T-cells, delayed hypersensitivity reaction (type III slow onset autoimmune) allergic alveolitis, inhaled antigens like moldy hay, acute or chronic, depending on renewed exposure
Restrictive lung disease
interstitial fibrosis, causing marked thickening of many alveolar walls by dense, scar-like fibrous tissue
Pulmonary edema
Fluid in the alveoi
Hemodynamic edema
Left heart failure causes blood to back up which produces pressure in the vascular bed. Fluid then enters the alveoli
Pulmonary thromboembolism
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
Pulmonary hypertension
Systolic pressure > 30 mm Hg or average pressure > 25 mm Hg
Average is 15 mm Hg
Most common cause is increased vascular resistance
Secondary pulmonary hypertension
due to COPD or interstitial lung disease, collagen vascular disease, or recurring thromboemboli
Cor pulmonale
Right ventricle is hypertrophic, dilated, failing... onionskin hyperplasia of pulmonary arteries in lugs
Adult respiratory distress syndrome
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
Bronchopneumonia
Alveolar inflammation is widespread but patchy, leaving some alveoli unaffected
Lobar pneumonia
all alveoli in the lobe are involved by intense acute inflammation
Tuberculosis
Nearly all cases are secondary
Primary TB causes caseous necrosis
Histoplasmosis
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)
Candidiasis
Bacteria common to healthy mouths, but problemmatic in AIDS
Bronchogenic carcinoma
most common cancer in humans
80-90% of smokers
Small cell type is VERY agressive
The barrier function of the glomerulus prevents what from entering the glomerular filtrate?
Protein
Azotemia is best described as
Nitrogen found in the blood, with no clinical symptoms
Only lab findings can diagnose
Poststreptococcal glomerulonephritis usually presents as
Acute nephritic syndrome
What is a cause of renovascular hypertension
Atherosclerosis
What is closely associated with chronic pyelonephritis?
Urinary reflux and obstruction
True or false? The innermost layer of the glomerulus is vascular endothelium
True
True or false? Uremia is a syndrome of laboratory results only
False, it comes with symptoms as well
True or false? Acute glomerulonephritis is an autoimmune disease
True
True or false? Urinary obstruction can cause renal damage without infection
True
True or false? Transitional cell carcinomas are tumors of the renal tubular epithelium
False, they are tumors of the renal pelvis
Functions of the kidneys
Eliminate wase
Regulate plasma osmolality
Regulate blood acid-base balance
Stimulate red blood cell production
Fluid must cross three layers of tissue in the Bowman space
basement membrane, and visceral epithelial cells
Urinary tract is more suscetible to virus or bacteria
Bacterial infection
Most primary glomerular disease is caused by
Autoimmune reactions
What is a common cause of kidney disease?
