Patho Final

Alveolus

People are crowded together indoors and infect one another

Surface area of pulmonary membrane is decreased

It can be caused by many different underlying conditions

Small cell carcinoma of the lung

False

False, exhaled air flow is slowed, FEV1 is reduced, but FVC remains the same

False, interstitial pneumonia is caused by viral infection, alveolar pneumonia is bacterial

False, most patients infected with mycobacterium TB are affected by a secondary infection

False, small cell carcinoma is much more agressive

secrete a soaplike surficant

collapsed lung

collapsed lung caused by obstruction

Collapsed lung

Lung collapsed caused by scarring

Asthma and and COPD: ephymsema and chronic bronchitis

narrow lumen containing large amounts of mucus; inflammatory cells present; increased number of mucus glands and smooth muscle cells

merging of alveoli into larger spaces; often caused by smoking

destroyed smooth muscle, dilated, flaccid, pus-filled bronchial tubes, lower lobes, vertical airways

Unknown cause, immune involvement, collagen-vascular disease of slow onset, hits middlement most (nongranulomatous)

unknown cause, mostly African-Americans, macrophage + lymphocyte accumulation, self-resolve or progressive fibrosis (granulomatous)

T-cells, delayed hypersensitivity reaction (type III slow onset autoimmune) allergic alveolitis, inhaled antigens like moldy hay, acute or chronic, depending on renewed exposure

interstitial fibrosis, causing marked thickening of many alveolar walls by dense, scar-like fibrous tissue

Fluid in the alveoi

Left heart failure causes blood to back up which produces pressure in the vascular bed. Fluid then enters the alveoli

Thrombus moves to the lung; most often arises in the deep veins of the leg and pelvis; eventually makes its way to the pulmonary artery, and if large enough can cause immediate death

• Systolic pressure > 30 mm Hg or average pressure > 25 mm Hg
• Average is 15 mm Hg
• Most common cause is increased vascular resistance

due to COPD or interstitial lung disease, collagen vascular disease, or recurring thromboemboli

Right ventricle is hypertrophic, dilated, failing... onionskin hyperplasia of pulmonary arteries in lugs

• edema accumulates in alveoli as a result of alveolar and pulmonary capillary damage and condenses into a thick protein membrane which coats alveolar walls
• 50% mortality

Alveolar inflammation is widespread but patchy, leaving some alveoli unaffected

all alveoli in the lobe are involved by intense acute inflammation

• Nearly all cases are secondary
• Primary TB causes caseous necrosis

• Fungal infection of the lungs
• found in the Ohio River and Mississippi River areas
• Caused by inhaled bird droppings
• TB-like sx (fever, cough, sputum, malaise)

Bacteria common to healthy mouths, but problemmatic in AIDS

• most common cancer in humans
• 80-90% of smokers
• Small cell type is VERY agressive

Protein

• Nitrogen found in the blood, with no clinical symptoms
• Only lab findings can diagnose

Acute nephritic syndrome

Atherosclerosis

Urinary reflux and obstruction

True

False, it comes with symptoms as well

True

True

False, they are tumors of the renal pelvis

• Eliminate wase
• Regulate plasma osmolality
• Regulate blood acid-base balance
• Stimulate red blood cell production

basement membrane, and visceral epithelial cells

Bacterial infection

Autoimmune reactions

High blood pressure

Excessive urination

Painful urination

Urination of WBCs

Urination of RBCs

Urination more than 2 times per night

Minimal urination

Urination of protein

Uriniation of glucose over 180 mg/dl

• Excess nitrogen in blood
• Only found in lab tests
• causes renal failure

• Excess BUN
• Found in lab tests, but also has clinical signs and symptoms

• Autoimmune
• High BP
• Hematuria

blood in the urine that is not visible

Kidney stones

Genetic/inherited

• Autoimmune
• presents as acute nephritic syndrome
• hematuria, HTN, increase BUN and Cr

• Autoimmune
• Arcs of cells (mases) form and collapse glomerulus

• Autoimmune
• Thickened basement membrane

• Glomerular epithelia cells change slightly
• only seen within electron microscopy

• Antibodies deposit in support (mesangial) cells of glomerulus
• Most common glomerulonephritis worldwide

