General patho 0422Q Flashcards
what is a common complication of aspiration PNA?
LUNG ABSCESS
caused by anaerobic bacteria of gingivodental sulcus (fusobacterium, peptostreptococcus, bacteroides)
who gets aspiration PNA?
pts with impaired consciousness OR decreased ability to swallow (alcoholics, chronically ill, demented)
what sx are seen with lung abscess?
cough with copious foul-smelling sputum.
fever, malaise, weight loss, clubbing, leukocytosis.
where do lung abscesses most often develop?
RIGHT lung bc right bronchus is straighter
where does gastric cancer commonly met to?
- left supraclavicular sentinel node (Virchows node)
- periumbilical region (SQ mass - Sister Mary Joseph nodule)
- ovary (Krukenberg tumor)
Krukenberg tumor
mucin-producing signet ring cells in ovarian stroma.
common type of metastatic ovarian cancer.
where do systemic emboli arise from?
left atrium or left ventricle
ex: LA clot, LV clot, valvular vegetation, aortic atherosclerotic plaque
what simultaneous clinical features point to emboli?
stroke, intestinal/foot ischemia, renal infarction
what gene mutation is involved in hemochromatosis?
HFE protein (chromo 6) - unregulated iron uptake by transferrin/iron complex endocytosis (high Fe GI absorption)
what are the more serious complications of hemochromatosis?
liver cirrhosis, HCC
what does positive babinski sign indicate?
[extension/dorsiflexion of toes with plantar stroking]
UMN lesion (other signs include hyperreflexia, muscle weakness/paralysis, and spasticity)
what is the straight leg raise test?
leg held straight while raised off exam table - pain indicates sciatic nerve root (L4-S3) irritation. intervertebral disc herniation causing sciatica.
kaposi sarcoma affects?
skin but can have extracutaneous spread to LUNGS and GI TRACT
what is the most important RF for development of intimal tears leading to aortic dissection?
hypertension
less commonly, cystic medial degeneration of marfan
what are major RFs for atherosclerosis predisposing to aortic aneurysm?
smoking, diabetes, hypercholesterolemia
what is the schilling test?
give pt oral radiolabeled vit B12 followed by IM injection of unlabeled B12 – measure urinary excretion of radioactive B12 – normal excretion indicates dietary deficiency while decreased excretion indicates intestinal problem (pernicious anemia or malabsorption)
sx of carcinoid syndrome (metastatic to liver)
- vasomotor instability: cutaneous flushing, dizziness
- GI: secretory diarrhea, crampy pain
- bronchoconstriction: dyspnea with wheezing
- right sided valvular heart disease (tricuspid, pulmo)
how does phosphatidylcholine affect cholesterol?
phospholipid that makes chol soluble - high levels (along with high levels of bile acid) help decrease risk for gallstones
complications of adult-type coarctation of aorta
HTN-associated: LV failure, ruptured dissecting aortic aneurysm, intracranial hemorrhage (increased incidence of congenital berry aneurysm)
causes of spontaneous intracranial hemorrhage in young adults
- AV malformations
- ruptured cerebral aneuryms
- sympathomimetic drugs (cocaine)
what change is seen with congenital pyloric stenosis?
hypertrophy of pyloric muscularis mucosa (palpable olive-sized mass)
how does desmopressin acetate (DDAVP) treat mild-moderate hemophilia A and vW disease?
synthetic vasopressin analog that release factor VIII and vWf from endothelial cells
what is Virchows triad?
- endothelial injury
- venous stasis
- hypercoag state
predispose to DVT
morphology of NSAID-assoc. chronic renal injury
papillary necrosis and chronic interstitial nephritis
vWf functions
- protective carrier for circulating factor VIII
2. promoter of plt adhesion to injured epith surfaces - bind plt glycoprots to collagen on injured bld vessel wall
what is the major cause of mitral regurg?
mitral insuff due to myxomatous degeneration (mitral valve prolapse predisposes to infected vegetations) - native valve bacterial endocarditis (plt and fibrin deposit on valves spontaneously, then microorgs colonize valves during bacteremia)
what is the COD in rare but lethal acute rheumatic fever?
heart failure due to severe myocarditis (with MR)
when does acute rheumatic fever occur?
10d-6wks after group A strep pharyngitis.
most often age 5-15.
how common is the occurrence of acute rheumatic fever and PSGN together?
RARE!
what is lacunar infarct most commonly due to?
hypertensive arteriolosclerosis of small penetrating arterioles.
involves basal ganglia, pons, internal capsule, or deep white matter of brain.
small size < 15 mm
what is most affected by ischemic ATN?
tubular epith cells - proximal tubule and thick ascending limb of Henle
what is syringomyelia?
formation of cavity (syrinx) in cervical SC - damage to ventral white commissure leads to bilateral loss of P&T. extension of syrinx destroys motor neurons (ventral horns) causing flaccid paralysis, atrophy of intrinsic hand mm, other LMN signs
red neuron
neuron responding to irreversible injury.
changes evident 12-24hrs after event.
cell body shrinks, eosinophilic cytoplasm, pyknosis of nucleus, loss of Nissl substance.
how does sickle cell disease affect spleen?
repeated splenic infarctions resulting in splenic atrophy with scarring/fibrosis or asplenia (by young adulthood) - after autosplenectomy, pts are predisposed to infx with encapsulated bact.
why are pts with sickle cell or other hemolytic anemias predisposed to folic acid deficiency (and thus, macrocytic change)?
increased RBC turnover
what do ECG findings in leads II, III, aVF along with MI sx indicate?
transmural ischemic injury to INFERIOR wall of heart (supplied by posterior descending branch of RCA)
how do pts with vWf disease often present?
lifelong hx of gingival bleeding, epistaxis, mucosal bleeding, menorrhagia.
occult bleeding may be sufficient to cause iron deficiency anemia.
histology of acute viral hepatitis
panlobular lymphocytic infiltrates.
ballooning hepatocytes.
hepatocyte necrosis.
hepatocyte apoptosis (acidophliic councilman bodies).
what is the most common hepatic malignancy?
mets from another primary site (breast, lung, colon). more common than HCC.
what does a matched V/Q defect mean?
ventilation defect matched by perfusion defect = lung collapse or consolidation
why is there an increased incidence of subdural hematoma in elderly indivs after minor trauma?
age-related brain atrophy: distance from skull to brain surf increases, and cortical bridging veins are under more tension/rupture more easily.
gradual onset of sx. subtle and variable presentation (“great imitator”)
what factors predispose to infective endocarditis?
prosthetic heart valves.
prior valvular inflamm, damage, and scarring.
what do the vegetations assoc. with bacterial endocarditis represent?
fibrin and plt deposition at site of bact colonization (most common: S.aureus)
what is a common cause of acute renal failure in children?
HEMOLYTIC-UREMIC SYNDROME (HUS) - shiga toxin producing E.coli or Shigella dysenteriae.
TRIAD: ARF, microangiopathic hemolytic anemia, thrombocytopenia
what are signs of hemolysis?
pallor.
red urine.
etc…
