paralysis fo the facial muscles supplied by CN VII
What is guillain-barre syndrome?
acute inflammatory demyelinating disease fo the peripheral nerves, usually preceded by immunization, viral infection or allergic reaction --> ascending muscle weakness, respiratory failure and death can occur
What is carpal tunnel syndrome?
pain, tingling, numbness in the hand over the distribution of the median nerve cuased by compression by the flexor retinaculum
What is tarsal tunnel syndrome?
entrapment of the posterior tibial nerve at the ankle
What is wrist drop?
paralysis of the extensors of the wrist and hand due to a radial nerve lesion
What is ape hand?
median nerve palsy
What is claw hand?
bishop's hand or benedictine hand - loss of ulnar nerve function
What is horner's syndrome?
ptosis (sagging eyelid), miosis (constricted pupil), anhydrosis (no sweat) and enopthalmosis (sunken eyeballs) due to a lesion in the ipsilateral sympathetic chain, associated with a pancoast tumor in the lung apex
What is a thrombus?
attached clot made of components in the blood, may or may not obstruct the lumen
What is an embolus?
a plug compsed of a detached thrombus, mass of bacteria, vegetation, fat or other body obstructing the lumen
What are the lines of zahn?
alternating layers of platelets and fibrin in a thrombus
What is arteriosclerosis?
rigidity and thickening of blood vessels
What is Monckeber's sclerosis?
arteriosclerosis of the tunica media wiht calcific rings resulting in "pipestream" arteries
What is atherosclerosis?
most frequent cause of vascular disease, fibrous plaques (atheromas) within the intima, made of cholesterol, esters, lipids, calcium and necrotic debris
What are the most common places for atherosclerosis?
coronary arteries, circle of Willis and the large vessels of the legs
What does atherosclerosis lead to?
ischemic heart disease, myocardial infarction, stroke
What are risk factors for atherosclerosis?
hypertension, high serum lipids (LDL), cigarette smoking, diabetes mellitus, obesity
What is a cerebral vascular accident?
stroke cuaed by a thrombis (most common in internal and external carotids, vertebral and basilar arteries and branches of the circle of Willis) or emolism (most common in middle cerebral artery --> contralateral paralysis)
What are Transient ischemic attacks (TIA)?
brief episodes of impaired neurologic function from temporary disturbances of cerebral circulation, precursor to CVA
What is polyarteritis nodosa?
inflammation and necrosis of parts of medium sized arteries leading to ischemia of the tissues supplied, occurs in heart, kidney and other organs, unknown cause
What is an intracerebral hemorrhage?
bleeding into the brain substance, most frequently from hypertension
What is a subarachnoid hemorrhage?
bleeding into the subarachnoid space, most frequently associated with a berry aneurysm in the circle of Willis
What is shock?
state in which blood flow and perfusion of tissues are inadequate, typically associated wiht a drop in blood pressure
Causes and types of shock?
- hypovolemic - hemorrhage or dehydration
- cardiogenic - decrease in CO (MI)
- anaphylactic - type 1 hypersensitivity
- neurogenic - vasodilation after trauma or drugs
- septic - abdominal or pelvic infection with gram negative bacteria
What is a berry aneurysm?
small lesions in circle of Willis, when burst they leak into the subarachnoid space
What is a dissecting aneurysm?
longitudinal intraluminal tear usually in the ascending aorta leading to cardiac tamponade and death, painful
What is an aortic or thoracic aneurysm?
erodes the anterior vertebral bodies, boring pain
What is essential hypertension?
idiopathic, most common type, risk factors are family history, dietary sodium intake, race and sex (black males), stress, obesity and smoking
What is secondary hypertension?
most commonly from renal disease or endocrine disorder
What is malignant hypertension?
essential or secondary, follows an accelerated course resulting in early death from heart failure, CVA or renal failure
What is angina pectoris?
chest pain caused by inadequate oxygenation of heart, stable is the most common (pain during exertion and relieved by rest)
What is myocardial infarction?
death of heart tissue, if survive can lead to arrhythmia, rupture of heart tissue, thrombosis along the heart wall and aneurysms, most common at left ventricle, involving the left anterior descending artery
What is rheumatic fever?
