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NBDE PART 1 MICRO/PATH > Micro/Path: Disorders and Inflammation > Flashcards

Micro/Path: Disorders and Inflammation Flashcards

1
Q
  1. increased melanin pigmentation is seen in?

2. decreased melanin pigmentation is seen in? (2)

A
  1. Addison’s Disease

2. Albinism and Vitiligo

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2
Q

Melanin is the only endogenous __ colored pigment

A

brown-black

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3
Q

what enzyme catalyzes the oxidation of tyrosine ==> dihydroxyphenylalanine in melanocytes?

A

tyrosinase

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4
Q

Homogentistic acid is a __ pigment that occurs in patients with ___ = a rare metabolic disease

A

black, alkaptonuria

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5
Q

Ochronosis __

A

is the syndrome caused by the accumulation of homogentisic acid in connective tissues: skin, cartilage, CT = alkaptonuria

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6
Q

occurs when melanocytes, the cells responsible for skin pigmentation, die or are unable to function

A

Vitiligo

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7
Q

the normal major pigment found in bile

A

Bilirubin

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8
Q
  1. Bilirubin is derived from ___

2. does it contain iron

A
  1. Hemoglobin

2 no

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9
Q

is bilirubin normal function and excretion vital to health

A

yes

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10
Q

excess ___ causes jaundice

A

bilirubin

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11
Q

hemosiderin

A

hemoglobin derived, yellow to brown pigment that serves as one of the major storage forms of iron

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12
Q

under normal conditions small amounts of hemosiderin can be seen in

A

mononuclear phagocytes of bone marrow, spleen and liver which are actively engaged in RBC break down

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13
Q

Local excess of Hemosiderin is seen when there is

A

hemorrhages in tissues.
Hemosiderin is most commonly found in macrophages and is especially abundant in situations following hemorrhage, suggesting that its formation may be related to phagocytosis of red blood cells and hemoglobin.

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14
Q
  1. best example of localized hemosiderosis is a

2, when there is SYSTEMIC overload of iron, hemosiderin may be deposited in organs and tissues. this is called

A
  1. bruise

2. hemosiderosis

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15
Q

an inherited condition of extreme accumulation of iron and is associated with the liver, heart, and pancreatic damage, resulting in liver fibrosis, heart failure, and DM

A

hemochromatosis

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16
Q

Gout = defect in metabolism = overproduction of

A

uric acid

or reduced ability of kidney to eliminate the uric acid

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17
Q

is gout inherited?

A

yes
may also develop in pp with DM, sickle cell anemia, kidney disease, or drug therapy that interferes with uric acid excretion

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18
Q

gout is a disorder of _ metabolism and predominantly in men/women

A

purine

men

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19
Q

monosodium urate crystals

A

gout

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20
Q

hyperuricemia causes deposition of ___ into joints of people w gout

A

monosodium urate crystals

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21
Q

gout occurs most frequently in which joint

A

metatarsophalangeal joint of the big toe

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22
Q

podagra

A

acute gouty arthritis in big toe is called

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23
Q

tophi

A

= large aggregates of urate crystals seen in chronic gouty arthritis

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24
Q

most individuals with chronic gout also develop

A

urate nephropathy

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25
Q

Primary gout is the most common form = means

A

hyperuricemia without evident cause: most common in middle aged men and family predisposition

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26
Q

secondary gout is much less common. this is hyperuricemia with causes like

A

leukemia, multiple myeloma, myeloproliferative syndromes,

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27
Q

Lesch-Nyhan syndrome

A

hyperuricemia w severe neurological manifestations.

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28
Q

calcium pyrophosphate dihydrate crystal depostions caused by

A

pseudogout = elicits inflammatory reaction in cartilage. resembles gout clinically

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29
Q

acute cholecystitis

A

sudden inflammation of the gallbladder = severe abdominal pain.

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30
Q

90% of acute cholecystitis is caused by

A

gallstones (cholelithiasis) in the gallbladder

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31
Q

What kind of bacteria is isolated in ACUTE cholecystitis 80% of the time?

A

enteric bacteria

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32
Q

acute cholecystitis causes __ to become trapped in the gallbladder. this build up = irritation and pressure in gallbladder that can lead to bacterial infection and perforation of the organ

A

bile

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33
Q

___cholecystitis is thickening of the gallbladder wall occurring as a result of extensive fibrosis. it is frequently complicated by gallstones and bacteria can be cultured 30% of the time

A

chronic

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34
Q

Gallstones (cholelithiasis) occur more freq in men/women

A

women

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35
Q

Gallstones (cholelithiasis) associated w/_ and _ in women

A

obesity and multiple pregnancies

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36
Q

Gallstones (cholelithiasis) become more common in both sexes with increasing

A

age

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37
Q

What ethnicity have a higher rate of Gallstones (cholelithiasis)

A

native americans

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38
Q

Urinary stones are typically classified by their location in the

  1. (nephrolithiasis),
  2. (ureterolithiasis)
  3. (cystolithiasis),
  4. (cholelithiasis)
A
  1. kidney stone
  2. ureter
  3. bladder
  4. gallblader
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39
Q

3 types of cholelithiasis:

  1. cholesterol stones
  2. pigment stones
  3. mixed stones
    which one is most common
A

mixed stones (80%)

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40
Q

this type of cholelithiasis is made of cholesterol and calcium salts

A

mixed stones

most common

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41
Q

type of cholelithiasis resulting from precipitation of excess insoluble UNCONJUGATED BILIRUBIN

A

pigment stones

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42
Q

type of cholelithiasis that is usually solitary and too large to enter the cystic duct or common bile duct

A

cholesterol stones

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43
Q

this type of cholelithiasis is associated with hemolytic anemia and bacterial infection

A

pigment stones

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44
Q

small yellow cholesterol flecks that are highlighted against a red background in the lining of the gallbladder

A

strawberry gallbladder aka Cholesterolosis

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45
Q

small finger like out pouchings of the gallbladder lining that develops as a person ages. may cause inflammation and require gallbladder removal

A

diverticulosis of the gallbladder

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46
Q

gallstones that block the __ duct result in obstructive jaundice (yelloo skin bc bile pigment deposited in skin)

