Pathology COPY Flashcards
Degeneration:
Calcification
Metastatic = Ca++ into normal tissue
Hypervitaminosis D
Dystrophic = Ca++ into abnormal/damaged tissue
Atherosclerosis, atheroma
Degeneration:
Caseous
cheesy
tuberculosis
Types of Degeneration
Albuminous
cloudy swelling
membrane injury, ion transfer fucked
Degeneration:
Coagulation
Infarction (MI)
Degeneration:
Enzymatic
Pancreas
(digests itself inside-out)
Degeneration:
Fatty
- *Liver = “nutmeg liver”** (reversible if caught early)
- *Heart = “tabby cat heart”** (stripes)
fatty dot → fatty streak → fatty plaque (atheroma) → fibroatheroma (fibrous tissue, calcium)
Degeneration:
Liquefactive
- *CNS**
- brain melts, tertiary syphilis, leprosy*
- *or skin**
- infection*
Degeneration:
Wallerian
peripheral nerves
degenerates to next Node of Ranvier
“dying back phenomenon”
Degeneration:
Zenker’s (Waxy)
hyaline cartilage
most common in skeletal muscle
(at epiphyseal plates)
muscle replaced with hyaline cartilage
Cellular Degeneration
Karyolysis: nuclear rupturing/fading/destruction
Karyorrhexis: nuclear swelling
Pyknosis: nuclear condensation
All the above = “nuclear dissolution”
leads to an anuclear necrotic cell
Developmental Changes
Agenesis: absence of organ (usually paired organs; renal, testicular.. odontoid)
Aplasia: small remnants of the organ, lack of development
Hypoplasia: smaller than normal, usually defective
Primary Pathology
vs
Secondary Pathology
Primary
- arrives spontaneously
- organ in question is fucked up
Secondary
- usually insidious
- resultant from other trauma/pathology
- organ in question is malfunctioning, due to some other organ not working properly
Growth Disturbances
Cancer
Metaplasia: functional change from one cell type to another
Dysplasia: change in size/shape/fx, precancerous, but last stage that can be returned to normal
- *Anaplasia:** complete disorganization of a cell (cancer)
- squamous cell carcinoma*
Collagen Types
Type 1
bone, muscle, tendons, ligaments
Type 2
disc (specifically nucleus pulposis)
- *Type 3**“reticular collagen”, spleen and lymph nodes
- *early wound healing**
Type 4
basement membrane of all tissues
Pneumoconiosis
Silicosis
silica from sand, rock, glass
Rocky QUarry disease
Pneumoconiosis
Asbestosis
asbestos
leads to mesothelioma
malignant tumor
Naval shipyard
Pneumoconiosis:
Siderosis
Iron dust particles
Iron Ore Mill/Steel Mill occupants
Pneumoconiosis:
Byssinosis
cotton dust
Brown Lung
Pneumoconiosis:
Anthracosis
Black Lung Disease from miners
Caplan’s Syndrome
(anthracosis + RA)
W.Virginia coal mines
Pneumoconiosis:
Histomycosis/Histoplasmosis
Endemic fungus
Mississippi/Ohio Valleys
“Mississippi Valley Fever”
“Ohio Valley Fever”
Pneumoconiosis:
Coccidiomycosis
Endemic fungus in deserts of SW USA
“San Joaquin Valley Fever”
(just Valley Fever in other states)
Pneumoconiosis:
Blastomycosis
Endemic fungus on Eastern seaboard
Florida to Nova Scotia
Asthma
Sputum analysis:
Curschmann’s Spirals
& Charcot-Leyden Crystals
↑IgE, ↑Eosinophils
(↑<em>IgE: wheezes, sneezes and weird ass diseases)</em>
Cystic Fibrosis
- Chloride channels affected
- “sweat test”
- mother notices, tastes salt = Salty Baby Syndrome
- Affects:
- GI mucous linings
- respiratory mucous linings
- exocrine secretions
- Susceptible to pseudomonas aeruginosa
- frequently requires lung transplants
Hemosiderosis
iron in lungs due to bleeding
rib fracture
pulmonary embolism (?)
