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Goljan Rapid Review
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505
Medical
Graduate
03/13/2012

Additional Medical Flashcards

 


 

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Term
Cerebral Edema - intracellular type
Definition
decrease serum sodium (SIADH); dysfunctional Na/K-ATPase pump (global hypoxia)
Term
Cerebral Edema - extracellular type
Definition
increase vessel permeability; caused by acute inflammation (meningitis), metastatis, trauma
Term
Respiratory acidosis, hypoxemia
Definition
increase cerebral vessel permeability; enhance cerebral edema
Term
Papilledema (of optic disk)
Definition
sign of cerebral edema
Term
Intracranial Hypertension
Definition
papilledema, bradycardia, projectile vomiting, hypertension
Term
Pseudotumor cerebri
Definition
increased intracranial pressure WITHOUT evidence of tumor or obstruction; most common in young obese women; decrease CSF resorption in arachnoid granulations; clinical findings include headache, blurry vision & diplopia
Term
Cerebral herniation
Definition
complication of intracranial hypertension
Term
Subfalcine herniation
Definition
compression of ACA (anterior cerebral artery)
Term
Uncal herniation
Definition
compression of CN III, PCA (posterior cerebral artery), parasympathetic fibers; eye deviated down and out; mydriasis
Term
Tonsillar herniation
Definition
coning of cerebellar tonsils; cardiorespiratory arrest
Term
Hydrocephalus
Definition
enlargement of ventricles
Term
CSF
Definition
produced by the choroid plexus; reabsorbed by arachnoid granulations
Term
Communicating hydrocephalus
Definition
increased production of CSF; decreased reabsorption of CSF
Term
Noncommunicating hydrocephalus
Definition
obstruction CSF outflow into ventricles. Blockage of aqueduct of Sylvius is the most common cause of hydrocephalus in newborns.
Term
Hydrocephalus in children
Definition
Ventricles dilate and enlarge head circumference
Term
Hydrocephalus in adults
Definition
no increase in head size; dementia, gait disturbance, urinary incontinence
Term
Hydrocephalus ex vacuo
Definition
dilated ventricles secondary to brain atrophy such as in Alzheimer's disease
Term
Normal pressure hydrocephalus
Definition
dilated ventricles + triad of dementia (from stretching of limbic fibers), urinary incontinence & wide-based gait (from stretching of sacral motor fibers). Potentially reversible cause of dementia with shunting.
Term
Neural tube defects
Definition
failure of fusion of lateral folds of neural plate; increased maternal AFP. Maternal folate level must be adequate BEFORE pregnancy.
Term
Anencephaly
Definition
absence of brain; maternal polyhydramnios
Term
Spina bifida occulta
Definition
dimple/tuft of hair overlying L5-S1. Defect in closure of posterior vertebral arch.
Term
Meningocele
Definition
cystic mass with meninges
Term
Meningomyelocele
Definition
cystic mass with meninges and spinal cord
Term
Arnold-Chiari malformation
Definition
caudal extension medulla/cerebellar vermis through the foramen; noncommunicating hydrocephalus; Associated with meningomyelocele & syringomyelia
Term
Dandy-Walker malformation
Definition
partial/complete absence of cerebellar vermis; cystic dilation of 4th ventricle; noncommunicating hydrocephalus
Term
Syringomyelia
Definition
Degenerative disease of spinal cord (usually cervical). Cervical cord enlargement; fluid-filled cavity which expands and causes degeneration of spinal tracts. Pathogenesis is obstruction of outflow from 4th ventricle. Decreased pain & temperature sensation in hands & loss of intrinsic muscles of the hand. MRI to visualize.
Term
Neurocutaneous syndromes
Definition
In descending order of incidence: Neurofibromatosis, tuberous sclerosis, Sturge-Weber Syndrome
Term
Neurofibromatosis (NF)
Definition
AD; incomplete penetrance; no gender predominance. Cafe au lait macules & neurofibromas
Term
NF1
Definition
optic gliomas; Lisch nodules; axillary/inguinal freckling. Associated with pheochromocytoma, Wilm's tumor, & juvenile chronic myelogenous leukemia (CML)
Term
NF2
Definition
bilateral acoustic neuromas; juvenile cataracts; meningiomas
Term
Tuberous sclerosis
Definition
AD; mental retardation; hamartomas in brain & kidneys; key findings include seizures, MR, angiofibromas, hypopigmented ash leaf lesions. Rhabdomyoma of the heart is highly predictive of tuberous sclerosis.
