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Pathology > Path II Final > Flashcards

Path II Final Flashcards

1
Q

Three signs of increased intracranial pressure

A

headache
nausea/vomiting
papilledema

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2
Q

most dangerous cause of increased intracranial pressure

A

brain tumor

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3
Q

Hydrocephalus Ex Vacuo is due to

A

brain atrophy disease

more common in elderly

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4
Q

symptoms of Hydrocephalus Ex Vacuo

A

bent knees
stooped posture
incontinence
loss of memory

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5
Q

With Hydrocephalus Ex Vacuo

A

loss of neurons or axons in the white matter leaves space in the cranial fossa to be filled with CSF

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6
Q

Is there increased ICP with Hydrocephalus Ex Vacuo

A

no

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7
Q

Signs of hydrocephalus in a child

A

Unequal measurements on each hemisphere of the head

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8
Q

Complications of hydrocephalus in a child

A

increased ICP

cerebellar tonsil herniation

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9
Q

Cerebral vascular disease

A 
aka stroke
#3 cause of death in US
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10
Q

3 types of stroke

A

generalized reduction in blood flow
infarct
hemorrhage

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11
Q

Generalized reduction in blood flow to the brain can be due to

A

Vascular shock: dramatic decrease in blood flow in the whole body
dilation of blood vessels leads to decrease in blood flow to the brain (gravity)
rare

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12
Q

Brain infarct

A

aka ischemic stroke
most common cause of stroke
obstruction in blood flow to brain leads to necrosis of tissue due to hypoxia

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13
Q

Brain Hemorrhage

A

aka hemorrhagic stroke

can be intracerebral or subarachnoid

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14
Q

Lacunar Infarction

A

aka hyaline arteriosclerosis
more common with advanced hypertension
arteriosclerosis of capillaries leads to microinfarctions
may find absence of motor function

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15
Q

What type of necrosis does the brain undergo?

A

liquefactive

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16
Q

what are neurons replaced with after a stroke?

A

microglia

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17
Q

Most common areas of atheroma development

A

cerebral artery
mesenteric artery
coronary artery
arteries of the extremities

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18
Q

Sources of emboli that may cause stroke:

A

mitral stenosis
bacterial endocarditis
valve replacement
myocardial infarction

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19
Q

Transient ischemic attack

A

temporary ischemic stroke
manifests as a true ischemic stroke but is temporary
all brain function is restored afterward

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20
Q

amaurosis fugax

A

temporary unilateral loss of vision

associated with thrombus in ophthalmic artery

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21
Q

What percentage of people develop full blown stroke within 6 months of TIA

A

1/3

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22
Q

Intracerebral hemorrhagic stroke

A

aka parenchymal or hypertensive

develops in people with long term hypertension as a result of hyaline arteriosclerosis

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23
Q

result of long term hypertension in brain

A

microaneurysm formed in peripheral arteries of the brain ruptures causing pressure on the adjacent vessels

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24
Q

mechanical compression of brain tissue leads to

A

development of neurological deficit
causes compression of walls of ventricles
promotes non-communicating hydrocephalus

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25
Q

Blood in the brain:

A

toxic

causes nerve atrophy and necrosis

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26
Q

Subarachnoid Hemorrhagic stroke

A

aka saccular or berry aneurysm
slow pouching of vascular wall into aneurysm
rupture before 50 years of age

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27
Q

Giant brain aneurysm

A

1-5cm
signs of brain tumor
not as vulnerable as a berry aneurysm

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28
Q

Traumatic Brain injury

A

caused by hematoma
30% die as a result
70% live with permanent diability

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29
Q

Epidural hematoma

A

above dura mater
rupture of the middle meningeal artery
causes separation of the dura from the cranium, compressing the brain

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30
Q

epidural hematoma leads to

A

pain/neurological deficits
herniation
non-communicating hydrocephalus

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31
Q

Subfalcine herniation

A

characterized by compression of cingulate gyrus against falx cerebri
can cause compression of anterior cerebral artery

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32
Q

transtentorial herniation

A

aka uncal/uncinate herniation
much more serious herniation
develops from compression of the free margin of the temporal lobe

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33
Q

complications of transtentorial herniation

A

compression of parasympathetic fibers of oculomotor- pupil dilation on involved side
compression of posterior cerebral artery

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34
Q

cerebellar herniation

A

aka tonsilar herniation
most dangerous herniation
like an acute arnold-chiari malformation