A

common bile duct

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47
Q

inadequate secretion of thyroid hormones during fetal life or early infancy

A

cretinism

congenital deficiency in the secretion of the hormone thyroxine from thyroid gland

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48
Q

cretinism is a condition of ___ growth and impaired __development

A

stunted body growth and impaired mental development

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49
Q

In cretinism, the mandible is ___ developed
the maxilla is ___ developed
the eruption of primary AND permanent teeth are

A
  1. mandible is underdeveloped
  2. maxilla overdeveloped
  3. delayed
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50
Q

baby has open mouth that drools, swollen face and tongue, umbilical hernia, coarse, dry skin

A

cretinism

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51
Q
  1. Myxedema

2. more common in

A

hypothyroidism in adults (or underactivity of thyroid)

women

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52
Q

puffiness of face, eyelids, swelling of tongue and larynx, dry rough skin, hair becomes sparse, mentally and physically sluggish. obesity, over 50y/o, women, xray/radiation treatment, thyroid surgery are risk factors

A

myxedema (hypothyroid)

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53
Q

the secretion of T3 (triiodothyronine) and T4 (thyroxine) is controlled by the __ and __ in the brain

A

pituitary and hypothalamus

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54
Q

majority of T3 is formed in __ tissues by

A

peripheral, conversion of secreted T4

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55
Q

Hematemesis
associated with?
source?

A

vomiting of blood. The source is the upper gastrointestinal tract. associated with esophageal varices common in alcoholics, or peptic ulcers

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56
Q

hemoptysis

associated with?

A

(coughing up blood) = in minor upper respiratory infections or bronchitis, TB, pneumonia, bronchiogenic carcinoma, idiopathic pulmonary hemosiderosis (iron in the lungs)

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57
Q

blood in urine usually caused by

A

Urinary tract and kidney diseases

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58
Q

in women, blood seen in urine may be coming from

A

vagina and not the urine

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59
Q

in men the urethra carries both urine and semen out of the body. if it is not urinary bleeding that causes blood in urine it could be a

A

prostate problem = bloody ejaculation

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60
Q

causes for blood in urine for children?

A

coagulation disorders: hemophilia, sickle cell, renal vein thrombosis, thrombocytopenias

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61
Q

idiopathic pulmonary hemosiderosis (iron in the lungs) main symptom is

A

hemoptysis (coughing up blood)

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62
Q

glucosuria

common in

A

glucose (sugar) in urine

DM

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63
Q

Ketonuria

common in

A

ketones in urine

produced by starvation, uncontrolled DM, occasionally alcohol intoxication

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64
Q

proteinuria

sign of

A

protein in urine

kidney disease

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65
Q

which vessels are particularly prone to tearing along their course thru the subdural space and are a source of bleeding in most cases of subdural hematoma

a. middle meningeal artery
b. middle cerebral artery
c. berry aneurysm in the circle of Willis
d. bridging veins

A

bridging veins

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66
Q

epidural hematomas usually occur from

A

skull fractures and laceration of middle meningeal artery

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67
Q

subdural hematomas usually occur from

A

bridging veins tearing from deceleration injury from a fall or motor vehicle accident but RARELY a fracture

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68
Q

subarachnoid hemorrhages usually occur from

A

Berry aneurism in circle of willis

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69
Q

immediate and temporary disturbance of brain functions - dizziness, cold perspiration visual disturbance and loss of consciousness

A

brain concussion

most pp recover completely within a few hours/days

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70
Q

one complication of a brain concussion is

A

postconcussion syndrome

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71
Q

meningioma - tumor arising from __

A

arachinoid

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72
Q

mnemonic for hematomas and hemorrhages?

A 
EDH = epidural hematomas = MMA (middle menigeal artery) or fracture
SDH = subdural hematomas = BV (bridging vein) tear, fall or deceleration accident. RARELY a fracture
SAH = subarachnoid hemorrhages= BA (berry aneurism)in circle of willis (berry aneurism)
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73
Q

clinical deficiency in vitamin A?

A

night blindness

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74
Q

vitamin a is called

A

retinol

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75
Q

Fat soluble vitamins

A

ADEK

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76
Q

Vitamin _ is involved in blood clotting. if there is a defect = coagulation defects

A

K

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77
Q

Vitamin _ is an antioxidant. Defects = neurological disorders, ex ataxia

A

E (tocopherol)

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78
Q

Vitamin _ is essential in bone formation. deficiency = Rickets in children and osteomalacia in adults

A

D (cholecalciferol)

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79
Q

This vitamin helps maintain normal body growth and health of specialized tissues especially the retina. it produces_____

A

Vitamin A (retinol) produces rhodopsin (photopigment)

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80
Q

vitamin A def causes

A

night blindness, keratomalacia, xerophthalmia, follicular hyperkeratosis

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81
Q

Xerophthalmia

cause?

A

the eye fails to produce tears

lack of Vit A

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82
Q

Nyctalopia

A

night blindness

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83
Q
  1. Pathologic calcification is the abnormal tissue deposition of?
A

calcium salts together with smaller amounts of iron, magnesium and other mineral salts

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84
Q
  1. Pathologic calcification: when deposition occurs LOCALLY IN DYING TISSUE it is known as ___(dystrophic/metastatic calcification)?
  2. What’s special about this is that it occurs despite?
A
  1. dystrophic calcification = dying (D =D)

2. despite NORMAL levels of calcium and in the ABSENCE of derangements in calcium metabolism.

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85
Q
  1. Pathologic calcification: when deposition occurs NORMAL TISSUE it is known as ___(dystrophic/metastatic calcification)?
  2. almost always results from
A
  1. metastatic calcification

2. hypercalcemia secondary to some disturbance in calcium metabolism

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86
Q

dystrophic/metastatic calcification = normal tissues whenever there is hypercalcemia.