Term
Sturge-Weber Syndrome (SWS)
Definition
vascular malformation of the face; ipsilateral AV malformation in meninges in some patients
Term
Coup injuries
Definition
occur at the SITE of impact (usually cerebellum)
Term
Contrecoup injuries
Definition
opposite to the site of impact (usually front and temporal lobes)
Term
Epidural hematoma
Definition
Temporoparietal skull fracture; tear of middle meningeal artery. CT scan is imaging test of choice
Term
Subdural hematoma
Definition
venous blood between dura and arachnoid membranes. Most often caused by trauma; increased risk with cerebral atrophy. Tear of bridging veins produces venous blood clot that follows convexity of the brain. CT scan is imaging of choice.
Term
Global hypoxic injury
Definition
hypotensive episodes; chronic CO poisoning. Complications include cerebral atrophy, watershed infarcts, & stroke. Red neurons are apoptotic neurons. Repeated episodes of hypoglycemia has a similar effect on the brain.
Term
Atherosclerotic stroke
Definition
most common overall stroke; ischemic type. Pale infarction extending to periphery of cerebral cortex. Most occur in the MCA distribution. Infarction with liquefactive necrosis. Most are preceded by transient ischemic attacks (TIAs) which are transient neurologic deficits lasting <24hrs and are usually caused by microembolization of plaque material.
Term
Amaurosis fugax
Definition
temporary loss of vision; embolic material trapped at bifurcation of retinal vessels (Hollenhorst plaque)
Term
MCA stroke
Definition
contralateral paresis/sensory loss in face/upper extremity; head/eyes deviate to side of the lesion
Term
ACA stroke
Definition
Contralateral paresis/sensory loss in lower extremity
Term
Embolic stroke
Definition
ischemic type; hemorrhagic infarction extending to periphery of cerebral cortex. Emboli most often originate from left side of the heart
Term
Intracerebral hemorrhage
Definition
complication of HTN; rupture of aneurysm. Rx of HTN reduces incidence of strokes by more than 40%. Basal ganglia is most common location.
Term
Subarachnoid hemorrhage
Definition
rupture of congenital berry aneurysm (junction of communicating branch with main cerebral artery). Severe occipital headache described as "worst headache ever."
Term
Lacunar strokes
Definition
microinfarction <1cm; hyaline arteriolosclerosis secondary due to hypertension and/or diabetes
Term
Diagnosis of strokes
Definition
CT without contrast is best test
Term
Most CNS infections are due to
Definition
sepsis
Term
Meningitis
Definition
inflammation of pia mater; nuchal rigidity; increased CSF protein (bacterial, fungal, some viruses) & decreased CSF glucose (bacterial & fungal)
Term
Bacterial meningitis
Definition
majority of organisms originate in nasopharynx
Term
Viral meningitis
Definition
most often transmitted by fecal-oral route
Term
Encephalitis
Definition
inflammation of brain; headache, drowsiness, & coma
Term
Cerebral abscess
Definition
hematogenous; contiguous spread
Term
Multiple Sclerosis
Definition
most common demyelinating disease. CD4 T cells react against self antigens in myelin sheath; cytokines activate macrophages that destroy myelin. There are genetic factors & environmental triggers. Sensory & UMN dysfunction; autonomic dysfunction; blurry vision due to optic neuritis; cerebellar ataxia; scanning speech; intention tremor,nystagmus; bilateral internuclear ophthalmoplegia (demyelination of the MLF)
Term
Demyelinating plaques
Definition
white mater looks like gray mater
Term
Sensory dysfunction
Definition
Paresthesias; loss pain/temp/vibratory senstation
Term
UMN (upper motor neuron) dysfunction
Definition
spasticity; increased deep tendon reflexes; muscle spasms; extensor plantar response (Babinski's sign); weakness
Term
Autonomic dysfunction
Definition
urge incontinence; sexual dysfunction; bowel motility dysfunction
Term
MS lab findings
Definition
INCREASED CSF lymphs, CSF proteins, & MBP; normal CSF glucose. OLIGOCLONAL BANDS in high-resolution electrophoresis = sign of demyelination
Term
Central pontine myelinolysis (CPM)
Definition
rapid IV correction of hyponatremia (usually in an alcoholic) that causes demyelination in the basis pontis.