• Long term renal failure or "smoldering" autoimmune state
• Seen as occult protein in urine
• Fatigue due to anemia

• Crescent of epithelial cells proliferate along the parietal rim of the glomerular space and obliterate the glomerulus
• Found in progressively worsening glomerulonephritis

• Diabetic glomerulosclerosis
• Renal ablation glomerulopathy

• Benign nephrosclerosis
• Malignant nephrosclerosis
• Renovascular hypertension caused by atherosclerosis

Causes onionskin hyperplasia of the renal arteriole

• necrotic tubular epithelium
• Pyramids are congested

• Interstitium filled with chronic inflammatory cells (lymphocytes)
• Tubules dilated and filled with protein casts
• Tubular epithelium is atrophic

• Obstruction and reflux encourage infection and stone formation and contribute directly to hydronephrosis and tubulointerstitial nephritis
• Does not always cause infection

• Caused by ascending infection of E. coli and other fecal bacteria that ascend to the kidney from the bladder
• Presence of bacteria in urine is not helpful in diagnosis
• Often associated with reflux or obstruction
• Responsible for 10% of patients on dialysis
• May cause chronic tubulointerstitial nephritis

Calcium stone in the renal pelvis

• Renal cell carcinoma often found in renal vein and vena cava
• Transitional cell carcinoma found in the renal pelvis

The cause is unknown

In the stomach

Esophageal carcinoma

chronic pancreatitis

Silent bleeding

True

False

True

True

False, most peptic ulcers occur in the duodenum

Is passage of black stool with high content of altered blood

Passage of overtly bloody stool (bright red)

Vomiting of blood

parastaltic paralysis

the one part of the intestine swallows the other, causing infarct

Inflammation of salivary glands (viral or autoimmune)

Dry mouth and dry eyes

• Most often benign salivary gland tumor
• 80% 5 year survival rate
• Excision may damage facial nerve

Painful, difficult swallowing

LES spasm, chronic

Protrusion of the stomach through the hiatus

Bulimic lacerations near gastro-esophageal junction

Dilated veins in esophogus due to cirrhotic scarring

• Atrophic gastritis
• Chronic peptic ulceration
• Gastric carcinoma
• Peptic ulcers are associated with H. pylori

Associated with severe trauma, sepsis, major surgeries, grave illness, alcohol abuse, burns, CNS trauma or surgery, chronic exposure to NSAIDs and corticosteroids

Congenital large remnant pouch on jejunum

Failure of abdominal wall, intestines protrude

Less severe bowel outpouching

Small 1-2 cm bowel extrusion at naval

• genetic absence of the autonomic ganglionic neural plexus in colon wall, which controls peristalsis
• No neural control
• upstrean colon is distended with feces

• Dilated (varicose) veins
• Bleed bright red regularly

Small collection of blood vessels in the cecum/colon

twisted bowel loops with infarction of small bowel

• Diarrhea caused by
• Bacteria ingested in food
• Rotavirus is most common cause

Malabsoprtion with fatty stools

In center of tube, lack of pancreatic enzymes (lipase)

• Intestine itself (lack of lactase)
• Autoimmune response to gluten

Gluten sensitivity

Deep granulomatous inflammation anywhere in the bowels

superficial nongranulomatous inflammation in only the colon

• Thin-walled outpouches without muscuar lining
• Common in high fat diets with low fiber

• 50% of population, 10-15 years before malignant
• Silent bleeding (occult)

• Large, fern-like
• Worse than adenomatous polyp

• genetic
• 1000s of polyps

Less deaths than lung, but more than breast

• Staging of progression of colonic carcinoma and survival rate
• Stages A through D

• 10% of population
• Often caused by a fecalith

Circulation of bile within the liver

parenataly or by sexual contact

Portal cirrhosis, as does Hep B

False

False

True

True

False, that is Hep B and C

True

True

leads to ascites, congestive splenomegaly, esophageal varices

• Epidemic
• Caused by food and water
• Not chronic, and does not cause cirrhosis

Signaled by continuing jaundice or clinical symptoms, or the continued presence of virus in blood

• Chronic hepatitis
• reappearance of jaundice or clinical symptoms

• No blood presence of blood markers of hep A,B,C
• Antibodies
• Liver abscess
• Ascending cholangitis
• Toxic liver injury

