Systems Pathology I Material Flashcards
1
Q
What is the general term for a developmental anomaly of bone?
A
dysostosis
2
Q
what causes dysostosis?
A
Abnormal mesenchymal migration during embryogenesis
3
Q
what is the result of dysostosis?
A
Defective ossification of fetal cartilage
4
Q
What is Klippel-Feil Syndrome?
A
Congenital fusion of any 2 cervical vertebrae
5
Q
What is the most common congenital malformation?
A
Syndactyly
6
Q
What condition represents malformation and dysostosis of the scapula?
A
Sprengel’s Deformity
7
Q
What term is used to describe absent or incomplete development of tissue?
A
aplasia
8
Q
What is dysplasia?
A
When mutations interfere with growth or homeostasis (dwarfism)
9
Q
Multiple fractures, extremity bowing, scoliosis, ligamentous laxity (dislocations), and hearing loss are associated with what musculoskeletal congenital disorder?
A
Osteogenesis imperfecta
10
Q
The zebra stripe sign is associated with what musculoskeletal congenital disorder?
A
Osteogenesis imperfecta
11
Q
Is achondroplasia usually sporadic or inherited?
A
sporadic (75%)
12
Q
What musculoskeletal congenital condition is accompanied by short proximal extremities, lower extremity bowing, frontal bossing, and mid face hypoplasia (low nasal bridge)?
A
Achondroplasia
13
Q
What percentage of achondroplasia diagnoses are inherited?
A
25%
14
Q
What type of dwarfism is primarily endocrine oriented and is more rare than achondroplasia?
A
Hypopituitary dwarfism
15
Q
Spinal issues including hyperlordosis and hyperkyphosis at birth, bullet vertebrae, scoliosis, and spinal stenosis are common among which musculoskeletal genetic disorder?
A
achondroplasia
16
Q
What two specific types of spinal stenosis are common among achondroplasia patients?
A
Foramen magnum stenosis and spinal canal stenosis
17
Q
What is another name for osteogenesis imperfecta?
A
brittle bone disease
18
Q
What type of dwarfism is completely fatal?
A
Thanatophoric dwarfism
19
Q
Extremely small thorax with shortened long bones leading to perinatal respiratory failure occurs with which musculoskeletal congenital disorder?
A
Thanatophoric dwarfism
20
Q
What rare genetic disorder is a result of decreased osteoclast-mediated bone resorption?
A
Osteopetrosis
21
Q
Why is deranged hematopoiesis common with osteopetrosis?
A
The medullary cavity fills with extra bone due to the decreased osteoclast activity
22
Q
Why does hepatosplenomegaly occur with osteopetrosis?
A
The liver and spleen attempt to take over the function of the bone marrow that has been compressed and therefore hypertrophy
23
Q
Erlenmeyer flask deformity is present among which musculoskeletal disorder?
A
osteopetrosis
24
Q
What is the most important form of osteopenia?
A
osteoporosis
25
What is usually the cause of localized osteoporosis?
disuse/immobilization
26
What is the most common type of osteoporosis?
primary
27
When does primary osteoporosis occur?
post-menopausal/ senile
28
Neoplasia, hyperparathyroidism, nutrient deficiency, and drug exposure are causes of what which type of osteoporosis?
secondary
29
What is mutated in osteogenesis imperfecta?
Type 1 collagen (alpha 1 or alpha 2 chains)
30
Osteoporosis is more likely to affect what kind of bone?
Trabecular (cancellous/spongy) bone
31
What are specific common locations of fractures as a result of osteoporosis due to these areas possessing increased amounts of trabecular bone?
Vertebral bodies, femoral neck, calcaneus
32
What type of bone cell is less impacted by aging and therefore retains normal activity?
osteoclasts
33
How is type I collagen affected by osteogenesis imperfecta?
Premature breakdown of collagen
34
Beginning in mid-20s, bone loss occurs at what rate?
.5% per year
35
What percentage of postmenopausal women experience an osteoporosis related fracture?
50%
36
Osteogenesis imperfecta follows what type of genetic pattern?
Autosomal dominant
37
What percentage of males (of the same age as postmenopausal women) experience an osteoporosis related fracture?
3%
38
Reduction in what hormone accelerates bone loss as seen in postmenopausal women with osteoporosis?
estrogens
39
What is the age of maximum bone density?
mid-adulthood, 25
40
How can osteoporosis be prevented?
diet and exercise
41
Calcium and vitamin D deficiency are most common among what gender?
females
42
Osteoporosis is usually asymptomatic, true or false?
true
43
What is the appropriate way of determining osteoporosis?
DEXA scan
44
What are the specific areas affected by osteogenesis imperfecta?
Eyes, inner ear bones, skin, joints, teeth
45
What are the two extreme issues with type II osteogenesis imperfecta?
Cerebral hemorrhage and respiratory failure
46
What is the unique effect of osteogenesis imperfecta on the eye?
Abnormal collagen of the sclera (choroid) giving a bluish appearance instead of white
47
With what type of osteogenesis imperfecta does abnormal collagen of the sclera occur?
type 1
48
What is the treatment used for children with osteogenesis imperfecta?
Bisphosphonates
49
What is the most common form of dwarfism?
achondroplasia
50
What are the results of achondroplasia?
Decreased cartilage synthesis and decreased growth plate expansion
51
What location is specifically affected by the decreased cartilage synthesis with achondroplasia?
growth plate
52
What is the genetic mutation with achondroplasia?
Fibroblast growth factor receptor (FGFR3) mutation
53
What is the genetic pattern of achondroplasia?
autosomal dominant
54
What is usually the death of those with achondroplasia?
brain stem compression
55
What is trident hand that is associated with achondroplasia?
Underdevelopment of the bones in the hands
56
What type of bone cell is inhibited in osteopetrosis & what is the result of that?
Osteoclasts; osteoblasts therefore overwork and build up extreme bone density leading to increased fractures
57
Why are cranial nerve palsies associated with osteopetrosis?
Foraminal stenosis occurs narrowing the bony canals for the nerves
58
What is the treatment for osteopetrosis?
stem cell replacement
59
Enlargement of what organ is a cause of secondary osteoporosis?
parathyroid
60
What types of drugs can be a cause of secondary osteoporosis?
Alcohol, smoking, long term corticosteroids
61
How is the cortex of the bone affected by osteoporosis?
Thinned (not completely destroyed)
62
What type of osteogenesis imperfecta results in a normal lifespan nonetheless?
type 1
63
What is the exaggerated forward hunching of those with osteoporosis called that is due to multiple compression fractures?
Dowager's hump
64
What type of bone cells is affected by the aging cause of osteoporosis?
Osteoblasts (decreased synthesis)
65
What is another feature important to consider with the aging cause of osteoporosis besides the reduction in osteoblast synthesis?
general sedentary lifestyle
66
What is the main location affected by osteogenesis imperfecta?
Extracellular matrix (ECM)
67
What is the result with brain stem compression with achondroplasia?
Cardiovascular abnormalities (may be lethal)
68
What are some issues that occur when the medullary cavity fills with excess bone in osteopetrosis?
Hepatosplenomegaly, recurrent infections, anemia
69
Which type of osteogenesis imperfecta is lethal in utero?
type 2
70
Why is cerebral hemorrhage common with type II osteogenesis imperfecta?
weak skull
71
At what point does osteopenia become the severe form of osteoporosis?
T score of 2.5 standard deviation (threshold from the norm)
72
Activity of what substances are decreased in senile osteoporosis?
growth factors and osteoblasts
73
What are some concerns following surgery for a femoral neck (hip) fracture?
Pneumonia, deep vein thrombosis, pulmonary embolism (result of disablement)
74
What is osteopenia?
reduced bone mineralization
75
What is a positive note on the current findings of Paget's Disease diagnoses?
its becoming less common and less severe
76
What is ivory vertebra sign?
Increased density of one specific vertebral level
77
What named conditions result from vitamin D deficiency?
Rickets (in children) or osteomalacia (in adults)
78
What is the name of the perpendicular fractures seen on X-ray with Paget's Disease?
chalk stick fractures
79
What is secreted from the parathyroid glands?
Parathyroid hormone (PTH)
80
In what condition can a "brown tumor" result?
Hyperparathyroidism
81
What is a "brown tumor"?
Collection of loose connective tissue filling a space, giving off a bloody appearance (not actually a tumor but a lesion)
82
Renal stones, peptic ulcers, bowing of long bones, and pathological fractures are present with what condition?
hyperparathyroidism
83
The salt & pepper skull is indicative of what condition?
hyperparathyroidism
84
Is hyperparathyroidism possibly reversible?
Yes, with normalization of PTH levels
85
Most cases of Paget's Disease are asymptomatic: true or false?
true, up to 90%
86
The appearance of Paget's Disease of the pelvis on X-ray is what?
fuzzy/shaggy looking
87
What is the appearance of the bone cells with Paget's Disease?
Mosaic, jigsaw puzzle appearance
88
What population is more like to develop Paget's Disease?
caucasians
89
What is the older term for Paget's Disease?
Osteitis Deformans
90
Why are there increased levels of serum alkaline phosphatase in those with Paget's Disease?
It is a byproduct of osteoblast activity
91
When ivory vertebra sign is present, what are likely causes?
Paget's Disease, metastatic cancer (usually from prostate cancer), lymphoma
92
If a patient comes in saying they've noticed their hats don't quite fit anymore, it could be indicative of what condition?
Paget's Disease
93
What is the average age of diagnosis of Paget's Disease?
70 years old
94
What gender is at a greater risk for Paget's Disease?
males (2X)
95
What is the treatment for Paget's Disease?
Bisphosphonates
96
What is the intention with treating Paget's Disease with bisphosphonates?
