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pathology Flashcards

1
Q

which degenerative disease:

  • most common cause of dementia in older adults
  • WIDESPREAD cortical ATROPHY
  • Sx: slow & progression intellectual degeneration, loss of short-term -> long term memory, motor problems, contractures, paralysis
  • RFS: advanced age, down syndrome, FHx, head trauma, increased ApoE-4, decreased ApoE-2 (protective)

● Unknown etiology, theory is low Ach or abnormal amyloid depositions

MOA: neuritic plaques & neurofibrillary tangles in cortex + granulovacuolar degeneration in hippocampus -> ATROPHY of cerebral cortex
o Tangles: composed of abnormal Tau proteins which destroy neurons
o Beta-amyloid: incorrectly spliced protein which crowd out neurons
o There is a loss of Ach (neurotrans for memory & learning) d/t degeneration of cerebral cortex

A

Alzheimer’s

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2
Q

which degenerative disease MOA is this:

MOA: neuritic plaques & neurofibrillary tangles in cortex + granulovacuolar degeneration in hippocampus -> ATROPHY of cerebral cortex
o neurofibrillary tangles: composed of abnormal Tau proteins which destroy neurons
o Beta-amyloid: incorrectly spliced protein which crowd out neurons
o There is a loss of Ach (neurotrans for memory & learning) d/t degeneration of cerebral cortex

A

Alzheimer’s

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3
Q

which degenerative disease:

is a progressive and fatal neurodegenerative disorder of the spinal cord, initially presenting with fasciculations, muscle atrophy, and asymmetric limb weakness of distal limbs.

Degeneration of LMN & UMN 🡪 muscle atrophy; middle age 🡪 fatal 1-6 yrs

● Etiology: mutations in superoxide dismutase 1 (SOD-1) & glutamate transporters

● Sx: symmetric atrophy, fasciculations (twitching), hyperreflexia, spasticity

A

ALS - Amyotrophic Lateral Sclerosis (ALS)

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4
Q

MOA: immune system attacks the peripheral nerves resulting in demyelination due to molecular mimcry

● Acute inflammatory demyelinating disease of peripheral nerves; autoimmune

autoimmune ddx that proceeds a viral infection

● M/c affects young adults after a viral infection, immunization or allergic rxn

● Sx: ascending muscle weakness & paralysis 🡪 recover or fatal

A

Guillain-Barre Syndrome

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5
Q

which degenerative disease:

  • a demyelinating disorder bc of autoimmune destruction of CNS myelin and oligodendrocytes
  • RFs: 20-30 yoa, women; relapses & remits after 20 yrs
  • Sx: (early) weakness in lower limbs, paresthesia of the face, trunk & limbs, visual disturbances, loss of bladder control (urinary incontinence) 🡪 (late) disability, mental deterioration

SX: Scanning speech, intention tremor, and nystagmus, Marcus Gunn pupil

A

Multiple Sclerosis

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5
Q

which degenerative disorder:

multifocal periventricular inflammation and demyelination often occurring after a viral infection, leading to rapidly progressive neurological symptoms and altered mental status

M/c presents with motor deficits.

A

Acute disseminated encephalomyelitis

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6
Q
A
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7
Q

● Acute demyelinating multifocal disorder occurring 7-14 days post-infection
● MOA: white matter of brain is infiltrated by macrophages
● Etiology: viral (measles, chicken pox, German measles, mumps, influenza, mono), bacterial (Mycoplasma), or scarlet fever
● RFs: recent infection or vaccination (smallpox & rabies)
● Sx: headache, fever, altered consciousness 🡪 focal neurological deficit & coma
● Complications: permanent neuro deficits or fatal (20%) in acute stage

A

Perivenous Encephalomyelitis

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8
Q

which degenerative disease:

Encompasses several conditions, including Parkinson’s Disease
● Appears > 50 yoa d/t nerve damage in substantia nigra & DA depletion in the corpus striatum
- Lewy bodies present
● Sx: resting “pill-rolling” tremor, masked/expressionless face, bradykinesia (slow movements), muscular rigidity, shuffling gait

A

Parkinsonism

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9
Q

which degenerative disease:

