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Types of Degeneration
- Coagulation
- Liquefaction
- Caseous
- Enzymatic
- Fatty
- Zenker's
- Wallerian
- Cloudy Swelling
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Coagulation
- Infarction
- Myocardial Infarction
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Zenker's (Waxy)
Hyaline- seen in skeletal muscle
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Wallerian
peripheral nerves
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Cloudy swelling
albuminous
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Developmental Changes
- Agenesis
- Hypoplasia
- Aplasia
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Agenesis
absence of an organ (usually paired organ)
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Hypoplasia
organ smaller than normal and defective
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Aplasia
small remnants of the organ present (lack of development)
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Disturbances of Growth
- Atrophy
- Hypertrophy
- Hyperplasia
- Metaplasia
- Dysplasia
- Anaplasia
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Atrophy
decreased in size (disuse)
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Hypertrophy
increase in size (muscle exercise)
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Hyperplasia
increase in number of cells (pregnant uterus)
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Metaplasia
changes from one cell type to another (PCCE changes to stratified squamous in the lung, a smoker)
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Dysplasia
changes in size, shape or function of a cell (precedes cancer, but is reversible)
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Anaplasia
complete disorganization of a cell (cancer)
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Carcinoma
cancer of epithelial tissue that usually spreads by way of the lymphatic system.
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Sarcoma
Cancer of the connective tissue that usually spreads by blood.
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General Terminology
- Bacteremia
- Septicemia
- Anoxia
- Hypoxia
- Thrombus
- Clot
- Embolus
- Diapedesis
- Chemotaxis
- Phagocytosis
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Bacteremia
bacteria in the blood
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Septicemia
pathogens or toxins in the blood
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Hypoxia
deficiency of oxygen
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Thrombus
platelet deposition
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Clot
fibrinogen into fibrin via thromboplastin
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Embolus
foreign body in the blood that travels
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Diapedesis
neutrophils and monocytes squeeze through the walls of blood vessels.
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Chemotaxis
Movement of WBC's in response to a concentration gradient of a variety of tissue damage products.
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Phagocytosis
accomplished by neutrophils and macrophages
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Pneumoconiosis
- Silicosis
- Asbestosis
- Siderosis
- Byssinosis
- Berylliosis
- Anthracosis
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Silicosis
silicon related to TB
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Asbestosis
asbestos leads to mesothelioma
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Byssinosis
cotton dust called Brown lung
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Berylliosis
Fibers- aircraft manufacturing
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Anthracosis
Black lung dz. from Miners
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Syphilis
- Congenital- 5 signs
- Acquired
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Syphilis Congenital- 5 signs
- Hutchinson's teeth
- Rhagades
- Saddle nose deformity
- Sabre blade tibia
- Interstitial keratitis
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Hutchinson's teeth
notched permanent incisors
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Rhagades
fissures or cracks at the edge of the mouth
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Saddle nose deformity
bridge of nose flattened
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Interstitial keratitis
Produces visual changes. This condition sometimes associated with deafness as well.
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Syphilis Acquired
- Primary stage
- Secondary stage
- Latency
- Tertiary
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Primary stage syphilis
hard, singular painless nodule on perineum
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Secondary stage syphilis
maculopapular rash and condylomata lata (flat warts on the vulva)
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Latency syphilis
May or may not have symptoms
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Tertiary syphilis
Tabes dorsalis, aortic aneurysm, argyll Robertson pupil, Gummas (necrosis in body tissues)
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Other venereal diseases
- Chancroid
- Gonorrhea
- Lymphogranuloma venereum
- Chlamydia trachomatis
- Granuloma inguinale
- Trichimonas
- Gardenella vaginalis
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Chancroid
Soft chancre, painful caused by Hemophilus ducery
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Gonorrhea
Gram negative diplococcus causes burning on urination with pus in the urine. Can produce arthritis in the knee.
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Lymphogranuloma venereum
Chlamydia is the organism. Produces rectal strictures. DX: Frei test
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Chlamydia trachomatis
white discharge. Pelvic Inflammatory Disease aka- PID
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Granuloma inguinale
red nodules in inguinal reagion
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Trichimonas
Purulent vaginal discharge, green and frothy protozoan
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Gardenella vaginalis
Foul smelling vaginal discharge. Clue cells.