stab/gunshot wound
Pulmonary Fibrosis
honeycomb lung
Tuberculosis
caseous necrosis in lung
Gohn complex, granulomas, epithelioid histiocytes
If spread to spine = “Pott’s Disease”
(with fracture or collapse of VB = Gibbus deformity)
Wegner’s Granulomatosis
Vasculitis of lung and kidney arteries
any system can be affected (polyangitis)
Ben Wegman has vasculitis of lung and kidney
Emphysema
Alpha-1-antitrypsin (A1AT) deficiency = loss of elasticity
can’t breathe out
Azotemia
decreased tubular excretion of nitrogen
↑nitrogen in the blood
Hydronephrosis
most commonly caused by prostate problems/ureter stones
Kidney Stones
“Nephrolithiasis”
acute nephritic shock:
mc stone: calcium oxalate/ Ca++ urate
pain pattern: constant LBP, radiates to flank
localized groin pain = stone in ureters
painful voiding, pink urine
Dx: Murphy’s Punch
Nephritic Syndrome
RBCs and minor amount of protein in urine
(hematuria, mild proteinuria)
acute glomerulonephritis
Nephrotic Syndrome
- *“Pre-eclampsia”**
- *“HEP”: H_ypertension / _E**dema / massive Proteinuria
Eclampsia
HEP + seizure/convulsions+ coma
(potentially fatal)
Polycystic Kidney
multiple cysts on kidneys
moth-eaten appearance
idiopathic
Renal Shock
acute tubular necrosis
Wilm’s Disease
“nephroblastoma”
mixed (palpable) tumor of kidney in children
(if kids experience LBP = no bueno)
*mc malignant tumor found in kids
Addison’s Disease
↓cortisol, ↓BP
hypoadrenia/adrenal fatigue
inadequate cortisol levels = ↑↑ACTH to stimulate cortisol release
↑↑ACTH leads to ↑MSH
↑Melanocyte Stimulating Hormone = hyperpigmentation
fatigue
Cushing’s Disease
↑cortisol (z. fasciculata)
hyperadrenia
moon faces, buffalo hump, purple striae, central obesity
hypertension, water retention
<i>(opposite of Addison’s Disease)</i>
Conn’s Disease
↑↑Aldosterone (z. glomerulosa)
↑↑ADH = water retention
hypertension
Goiter
hyperplasia of thyroid cells due to lack of iodine
Grave’s Disease
Hyperthyroidism
exopthalmoses
heat intolerance
weight loss
rapid HR
weight loss
T3/T4 fiddles with thermostat, turns ↑ = <strong>↑HR, ↑BP, hot</strong>
Hashimoto’s
Autoimmune cause of hypothyroidism
Myxedema
Hypothyroidism
Cretinism in child
cold intolerance
weight gain
slow HR/bradycardia
loss of lateral 1/3 eyebrows
slow mental faculties (memory, common sense)
Cryptorchism
undescended testes
can cause testicular cancer
Endometriosis
mc site: ovary
<em>(endometrial cells should only be in uterus or outside body)</em>
Epispadias/Hypospadias
Epispadias: urethra exits dorsal surface of penis
Hypospadias: urethra exits ventral surface of penis
extreme cases lead to chordee
= sharp angulation of penis
↑HCG
- pregnancy
- hydatidiform mole
- non-viable embryo that has implanted
- “cancer-like”
Leiomyoma
tumor of smooth muscle
fibroids in the uterus
(may disappear at menopause)
Polycystic Ovarian Disease
PCOS
anovulation
obesity
hirsutism
(excess hair on body and face)
Seminoma
cancer of testes (mc form)
mesenchymal/stem cells
Congenital Syphilis
born to mother with syphilis
- Hutchinson’s teeth = notched upper incisors
- Rhagades = cracks at edge of mouth
- Saddle nose deformity = bridge flattened
- Sabre Blade Tibia
- Interstitial keratitis = produces visual changes, sometimes at tympanic membrane
Acquired Syphilis
Treponema Pallidum
Primary
Hard, painless chancre on perineum
Secondary
maculopapular rash and condylomata lata
Latency
may or may not have symptoms
Tertiary
tabes dorsalis, aortic aneurysm, gummas in CNS,
Argyll Robertson Pupil/ “prostitute’s pupil”
<em>accomodates, but doesnt respond)</em>
Pupils
Argyll Robertson Pupil
does not react to light, but constricts upon accomodation
Adie’s Pupil
tonic pupil dilation (mydriasis) due to CNIII Edinger-Westphal nucleus
Miosis
tonic pupil constriction due to injury to sympathetic cervical ganglia
Changroid
soft, painful chancre
Haemophilus ducreyi infection
(G- coccobacillus)
Gardnerella vaginalis
bacterial vaginosis
similar to Trichimonas, except bacterial
Gonorrhea
Gram (-) diplococcus
