Pathology Dr. Guy's

An increase in the size of the cells of an organ

An increase in the number of cells of an organ

The failure of cell production resulting in lack of development of an organ or tissue

Aplasia during fetal development resulting in the absence of an organ or tissue

A decrease in cell production

Decrease in the mass of pre-existing cells of an organ, wasting

The replacement of one differentiated tissue by another because of chronic irritation or inflammation, seen in smokers

squamous replacement of columnar epithelium in the cervix

Complete disorganization of cells

Change in shape, size or function of cells

anoxia or hypoxia caused by an obstruction, anemia, CO poisoning, poor oxygenation of blood

Condensation of nucleus, shrinking of cells through degeneration, occurs with necrosis

Fragmentation of nucleus, occurs with necrosis

Destruction of the nucleus, occurs with necrosis

• Necrosis from sudden cut-off of blood supply (infarct) to an organ, characterized by preservation of tissue structure
• Heart, kidney, adrenal glands

• Characterized by digestion of tissue
• Most often occurs from ischemic injury to CNS
• "Wet brains"

• cheese-like consistency
• Tuberculosis
• "cheesy TB"

Caused by interruption of blood supply to an extremity or bowel

Accompanied by liquefactive necrosis secondary to bacterial infextion

accompanied by coagulative necrosis due to arterial obstruction of an extremity

• enzymatic necrosis
• a complication of acute hemorrhagic pancreatitis where pancreatic enzymes begin to digest the parenchymal cells of the pancreas

The way peripheral nerves die when severed

degeneration in hyaline cartilage and/or skeletal muscle

• liver, hear, kidney during degeneration
• fatty liver secondary to alcoholism, diabetes, obesity, anemia

• Melanin
• Bilirubin
• Hemosiderin (contains iron)
• Lipofuscin

• albinism
• vitiligo

• hemolytic anemia, biliary obstruction, liver disease
• skin, sclera and organs (jaundice)

• Hemosiderosis - accumulates in macrophages, benign
• Hemochromatosis - accumulates in parenchymal cells resulting in tissue damage, scarring and organ dysfunction

• yellowish breakdown product of lipids
• wear and tear pigment
• liver, skin and heart of elderly

combination of organ atrophy and lipofuscin deposits

hypercalcemia due to hyperparathyroidism, excess vitamin D or milk-alkali syndrome (excess calcium intake)

prevsiously damaged tissue (note: calcium levels are normal)

• 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.

• a vascular response to injury
• Rubor (redness)
• Dolor (pain)
• Calor (heat)
• Tumor (swelling)
• Function laesa (loss of function)

• 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

emigrating leukocytes

• macrophage - tissue
• monocyte - circulation

• Histamine
• Serotonin
• Bradykinin
• Arachidonic acid

• mast cells, basophils and platelets
• increased vascular permeability, vasodilation
• decreases within an hour after onset

• Platelets, mast cells
• Increase vascular permeability

• coagulation pathway
• vasodilator, stimulates pain receptors

• phospholipids of cell membranes
• prostoglandins, leukotriences, and other mediators of inflammation

• Abcess (cavity filled with pus)
• Scar
• Keloid (tumorlike scar)
• Fistula (abnormal communication between two organs)
• Ulcer
• "ASK FU what inflammation can do"

• Immune response - lymphocytes, plasma cells, macrophages
• Phagocytosis
• Necrosis
• Repair

• 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

uncontrolled, disorderly proliferation of cells resulting in a benign or malignant tumor (neoplasm)

spread of a malignant tumor to a non-contigous site, defining characteristic of malignant tumor (benign tumors do not metastasize)

a malignant tumor of epithelial origin

a benign tumor of epithelial origin

carcinoma of glandular epithelium such as breast, pancreas, prostate

benign tumor of glandular epithelium

Malignant tumor of mesenchymal origin such as osteosarcoma (bone), rhabdomyosarcoma (skeletal muscle), leiomyosarcoma (smooth muscle) and liposarcoma (fat)

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

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)

invasive carcinoma that is limited to the layers of the epithelium

malignancy of B-cells (starry sky appearance), associated with Epstein-Barr virus

malignancy of lymphoid tissue diagnosed by the presence of Reed-Sternberg cells, presents as painless lymphadenopathy