Term
Arboviruses in CNS
Definition
Cuase encephalitis; mosquito vector; West Nile virus
Term
Coxsackievirus in CNS
Definition
Most common cause of viral meningitis
Term
CMV in CNS
Definition
Most common viral CNS infection in AIDS; causes encephalitis; intranuclear basophilic inclusions
Term
HSV-1 in CNS
Definition
Causes hemorrhagic necrosis of temporal lobes (meningitis & encephalitis)
Term
HIV in CNS
Definition
Most common cause of AIDS dementia (encephalitis)
Term
Lymphocytic choriomeningitis
Definition
transmitted by mouse urine/feces; meningoencephalitis is combo of nuchal rigidity & mental status abnormalities (CSF has increased protein, lymphs & normal to decreased glucose)
Term
Poliovirus
Definition
Destroys upper and lower motor neurons causing muscle paralysis; post-polio syndrome
Term
Rabies virus
Definition
fever, paresthesias in and around wound site; hydrophobia due to spasms of throat muscles when swallowing; encephalitis (death of neurons) with eosinophilic intracytoplasmic inclusions called Negri bodies
Term
Creutzfeldt-Jakob disease (CJD)
Definition
Fatal encephalopathy due to to prions; normal prion protein in neuronal membranes misfolds, becomes infectious, & results in death of neuron and spongiform change. Transmitted by corneal transplants; grafts of dura mater; handling infected brain tissue, contaminated beef. Causes severe dementia.
Term
Progressive multifocal leukoencephalopathy
Definition
Conventional slow virus encephalitis due to papovavirus; intranuclear inclusion in oligodendrocytes. Occurs in AIDS when CD4 T count <50 cells/mm
Term
Subacute sclerosing panencephalitis
Definition
Slow virus encephalitis associated with rubeola (measles) virus; intranuclear inclusions in neurons and oligodendrocytes; death w/in 1-2 years
Term
Group B Strep in CNS
Definition
gram-positive coccus; most common cause of neonatal meningitis
Term
E. coli in CNS
Definition
Gram-negative rod; second most common cause of neonatal meningitis
Term
Listeria monocytogenes in CNS
Definition
Gram-positive rod with tumbling motility; actin rockets help organism to move from cell to cell. Pathogen found in soft cheese & hot dogs. Causes neonatal meningitis.
Term
Streptococcus pneumoniae in CNS
Definition
Gram-positive diplococcus; one of these most common causes of meningitis in those between 1 month and 18 years old.
Term
Neisseria meningitidis in CNS
Definition
Gram-negative diplococcus; most ocmmon cause of meningitis in patients b/w 1 month and 18 years old
Term
Mycobacterium tuberculosis in CNS
Definition
Meningitis; Complication of primary tuberculosis; involves base of the brain; vasculitis (infarction) and scarring (hydrocephalus).
Term
Treponema pallidum in CNS
Definition
Spirochete that causes meningitis, encephalitis, & myelitis. Types of neurosyphilis = meningovascular (vasculitis causing strokes), general paresis (dementia), tabes dorsalis (posterior root ganglia & posterior column; causes ataxia, loss of vibration sensation, absent deep tendon reflexes)
Term
Cryptococcus neoformans in CNS
Definition
Causes meningitis & encephalitis; occurs in immunocompromised host; most common fungal CNS infection in AIDS; budding yeasts visible with India ink
Term
Mucor species in CNS
Definition
Frontal lobe abscess; occurs in diabetic ketoacidosis; spreads from frontal sinuses
Term
Naegleria fowleri in CNS
Definition
Protozoa (amoeba) that causes meningoencephalitis involving the frontal lobes. Contracted by swimming in freshwater lakes.