mcc PID/Pelvic Inflammatory Disease
mcc salpingitis (fallopian tube infection)
- *burning urination**
- *yellow/green pus** in urine
may produce arthritis (mc DJD in knee)
coffee bean shaped
Lymphogranuloma venereum
Chlamydia
rectal strictures (elasticity loss)
Dx: Frei Test
Trichimonas Clamydia
Purulent vaginal discharge
Protozoan
vaginosis
(green/yellow, frothy, foul, fish-like)
Achalasia
spasm of lower esophageal sphincter
causes megaesophagus (expansion) of upper esophagus
lack of motility
(due to absence of myenteric plexus)
Barrett’s esophagus
metaplasia of esophageal cells into stomach cells
caused by GERD
Budd-Chiari
occlusion of hepatic veins
Triad
abdominal pain / ascites / hepatomegaly
Acute
rapid severe upper abdominal pain, jaundice, hepatomegaly, ↑liver enzymes, eventual encephalopathy/shock
Celiac Disease
aka “non-tropical sprue”
gluten intolerance/enteropathy
loss of villi = loss of absorption
intestinal lining flattened & hole-punched
GF diet
Cholecystitis
1 cause of gallstones
gallbladder inflammation
Cholelithiasis
gallstones
mcc by cholecystitis
Chron’s Disease
“regional ileitis”, “distal ileitis”, “regional enteritis”
seen in young people
distal small intestine (ileum), cecum, ascending colon
(R-sided problem)
skip-lesions = “cobblestone” appearance
NO bloody diarrhea
autoimmune
leads to dehydration bc most water absorbed in small intestine
Diverticula
outpouching in the intestine
usually lower L quadrant
(sigmoid and descending)
Dysphagia
difficulty swallowing
Enteritis
bowel inflammation due to improper sanitation
mcc of death of children worldwide
due to dehydration from diarrhea
Hemorrhoids
Swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding
mcc of frank red blood in stool
frank blood = bright red
melena = upper GI bleed- - dark, digested blood
Hirschprung’s Disease
Congenital megacolon
absence of myenteric plexus
= parasympathetic motor plexus
*Meissner’s plexus is chemosensitive
Intussusception
telescoping (collapsing) of intestine onto itself
Irritable Bowel Syndrome
IBS
stress related
spastic colon
distention
pain
diarrhea
Mallory-Weiss Syndrome
Hematemesis (vomitting blood)
due to alcoholism
distention of esophageal veins → bleed into stomach
“Mallory Weiss tears”
= distal esophageal/proximal stomach lacerations
Meckel’s Diverticulum
outpouching of distal ileum
(R side: iliocecal/distal ileum)
Peutz Jegher’s Syndrome
Polyposis, characterized by polypz in the entire GI tract
beningn
Plummer Vinson Syndrome
iron deficiency anemia
cheilosis
esophageal webbing
(partial esophageal occlusion)
glossitis
Pyloric stenosis
Infant projectile vomitting
newborns
Sliding hiatal hernia
anatomically shortened esophagus
too short
Steatosis
fat in stool
problem with gallbladder
Guacamole rampage = steatosis
Ulcerative Colitis*
“Toxic Megacolon”
pathological intestingal changes
ulcers
bloody diarrhea
affects L abdomen
(descending colon, sigmoid colon)
“lead pipe rigidity”
starts at colon, moves distally
Volvulus
twisting of an organ around its long axis
Zenker’s Diverticulum
outpouching of esophagus/pharynx
Diabetes Insipidus
↓ADH
due to PP problem
dehydration
Diabetes Mellitus
↓insulin production by β-cells of pancreas
1st seen in eyes
mc die from heart disease or renal failure
polydipsia, polyuria, polyphagia
(Islets of Langerhaans)
Hemochromatosis
iron in organs and skin
“bronze diabetes”
*iron absorption requires vitamin C
Kwashiorkor
protein malnutrition
severe edema
Marasmus
calorie malnutrition, includes protein
wasting away
Wilson’s Disease
inborn error of copper metabolism
Kayser-Fleisher Rings = copper deposits in eye
Hepatolenticular degeneration
ALS
Amyotrophic Lateral Sclerosis
“Lou Gherig’s Disease”
anterior horn and corticospinal tracts affected
complete motor loss
no sensory loss
LMN in upper extremities
UMN in lower extremities
progressive disease
Alzheimer’s
severe atrophy of cerebral cortex
progressive
↓ACh
#1 cause of dementia
50-60+ years old
Arnold Chiari
Type 1
cerebellar tonsils herniate (specifically vermis)