5 to 16, cuaed by strep pyogens, characterized by aschoff body, results in endocarditis (vegetations usually in mitral valve but all valves can be damaged, symptoms are SPECS (subcutaneous nodules, polyarteritis, erythema nodosa, carditis, syndenhams chorea)
What is endocarditis?
bacterial infection of the endocardium, vegetations consisting of fibrin, inflammatory cells and bacteria, mitral valve is most affected but all valves can be damaged
What is actue bacterial endocarditis (ABE)?
caused by strep pyogens or staph aureus, normally secondary to infection occurring elsewhere in body
What is subacute bacterial endocarditis (SBE)?
caused by strep viridans, tends to occur in those with preexisting heart conditions like rheumatic fever
What is cardiac tamponade?
compression of the heart due to build up of fluid in the pericardial sac
What type of tissue is the esophagus?
What is achlasia?
a neurogenic problem causing constriction of the lower esophagus so food cannot enter the stomach
What is a hiatal hernia?
protrusion of the stomach above the diaphragm, heartburn from gastro-esophageal reflux may occur
What are esophageal varices?
dilated veins at the lower end of the esophagus caused by portal hypertension, prone to massive bleeding which may be fatal, common to alcoholics
What is plummer vinson?
anemia which can cause esophageal webs "webs in your pipes"
What is mallory-weiss syndrome?
laceration of the lower end of the esophagus --> mediastinal inflammation and hematemesis (vomiting blood), seen in alcoholics from severe vomiting
What is a sliding hernia?
gastroesophageal junction and stomach are above the diaphragm
What is a rolling hernia?
The stomach alone is above the diaphragm, the gastroesophageal junction is normal
What is gastric carcinoma?
stomach cancer, > 50, "Leather bottle stomach", common in japan, fineland and iceland from nitrosamines (smoked fish and pickled vegetables), may involve superaclavicular lymph node (virchow's node or sentinal node)
What is chron's disease?
chronic inflammatory condition of unkown etiology, usually the ileocecal region, small intestine or colon, affects jewish males in their teens and twenties, "skip lesions" (segments of normal tissue between granulomatous inflammation)
What is meckel's diverticulum?
remnant of the embyonic vitelline duct, most common congenital abonormality of th esmall intestine, can bleed or ulcerate
What is celiac disease?
non-tropical sprue, malabsorption caused by gluten sensitivity
What is tropical sprue?
malabsorption of unkonwn cause
What is whipple's disease?
rare and severe malabsorption disease in men 30 to 60 --> anemia, skin pigmentation, joint symptoms and diarrhea
What is ulcerative colitis?
chronic inflammatory condition of unknown etiology, similar to chron's but affects only th elarge intestine (the rectum is always affected), bleeding
What is diverticulosis?
pockets of mucosa and submucosa herniating through the muscular layer of the bowel, sigmoid colon is the most common, when inflammed --> diverticulitis, perforation, peritonitis or bowel stenosis, bleeding
What is volvulus?
"twisting of a portion of GI tract --> bowel obstruction
What is intussusception?
"telescoping" of proximal segment to more distal segment --> bowel obstruction
What is puetz-jegher syndrome?
multiple intestinal polyps in GI tract, plus pigmentation of the lips and gums
What is colon carcinoma?
most common in rectosigmoid region, adenocarcinoma
What is appendicitis?
occurs between 10 to 30, intitiated by fecalith --> anorexia, nausea, severe right lower quadrant pain
What is jaundice?
yellow discoloration of tissue caused by hyperbilirubinemia, usually due to liver disease, biliary obstruction or hemolytic anemia
What is hepatitis A virus?
"infectious hepatitis" - fecal/oral transmission, complete recovery
What is hepatitis B virus?
"serum hepatitis" - sex/needle transmission, chronic carrier state possible
What is hepatitis C virus?
"Non-A, Non-B hepatitis" - needle or trasfusion transmission, chronic liver disease
What is a nutmeg liver?
speckled liver, chronic passive liver congestion, usually from right heart failure
What is cirrhosis?
chronic liver disease characterized by scarring, general disorganization, caused by alcoholism, hepatitis, biliary obstruction and heart failure and wilson's disease
What is portal hypertension?
increase in blood pressrue leading into the liver from thrombosis, cirrhosis, metastatic tumors or liver parasites --> esophageal varices, death, hemorrhoids
What is cholecystitis?
inflammation of the gallbaldder, often with gallstones --> nausea, vomiting, fever, right upper quadrant pain
What is acute pancreatitis?
activation of pancreatic enzymes --> autodigestion --> severe abdominal pain and prostration, serum amylase levels are increased
Where does a carcinoma of the pancreas usually occur? In who?
head of pancreas --> obstructive jaundice, more common in smokers, death within a year
What is COPD?