Similare to Hodgkin's but no RS cells

• Nephroblastoma
• occurs in children 2 to 4
• huge palpable flank mass around kidney

• ovarian cancer that has spread from the stomach
• ovarian cells are replaced by signet-ring cells

fibroid tumor, most common neoplasm of women, uterine smooth muscle present in 10 to 20 % of women, usually 20 to 40 years of age

• Sentinel or signal node
• enlarged, firm, supraclavicular lymph node, usually on the left side
• indicates a visceral malignancy, often gastric carcinoma

• 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)

• group of malignancies of either lymphoid (lymphocytic) or hematopoietic (myeloid) origin
• bone marrow is filled wiht abnormal cells resulting in anemia, infection or hemorrhage

• ALL - children
• AML - all ages
• CLL - elderly men
• CML - adult men

CML

• 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

• deletion of the short arm of chromosome 5
• severe mental retardation, microencephaly and an unusual cat-like cry
• "cry of the cat"

• trisomy 18
• premature infant
• hypoplasia of muscle
• mental retardation

• Familial hypercholesterolemia
• Huntington's disease
• Marfan's syndrome
• Neurofibromatosis

high LDL, early onset atherosclerosis, xanthoma

age 30 to 40 onset, progressive atrophy of the caudate nuclei and putamen, results in choreiform movements and progressive dementia

• 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"

• von Recklinghausen's disease of the nerves
• acoustic neuromas
• cafe au lait spots
• skeletal disorders
• elephant man's disease

• 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

karyotype 47, XXY (male) --> male hypogonadism, atrophic testes, gynecomastia, tall stature

Karyotype 47, X (female), female hypogonadism, primary amenorrhea and short stature

Karyotype 47, male, tall, severe acne, possibly violent behavior

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)

• Females carry
• Males inherit
• (passed mother to son)
• Classic hemophilia
• Christmas disease

• Hemophilia A
• Deficiency of factor VIII
• hemorrhage from minor wounds
• recurrent hemarthrosis (bleeding into joints)
• crippling deformities

• Hemophilia B
• Deficiency of factor IX
• Same symptoms as hemophilia A

• Tay Sachs disease
• Gaucher's disease
• Nieman-Pick 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"

• accumulation of glucocerebrosides in the monocytes
• Hepatomegaly, erosion of the long bones and anemia

accumulation of sphingomyelin lipidosis in RE cells

• 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

• Phenylketonuria
• Alkaptonuria

• 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

• 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!"

• motor function and coordination are lost
• spastic syndrome
• sometimes accompained by athetoid movements
• hemi or paraplegia, due to UMNL
• scissor's gait

congenital elevation of the scapula sometimes accompained by an omovertebral bone

multiple congenital fusions of cervical vertebrae, may be accompained by Sprengel's deformity and brain stem abnormalities

congenital megacolon (blockage of colon) caused by the absence of nerve plexus and ganglions

malformed cerebellum/medullary structures (below foramen magnum) causing hydrocephalus and possibly spina bifida

• 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)

• 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

Hutchinson's teeth and saddle nose

failure of the interventricular foramen to close, leaving communication open between the left and right ventricles

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

failure of the foramen ovale to close, leaving the two atria communicating

• most common cyanotic congenital anomaly "blue babies"
• Dextrarotation fo aorta
• Right ventricular hypertrophy
• Interventricular septal defect
• Pulmonary stenosis
• "DRIP"

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

• anaphylaxis, allergies, asthma
• IgE response
• mast cells or basophils release histamine, prostagladins and chemotactic factors (to alert phagocytic cells)

• Cytotoxic
• Antibody-antigen reactions cause cell destruction and lysis
• complement system --> lysis
• transfusion reactions, Rh incompatibility, hemolytic anemia

• immune complex
• large antibody-antigen complexes cause platelet aggregation, clotting activation and inflammation
• serum sickness (arthus reaction)
• RA, SLE, GMN (glomularnephritis)

• delayed type (cell-mediated)
• delayed overreaction (because no Ab is involved) because of sensitized T-cells containing a specific antigen
• tuberculin skin test (PPD)

ACID

• G-most numerous
• A-saliva
• M-1st to go up
• E-last to go up, allergies, parasites
• D