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35
Q

cerebellar herniation results in

A

compression of the brainstem (cardiac and respiratory centers)
leading to immediate death

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36
Q

Duret Hemorrhage

A

aka secondary brainstem herniation
hemorrhage into the pons
assocaited with cerebellar herniation
due to kink in basilar artery

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37
Q

Subdural hematoma

A

rupture of bridging vein
blood flows into subarachnoid space
see the same type of manifestations as epidural hematoma but not as acute
creates lake on cerebral surface leading to poisoning of grey matter

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38
Q

causes of subdural hematoma

A

sudden change in speed of head movement

shift can tear veins

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39
Q

Traumatic parenchymal brain injury

A

damage to brain parenchyme

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40
Q

categories of Traumatic parenchymal brain injury

A

Concussion
Contusion
Laceration
Basilar skull fx

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41
Q

Concussion

A

characterized by immediate and transient loss of neurological function secondary to mechanicl forces

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42
Q

2 major manifestations of concussion

A

loss of consciousness

retrograde amnesia

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43
Q

Loss of consciousness (concussion)

A

can be short or long term
functional loss of reticular formation
neurons that have contact with different parts of the brain are disrupted
loss of consciousness has to do with the time needed for restoration of contacts

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44
Q

retrograde amnesia (concussion)

A

permanent loss of memory about events immediately before/after and during the trauma
completely erased from memory

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45
Q

Contusion

A

hemorrhage into the superficial layers of the brain

due to blunt trauma

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46
Q

types of brain contusion

A

Coup: damage is at impact site, head immoble/force mobile

Contre-coup: damage opposite the impact sire, head mobile/force immoble

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47
Q

Laceration of brain tissue

A

real tear in tissue, never comes back

associated with tear in blood vessels

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48
Q

basilar skull fracture

A

very brittle/thin

predisposes to infection in CNS

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49
Q

Signs of basilar skull fx

A

Rinorhea- CSF leakage from nose, bilateral periorbital bruising
Otorhea- CSF leakage from ear, battle sign

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50
Q

Rheumatoid arthritis

A

chronic inflammatory autoimune disease

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51
Q

age at RA onset

A

40’s-50’s

52
Q

Pathogenesis of RA

A

attacks synovium, hyperplasia takes synovium from 1-4 cell layers to over 400
pannus formation in joints (granulation-like tissue)
loss of articular cartilage with pariarticular bone loss

53
Q

RA symptoms

A

acculumation of exudate in joints
ulnar deviation of the fingers
atrophy of lumbricals and interossei
tenosynovitis

54
Q

periarticular osteopenia

A

seen with RA
inflammation near bone leads to loss of local bone density
long term inflammation leads to cytokine release, stimulating osteoclasts to resorb bone resulting in erosions

55
Q

Swan Neck deformity

A

hyperextension of the PIP

hyperflexion of the DIP

56
Q

Boutonniere deformity

A

hyperflexion of the PIP

hyperextension of the DIP

57
Q

Effect of RA on the feet

A

contracture leads to hammer toes
bunion on outside of 1st MTP due to hallux valgus
callus on bottom of feet due to hyperplasia
loss of arch

58
Q

effect of RA on the knee

A

swelling in knee joint

exercise will injure the joint (fluid is incompressible so will damage bones)

59
Q

effect of RA on hip

A

compression of vessels and nerve leads to destruction of femur head
corticosteroid injection will cause aseptic osteonecrosis
protrusio acetabuli

60
Q

Rheumatoid nodule

A

sign of disease progression into more severe involvment
involvement of blood vessels- vasculitis
can be anywhere and have many different characteristics, commonly seen on elbow

61
Q

Kaplan’s syndrome

A

rheumatoid arthritis and interstitial fibrosis in lung

62
Q

Juveline Rheumatoid Arthritis

A

presenting in patients under 16

usually seronegative

63
Q

Specific features in juvenile RA

A 
Knee jt involvement- arthritic leg grows longer
receding chin
still's disease
extensive multiple deformations
fixed FHP
neutropenia
increased ADI
64
Q

Still’s Disease

A

hepatosplenomegaly
lymphadenopathy
fever

65
Q

Felty’s syndrome

A

neutropenia- low concentration of neutrophils in blood, also see leukopenia
body is prone to infection

