test #27 4.16 Flashcards
1
Q
why does C. perfringens make gas necrosis?
A
rapid metabolism of muscle tissue carbohydrate –> gas
2
Q
osmium tetroxide
A
fat = black
3
Q
fat embolism syndrome
A
(1) respiratory distress
(2) nonfocal neurological disturbance
(3) chest lesions consistent w/ thrombocytopenia
4
Q
describe path of fat emboli
A
dislodge from bone marrow, enter marrow vascular sinusoids,
- occlude pulmonary microvessels –> impair gas exchange
- occlude vasculature in CNS
5
Q
describe promotion of parenchymal destruction w/ fat emboli (2)
A
- platelet & mediators coat & adhere to emboli –> thrombocytopenia
- systemic activation of LPL (lipoprotein lipase) releases oleic acid systemically –> toxic levels
6
Q
wright stain
A
often hemotological stain. purple platelets
7
Q
iron stain // hemosiderin
A
brown on H&E
dark blue on prussian blue
8
Q
second trimester quad screen for down’s syndrome:
A
increased: b-HCG, inhibin A.
decreased: AFP, estriol
9
Q
first trimester findings in down’s syndrome:
A
ultrasound:
increased nuchal translucency &
hypoplastic nasal bone.
serum:
increased b-HCG
decreased PAPP-A
10
Q
edward’s syndrome (trisomy 18) screening findings
A
everything is down.
1st trimester:
DOWN: PAPP-A and b-HCG
quad screen:
DOWN: AFP, b-HCG, estriol, inhibin-A (could be normal)
11
Q
elevated b-HCG and inhibin in 2nd semester?
[low estriol and AFP]
A
down’s syndrome
12
Q
low bHCG, inhibin, estriol, and ADP
A
edward’s syndrome
13
Q
patau syndrome screening findings
A
first trimester:
DOWN: bHCG, PAPP-A
increased nuchal translucency
14
Q
low b-HCG and PAPP-A w/ nuchal translucency? without nuchal translucency
A
nuchal translucency: patau
w/o nuchal translucency: edwards
15
Q
vast majority of trisomy 21 occur due to..
A
nondisjunction in meiosis I
failure of homologous chromosomes to separate
16
Q
nondisjunction in meiosis I due to? nondisjunction in meiosis II due to?
A
meiosis I: failure of homologous chromosomes to separate
meiosis II: failure of sister chromatids to separate
17
Q
lagging strand is CONSTRUCTED in which direction? SYNTHESIZED in which direction?
A
constructed in 3’->5’ direction.
synthesized in 5’->3’ direction
18
Q
elder abuse
A
FIRST: try to speak to patient alone – to avoid intimidation.
ask:
1. do you feel safe at home
2. who prepares your meals
3. who handles your checkbook
REPORT only after information is collected
19
Q
anovulatory cycles
A
common in early menarche years.
immature HPA-axis
longer menstrual cycles and irregular bleeding patterns due to presence of anovulatory cycles
no ovulation -> no corpus luteum -> no progesterone -> continuous estrogen
results in continued proliferation.
becomes disorganized, fragile, w/ unstable venous capillaries –> irregular periods of stromal breakdown w/ variable (spotting) & heavy bleeding.
20
Q
three major causes of valvular aortic stenosis. most common world-wide? in USA?
A
(1) congenitally abnormal valve w/ calcification (i.e. biscuspid)
(2) calcified normal valve
(3) rheumatic heart disease
world-wide: rheumatic heart disease.
US: calcific aortic valve (either bicuspid/tricuspid)
21
Q
right horn of sinus venosus
A
originally receives blood from IVC. l
becomes smooth part of right atrium.
(smooth part of left from primitive pulmonary vein)
22
Q
bulbos cordis
A
forms beginning of ventricular outflow tract in embryonic heart. later –> smooth portion of left and right ventricles (adjacent to aorta and pulmonary artery, respectively)
23
Q
primitive atrium
A
receives blood from sinus venosus in embryonic heart, transmits to primitive ventricle.
primitive atrium –> rough portions of left and right atria
24
Q
close PDA? keep it open?
A
close: indomethacin.
keep open: PGE2
25
primitive pulmonary vein forms..
smooth part of left atrium
26
left horn of sinus venosus
coronary sinus
right horn --> smooth part of right atrium
27
right common cardinal vein & right anterior cardinal vein
SVC
28
what is the first functional organ in human embryo? when does it function?
fetal heart. begins to pump 4 wks in.