• IgG and IgM
• women
• SLE
• Sjrogren syndrome
• Goodpasture's syndrome
• Myasthenia gravis
• Scleroderma
• Hasimoto's thyroiditis

• 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

• 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

Glomerulonephritis and hemoptysis due to autoimmune complexes forming on the glomerular basement membrane and in the lungs

• antibodies act on the acetylcholine receptors at neuromuscular junctions
• muscle weakness upon exertion
• facial (mainly eye muscles) and extremity muslces are primarily affected

• Progressive systemic sclerosis (PSS)
• CREST syndrome:
• Calcinosis
• Raynaud's phenomenon
• Esophageal dysfunction
• Sclerodactyly (claw hands)
• Telagiectasia (dilation of small vessels)

anti-thyroglobulin antibodies, affects the thyroid follicles resuling in hypothyroidism (myxedema)

• Bruton's agammaglobulinemia
• DiGeorge's syndrome
• Wiskott-Aldrich syndrome
• AIDS

• 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

• congenital T-cell deficiency due to hypoplasia of the thymus leading to lymphopenia
• B-cells are unaffected
• leads to recurrent viral and fungal infections

Immunodeficiency accompanied by eczema and thrombocytopenia

• 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

• Pneumocystis carinii pneumonia, CMV and fungal infections (candida, toxoplasmosis and histoplasmosis)
• Kaposi's sarcoma and non-hodgkin's lymphoma

Marsmus and Kwashiorkor

• Protein and calorie malnutrition
• retarded growth and loss of muscle tissue "waste away", NO edema
• "Mars bars are high in protein and calories"

• Protein deficiency with adequate calories
• severe edema, anemia, and fatty liver (swollen belly)

• Toxicity is rare because extra is peed out
• Deficiency leads to glossitis, dermititis and diarrhea

• Thiamine
• 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

• Riboflavin
• Cheilosis, glossitis, seborrheic dermatitis

• Niacin
• Pellagra
• Dementia, dermatitis, diarrhea, death

• Pyridoxine
• Cheilosis, glossitis, and seborrheic dermatitis

• 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

• Cyanocobalamin
• 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

poor collagen formation from impaired wound healing and abnormal bleeding (fragile capillaries)

• poor absorption of fat leads to deficiency
• vitamins A and D

• Deficiency: Nyctalopia (night blindness), xerophthalmia (dry eyes), Keratomalacia (corneal softening), squamous metaplasia of trachea and bronchi
• Toxicity: Alopecia and liver damage

• Calciferol
• Deficiency: Rickets (children), osteomalacia (adults)
• Toxicity: Growth retardation (children), hypercalcuria, nephrocalcinosis and renal calculi

Tocopherol

Deficiency: "Hemorrhagic disease of the newborn" and abnormal bleeding in adults, no toxicity

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)

myxedema and goiter in adults, creatinism in children (primary hypothyroidism)

• impairs the function of insulin --> diabetes
• chromium is found in Glucose Tolerance Factor (GTF)

• assists enzymes in all organs and cells
• deficiency causes growth retardation with sexual immaturity in children
• toxicity has been linked to atherosclerosis

hallucinations, inability to survive a mild heart attack

• stabilizes bones and makes teeth resistant to decay
• excess flouride discolors teeth and makes them brittle

• 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

• 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)

• 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)

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

Vitamin D deficiency in children, causes late closing of fontanelles, long bone deformities, rachitic rosary, pigeon breast

• Osteitis deformans
• affects spine, pelvis, skull
• increased bone density and thick trabecular patterns
• monostotic - affects one bone
• polyostotic - affects many bones

autosomal dominant disorder characterized by short limbs with a normal size head and trunk

• replacement of portions of bone with fibrous tissue
• can result in spontaneous fractures
• can be monostotic or polyostotic
• cobb webb appearance on x-ray

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)

• Neurogenic or neuropathic joint
• destroyed joint because of diminished proprioception
• seen in tertiary syphilis (tabes dorsalis, neurosyphilis), diabetic neuropathy and syringomyelia

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)

• Albers Schonberg disease
• increased density fo the skeleton due to failure of the osteoclastic activity resulting in anemia, blindness, deafness and cranial nerve invlovement

• 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)