A

metastatic

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87
Q

dystrophic/metastatic calcification = encountered in areas of necrosis, and in necrosis of fat

A

dystrophic

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88
Q

4 principal causes of hypercalcemia

A
  1. increased PTH secretion = increases bone resorption
    (hyperPTH)
  2. destruction of bone tissue (bone tumors/bone marrow)
  3. vitamin D disorder
  4. renal failure = retention of phosphate leading to secondary hyperparathyroidism
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89
Q

sialolith

A

stone in salivary duct (salivary calculus)

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90
Q

sialolithiasis

A

formation of sialolith = stone in salivary duct (salivary calculus) = can cause swelling/pain

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91
Q

___ occurs as a result of precipitation of calcium and phosphate salts around a nidus of mucous or bacterial debris

A

sialolithiasis

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92
Q

Most sialoliths are found in the __ duct and gland

A

submandibular duct (Wharton’s duct) and gland

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93
Q

Stenson’s duct belongs to which gland

A

parotid

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94
Q

Wharton’s duct belongs to which gland

A

submandibular

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95
Q

the smallest, most diffuse, and the only unencapsulated major salivary gland

A

sublingual gland

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96
Q

ducts of Rivinus belongs to which gland

A

sublingual

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97
Q
  1. sublingual glands lie ___ to the submandibular gland inferior to the tongue, as well as beneath the mucous membrane of the floor of the mouth.
  2. Each gland is effectively palpated on the floor of the mouth posterior to which teeth?
  3. can you palpate them?
A
  1. anterior
    2, each mandibular canine
  2. yes Placing one index finger intraorally and the fingertips of the opposite hand extraorally, the compressed gland is manually palpated between the inner and outer fingers
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98
Q

calcinosis

A

calcification that occurs under the skin. scleroderma, dermatomyositis, multiple miliary osteomas are examples

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99
Q

__ is required for porphyrin synthesis, is associated with anemia and cheilosis, glossitis, and synthesis of niacin from tryptophan

A

vitamin B6 = pyridoxine

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100
Q

which vitamins are water soluble?

A

B1, B2, B3, B5, B6, B12, folic acid and C

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101
Q

a deficiency in this vitamin causes defective wound healing

A

C

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102
Q

a deficiency in this vitamin causes Scurvy

A

C

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103
Q

a deficiency in this vitamin causes Pellagra

A

B3 niacin (Don’t confuse with Podagra = gout in big toe!)

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104
Q

a deficiency in this vitamin causes wet and dry beriberi

A

Vitamin B1 thiamine

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105
Q

a deficiency in this vitamin causes cheilosis, gossitis, and dermatitis

A

B2 riboflavin

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106
Q

a deficiency in either of these 2 vitamins causes megaloblastic anemia

A

Folic acid and B12 (cobalamine)

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107
Q

a deficiency in this vitamin causes megaloblastic anemia AND NEUROLOGIC DYSFUNCTION

A

B12(cobalamine)

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108
Q

deficiency in this vitamin causes megaloblastic anemia AND NOOOO NEUROLOGIC DYSFUNCTION

A

Folic acid

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109
Q

a deficiency in this vitamin causes WERNICKE-KORSAKOFF SYNDROME

A

B1 thiamine

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110
Q

this vitamin is a component of FAD and FMN and is essential for oxidation reduction processes

A

B2 riboflavin

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111
Q

this vitamin is required for transamination, porphyrin synthesis, synthesis of niacin from tryptophan

A

B6 pyridoxine

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112
Q

this vitamin is a component of NAD and NADP, essential to glycolysis, TCA, and oxidation reactions

A

B3 niacin

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113
Q

these 2 vitamins are 1 carbon transferers

A

B12 (cobalamine) and folic acid.

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114
Q

this vitamin is required for the hydroxylation of proline and lysine, which are essential for collagen synthesis, and hydroxylation of dopamine in synthesis of norepinephrine

A

Vitamin C

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115
Q

deficiency in this vitamin causes cheilosis, glossitis and anemia

A

B6 pyridoxine

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116
Q

this vitamin is required for folate synthesis and FH4 activation

A

B12 cobalamine

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117
Q

Trachoma is an ___ infection caused by what bacteria

A

eye

chylamydia trachomatis

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118
Q

conjunctivitis

A

pink eye = inflammation of conjunctiva (the tissue that lines the INSIDE of the eyelids

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119
Q

most common and treatable eye infection is

A

conjunctivitis

pink eye

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120
Q

conjunctivitis can be caused by virus, bacteria, irritating substances (shampoo/dirt/smoke/pool chlorine), allergens or STDs. Pink eye caused by which one can be spread from person to person

A

bacteria, virus, Std

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121
Q

conjunctivitis COMMON features

A

soreness redness discharge, visual acuity is good

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122
Q

if a neonate has conjunctivitis we must ensure

A

that there has been no maternal STD association with it

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123
Q

Trachoma is an eye infection caused by __

A

chylamydia trachomatis

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124
Q

__ is the most common cause of preventable blindness in underdeveloped areas of the world

A

chylamydia trachomatis

Trachoma

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125
Q

toxicity of therapeutic oxygen, most often administered because of neonatal respiratory distress syndrome that lead to blindness

A

retinopathy of prematurity = retrolental fibroplasia

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126
Q

diabetic retinopathy is a major cause of

A

blindness

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127
Q

hereditary night blindness with progressive loss of central vision caused by early loss of rods and later loss of cones

A

retinitis pigmentosa

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128
Q

macular degeneration of the aged (senile macular degeneration) is a major cause of impaired vision in the __ and is often bilateral

A

elderly

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129
Q

glaucoma has two forms:

A

open angle and angle closure

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130
Q

most common form of glaucoma

A

open angle glaucoma

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131
Q

this type of glaucoma = narrow anterior chamber angle and increase in intraocular pressure on dilation of pupil

A

angle closure glaucoma (less common)

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132
Q

this type of glaucoma = gradually increasing ocular pressure leading to visual impairment and eventually blindness

A

open angle glaucoma (most common form)

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133
Q

a malignant retinal tumor of childhood

A

retinoblastoma

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134
Q

pt in emergency room w/severe mid abdominal pain. Dr thinks its acute pancreatitis and orders a blood test. lab values show elevated serum lipase. to confirm the diagnosis which other enzyme would likely be elevated?

a. alkaline phosphate
b. amylase
c. glucose-6-phosphatase
d. acid phosphatase

A

amylase.