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Gastrointestinal Disorders
- Dysphasia
- Siding hiatal hernia
- Diverticula
- Volvulus
- Intussusception
- Celiac disease
- Crohns
- Hirschbrung's
- Ulcerative colitis
- Irritable bowel
- Peutz Jegher's
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Dysphagia
difficulty swallowing
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Sliding hiatal hernia
due to anatomically shortened esophagus
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Diverticula
Outpouching in the intestine. Usually lower left quadrant of the abdomen.
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Volvulus
twisting of an organ
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Intussusception
telescoping of intestine onto itself
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Celiac disease
intolerance to gluten. low of villi. must stay on gluten free diet.
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Crohn's disease
Regional ileitis. Seen in young people. Affects the proximal small intestine and colon. Produces skip lesions, autoimmune. Right abdomen.
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Hirschbrung's
Congenital megacolon. Absence of the myenteric plexus. Aeurbach plexus.
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Ulcerative colitis
Pathological intestinal changes, ulcers, bloody diarrhea, complications produce toxic megacolon. Left side.
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Irritable bowel
Spastic colon, distension, pain, diarrhea. Stress related.
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Peutz Jegher's
Polyposis characterized by polyps in the entire GI tract.
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Miscellaneous Diseases
- Still's
- Paget's
- Parkinson's
- Multiple Sclerosis
- Myasthenia gravis
- ALS
- PLS
- Syringomyelia
- Arnold Chiari
- Huntington's
- Alzheimer's
- Friedreich's ataxia
- Guillian Barre
- Poliomyelitis
- Korsakoff
- Charcot Marie Tooth
- Duchenne's muscular dystrophy
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Still's Disease
A form of juvenile rheumatoid arthritis
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Paget's Disease
Osteitis deformans. Produces thickening and deformity of bone
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Parkinson's Disease
AKA- paralysis agitans. Problem with dopamine in the basal ganglia. Inclusion bodies called Lewy bodies. Patient has masked face, stooped posture, resting tremor and festinating gait.
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Multiple Sclerosis
Demyelinization and plaguing of the spinal cord or brain. Charcot's triad: scanning speech, intention tremor and nystagmus. Characterized by exacerbations and remissions.
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Myasthenia gravis
Formation of antibodies that block the ACH receptors at the myoneural junction producing excess cholinesterase. Thymic enlargement. Causes progressive weakness and fatigue. First starts in the extra ocular muscles. Diplopia.
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ALS
AKA- Lou Gherig's disease. Anterior horn and corticospinal tracts afected with no sensory loss. MOTOR.
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PLS
AKA- combined systems disease. Dorsal columns and corticospinal tract affected. Results from long term pernicious anemia.
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Syringomyelia
Cyst like formation from the central canal of the spinal cord that leads to loss of pain and temperature and signs of an upper motor neuron lesion. Describes as a "cape like" distribution of pins and needles sensation.
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Arnold Chiari
Congenital- brain stem drops through foramen magnum
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Huntington's
Hereditary onset 30-50 yoa. Basal ganglia affected, deficiency of GABA. Produces dementia and death.
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Alzheimer's
Progressive severe atrophy of the cerebral cortex. Aluminum deposits found in the brain.
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Friedreich's ataxia
Lesions of sclerosis of the spinocerebrellar tract
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Guillian Barre
Polyneuritis of the PNS. Seen following immunizations and produces an ascending paralysis. Can be fatal.
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Poliomyelitis
If it affects the anterior horn it produces LMNL. If it affects the brain stem, then cranial nerves are affected and the breathing apparatus may be damaged.
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Korsakoff
Alcoholic psychosis. Depletion of thiamine (B1) due to severe alcoholism.
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Charcot Marie Tooth
Hereditary progressive peroneal muscle atrophy
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Duchenne's Muscular Dystrophy
Pseudohypertrophy of the calves usually boys 3-7 yoa. Recessive sex linked gene. X chromosome linked. Fatal.
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Metabolic Disorders
- Kwashiorkor
- Marasmus
- Wilson's
- Diabetes insipidus
- Diabetes mellitus
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Kwashiorkor
Protein malnutrition
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Marasmus
calorie malnutrition, includes protein
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Wilson's
Inborn error of copper metabolism. Kayser Fleisher rings in the iris.