High blood pressure
Diuresis
Excessive urination
Dysuria
Painful urination
Pyuria
Urination of WBCs
Hematuria
Urination of RBCs
Nocturia
Urination more than 2 times per night
Oliguria
Minimal urination
Proteinuria
Urination of protein
Glycosuria
Uriniation of glucose over 180 mg/dl
Azotemia
Excess nitrogen in blood
Only found in lab tests
causes renal failure
Uremia
Excess BUN
Found in lab tests, but also has clinical signs and symptoms
Acute nephritic syndrome
Autoimmune
High BP
Hematuria
Occult hematuria
blood in the urine that is not visible
Nephrolitiasis
Kidney stones
Polycystic kidney disease
Genetic/inherited
Post-streptococcal glomerulonephritis
Autoimmune
presents as acute nephritic syndrome
hematuria, HTN, increase BUN and Cr
Rapidly progressive glomerulonephritis
Autoimmune
Arcs of cells (mases) form and collapse glomerulus
Membranous glomerulonephritis
Autoimmune
Thickened basement membrane
Minimal change glomerulonephritis
Glomerular epithelia cells change slightly
only seen within electron microscopy
IgA glomerulonephritis
Antibodies deposit in support (mesangial) cells of glomerulus
Most common glomerulonephritis worldwide
Chronic glomerulonephritis
Long term renal failure or "smoldering" autoimmune state
Seen as occult protein in urine
Fatigue due to anemia
Cresentic glomerulonephritis
Crescent of epithelial cells proliferate along the parietal rim of the glomerular space and obliterate the glomerulus
Found in progressively worsening glomerulonephritis
Secondary glomerular disease
Diabetic glomerulosclerosis
Renal ablation glomerulopathy
Diseases of renal vasculature
Benign nephrosclerosis
Malignant nephrosclerosis
Renovascular hypertension caused by atherosclerosis
Malignant nephrosclerosis
Causes onionskin hyperplasia of the renal arteriole
Acute tubular necrosis
necrotic tubular epithelium
Pyramids are congested
Tubulointerstitial nephritis
Interstitium filled with chronic inflammatory cells (lymphocytes)
Tubules dilated and filled with protein casts
Tubular epithelium is atrophic
Obstruction, reflux, and stasis
Obstruction and reflux encourage infection and stone formation and contribute directly to hydronephrosis and tubulointerstitial nephritis
Does not always cause infection
Acute pyelonephritis
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
Nephrolithiasis
Calcium stone in the renal pelvis
Tumors of kidney
Renal cell carcinoma often found in renal vein and vena cava
Transitional cell carcinoma found in the renal pelvis
What is the cause of apthous oral ulcers?
The cause is unknown
A peptic ulcer can be found where?
In the stomach
Barrett metaplsia is associated with an increased risk of what?
Esophageal carcinoma
What is luminal phase malabsorption syndrome caused by?
chronic pancreatitis
What is characteristic of colonic carcinoma
Silent bleeding
True or false? Carcinoma of the colon kills more people anually than breast cancer does
True
True or false? Helicobactor pylori infection is the cause of most malabsorption syndromes
False
True or false? Barrett esophagus carries an increased risk of carcinoma
True
True or false? A single stool exam for occult blood can detect most premalignant lesions of the colon
True
True or false? Most peptic ulcers occur in the stomach
False, most peptic ulcers occur in the duodenum
Melena
Is passage of black stool with high content of altered blood
Hematochezia
Passage of overtly bloody stool (bright red)
Hematemesis
Vomiting of blood
Ileus
parastaltic paralysis
Pathologic intussusception
the one part of the intestine swallows the other, causing infarct
Sialadenitis
Inflammation of salivary glands (viral or autoimmune)
Sjogren syndrome
Dry mouth and dry eyes
Pleomorphic adenoma
Most often benign salivary gland tumor
80% 5 year survival rate
Excision may damage facial nerve
Dysphagia
Painful, difficult swallowing
Achalasia
LES spasm, chronic
Hiatal hernia
Protrusion of the stomach through the hiatus
Mallory-Weiss syndrome
Bulimic lacerations near gastro-esophageal junction
Esophageal varices
Dilated veins in esophogus due to cirrhotic scarring
Conditions associated with helicobacter pylori infection include
Atrophic gastritis
Chronic peptic ulceration
Gastric carcinoma
Peptic ulcers are associated with H. pylori
Acute gastric erosions
Associated with severe trauma, sepsis, major surgeries, grave illness, alcohol abuse, burns, CNS trauma or surgery, chronic exposure to NSAIDs and corticosteroids
Meckel diverticulum
Congenital large remnant pouch on jejunum
Gastroschisis
Failure of abdominal wall, intestines protrude
Omphalocele
Less severe bowel outpouching
Umbilical hernia