66
Q

Osteoarthritis

A

non-inflammatory

most common degenerative joint diseae

67
Q

Primary target of OA

A

cartilage

68
Q

Primary OA

A

unknown cause

69
Q

secondary OA

A

known cause

more predictable

70
Q

Heberden’s node

A

irregular hyperplastic bony nodule

DIP

71
Q

Bouchard’s node

A

PIP

72
Q

periarticular osteosclerosis

A

increased density of endplate in OA

73
Q

OA in the knee

A

will see narrowing of the medial portion of the jt space causing bowing of the legs
osteophyte formation

74
Q

OA in the hip

A

can be crippling
will change posture/gait
degenerative changes in acetabulum and on femoral head

75
Q

Spinal involvement in OA

A

decreased IVD height
osteophytes on margins
decrease in IVF diameter
Slippage of the facet joint

76
Q

Bronchi

A

covered by cartilage
have goblet cells producing mucous
submucosal mucous glands

77
Q

Bronchioles

A

no cartilage cover

few goblet cells/very little mucous production

78
Q

diffuse pulmonary disease

A

involves both lungs
two categories:
COPD and restrictive disease

79
Q

COPD

A

airway disease
limitation of airflow resulting from an increase in resistance
characterized by normal or increased total lung capacity

80
Q

types of COPD

A

bronchial asthma
emphysema
chronic bronchitis
bronchiectasis

81
Q

Restrictive disease

A

reduced expansion of lung parenchyma

decreased total lung capacity

82
Q

Bronchial asthma

A

episodic, reversible

exaggerated bronchospasm due to various stimuli

83
Q

Extrinsic asthma

A

aka atopic asthma
initiated by a type I hypersensitivity reaction (anaphylaxis)
induced by reaction to extrinsic antigen (ie pollen)

84
Q

Pathogenesis of extrinsic asthma

A

first exposure to antigen- type I immune response,
IgE immunoglobulin located on mast cell
prepares for next encounter

Second exposure to antigen- formation of immune complex leading to mast cell degranulation and asthmatic attack

85
Q

4 major phenomena in extrinsic asthma

A

vasodilation
increased permeability of blood vessels
bronchospasm
increased mucous production

86
Q

Functions of histamine in extrinsic asthma

A 
causes increased blood vessel permability (lumen swelling)
causes vasodilation (more blood flow, increased swelling, lumen narrowing)
stimulates mucous production (further airway obstruction)
87
Q

Histamine stimulation of vagus nerve

A

through the ganglia- return of stimulation through parasympathetic fibers resulting in nerve dysfunction and bronchospasm

88
Q

Charcot Leyden crystals

A

pathomnemonic sign of bronchial asthma
rhomboid shaped crystal found in sputum
made of protein released after destruction of eosinophils

89
Q

Status asthmaticus

A

severe asthmatic attack lasts for days to weeks

may result in death

90
Q

Bronchial asthma characterized by 3 major clinical factors

A

expirational dyspnea (shortness of breath due to inability to remove air from lungs)
cough (expectorates mucous)
wheezing (narrowing of lumen causes whistling sound)

91
Q

Intrinsic asthma

A

aka non-atopic

same manifestations of extrinsic, however triggering mechanisms are non-immune

92
Q

Pathogenesis of intrinsic asthma

A

pulmonary or bronchial infection most common provoker (virus)
can also be due to some drugs, psychological stress, atlas misalignment

93
Q

Emphysema

A

characterized my permanent enlargement of airspaces distal to terminal bronchioles accompanied by alveolar wall destruction
irreversible

94
Q

Terminal bronchioles

A

less than 2mm
aka acinus or primary respiratory unit
consists of respiratory bronchiole, small alveolar duct, alveoli

95
Q

Consequences of alveolar tear

A

results in dramatic decrease in blood flow
blood pools in the lungs causing hypertrophy of the right ventricle and less blood flow to left ventricle causing less oxygenation of the body

96
Q

3 types of emphysema

A

Centracinar
panacinar
distal acinar

97
Q

Centracinar emphysema

A 
AKA centrilobular 
proximal acini affected while distal alveoli are spared
only respiratory bronchioles distended
alveoli and alveolar ducts not involved
usually develops in upper lobes of lungs
98
Q

Panacinar emphysema

A

all components of acini are involved/ uniformly enlarged

occurs in lower lobes of the lungs

99
Q

Distal acinar emphysema

A

aka paraseptal emphysema
distal acini are affected while proximal are spared
usually develops in upper lung lobes
common cause of spontaneous pneumothorax