Term
Trypanosoma gambiense/rhodesiense in CNS
Definition
Protozoa (hemoflagellate) that causes encephalitis. Transmitted by tsetse fly. Initial drainage into the posterior cervical nodes produces lymphadenopathy (Winterbottom's sign); diffuse encephalitis (sleeping sickness);
Term
Taenia solium in CNS
Definition
Helminth (tapeworm/cestode). Pig transmitted disease causing cysticercosis. Larval forms invade brain, producing calcified cysts causing seizures, hydrocephalus
Term
Toxoplasma gondii in CNS
Definition
protozoa that causes encephalitis; most common CNS space-occupying lesion in AIDS; ring-enhancing lesions on CT.
Term
Adrenoleukodystrophy
Definition
X-linked recessive; peroxisomal enzyme deficiency in beta-oxidation of fatty acids; causes generalized loss of myelin in brain & adrenal insufficiency
Term
Metachromatic leukodystrophy
Definition
Autosomal recessive; lysosomal storage disease (LSD); deficiency in arylsulfatase A --> accumulation of sulfatides
Term
Krabbe's disease
Definition
autosomal recessive; lysosomal storage disease; deficiency in beta-galactocerebrosidase with increase in beta-galactocerebroside in lysosomes. Brain shows large, multinucleated, histiocytic cells (globoid cells)
Term
Alzheimer's disease
Definition
most common overall cause of dementia. Sporadic late onset type most common. Mutations of amyloid precursor protein (APP) on chromosome 21 and presenilin 1 on ch'some 14 & presenilin 2 on ch'some 1. Prevalence increases with age. Increase phosphorylated ABeta protein which is neurotoxic & damages medial temporal lobe & frontal cortex.
Term
ABeta in Alzheimer's
Definition
Activation of GSK (glycogen synthase kinase-3B) causes phosphorylation of ABeta, which produces neuronal & synaptic dysfunction and signaling for neuronal apoptosis. ABeta can also be converted into amyloid which deposits in cerebral vessels. ABeta is a metabolic product of APP, coded for on ch'some 21. Beta-secretases followed by gamma-secretases cleave APP to produce ABeta.
Term
Sporadic early onset type of AD
Definition
apolipoprotein gene E, allele E4 codes for product that can't eliminate ABeta from brain
Term
Tau protein in AD
Definition
activated GSK enhances hyperphosphorylation of tau protein, causing neurofibrillary tangles (twisted fibers). PIN1 enzyme dephosphorylates hyperphosphorylated tau protein and is deficient in some causes of AD.
Term
AD gross and microscopic findings
Definition
increased density of NF tangles and senile (neuritis) plaques in the brain; occipital lobe usually spared. Senile (neuritic) plaques are a core of ABeta surrounded by neuronal cell processes with tau protein. Confirmation of AD must be made at autopsy.
Term
Amyloid Angiopathy
Definition
ABeta is present in cerebral vessels. Risk for cerebral hemorrhage.
Term
Parkinsonism
Definition
alteration in dopaminergic pathways involved in voluntary muscle movment
Term
Dopamine
Definition
principal neurotransmitter in nigrostriatal tract
Term
Idiopathic Parkinson's disease
Definition
depigmentation of substantia nigra neurons; decreased dopamine. Expressionless face, blepharospasm; SEBORRHEIC DERMATITIS
Term
Clinical s/s of Parkinson's
Definition
rigidity; resting tremor; bradykinesia (slow voluntary muscle movements)
Term
Huntington's Disease (HD)
Definition
Autosomal dominant; trinucleotide repeat disorder (CAG) involving ch'some 4. Atrophy of caudate nucleus, putamen, globus pallidus. Leads to chorea & oculomotor abnormalities. Delayed appearance of symptoms to 30-40 y/o.