29
first heart loop establishes
left-to-right polarity.
30
patent foramen ovalue
failure of septum primum and septum secundum to fuse. usu left untreated.
31
embryological origin of AV values (tricuspid and mitral)
from fused endocardial cushions of AV canal
32
embryological origin outflow valves (aortic/pulmonary)
endocardial cushion of outflow tract
33
PTH and Ca2+ abnormalities in osteoperosis? osteopetrosis?
NONE
| osteopetrosis might have low Ca2+
34
PTH and Ca2+ in osteoperosis?
NORMAL
35
high PTH, low Ca2+
renal failure, vitamin D deficiency
36
causes of PTH-independent hypercalcemia?
humoral hypercalcemia of malignancy, vitamin D toxicity, excessive ingestion of Ca2+, thyrotoxicosis, immobilization
37
age of calcification w/ bicuspid aortic valve? tricuspid
bicuspid: premature: 60-70
tricuspid: senile: 80-90
38
damage to common peroneal n. sustained w/? physical finding?
lateral aspect of leg, fibular neck fracture.
| foot dropPED & can't feel foot dorsum
peroneal everts and dorsiflexes
39
damage to tibial n. sustained w/? physical finding
knee trauma, proximal: baker's cyst. distal: tarsal tunnel.
can't TIP toe & sense sole of foot
tibial inverts and plantar flexes
40
sensation to sole of foot? dorsum?
dorsum: superficial peroneal n.
41
sensation to medial leg? lateral leg?
medial: saphenous n. branch of femoral n.
lateral: superficial peroneal
42
superficial branch of common peroneal?
mostly lateral compartment: foot eversion & sensation of lateral leg & foot dorsum
43
deep branch of common peroneal?
anterior compartment: dorsiflexors of foot and toes. inversion of foot.
sensation to only region between 1st and 2nd digits.
44
where does the coronary sinus reside?
atrioventricular groove on posterior surface.
45
describe placement of biventricular pacemaker
2 leads -> right heart
via left subclavian -> SVC -> right atrium & ventricle
1 lead -> left ventricle
via right atrium -> coronary sinus (atrioventricular groove of posterior heart) -> lateral venous tribituaries
46
swan ganz catheter
insert catheter into pulmonary artery, diagnostic, test for heart failure
47
cataracts, frontal balding, gonadal atrophy, and muscle atrophy / myotonia
myotonic muscular dystrophy type 1. (autosomal dominant)
2nd most common muscular dystrophy (after duchenne's)
48
typical symptom of myotonic muscular dystrophy type 1
difficulty loosening one's grip after handshake. or inability to release doorknob.
49
pathogenesis of myotonic muscular dystrophy
autosomal DOMINANT
CTG repeat expansion in gene for myotonia-protein kinase (DMPK gene)
has anticipation
50
4 diseases w/ trinucleotide expansion
fragile X: CGG
friederich ataxia: GAA
huntington: CAG
myotonic dystrophy: CTG
51
muscle histology in myotonic dystrophy
atrophy of type 1 muscle fibers (esp).
no necrosis or fibrofatty replacement (unlike duchenne's)
52
2 inflammatory myopathy
dermatomyositis and polymyositis
53
ion channel myopathy
myotonia and episodes of hypotonic paralysis. often associated w/ exercise. no atrophy on light microscope.
PAS+ intracytoplasmic inclusions
54
side effect of corticosteroid treatment for atoptic dermatitis?
good: reduces inflammatory response
bad: decreases fibroblast production of ECM collagen and glycosaminoglycans
- -> atrophy of dermis w/ loss of collagen, drying, cracking, tightening in skin.
- -> also teleangiectasia, ecchymoses from mild trauma, atrophic striae
55
rx for conn syndrome
primary hyperaldosteronism
spironolactone / epeleperone
56
most common CNS tumor in immunosuppresed?
CNS lymphoma
57
describe CNS lymphoma
micropscopically: dense cellular aggregates of uniform, atypical lymphoid cells. majority: B cells.
diffuse large B cell = most common type. (CD20, CD79a+)
associated w/ EBV
nonspecific clinical presentation
usu high grade, poor response to chemo
solitary mass in brain.