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135
Q

pancreatitis is an __ or __ of the pancreas

A

infection or inflammation

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136
Q

pancreas is an elongated tapered gland located behind/in front of the stomach

A

behind

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137
Q

pancreas secretes

A

digestive enzymes and hormones insulin and glucagon

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138
Q

pancreatitis is often caused by the digestion of parts of the organ by pancreatic enzymes that are normally carried to the small intestine within the pancreatic ducts. IN acute pancreatitis, what has occured

A

obstruction of the normal pathway of pancreatic juice into the intestine. the zymogens of the proteolytic enzymes are converted into their catalytically active form prematurely inside the pancreatic cells. = attack the pancreas itself = painful and serious destruction of the organ = which can be fatal.

139
Q

acute pancreatitis is associated with

A

alcoholism and biliary disease

140
Q

acute pancreatitis consequences include enzymatic hemorrhagic fat necrosis with __ formation and resultant __

A

calcium soap

hypocalcemia

141
Q

cardinal clinical sign of acute pancreatitis is

A

severe mid-abdominal pain

142
Q

cardinal sign of acute cholecystitis is

A

severe RUQ or upper abdominal pain

143
Q

cardinal sign of acute appendicitis is

A

severe RLQ abdominal pain with marked rebound pain to palpation

144
Q
  1. severe mid-abdominal pain
  2. severe RUQ or upper abdominal pain
  3. severe RLQ abdominal pain with marked rebound pain to palpation
A
  1. acute pancreatitis
  2. acute cholecystitis
  3. acute appendicitis
145
Q

Neurobromatosis type 1 is aka

A

von Recklinghausen’s disease

146
Q

Neurobromatosis type 1 is aka von Recklinghausen’s disease is an autosomal __ disorder

A

dominant

147
Q 
gliomas of the optic nerve
neurofibromas (plexiform and solitary)
pigmented nodules of the iris (Lisch nodules)
cutaneous hyperpigmented macules
(café-au-lait spots) 
are?
A

Neurobromatosis type 1 is aka von Recklinghausen’s

148
Q

bilateral eighth nerve schwannomas and multiple meningiomas, gliomas are

A

Neurobromatosis type 2

149
Q

Neurobromatosis type 1 (von Recklinghausen’s disease), Neurobromatosis type 2, Marfan Syndrome, Familial hypercholesterolemia, hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) and Adult polycystic kidney disease are all

A

autosomal dominant disorders

150
Q

autosomal dominant disease w/anomalies of receptors for low density lipoproteins (LDLs)

A

Familial hypercholesterolemia

151
Q

autosomal dominant disease characterized by local telangiectases of the skin and mucous membranes and by recurrent hemorrhage of lesions. Common in Mormon families of Utah

A

hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)

152
Q

autosomal dominant disease characterized by defects in skeletal, visual and cardiovascular structures. Patients are tall thin w/abnormally long arms and spider like fingers (archnodactyly) and hyperextensible joints. heart problems: aneurysm of the proximal aorta, mitral valve prolapse and dissecting aneurysm of the aorta

A

Marfan syndrome

153
Q

autosomal dominant disease characterized by numerous bilateral cysts that replace and destroy the renal parenchyma

A

Adult polycystic kidney disease

154
Q

T/F the most common cause of hypothyroidism in adults is Grave’s disease

A

false. Most common cause is Hashimoto’s thyroiditis (aka chronic thyroiditis or Hashimoto’s Disease)

155
Q

T/F hypothyroidism can be caused by iodine deficiency

A

true

156
Q

The strongest female predilection of any disease known to man

A

Hashimoto’s thyroiditis (most common cause of hypothyroidism)

157
Q

Hashimoto’s thyroiditis:

  1. onset of disease is __slow/fast
  2. thyroid may initially be painlessly enlarged, over time the inflammation leads to __
  3. it is associated with various __
  4. histologic characteristic = massive infiltrate of __ with germinal center formation
A
  1. slow
  2. atrophy of the thyroid
  3. autoantibodies: antithyroglobulin, antithyroid peroxidase, anti-TSH receptor, and anti-iodine receptor antibodies.
  4. lymphocytes
158
Q

slowed speech, fatigue, cold intolerance, dry skin, coarse hair and puffy face are symptoms of

A

hypothyroidism

159
Q

in Hashimoto’s disease there is a production of antibodies in response to thyroid antigens and the replacement of normal thyroid tissue with

A

lymphocytes and lymphoid germinal centers

160
Q

primary hyperparathyroidism (HPT) is most often caused by

A

parathyroid adenoma

161
Q

hypothyroidism (cretinism and myxedema) can be caused by __ deficiency

A

iodine

162
Q

Grave’s disease is the most common cause of endogenous ___

A

hyperthyroidism

163
Q
  1. ___is the most common cause of endogenous hyperthyroidism

2. ___ most common cause of hypothyroidism

A
  1. Grave’s Disease = 10x more likely in women
  2. Hashimoto’s Thyroiditis Disease
    Note both are autoimmune disease and both women are WAY more likely to get it
164
Q

Grave’s disease = multiple autoantibodies form against the

A

thyroid antigens especially the TSH receptor

165
Q

a somatotropic adenoma with hypersecretion of growth hormone that develops before epiphyseal closure results in

a. cretinism
b. acromegaly
c. gigantism
d. myxedema

A

c. gigantism

166
Q

anterior pituitary HYPERFUNCTION is usually due to

A

benign slow growing tumors

167
Q

most common pituitary tumor

A

Prolactinoma with hyperprolactinemia

168
Q

in women, Prolactinoma with hyperprolactinemia results in

A

amenorrhea and galactorrhea (inappropriate milk secretion)

169
Q

Second most common pituitary tumor

A

somatotropic adenoma with hypersecretion of growth hormone

170
Q

somatotropic adenoma with hypersecretion of growth hormone:

  1. ___ results if adenoma develops before epiphyseal closure
  2. ___ results if adenoma develops AFTER epiphyseal closure
A
  1. gigantism

2. acromegaly

171
Q

Deep voice
enlarged tongue
prognathism (mandible protrudes)
excessive perspiration and offensive body odor
gradual marked enlargement of the head, face, hands, feet and chest

A

gigantism/acromegaly (somatotropic adenoma w/ hypersecretion of GH)

172
Q

corticotropic adenoma with hypersecretion of ACTH causes

A

hypercorticalism (CUSHING SYNDROME) = elevated glucocorticoid levels

173
Q

the vast majority of Cushings syndrome are the result of exogenous/endogenous glucocorticoids?