Term
Friedreich's ataxia
Definition
Autosomal recessive; trinucleotide repeat disorder (GAA) leads to deficiency of frataxin. Degeneration sites include dorsal root ganglia, posterior/spinocerebellar/corticospinal tracts. Associated with hypertonic cardiomyopathy & type 1 diabetes mellitus.
Term
Lou Gehrig's disease (amyotrophic lateral sclerosis - ALS)
Definition
Degeneration of LMN & UMN; atrophy of intrinsic muscles of hand. NO SENSORY CHANGES & bowel/bladder function intact.
Term
Werdnig-Hoffmann disease
Definition
LMN disease in children
Term
Wilson's disease
Definition
AR disease that involves defect in copper metabolism. Leads to liver cirrhosis and cystic degeneration of basal ganglia.
Term
Acute intermittent porphyria (AIP)
Definition
AD; defect in porphyrin metabolism. Deficiency in uroporphyrinogen synthase; severe belly pain leading to "bellyful of scars" (mistaken for surgical abdomen); peripheral neuropathy; dementia. Urine is colorless when first voided, but exposure to light produces color.
Term
Vitamin B12 deficiency
Definition
subacute combined degeneration; dementia; peripheral neuropathy
Term
Wernicke-Korsakoff Syndrome
Definition
hemorrhage in mamillary bodies; encephalopathy s/s include confusion, ataxia, nystagmus, ophthalmoplegia. Korsakoff's psychosis is the advanced irreversible stage with anterograde & retrograde amnesia. Alcoholics receiving IV infusion with glucose should supplement IV with thiamine to prevent acute Wernicke's
Term
Most common primary CNS tumors in adults
Definition
glioblastoma multiforme, meningioma, ependymoma (usually above tentorium cerebelli)
Term
Common primary brain tumors in children
Definition
Cystic astrocytoma & medulloblastoma (both in cerebellum)
Term
Clinical findings of CNS tumor
Definition
Headache, seizures, intracranial hypertension
Term
Astrocytoma
Definition
Most common neuroglial tumor. Glioblastoma multiforme (GBM) is grade IV astrocytoma that often crosses the corpus callosum --> hemorrhagic and cystic tumor that rarely metastasizes outside the CNS.
Term
Meningioma
Definition
Most common benign brain tumor in adults. Female predominance (estrogen receptors). Psammoma bodies are present. Associated with neurofibromatosis & hx of radiation
Term
Ependymoma
Definition
Benign tumor in fourth ventricle of children & the cauda equina in adults.
Term
Medulloblastoma
Definition
Malignant small cell tumor of children. Arises from external granular cell layer of cerebellum & often seeds neuraxis & invades fourth ventricle.
Term
Oligodendroglioma
Definition
front lobe calcifications in an adult
Term
Primary CNS Lymphoma
Definition
Occurs in AIDS; EBV-mediated cancer
Term
Most common brain malignancy
Definition
Metastasis
Term
Charcot-Marie-Tooth (CMT) disease
Definition
Most common HEREDITARY neuropathy; AD. Peroneal nerve neuropathy which causes atrophy of muscles of lower legs (inverted bottle appearance)
Term
Guillain-Barre syndrome (GBS)
Definition
Most common ACUTE peripheral neuropathy and most common cause of acute flaccid paralysis. Common preceding infections are M. pneumoniae, Campylobacter jejuni enteritis, & viruses. Causes an ascending paralysis. Usually starts in proximal muscles and goes distally. Treatment of GBS is IV immunoglobulin or plasma exchange
Term
Most common cause of peripheral neuropathy
Definition
Diabetes mellitus
Term
Idiopathic Bell's palsy
Definition
facial muscle paralysis due to inflammation of CN VII. HSV is the most common association.
Term
LMN Bell's Palsy
Definition
Ipsilateral weakness upper/lower face.
Term
UMN Bell's Palsy
Definition
Contralateral weakness of lower face; sparing of upper face.
Term
Drugs producing peripheral neuropathy
Definition
Vincristine, Hydralazine, Phenytoin
Term
Vitamin Deficiencies producing peripheral neuropathy
Definition
thiamine, pyridoxine, vitamin B12
Term
Schwannoma
Definition
Benign tumor of schwann cells. Trigeminal and VIII may be involved.