58
presentation of sporothrix schenckii. biopsy of innoculation site?
infects immunocompetent!
dimorphic fungi. via thorn pick. spread along lymphatics forming subcutaneous nodules & ulcers
biopsy of innoculation site: granuloma w/ histiocytes, multinucleated giant cells, neutrophils, surrounded by plasma cells.
59
fungus from animal contact?
dermatophytoses -- microsporum species. i.e.
microsporum canis --> tinea capitis
60
woolsorter's disease
pulmonary anthrax!
exposure to animal products (hair, infected hides, hide-based clothing pdt, wool).
GOAT HAIR: most common implicated exposure
61
antiphagocytic D-glutamate capsule?
bacillus anthracis. required for pathogenicity.
62
describe pathogenesis of pulmonary anthrax:
ingested by pulmonary macrophages --> move to mediastinal lymph nodes --> cause hemorrhagic mediastinitis
when spores germinate into vegetative cells, begin to produce 3-part anthrax toxin. symptoms follow.
63
progression of symptoms of pulmonary anthrax
myalgia, fever, malaise.
rapidly progress to hemorrhagic mediastinitis (widened mediastinum on chest x-ray), bloody pleural effusions, septic shock, death
64
hemorrhagic mediastinitis?
pulmonary anthrax
65
long chain "serpentine" or "medusa head" colonies. nonhemolyzing, standard culture medium?
b. anthracis
66
protein A (bind Fc portion of IgG)
staph aureus
67
peritrichous flagella
proteus mirabilis.
flagella distributed uniformly over entire surface of bacterial cell.
characteristic of highly motile organisms.
68
anterior hypothalamic nuclei? destruction?
cooling via parasympathetics. destruction = hyperthermia
69
posterior hypothalamic nuclei? destruction?
heating via sympathetics. destruction = hypothermia
70
ventromedial hypothalamic nuclei? destruction?
satiety.
stimulated by leptin.
destruction = chubs.
71
lateral hypothalamic nuclei? destruction?
hunger.
inhibited by leptin.
destruction = skinny.
72
arcuate nucleus of hypothalamus
secretes:
1. dopamine (inhibit prolactin)
2. GHRH
3. GnRH
73
paraventricular nucleus of hypothalamums
secrete oxytocin, ADH, TRH, CRH
74
supraoptic nucleus of hypothalamus
ADH and oxytoxin
75
suprachiasmatic nucleus
input from retinohypothalamic tract (specialized photosensitive ganglion cells in retina)
secrete NE --> pineal gland --> melatonin
also regulates body temperature and production of cortisol.
regulate circadian rhythm.
76
jetlag
dysynchrony between body's circadian rhythm (sleep/wake cycle) and local environmental rhythm
77
diurnal variation: melatonin levels? cortisol levels
melatonin: high at night, low in day. secreted by pineal gland.
cortisol: high in day, low at night.
78
superficial candidiasis (thrush, esophagitis, cutaneous, vulvovaginitis) directly related to?
hematogenous candidiasis related to?
superficial: low T-LYMPHOCYTE
hematogenous: NEUTROPENIA
79
what type of candida infection are HIV pts susceptible?
what about neutropenic?
HIV: low T count: superficial (oral, cutaneous, etc)
neutropenic: disseminated (right sided endocarditis, liver & kidney abscesses, candidemia)
(note if HIV + neutropenic: susceptible to both)
80
C1 esterase deficifiency
hereditary angioedema
| ACE inhibitors contraindicated
81
C3 deficiency
(1) recurrent pyogenic sinus, respiratory tract infection.
| (2) susceptible to type III HSR
82
C5-9 deficiency
both Neisseria (gonorrhea & meningitidis)
83
nitroglycerin
venodilator (large veins) reduce preload (decreased myocardial oxygen demand and treats angina pectoris)
note: reflex tachycardia and contractility, but overall low O2 demand in heart
84
large veins
modulated by nitroglycerin (venodilate)
85
small arteries & arterioles
primary site of hormonal regulation of systemic blood pressure & site of action of vasoactive antihypertensive drugs (nifedipine and prazosin)
large doses; nitrates affect arteries -- flushing, headache
86
large arteries
primary conduits for blood delivery to tissues. contain large amount of smooth muscle to regulate blood pressure and withstand high pressures
87
precapillary sphincters
bands of smooth muscles at junction of capillary and arteriole. limit flow of blood. respond to NE & E (contract or relax)
also directly responsive to local environment (histamine, low O2, high CO2, decreased pH)
88
equinovarus posture
plantarflexed and inverted
damage to common peroneal n.
paralysis of peroneus longus and peroneus brevis muscle (eversion), tibialis anterior (dorsiflexion), and extrinsic extensors of toe.