Slowing of the osteolytic (first) phase
97
What are ways vitamin D deficiency can occur?
Malnutrition, deficient UV Rays, abnormal metabolism
98
Osteomalacia is similar to what condition?
osteoporosis
99
What is the main function of the parathyroid glands?
Maintains serum calcium (in blood)
100
What type of hyperparathyroidism involves autonomous PTH production?
primary
101
What is the most common cause of excessive PTH?
From an adenoma (80%)
102
Excessive PTH has what kind of effect on bone cells?
Increased osteoclast activity
103
What is absorbed more heavily from renal tubules in a state of excessive amounts of PTH?
vitamin D and calcium
104
What can result from secondary hyperparathyroidism?
Mild renal failure
105
How is hyperparathyroidism diagnosed?
Hypercalcemia, parathyroid immunoassay
106
What is the most common nonmalignant cause of hypercalcemia?
Hyperparathyroidism
107
In which group is hyperparathyroidism most common?
Post menopausal women
108
Hyperparathyroidism results in resorption of what type of bone?
BOTH cortical and trabecular bone
109
When cortical and trabecular bone are resorbed in hyperparathyroidism, what replaces that bone?
Loose connective tissue
110
What is a condition that produces holes in the skull that can appear similar to the salt and pepper skull seen on X-rays of those with hyperparathyroidism?
multiple myeloma
111
Rugger-jersey spine is seen on X-rays of those with what condition?
Hyperparathyroidism
112
Bone pain, fractures, deformation, kidney stones, nausea, anorexia, fatigue, and decreased cognition are features of what condition?
hyperparathyroidism
113
Subperiosteal resorption of the radial side of the middle phalanges is unique to what condition?
hyperparathyroidism
114
What are the three phases of Paget's Disease?
Osteolytic phase, mixed osteolytic and osteoblastic phase, osteosclerotic phase
115
What are the general symptoms of Paget's Disease when they're present?
Bone pain, multiple fractures, nerve compression
116
In what percentage of cases is hyperparathyroidism asymptomatic?
>50%
117
What is the most common joint disorder?
Osteoarthritis
118
What is affected with osteoarthritis?
Degeneration of articular cartilage occurs (collagen)
119
What substance is decreased in OA and what is the result of that reduction?
Decreased proteoglycans leading to matrix breakdown
120
Is OA largely inflammatory?
not necessarily
121
What causes OA?
Both mechanical wear and tear from aging along with a genetic influence
122
Which type of OA occurs without trauma and is common among adults?
primary
123
Which type of OA is insidious in onset and is oligocarticular in nature?
primary
124
Which type of OA is associated with trauma or obesity, deformity, or a systemic disease?
secondary
125
Which type of OA involves a predisposing injury or deformity?
secondary
126
What are the common specific locations for OA?
Spine (cervical, lumbar), DIP joints, 1st metacarpal joint, 1st tarsal metatarsal joint
127
What is the most common location for OA in females?
knees and hands
128
What is the most common location for OA in males?
hips
129
What occurs to the intervertebral discs and is seen on X-ray during OA?
Dehydration of discs
130
When can inflammation in OA develop?
After full blown degeneration
131
What are the functions of articular cartilage?
Decrease friction and shock allow load absorption
132
OA disrupts the function of what cells?
chondrocytes
133
What are risks for OA?
Mechanical stress, age 50s-60s, genetics, increased bone density, increased circulating estrogen
134
Insidious onset, deep/achy pain, crepitus, decreased range of motion, and worse pain the morning are all associated with what joint condition?
OA
135
What affect can osteophytes in OA have on nerves?
possible impingement on nerve rootlets
136
What is the treatment for OA?
Palliative: ice, heat, NSAIDs, adjust, joint replacement
137
What is ankylosis?
Abnormal fusion of joints
138
Is ankylosis present in OA?
no
139
Is ankylosis present in rheumatoid arthritis?
yes
140
OA is more common among which gender?
females
141
What is the name for the enlargement of the DIP joints?
Heberden's nodes
142
What is the name for the visual enlargement of the PIP joints?
Bouchard's nodes
143
Which joint disease is a systemic, chronic autoimmune disease?
RA
144
RA results in what effect on the joints?
Increased collagenase and osteoclast activity
145
The biomarker, HLA-DRB1, is a risk factor for what joint issue?
RA
146
What two things are commonly tested for when checking for RA?
Anti-CCP antibodies and rheumatoid factor (RF)
147
In 70% of cases, RA patients test positive for what?
anti-CCP antibodies
148
What is another cause of testing positive for anti-CCP antibodies?
inflammation due to smoking or infection
149
80% of people, with RA will test positive for what test?
rheumatoid factor (RF)
150
What are the most common specific locations for RA?
MCP and PIP joints (Bouchard's nodes)
151
What is the name for the visual swelling in the fingers seen with RA?
Fusiform swelling
152
What is significant about the patients with RA and their C1/C2 region?
30% demonstrate atlanto-axial instability
153
Pannus is associated with what joint condition?
RA
154
Swan neck deformity and ulnar deviation are associated with what joint condition?
RA
155
Which joint condition has relatively symmetric defects?
RA
156
What is a condition that is similar to RA but shows up negative for RF and positive for HLA-B27 (seronegative)?
Seronegative spondyloarthropathies
157
What is the unique location for the inflammation seen with seronegative spondyloarthropathies?
Sacroiliitis, spinal ligaments (syndesmophytes)
158
What are the categories of seronegative arthropathies?
Psoriatic arthritis (psoriasis), enteropathic arthritis (IBD), ankylosing spondylitis, reactive arthritis
159
What is the most common diagnosis when a negative test for RF is seen?
Juvenile rheumatoid arthritis
160
What gender is more likely to develop juvenile rheumatoid arthritis?
females
161
What is the most common age for juvenile rheumatoid arthritis to be causing pain?
1-6
162
What is Still's disease?
Spiking fever, rash, pericarditis
163
In what location does inflammation typically occur with juvenile rheumatoid arthritis?
Large joints like the knee and hip leading to dysfunction
164
What is the other name for ankylosing spondylitis (AS)?
Marie-Strumpell disease
165
What part of the skeleton is affected by ankylosing spondylitis?
Axial skeleton
166
Where do you see referred pain with ankylosing spondylitis?
gluteal region
167
What is the actual pain in ankylosing spondylitis?
Sacro iliac joint
168
Bamboo spine is associated with what joint condition?
Ankylosing spondylitis
169
What is the typical onset age for ankylosing spondylitis?
before age 40
170
Characteristic morning stiffness after thirty minutes of being awake is associated with what joint condition?
Ankylosing spondylitis
171
Nocturnal low back pain that is unrelieved when lying down is associated with what joint condition?
Ankylosing spondylitis
172
95% of ankylosing spondylitis cases test positive for what test?
HLA-B27
173
Where is a secondary location for ankylosis in patients with ankylosing spondylitis?
rib joints
174
Syndesmophytes are indicative of what general joint condition?
Seronegative spondyloarthropathies
175
Trolley track sign and dagger sign on X-ray is indicative of what condition?
Ankylosing spondylitis
176
What are the effects of ankylosing spondylitis?
Decreased flexion and lordosis leaded to a hunched appearance
177
What condition is an abnormal purine metabolism leading to uric acid accumulation?
gout
178
Red meat and alcohol can be risk factors for what condition due to purine emphasis?
gout
179
When uric acid accumulates in gout, what do they become?
Monosodium urate crystals (tophus/tophi)
180
What occurs with gout?
Recurrent acute joint inflammation leading to destruction and fibrosis
181
Over 90% of the cases of gout is what kind?
Primary - hyperuricemia
182
What is the hypothesized cause of primary gout?
enzyme defects
183
With primary gout, what accumulates in the blood?
uric acid
184
What is secondary gout?
Gout that is secondary to another disease or from drug exposure
185
What are examples of some causes of secondary gout?
Renal disease leukemia, multiple myeloma, diuretics
186
What is the cause of the inflammation of gout?
failed crystal phagocytosis
187
What is the usual age of those with gout?
over 30
188
Gout usually occurs among which gender?
males
189
What is the most common location for gout inflammation?
Hallux (MTP) aka podagra
190
About what percent of the population is affected by gout?
1%
191
The historical name, "Kings Disease", is associated with what condition?
gout
192
Monoarticular inflammation is characteristic of what condition?
gout
193
What is the first stage of gout?
Asymptomatic hyperuricemia
194
What is the second stage of gout?
Acute gouty arthritis causing erythema
195
What is the third stage of gout?
Repeated chronic tophaceous arthritis that fails to resolve itself between cycles
196
20% of those with gout die from what issue?
renal failure
197
What are other names for pseudogout?
Chondrocalcinosis or Calcium Pyrophosphate Deposition Disease (CPDD)
198
What causes pseudogout?
Altered pyrophosphate metabolism
199
Are most cases of pseudogout inherited?
no most commonly sporadic
200
What is the usual location for pyrophosphate crystal deposition of pseudogout?
Knee, wrist, shoulder, hip, elbow, ankle
201
Only about how many cases of pseudogout lead to destruction of joints from inflammation?
50%
202
After what age is pseudogout seen among half of the population?
over the age of 85
203
What is the usual onset age for pseudogout?
over 50
204
What is the treatment for pseudogout?
Palliative medicine (NSAIDs or corticosteroids)
205
What specific location in the wrist is common for pseudogout to occur?
Triangular fibrocartilage complex
206
What is hydroxyapatite deposition disease usually called?
calcific tendonitis
207
What is the sign of calcific tendinitis on X-ray?