A

exogenous

174
Q

the endogenous cushing’s syndrome can be divided into those that are ACTH dependent and those that are ACTH independent. deficiency.

  1. A deficiency in growth hormone in children results in __
  2. A deficiency in growth hormone in adults results in
A
  1. dwarfism

2. increased insulin sensitivity and hypoglycemia, decreased muscle strength and anemia

175
Q

deficiency in gonadotropins:

  1. in preadolescent children results in
  2. in adults results in
A
  1. retarded sexual maturation

2. loss of libido, impotence, loss of muscular mass, and decreased facial hair in men and amenorrhea in women

176
Q

the pathognomonic lesion of erythema multiforme is

a. butterfly rash
b. “target lesion”
c. “pasted on plaque”
d. hill sachs lesion

A

b. “target lesion” = red macule or papule with a pale, vesicular or eroded center, symmetric lesions. concentric rings of pallor and redness, referred to as iris, or bulls eye shaped

177
Q

erythema multiforme = uncommon disorder = hypersensitivity to certain drugs and infections. an extensive and symptomatic febrile form of the disease which is often seen in children is called

A

Stevens-Johnson syndrome

178
Q

erythema multiforme = uncommon disorder = hypersensitivity to certain drugs and infections. a variant of this disease called __ results in diffuse necrosis and sloughing of cutaneous and mucosal epithelial surfaces, producing a clinical situation analogous to an extensive burn when both infection and fluid loss are clinical concerns

A

toxic epidermal necrosis

179
Q

concentric rings of pallor and redness, referred to as iris, or bulls eye shaped, target lesion

A

erythema multiforme

180
Q

Herald patch

A

Pityriasis

spreads along flexural lines. may be of viral origin

181
Q

Large, red nose

A

Rosacea

182
Q

Vesicles on mucosa

A

pemphigus

autoantibodies against intracellular junctions of keratinocytes

183
Q

Irregular pigmentation

A

Vitiligo

184
Q

Honey colored crust, superficial skin infection

A

impetigo

Staph Aureus or Group A beta-hemolytic Strep

185
Q

pemphigoid is like pemphigus but it is

A

larger bullae on abdomen and groin

186
Q

hyperlipidemia, foamy histiocytes

A

xanthoma

187
Q

“salmon patches” and stork bites -spontaneously regresses

A

Capillary hemangioma

188
Q

“Strawberry hemangiomas” =initially grows, later regresses

A

Capillary hemangioma

189
Q

“Port-wine stain” seen in Sturge Weber syndrome does not resolve spontaneously

A

Cavernous hemangioma

190
Q

Café-au-lait spots

A

Neurofibromatosis Type 1 (von Recklinghausen disease) autosomal dominant

191
Q

Impetigo is an infection caused by what 2 bacteria

A

coagulase positive staphylococcus aureus

and Group A beta hemolytic strep (strep pyogenes). enter thru damaged skin and transmitted thru direct contact

192
Q

impetigo is a highly infectious skin infection common in __

A

pre-school aged children (2-5 years old) during warm weather

193
Q

impetigo usually appears on child’s

A

nose and mouth. starts as red sore that quickly ruptures, oozes for a few days and then forms a yellowish-brown crust that looks like HONEY or BROWN SUGAR

194
Q

impetigo is contagious T/F

A

true = carried in fluid that oozes from the blisters. rarely may form deeper skin ulcerations

195
Q

recurrent peptic ulcers or peptic ulcers in aberrant sites such as the jejunum is suggestive of

a. cushing syndrome
b. acromegaly
c. sipple syndrome
d. zollinger-Ellison syndrome

A

d. zollinger Ellison syndrome

196
Q

zollinger Ellison syndrome causes ___ in the pancreas and duodenum and ___ in the stomach and duodenum.

A

tumors

ulcers

197
Q

peptic ulcers (lesions in the mucosal membrane) can develop in esophagus, stomach, pylorus, duodenum or jejunum. 80% of all peptic ulcers are in

A

duodenum and in men 20-50

198
Q

___ulcers which affect the stomach mucosa are most common in middle aged and elderly men

A

gastric

199
Q

__ ulcers are caused by repeated regurgitation of stomach acid (HCl) into the lower part of the esophagus

A

esophageal

200
Q

except for peptic ulcers of the stomach, peptic ulcers are always associated with hypersecretion of _ and _

A

gastric acid and pepsin

201
Q

ulceration closely related to gastric ____ which affects all patients with duodenal ulcers and majority of patients with gastric ulcers

A

Helicobacter pylori infection

202
Q
  1. most common symptom of peptic ulcer
  2. most common complication of peptic ulcer is
  3. malignant change is common/uncommon
A
  1. pain
  2. hemorrhage
  3. uncommon
203
Q

in extreme cases ulcers can lead to

A

perforation = hole in GI tract = leads to acute peritonitis = lead to death

204
Q

aspirin, NSAIDs, smoking, Zollinger Ellison syndrome, primary HPT, multiple endocrine neoplasia (MEN) type 1 (Wermer syndrome) associated with

A

peptic ulcer

205
Q

vasopressin is produced in which location

A

supraoptic nuclei of hypothalamus

206
Q

the most common disease of man related to anti-diuretic hormone (vasopressin) is

A

diabetes insipidus (DI)

207
Q

____can arise from two situations:

Hypothalmic “central” diabetes or Nephrogenic diabetes

A

diabetes insipidus (DI)

208
Q

deficiency of ADH from the posterior pituitary. causes = head trauma, infections, tumors in hypothalamus

A

Hypothalmic “central” diabetes (diabetes insipidus (DI) )

209
Q

kidney is unable to respond to ADH = results from kidney disease or mutations in ADH receptor gene

A

Nephrogenic diabetes = diabetes insipidus (DI)

210
Q

ADH is produced by __ of hypothalamus but secreted by

A

supraoptic nuclei of hypothalamus

secreted by posterior pitutiary

211
Q

ADH binds to receptors on cells of the ___ duct of the kidneys

A

collecting = promotes reabsorption of water back into the circulation.