Type 2
[Type1] + meningiomyelocele in lumbar spine
*can get syrinx because of hydrocephalus - Rexed Lamina 10
brain matter outside brain
Brain Tumors
Astrocytoma
Types I and II
mc CNS tumor
best prognosis
Brain Tumors:
Glioma
mc CNS tumor
Brain Tumors:
Glioblastoma multiform
worst prognosis
affects cerebrum
Brain Tumors:
Medulloblastoma
mc seen in cerebellar vermis in children
mc cerebellar tumor
Brain Tumors:
Oligodendroglioma
slowest growing
affects cerebrum
Brain Tumors:
Schwannoma
CN VIII
Acoustic neuroma
onion bulb tumor
mcc of unilateral sensorineural hearing loss
Brain Tumors
mc brain tumor = Astrocytoma
mc cns tumor = Glioma
worst prognosis = Glioblastoma Multiform
mc cerebellum tumor = Medulloblastoma
slowest/cerebrum = Oligodendroglioma
CN VIII/acoustic neuroma = Schwannoma
Friedreich’s Ataxia
lesions of sclerosis of spinocerebellar* tract
chromosome 9
*spinocerebellar: unconscious proprioception
(neurofibrillary tangles)
Guillan-Barre Syndrome*
“post-infectious polyradiculopathy”
mc seen after recent flu or vaccination
PNS demyelination
areflexia and ascending paralysis
reaches diaphragm = fatal
Horner’s Syndrome
interruption of cervical sympathetics
(trauma, pancoast tumor*)
S/Sx: ptosis, miosis, anhydrosis, enophthalmosis
*pancoast tumor @ lung apices, disrupts cervical sympathetic ganglia
Leprosy
“Hansen’s Disease”
liquefactive necrosis
skin damage
sensory nerve destruction
(early sign = feels no pain)
Multiple Sclerosis
CNS demyelinization
and plaquing of spinal cord or brain
- *Charcot’s Triad (SIN)**
- *s**canning speech, intention tremor, nystagmus
distal mms affected
visual disturbances
Corticospinal tracts* affected
Myasthenia Gravis
formation of antibodies against ACh receptors
@ myoneural junction
Thymoma: thymus enlargment
progressive weakness and fatigue
Starts in ocular muscles, worse at end of day
diplopia: dbl vision
tight, sore mms in jaw and hands
autoimmune
Corticospinal tracts affected
Neurofibromatosis
“Von Recklinghausen’s Disease”
Café au Lait spots
“coast of California” appearance
Onion Bulb Tumor
Schwann cell tumor
Parkinson’s Disease
“Paralysis Agitans”
↓dopamine in basal ganglia
difficulty starting/stopping motion
inability to move + tremor = “cogwheel rigidity”
Inclusions: Lewy Bodies
masked faces, stooped posture, resting tremor,
shuffling/propulsive gait
Substantia nigra of mesencephalon
affected
PLS
Posterolateral Sclerosis
“Combined Systems Disease”
Longstanding B12 deficiency* (Pernicious Anemia) → PLS
Dorsal columns and corticospinal tract affected
*lack of intrinsic factor
Poliomyelitis
Affects brainstem, then CNs, possibly breathing apparatus
If affects anterior horn = produces LMNL
<em>(Polio transmission = oral/fecal)</em>
Syringomyelia
cystlike formation from central canal of sc
leads to loss of pain/temperature, bilaterally
+ signs of UMNL in upper ext
“cape-like” distribution of pins and needles sensation
(shoulders, arms, back)
Caused by syrinx (central dilation of sc)
Wernicke-Korsakoff
Alcoholic psychosis with dementia
Thiamine (B1) depletion
due to severe alcoholism over time
Destroys: Wernicke’s area @ angular gyrus, temporal lobe
Tumors, Cancers, Cysts
Benign vs Malignant
Benign
- slow-growing
- encapsulated
- non-destructive
- asymptomatic, usually
- short zone of transition
- easily removed
- “-oma” (usually)
Malignant
- non-encapsulated
- long zone of transition
- periosteal reactions if in bone
- deep, boring night pain
- weight loss
- fevers, night sweats
- metastases
- automatically worst grade
- mcc bone cancer
- “-carcinoma”
- “-sarcoma”
Aneurysmal Bone Cyst
“ABC”
benign
metaphyseal/diaphyseal
(without crossing growth plate)
eccentric: not at center of bone
“Blister of Bone”
blisters, bubbles
<20 yo
Brown’s Tumor*
“tumor-like” radiolucency
loss of bone density from hyperparathyroidism (↑PTH)
Chordoma
cancer mc seen in sacrum
crosses jts
(notochord remnants)
Ewing Sarcoma
multi-laminated periosteal reaction
cortical saucerization
Children 10-25 (?)