chronic obstructive pulmonary disease - group of disorders of airflow obstruction, these include asthma, bronchitis and emphysema (blue boaters)
What is asthma?
bronchial asthma - dyspnea, wheezing expiration, may lead to status asthmaticus (prolonged bout which may lead to death), chronic broncitis or emphysema
What is chronic bronchitis?
cigarette smoking cuases productive cough occurring at least three consecutive months over at least 2 consecutive years
What is emphysema?
cuased by smoking --> dilation of air spaces with destruction of alveolar walls, barrel chest loss of elastic recoil (pink puffer)
What is pneumoconioses?
caused by inhalation of carbon dust (anthracosis), coal dust, silica (silicosis), asbestos (asbestosis --> bronchogenic carcinoma and malignant mesothelioma), iron (siderosis), cotton dust (byssinosis)
What is pneumonia?
chills, fever, bloody sputum
What is lobar pneumonia?
pneumococcal pneumonia (strep), intra-alveolar, consolidation of part or entire lobe
What is bronchopneumonia?
affects the bronchioles and adjacent alveoli and is patchy over one or more lobes
What is interstitial pneumonia?
influenza or mycoplasm --> diffuse and patchy
What is pneumocystis pneumonia?
pneumocystitis carinii, common in AIDS patients
What is cor pulmonale?
right sided heart failure due to either chronic pulmonary disease or a pulmonary embolism
What is empyema?
pus in the thorax or "pyothorax", also can describe bacterial inflammation elsewhere in the body
What is hyaline membrane disease?
respiratory distress syndrome, premature infants have lack of surfactant in lungs
What is coccidiomycoses?
valley fever, from inhaling dust containing the fungus coccidioides immitis in san joaquin valley of california --> URI can be benign or fatal "valley girls like to suck cock"
What is tuberculosis?
mycobacterium tuberculosis, begins as a ghon complex (granulomas in lung parenchyma and lymph) --> caseous necrosis, disability, fever, hemoptysis and general wasting, cold abscess, type IV hypersensitivity
What is military TB?
TB that has spread throughout the body
What is Pott's disease?
TB of the spine
What is sarcoidosis?
lung disease presenting with granulomas, enlarged hilar lymph nodes, hypercalcemia and enlarged liver and spleen, more common in black young adult and teenager
What is atelectasis?
alveolar collapse due to tumor, pleural fluid accumulation or neonatal failure to expand
What is bronchogenic carcinoma?
leading cause of death from cancer in men and women, directly proportional in incidence to the number of cigarettes smoked daily and the number of years smoking, most common is squamous cell (usually preceded by squamous metaplasia), ex. pancoast tumor
What is anuria?
absence of urine
What is oliguria?
decreased urine output
What is diuresis?
production of an unusually large amount of urine
What is leukoplakia?
white patch on mucous membrane
What is anasarca?
What is nephrotic syndrome?
massive proteinuria, hypoalbuminemia, generalized edema and hyperlipidemia caused by diabetic kidney diesease, systemic lupus and glomerulonephritis
What is nephritic syndrome?
glomerulonephritis: hematuria, hypertension, azotemia (high BUN and Creatinine) and oliguria from inflammatory rupture of the glomerular capillaries, cuased by cuased by strep pyogens or goodpasteur's syndrome, hepatitis or malaria, RBC casts in urine
What is a urinary tract infection?
E. coli infection, increased urinary frequency and painful urination containing pus or blood
What is pyelonephritis?
bacterial infection of the kidney parenchyma, fever, flank tenderness, WBC casts in urine
What are kidney calculi?
stones or uroliths, more frequent in men, 80 to 85% of stones are calcium oxalate or calcium phosphate, cuased by hypercalcemia due to hyperparathyroidism
What is hypospadias?
urethra opens onto the ventral surface of the penis
What is epispadias?
When the urethra opens onto the dorsal suface of the penis, less common than hypo
What is phimosis?
abnormally tight foreskin, unable to retract over the glans
What is priapism?
unwanted, painful erection
What is balanitis?
inflammation of the glans penis
What is cryptorchidism?
failure of a testis to descend into the scrotum, increases risk for germ cell tumors like seminoma and embryonic carcinoma
What is a seminoma?
malignant germ cell tumor, most frequent in mid-30's, painless and curable, most common testicular tumor
What is benign prostatic hyperplasia?
most frequent cuase of urinary tract obstruction, extremely common, rubbery, nodular enlargement of the lateral and middle lobes --> frequency, hesitancy, painful urination
What is prostatic carcinoma?