• granulation tissue surrounding a bone infection such as osteomyelitis
• most common in male children
• pain worse at night, relieved by asprin

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

Benign exostosis (bony growth covered by a cap of cartilage), any age

benign, soap-bubble epiphyseal lesion containing giant cells, age 25

benign eccentrally located bone tumor, runs from metaphysis to diaphysis, under 20

Benign, centrally located bone tumor, runs from metaphysis to diaphysis, under 20

benign cartilaginous tumor of the hands and feet (most often), multiple --> Ollier's disease

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)

• 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

• Alkaline phosphatase indicates bone growth
• Acid phosphatase indicates bone disease

• Multiple myeloma
• Osteosarcoma
• Chondrosarcoma
• Ewing's sarcoma

• 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

• 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

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

• 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

a fracture in which the bone has broken into three or more pieces

compound fracture, skin has been broken by the bone

simple fractue, skin is intact

bending of the bone when there is an incomplete fracture on the convex side

tearing away of a portion of the bone by forceful muscular or ligamentous pulling

local bulging of bone, usually in children, due to longitudinal compression of soft bone, usually in the radius or ulna or both

a compression fracture of the atlas in which bilateral fractures occur through the anterior and posterior arches

bilateral fractures through the pedicles of C2 (axis) with anterior displacement of C2 on C3

avulsion fracture of the spinous process of C7 (most common) or C6 or T1

fracture of the distal radius with posterior displacement of the distal fragment, most common fracture of the wrist (associated with osteoporosis --> falls)

a fracture of the distal radius with anterior displacement of the distal fragment

fracture of the lower part of the fibula at the malleolus resulting in outward displacement of the foot

Rheumatoid arthritis, Still's disease (juvenille RA)

Ankylosing spondylitis, Reiter's syndrome, Psoriatic arthritis, HLA B27 positive, usually present with peripheral arthritis and sacroilitis

• chronic inflammatory autoimmune disorder
• women 20 to 50
• proximal interphalangeal and metacarpophalangeal joints, ulnar deviation is a characteristic sign

• synovitis, acute inflammatory reactions, edema, pannus (granulation
• tissue), erosion of bone, deformity, swelling and stiffness especially
• in the morning or after inactivity

Juvenile RA, acute onset of fever, generalized swollen glands, liver and spleen enlargment

Marie-strumpell disease, chronic condition of the spine and sacroiliac joints leading to rigidity and fixation from ligamentous calcification and bony fusion (ankylosis)

• conjunctivitis, urethritis, arthritis, often associated with venereal or intestinal disease
• "Can't see, can't pee, can't dance with me"

occurs in about 10% of patients with psoriasis

chronic noninflammatory degenerative joint disease characterized by degeneration of articular cartilage with new bone formation

asymmetrical, from wear and tear, eburnation (ivory bone), osteophyte formation, joint mice, Heberden's nodes (DIP) and Bouchard's nodes (PIP)

• 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

Chondrocalcinosis, caused by depostition of calcium pyrophosphate dihydrate crystals, resembles gout clinically

infective polyarthritis caused by borrelia burgdorferi (spirochete transmitted by a tick), skin lesion (erthema chronicum migrans - bulls eye lesion)

a small cystic nodule arising in the tendon sheath or joint capsule of the wrist "ganglion cyst on the wrist"

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)

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)

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

• dysplastic disease deposits bone into muscle causing pain and swelling
• myositis ossificans cricumscripta usually follows a trauma, usually to quadriceps

disease of the palmar fascia resulting in flexion deformity and loss of finger function

• 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

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

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

loss of direct or consensual light reflex, with normal constriction to convergence "argyll accomodates but does not react", it is present in tertiary syphilis

associated with rheumatic fever, results in involuntary, irregular, jerky movements of the muscles of the head, neck and limbs

in children, problem wiht the spinocerebellar tract, results in lower limb incoordination followed by paralysis

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

Progressive dementia, loss of recent memory then long-term and other intellectual functions, unknown cause

30 to 40, progressive atrophy of the caudate nuclei and putamen, results in choreiform movements and progressive dementia

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

progressive atrophy of tongue, lips, palate, larynx due to cranial nerve degeneration

viral disease --> inflammation of the anterior horn cells of the spinal column --> fever, GI disturbances followed up flaccid paralysis and atrophy

astrocytoma, most common primary brain tumor, occurs in late middle age, hgihly malignant