212
Q

in absence of ADH the collecting ducts are

A

impermeable to water = and water flows out as urine

213
Q

diabetes insipidus (DI) is characterized by

A

polyuria bc kidney cant resorb water properly from urine

214
Q

diabetes insipidus (DI) should not be confused with

A

Diabetes mellitus = results from insulin deficiency or resistance leading to high blood glucose

215
Q

diabetes insipidus (DI) and DM are unrelated although they can have similar

A

signs and symptoms, like excessive thirst and urination

216
Q

which is more common DI or DM

A

DM

217
Q

the most important variable regulating ADH secretion is

A

plasma osmolarity (concentration of solutes in the blood). osmolarity is sensed by hypothalamus by neurons known as osmoreceptors. those neurons stimulate neurons that produce the ADH

218
Q

What hormone stimulates ADH secretion

A

Angiotensin II

219
Q

What reduces vasopressin secretion at neurohypohyseal nerve terminals

A

ethanol

220
Q

ADH is also stimulated by _ in blood pressure and volume, conditions sensed by __

A

decrease, stretch receptors in the heart and large arteries

221
Q

self-limited disease

A

a disease process that resolves spontaneously with or without specific treatment

222
Q

infectious mononucleosis is a benign, self limiting disorder caused by

A

Epstein Barr Virus (EBV) = has affinity for B lymphocytes

223
Q

infectious mononucleosis is a viral/bacterial infection

A

viral

224
Q

infectious mononucleosis causes

A

high temp sore throat lymphadenopathy and hepatosplenomegaly

225
Q

EBV (aka human herpesvirus 4 (HHV-4)) transmitted by

A

close human contact, freq saliva during kissing

226
Q

lymphocytosis with atypical activated T lymphocytes (mononucleosis cells)

A

infectious mononucleosis

EBV specific CD8+ cytotoxic T cells and CD16+NK cells in blood

227
Q

acute pharyngitis and tonsillitis, gray-white exudative membrane, enlargement of lymph nodes in neck, palatal petechiae

A

infectious mononucleosis

228
Q

Heterophil antibodies (hetrophil agglutinins) are ONLY SEEN IN

A

infectious mononucleosis

229
Q

The monospot test

A

, a form of the heterophile antibody test, is a rapid test for infectious mononucleosis due to Epstein–Barr virus (EBV).

230
Q

Are antiviral therapy needed for infectious mononucleosis?

A

no, spontaneous recovery usually occurs in 2-3 weeks.

231
Q

is there a vaccine for EBV (human herpesvirus 4 (HHV-4),)

A

no ebv vaccine

232
Q

the __ is especially susceptible to traumatic rupture in EBV

A

spleen

233
Q

EBV is associated with

A

Burkitt’s lymphoma and nasopharyngeal carcinoma and hairy leukoplakia

234
Q

Patients with an __ infectious disease will have a rising antibody titer (acute/chronic)?

A

acute

235
Q

although asthma can strike at any age, half of all cases occur in

A

children under 10.

236
Q

wheezing breathlessness chest tightness and cough esp at night and early mornings =

A

asthma

237
Q

increased airway responsiveness to a variety of stimuli resulting in episodic bronchoconstriction (bronchospasm), increased mucus secretion and inflammation of bronchial walls

A

asthma

238
Q

atopic asthma

A

evidence of allergen sensitization,
usually patient with history of allergic rhinitis
eczema

239
Q

non atopic asthma

A

w/o evidence of allergen sensitization

240
Q

asthmatic bronchitis

A

smokers

241
Q

in __ bronchial linings overreact to various stimuli causing smooth muscle spasms called bronchospasms = severely constrict the airways

A

asthma

242
Q

extrinsic allergen inhaled stimulates mast cells in the lung interstitium to release both

A

histamine and SRS-A (slow reacting substance of anaphylaxis) = cause swelling of bronchial smooth muscle = narrow lumen

243
Q

___ is safe to administer to pp w/asthma and is especially indicated for pt whose asthma is triggered by anxiety

A

nitrous oxide

244
Q

if patient is taking steroids, and has asthma you should

A

consult physician to possible augment the corticosteroid drugs (since he shouldn’t be having the attacks if he is on the corticosteroids) All forms of corticosteroids reduce inflammation in the airways that carry air to the lungs (bronchial tubes) and reduce the mucus made by the bronchial tubes. This makes it easier for you to breathe

245
Q

Preferred treatment for an ACUTE ASTHMATIC ATTACK

A

short acting selective beta-2 agonist (albuterol, terbutaline)

246
Q

Status asthmaticus = severe episode of asthma usually requiring hospitalization that does not respond adeq to ordinary therapeutic measures. may lead to death from

A

respiratory acidosis

247
Q

characterized by a breakdown of self-tolerance to thyroid auto-antigens most importantly the TSH receptor

A

Grave’s disease

= hyperthyroidism aka thyrotoxicosis

248
Q
  1. Primary role of thyroxine is to stimulate

2. if in excess =

A
  1. cellular metabolism, growth, and differentiation of all tissues
  2. high basal metabolism, fatigue, weight loss, excitability, elevated temp, osteoporosis
249
Q

hyperthyroidism aka thyrotoxicosis oral manifestations are not remarkable but are

A

premature eruption of teeth and loss of deciduous dentition

250
Q

___ is most common cause of endogenous hyperthyroidism aka thyrotoxicosis

A

Grave’s disease

251
Q

thyroid specific autoimmune disorder, body makes Ab to thyroid stimulating hormone receptor (TSHR), leading to hyperthyroidism, abnormally strong release of hormones from the thyroid gland