Soft tissue opacities from ossification
208
What is the most common location for calcific tendinitis?
rotator cuff muscles
209
What is the age of onset for calcific tendinitis?
40-70
210
What is the most common muscle affected by calcific tendinitis?
supraspinatus
211
Adhesive capsulitis (frozen shoulder) and increased age are risk factors for what condition?
calcific tendonitis
212
What is the other name for diffuse idiopathic skeletal hyperostosis?
Forestier disease
213
What ligament is affected in the cervical and thoracic spine in DISH?
anterior longitudinal ligament (ALL)
214
What is the usual spinal location for DISH?
T7-T11
215
What is the most common age for DISH?
50-70
216
What are risks for DISH?
Diabetes and HLA-B27
217
What is the most common cause of infectious arthritis?
bacteria
218
What occurs with infectious arthritis?
Rapid joint destructions within days
219
What is the treatment for infectious arthritis?
Based on microbial agent: IV antibiotics and analgesics
220
What is the name of the pus forming infectious arthritis?
Suppurative arthritis
221
What is the most common location for suppurative arthritis?
knee
222
90% of suppurative arthritis involve how many joints?
one
223
Which microbe is the most common agent involved with suppurative arthritis among children under 2 years of age?
Haemophilus influenzae
224
Which microbe is the most common agent involved in suppurative arthritis among children older than 2 years of age and adults?
Staphylococcus aureus
225
Which microbe is the most common agent involved in adolescents and young adults?
Neisseria gonorrhoeae
226
Who is at a higher risk for neisseria gonorrhoeae causing infectious arthritis?
sexually active females
227
What is the most common microbe at fault for infectious arthritis among those with sickle cell anemia?
salmonella
228
Are primary joint neoplasms rare or common?
rare and most commonly benign
229
Which is more common: tumor like lesions or neoplasia in joints?
tumor like lesions
230
What makes up a ganglion?
degenerative CT
231
What is the name of a synovial cyst in the popliteal region?
bakers cyst
232
What is the difference between a ganglion and a synovial cyst?
Communication with the synovium is present in synovial cysts only
233
What is the typical age for tenosynovial giant cell tumors?
20-50 years old
234
What joint condition involves an aggressive benign tumor?
Tenosynovial giant cell tumor (TGCT)
235
What is the type of TGCT that is larger?
Diffuse TGCT (pigmented villonodular synovitis)
236
Which type of TGCT is smaller and involved with the tendon sheaths?
Localized TGCT
237
What is the common location for diffuse TGCT?
knee
238
What is the common location for localized TGCT?
hand
239
What is the most common soft tissue tumor of the hand?
localized TGCT
240
Tumors of adipose, fibrous, muscle, vessels, or the PNS are what kind of tumors?
Soft tissue tumors
241
Are soft tissue tumors usually benign or malignant?
benign (100X)
242
If a soft tissue tumor is malignant, what is it called?
soft tissue sarcoma
243
What is the most common area for a soft tissue tumor or sarcoma?
thigh
244
What is the exception for a location where soft tissue tumors are more likely to be malignant than benign?
skeletal muscle
245
What is a malignant tumor of adipocytes?
liposarcoma
246
What is the most common type of soft tissue tumor of adults?
lipoma
247
What type of soft tissue tumor is likely to be encapsulated?
lipoma
248
What is the usual age range for liposarcomas?
40-50
249
What is the location for possible metastasis for a liposarcoma?
lungs
250
What is the usual location for liposarcomas?
Retroperitoneum, thigh
251
What is the genetic factor of liposarcomas?
Degraded p53 resulting from a translocation of chromosomes 12 and 16
252
What is the term for a reactive fibroblastic mass?
Nodular fasciitis
253
What is the usual location for a nodular fasciitis?
Volar (Palm-side) of arm, chest, back
254
Nodular fasciitis tends to result from what kind of event?
trauma (10-15%)
255
What is the term for reactive metaplastic bone?
Myositis ossificans
256
What is the most common location for myositis ossificans?
proximal extremity muscles
257
A hard, painless mass is characteristic of what kind of fibrous tumor like mass?
Myositis ossificans
258
What condition should you attempt to rule out when suspicious of myositis ossificans due to their similarities in appearance?
osteosarcoma
259
Myositis ossificans is common among what group of people?
adolescent athletes
260
What type of fibrous like tumor mass is benign but locally invasive that tends to commonly recur?
fibromatosis
261
Dupuytren contracture and Peyronie disease are examples of what kind of fibromatosis?
superficial
262
What is the most common age for superficial fibromatosis?
40-70
263
What another term for deep fibromatosis?
desmoid tumor
264
Where are desmoid tumors or deep fibromatoses most commonly found?
abdominal area
265
Which type of fibromatosis is associated with Gardner Syndrome?
deep
266
What is the term for a slow growing, malignant fibrous like tumor mass?
fibrosarcoma
267
What are the usual locations for fibrosarcomas?
Thigh, retroperitoneum, knee
268
What is the most common age for fibrosarcomas?
35-55
269
Neoplastic fibroblasts and anaplastic spindle cells are associated with what kind of fibrous like tumor mass?
fibrosarcomas
270
25% of fibrosarcomas metastasize hematogenously to what location, most commonly,
lungs
271
Herringbone pattern is associated with what fibrous like mass tumor?
fibrosarcomas
272
What are skeletal muscle precursors?
Rhabdomyoblasts
273
What is the term for a malignant and aggressive skeletal muscle tumor?
Rhabdomyosarcoma
274
What is the most common location generally and specifically for rhabdomyosarcomas?
Generally in areas with little skeletal muscle. Specifically in the areas of the head and neck
275
What is the most common pediatric soft tissue sarcoma?
Rhabdomyosarcoma
276
What changes with the prognosis for adults with rhabdomyosarcomas?
Poor prognosis (2/3 of pediatrics will be 100% cured)
277
What is the term for a benign smooth muscle tumor?
leiomyoma
278
What is the term for a malignant smooth muscle tumor?
Leiomyosarcoma
279
What is the most common location for a leiomyoma?
uterus (often called fibromas)
280
What population is more at risk for leiomyosarcomas?
Adult females
281
What is a unique common area for leiomyosarcomas?
inferior vena cava
282
Spindle cells and cigar shaped nuclei are associated with what kind of smooth muscle tumor?
Leiomyosarcoma
283
What makes up 10% of all soft tissue sarcomas?
Synovial sarcomas
284
What is the most common age range for synovial sarcomas?
20-40
285
What is the unique pattern of growth associated with synovial sarcomas?
Cells grow in solid cords or aggregates
286
What is the most common location for a synovial sarcoma?
knee
287
What is the treatment for synovial sarcomas?
Limb-sparing surgery and chemotherapy
288
What is the usual survivability for those with synovial sarcomas?
10 year survivability of 10-30%
289
Can stress fractures be visible on X-rays?
no microfractures occur
290
What causes the bony necrosis with AVN?
ischemia
291
What is the most common cause of AVN?
vascular disruption via fracture
292
What is the most common form of osteomyelitis?
acute
293
What condition is known as "bone-marrow-inflammation"?
Osteomyelitis
294
What is specifically infected in osteomyelitis?
bone marrow
295
What are signs and symptoms of osteomyelitis?
Acute fever, intense malaise, throbbing pain
296
What is usually the bacterial cause of osteomyelitis?
pyogenic bacteria
297
What is the most common pyogenic bacteria to cause osteomyelitis?
Staph aureus
298
Possible collapse with AVN creates a risk for what condition?
OA
299
What is another name for tuberculous osteomyelitis?
skeletal TB
300
What is the most common form of spread in tuberculous osteomyelitis?
Hematogenous (other form would be lymphatics)
301
Which is more common: secondary or primary bone tumors?
secondary
302
What six factors indicate a larger risk of a bone tumor being the cause of low back pain?
50 years of age or older, history of cancer, unexplained weight loss, failure to improve after a month of conservative care, unrelieved with bed rest, and pain duration longer than one month
303
What category of fibrous dysplasia is most commonly represented?
Monostotic (70%)
304
What category of fibrous dysplasia is asymptomatic and results in minimal bony distortion or enlargement?
monostotic
305
When does polystotic fibrous dysplasia typically develop?
Late childhood and adolescence (earlier than monostotic)
306
Craniofacial involvement is present in about half of the cases of which category of fibrous dysplasia?
polystotic
307
What is the metastatic pathway of sarcomas?
Hematogenous
308
What is the metastatic pathway of carcinomas?
lymphatic
309
What is the most common type of secondary metastasis to bone?
Mixed- both osteoblastic and osteolytic
310
What are the most common forms of secondary metastasis to bone in adults?
Prostate (blastic), breast (lytic), lung
311
In pyogenic osteomyelitis, what is the reactive woven/lamellar bone that surrounds the infected bone called?
Involucrum
312
In pyogenic osteomyelitis, what is that dead bone seen at the site of infection?
Sequestrum
313
In pyogenic osteomyelitis, what is the ruptured periosteum that leads to an abscess in the surrounding soft tissue?
Draining sinus
314
What is fibrous dysplasia?
Arrested development of bone resulting in a benign lesion (failure of bone differentiation)
315
McCune-Albright syndrome is part of what category of fibrous dysplasia?
Polystotic + café-au-lait spots & endocrinopathy
316
What is the age range of monostotic fibrous dysplasia?
10-30
317
The "ground glass" appearance on X-ray is characteristic of what bone condition?
Fibrous dysplasia
318
How can you distinguish Paget's disease from fibrous dysplasia on X-ray?
Fibrous dysplasia tends to be focused on the proximal region of the bone, while Paget's disease is throughout the entire bone
319
What is the treatment for fibrous dysplasia?