100
Q

Protease-antiprotease theory

A

AKA oxidase-antioxidase theory
with lung infection- neutrophils release elastase to attack infection and antielastase prevents excess lung damage
Deceased levels of antielastase in lungs of those with emphysema

101
Q

Chronic Bronchitis

A

caused by inhaled irritants,, decreases resistance of bronchial wall to infection
results in inflammation, hyperplasia of goblet cells, and then metaplasia to replace goblet cells with squamous cells

102
Q

Bronchiolitis obliterans

A

aka small airway disease
occurs after metaplasia in lungs to replace goblet cells with squamous cells
lack of normal gas exchange leads to inflammation causing bronchiole wall fibrosis and irreversible narrowing of the lumen

103
Q

Chronic bronchitis and Bronchiolitis obliterans predisposes to

A

lung cancer

chronic infection- lack of normal cells with villi to remove debris

104
Q

Bronchiectasis

A

characterized by permanent dilation of bronchi and bronchioles
caused by destruction of muscle and elastic tissue
results in chronic necrotizing infections

105
Q

Predisposing conditions to Bronchiectasis

A

Kartagener syndrome- lack of alveoli vili movement, infection flourishes

106
Q

Kartagener syndrome

A

genetic disease

lack of mobility in sperm and alveolar villi

107
Q

Restrictive pulmonary disease

A

Reduced total lung capacity

extrapulmonary or intrapulmonary origin

108
Q

Extrapulmonary origin of Restrictive pulmonary disease

A

obesity
kyphoscoliosis (pott’s disease)
restricted ROM
high placement of diaphragm

109
Q

intrapulmonary origin of Restrictive pulmonary disease

A

acute
chronic interstitial lung disease ie:
scleroderma (systemic sclerosis of lung)
overactivity of fibroblasts
replacement of lung tissue with scar tissue
lung shrinkage resulting in contractive atelectasis

110
Q

Hamman-Rich syndrome

A

idiopathic pulmonary fibrosis

honeycomb appearance to lungs

111
Q

Sarcoidosis

A

most common granulomatous non-caseating disease
characterized by hilus lymphadenopathy
involves eyes and skin

112
Q

Pneumoconiosis

A

Development of lung fibrosis due to dust exposure
different names depending on type of dust
silicosis=silica
asbestosis=asbestos
anthracosis=coal dust (aka coal worker’s pneumoconiosis)

113
Q

Most dangerous part of cigarette

A

paper- produces 1200 carcinogens while burning

114
Q

Lung Cancer

A

aka bronchiogenic carcinomas

95% of lung tumors are due to lung cancer

115
Q

common features of bronchiogenic carcinoma

A

majority arise in epithelium of major bronchi near hilus
associated with smoking
aggressive, locally invasive, widely metastisizing neoplasm
all have capacity to make bioactive products producing paraneoplasmic syndromes

116
Q

80% of inappropriate ADH secretion is due to

A

lung cancer

117
Q

Squamous cell carcinoma

A

25-40% of lung cancers
most common
least malignant
more common in males

118
Q

Small cell carcinoma

A

20-25% of lung cancers
most malignant
aka oat cell carcinoma
6 months to live after dx

119
Q

Adenocarcinoma

A

25-40%
multiple subtypes (acinar, papillary, bronchioloalveolar, solid, mixed)
have a peripheral location (can be removed if caught in time)
most common lung cancer in women

120
Q

Large cell carcinoma

A

10-15%
large cell neuroendocrine carcinoma
rare but very aggressive, mets to lymph nodes in trachea

121
Q

Pancoast tumor

A

aka apical tumor
no histological pattern
develops unilaterally
destroys C7, T1, and first rib, may extend out as well
compresses brachial plexus, characterized by spinal pain

122
Q

Virchow’s nodes

A

seen with pancoast tumors

lymphadenopathy of supraclavicular lymph nodes with lung cancer or stomach cancer

123
Q

Horner’s syndrome

A 
develops with pancoast tumors
anhydrosis- lack of sweating
ptosis- drooping of eyelid
meiosis- narrowing of pupil
anophthalmus- eyeball sunk into orbit
124
Q

Mesothelioma

A

tumor resulting from exposure to asbestos

100x higher chance of developing in smokers

125
Q

Cannonball metastasis

A

seen with osteosarcoma

Pathology (4 decks)

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