A

Grave’s disease

252
Q

what are autoantibodies

A

An autoantibody is an antibody (a type of protein) by the immune system that is directed against one or more of the individual’s own proteins

253
Q

are the autoantibodies made in Grave’s disease subject to negative feedback

A

no, so they continue to be produced and bind to TSHR even when thyroid hormone levels are too high. these antibodies act as antagonists stimulating more hormones to be released

254
Q

insomnia, anxiety, restlessness, weight loss, exophthalmos, irritation and tearing

A

hyperthyroidism

255
Q

Plummer’s disease aka toxic nodular goiter:

  1. arises from long-standing __
  2. symptoms?
  3. Seen in children?
A
  1. simple goiter
  2. same as hyperthyroidism but the protruding eyes seen in Grave’s disease DO NOT OCCUR.
  3. NEVER SEEN IN Children. MOSTLY ELDERLY
256
Q

The 1st WBC on the scene during the acute or early stage of inflammation

A

Neutrophils

257
Q

most numerous WBC

A

Neutrophils

258
Q

the primary constituent of pus

A

Neutrophils

259
Q

Neutrophils attracted to site of inflammation by __ and they can identify the foreign antigen and attach to it, engulf it.

A

chemotaxis

260
Q

if the infection continues after the Neutrophils arrive, ___ arrive

A

monocytes = cells with even greater ability to engulf organisms

261
Q

substances that are chemotactic for Neutrophils are

A

complement proteins C3a and C5a = anaphylatoxins

262
Q

in order to kill its target, Neutrophils use

A

oxygen dependent killing mechanisms and defensin molecules

263
Q

oxygen dependent killing mechanisms of Neutrophils

A

superoxide, myeloperoxide, hydrogen peroxide, and NADPH oxidase

264
Q

NADPH oxidase = multi unit enzyme that produces __ and contributes to the killing of internalized pathogens by neutrophils

A

superoxide radicals

265
Q

a deficiency in any of the NADPH subunits can cause

A

chronic granulomatous disease = immunodeficiency disease.

266
Q

NADPH is made in __ pathway

A

pentose phosphate pathway

267
Q

Defensins are antimicrobial peptides 40 amino acids long that can

A

penetrate membranes and disrupt their integrity

268
Q

abscesses have a central region of mass of necrotic leukocytes and tissue cells. a zone of preserved neutrophils surround this necrotic focus, and outside that is a vascular dilation and parenchymal and fibroblastic proliferation including chronic inflammation and repair. In time the abscess may become walled off and replaced by

A

CT

269
Q

A ___ is an abnormal sac within body containing fluid or air. lined with epithelium

A

cyst

270
Q

a tumor composed of granulation tissue that is usually associated with ulcerated infections. epitheloid cells and giant cells are derived from macrophages and characteristic

A

granuloma

271
Q
  1. a tumor is a growth of tissue that forms an abnormal mass. tumors aka
  2. caused by abnormal regulation of
  3. provide __ function and grow at expense of healthy tissues
A
  1. neoplasm
  2. cell division
  3. no useful function
272
Q

a local defect/excavation of the surface of an organ or tissue that is produced by sloughing (shedding) of inflamed necrotic tissue.

A

Ulcer

273
Q

ulceration can occur only when tissue __and __ exist on or near the surface

A

necrosis and resultant inflammation

274
Q

myonecrosis aka gas gangrene caused by

A

anaerobic, spore forming gram + Clostridium perfringes = occurs at site of trauma or recent surgical wound, onset is sudden and dramatic

275
Q

crackly sensation when the swollen area is pressed w fingers

A

gas gangrene = extremely painful

276
Q

gangrene is the death of a tissue usually associated w loss of

A

blood supply to the area = necrosis combined with putrefaction = rotting and decomposition

277
Q

gas gangrene prevented by

A

proper wound care

278
Q

systemic symptoms of gangrene

A

anxiety, sweating, fever, shock-like syndrome, hypotension, renal failure, coma, and finally death

279
Q

clostridia are obligate

A

anaerobes, gram + and endospore formers

280
Q

clostridia can form many different toxins the most important is the

A

alpha toxin = lecithinase = damages cell membranes = resulting in hemolysis

281
Q

most basic and most common type of necrosis

A

coagulation = coagulative necrosis = denaturation of proteins is the dominant process

282
Q

nuclear changes appear in one of 3 patterns, all due to non-specific breakdown of DNA. = ?

A

karyolyisis, pyknosis, karyorrhexis

283
Q

___necrosis = enzymatic digestion is the dominant process

A

liquefactive necrosis

284
Q

when larger areas of tissue are dead = called

A

gangrene

285
Q

a localized area of coagulative necrosis is called

A

infarct

286
Q

autolysis

A

source of hydrolytic enzymes is the dying cell’s own lysosome

287
Q

heterolysis

A

hydrolytic enzymes come from other infiltrating cells

288
Q

injured pancreas would cause which kind of necrosis

A

fat necrosis

289
Q

trauma to adipose tissue would cause which kind of necrosis

A

fat necrosis

290
Q

most common sites for fat necrosis

A

pancreas and adipose tissue

291
Q

immune mediated vascular damage would cause which kind of necrosis

A

fibrinoid

292
Q

most common site for fibrinoid necrosis

A

arterial walls

293
Q

ischemia would cause which kind of necrosis

A

coagulative necrosis

294
Q

most common sites (2) for coagulative necrosis

A

kidneys/heart

295
Q

suppuration, abscesses and ischemic injury to CNS would cause which kind of necrosis

A

liquefactive necrosis

296
Q

granulomatous infection (ex. TB) would cause which kind of necrosis

A

caseous necrosis

297
Q

most common site for liquefactive necrosis (2)

A

brain or spinal cord

298
Q

putrefactive bacteria acting on necrotic bowel or extremities would cause which kind of necrosis

A

gangrenous = most common in lower extremities or bowel

299
Q

Epithelioid cells are

A

Epithelioid histiocytes (Epithelioid cells) are activated macrophages resembling epithelial cells

300
Q

Epithelioid cells and giant cells are derived from macrophages and are important in the development of

A

granulomatous inflammation

301
Q

granulomatous inflammation is a chronic/acute inflammation

A

chronic
characterized by granulomas = which are nodular collections of specialized macrophages referred to as epitheloid cells. frequently epithelioid cells fuse to form MULTINUCLEATED GIANT CELLS (Langerhans giant cells and foreign body giant cells)

302
Q

TB is a __ disease

A

granulomatous = mycobacterium tuberculosis

303
Q

Granulomatous inflammation is characteristically associated with areas of ____ necrosis

A

caseous

304
Q

TB, leprosy, syphilis, cat scratch disease sarcoidosis and Crohns disease are

A

granulomatous inflammation diseases

305
Q

in response to injury, mononuclear inflammatory cells coupled w/ production of fibrous CT are indicative of

a. acute inflammation
b. chronic inflammation
c. edema
d. gangren

A

b. chronic inflammation = develops @ site of injury and persists longer than several days. it is more proliferative than exudative.