moth-eaten appearance in medulla
mimics osteomyelitis
(onion-skin appearance)
Multiple Myeloma
“Plasma cell leukemia/sarcoma”
mc primary bone malignancy in adults
amyloid buildup
inclusion bodies: Russell bodies
xray: “punched-out” lesions, raindrop skull
Osteosarcoma
most common primary bone cancer in children (10-30)
Simple/Unicameral bone cyst
“SBC” or “UBC”
benign
metaphyseal/diaphyseal
concentric
“fallen fragment sign”
Age < 20
found in long bones
Adenoma
tumor of glandular tissue
Cachexia
wasting away
Carcinoma in situ
cancer that has not invaded basement membrane
“in stasis”, no metastases
Chondroblastoma
benign bone tumor
age < 20
epiphyseal/metaphyseal
(mostly cartilagenous tissue)
Chondroma
benign tumor of cartilage
most commonly within feet/hands
Cryptorchidism
absence of one or both testes in scrotum
can cause testicular cancer
(failure to descend)
Enchondroma
benign hand tumor
stippled calcification
2+ = “multiple enchondromatosis”
enchondromatosis + soft tissue swelling + bone deformity
= Maffuci’s Syndrome
Fibroma
myxomatous tissue
spindled, polyhedral cells
multiple nuclei
Fibrous dysplasia
benign tumor
ground glass appearance
café au lait patches
“Coast of Maine” appearance
in early puberty = Albright’s Disease
rind sign
Giant Cell Tumor
tumor of osteoclasts
osteoclastoma
mc in knee
quasi-malignant
epiphyseal/metaphyseal
ages 20-40
Histiocytosis X
“Hans-Schüller-Christian disease”
“histocytic granuloma”
“eosinophilic granuloma”
lipid accumulation → vertebral plana (“pancake vertebrae”)
discs preserved
Krukenberg’s
cancer of stomach
metastasizes to ovaries
signet ring cell tumor
form of adenocarcinoma
Leukoplakia
white patch on oral mucosa from tobacco
cannot be wiped off
precancerous
Lung Cancers
Adenocarcinoma
Oat cell/Small cell
Squamous cell
can get lung cancer from arsenic poisoning
(arsenic in treated wood)
metastasis from lung most commonly goes to the brain
Lung Cancers
Adenocarcinoma
mc with non-smokers
best prognosis
Lung Cancers
Oat Cell/Small Cell
worst prognosis
Lung Cancers
Squamous Cell
most common in smokers
Neurofibromatosis
“Von Recklinghausen’s Dz”
Café au Lait patches
“Coast of California” appearacnce
Osteoid Osteoma
pain worse at night
relived by aspirin
ages 15-25
radiolucent nidus
w/reactive sclerosis
Osteoma
mc benign tumor of the skull
mc in frontal sinus (frontal bone)
Osteomyelitis
Chronic = Brodie’s Abcess
sequestrum involucrum cloaca
dead bone newly-formed bone drainage
mcc staph aureus
Pheochromocytoma
neuroblastoma
benign tumor of adrenal medulla
episodic hypertension
Stomach Cancer
mc in lesser curvature
“leather bottle” stomach
= adenocarcinoma
Virchow’s Nodes
enlarged supraclavicular lymph nodes (L)
due to metastasis
usually GI tract
usually L side
supraclavicular lymph nodes
Chemotaxis
movement of WBCs along concentration gradient
of tissue-damage byproducts
Pavementing/Margination
WBCs lining damaged vessels
adhesion of leukocytes to endothelium
Diapedesis
AKA Leukocyte extravasation
neutrophils and monocytes squeeze through walls of blood vessels towards site of damaged tissue or infection
Clot Formation
fibrinogen → via THROMBOPLASTIN → fibrin
requires Vit K and Calcium in cascade
Exudate
fluid and [high protein}
= damaged capillary wall
Transudate
fluid and [low protein}
= normal capillary wall
5 Stages of Inflammation
- injury
- vasoconstriction
- vasodilation (via histamine and bradykinin)
- swelling/edema (chemotaxis → diapedesis)
-
healing
mast cells make heparin and serotonin, triggers myofibroblasts to constrick and make type 3 collagen for early wound healing. scar = fibrin
Bradykinin/Histamine
vasodilation
↑ inflammation
Leukotrienes
Prostaglandins
Substance P
inflammation pathway
↑ inflammation
Enkephalins
Endorphins
pain control
“personal morphine”