  • Extrapyramidal brkwn of spinocerebellar tract (required for posture) 🡪 ataxia
    ● Most common type is Friedreich’s ataxia (recessive, European descent)
    ● Sx: begins < 20 yoa w/ multi-limb ataxia, skeletal malformation, intellectual disability
A

Spinocerebellar Degeneration

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10
Q

which degenerative disease:

Autosomal dominant; extrapyramidal disease causing atrophy of basal ganglia (voluntary movement) & frontal cortex (mental function)
● Appears after age of 50, w/ signs beginning around 30-40
● Tangles of abnormal Huntington protein accumulate & stick to each other, contributing to loss of inhibitory GABA neurons functionality (jerky movement)
● Sx: involuntary jerking & athetoid (writhing, involuntary) movements 🡪 deterioration w/ hypertonicity (muscle tightness), incontinence, anorexia, weight loss & death

A

Huntington’s Disease

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11
Q

disease of increased intracranial fluid:

● Very common; brain swelling d/t excessive fluid & flat gyri as brain pushes against cranial bones
● 3 types:
o Vasogenic: m/c, increased permeability or “leaky head” into white matter
▪ RFs: trauma, lead poisoning, infarct, abscess, hematoma
o Cytotoxic: cell injury/ischemia 🡪 edema & increase of intracellular water
▪ Affects mostly the grey matter
o Interstitial: fluid accumulates in white matter d/t hydrocephalus

A

cerebral edema

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12
Q
  • overproduction or decreased absorption of CSF
  1. communicating = no blockage, but cannot reabsorb CSF by arachnoid villi
  2. non-communicating = blockage
A

hydrocephalus

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13
Q

what metabolic and nutritional disease:

Toxic compounds buildup in brain d/t liver failure
● Sx: personality changes, wax/wane, neurologic sx, flapping tremor, coma

A

Hepatic Encephalopathy

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14
Q

what metabolic and nutritional disease:

  • Thiamine deficiency causes demyelination & axonal destruction of long nerves
    o I cannot feel this thigh of mine (thiamine) because of my neuropathy
A

Peripheral Neuropathy

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15
Q

which VitB def:

Often d/t malabsorption (especially from pernicious anemia)
● Sx: megaloblastic anemia & neuropathy (demyelinates CNS axons)

A

Vitamin B12 Deficiency

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16
Q

● Combination of the following two syndromes:
o Wernicke syndrome: thiamine deficiency 🡪 encephalopathy, ataxia & eye abnormalities
o Korsakoff psychosis: thiamine B1 deficiency linked w/ alcoholism
● Sx: disordered memory for recent events & creation of false memories (confabulation), confusion, ataxia (can’t coordinate muscle activity), paralysis of one or more eye muscles

A

Wernicke-Korsakoff Syndrome

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17
Q

which congenital/genetic disease:

presence of total or partial 3rd copy on chrom 21
● RFs: increased maternal age; Sx: intellectual disability, macroglossia, close-set slanted eyes, low nose bridge, congenital heart disease, accelerated aging

A

Down’s Syndrome/Trisomy 21

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18
Q

● Group of white matter disorders 🡪 cerebral deterioration in early life
● Involves absence or loss of myelin in CNS & PNS + glial reaction (phagocytic)
● Very few are autosomal dominant; most autosomal recessive or X-linked

A

Leukodystrophies

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19
Q

● Phenylalanine (amino acid) — phenylalanine hydroxylase —-> tyrosine
o Tyrosine is needed to make proteins, neurotransmitters & melanin
● Genetic defect of phenylalanine hydroxylase causes phenylalanine to buildup to toxic levels
● Sx: intellectual disability, seizures, hyperactivity
● Can minimize effects by limiting phenylalanine in the diet

A

Phenylketonuria (PKU)

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20
Q

2 types of storage disease

A

Tay Sach’s

Hurler’s

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21
Q

● Buildup of COPPER; autosomal recessive w/ decrease serum ceruloplasmin (copper-binding protein)
o KNOW THAT IT’S A BUILDUP OF COPPER!