Term
Acoustic neuroma
Definition
Schwannoma of CN VIII; located at cerebellopontine angle. Associated with NF2, usually bilateral tumors. Produce tinnitus and sensorineural hearing loss.
Term
Ulnar nerve injury (C8-T1)
Definition
Caused by fracture of medial epicondyle of humerus. Injury produces "claw hand" (loss of interosseous muscles)
Term
Radial nerve injury (C5-T1)
Definition
Midshaft fracture of humerus. Draping the arm over a park bench. Injury produces wrist drop.
Term
Axillary nerve (C5-6)
Definition
Fracture of surgical neck of humerus; anterior dislocation of shoulder joint. Cannot abduct arm to horizontal position or hold horizontal position when downward force is applied to arm (paralysis of deltoid).
Term
Erb-Duchenne Palsy
Definition
Brachial plexus lesion involving C5 and C6. "Waiter's tip" deformity.
Term
Median Nerve (C6-T1)
Definition
Most commonly cause by entrapment in transverse carpal ligament of the wrist or b/w bellies of pronator teres muscle. RA and pregnancy are two most common causes.
Term
Common peroneal nerve (L4-S2)
Definition
Common peripheral neuropathy; lead poisoning; fractured neck of fibula; cast tightness. Loss of foot eversion (weak peroneus longus & brevis muscles), loss of foot dorsiflexion (weak tibialis anterior --> high-stepping gait), loss of toe extension (weak extensor digitorum longus & hallicus longus). Overall get plantar flexion with foot drop & foot inversion. Loss of ankle jerk reflex.
Term
Arcus senilis
Definition
Elderly; gray-opaque ring at corneal margin; cholesterol deposits in corneal stroma (may indicate hypercholesterolemia)
Term
Ophthalmia neonatorum
Definition
Conjunctivitis in newborn; Neisseria gonorrhoeae (first week), Chlamydia (second week)
Term
Bacterial conjunctivitis
Definition
purulent; pain but NO blurry vision; Staph aureus, Strep pneumo, H. influenzae
Term
Viral conjunctivitis
Definition
Watery exudates; adenovirus (pink eye & preauricular lymphadenopathy); HSV-1 leads to keratoconjunctivitis with dendritic ulcers noted with fluorescein staining.
Term
Allergic conjunctivitis
Definition
seasonal itching of eyes
Term
Acanthamoeba infection
Definition
severe keratoconjunctivitis in pts who do not clean contact lenses properly
Term
Stye
Definition
Infection of eyelid most commonly due to S. aureus
Term
Chalazion
Definition
Granulomatous inflammation involved meibomian gland in eyelid; usually disappear on own
Term
Orbital cellulitis
Definition
Periorbital redness & swelling often secondary to sinusitis. S. pneumo & H. influenzae. Fever, proptosis, periorbital swelling, ophthalmoplegia (eye movement impaired) & normal retinal exam
Term
Orbital fracture
Definition
Associated with blunt trauma to eye. Associated with edema & ecchymoses of eyelids. Vertical diplopia, prolapse of orbital contents into maxillary sinus & could get damage to infraorbital nerve.
Term
Pterygium
Definition
Raised, triangular encroachment of thickened conjunctiva on nasal side of conjunctiva. Due to excessive exposure to wind, sun & sand.
Term
Pinguecula
Definition
Yellow-white conjunctival degeneration at junction of cornea and sclera on temporal side of conjunctiva. Does not grow into cornea like pterygium.
Term
Optic neuritis
Definition
Inflammation of optic nerve. MS is most common cause; also methanol poisoning. Blurry vision or loss of vision. May cause optic atrophy.