89
what three rxns is pyrodoxine B6 important for
(1) transamination and (2) decarboxylation of amino acids. (3) gluconeogenesis.
90
transamination
between amino acid and alpha-keto acid
91
transamination w/ oxaloacetate (alpha-keto-acid) & glutamate (amino acid)
aspartate (amino acid) & alpha-ketoglutarate (keto-acid)
92
transaminases require what cofactor
pyridoxine B6
93
hypertensive crisis defined as..
persistent diastolic pressure exceeding 130mmHg.
associated w/ acute vascular damage
94
hyperplastic arteriolosclerosis histology:
malignant hypertension
onion-like concentric thickening of walls:
due to (1) laminated smooth muscle cells & (2) reduplicated basement membranes
95
major toxicity of statins
hepatoxicity and myopathy (elevated creatinine kinase)
96
statins post MI?
decrease both incidence of 2nd MI and mortality. lower cholesterol & directly stabilize atheromatous plaques
97
statin myopathy amplified w/
concomittant use of fibrates & niacin
98
myopathy-inducing drugs
statins, fibrates, nitrates, hydroxychloroquine, glucocorticoids, colchicine, interferon alpha, penicillinaime.
99
reliability?
reproductability (test, retest).
measured in terms of coefficient of variation (CV) = standard deviation of the set of repeated measurments divided by mean
100
validity (accuracy)?
ability to measure that which it is supposed to measure
| test can be highly reliable but invalid
101
minute ventillation vs. alveolar ventilation
minute ventilation: total volume of air entering (or leaving) lungs per minute
Ve = Vt x RR
alveolar ventillation: air entering (or leaving) alveoli per minute
Va = (Vt - Vd) x RR
differ on dead space
102
formula for physiological dead space
Vd: Vt x ((PaCO2 x PeCO2)/PaCO2)
Taco, Paco, Peco, Paco
103
what part of bone is usu affected in hematogenous osteomyelitis in children? why?
metaphysis: has slow-flowing sinusoidal vasculature that is conducive to microbial passage.
104
progression of osteomyelitis
seeding event --> acute cellulitis of bone marrow. inflammation in confined boney space leads to increased intramedullarly pressure --> compromises blood flow and forces infectious exudate through vascular chanels into cortex & periosteal region (further compromises blood flow --> ischemia --> necrosis)
can progress to suppurative osteomyelitis (condition where necrotic bone [sequestrum] serves as reservoir for infection and becomes covered by poorly constructed shell of new bone [involcrum]
1+ sinus tracts develop to drain purlent material to soft tissue / out of skin surface
105
how does flat bone (skull, sternum, pelvis) osteomyelitis often occur?
contiguous spread of infection (mastoiditis or dental abscess)
106
most common site for hematogenous osteomyelitis in adults? children?
adult: vertebral body (location of pott's disease, TB)
children: metaphysis of long bone.
(adults less likely to have osteomyelitis bc of changes due to epiphyseal closure)
107
which drugs are metabolized by liver (i.e. affected by inducers / inhibitors)
warfarin, cyclosporine, tacrolimus, phenytoin, isoniazid, rifampin, oral hypoglycemics
108
how do beta-blockers (i.e. timolol) help open-angle glaucoma?
reduce production of aqueous humor by ciliary epithelium
109
what does schlemm's canal drain into
drains into episcleral and conjunctival veins
110
what drugs precipitate narrow angle glaucoma crisis?
anticholinergics (exacerbate small angle in posterior chamber) during mydriasis
111
what drugs reduce aqueous humor production in the eye?