A

Wilson’s Disease

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22
Q

● Deficiency of hexosaminidase A; needed to breakdown toxins in brain/SC 🡪 buildup & degrade CNS 🡪 severe mental/motor impairment
● Lack of enzymes leads to fat accumulation in the brain & nerve cells
● RFs: Ashkenazic Jews

A

Tay-Sach’s = Sack of Fat = fat accumulation

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23
Q

● Deficiency of alpha-L iduronidase (IDUA) 🡪 accumulation of heparan sulfate & dermatan sulfate in the heart, brain, liver & other organs
● Sx: progressive mental deterioration, dwarfism, stubby fingers, cloudy cornea, large head, low nasal bridge

A

Hurler’s Disease

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24
Q

which type of neoplasm

Primitive neuroectodermal tumor w/ neoplastic cells resembling undifferentiated cells of the medullary tube
● Usually found in vermis of cerebellum, brainstem & SC; m/c in children within 1st year of life
● Neoplastic cells are compact, round, have hyperchromatic nuclei & lie in a pseudorosette pattern (Homer-Wright rosette)
● Tumor grows into the CSF & can metastasize to the spinal cord (unique)

A

Medulloblastoma

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25
Q

● Benign; originates from arachnoid; m/c in adults & females; look like long fusiform cells in whirls or lobules
● Frequently along sagittal sinus, sphenoid ridge or at optic chiasm

A

Meningioma

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26
Q

● Includes astrocytoma & oligodendrocytoma; 60% of all intracranial neoplasms
● M/c dx is glioblastoma multiforme (grade IV astrocytoma); RFs: late/middle age
● Very poor prognosis

A

Neuroglial Tumors

27
Q

neuronal tumors are common in children

A

false! RARE

28
Q

tumors of peripheral nerves include

A
  1. Schawannonmas
  2. Neurofibromatosis
  3. Von Recklinghausen’s Neurofibromatosis
29
Q

match

  1. Schawannonmas
  2. Neurofibromatosis
  3. Von Recklinghausen’s Neurofibromatosis

a.
● Autosomal dominant
● Sx: multiple neurofibromas in the skin, hyperpigmentation of the skin
● Complications: neurofibroma can become large & cause disfigurement, bone erosion & compression of nerves

b.
● Also from Schwann cells, occur all over the peripheral nerves

c.
● Benign; arise form Schwann cells
● Acoustic schwannoma: found on CN VIII, Sx: hearing loss & ataxia d/t pressure on the brain; 3rd m/c intracranial tumor but does NOT occur in the brain

A
  1. c
  2. b
  3. a
30
Q

anything transmitted by a mosquito (mostly Flaviviruses, (+) ssRNA is called

A

Arboviruses

31
Q

● Clostridium botulinum; spore producing; food poisoning & infant botulism
● Can produce several toxins – strains A, B & E are most likely to cause disease
● Spores survive at high temperatures, requiring 120 C to be destroyed, but the toxins are heat-labile – DO NOT reheat the food
● Infection: botulinum toxin carried thru the LI 🡪 systemic 🡪 peripheral nerves 🡪 acts as a protease & chews up protein needed to make Ach 🡪 blocks the release of Ach 🡪 flaccid paralysis or “floppy baby syndrome”
● RFs: infants (high gut permeability)
● Sx: N/V, cramping, diarrhea/constipation, urinary retention
● Complications: respiratory failure, neuromuscular paralysis

A

Botulism

32
Q

● Etiology: Staph, Strep, gram (-) bacteria, fungi, TB, parasites
● Can spread thru blood or direct entry or sinuses, eyes, ear, mastoid, teeth & skin
● Sx: stages
o Initial (days 1-5): cerebritis, abscess in one site, not walled-off, no necrosis
o Late (days 5-10): cerebritis w/ necrotic tissue, vessels & granulation tissue begin to surround dying area
o Capsular (wks-months): body forms capsule around dying area 🡪 changes in mental status, headache, fever, seizure, vomiting, unilateral weakness or paralysis & cranial nerve signs
● Complications: fatal

A

brain abscess

33
Q

● DNA enveloped herpesvirus

Infects lymphoid cells (primarily B-lymphocytes) and transmitted via saliva
▪ Infection starts in the oropharynx and spreads via the blood to infect B cells
▪ Cytotoxic T cells start to fight against infected B cells
▪ IgM Abs to the viral capsid antigen are produced and IgG AB start to rise and persist for a lifetime.
▪ Nonspecific heterophile Abs can be produced but disappear after 6 months post- infection.
● Sx: fever, sore throat, lymphadenopathy, splenomegaly
● Complications: chronic fatigue syndrome, Burkitt’s lymphoma (cancer cells have shown to shed the virus)
● Dx: blood smear showing lymphocytosis