Term
Central retinal artery occlusion
Definition
Embolization of plaque material from ipsilateral carotid or ophthalmic artery; giant cell temporal arteritis. Sudden, painless, complete loss of vision in one eye, pallor of optic disk due to narrowed arteries, "boxcar" segmentation of blood in retinal veins. CHERRY RED MACULA
Term
Central retinal vein occlusion
Definition
Hypercoaguable state (polycythemia vera). Sudden, painless unilateral loss of vision, swelling of optic disk, engorged retinal veins with hemorrhage
Term
Glaucoma
Definition
Increased intraocular pressure. Chronic open angle - decreased rate of aqueous outflow into canal of Schlemm; bilateral aching eyes; pathologic cupping of optic disks; night blindness & gradual loss of vision leading to tunnel vision and blindness. Acute angle-closure type - narrowing of anterior chamber angle, severe pain associated with photophobia and blurry vision; red eye with steamy cornea; pupil fixed & nonreactive to light.
Term
Optic nerve atrophy
Definition
pale optic disk; optic neuritis or glaucoma
Term
Uveitis
Definition
inflammation of uveal tract (iris, ciliary body, choroid). Caused by sarcoidosis, ulcerative colitis, ankylosing spondylitis. Pain with blurry vision, miotic pupil, circumcorneal ciliary body vascular congestion, normal intraocular pressure, adhesions between iris and anterior lens capsule.
Term
Macular degeneration
Definition
most common cause of permanent visual loss in the elderly. Disruption of Bruch's membrane in the retina. Dry type = thinning of retina & formation of yellow-white deposits. Wet type = extension of dry type; vessels under retina hemorrhage causing retinal cells to die, creating blind spots or distored vision.
Term
CMV retinitis
Definition
Most common cause of blindness in AIDS; occurs when CD4 T helper cell count <50. Cotton-wool exudates and retinal hemorrhages
Term
Cataracts
Definition
Opacity in the lens; caused by advanced age, diabetes mellitus, infection, corticosteroids; common in congenital infections (CMV & rubella)
Term
Malignant tumors
Definition
retinoblastoma in children; malignant melanoma in adults
Term
Meniere's disease
Definition
Increased endolymph in inner ear & loss of cochlear hairs. Dizziness, vertigo, tinnitus, sensorineural hearing loss.
Term
Sensorineural defect
Definition
Weber test: lateralizes to normal ear (contralateral ear is affected)
Term
Otosclerosis
Definition
most common cause of conduction deafness in elderly; due to fusion of middle ear ossicles
Term
Conduction defect
Definition
Weber test: lateralizes to affected ear
Term
Otitis media
Definition
Most common cause of conduction deafness in children; Strep pneumo
Term
External otitis
Definition
Inflammation of outer ear canal; "Swimmer's Ear" due to Pseudomonas aeruginosa, Staph aureus. Malignant external otitis is severe infection of outer ear canal in pts with diabetes mellitus
Term
Presbycusis
Definition
Most common cause of sensorineural hearing loss in elderly. Due to degeneration of cochlear hairs.
Term
Most common cause of endocrine gland hyperfunction
Definition
Benign adenoma
Term
Hypothalamic dysfunction
Definition
Secondary hypopituitarism, Central diabetes insipidus (ADH), increased prolactin, precocious puberty, visual field defects, mass effects (obstructive hydrocephalus)
Term
Pineal Gland
Definition
Midline above quadrigeminal plate. Releases melatonin (chemical messenger of darkness). Commonly undergoes dystrophic calcification.
Term
Pineal gland tumors
Definition
Paralysis of upward gaze (Parinaud's syndrome); obstructive hydrocephalus (compression of aqueduct of Sylvius in third ventricle)
Term
Pituitary infarction
Definition
invariably produces panhypopituitarism
Term
Hypopituitarism in adults most common cause
Definition
Nonfunctioning adenoma. Association with MEN I syndrome (pituitary adenoma, hyperparathyroidism, pancreatic tumor).
Term
Craniopharyngioma
Definition
Most common cause of hypopituitarism in children. Benign pituitary tumor derived from Rathke's pouch remnants
Term
Rathke's pouch
Definition
Ectodermal derivative derived from oral cavity. Develops into anterior lobe of pituitary gland.