Excision, othropedic hardware
320
McCune-Albright syndrome is more common among what gender?
females
321
What types of endocrine hyperfunction is associated with McCune-Albright syndrome?
Hyperthyroidism, pituitary adenoma, and adrenal hyperplasia
322
Are the skin and bony lesions of McCune-Albright Syndrome commonly unilateral or bilateral?
unilateral
323
What is PNET?
Primitive neuroectodermal tumor
324
What causes Ewing sarcoma or PNET?
Translocations of genetic bits of information
325
"Small round cell tumors of bone" is associated with what bone condition?
ewing sarcoma or PNET
326
What is the appearance of the cells involved with an Ewing sarcoma?
highly primitive and undifferentiated
327
What is the second most common pediatric bone cancer (#1 osteosarcoma)?
Ewing sarcoma
328
What is the difference between Ewing sarcoma and PNET?
PNET has some neural differentiation while Ewing sarcoma is virtually completely undifferentiated
329
What is the most common age range of Ewing sarcoma and PNET?
10-20
330
What race is more likely to be affected by Ewing sarcoma or PNET?
caucasians (9X)
331
What gender is at a greater risk for Ewing sarcoma and PNET?
males
332
What is the most common location of bone for Ewing sarcoma or PNET?
femur
333
What effect does an Ewing sarcoma or PNET mimic?
That of infection: pyrexia, leukocytosis, increased erythrocyte sedimentation rate
334
What is the most common mode of infection with osteomyelitis?
Hematogenous (sepsis)
335
"Onion-skinning" appearance of the periosteum is associated with what bone condition?
ewing sarcoma
336
What percentage of patients with Ewing sarcoma or PNET end up with complete remission?
50%
337
Homer-Wright pseudo rosettes are associated with what bone condition?
PNET
338
What is the age range for giant-cell tumors of bone (GCT)?
20-40
339
What is the most common location for giant-cell tumors of bone?
knee
340
What type of bone condition produces arthritis like pain, is osteolytic, and is painful?
giant cell tumor of bone
341
What is the most common location of metastasis for a giant-cell tumor of bone, although it rarely metastasizes?
lungs
342
The "soap bubble" appearance on X-ray is associated with which bone condition?
giant cell tumor of bone
343
What part of the skeleton is the most common location for secondary metastasis of bone?
axial skeleton
344
What destroys the bone in osteomyelitis?
Leukocytes
345
What are other modes of infection for osteomyelitis besides the most common one?
Adjacent infection or traumatic implantation
346
What is the common location of chondrosarcomas?
Intramedullary
347
What are the usual osseous locations of chondrosarcomas?
Large joints like the pelvis, shoulder, ribs, and proximal femur
348
Which type of cartilage forming tumor creates an expansile glistening mass?
chondrosarcoma
349
What is the usual age range for osteomalacia (benign)?
40-50
350
What effect can chondrosarcomas have on the cortex?
it may thicken or erode it
351
Which type of chondrosarcoma is more common?
low grade
352
Where do high grade chondrosarcomas tend to metastasize the most?
lungs
353
What is the survival rate of a high grade chondrosarcoma?
40%
354
What percentage of high grade chondrosarcomas metastasize?
70%
355
At what size is an chondrosarcoma indicative of a poor prognosis and being extremely fatal?
>10 cm
356
What is the treatment for chondrosarcomas?
wide excision and chemo
357
What does exophytic mean?
growing out, not growing in
358
What is the usual specific location of osteoid osteomas?
Near cortex of long bones like the femur and tibia
359
What is the most common location of chondroma development?
medullary cavity
360
What is the typical age range for a chondroma?
20-50
361
Which is more common: chondrosarcoma or osteosarcoma?
osteosaroma
362
What is the usual age range of chondrosarcomas?
40-60
363
What gender is more commonly affected by chondrosarcomas?
males (2X)
364
What type of bone tumors are the most common?
matrix and fibrous producing tumors
365
In regards to bone tumors, are benign or malignant tumors more common?
benign
366
What are the two most common benign bone tumors?
Osteochondroma, fibrous cortical defects
367
What are the most common primary bone cancers?
Osteosarcoma, chondrosarcoma, Ewing sarcoma
368
What population has an increased risk of bone cancer?
elderly
369
What bones are usually affected by bone tumors?
long bones of the extremities
370
How are bone tumors diagnosed?
incidental or pathological fracture
371
What is usually the age range for osteosarcomas?
10-20
372
What is the usual location of osteosarcomas?
knee
373
What is the usual location of osteomas?
Facial bones, skull (frontal bone)
374
How are bone forming tumors usually diagnosed?
biopsy
375
What are the main types of bone forming tumors?
Osteoma, osteoid osteoma & osteoblastoma, osteosarcoma
376
Which type of bone forming tumor is now said to be a developmental anomaly or reactive growth following trauma?
osteoma
377
Which type of bone forming tumor creates matter very similar to normal bone?
osteoma
378
Which type of bone forming tumor is completely non-invasive and benign?
osteoma
379
Who is at a greater risk for osteoid osteomas/osteoblastomas?
males (2X)
380
Which type of bone forming tumor is smaller and found in the extremities?
osteoid osteoma
381
Which type of bone forming tumor is large and found in the spine?
osteoblastoma
382
What age range is usually affected by osteoid osteomas and osteoblastomas?
10-20
383
What is the middle part of the oval lesion with an osteoid osteoma or osteoblastoma?
Central "nidus" which is radiolucent
384
What surrounds the central nidus in the lesions involved with osteoid osteomas and osteoblastomas?
Rim of sclerosis
385
What is a common complaint and feature of osteoid osteomas and osteoblastomas?
Localized nocturnal pain
386
What is the unique method of relief for osteoid osteomas?
aspirin
387
What is the size of osteoblastomas?
2-6 cm
388
What is the specific location of osteoblastomas?
Spinous and transverse processes of vertebrae
389
What is the treatment for osteoblastomas?
Excision, possible irradiation
390
Which is associated with mild pain that is unrelieved by aspirin: osteoid osteoma or osteoblastoma?
osteoblastomas
391
Which type of bone forming tumor is aggressively malignant?
osteosarcoma
392
What is the most common primary bone cancer?
osteosarcoma
393
How do osteosarcomas usually metastasize?
Hematogenously
394
Who is at a larger risk for osteosarcomas?
adolescent males (1.5X)
395
What age range makes up 75% of osteosarcoma cases?
10-20
396
What is usually the cause of osteosarcomas among those over the age of forty?
Co-morbid bone pathology like Paget disease, AVN, or irradiation
397
What X-ray feature is a red flag for osteosarcomas?
codman triangle
398
What is the usual location of an osteosarcoma among adults over 40?
femur, humerus and pelvis
399
What is the usual location of an osteosarcoma among adolescents?
Knee area: metaphysis of distal femur, proximal tibia, and humerus too
400
What is the end result of the Codman triangle as seen with osteosarcomas?
Periosteal cortex destroyed resulting in "starburst" appearance on X-ray
401
What is a big risk with osteosarcomas?
pathological fractures
402
What is the most common location of metastasis of an osteosarcoma?
lungs (10-20%)
403
What genetic issue leads to a 1000 times increased risk of developing an osteosarcoma?
Retinoblastoma syndrome
404
Are cartilage forming tumors most commonly benign or malignant?
benign
405
What types of cartilage are formed in cartilage forming tumors?
Hyaline and myxoid
406
What are the three main types of cartilage forming tumors?
Osteochondroma, chondroma, chondrosarcoma
407
What is another name for osteochondroma?
Exostosis
408
What type of cartilage forms with an osteochondroma?
hyaline
409
Which gender is at a greater risk for an osteochondroma?
males (3X)
410
What is the age range for osteochondromas?
10-30 years
411
What is the most common way osteochondromas are developed?
solitary or isolated incidents
412
Where do osteochondromas usually originate?
Near the growth plates on the metaphysis of long bones
413
What is the most common location of osteochondromas?
knee
414
What is the usual size of osteochondromas?
1-20cm
415
Osteochondromas rarely occur after what time period?
skeletal maturity
416
What is another term commonly used for chondroma?
enchondroma
417
What cartilage type forms with a chondroma?
hyaline
418
Where does the cartilage with chondromas develop specifically on the skeleton?
Metaphysis of small tubular bones of the hands and feet
419
What is the name of the condition where multiple lesions of chondromas occur?
Ollier disease (enchondromatosis or multiple enchondromas)
420
The "o-ring" sign of sclerosis is associated with which type of cartilage forming tumor?
Chondromas
421
Are chondromas typically asymptomatic or symptomatic?
asymptomatic
422
Chondromas make up what percentage of all benign bone tumors?
10%
423
Solitary chondromas of the hands are usually seen where?
proximal phalanges
424
What makes up the motor unit?
Lower motor neuron/peripheral axon, neuromuscular junction, innervated myocytes
425
What is the parenchyma of the PNS?
neuron
426
What makes the myelin in the PNS?
Schwann cells
427
What kind of peripheral neuropathy involves direct injury to the axon and degeneration of peripheral segments?
Axonal neuropathy
428
What is the secondary loss of myelin called with axonal neuropathy?
Wallerian degeneration
429
After repair of axonal neuropathy, how is the axon different from before?
Decreased axon density and overall amplitude is decreased, as well
430
What kind of peripheral nerve injury involves damage to Schwann cells or myelin?
Demyelinating neuropathy
431
What is the pattern of destruction for demyelinating neuropathy?
Random internode demyelination (segmental demyelination)
432
How is the myelin different after repair of demyelinating neuropathy?