A

Epstein-Barr Virus

34
Q

DNA enveloped herpesvirus (same as EBV & VZV)

  • primary infection of immunocompromised individuals; usually asx, lifelong latency

● Transmission = saliva or mucosal, infants via vaginal delivery, breast milk & placenta
o Infections that cross placenta are TTORCH
{Toxoplasma gondhi, Treponema (syphilis), Other (Parvo B19, VSV, TB), Rubella, Cytomegalovirus, HSV}

  • high severity infection in px w/ transplantatino of bone marrow & solid organs

● Sx: asx in adults vs infants, hepatic & brain damage, stillbirth, postnatal death

A

Cytomegalovirus

35
Q

● “Slapped Cheek” or 6th disease; RFs: age 6 mo-4 yrs; self-limiting
● Sx: abrupt fever followed by “slapped cheek” macular rash 3-5 days

A

Roseola Infantum / Herpesvirus 6

36
Q

Etiology:
o E coli – m/c cause in infants when IgM response is lowest
o H influenzae B – ages 3 mo-3 yrs
o Step pneumoniae – m/c cause in adults
o Neisseria meningitidis – “epidemic” meningitis from crowded areas

Sx: headache, fever, vomiting, cervical rigidity, convulsions in children

A

meningitis

37
Q

● Caused by Poliovirus (ssRNA w/ no envelope); affects motor neurons of SC, medulla & cerebellum
● Sx: (initial) fever, fatigue, headache, vomiting, stiff neck, pain in limbs
● Complications: 1 in 200 progress to paralysis of respiratory muscles

A

Poliomyelitis

38
Q

● Clostridium tetani (gram + rod); forms spore at one end, looks like tennis racket
● Spread thru rusty nails, soil & manure
● Infection: exotoxin tetanospasmin -> blocks GABA release -> can’t relax muscles -> spasming (tetany)
● Sx: trismus/lockjaw (spreads thru cranial nerves first), progressive infection of all muscles, opisthotonos (hyperextension of neck & back), small stimuli cause massive muscle contractions
● Complications: respiratory failure

▪ First muscle affected is the masseter which causes lockjaw
▪ Death can occur due to respiratory failure

A

Tetanus

39
Q

▪ Result of rubeola infection (measles)
▪ 6-8 year incubation period following initial infection

Causes slowly progressive mental deterioration followed by focal neurological problems
▪ Seizures, ataxia, visual changes, spastic paralysis

A

Subacute Sclerosing Panencephalitis

40
Q

▪ Caused by JC (John Cunningham) virus
▪ Results in multi-focal demyelination and astrocyte and oligodendrocyte
enlargement
▪ Deterioration is slow and results in hemianopsia, motor weakness, mental impairment
▪ M/c immunocompromised patients
▪ Assoc. leukemia or lymphoma

A

Progressive Multifocal Leukoencephalopathy

41
Q

● Non-viral glycoproteins; transmissible but are NOT affected by immune system
● Highly resistant to inactivation by chemicals, UV, heat & enzymes
● T = food-borne, organ transplants, iatrogenic (drugs)

Creutzfeldt-Jakob
● Looks very similar to Alzheimer’s; from cows w/ bovine spongiform (mad cow)
● “dementia plus”; lethal

Kuru
● Tribe in Papau New Guinea who engaged in cannibalism of brain tissue

A

Prion Disease

42
Q

● Mycobacterium leprae; grows on skin
● Beside humans, it is only known to infect armadillos

A

leprosy

43
Q

tuberculoid or lepromatous leprosy; contagious/non-contagious

infection: immune system can’t control infection -> no granulomas, instead foamy histiocytes w/ several bacteria inside spread thru skin & mucosal surfaces
▪ Skin infiltration -> skin thickens
▪ Absorption of bone -> loss of nose & fingertips
▪ Anesthesia of skin -> repeated trauma -> disfigurement

o Most severe; begins with small symmetrical lesions -> larger -> skin deformity, loss of innervation & function
o Eyes with optic nerve involvement – glaucoma, photophobia, blindness
o “Saddle nose”, peripheral neuropathy