2nd most common primary brain tumor, benign, slow growing, usually arises from arachnoid cells of the meninges

benign tumor of schwann cells, third most common primary brain tumor, on eighth cranial nerve

tumor of the adrenal medulla (increases catecholamines) and/or sympathetic ganglia

common in children, highly malignant tumor of the cerebellum and brain stem

malignant, intraocular tumor of children, genetic, enucleation (removal of the eye) will cure if has not spread

lungs (#1) and breat (#2)

trigeminal neuralgia --> servere, paroxysmal (sudden) bursts of pain in one or more branches of the trigeminal nerve (CN V)

unilateral paralysis fo the facial muscles supplied by CN VII

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

pain, tingling, numbness in the hand over the distribution of the median nerve cuased by compression by the flexor retinaculum

entrapment of the posterior tibial nerve at the ankle

paralysis of the extensors of the wrist and hand due to a radial nerve lesion

median nerve palsy

bishop's hand or benedictine hand - loss of ulnar nerve function

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

attached clot made of components in the blood, may or may not obstruct the lumen

a plug compsed of a detached thrombus, mass of bacteria, vegetation, fat or other body obstructing the lumen

alternating layers of platelets and fibrin in a thrombus

rigidity and thickening of blood vessels

arteriosclerosis of the tunica media wiht calcific rings resulting in "pipestream" arteries

most frequent cause of vascular disease, fibrous plaques (atheromas) within the intima, made of cholesterol, esters, lipids, calcium and necrotic debris

coronary arteries, circle of Willis and the large vessels of the legs

ischemic heart disease, myocardial infarction, stroke

hypertension, high serum lipids (LDL), cigarette smoking, diabetes mellitus, obesity

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)

brief episodes of impaired neurologic function from temporary disturbances of cerebral circulation, precursor to CVA

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

bleeding into the brain substance, most frequently from hypertension

bleeding into the subarachnoid space, most frequently associated with a berry aneurysm in the circle of Willis

state in which blood flow and perfusion of tissues are inadequate, typically associated wiht a drop in blood pressure

• 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

small lesions in circle of Willis, when burst they leak into the subarachnoid space

longitudinal intraluminal tear usually in the ascending aorta leading to cardiac tamponade and death, painful

erodes the anterior vertebral bodies, boring pain

idiopathic, most common type, risk factors are family history, dietary sodium intake, race and sex (black males), stress, obesity and smoking

most commonly from renal disease or endocrine disorder

essential or secondary, follows an accelerated course resulting in early death from heart failure, CVA or renal failure

chest pain caused by inadequate oxygenation of heart, stable is the most common (pain during exertion and relieved by rest)

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

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)

bacterial infection of the endocardium, vegetations consisting of fibrin, inflammatory cells and bacteria, mitral valve is most affected but all valves can be damaged

caused by strep pyogens or staph aureus, normally secondary to infection occurring elsewhere in body

caused by strep viridans, tends to occur in those with preexisting heart conditions like rheumatic fever

compression of the heart due to build up of fluid in the pericardial sac

stratified squamousepithelium

a neurogenic problem causing constriction of the lower esophagus so food cannot enter the stomach

protrusion of the stomach above the diaphragm, heartburn from gastro-esophageal reflux may occur

dilated veins at the lower end of the esophagus caused by portal hypertension, prone to massive bleeding which may be fatal, common to alcoholics

anemia which can cause esophageal webs "webs in your pipes"

laceration of the lower end of the esophagus --> mediastinal inflammation and hematemesis (vomiting blood), seen in alcoholics from severe vomiting

gastroesophageal junction and stomach are above the diaphragm

The stomach alone is above the diaphragm, the gastroesophageal junction is normal

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)

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)

remnant of the embyonic vitelline duct, most common congenital abonormality of th esmall intestine, can bleed or ulcerate

non-tropical sprue, malabsorption caused by gluten sensitivity

malabsorption of unkonwn cause

rare and severe malabsorption disease in men 30 to 60 --> anemia, skin pigmentation, joint symptoms and diarrhea

chronic inflammatory condition of unknown etiology, similar to chron's but affects only th elarge intestine (the rectum is always affected), bleeding