extremely common in older men, posterior lobe is affected --> increased prostatic acid phosphatase and prostate specific antigen (PSA), frequently metastasizes to the bone
What is candidiasis?
yeast infection, the most common form of vaginitis, caused by candida albicans from antibiotic use, oral contraceptives, diabetes and pregnancy --> thick, white "cottage cheese" discharge and itching
What is toxic shock syndrome?
highly absorbent tampons, exotoxin of staph aureus --> fever, vomiting, diarrhea --> renal failure and shock
What is chlamydia?
trachoma or bedsonia, most common sexually transmitted disease --> keratoconjunctivitis and pelvic inflammatory disease
What are condyloma acuminata?
veneral warts caused by human papilloma virus (HPV), usually benign
What is cervical carcinoma?
squamous cell carcinoma at the entrance of the uterus, detected by Pap test, high incidence in those with early sexual activity or who have had multiple sex partners
What is endometriosis?
ectopic endometrial tissue on ovary, ligaments or other pelvic structures which proliferates and bleeds with the menstrual cycle forming blood filled cysts --> severe menstrual pain and infertility
What are fibroid tumors?
uterine leiomyoma, most common uterine tumor and most common tumor in women, benign neoplasm, estrogen sensitive (increases in pregnancy, decreases in menopause)
What are ovarian tumors?
most malignant are cystadenocarcinomas, many other tumors: teratomas (germ cell origin), many secrete large amounts of HCG, estrogen, androgens or alpha-fetoprotein
What is krukenberg tumor?
an ovarian cancer that has spread from the stomach, ovarian cells are replaces by signet ring cells
What is eclampsia?
toxemia of pregnancy --> hypertension, albuminuria and edema (all three also present in preeclampsia), plus convulsions an dcoagulation disorders
What is puerperal sepsis?
unexplained fever beginning 24 hours after giving birth
What is an ectopic pregnancy?
occurs in the fallopian tubes usually, can occur in the ovary, abdominal wall or cervix
What is fibrocystic disease?
most common disorder of the breast, masses between ages 25 and 50, mid-cycle tenderness, risk of cancer
What is a fibroadenoma?
most common tumor of the breast in women under 25, benign
What is carcinoma of the breast?
most often in the upper outer quadrant, predisposing factors: family history, high animal fat diet, nulliparous women (no children) and increased age
What is the adenohypophysis?
What is giantism?
secretion of too much growth horomone (somatotropin) before the epiphyseal plates close --> overgrowth of entire body
What is acromegaly?
secretion of too much growth hormone after the epiphyseal plates close --> enlarged jaw, face, hands, feet "Acidophilic Adenoma of the Adenohypophysis most commonly causes Acromegaly"
What is pituitary cushing's syndrome?
secretion of too much adrenal corticotrophic hormone (ACTH) due to pituitary tumor causing cushing's syndrome
What is pituitary dwarfism?
levi-lorain dwarfism - a deficiency of growth hormone, causing growth retardation (NOT to be confused with achondroplasia which is genetic dwarfism)
What is the neurohypophysis?
What is diabetes insipidus?
deficiency of antidiuretic hormone (ADH) --> polyuria and polydipsia
What is a goiter?
enlargement of the thyroid gland - iodine deficiency or hashimoto's thyroiditis or toxic goiter (hyperthyroid)
What is hypothyroidism?
manifests as myxedema in adults, cretinism in children
What is myxedema?
myxedema - iodine deficiency or hashimoto's thyroiditis --> coarse/brittle hair, puffy face/eyelids, obesity and mental slowness, lateral 1/3 of eyebrow is missing
What is cretinism?
iodine deficiency or maldevelopment of the thyroid --> severe mental retardation, dwarfism, large tongue
What is hashimoto's thyroiditis?
autoimmune disorder where the thyroid is attacked by anti-thyroid antibodies and anti-microsomal antibodies
What is hyperthyroidism?
thyrotoxicosis (Grave's disease or plummers disease) --> toxic goiter, exopthalmos, restlessness, irritability, tremor, tachycardia, weight loss
What is a medullary carcinoma?
produces excess calcitonin --> lowers blood levels of calcium
What is primary hyperparathyroidism (HPT)?
caused by a parathyroid adenoma or hyperplasia, high calcium and low phosphorous will be in the blood due to mobilization out of the bone --> renal calculi, calcification of tissues and osteitis fibrosa cystica (von recklinghausen's disease - brown tumors)
What is secondary HPT?