A

● Lepromatous - CONTAGIOUS

44
Q

tuberculoid or lepromatous leprosy; contagious/non-contagious

Infection: immune response limits growth to a few granulomas of skin
o Mild; asymmetrical rashes that are sensitive to touch; might have pain, muscle weakness, skin stiffness, dryness, or loss of skin sensation

A

tuberculoid; non- contagious

45
Q

▪ Inflammation of the eyelids.
▪ Usually involves the part of the eyelid where the eyelashes grow and affects both
eyelids.
▪ Watery and red eyes, a gritty, burning or stinging sensation in the eyes, eyelids that appear greasy, itchy eyelids, flaking of the skin around the eyes, crusted eyelashes upon awakening, sensitivity to light

which special sense cdx

A

BLEPHARITIS

46
Q

▪ Opacity of the lens of the eye
▪ Gradual painless loss of vision, blurred vision, halos seen around light, issues with
glare, absence of the red reflex, visual acuity worse than 20/30
▪ Associated with age, diabetes, smoking, obesity, eye injury, prolonged corticosteroid use
▪ Can result in blindness

which special sense cdx

A

cataracts

47
Q

▪ Inflammation of the conjunctiva of the eye

▪ Causes include viruses, bacteria (Gonorrhea or chlamydia), irritants, and allergies

▪ Erythema of the sclera or inner eyelid, tearing, thick yellow discharge that crusts over the eyelashes but discharge can be clear, itchy, burning eyes, blurred vision, photophobia

A

CONJUNCTIVITIS

48
Q
  • disordered aqueous flow from the posterior to anterior chambers of the eye
  • characterized by increased intra ocular pressure -> impair vision
A

GLAUCOMA

49
Q
  1. primary open-angle glaucoma
  2. primary angle-closure glaucoma

a.
- most common
- chronic obstruction of aqueous humor outflow increases intraocular pressure
- leads to progressive damage to eye and optic nerves

b.
- pupillary block causing forward displacement of the iris
- increased ocular pressure
- MEDICAL EMERGENCY

A
  1. a
  2. b
50
Q

match IRITIS/KERATITIS

a.
- inflamm. of iris
- results in a constricted pupil with poor light response, moderate-severe pain,
photophobia, often affects one eye, vision is slightly blurry

b.
- inflamm. of sclera
- infection involving bacteria, viruses, fungi/parasites

▪ Eye redness, eye pain, tearing of the eye, difficulty opening your eyelid because of pain
or irritation, blurred vision, photophobia

A

iritis = a
keratitis = b

51
Q

atrophy/degeneration of macula -> loss of central vision

insidious onset with slow, painless, bilateral loss of central visual acuity

drusen present

atrophic (dry) = common/uncommon pigmentary disorder w/o scarring or ___

exudative (wet) = common/uncommon with choroidal ____, hyper/hypo pigmentation, and scarring

A

macular degeneration

atrophic = common, w/o hemorrhage

exudative = uncommon, w/ choroidal neovascularization, hyperpigmentation

52
Q

▪ Inflammation of the uveal tract (iris, ciliary body, choroid)

▪ Anterior = inflammation of the iris and/or ciliary body
▪ Intermediate = inflammation of the structure just posterior to the lens
▪ Diffuse = inflammation of the choroids, retina, or vitreous

▪ SX: Diminished vision, black, floating spots, SEVERE PAIN, redness and photophobia, PUPILLARY CONSTRICTION & INJECTION, pus may form in the anterior eye chamber, macular edema, perivasculitis of the retinal vessels

A

UVEITIS

53
Q

▪ Syndrome with vertiginous episodes associated with increased volume and pressure of the endolymphatic fluid.