306
Q

ex of chronic inflammation

A

chronic hepatitis chronic pyelonephritis, autoimmune disorders. necrosis commonly occurs and recurs

307
Q

granulomatous is a subtype of _ inflammation

A

chronic

308
Q

acute inflammation is the initial response to tissue injury esp _ infections involving vascular and cellular responses

A

bacterial

309
Q

3 major occurences in acute inflammation

A 
increased vascular permeability w tissue exudate formed
luekocytic infiltration (mainly neutrophils by C3a and C5a), and repair (either by regeneration or replacement
310
Q

local signs of acute inflammation

A

redness (rubor), heat (calor), swelling (tumor), pain (dolor) and loss of function

311
Q

systemic effects of acute inflammation

A

fever, tachycardia, leukocytosis (esp neutrophils)

312
Q

Macrophages appear late in the cellular phase and represent a transition b/w

A

acute and chronic inflammation

313
Q

IL-1, prostaglandins and TNF are the mediators that produce what action

A

fever

314
Q

IL-1, IL-6, TNF-alpha are the mediators that produce what action

A

acute phase response

315
Q

Bradykinin, prostaglandins are the mediators that produce what action

A

pain

316
Q

C5a, C3a, IL-8, chemokines, PAF, Leukotriene B4 are the mediators that produce what action

A

leukocyte chemotaxis

317
Q

LTB4, IL-1, TNF-alpha, and C5a are the mediators that produce what action

A

Luekocyte adhesion

318
Q

Histamine, protoglandins, PAF, nitric oxide are the mediators that produce what action

A

vasodilation

319
Q

histamine, bradykinin, C3a, C5a, leukotrienes, PAF, substance P are the mediators that produce what action

A

increase vascular permeability

320
Q

in response to injury, capillary permeability increases resulting in the formation of

a. plasma
b. serum
c. exudate
d. transudate

A

exudate

321
Q

the edema fluid resulting from inflammation is called

A

exudate aka pus

322
Q

the easiest way to see exudate is to puncture a blister. the fluid that escapes is exudate. if the fluid is cloudy or discolored it is a strong indication of the presence of

A

infection in the wound.

323
Q

exudate is characterized by being

  1. protein rich/poor
  2. cell rich or poor
  3. high/low specific gravity
A

protein and cell rich with a HIGH specific gravity (greater than 1.02)

324
Q

types of inflammatory exudates

A

suppurative, purulent, fibrinous, pseudomembranous

325
Q

in addition to water, exudate contains nutrients oxygen antibodies and neutrophils. the FIRST ROLE of exudate is to

A

flush away the foreign material from site of injury

326
Q

exudate also acts as a carrier medium to bring __

A

fibrin and other repair materials to site of injury

327
Q

later in inflammatory process exudate acts as a carrier for

A

leukocytes (PMN) and monocytes and supplies them with oxygen and nutrients while they ingest bacteria and debris in the wound.

328
Q

presence of exudate enables the movement of phagocytic cells, and later in the healing process the nutrients are used b the new tissue to help

A

in regeneration of granulation tissue

329
Q

finally, the exudate acts as a lubricant to speed up the migration of

A

epithelial cells across the wound to complete the initial wound repair

330
Q

___ results from increased intravascular hydrostatic pressure or from altered osmotic pressure. This fluid is thin and watery and is characterized by

  1. protein rich/poor
  2. cell rich or poor
  3. high/low specific gravity
A
  1. low protein
  2. few cells
  3. low specific gravity (less than 1.012)

opposite of exudate!)

331
Q
  1. transudates are present in __condition
A

non-inflammatory conditions (opposite of exudate!)

332
Q

an ultrafiltrate of blood plasma is transudate or exudate?

A

transudate

333
Q

most common acute inflammatory rxns contain large # of neutrophils and are termed

A

suppurative = produce purulent matter = result of tissue necrosis, proteolytic enzmes, WBC and tissue fluid build up

334
Q

tissue damage is caused MOSTLY by neutrophils/complement/macrophages

A

neutrophils in acute inflammation

335
Q

Cox 2 converts arachidonic acid to

A

prostoglandins

336
Q

5-lipoxygenase converts arachidonic acid to

A

leukotrienes

337
Q

prostaglandins and leukotrienes mediate _ inflammation

A

acute

338
Q

which 2 proteins increase rapidly in acute phase?

A

C-reactive protein (1000x increase in 24-48 hours) and serum amyloid A

339
Q

polymorphonuclear neutrophils (PMNs) are the first defense cell at injured tissue. they engulf matter by phagocytosis. the engulfed matter becomes a __ which combines with lysosomal granules to form a ___ in which digestion of the engulfed particle occurs

A

phagosome

phagolysosome

340
Q

basophils mast cells and platelets are impt in _ phase of acute inflammation

A

vascular

341
Q

PMNs predominate in the _ phase of acute inflammation

A

cellular

342
Q

macrophages appear late in the _ phase of inflammation

A

cellular

343
Q

___ are the predominant inflammatory cells in allergic reaction and parasitic infections

A

eosinophils

344
Q

Iron is stored, mostly in the liver, as ferritin or hemosiderin.

which is the major storage form

A

ferritin is the major form of iron storage.

NBDE PART 1 MICRO/PATH (20 decks)

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