(1) nonselective beta blockers (like timolol)
| (2) acetazolamide
112
what drugs increase outflow of aqueous humor
(1) prostaglandin F2a (latanoprost, unoprostone, travoprost)
| 2) cholinomimetics (pilocarpine, carbachol
113
latanoprost, unoprostone, travoprost
prostaglandin F2a. increase drainage of aqueous humor: glaucoma
114
epinephrine & brimonidine for glaucoma
alpha-2 agonists: decreases aqueous humor secretion BUT causes mydriasis.
can use for open angle, but NOT closed angle glaucoma
115
exonuclease vs. endonuclease
exonuclease: remove nucleotide from the END of a DNA molecule
endonuclease: cut DNA at very specific DNA sequences within molecule (i.e. restriction endonucleases)
116
secondary structure (alpha helices & beta sheets) of amino acids dictated by..
hydrogen bonding
- alpha, between every 4th AA
- beta, between all residues of antiparallel strands)
117
tertiary structures form what bonds
many; ionic, hydrophobic, hydrogen, disulfide
118
what is the first step in the pathogenesis of atherosclerosis?
endothelial injury!
| from HTN, hyperlipidemia, smoking, diabetes, homocysteine, toxins (inclu alcohol), viruses, immune rxn
119
gallstone ileus
rare type of mechanical bowel obstruction, when a large gallstone (> 2.5cm) erodes into the intestinal lumen (via cholecystoenteric fistula)
eventually gets stuck in ileum: smallest lumen in intestinal tract
imaging: pneumobilia (air in billiary tree)
120
GI causes of left pleural effusion
pancreatitis, esophageal rupture
121
progression of irreversible neuronal injury? 12-48 hrs
"red neurons" -- eosinophilic cytoplasm, pynkinotic nuclei, loss of nissl substance
122
progression of irreversible neuronal injury? 24-72 hrs
necrosis & neutrophil invasion
123
progression of irreversible neuronal injury? 3-5 days
macrophage infiltration and phagoytosis
124
progression of irreversible neuronal injury? 1-2wks
reactive gliosis & vascular proliferation around necrotic area
macroscopic: see liquefactive necrosis: well demarcated soft area (1wk-1month)
125
progression of irreversible neuronal injury > 2 wks
glial scar
macroscopic: cystic area surrounded by gliosis (>1 month)
126
severe skin & subcutaneous fat necrosis soon after initiating warfarin?
related to early prothrombotic effects, as warfarin inhibits protein C early (shortest half-life), intitially pro-thrombotic
pronounced w/ high doses of warfarin & patients w/ preexisting protein C deficiency
127
definition of polycythemia in men? women
hematocrit > 52% in men
| >48% in women.
128
differentiate between relative vs. absolute polycythemia?
measure RBC mass
129
secondary erythrocytosis can be driven by what level of hypoxia?
SaO2 < 92% (PaO2 < 65 mmHg)
130
'classic' phases of acid secretion within stomach
cephalic: ACh and vagal influence (thought sight, smell)
gastric: mediated by gastrin (which stimulates histamine, and therefore, acid secretion)
intestinal: when protein-containing food enters duodenum. THIS ACTUALLY DOWNREGULATES gastric acid secretion
131
role of the intestinal phase in gastric acid secretion
presence of protein in duodenum actually downregulates acid secretion.
ileum and colon release peptide YY, bind to receptors on ECL cells, inhibits gastrin-stimulated histamine release.
132
receptive relaxation
reflex that allows gastric fundus to dilate in anticipation of food passing through pharynx and esophagus.
133
prostprandial alkaline tide
increase in plasma HCO3- and decrease in plasma Cl- secondary to surge of acid within gastric lumen.
does not play a role in downregulating post-prandial gastric secretion
134
delusional disorder
presence of a NON-BIZARRE delusion for at least one month.
unlikely, but possible, like being followed, cheated, or poisoned (as opposed to covert alien activity)
usu single overriding delusion w/ preserved occupational and social functioning. does not meet diagnostic criteria for SZ
135
paranoid personality vs. delusional disorder
paranoid personality disorder: pervasive pattern of suspiciousness vs. one fixed delusion (delusional disorder)
136
coagulative necrosis
after ischemic injury in most tissue (except brain)
- architecture PRESERVED after death (due to denaturation of lytic enzymes & disrupted proteolysis)
- cell = ANUCLEATED w/ eosinophilic cytoplasm
- leukocytes eventually infiltrate & digest
137
liquefactive necrosis
- seen w/ focal BACTERIAL infection that stimulate MASSIVE leukocyte recruitment
- occurs in CNS infarcts due to LACK of substantive supporting STOMA.