Small 1-2 cm bowel extrusion at naval
Hischsprung disease
genetic absence of the autonomic ganglionic neural plexus in colon wall, which controls peristalsis
No neural control
upstrean colon is distended with feces
Hemorrhoids
Dilated (varicose) veins
Bleed bright red regularly
Angiodysplasia
Small collection of blood vessels in the cecum/colon
Volvulus
twisted bowel loops with infarction of small bowel
Bacterial enterocolitis
Diarrhea caused by
Bacteria ingested in food
Rotavirus is most common cause
Sprue
Malabsoprtion with fatty stools
Luminal malabsorption
In center of tube, lack of pancreatic enzymes (lipase)
Intestinal malabsorption
Intestine itself (lack of lactase)
Autoimmune response to gluten
non-tropical sprue
Gluten sensitivity
Crohn's
Deep granulomatous inflammation anywhere in the bowels
Ulcerative colitis
superficial nongranulomatous inflammation in only the colon
Diverticulosis
Thin-walled outpouches without muscuar lining
Common in high fat diets with low fiber
Tubular adenoma (adenomatous polyp)
50% of population, 10-15 years before malignant
Silent bleeding (occult)
Villous adenoma
Large, fern-like
Worse than adenomatous polyp
Familial polyposis
genetic
1000s of polyps
Colon carcinoma
Less deaths than lung, but more than breast
Astler-Coller staging system
Staging of progression of colonic carcinoma and survival rate
Stages A through D
Acute appendicitis
10% of population
Often caused by a fecalith
Enterohepatic circulation refers to
Circulation of bile within the liver
Hepatitis B and C infections are transmitted by
parenataly or by sexual contact
What type of cirrhosis does alcoholism cause?
Portal cirrhosis, as does Hep B
True or false? Bacterial infection causes most cholecystitis
False
True or false? Genetic hemochromatosis can be treated effectively by phlebotomy
False
True or false? Biliary obstruction causes increased conjugated bilirubin
True
True or false? Esophageal varices are a direct consequence of portal hypertension
True
True or false? Hepatitis A is usually transmitted by blood transfusion or needlestick
False, that is Hep B and C
True or false? Cirrhosis is the most common cause of portal hypertension
True
True or false? Acute cholecystitis is the most common major complication of gallstones
True
Portal hypertension
leads to ascites, congestive splenomegaly, esophageal varices
Hepatitis A
Epidemic
Caused by food and water
Not chronic, and does not cause cirrhosis
Chronic hepatitis
Signaled by continuing jaundice or clinical symptoms, or the continued presence of virus in blood
Hepatitis C
Chronic hepatitis
reappearance of jaundice or clinical symptoms
Autoimmune hepatitis
No blood presence of blood markers of hep A,B,C
Antibodies
Liver abscess
Ascending cholangitis
Toxic liver injury
Alcoholic liver disease
Fatty liver
Hemochromatosis
Excess iron buildup
Common genetic mutation
10% northern Europeans at least carriers
10x more men
Wilsons Disease
Genetic build up of copper
Poor excretion
Neurologic symptoms requires transplant or if early possible chelation therapy
Hepatocellular carcinoma
Primary tumor is a single large mass
Liver is cirrhotic
Cirrhosis
Major cause of hepatocellular carcinoma
Acute pancreatitis is most commonly associated with
Alcoholism
What is type 1 diabetes associated with
Autoimmunity, young age at onset, risk of ketoacidosis
What is diagnostic of diabetes
Fasting blood glucose level of 150 mg/dL
All of the complications of diabetes are caused by
hyperglycemia
True or false? Blood amylase and lipase levels are elevated only in chronic pancreatitis
False
True or false? Shock in acute prancreatitis occurs when sympathetic nerve signals relax peripheral vascular tone
False
True or false? Carcinoma of the pancreas is usually incurable by the time symptoms occur
True
True or false? Type 2 diabetes is the result of peripheral insulin resistance
True
True or false? Diabetic microvascular disease is the cause of diabetic retinopathy
True
Acute and chronic pancreatitis
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
Acute pancreatitis
Painful and catastrophic medical emergency associated with shock and death
Chronic pancreatitis
Fibrotic and calcified pancreas
Occurs after repeat episodes of acute pancreatitis
Cause intestinal malabsorption and secondary diabetes
Pancreatic carcinoma
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
Diabetes Mellitus (type 1)
Caused by autoimmune destruction of beta cells (islets of langerhans)
Ketoacidosis is a concern
Type 2 diabetes
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
Epidermal stem cell
Basal cell
What is a skin condition associated with pregnancy?