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Diabetes insipidus
Decreased ADH due to posterior pituitary problem
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Diabetes mellitus
Decreased production of insulin by the beta cells of the pancrease (Islets of Langerhans) Produces polydypsia, polyuria and polyphagia
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Genetic Disorders
- Turner's
- Kleinfelter's
- Down's
- Fragile X
- Phenylketonuria
- Von Gierke's
- Tay Sach's
- Gaucher's
- Krabbe's
- Niemann Pick's
- Alkaptonuria
- Duchenne's MD
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Turner's
XO, female, short stature, webbed neck, lacks female secondary sex characteristics 45X karyotype
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Kleinfelter's
XXY, tall male, low IQ, testicular atrophy, gynecomastia, sterile
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Down's
Trisomy 21, male or female, retarded
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Fragile X
The most common form of mental retardation involving a minimum of 2 X chromosomes and one or more Y chromosomes
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Phenylketonuria
Con not convert phenylalanine to tryosine due to lack of phenylalanine hydolases, retardation can be controlled by diet if caught early.
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Von Gierke's
Lacks enzyme to breakdown glycogen. Excessive amounts of glycogen deposited in the liver.
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Tay Sach's
Inscreased ganglioside content in the brain (glycocerebroside), hexosaminidase A deficency, cherry red spots in the macula, infant death.
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Gaucher's
Excess glucocerebroside in the brain, liver and spleen
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Krabbe's
Excess galactocerebroside in white matter
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Niemann Pick's
abnormal increase in sphingomyelin
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Alkaptonuria
Accumulation of homogentisic acid, blue black deposits in the ears, nose and cheeks. Produces ochronosis causing calcification of the discsof the spine. Urine turns black on standing.
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Duchenne's MD
Seen mostly in boys 3-7 yoa. Produces hypertrophy of the calf muscles. Recessive sex linked gene. Increased CPK.
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Tumors
- Cardiac Sarcoma
- Myxoma
- Teratoma
- Adenoma
- Krukenberg's
- Wilm's
- Leiomyoma
- Rhabdomyoma
- Osteosarcoma
- Multiple myeloma
- Metastasis
- Lipoma
- Hemangioma
- Xanthoma
- Chondroma
- Papilloma
- Seminoma
- Virchow's nodes
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Cardiac Sarcoma
Most commom cardiac malignant tumor of the heart
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Myxoma
Most common benign tumor
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Teratoma
tumor of all three germinal layers
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Adenoma
tumor of glandular tissue
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Krukenberg's
cancer of the stomach that metastasizes to the ovary
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Wilm's
Mixed tumor of the kidney in children
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Leiomyoma
tumor of smooth muscle (fibroids in the uterus)
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Rhabdomyoma
tumor of striated muscle or heart muscle
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Osteosarcoma
Most common bone caner in children
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Multiple myeloma
Most common primary malignancy in adults
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Metastasis
Most common form of cancer in the spine
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Hemangioma
Benign tumor of blood vessels
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Xanthoma
Yellow tumor of connective tissue
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Chondroma
Benign tumor of cartilage
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Papilloma
associated with warts
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Seminoma
Most common cancer of testes
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Virchow's nodes
Enlarged supraclavicular lymph nodes due to metastasis, usually GI tract
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White Blood Cells
- Neutrophils
- Lymphocytes
- Monocytes
- Eosinophils
- Basophils
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Neutrophils
60% increased in acute bacterial infections
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Lymphocytes
30% increased in viral conditions
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Monocytes
5-8% chronic conditions, changes to phagocytes
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Eosinphiles
2-4% parasites and allergies
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Basophils
0-.5% similar to mast cells, produces heparin and histamine. Increased in blood disorders
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B Lymphocytes
Transforms to a plasma cell
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T Lymphocytes
- Matures in the thymus
- 1. Helper: activates B
- 2. Supressor: decreases antibody production
- 3. Killer: kills foreign agents ( transplant rejection)
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Immune Complex
Step 1 of 5
1. antigen enters
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Immune Complex
2 of 5
2. phagocytosed by macrophages
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Immune Complex
3 of 5
3. Exposes antigen to B cells and T helper cells
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Immune Complex
4 of 5
4. T cells make sure that B cells react
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Immune Complex
5 of 5
5. Plasma cells make antibodies forming the immune complex
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Heart and Blood Vessel Disease
- arteriosclerosis
- atherosclerosis
- Monkeberg's sclerosis
- Aneurysm
- Buerger's
- Raynaud's
- Temporal arteritis
- Takayasu arteritis
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Arteriosclerosis
thickening, calcification and loss of elasticity of the arterial walls
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Atherosclerosis
deposition of fatty plaques (atheroma) This is a form of arteriosclerosis.