↓ inflammation
NSAIDs
Non-Steroidal Anti-Inflammatory Drugs
Cycloxygenase (COX) inhibitor
↓ inflammation
Steroids
phospholipase A2 inhibitor
prednisone
↓inflammation
Basophils
become mast cells
make histamine, bradykinin, srotonin, heparin
B-lymphocytes
transform into plasma cells
make antibodies
Granulocytes
“BEN”
Basophils
Eosinophils
Neutrophils
Agranulocytes
Lymphocytes and Monocytes
Macrophage
Monocyte at tissue level
Kupffer cells = liver
Dust cells = lung
Microglia = brain
Langerhaan = skin
Natural Killer Cells
“MEN”
Monocytes
Eosinophils
Neutrophils
T-Lymphocytes
-
T-Helper Cells (CD4)
activate B-cells
mature in thymus -
T-Killer Cells (CD8)
cytotoxic
destroys cancer, kills foreign agents
transplant rejections
mature in thymus -
T-Suppresor Cells
T-Regulatory cells
↓ immune system
slows antibody production
mature in thymus
Neutrophils
60%
increase in acute bacterial infections
and acute inflammation
Lymphocytes
30%
increase in viral conditions
and chronic inflammation
Monocytes
5-8%
chronic conditions
change into phagocytes at tissue level
Eosinophils
2-4%
increase in parasites and allergies
Basophils
0-0.5%
like mast cells
produce heparin and histamine
↑ in conditions that cause histamine release
Immune Complex
(Acquired Immunity)
Antigen
↓
Macrophage
↓
CD4
↓
productes lymphokines
↓
stimulates b-lymphocytes
↓
converts plasma cells
↓
produce antibodies
Natural Immunity
Involves:
Natural Killer Cells
Mast Cells
Basophils
Macrophages
Bruton’s Agammaglobulinemia
blood cell disorder
↓Bcells and ↓IgG
mc primary immunodeficiency at birth
X-linked
DiGeorge’s Syndrome
hypoplasia of thymus
↓
primary T-cell deficiency at birth
(all T-cells)
Hodgkin’s
Pel Epstein fever
Biopsy: Reed Sternberg Cells
enlarged lymph nodes
hepatosplenomegaly
Multiple Myeloma
Leukemia of bone marrow
affects plasma cells
Age 50+
example of non-Hodgkin’s Lymphoma
Severe combined immune deficiency
Newborn w/o proper B or T cells
bone marrow problem
in adult, mc due to aplastic anemia
benzene poisoning
Coagulation
- Injury → thromboplastin release (needs vitamin K)
- thromboplastin triggers production of prothrombin in liver
- prothrombin (w VitK & Ca) converts to thrombin (II)
- fibrinogen (using thrombin) converts to fibrin (clot)
- positive feedback/”feed forward” more thrombin produced = more fibrin produced
- clot breakdown: fibrolysin & plasmin dissolve clot
Hemophilia A
CF VIII deficiency
“a” / “eight”
Von Willebrand Disease
decrease in platelet adhesion
Hemophilia B
CF IX deficiency
Christmas Factor Disease
X-chromosome
females = carrier, males = disease
Hemophlia C
CF XI deficiency
mild hemophilia
Clotting Factors
- X = Stuart Prower Factor
- XII = Hageman Factor
Aplastic Anemia
↓RBCs, ↓WBCs in blood
caused by benzene poisoning
associated with bone marrow degeneration
Iron Deficiency Anemia
↓RBC production
nutritional
mcc by chronic blood loss
menses
microcytic, hypochromic
Pernicious Anemia
↓RBC production
nutritional
lack of intrinsic factor
gastritis can be a cause
Folic Acid Anemia
↓RBC production
nutritional
during pregnancy
B9 deficient
megaloblastic anemia
leads to spina bifida occulta
B12 Anemia
↓RBC production
nutritional
seen in vegetarians
macrocytic, hypochromic
Anemias caused by
bone marrow suppression
toxins (benzene → aplastic anemia)
chemotherapy
Anemia from
chronic blood loss
↓iron
microcytic, hypochromic
Fe+ is the only “red” thing in the body
Anemia from
Hemorrhage
normochromic, normocytic
Anemia from
Hemolytic breakdown
due to sickle cell or malaria
Thalassemia Major
“Cooley’s Anemia”
“Homozygous Beta Thalassemai”
“Mediterranean anemia”
body makes an abnormal form of hemoglobin
child inherits 2 mutated genes, one from each parent
“hair on end” appearance on skull xray
genetic
Anemia from
Erythroblastosis Fetalis