Fatty liver

• Excess iron buildup
• Common genetic mutation
• 10% northern Europeans at least carriers
• 10x more men

• Genetic build up of copper
• Poor excretion
• Neurologic symptoms requires transplant or if early possible chelation therapy

• Primary tumor is a single large mass
• Liver is cirrhotic

Major cause of hepatocellular carcinoma

Alcoholism

Autoimmunity, young age at onset, risk of ketoacidosis

Fasting blood glucose level of 150 mg/dL

hyperglycemia

False

False

True

True

True

• Hal of patients have gallstones
• 2/3 of patients abuse alcohol
• Amylase (CHO) and lipase (FAT) enzymes self-digest nerves, vessles, and glands
• Excess proteases

Painful and catastrophic medical emergency associated with shock and death

• Fibrotic and calcified pancreas
• Occurs after repeat episodes of acute pancreatitis
• Cause intestinal malabsorption and secondary diabetes

• Usually begins with upper abdominal pain or back pain
• Painless jaundice may be initial sign that tumor is obstructing the common bile duct
• Unexplained weight loss or migratory thrombophlebitis is suggestive

• Caused by autoimmune destruction of beta cells (islets of langerhans)
• Ketoacidosis is a concern

• Inability to respond to insulin
• Resistance of peripheral (target) cells to the action of normal levels of insulin, necessitating increased pancreatic secretion of insulin
• Later, B-cell exhaustion = decreased insulin

Basal cell

Melasma (mask of pregnancy)

Epidermal over-proliferation

Chronic rubbing or scratching

Malignant melanoma

True

True

False, it is most common in middle aged women

False

True

Surface squamous epithelium of skin and includes stem cells (basal cells)

Fibrocollagen layer of skin beneath the epidermis, which is separated from the epidermis by the basement membrane and contains skin appendages such as sweat glands and hair folicles

Layer of fat immediately beneath the dermis

Surface collectino of dried serum and cell debris

Closed space beneath the epidermis that contains fluid or semisolid material

Inflamed, crusted skin with vesicles

A grove or crack-like lesion

Area of skin with thickening of epidermis and exaggeration of normal skin lines caused by chronic rubbing or scratching

Flat, discrete, discolored lesion <1.0 cm

A raised, domed superficial lesion <0.5 cm

A firm, raised lesion, larger and deeper than a papule

A flat, discrete, discolored lesion larger than a macule

A raised, flat-topped superficial lesion larger than a papule

A small superficial abscess

A superficial, thin, plate-like flaking off of shedding epidermal cells

A cavity not covered by epidermis

A blister filled with a fluid; a vesicle is small (<0.5 cm) whereas a bulla is larger

A smooth, slightly elevated lesion that is reddish or pale and usually itchy

• Dermatitis expressed as itchy, paulovesicular, oozing, crusted lesions
• The most common type of eczema is allergic contact dermatitis - poison ivy for example

• Caused by high estrogen content
• Radiating vascular spokes on upper body and face during pregnancy

Hair loss

Excess hair

• Confluent macules and patches
• Lack of melanocytes in that area
• All races can suffer

• Flat, brown patches
• Hyperplasia of melanocytes
• Non-neoplastic, non-darkening in sun

Caused by an over-proliferation of epidermal cells in genetically inclined persons

thickened, white skin caused by rubbing and scratching

• Photoaging effect (leathery skin)
• Stasis dermatitis (vericose veins and poor blood flow)
• Urticaria (itchy, hives, allergic)

• Allergic: atopic dermatitis, nummular dermatitis
• Commonly called eczema

• Confluent, erythematous papules, patches, and pustules
• often caucasians
• Genetic components

Sebaceous plugs (comedos)

black heads

• Common superficial skin infection that forms pustules
• Often occurs in infants and children
• Caused by staphylococcus or streptococcus infection

Oral herpesvirus

• Warts
• Caused by human papilloma virus

• often pre-malignant
• Squamous carcinoma
• Light-skinned persons
• In the base of the lesion is a focus of invasive squamous cell carcinoma

• Pearly plaque/nodule with raised, rolled edges
• Masses of small, dark basal cells invading the dermis
• Most common skin cancer