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Monkeberg's sclerosis
tunica media of medium sized arteries calcified
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Aneurysm
- Berry
- Dissecting
- Abdominal aorta
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Berry Aneurysm
Berry in the circle of Willis, subarachnoid hemorrhage
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Dissecting Aneurysm
longitudinal tearing away from the aorta
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Abdominal aorta aneurysm
can cause low back pain due to erosion of the anterior vertebral body (m/c area to see an aneurysm)
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Buerger's
AKA- thromboangitis obliterans. Young male who smokes heavily. Intermittent claudication. (lower exteremities, femoral art.)
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Raynaud's
Vasospasm of the arteries. May be primary or secondary to other collagen diseases such as Lupus. Found in the hands and feet producing a triphasic color change, from pallor to cyanosis to rubor. Brought on by cold or emotion. Can lead to gas gangrene.
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Temporal arteritis
AKA- Giant cell arteritis. Affects the temporal arteries. Associated with long standing hypertension. Blindness. (Medical emergency)
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Takayasu arteritis
AKA- pulseless disease. granulomatous inflammation of the aortic arch.
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Congenital heart and blood vessel disease
- Tetralogy of Fallot
- Coarctation of the aorta
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Tetralogy of Fallot
likely to cause cyanosis
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Tetralogy of Fallot
DRIP
D. Dextro rotation of the aorta
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Tetralogy of Fallot
DRIP
R. Right ventricular hypertrophy
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Tetralogy of Fallot
DRIP
I. Interventricular septal defect
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Tetralogy of Fallot
DRIP
P. Pulmonic stenosis
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Coarctation of the aorta
narrowing of the lumen produces increased blood pressure in the upper extremities and decreased blood pressure in the lower extremities.
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Blood Cell Disorders
- Hodgkin's lymphoma
- Non Hodgkin's lymphoma
- Burkett's lymphoma
- Multiple Myeloma
- Bruton's agammaglobulinemia
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Hodgkin's lymphoma
Causes seriously enlarged lymph nodes. Produces a Pel Epstein fever which comes and goes. Diagnosed based upon tissue biopsy and presence of the Reed Sternberg cell
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Non Hodgkin's lymphoma
Mostly seen in older people. No Reed Sternberg cells. Symptoms same as Hodgkin's, but more severe. Includes Burkett's lymphoma which is described by its "starry sky" appearance and if found in Africa. Produced Jaw swelling.
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Burkett's lymphoma
described by its "starry sky" appearance and if found in Africa. Produced Jaw swelling.
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Multiple Myeloma
A leukemia of the bone marrow. Affects plasma cells. Seen over the age of 50.
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Bruton's agammaglobulinemia
X linked hereditary disease, decreased IgG, decreased B cells, B cell deficiency.
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Leukemia
- Acute lymphoblastic (ALL)
- Chronic lymphocytic (CLL)
- Acute myeloblastic (AML)
- Chronic myelocytic (CML)
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Acute lymphoblastic (ALL)
seen in children
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Chronic lymphocytic (CLL)
older 75% over 60 increased mature lymphocytes
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Acute myeloblastic (AML)
Any age (worse prognosis)
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Chronic myelocytic (CML)
young adulthood, increased granulocytes "Philadelphia chromosome"
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Anemia
Lack or loss of RBC's
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Anemia
LOSS
Hemorrhage. Hemolytic breakdown of cells by some disease in the body such as sickle cell anemia or malaria.
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Anemia (loss)
Thalassemia Major
AKA- Cooley's anemia. Homozygous Beta thalassemia. AKA- Mediterranean anemia
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Anemia (loss)
Erythroblastosis fetalis
Rh (-) Mother, Rh (+) Father, Rh (+) baby (2nd baby is affected)
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Anemia (decreased production of RBC's)
- Nutritional
- Bone Marrow suppression
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Anemia (decreased)
Nutritional
iron deficiency most common.
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Anemia (decreased)
Pernicious
due to lack of intrinsic factor
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Anemia (decreased)
Folic acid
seen in pregnancy
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Anemia (decreased)
B-12
seen in vegetarians
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Anemia (decreased)
Bone Marrow suppression
Decreased RBC's due to toxins or chemotherapy
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Polycythemia
- increase in RBC's
- Can be in response to high altitudes or lung problems
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Process of Coagulation
- Injury leads to release of thromboplastin (need vitamin K) ---> production of prothrombin ---> thrombin.
- fibrinogen ---> fibrin (clot)
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Process of Coagulation
- Thromboplastin (released by damaged cells)
- Prothrombin (formed in liver)
- Fibrinogen (formed in liver)
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Process of Coagulation
Positive feedback
the more thrombin produced, the more fibrin is produced.