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

"twisting of a portion of GI tract --> bowel obstruction

"telescoping" of proximal segment to more distal segment --> bowel obstruction

multiple intestinal polyps in GI tract, plus pigmentation of the lips and gums

most common in rectosigmoid region, adenocarcinoma

occurs between 10 to 30, intitiated by fecalith --> anorexia, nausea, severe right lower quadrant pain

yellow discoloration of tissue caused by hyperbilirubinemia, usually due to liver disease, biliary obstruction or hemolytic anemia

"infectious hepatitis" - fecal/oral transmission, complete recovery

"serum hepatitis" - sex/needle transmission, chronic carrier state possible

"Non-A, Non-B hepatitis" - needle or trasfusion transmission, chronic liver disease

speckled liver, chronic passive liver congestion, usually from right heart failure

chronic liver disease characterized by scarring, general disorganization, caused by alcoholism, hepatitis, biliary obstruction and heart failure and wilson's disease

increase in blood pressrue leading into the liver from thrombosis, cirrhosis, metastatic tumors or liver parasites --> esophageal varices, death, hemorrhoids

inflammation of the gallbaldder, often with gallstones --> nausea, vomiting, fever, right upper quadrant pain

activation of pancreatic enzymes --> autodigestion --> severe abdominal pain and prostration, serum amylase levels are increased

head of pancreas --> obstructive jaundice, more common in smokers, death within a year

chronic obstructive pulmonary disease - group of disorders of airflow obstruction, these include asthma, bronchitis and emphysema (blue boaters)

bronchial asthma - dyspnea, wheezing expiration, may lead to status asthmaticus (prolonged bout which may lead to death), chronic broncitis or emphysema

cigarette smoking cuases productive cough occurring at least three consecutive months over at least 2 consecutive years

cuased by smoking --> dilation of air spaces with destruction of alveolar walls, barrel chest loss of elastic recoil (pink puffer)

caused by inhalation of carbon dust (anthracosis), coal dust, silica (silicosis), asbestos (asbestosis --> bronchogenic carcinoma and malignant mesothelioma), iron (siderosis), cotton dust (byssinosis)

chills, fever, bloody sputum

pneumococcal pneumonia (strep), intra-alveolar, consolidation of part or entire lobe

affects the bronchioles and adjacent alveoli and is patchy over one or more lobes

influenza or mycoplasm --> diffuse and patchy

pneumocystitis carinii, common in AIDS patients

right sided heart failure due to either chronic pulmonary disease or a pulmonary embolism

pus in the thorax or "pyothorax", also can describe bacterial inflammation elsewhere in the body

respiratory distress syndrome, premature infants have lack of surfactant in lungs

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"

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

TB that has spread throughout the body

TB of the spine

lung disease presenting with granulomas, enlarged hilar lymph nodes, hypercalcemia and enlarged liver and spleen, more common in black young adult and teenager

alveolar collapse due to tumor, pleural fluid accumulation or neonatal failure to expand

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

absence of urine

decreased urine output

production of an unusually large amount of urine

white patch on mucous membrane

generalized edema

massive proteinuria, hypoalbuminemia, generalized edema and hyperlipidemia caused by diabetic kidney diesease, systemic lupus and glomerulonephritis

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

E. coli infection, increased urinary frequency and painful urination containing pus or blood

bacterial infection of the kidney parenchyma, fever, flank tenderness, WBC casts in urine

stones or uroliths, more frequent in men, 80 to 85% of stones are calcium oxalate or calcium phosphate, cuased by hypercalcemia due to hyperparathyroidism

urethra opens onto the ventral surface of the penis

When the urethra opens onto the dorsal suface of the penis, less common than hypo

abnormally tight foreskin, unable to retract over the glans

unwanted, painful erection

inflammation of the glans penis

failure of a testis to descend into the scrotum, increases risk for germ cell tumors like seminoma and embryonic carcinoma

malignant germ cell tumor, most frequent in mid-30's, painless and curable, most common testicular tumor

most frequent cuase of urinary tract obstruction, extremely common, rubbery, nodular enlargement of the lateral and middle lobes --> frequency, hesitancy, painful urination

extremely common in older men, posterior lobe is affected --> increased prostatic acid phosphatase and prostate specific antigen (PSA), frequently metastasizes to the bone