Melasma (mask of pregnancy)
What is the pathogenesis of psoriasis?
Epidermal over-proliferation
What is lichen simplex chronicus caused by?
Chronic rubbing or scratching
What is the most common malignancy of skin?
Malignant melanoma
True or false? A papule is a small, solid, raised lesion less than 0.5 cm in diameter
True
True or false? People exposed to relatively large amounts of sunlight in childhood are more likely to develop nevi
True
True or false? Rosacea is most common in adolescent females
False, it is most common in middle aged women
True or false? Seborrheic keratosis are premalignant
False
True or false? The underlying immune reaction is the same in systemic lupus and cutaneous discoid lupus
True
Epidermis
Surface squamous epithelium of skin and includes stem cells (basal cells)
Dermis
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
Subcutis
Layer of fat immediately beneath the dermis
Crust
Surface collectino of dried serum and cell debris
Cyst
Closed space beneath the epidermis that contains fluid or semisolid material
Eczema
Inflamed, crusted skin with vesicles
Fissure
A grove or crack-like lesion
Lichenified
Area of skin with thickening of epidermis and exaggeration of normal skin lines caused by chronic rubbing or scratching
Macule
Flat, discrete, discolored lesion <1.0 cm
Papule
A raised, domed superficial lesion <0.5 cm
Nodule
A firm, raised lesion, larger and deeper than a papule
Patch
A flat, discrete, discolored lesion larger than a macule
Plaque
A raised, flat-topped superficial lesion larger than a papule
Pustule
A small superficial abscess
Scale
A superficial, thin, plate-like flaking off of shedding epidermal cells
Ulcer
A cavity not covered by epidermis
Vesicle/bulla
A blister filled with a fluid; a vesicle is small (<0.5 cm) whereas a bulla is larger
Wheal
A smooth, slightly elevated lesion that is reddish or pale and usually itchy
Eczema
Dermatitis expressed as itchy, paulovesicular, oozing, crusted lesions
The most common type of eczema is allergic contact dermatitis - poison ivy for example
Spider angiomas
Caused by high estrogen content
Radiating vascular spokes on upper body and face during pregnancy
Alopecia
Hair loss
Hirsutism
Excess hair
Vitiligo
Confluent macules and patches
Lack of melanocytes in that area
All races can suffer
Lentigo
Flat, brown patches
Hyperplasia of melanocytes
Non-neoplastic, non-darkening in sun
Psoriasis
Caused by an over-proliferation of epidermal cells in genetically inclined persons
Lichen simplex chronicus
thickened, white skin caused by rubbing and scratching
Non-contact dermatitis
Photoaging effect (leathery skin)
Stasis dermatitis (vericose veins and poor blood flow)
Urticaria (itchy, hives, allergic)
Contact dermatitis
Allergic: atopic dermatitis, nummular dermatitis
Commonly called eczema
Acne vulgaris
Confluent, erythematous papules, patches, and pustules
often caucasians
Genetic components
White heads
Sebaceous plugs (comedos)
Oxidized melanin
black heads
Impetigo
Common superficial skin infection that forms pustules
Often occurs in infants and children
Caused by staphylococcus or streptococcus infection
Cold sores
Oral herpesvirus
Verrucae vulgaris
Warts
Caused by human papilloma virus
Actinic (solar) keratosis
often pre-malignant
Squamous carcinoma
Light-skinned persons
In the base of the lesion is a focus of invasive squamous cell carcinoma
Basal cell carcinoma
Pearly plaque/nodule with raised, rolled edges
Masses of small, dark basal cells invading the dermis
Most common skin cancer
Nevi
Moles
Most common benign tumor of melanocytes
Malignant melanoma
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
The normal growth of long bones occurs in which part of the bone?