Thinner myelin and shorter internodes leading to slowed nerve conduction velocity (NCV)
433
A shoulder dislocation can lead to which mononeuropathy?
axillary nerve palsy
434
Carpal tunnel syndrome can lead to which mononeuropathy?
thenar atrophy
435
What two things can cause mononeuropathies?
entrapment or trauma
436
Which axons are more at risk to be affected by polyneuropathies?
Distal segments of long axons
437
Stocking and glove paresthesia is seen among what kind of peripheral nerve injury?
polyneuropathies
438
What kind of peripheral nerve injury damages random portions of individual nerves?
Polyneuritis multiplex
439
What type of peripheral nerve injury is common among autoimmune diseases?
Polyneuritis multiplex
440
What are various categories of causes of peripheral nerve injury?
Nutritional, toxic, vascular, inflammatory, genetic
441
What is the effect of Guillain-Barré syndrome on the nervous system?
Acute motor neuron demyelination
442
What is unique about the paralysis of Guillain-Barré syndrome?
Ascending paralysis leading to "rubbery legs"
443
How can Guillain-Barré syndrome be lethal?
respiratory failure
444
What reflex is decreased with Guillain-Barré syndrome?
deep tendon reflexes
445
Why is Guillain-Barré syndrome considered an auto immune disease?
Macrophages are seen near the nerve roots
446
What is the cause of Guillain-Barré syndrome?
60% the cause is unknown, but the remaining 40% are due to viruses such as C. jejuni, EBV, CMV, HIV (most of these except for HIV are minor viruses)
447
What is unique about the age range likelihood for diagnoses of Guillain-Barré syndrome?
Biphasic distribution (males ages 15-35 and 50-57)
448
What is the treatment for Guillain-Barré syndrome?
Ventilation, plasmapheresis, IV antibodies
449
What is CIDP?
Chronic inflammatory demyelinating polyneuropathy
450
What is essentially the chronic and relapsing version of Guillain-Barré syndrome?
Chronic inflammatory demyelinating polyneuropathy (CIDP)
451
CIDP is associated with which immune disorders?
Lupus, HIV
452
What are symptoms for CIDP?
Pain, paresthesia, ataxia, decreased deep tendon reflexes
453
What is the #1 cause of peripheral neuropathy?
Diabetic peripheral neuropathy
454
Vascular tissue injury as a result from hyperglycemia ultimately leading to nerve damage is associated with what cause of peripheral nerve injury?
Diabetic peripheral neuropathy
455
What is the name of the blood vessels that are damaged in diabetic peripheral neuropathy?
Vasa nervorum
456
What is the genetic cause of periphery nerve injury?
Charcot-Marie-Tooth disease
457
Charcot-Marie-Tooth disease is most common amount what population?
young adults
458
Extreme pes cavus is seen with what cause of peripheral nerve injury?
Charcot-Marie-Tooth disease
459
What is the pathway for myofiber depolarization?
Pre synaptic calcium influx ---> acetylcholine release ---> post synaptic ACh receptor
460
What neuromuscular junction disorder involves the degradation of post synaptic ACh receptors disabling the neuronal impulse?
Myasthenia gravis
461
What effects of the thymus can be see with myasthenia gravis?
Hyperplasia (60%) or a benign thymoma (20%)
462
What is the result of thymic lesions from myasthenia gravis on the individual cells?
Autoreactive T cells and B cells
463
What is the hallmark sign for myasthenia gravis?
Extraocular weakness, diplopia, and ptosis
464
What gender is more likely to be affected by myasthenia gravis?
females
465
What is the typical age range for females acquiring myasthenia gravis?
20-30
466
What is the typical age range for males acquiring myasthenia gravis?
50-70
467
What effect does e-stimulation have on those with myasthenia gravis?
worsened condition
468
What neuromuscular junction disorder involves the degradation of pre synaptic calcium channels disabling the neuronal impulse?
Lambert-Eaton syndrome (LES)
469
What effect does e-stimulation have on Lambert-Eaton syndrome?
Improves condition
470
What gender is more likely to have Lambert-Eaton syndrome?
females
471
What is the usual age range for Lambert-Eaton syndrome?
60
472
Paraneoplastic syndrome or small cell lung cancer is associated with which neuromuscular junction disorder?
lambert-eaton syndrome
473
What condition involves increased acetylcholine released to contract the muscles consistently leading to neuromuscular junction disorders?
tetanus
474
How do clostridium tetani and botulinum spread to cause infection and release neurotoxins?
through soil
475
What condition involves decreased acetylcholine release resulting in descending paralysis?
Botulism (clostridium botulinum)
476
Does a peripheral axon innervate just one or multiple myocytes?
multiple
477
Which muscle fiber type involves slow twitch movement?
type 1
478
Which muscle fiber type involves dark tissue?
type 1
479
Which muscle fiber type is associated with fat metabolism and being aerobic?
type 1
480
Why do type I muscle fibers appear dark?
excess myoglobin
481
Which muscle fiber type is associated with fast twitch movement?
type 2
482
Which muscle fiber type appears white?
type 2
483
What muscle fiber type is associated with glycogen metabolism and being anaerobic?
type 2
484
What determines myofiber type?
peripheral axons
485
What is the definition of myopathy?
disease of muscular origin, weakness
486
What effect do neuropathic changes have on motor units?
They become fewer in number and larger in size
487
Disuse atrophy primarily affects what type of muscle fibers?
type 2
488
Glucocorticoid atrophy primarily affects which type of myofiber?
type 2
489
What is the most common way to develop glucocorticoid atrophy?
Exogenously (endogenously would occur due to something like a pituitary tumor in Cushing's disease)
490
Static hypotonia is a characteristic of what kind of inherited disorder of skeletal muscle?
congenital myopathies
491
Is muscular dystrophy congenital?
no
492
Which disorder of skeletal muscle is progressive in nature, inherited, but not congenital?
Muscular dystrophy
493
What is the most common cause of muscular dystrophy?
Dystrophinopathies (dystrophin gene mutation on the X chromosome)
494
What gender is more likely to be affected by muscular dystrophy?
males (x-linked)
495
What occurs with muscular dystrophy?
Myocyte degeneration outpaces repair
496
What are the two types of muscular dystrophy?
Duchenne and Becker
497
Which type of muscular dystrophy is associated with the complete absence of dystrophin?
duchenne
498
Which type of muscular dystrophy is more severe?
duchenne
499
What is the age and pattern of progression of Duchenne muscular dystrophy?
Weakness by age 5, wheelchair by teens, fatal by young adulthood
500
Which type of muscular dystrophy involves abnormal dystrophin and variable severity?
becker
501
Which is more common: Duchenne of Becker muscular dystrophy?
duchenne
502
Which type of muscular dystrophy has an adolescent onset and usually a normal life span?
becker
503
What specific areas exhibit extreme weakness in those with dystrophinopathies?
Pelvic girdle (also possible shoulder girdle weakness in advanced stages)
504
Elevation of what substance seen in a blood test can indicate dystrophinopathies?
creatine kinase
505
How do those with dystrophinopathies usually die?
Cardiorespiratory insuffiency (specifically cardiomyopathy, arrhythmia, pneumonia
506
Gower's sign is associated with what condition?
muscular dystrophy
507
What is Gower's sign?
Using hands to push on legs "crawling up" on oneself in order to stand
508
In polymyositis, T cells attack what structure to induce inflammation?
endomysium
509
What gender and age range are likely to develop polymyositis?
males 45-60
510
What is the most common inflammatory myopathy in children?
Dermatomyositis
511
Which inflammatory myopathy is also considered a paraneoplastic syndrome in adults?
Dermatomyositis
512
What inflammatory myopathy involves tau proteins in the cytoplasm, progressive weakness, wasting, and dysphagia that may lead to degeneration?
Inclusion body myositis
513
What is the most common inflammatory myopathy in the elderly (>60)?
Inclusion body myositis
514
Which toxic myopathy involves the overproduction of thyroxine (thyrotoxicosis)?
Thyrotoxic myopathy
515
Goiter and Graves' disease are what kind of myopathy?
Thyrotoxic myopathy
516
Rhabdomyolysis is associated with what toxic myopathy?
ethanol myopathy
517
Binge drinking can result in what toxic myopathy?
ethanol myopathy
518
What is the most common cause of drug myopathy?
statins
519
Peripheral nerve sheath tumors are most common among what age group?
adults
520
What is the issue associated with a benign peripheral nerve sheath tumor?
impingement can lead to pain and loss of function
521
Are Schwannomas usually benign or malignant?
benign
522
What cranial nerve is most commonly involved with a Schwannoma?
VIII (vestibular Schwannoma)
523
Which type of peripheral nerve sheath tumor is 90% sporadic?
schwannoma
524
What is Schwannomatosis?
Multiple CNS and cutaneous Schwannomas
525
Is cranial nerve VIII also usually affected by Schwannomatosis?
no usually avoided
526
What is a neurofibroma?
benign and cutaneous nerve sheath tumor
527
When can neurofibromas become a greater issue?
When involved in a plexiform area like the brachial or sacral plexus
528
What condition involves bilateral vestibular Schwannomas?
Neurofibromatosis type 2 (NF2)
529
What is the genetic pattern of neurofibromatosis type 2?
autosomal dominant
530
What types of issues are seen with those with neurofibromatosis type 2?
Vision and hearing difficulties (no cutaneous lesions)
531
What condition involves pronounced neurofibromas and vascular stenosis?
Neurofibromatosis type 1
532
What are some effects of neurofibromatosis type 1?
Decreased condition and seizures
533
What is the genetic pattern of neurofibromatosis type 1?
autosomal dominant
534
What sign on the iris is associated with neurofibromatosis type 1?