- *Rh ( - ) mother**
- mother is “negative” with worry*
- ( Rh ( + ) father )*
Rh ( + ) baby
Type II Hypersensitivity
cytotoxic
Only relevant in <strong>2nd pregnancy</strong>
Developed in first pregnancy - attack in second
Pancytopenia
↓RBC
↓WBC
↓platelets
Polycythemia
↑RBCs
1° polycythemia = Polycythemia Rubra Vera
(pathological)
2° polycythemia = relative polycythemia
(normal response to high altitudes)
Thrombocytopenia
↓platelets in the blood
Berry Aneurysm
localized dilation of an artery
Berry in the Circle of Willis
=subarachnoid hemorrhage
Dissecting Aneurysm
localized dilation of an artery
longitudinal tearing away of the aorta
“tearing pain”
Abdominal Aortic Aneurism
“AAA”
localized dilation of aorta
sudden LBP
hypovolemic shock
thready pulse
“curvilinear calcification”
“fusiform shape”
Atherosclerosis
fatty plaque deposition
(atheroma)
form of arteriosclerosis
lipid deposits in intima of
large and medium sized arteries
narrowing of lumen
Buerger’s Disease
“Thromboangitis Obliterans”
lower extermity
males w history of smoking
intermittent claudication
= cramping upon exertion
Cardiac Tamponade
fluid to pericardial space
prevents proper ventricular filling
emergency room!
Monkeberg’s Sclerosis
tunica media of medium sized arteries
calcified
smokers and diabetics
Prinzmetal’s Angina
coronary artery vasospasm
Raynaud’s Syndrome
arterial vasospasm
may be 1° or 2° to other collagen diseases like lupus
hands and feet
triphasic color change:
WHITE → BLUE → RED
triggered by cold or emotion
can lead to dry gangrene
typically upper extremity in female smokers
Rhabdomyoma
tumor of striated muscle or heart muscle
Sickle Cell Anemia
half-moon shaped RBCs
“H-shaped vertebra”
homozygous sickle cell allele
Temporal Arteritis
“giant cell arteritis”
temporal arteries
assoc. w long-standing hypertension
affects opthalmic artery
can lead to blindness
Tetralogy of Fallot“DRIP”
D extrorotation of aorta
“dextroposition”
R ight ventricular hypertrophy
I nterventricular septal defect
P ulmonic Stenosis
Valvular lesions
tooth extractions
(<em>Strep</em> infection causing Aschoff bodies from rheumatic fever)
mitral valve affected
(Syphilis affects aortic valve
Strep affects mitral valve)
Acute Lymphoblastic Leukemia
ALL
mc in children
“ALL the little children”
Acute Myeloblastic Anemia
AML
any age
mc acute leukemia in adults
(85% of cases)
worst prognosis
Chronic Lymphoblastic Leukemia
CLL
mc chronic leukemia in adults
- chronic leukemia*
- “Cranky Late Lifers”*
Chronic Myelocytic Leukemia
CML
young adulthood (30-40)
↑granulocytes
“Philadelphia chromosome”
(#22)
Alkaptonuria
homogentistic acid accumulation
black/blue deposits in cartilage, ears, nose, cheeks
causes onchronosis
(IVD calcification)
black urine
can have ↑tyrosine
(Homogentistic acid is intermediate in
phenylalanine & tyrosine metabolism)
Charcot Marie Tooth
hereditary
progressive peroneal muscle atrophy
tibialis anterior
seen in swing of gait
Huntington’s Chorea
hereditary onset age 30-50
basal ganglion affected
(atrophy of caudate)
↓GABA
dementia, death
Marfan’s Syndrome
arachnodactyly
spider-like fingers
lens dislocation
dissecting aortic aneurysms
tall, thin stature
Phenylketonuria
phenylalanine → X → tyrosine
due to phenylalanine hydroxylase
retardation
possibly managed if caught early:
phenylalanine-free diet for life
Cri du Chat Syndrome
piece of chromosome 5 missing
“CHS #5 aberration”
Cat’s cry
characteristic cry of newborn
usually disappears by age 1-2
Neimann Pick’s
lipodystrophy
sphingomyelinase deficiency
= ↑sphingomyelin
Tay Sach’s
lipodystrophy
↑gangliosides in brain
cherry red spots on macula
infant death
mc in Ashkenasi Jews
Duchene’s Muscular dystrophy
boys age 3-7
pseudohypertrophy of calves
muscle replaced with fat
recessive, x-linked
waddling gait