▪ Sudden disabling episodes that can last minutes to hours, vertigo, tinnitus, sensorineural hearing loss, ear fullness, nystagmus, severe nausea and vomiting, unsteadiness, generally unilateral, symptoms are worse with sudden motion

▪Also called idiopathic endolymphatic hydrops

A

meniere’s disease

54
Q

▪ Benign disorder involving inflammation of the vestibular apparatus
▪ Sudden onset of severe vertigo, persistent at first then paroxysmal, no hearing loss, no tinnitus

A

vestibulitis

55
Q

▪ Paralysis or weakness of the muscles on one side of your face.
▪ Damage to the facial nerve that controls muscles on one side of the face causes
facial drooping.
▪ Nerve damage may also affect your sense of taste and how you make tears and saliva.
▪ Arises suddenly, often overnight, and usually gets better on its own within a few weeks.
▪ Most cases are thought to be caused by herpes simplex virus.
▪ most cases the nerve that controls muscles on one side of the face is damaged by inflammation.

A

BELLS PALSY

56
Q

▪ Entrapment neuropathy caused by pressure on the median nerve from the carpal retinaculum
▪ Caused by repetitive motions of the arm and wrist
▪ Associated with pregnancy, autoimmune diseases, acromegaly, hypothyroidism,
amyloidosis
▪ Results in hand and wrist weakness with pain that radiates into the hand (lateral portion of the palmar hand and medial portion of the dorsal hand)

A

CARPAL TUNNEL SYNDROME

57
Q

▪ Bulging of the soft, inner nucleus pulposus of an intervertebral disc due the tearing/weakness of the annulus fibrosus
▪ Usually occurs posteriorly where the posterior longitudinal ligament is located.
▪ Results in nerve compression and nerve root entrapment

A

DISC HERNIATION

58
Q

▪ Compression of a nerve root
▪ Paresthesia, pain, weakness and other symptoms depending on the nerve affected.

A

NERVE ROOT ENTRAPMENT

59
Q

▪ Neuropathic syndrome caused by the compression or one or both sciatic nerves
M/C from herniated lumbar disc, piriformis muscle spasm, or inflammation in the sciatic nerve area
▪ The sciatic nerve can pass through the piriformis muscle rather than under it in some people
▪ Results in paresthesias, pain, weakness along the sciatic nerve distribution

A

SCIATICA

60
Q

▪ Results from damage to the peripheral nerves
▪ Diabetes (one of most common causes, remember thiamine deficiency also causes), uremia, AIDS, nutritional deficiencies, nerve entrapment, trauma/injury, contusions, fracture, bone dislocation, SLE, scleroderma, sarcoidosis, RA, polyarteritis nodosa, atherosclerosis

A

PERIPHERAL NEUROPATHY

60
Q

▪ Compression of the brachial plexus
▪ Spasm of a scalene muscle
▪ Unusual configuration of brachial plexus
▪ Traumatic hypertrophy of a scalene muscle
▪ Subclavian vein and artery also affected
▪ pain, paresthesias, and weakness in the entire arm

A

THORACIC OUTLET SYNDROME

60
Q

▪Also known as Tic Douloureux
▪ Idiopathic
▪ Pain is extreme, electric, and intermittent
▪ Slightest touch can aggravate
▪ Most often occurs in middle-aged or elderly women
▪ Other causes include:
▪ Tumor
▪ Shingles
▪ Herpesinfection
▪ Enlargedsuperiorcerebellarartery ▪ Arachnoid cyst
▪ Trauma

A

TRIGEMINAL NEURALGIA

61
Q

▪ Acute demyelinating multifocal disorder which occurs a week to two weeks after an infection or vaccination.
▪ Infections include measles, chicken pox, German measles, influenza, mumps, infectious mononucleosis, mycoplasma infection, or scarlet fever
▪ M/C associated vaccinations are small pox and rabies

▪ Latent period can range between days and weeks before symptoms begin.
▪ Headache, decreased consciousness, fever initially
▪ Focal neurological deficits and coma can occur
▪ Mononuclear cells infiltrate small veins causing gray discolouration in the white matter of the brain.

A

PERIVENOUS
ENCEPHALOMYELITIS

62
Q

▪ Inflammation of the external auditory canal
▪ Pruritis, local pain, foul discharge, obstructive hearing loss, painful pinna and tragus,
erythematous canal

A

Otitis Externa

63
Q

▪ Inflammation of middle ear
▪ Acute or recurrent
▪ Otitis media with effusion = acute non-infectious condition
▪Chronic otitis media is also called serous or secretory otitis media
▪ Irritability, difficulty sleeping, ear tugging, relief with tympanic membrane rupture, loss of balance

A

Otitis Media

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