Lisch nodules
535
Axillary freckling, multiple neurofibromas, and cafe au lait spots are associated with what peripheral nerve sheath tumor condition?
neurofibromatosis type 1
536
What is the most common location for malignant peripheral nerve sheath tumors?
plexiform
537
Malignant nerve sheath tumors are the result of the transformation of what previous condition?
Neurofibroma
538
50% of all malignant peripheral nerve sheath tumors arise in patients with what condition?
neurofibromatosis type 1
539
What is the common location for traumatic neuroma?
Metacarpals and metatarsals
540
Are traumatic neuromas malignant?
no
541
What makes up a traumatic neuroma?
Schwann cells, axons, and connective tissue
542
Both stroke and Bell palsy cause paralysis of what part of the face?
Lower part
543
What part of the face has dual innervation?
the upper part
544
In strokes, what ability of the face is maintained that is still paralyzed with Bell palsy making it possible to distinguish the condition?
wrinkling the forehead (raising the eyebrows)
545
What type of tissue lacks a lot of collateral blood supply therefore making them more susceptible to ischemia?
Deep tissues (like the thalamus, basal ganglia, deep white matter)
546
What is the third leading cause of mortality in the U.S.?
Cerebrovascular disease (CVA)
547
What is the most common type of arteriovenous malformation?
Cerebrovascular malformation
548
How long does the inflammation of the facial nerve typically last in Bell palsy?
2-8 weeks
549
Where can ependymal cells be found?
lining ventricles and spinal cord
550
What is the most common age range for Bell palsy?
15-45
551
What neural viral infection produces the sign of Negri bodies?
rabies
552
What is the treatment for Bell palsy?
Facial exercises, eye drops/patch
| Corticosteroids, antivirals
553
What neural viral infection produces the sign of "owl's eye"?
Cytomegalovirus
554
Which neurodegenerative disease is associated with neurofibrillary tangles, beta-amyloid plaques, and Tau proteins?
Alzheimer's disease
555
What are two causes of functional hypoxia?
Decreased oxygen partial pressure
| Decreased oxygen availability
556
What is intracellular inclusion is known known as the aging pigment due to lipid accumulation?
Lipofuscin
557
What is disrupted enabling increased permeability with vasogenic edema?
blood brain barrier
558
What is the effect of hydrocephalus in those under two years of age?
crainial enlargement
559
What is the effect of hydrocephalus in those above two years of age?
Increased cranial pressure, ventricular enlargement
560
What is the most common cause of neurological morbidity?
Cerebrovascular disease (CVA)
561
Which type of brain herniation involves a displaced cingulate gyrus (located under falx cerebri)?
Subfalcine (cingulate)
562
What can result from subfalcine herniation?
abnormal posturing, coma
563
What type of brain herniation involves a displaced temporal lobe (under the anterior tentorium)?
Transtentorial (uncinate)
564
Which type of brain hemorrhage involves displaced cerebellar tonsils through the foramen magnum?
tonsillar
565
What is the more common type of Arnold-Chiari malformation?
type 1
566
Which type of Arnold-Chiari malformation is more severe?
type 2
567
Type I Arnold-Chiari malformation occurs among what population?
adults
568
Type II Arnold-Chiari malformation occurs among what population?
infants
569
Which Arnold-Chiari malformation involves the low-lying cerebellar tonsils and downward extension through the foramen magnum?
type 1
570
What is the treatment for Arnold-Chiari malformations?
Neurosurgery (decompression)
571
Cardiac arrest, shock, and severe hypotension's effect on blood pressure leads to what condition?
Global cerebral ischemia
572
What condition is cause by an arterial occlusion due to localized ischemia?
focal cerebral ischemia
573
Neutrophils, red neurons, and edema are seen in what stage of a cerebral infarction?
First stage (roughly 12-48 hours)
574
Nuclear fragmentation (karyorrhexis) is seen in what stage of a cerebral infarction?
Second stage (rough to 48 hours to 2 weeks)
575
Macrophages and gliosis are most commonly seen in what stage of a cerebral infarction?
Third stage (roughly months to years, also cavitation)
576
Ischemic strokes are treated with what kind of medication?
thrombolytic
577
What is the condition involving a cerebral microbleed?
Primary parenchymal hemorrhage
578
What is the most common age for a primary parenchymal hemorrhage?
60
579
What condition is so commonly associated with the phrase from patients, "This is the worst headache I've ever had."?
Subarachnoid hemorrhage
580
It is currently hypothesized that what virus is associated with Bell palsy?
HSV-1
581
What is the fatality rate of a first episode of a subarachnoid hemorrhage?
25-50%
582
A saccular (berry) aneurysm makes up what percentage of all intracranial aneurysms?
80-90%
583
Where is the most common location in the circle of Willis for a saccular (berry) aneurysm?
Anterior circulation of the circle of Willis
584
What is a lacunar infarct?
Occlusion of a single artery resulting from hypertension
585
What diastolic blood pressure is seen with acute hypertensive encephalopathy?
>130 which means there is severe increased intracranial pressure
586
"Red neurons" is a sign present with which type of neuronal injury?
irreversible
587
What occurs with reversible neuronal injury?
Decreased axonal transport, swelling of soma, displacement of the Nissl substance (central chromatolysis)
588
What occurs with irreversible neuronal injury?
Soma shrinkage, pyknosis, eosinophilia, "red neurons", cerebral edema, loss of nucleolus and Nissl body
589
Which neurodegenerative disease is associated with Lewy bodies?
Parkinson's disease
590
What are the two kinds of cerebral edema?
Vasogenic and cytotoxic
591
Which is associated with extracellular edema: vasogenic or cytotoxic edema?
vasogenic
592
Which is associated with intracellular edema: vasogenic or cytotoxic edema?
cytotoxic
593
What resorbs the CSF produced by the choroid plexus?
Arachnoid granulations (villi)
594
What rare condition can cause overproduction of CSF?
Choroid plexus tumor
595
What condition involves compensatory hydrocephalus accompanied by infarct and neurodegeneration?
Hydrocephalus ex vacuo
596
What is the most common type of brain herniation?
Subfalcine (cingulate)
597
Which cranial nerve can suffer from compression from a transtentorial brain herniation, and what is the result?
Cranial nerve III (oculomotor) resulting in abnormal vision ("blown pupil")
598
What is the secondary hemorrhage associated with transtentorial brain herniations?
duret hemorrhage
599
What type of hemorrhage is also known as the "flame-shaped" hemorrhage?
duret hemorrhage
600
What type of hemorrhage occurs when vessels that enter the pons are disrupted by herniation?
duret hemorrhage
601
What are the most common locations of emboli that cause focal cerebral ischemia?
Middle meningeal artery and internal carotid artery
602
What is the most common cause of primary parenchymal hemorrhage?
hypertension
603
What is the most common cause of a subarachnoid hemorrhage?
Ruptured saccular (berry) aneurysm
604
What defect is associated with a ruptured saccular (berry) aneurysm that most commonly causes a subarachnoid hemorrhage?
tunica media defect
605
What gender and age group are most at risk for arteriovenous malformation?
males 10-30
606
What condition is a systemic autoimmune condition with fibrinoid necrosis involving the small cerebral arteries and heart that results from vasculitis within the CNS?
Polyarteriosis nodosa
607
Primary angiitis of the CNS is limited to what locations?
brain and spinal cord
608
What is the treatment for primary angiitis of the CNS and polyarteritis nodosa?
immunosuppression
609
Neuronophagia is associated with what cells of the CNS?
microglia
610
What can cause localized vasogenic edema?
tumors, infection, inflammation
611
What can cause generalized vasogenic edema?
severe trauma
612
Lethal tonsillar herniation (and eventually respiratory failure) occurs when what condition is left untreated?
Hydrocephalus
613
What form of abnormal posturing involves brachial flexion, extension of the legs along with internal rotation?
Decorticate rigidity
614
What is the location of injury associated with decorticate rigidity?
Between the cortex and red nuclei (midbrain)
615
What form of abnormal posturing involves extension of all 4 limbs, pronation of arms, and plantar flexion?
Decerebrate rigidity
616
What condition involves the paralysis of the facial nerve results in a rapid onset of unilateral facial weakness?
bell palsy
617
What is the most common cause of focal cerebral ischemia?
emboli
618
Where do primary parenchymal hemorrhages tend to occur?
Basal ganglia, thalamus, pons, cerebellum
619
What are the usual locations for hypertensive cerebrovascular disease?
Basal ganglia, white matter, brainstem
620
What is the most common gender and age group affected by primary angiitis of the CNS?
males 30-60
621
What is the location of injury associated with decerebrate rigidity?
Between red nuclei & vestibular nuclei (brainstem)
622
What condition is responsible for 50% of post traumatic comas?
Diffuse axonal injury
623
What is the term for when the location of injury occurs at the impact site of a cerebral contusion?
coup injury
624
Epidural hematoma affect what blood vessels?
dural arteries
625
Subdural hematomas affect what blood vessels?
veins
626
Which occur more rapidly: epidural or subdural hematomas?
epidural hematomas
627
Which is more common: epidural or subdural hematomas?
Subdural hematomas (epidural hematomas make up 2% of severe head traumas)
628
What artery is most likely affected by epidural hematomas?
middle meningeal artery
629
Which is more of a medical emergency: epidural or subdural hematomas?
epidural
630
What is a myelomeningocele?
Extension of CNS through vertebral defect leading to lower extremity motor/sensory defects
631
What is the most common location of the spine for myomeningoceles?
lumbosacral region
632
What condition develops following trauma to the cerebrum that injures and disrupts vessels leading to hemorrhage?
contusion
633
What is the serious issue with epidural abscesses?
Can compress the spinal cord (neurosurgical emergency)
634
What is meningitis?
Subarachnoid inflammation of leptomeninges
635
What type of bacteria is likely to cause meningitis in young children?