- necrotic cells completely digested by hydrolytic enzymes, forming VISCOUS LIQUID MASS
- often creamy yellow due to dead leukocytes (PUS)
- associated w/ ABSCESS formation in peripheral tissue. brain = CSF-FILLED SPACES
138
fat necrosis
-acute pancreatitis
- release of active pancreatic enzymes, included LIPASES, digest adipose cells & release free fatty acids
- SAPONIFICATION (CHALKY-WHITE DEPOSITS) form when fatty acids combine w/ calcium.
139
Caseous necrosis
- most commonly withTB INFECTION
- also w/ FUNGAL (histo, cryptococcus, coccidioides)
- necrotic tissue = CHEESY TAN-WHITE gross appearance & consists of fragmented cells & acellular proteinaceous material.
- surrounded by macrophages & other inflammatory cells, forming GRANULOMA
140
TB in brain parenchyma
could cause CASEOUS NECROSIS (even though brain is often liquefactive necrosis)
141
fibrinoid necrosis
histologic pattern of injury seen in walls of blood vessels affected by vasculitis syndromes (i.e. polyarteritis nodosa), malignant HTN, and diabetes mellitus
142
nonenzymatic fat necrosis
following trauma, female breast = common example. often mistaken for breast tumor.
143
gallbladder hypomotility? risk factors?
slow / incomplete gallbladder emptying in response to cholecystokinin stimulation
pregnancy, rapid weight loss, prolonged use of parenteral nutrition or ocreotide, high spinal cord injury.
144
describe biliary sludge
consequence of gallbladder hypomotility. results from bile ppt.
contains cholesterol monohydrate crystals, calcium billirubinate, & mucus.
known precursor to stone
acute cholecystitis can occur in 20% of patients w/ biliary sludge.
145
brown GB pigment stones
arise in cases of biliary tract infection
146
black GB pigment stones
arise in causes of intravascular hemolysis
147
cystinuria presents w/ defective transport of..
autosomal recessive
COLA
cysteine, ornithine, lysine, and arginine
148
when does scarlet fever begin post group A strep infection? symptoms?
1-5 days
- fever, malaise, abdominal pain, sore throat
- "strawberry tongue" - inflammed red papillae
- pharynx: erythematous, swollen, covered w/ gray-white exudate
after 1-2 days:
- rash on neck, armpit, groin.
- subsequently generalizes to rest of body
early:
- 'boiled lobster' appearance - scarlet spots / blotches
spread:
- "sandpaper-like" - sunburn w/ goose pimples
cheeks: flushed, giving area around mouth circumoral pallow.
end of 1st wk:
- desquamation in armpits, groin, tips of fingers, toes
predispose to glomerulonephritis / rheumatic fever
149
differentiate kawasaki vs. scarlet fever
tonsilar exudate: scarlet fever
bilateral conjunctivitis: kawasaki
coronary aneursym: kawasaki
both have strawberry red tongue, desquamation
150
3 different neuro manifestations of measles
acute: encephalitis
recovery: acute disseminated encephalomyelitis
years later: subacute sclerosing panencephalitis
151
factor V leiden
DVT, cerebral vein thrombosis, recurrent pregnancy loss.
most common inherited thrombophilia.
hets have 5-10x risk of thrombosis
homoz have 50-100x risk
- factor V has less susceptibility to protein C cleavage
- factor V cannot support activated protein C activity
(increased coag, decreased anticoag)
152
renal artery stenosis primary caused by (2)
atherosclerosis
| fibromuscular disease
153
where does malignant melanoma arise
typically skin.
can arise in: eye, esophagus, meninges, mucosal surfaces
risk factors: sun exposure, hereditary, history of pre-existent dysplastic nevus in same location.
154
describe appearance of melanoma gross?
either asymptomatic or pruitic. -
- usu > 1cm.
- demonstrated change in color, size, shape.
- variability in pigment: shades of black, brown, red, navy blue, gray
- borders irregular/notched
155
histology of melanoma?
congregate in poorly formed nests. large w/ irregular nuclei, clumped chromatin. prominent nucleoli.
156
risk of melanoma metastasis
based on growth phase.
radial growth: remain superficial and extend horizontal within epidermis / superficial dermis. no risk of metastasis
vs.
melanoma w/ vertical growth -- atypical immature cells travel down into deep dermal layeres -- increase risk of mets.
157
most important prognostic factor in malignant melanoma?
depth of invasion (breslow thickness)