Epiphysis
Bone broken at the site of cancer metastasis is what kind of fracture
Pathologic
What sex is osteoporosis related to?
Female sex
What disease, other than RA, can rheumatoid factor be found?
Hepatitis B
What type of disease is Myasthenia Gravis?
Autoimmune
True or false? Malignant fibrous histocytoma (MFH) of skin is much less malignant that MFH of other sites
True
True or false? Becker muscular dystrophy is characterized by abnormal dystrophin
True
True or false? Acute septic arthritis is a common form of arthritis
False
True or false? In a patient with apparent rheumatoid arthritis, the presence of rheumatoid nodules confirms the diagnosis
True
True or false? The head of the femur is especially prone to aeptic necrosis
True
Scoliosis
Abnormal curvature of the upper spine
Kyphosis
Abnormal forward curvature
Lordosis
Abnormal backward curvature (may protrude belly)
Achondroplasia
Genetic short-limbed dwarfism
Osteogenesis imperfecta
Genetic cartilage defects
Brittle bone disease, heart valves, inner ear affected
Paget disease
Common
Cause may be chronic viral infection
Rapid bone formation and breakdown
Osteoblastic exhaustion later
Pain, deformity, fracture
1% leads to osteosarcoma
Comminuted fracture
Shattered
Osteomyelitis
Bacterial infection from direct traumatic implantation into bone
Aseptic (avascular) necrosis
Impaired blood flow, corticosteroid
Infarction, necrosis
Especially in head of femur and carpals
Mainly issue in growing children
Osteomalacia
Soft, QUALITITATIVE probem of bone hardness
Caused by inadequate calcium, vitamin D, and phosphate
Rickets
Vitamin D deficiency
Malformations in growing kids (legs bowed)
Renal Osteodystrophy
Kidneys do not excrete PO4 properly
Blood levels of phosphate drives down Ca2+ in blood
Metastatic carcinoma
Most common breast cancer, prostate cancer, and lung cancer
Osteosarcoma
Most common malignant tumor of bone
80% primary bone tumors is knee
Bone-forming tumors
Benign: small, little consequence
Cartilage-forming tumors
Benign: little consequence
Malignant (chondrosarcoma): Neoplastic cartilage; most are low grade, sluggish tumors, 5-yr survival 80%
Fibrous tumors and tumor-like conditions
Fibrous cortical defect (nonossifying fibroma): Children
developmental defect, not neoplasm
Fibrosarcoma: Malignant tumor of fibrocytes
Ankylosis
Fibrous binding and welding of a joint
Z deformity
Ulnar drift with fingers deviating oppositely
Secondary amyloidosis
Autoimmune Ig complexes deposit in kidneys, liver, spleen, adrenals
Juveneile RA
sudden, systemic, toxic, no RF antibodies but instead anti-nuclear antibodies
Ankylosing spondylitis
Relapsing, vertebral fibrous fusion, stiff spine, chronic back pain
Reactive arthritis
Presents 1 month post infection elsewhere
Psoriatic arthritis
10% of psoriasis (skin disease) patients
Affects small joints of hands and feet first
Spondyloarthropathies
Ankylosing spondylitis
Gout
Metabolic, inflammatory disease
Men
Uric acid crystals in joints, usually the big toe
Atherosclerosis accelerated by high serum uric acid
Lyme disease
Bacterial infection; deer tick vector
Late stage = arthritis, WI and MN are primary band of states involved
Polymyalgia rheumatica
Dx made in absence of other dx shoulder pain, stiffness, malaise, moodiness; no arthritic inflammation
Degenerative disc disease
Ring of tough cartilage around discs bulges or ruptures
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