chronic renal disease in which calcium is not reabsorbed caused the parathyroid to produce hormone and take calcium from the bone (osteoclastic bone disease, renal osteodystrophy)
What is pseudohypoparathyroidism?
genetic, end-organ (kidney) is unresponsiveness to parathyroid hormone
What is Cushing's syndrome?
overproduction of ACTH by the pituitary or an adenoma in the adrenal cortex --> increases circulation of glucocorticoids, mainly cortisol --> central obesity with thin extremities, purple straiae over abdomen and amenorrhea, round moon face, "buffalo hump"
What is addison's disease?
deficiency of glucocorticoids and mineralcorticoids, mainly aldosterone, most often due to adrenal atrophy --> decreased blood pressure, skin pigmentation, hyponatremia, hyperkalemia
What is conn's disease?
excess secretion of mineralocorticoids, primarily aldosterone --> sodium (and water) retention, leading to hypertension
What is waterhouse-friderichsen disease?
meningococcemia and meningitis --> hemorrhage into the adrenal glands --> circulatory collapse
What is pheochromocytoma?
benign tumor of the chromaffin cells of the adrenal medulla --> surgically correctable hypertension from the overproduction of the catecholamines (epi and norepi)
What do both types of diabetes mellitus result in?
renal dysfunction, atherosclerosis, vascular disorders (gangrene of lower extremeties), cataracts, retinopathies, and frequent infections (ex. candida)
What is diabetes mellitus (type 1)?
Insulin dependent diabetes mellitus (IDDM) or juvenile diabetes - due to failure of insulin synthesis by beta cells of the pancreas --> carbohydrate intolerance with hyperglycemia and ketoacidosis --> polyuria, polydipsia, polyphagia and weight loss, increased appetite, coma, death
What is diabetes mellitus (type 2)?
Non-Insulin dependent diabetes mellitus (NIDDM) or adult-onset diabetes - much more common, begins in middle age, due to increased insulin resistance of cell membranes, predisposing factors include obestity and family history, managed by diet and/or medication, insulin therapy is NOT used
What is bronze diabetes?
idiopathic hemochromatosis, defect in iron absorption --> diabetes mellitus, cirrhosis and skin pigementation
What is carcinoid syndrome?
intestinal tumors (carcinoid tumors) release vasoactive substances (SEROTONIN mostly but also histamine and bradykinin) --> flushing of the head and neck, cyanosis, abdominal cramping, diagnosis wiht 5-HIAA urine levels
What is polycythemia vera?
increase in number of ALL blood cells
What is iron deficiency anemia?
dietary deficiency (infants), chronic blood loss (adults) or pregnancy --> pallor, fatigue, dypsnea on exertion, hypochromic, microcytic RBC's
What is megaloblastic anemia?
macrocytic, normochromic erythrocyte precursor cells due to deficiency of B12 (pernicious anemia) or folate (true megaloblastic anemia) --> chelosis, sore tongue
What is pernicious anemia?
B12 defiency anemia usually from failure to produce intrinsic factor in stomach can also be from diphyllobothrium latum or vegetarian diet --> B12 is not absorbed in the distal ileum --> lemon yellow color of the skin, "beefy red tongue", peripheral neuropathy, positive rhomberg's and mittlemeyer's diagnosed by anti-parietal antibodies or anti-intrinsic factor antibodies
What is aplastic anemia?
secondary to toxic exposure to radiation, chemicals, therapeutic drugs or viral infection --> bone marrow destruction and pancytopenia (all blood cells decreased)
What is hemolytic anemia?
RBC destruction and increased erythropoiesis cuased by autoimmune hemolytic disease, erthroblastosis fetalis, enzyme deficiencies, or hemoglobin disorders --> spherocytes, reticulocytes (immature RBC's), hemoglobinuria and a positive coomb's test
What is erthroblastosis fetalis?
hemolytic disease of the newborn from Rh negative mom and Rh positive fetus, usually occurs in 2nd child or later, the anti-Rh antibodies cross the placenta and lyse the fetal blood --> kernicterus (brain damage) or stillborn
What is sickle cell anemia?
7% of american blacks carry but not expressed in most, hemoglobin S, which polymerizes at low oxygen tension --> distortion and weakness in the RBC membrane --> severe, life-long anemia, chronic leg ulcers, lung and spleen infarctions, occlusive episodes to the blood vessels, sickle cell trait has no symptoms
What is thalassemia major?
cooley's anemia or mediterranean anemia, increase in hemoglobin F, sickle cell anemia symptoms plus distortion of the skeleton, thalassemia minor (trait) few symptoms
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