proximal muscles affected
Myotonic dystrophy
can’t relax muscles
cataracts, insulin resistance
Kleinfelter’s
47XXY karyotype
tall male
low IQ
testicular atrophy
gynecomastia
sterile
Turner’s
45X0 karyotype
female
short
webbed neck
amenorrhea
lacks female 2° characteristics
Myositis Ossificans
calcium or bone within muscle
d/t trauma
mc in quads or biceps
if adductors = “Prussian’s Disease”
example of metaplasia
Paget’s
“Osteitis Deformans”
Case Hx: men over 50, increased hat size, bone deformity or enlargement, cortical thickening
4 Radiology phases:
lytic → mixed → blastic → malignant degeneration
osteoclastic combined osteoblastic <strong>osteosarcoma</strong>
Lab:
↑alkaline phosphatase, ↑urinary hydroxyproline
normal calcium and phosphorus
pathological cell = osteoclastic cell
Scleroderma
“Progressive Systemic Sclerosis”
CREST Signs:
- Calcinosis Cutis
- Raynaud’s phenomenon
- Esophageal problems
- Sclerodactyly
- Telangectasis
- = dilation of superficial blood vessels*
sero(+) for RA
resorption of distal tufts (acrosteolysis)
Acid Phosphatase
elevated in prostate cancer
w ruptured the prostate capsule
Alkaline phosphatase
elevated in liver and bone conditions
Brown’s Atrophy
lipofuscin buildup in organs
“lipofuscin granules are old age pigments”
Mineral Deficiencies
#1 in United States
Calcium deficiency
#1 Worldwide
Iron deficiency
Caplan’s Syndrome
arthritis
coal miners lung w RA nodules
Felty’s Syndrome
chronic rheumatoid arthritis with splenomegaly
Gonococcal Arthritis
usually affects the knee
Gonorhhea - mcc PID in females
Gouty Arthritis
(metabolic arthritis)
Uric acid in blood
<strong>tophi</strong> = crystal deposits in tissue
if in big toe = “podagra”
monoarticular
MCC: high purine diet
red wine, red meat, aged cheeses
destroys from outside-in
“juxtarticular erosions”
“overhanging edge sign”
Osteoarthritis
OA or DJD
unilateral distribution
in weight-bearing joints
subchondral sclerosis, osteophytes
Heberden’s Nodes (DIP)
Bouchard’s Nodes (PIP)
mc location = hip, then knee
mc arthritis
Psoriatic Arthritis
PA
seronegative arthritide
HLAB27+
periarticular erosions
mouse ear erosions
silver scales, pitted nails
Rheumatoid Arthritis
RA
inflammatory
bilateral, symmetrical distribution
ulnar deviation of wrist
ankylosing of spine
pannus formation
hypertrophy of synovium of joint
Haygarth’s Nodes (MCP)
Bouchard’s Nodes (PIP)
<strong>(never hits DIP joints) *</strong>
( + ) RA factor
Boutonniere or Swan Neck deformities
transverse ligament instability
Seronegative Arthritis
“PEAR”
Psoriatic
Enteropathic arthropathy
Ankylosing Spondylitis
Reiter’s Syndrome
Seropositive Arthritis
“RSSS”
Rheumatoid Arthritis
Sjogren’s
Scleroderma
Systemic Lupus Erythematosus
Sjogren’s
xeropthalmia
dry eyes
xerostomia
dry mouth
seropositive
for RA latex
“Sjogren’s in the desert”
Systemic Lupus Erythematosus
photosensitivity butterfly rash ("malar rash")
autoimmune
antibodies against DNA
most damaged organ: kidney
ANA/FANA Test
Legg Calve Perthes Disease
“Perthes Disease”
AVN of head of femur
in child
Avascular Necroses
“osteonecrosis” = death of bone due to lack of blood
AVN of lunate = Keinbock’s
“kind hands, cold feet”
AVN of tarsal navicular = Kohler’s
AVN of head of femur in child = Legg Calve Perthes
AVN of scaphoid/navicular = Preisser’s
AVN of multiple vertebral endplates = Scheuermann’s
<strong> disc space spared </strong>- leads to <strong>hyperkyphosis</strong>
Colles Fracture
most common fracture of the wrist
Fx of distal radius with posterior displacement
(of distal fragment)
“dinner fork deformity”
FOOSH
Smith’s Fracture
“Reverse Colles”
Fx of distal radius with anterior displacement
of distal fragment
“garden spade deformity”
Osgood Schlatter’s
“Tibial Apophysitis”
avulsion of tib tub of knee
in young, athletic children