• Moles
• Most common benign tumor of melanocytes

• Most dangerous skin cancer
• Irregular border and variation of pigmentation
• Deep black pigmentation and irregular border
• Pinkish area and irregular border
• Initially spreads outward in a radial fashion as an in situ malignancy before penetrating the basement membrane
• Tumor later becomes nodular and grows vertically into the dermis

Epiphysis

Pathologic

Female sex

Hepatitis B

Autoimmune

True

True

False

True

True

Abnormal curvature of the upper spine

Abnormal forward curvature

Abnormal backward curvature (may protrude belly)

Genetic short-limbed dwarfism

• Genetic cartilage defects
• Brittle bone disease, heart valves, inner ear affected

• Common
• Cause may be chronic viral infection
• Rapid bone formation and breakdown
• Osteoblastic exhaustion later
• Pain, deformity, fracture
• 1% leads to osteosarcoma

Shattered

Bacterial infection from direct traumatic implantation into bone

• Impaired blood flow, corticosteroid
• Infarction, necrosis
• Especially in head of femur and carpals
• Mainly issue in growing children

• Soft, QUALITITATIVE probem of bone hardness
• Caused by inadequate calcium, vitamin D, and phosphate

• Vitamin D deficiency
• Malformations in growing kids (legs bowed)

• Kidneys do not excrete PO4 properly
• Blood levels of phosphate drives down Ca2+ in blood

Most common breast cancer, prostate cancer, and lung cancer

• Most common malignant tumor of bone
• 80% primary bone tumors is knee

Benign: small, little consequence

• Benign: little consequence
• Malignant (chondrosarcoma): Neoplastic cartilage; most are low grade, sluggish tumors, 5-yr survival 80%

• Fibrous cortical defect (nonossifying fibroma): Children
• developmental defect, not neoplasm
• Fibrosarcoma: Malignant tumor of fibrocytes

Fibrous binding and welding of a joint

Ulnar drift with fingers deviating oppositely

Autoimmune Ig complexes deposit in kidneys, liver, spleen, adrenals

sudden, systemic, toxic, no RF antibodies but instead anti-nuclear antibodies

Relapsing, vertebral fibrous fusion, stiff spine, chronic back pain

Presents 1 month post infection elsewhere

• 10% of psoriasis (skin disease) patients
• Affects small joints of hands and feet first

Ankylosing spondylitis

• Metabolic, inflammatory disease
• Men
• Uric acid crystals in joints, usually the big toe
• Atherosclerosis accelerated by high serum uric acid

• Bacterial infection; deer tick vector
• Late stage = arthritis, WI and MN are primary band of states involved

Dx made in absence of other dx shoulder pain, stiffness, malaise, moodiness; no arthritic inflammation

• Ring of tough cartilage around discs bulges or ruptures
• Puts pressure on spinal root nerves = pain, tingling, numbness, paraysis

Sliding lumbar vertebrae from abnormal joint stress, usually asymptomatic

Inflammed bursal sacs that lubricate tendons sliding over bones or where bone is near skin

Inflammed tendons

Chronic pain, percieved swelling, little physical evidence, malfunction of brain pain centers

Small pseudo-cyst near tendon sheath, usually only removed if unsightly, limit motion, painful

• Benign but locally invasive neoplasm
• Does NOT metastasize
• 80% in knee, tendon sheaths
• Surgical excision is curative

simlar to pigmented villonodular synovitis, but in wrist

shrinking muscle upon denervation

• Immobilization, corticosteroid therapy
• Type 2 fibers affected

Muscular dystrophy

• Genetic
• Absence of dystrophin protein in muscle cells

• Milder, present but abnormal dystrophin
• Muscle cells ultimately die, fatty fibrous tissue replaces it

• Autoimmune defense infiltrate of inflammatory cells
• Lymphocytes among muscle cells
• High serum CK
• T-cell damage

• Type-2 autoimmune reaction: cytotoxic hypersensitivity
• Antibodies attach to target cell, which is destroyed by phagocytosis or inflammation
• Antibodies attach to target-cell receptors and interfere with target-cell function, as in the blockage of signal transmission from nerve to muscle in myesthemia gravis

• Benign fatty tumor
• Liposarcoma - malignant, deep, large

Cartilage-producing benign tumor

Malignant, commonly around knee

• Most common soft tissue sarcoma in adults
• Quite malignant, about half metastasize