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

highly absorbent tampons, exotoxin of staph aureus --> fever, vomiting, diarrhea --> renal failure and shock

trachoma or bedsonia, most common sexually transmitted disease --> keratoconjunctivitis and pelvic inflammatory disease

veneral warts caused by human papilloma virus (HPV), usually benign

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

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

uterine leiomyoma, most common uterine tumor and most common tumor in women, benign neoplasm, estrogen sensitive (increases in pregnancy, decreases in menopause)

most malignant are cystadenocarcinomas, many other tumors: teratomas (germ cell origin), many secrete large amounts of HCG, estrogen, androgens or alpha-fetoprotein

an ovarian cancer that has spread from the stomach, ovarian cells are replaces by signet ring cells

toxemia of pregnancy --> hypertension, albuminuria and edema (all three also present in preeclampsia), plus convulsions an dcoagulation disorders

unexplained fever beginning 24 hours after giving birth

occurs in the fallopian tubes usually, can occur in the ovary, abdominal wall or cervix

most common disorder of the breast, masses between ages 25 and 50, mid-cycle tenderness, risk of cancer

most common tumor of the breast in women under 25, benign

most often in the upper outer quadrant, predisposing factors: family history, high animal fat diet, nulliparous women (no children) and increased age

anterior pituitary

secretion of too much growth horomone (somatotropin) before the epiphyseal plates close --> overgrowth of entire body

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"

secretion of too much adrenal corticotrophic hormone (ACTH) due to pituitary tumor causing cushing's syndrome

levi-lorain dwarfism - a deficiency of growth hormone, causing growth retardation (NOT to be confused with achondroplasia which is genetic dwarfism)

posterior pituitary

deficiency of antidiuretic hormone (ADH) --> polyuria and polydipsia

enlargement of the thyroid gland - iodine deficiency or hashimoto's thyroiditis or toxic goiter (hyperthyroid)

manifests as myxedema in adults, cretinism in children

myxedema - iodine deficiency or hashimoto's thyroiditis --> coarse/brittle hair, puffy face/eyelids, obesity and mental slowness, lateral 1/3 of eyebrow is missing

iodine deficiency or maldevelopment of the thyroid --> severe mental retardation, dwarfism, large tongue

autoimmune disorder where the thyroid is attacked by anti-thyroid antibodies and anti-microsomal antibodies

thyrotoxicosis (Grave's disease or plummers disease) --> toxic goiter, exopthalmos, restlessness, irritability, tremor, tachycardia, weight loss

produces excess calcitonin --> lowers blood levels of calcium

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)

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)

genetic, end-organ (kidney) is unresponsiveness to parathyroid hormone

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"

deficiency of glucocorticoids and mineralcorticoids, mainly aldosterone, most often due to adrenal atrophy --> decreased blood pressure, skin pigmentation, hyponatremia, hyperkalemia

excess secretion of mineralocorticoids, primarily aldosterone --> sodium (and water) retention, leading to hypertension

meningococcemia and meningitis --> hemorrhage into the adrenal glands --> circulatory collapse

benign tumor of the chromaffin cells of the adrenal medulla --> surgically correctable hypertension from the overproduction of the catecholamines (epi and norepi)

renal dysfunction, atherosclerosis, vascular disorders (gangrene of lower extremeties), cataracts, retinopathies, and frequent infections (ex. candida)

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

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

idiopathic hemochromatosis, defect in iron absorption --> diabetes mellitus, cirrhosis and skin pigementation

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

increase in number of ALL blood cells

dietary deficiency (infants), chronic blood loss (adults) or pregnancy --> pallor, fatigue, dypsnea on exertion, hypochromic, microcytic RBC's

macrocytic, normochromic erythrocyte precursor cells due to deficiency of B12 (pernicious anemia) or folate (true megaloblastic anemia) --> chelosis, sore tongue

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

secondary to toxic exposure to radiation, chemicals, therapeutic drugs or viral infection --> bone marrow destruction and pancytopenia (all blood cells decreased)

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

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

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

cooley's anemia or mediterranean anemia, increase in hemoglobin F, sickle cell anemia symptoms plus distortion of the skeleton, thalassemia minor (trait) few symptoms