Haemophilus influenzae
636
What bacteria is likely to cause meningitis in adolescents and young adults?
Neisseria meningitidis
637
What constitutes post-concussion syndrome?
Decreased cognition, loss of consciousness, amnesia, nausea, depression, anxiety, irritability, headache, dizziness, photophobia
638
What is the term for when the location of injury occurs at the opposite side of the site of a cerebral contusion?
Contrecoup injury
639
What bacteria is likely to cause meningitis among older adults?
Strep. pneumoniae, listeria monocytogenes
640
What kind of necrosis can be produced from a bacterial abscess?
Liquefaction necrosis
641
What does poliovirus attack?
Gray matter of the spinal cord/brainstem
642
What is usually the recovery time period for a concussion?
7-10 days without treatment (80% recovery rate)
643
What is the most common disorder of myelin?
Multiple sclerosis (MS)
644
Which disorder of myelin is known to be "relapsing-remitting"?
MS
645
What is the activity of an active plaque in MS?
ongoing myelin breakdown
646
What is the condition of movement of one brain region relative to another region?
Diffuse axonal injury (DAI)
647
What kinds of movements can cause diffuse axonal injury?
Angular acceleration or shaking
648
What condition is a tearing of cerebral parenchyma that disrupted vasculature that leads to hemorrhage?
laceration
649
What is an encephalocele?
CNS diverticulum through cranium
650
Type 1 Arnold-Chiari malformation is associated with what condition?
Syringomyelia
651
What is syringomyelia (syrinx)?
cyst within the spinal cord
652
What is the most common location for diffuse axonal injury?
lateral ventricles and brain stem
653
What is the most common way that infections of the nervous system are spread?
Hematogenously (other ways = direct implant by trauma, local extension, PNS)
654
What is a subdural empyema?
Infection of skull or sinus in the subdural space
655
What makes up the leptomeninges?
Arachnoid and pia mater
656
What three signs/symptoms are extremely indicative of acute pyogenic (bacterial) meningitis?
Headache, nuchal rigidity, and photophobia
657
What bacteria are likely to cause meningitis in neonates?
E. Coli and group B strep (strep agalactiae)
658
What is affected with MS?
White matter (demyelination)
659
What vision ailment is commonly seen with MS?
Diplopia (unilateral vision impairments leading to double vision)
660
What are some signs and symptoms of MS?
Cranial nerve dysfunction, ataxia, motor/sensory impairments, bowel/bladder dysfunction, sexual dysfunction, seizures, decreased cognition, depression
661
Deficiency in what substance associated with CNS issues like Wernicke-Korsakoff syndrome, confusion, memory, ataxia, chronic alcoholics, chronic gastritis?
Thiamine (B1)
662
Necrosis and macrophages in the thalamus can be seen with what kind of deficiency?
Thiamine (B1)
663
What are the effects of hypoglycemia?
Mimics global hypoxia (edema)
664
What part of the brain is susceptible to injury with hypoglycemia?
Hippocampus
665
What are the effects of hyperglycemia?
Hyperosmolar state, confusion, stupor, coma, glycosuria, decreased water
666
What condition involves the extension of the fourth ventricle?
Hydromyelia
667
What location of the cerebrum are more susceptible to a brain contusion?
Gyri of the frontal and temporal lobes
668
What kind of white blood cells are seen with viral encephalitis?
Mononuclear (monocytes, macrophages)
669
What are the signs and symptoms of polio?
Gastritis, motor neuron damage leading to wasting and flaccidity
670
What is the cause of the myelin deterioration in MS?
Autoimmune inflammatory attack from lymphocytes and macrophages resulting in white matter lesions (plaques)
671
Increased vascular resistance can lead to what vascular condition?
hypertension
672
What is malignant hypertension?
Around 200/120 BP (5% of all hypertension cases) which is usually lethal within 1-2 years
673
How can malignant hypertension be detected early on?
Papilledema or retinal hemorrhage
674
What are the steps of vascular wall responses to injury?
1. Endothelial injury/dysfunction
2. Smooth muscle cell recruitment
3. Growth of smooth muscle cell & ECM
4. Irreversible intimal thickening
675
What can irreversible intimal thickening as a result of vascular injury lead to?
Vessel stenosis (tissue ischemia)
676
What is the term for hardening of the arterioles?
ArterioLOsclerosis
677
What is term for the hardening of arteries?
Arteriosclerosis
678
What condition involves the calcification of the tunica media?
Monckeberg medial sclerosis
679
What is the usual age range of Monckeberg medial sclerosis?
> 50 years old
680
What is the most common form of arteriosclerosis?
Atherosclerosis
681
What is atherosclerosis?
Formation of atheromas (plaques)
682
What form of arteriosclerosis is age-related?
Monckeberg medial sclerosis
683
What organs are most sensitive to hyperplastic arteriolosclerosis?
kidneys
684
Which arteriole reaction occurs in response to benign hypertension?
hyaline arteriolosclerosis
685
Which type of arteriole reaction occurs in response to severe hypertension?
Hyperplastic arteriolosclerosis
686
Onionskin appearance is indicative of what arteriole response to hypertension?
Hyperplastic arteriolosclerosis
687
Prolonged diabetes mellitus is associated with which arteriole response to hypertension?
Hyaline arteriolosclerosis
688
What is the number one cause of morbidity and mortality in the U.S.?
Atherosclerosis (CAD, myocardial infarction, stroke)
689
What effect does atherosclerosis have on blood flow?
decrease
690
What layer of the vessel is weakened in atherosclerosis?
Tunica media
691
A weakened tunica media is a risk for what issue?
Aneurysm
692
What are the foam cells seen in an atherosclerosis plaque?
Fat-laden macrophage
693
Which type of plaque has inflammation present, as well?
vulnerable
694
Which type of plaque has a fibrous cap providing support?
stable plaque
695
Too many LDLs and too little HDLs (hyperlipidemia) increase the risk of what vascular condition?
Atherosclerosis
696
What usually causes hypertension?
95% idiopathic
697
What is the response to injury hypothesis involved with atherosclerosis?
Chronic endothelial injury ---> atherosclerosis
698
Metabolic syndrome presents a risk for what condition?
CVD
699
What issues can make up metabolic syndrome?
Central obesity, hypertension, insulin resistance, dyslipidemia, hypercoagulability/pro-inflammatory state (adipokines)
700
Peripheral vascular disease can lead to what condition following atherosclerosis?
gangrene
701
What is the difference between a true and false aneurysm?
True aneurysm - all three layers of a vessel spread out
| False aneurysm - defect in vascular wall leading to extravascular hematoma
702
What are some common locations for a true aneurysm?
Aortic arch, abdominal aorta, iliac arteries
703
What is the size of an AAA?
Dilation of >50% of normal
| Diameter >5cm
704
Who is most at risk for an aortic dissection?
males 40-60
705
What type of genetic pattern is seen with Wilson disease?
autosomal recessive
706
What is Wilson disease?
Abnormal copper ion transpiration leading to excessive copper accumulation
707
How is the liver affected by Wilson disease?
Steatohepatitis
708
How is the brain affected by Wilson disease?
Psychosis, Parkinsonism (the movement disorder, not Parkinson's disease)
709
How does Wilson disease affect the eye?
Kayser-Fleischer ring
710
Pain with an aortic dissection can resemble what other condition?
MI
711
Where is pain felt with an aortic dissection?
Anterior chest, projects posteriorly between the scapulae
712
What type of aortic dissection is the most common and most severe?
type A
713
Which type of aortic dissection is in the ascending aorta?
type A
714
Which type of aortic dissection is seen in the left subclavian artery?
type B
715
Vasculitis is most common in what kind of arteries?
small arteries
716
What kind of infection could cause vasculitis?
hepatitis B
717
What most common type of vascular tumor?
benign
718
A Kaposi sarcoma is an example of what type of vascular tumor?
fairly aggressive
719
An angiosarcoma is an example of what type of vascular tumor?
Rare and highly malignant sarcoma
720
What is a hemangioma?
Common benign vascular tumor affecting 1:200 newborns
721
What virus is responsible for a Kaposi sarcoma?
HHV-8
722
Angiosarcomas are more common among what population?
older adults
723
What are the most common locations for angiosarcomas?
skin, breast, liver
724
How can endovascular stenting affect the luminal wall layers?
Possible intimal hyperplasia
725
What causes giant cell arteritis?
Idiopathic but T cell activity and autoimmune hypothesis
726
Giant cell arteritis involves what arteries?
large and small arteries of the head
727
What artery is most commonly affected during giant cell arteritis (50% of cases)?
ophthalmic artery
728
What is usually the quick treatment for giant cell arteritis?
Corticosteroids (especially to prevent blindness)
729
What kind of inflammation is present in giant cell arteritis?
Granulomatous
730
What is also known as the "pulseless disease"?
Takayasu arteritis
731
What form of arteritis is exclusively seen in the aortic arch and its branches?
Takayasu arteritis
732
What causes the loss or minimized pulse of Takayasu arteritis?
Narrowing of the lumen of branches off of the aortic arch
733
Takayasu arteritis is most common among what population?
Younger individuals
734
What kind of necrosis is seen with polyarteritis nodosa?
transmural necrosis
735
What is polyarteritis nodosa?
System wide vasculitis of small and medium sized arteries
736
What can happen with polyarteritis nodosa?
Tissue atrophy, ischemia, infarction
737
What arteries are avoided by polyarteritis nodosa?
pulmonary
738
Polyarteritis nodosa is most common among what population?
young adults
739
What chronic infection is seen among 1/3 of polyarteritis nodosa cases?
hepatitis B
740
Around what fraction of polyarteritis nodosa cases are said to be autoimmune or idiopathic in nature?