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IgA
Exocrine secretions, milk, tears and saliva
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IgE
Lines respiratory and intestinal tracts. Associated with allergies (increased eosinophils), asthma, Hay fever, parasitic infection
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IgG
Major antibody against virus, bacteria, toxins. Passes placenta
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IgM
Early part of every immune response. Largest. 10 binding sites. primary immune response.
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Hypersensitivity Reactions
- Type I: Anaphylactic
- Type II: Cytotoxic or autoimmune
- Type III: Immune complex
- Type IV: Delayed
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Type I: Anaphylactic
Seen in bronchial asthma, hay fever, food allergies, drug reactions, bee stings. Mast cells and basophils make histamine. Reaction occurs in minutes.
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Type II: Cytotoxic or autoimmune
erythroblastosis fetalis, Goodpasture's, IgG and IgM produced. Reaction takes hours to days.
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Type III: Immune complex
Seen in serum sickness, acute glomerulonephritis, SLE, Arthus reaction. IgG/ antigen antibody complex produced. Takes days.
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Type IV: Delayed
Seen in TB testing, transplant rejection, contact dermatitis (poison ivy). antigen sensitivity T cells. Takes a few days.
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Arthritis
- Rheumatoid
- Osteoarthritis
- Gouty arthritis
- Reiter's
- SLE
- Gonococcal
- Hemophilia
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Rheumatoid
Inflammatory condition usually begins in the hands. Symmetrical distribution. Leads to deformity (ulnar deviation of the wrist) and ankylosis in the spine. Produces pannus fomation over the joints an exudate on synovial cells. Haygarth's and Bouchard's nodes.
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Osteoarthritis
- A degenerative change that occurs in everyone. Usually unilateral distribution in weight bearing joints such as the hips and knees. Produces decreased joint space, subchondral sclerosis and osteophytes.
- Dip joint- Heberden's node
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Gouty arthritis
From inability to properly digest purines. Produces synovial thickening and secondary inflammatory edema (no pannus). Excess uric acid in the blood leads to tophi formation. Big toe- podagra.
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Reiter's
Associated with chlamydia infection. Includes conjunctivitis, urethritis and arthritis
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SLE
A collagen disease ( autoimmune) that can produce arthritis. Produces skin changes, Libman endocarditis. butterfly rash, produces antibodies against double stranded DNA. (ANA test- Anti Nuclear Antibody test)
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Gonococcal
usually affects the knee
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Hemophilia
usually affects the knee
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Bone Tumors: Benign
- Epiphysis
- Metaphysis
- Diaphysis
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Bone Tumors: Benign
Epiphysis
- chondroblastoma
- Giant Cell tumor
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Bone Tumors: Benign
Metaphysis
- osteoblastoma
- osteochondroma
- non-ossifying fibroma
- osteoid osteoma
- chondromyxoid fibroma
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Bone Tumors: Benign
Diaphysis
- enchondroma (hands most common)
- fibrous dysplasia
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Bone Tumors: Malignant
- Diaphysis
- Metaphysis
- Epiphaseal plate
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Bone Tumors: Malignant
Diaphysis
- Ewing's sarcoma 5-20 yoa
- chondrosarcoma
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Bone Tumors: Malignant
Metaphysis
- osteosarcoma (knee) 10-20 yoa (femur) 50%
- osteomyelitis
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Bone Tumors: Malignant
Epiphseal plate
Hematogenous osteomyelitis
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Clotting
- PROTHROMBIN
- (liver makes it and puts it into the blood)
- BLOOD
- (add calcium and potassium)
- THROMBIN
- FIBRINOGEN
- FIBRIN
- CLOTS
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Hypersensitivity Reactions
- Type I: Anaphylactic
- Type II: Cytotoxic
- Type III: Immune Complex
- Type IV: Cell Mediated Hypersensitivity (Delayed)
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Type I: anaphylactic
- Disorder: Bronchial asthma
- Immune Machanism: IgE, Basophils, Mast cells
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Type II: Cytotoxic
- Disorder: Goodpasteur's, Erythroblastosis fetalis, blood tranfusions
- immune Mechanism: Traget cells, Phagocytosis, IgG
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Type III: Immune Complex
- Disorder: Arthus reaction, serum sickness, RA, Lupus
- immune Mechanism: antigen/ antibody, compliment
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Type IV: Cell Mediated Hypersensitivity (Delayed)
- Disorder: TB, contact dermatitis (poison ivy), transplant rejection
- Immune Mechanism: T cells
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