2/3
741
What is seen with polyarteritis nodosa of the renal artery?
Rapidly increasing blood pressure (renovascular hypertension)
742
What is seen with polyarteritis nodosa of the GI arteries?
abdominal pain, bloody stools
743
What is the treatment for polyarteritis nodosa?
Corticosteroids
744
What happens if polyarteritis nodosa is left untreated?
Fatal
745
Segmental fibrinoid necrosis and thrombosis is seen among what widespread vascular condition?
Polyarteritis nodosa
746
The "rosary sign" is seen among what vascular condition?
Polyarteritis nodosa
747
Kawasaki disease primarily affects what population?
pediatrics
748
What is the fatality rate of Kawasaki related heart attacks in children?
1%
749
How does CAD influence the prognosis of Kawasaki disease?
Patients without CAD recover fully
| Severity of CAD determines prognosis
750
What is the cause of Kawasaki disease?
Idiopathic but suggestive of type IV hypersensitivity and possibly viral antigens, genetics
751
What gender and race are more likely to get Kawasaki disease?
Asian descent and males
752
What is the hallmark sign of Kawasaki disease?
Acute/persistent fever
753
What are the unique signs of the skin and tongue seen with Kawasaki disease?
Desquamation of extremities, strawberry tongue (oral erythema)
754
What type of hypersensitivity is seen with Wegener granulomatosis?
type 2
755
Wegener granulomatosis is seen in what locations?
kidneys and upper/lower respiratory tracts
756
What is seen with Wegener granulomatosis?
Granulomas, systemic vasculitis of small/medium arteries, glomerulonephritis
757
What population is more likely to be affected by Wegener granulomatosis?
Middle aged (40 years old), males
758
What lung condition is seen in 95% of cases of Wegener granulomatosis?
Bilateral pneumonitis
759
How are the kidneys affected by Wegener granulomatosis?
Hematuria, proteinuria, possible renal failure
760
How is the nasopharyngeal area affected by Wegener granulomatosis?
Rhinitis, sinusitis, nose bleeds
761
What is another name for Buerger disease?
Thromboangiitis obliterans
762
What group of people are at risk for thromboangiitis obliterans?
Heavy tobacco smokers
763
Vascular insufficiency of what arteries and locations is seen with thromboangiitis obliterans?
Radial and tibial arteries, leading to cold feet and hands
764
What is unique about the pain felt with thromboangiitis obliterans?
seen at rest
765
What is the most common vasculitis in older adults?
Giant cell arteritis (temporal arteritis)
766
What kind of condition is Raynaud phenomenon?
Exaggerated arteriole vasoconstriction
767
In chronic conditions, what can result from Raynaud phenomenon?
Atrophy of skin, connective tissue, and/or muscles
768
What are traditional triggers for primary Raynaud phenomenon?
Cold and emotional triggers (5% of the U.S.)
769
Raynaud phenomenon can be secondary to what other conditions?
Atherosclerosis, Buerger disease, Lupus, scleroderma
770
What condition is also known as "broken heart syndrome", stress cardiomyopathy, or "cardiac Raynaud"?
Takotsubo cardiomyopathy
771
What is the location of exaggerated vasoconstriction of Takotsubo cardiomyopathy?
coronary arteries
772
What is usually the cause of broken heart syndrome?
psychological stress
773
What kinds of hormones are produced more heavily with cardiac Raynaud?
Catecholamine (stress hormones)
774
What occurs with Takotsubo cardiomyopathy?
Vasospasm, increased heart rate and contractility, fatal arrhythmia (ventricular fibrillation), possible ischemia and heart attack in severe cases
775
What is the term for venous inflammation?
Phlebitis
776
90% of venous disease fall into what three categories?
Varicose veins, phlebothrombosis, thrombophlebitis
777
What is phlebothrombosis?
Venous thrombosis without previous inflammation
778
What is thrombophlebitis?
Venous thrombosis following inflammation
779
What is a risk factor for thrombophlebitis?
Immobilization (examples: recent surgery, pregnancy, obsesity), congestive heart failure, genetics, any pro-thrombotic medication, oral contraceptive
780
What could be the first indication of thrombophlebitis?
Pulmonary embolism
781
What test can be used to diagnosis thrombophlebitis?
Dorsiflexion of the foot (Homan sign)
782
What is important to note with the Homan sign?
Could produce clot or embolism (only about 50% sensitive to thrombophlebitis)
783
What are signs of superior vena cava syndrome?
Congested upper extremity veins, edema in head, neck, and arms
784
What conditions are associated with superior vena cava syndrome?
Bronchogenic carcinoma, mediastinal lymphoma
785
What conditions are associated with inferior vena cava syndrome?
Hepatocellular carcinoma, renal cell carcinoma
786
What are some signs of inferior vena cava syndrome?
Congestion of lower extremity veins, edema, proteinuria
787
Which form of lymphedema is congenital?
primary
788
What is another name for congenital lymphedema?
Milroy disease
789
What can cause secondary lymphedema?
Neoplasia, infection (filariasis), thrombosis, fibrosis (surgery)
790
What appearance of the skin is associated with acute lymphedema?
Peau d'orange
791
What skin appearance is seen with chronic lymphedema?
Brawny induration (hardening of the skin)
792
What is the term for when there is passage of blood through layers of a vascular wall?
dissection
793
What makes up the tunica intima?
endothelial cells
794
What makes up the tunica media?
smooth muscle
795
What makes up the tunica adventitia?
CT, nerves, vessels
796
Activation of what part of the vascular vessel wall via vascular lesions or thrombosis is pro-inflammatory?
endothelial lining
797
What is the function of the endothelial cells?
Regulate vasoreactivity by NO & endothelin
| Regulate cell growth
798
What is fibromuscular dysplasia?
Local thickening of medium/large artery walls that leads to ischemia (non-atherosclerotic and non-inflammatory)
799
Fibromuscular dysplasia is more common with what gender?
females
800
Aldosterone helps regulate blood volume and vascular tone in what area?
adrenals
801
Atrial natriuretic peptide (ANP) helps regulate vascular tone and blood volume in what organ?
heart
802
How does atrial natriuretic affect the heart and blood pressure?
Stretches heart and decreases blood pressure (reduced sodium resorption)
803
The kidney can produce what substances that initiate vasodilation and decrease blood pressure?
Prostaglandins and NO
804
Without treatment, 50% of those with hypertension will die from what complication?
MI
805
What is the resulting substance from the neuronal degeneration of Alzheimer's disease?
tau proteins
806
What is the culprit for CNS degeneration?
abnormal protein accumulation
807
What is Parkinsonism?
Abnormal motor function, tremor, rigidity, bradykinesia, instability
808
What neurons are damaged in Parkinsonism?
dopaminergic neurons
809
What type of inclusion is associated with Parkinson's disease?
lewy bodies
810
What is the genetic factor involved in Huntington disease?
Huntington gene, trinucleotide repeat: CAG (anticipation generation by generation)
811
Chorea of the entire body is associated with what condition?
huntington disease
812
What neurological condition is uniquely associated with both lower and upper motor neuron death?
ALS
813
What is significant about the stages of CNS tumors?
No premalignant (in situ) stages
814
What are the three broad categories of gliomas?
Astrocytoma, oligodendroglioma, ependymoma
815
Which categories of gliomas are known to be diffuse/infiltrative?
Astrocytoma and oligodendroglioma
816
Are diffuse astrocytomas benign or malignant?
malignant
817
What is the most common location for ependymomas in pediatrics?
periventricular regions
818
What is the most common mechanism of heart disease?
Contractile (pump) failure
819
What are the risks for systolic dysfunction?
CAD, systemic hypertension, decreased pH (shock)
820
What causes systolic dysfunction?
weak contraction
821
What causes diastolic dysfunction?
failure to relax which inhibits filling
822
What is common with an adult form of aortic coarctation?
Infolding near the ligamentum arteriosum (asymptomatic)
823
What is the most common cause of left-side heart failure?
Ischemic heart disease (CAD)
824
How can left-sided heart failure affect the pulmonary system?
Decreased cardiac output leads to pulmonary edema
825
How is heart rate affected by left-sided heart failure?
Tachycardia (Over 100bpm)
826
Right-sided heart failure most commonly results from what prior condition?
Left-sided heart failure (backward failure)
827
What is the condition involved with pulmonary hypertension and isolated right-sided heart failure?
cor pulmonale
828
What valves can be impaired in right-sided heart failure?
Pulmonary or tricuspid
829
Peripheral congestion and edema are seen in what vascular structures during right-sided heart failure?
systemic and portal veins
830
What are some clinical features seen with right-sided heart failure?
Ascites and hepatosplenomegaly
831
Over half of congenital heart disease cases involve which septal defects?
Ventricular and atrial septal defects
832
What defects can result from right-to-left shunts in congenital heart disease?
Tetralogy of Fallot, transposition of great arteries
833
What type of septal defects is most commonly asymptomatic until adulthood?
atrial septal defect
834
A patent ductus arteriosus is associated with what type of shunt?
Left-to-right
835
What is the most common type of congenital heart disease to cause cyanosis?
Tetralogy of Fallot
836
What are the four features of tetralogy of Fallot?
Large ventricular septal defect
Valve stenosis with right ventricular outflow obstruction
Overriding aorta between ventricles
Right ventricular hypertrophy
837
What are the features of coronary atherosclerosis?
Inflammation, thrombosis, vasoconstriction
838
What is the unique type of angina pectoris?
Variant angina (Prinzmetal angina)
839
Which artery is most likely to be involved in a heart attack?
Left anterior descending coronary artery (40-50%)