Term
Sheehan's postpartum necrosis
Definition
sudden cessation of lactation; pituitary infarction secondary to shock
Term
Pituitary apoplexy
Definition
hemorrhage into preexisting adenoma
Term
Lymphocytic hypophysitis
Definition
autoimmune destruction of pituitary gland; occurs during or after pregnancy
Term
Empty sella syndrome
Definition
subarachnoid space extends into sella; increased CSF pressure compresses gland. Often associated with obese women with hypertension.
Term
Gonadotropin (LH & FSH) deficiency (hypopituitarism)
Definition
Children have delayed puberty. Adult females have secondary amenorrhea; produces osteoporosis, hot flashes (lack of estrogen) & decreased libido. Males have impotence, due to decreased libido from decreased testosterone. GnRH stimulation test (no increased in FSH/LH in hypopituitarism, but eventual increased in hypothalamic disease)
Term
Growth hormone (GH)deficiency (hypopituitarism)
Definition
Decreased GH decreases synthesis and release of IGF-1. Children have growth delay (fusion of epiphyses). Adults have hypoglycemia from decreased gluconeogenesis; loss of muscle mass; increased adipose around waist. Arginine & sleep stimulation tests: NO increase in GH or IGF-1; normally, GH and IGF-1 are released around 5am
Term
Thyroid-stimulating hormone (TSH)deficiency (hypopituitarism)
Definition
Secondary hypothyroidism: decreased serum T4 and TSH. Cold intolerance, constipation, weakness. NO increased in TSH after TRF stimulation.
Term
Adrenocorticotropin hormone (ACTH) deficiency (hypopituitarism)
Definition
Metyrapone test: stimulation test of pituitary ACTH and adrenal gland reserve. Metyrapone inhibits adrenal 11-hydroxylase, which causes decrease in cortisol & corresponding increase in plasma ACTH (pituitary) and 11-deoxycortisol (adrenal), which is proximal to the enzyme block; in hypopituitarism, neither ACTH or 11-deoxycortisol are increased; in adrenal disease, ACTH is increased, but 11-deoxycortisol is decreased.
Term
Posterior pituitary
Definition
storage of ADH and release of oxytocin
Term
Prolactinoma
Definition
most common pituitary tumor. Causes secondary amenorrhea + galactorrhea. In men it causes impotence due to loss of libido & headache.
Term
Growth hormone (adenoma)
Definition
stimulates gluconeogenesis & increases amino acid uptake in muscle; stimulates IGF-1 in liver
Term
IGF-1
Definition
stimulates bone, cartilage, soft tissue growth
Term
Gigantism
Definition
Increased linear/lateral bone growth in children. Epiphyses NOT fused.
Term
Acromegaly
Definition
Increased lateral bone growth only (epiphyses fused); organomegaly; hyperglycemia. Comparing old vs new photograph is useful diagnostic tool. HF from cardiomyopathy is common cause of death.
Term
Total Serum T4
Definition
T4 bound to TBG + FT4 (free/unbound T4)
Term
Estrogen effects on thyroid hormones
Definition
Increases TBG which increases total serum T4 for NOT FT4
Term
Decrease TBG
Definition
decrease total serum T4 but NOT FT4; alterations in TBG alter total serum T4 but have no effect on FT4 and TSH
Term
Serum TSH used for what?
Definition
Best test for thyroid dysfunction
Term
Iodine 123 uptake evaluates what?
Definition
Evaluates synthetic activity of thyroid gland. Increased uptake (hot nodule) indicates increased synthesis of thyroid hormone (Graves' disease). Decreased uptake (cold nodule) indicates thyroiditis or patient taking excess thyroid hormone.
Term
Mass at base of tongue
Definition
Lingual thyroid
Term
Thyroglossal duct cyst
Definition
cystic midline mass
Term
Branchial cleft cyst
Definition
located in the anterolateral neck
Term
Acute thyroiditis
Definition
Bacterial infection (S. aureus). Initial thyrotoxicosis from gland destruction, decreased iodine 123 uptake. Tender gland with painful cervical adenopathy.
Term
Subacute granulomatous thyroiditis
Definition
most common cause of painful thyroid; virus induced; no adenopathy
Term
Hashimoto's thyroiditis
Definition
Autoimmune. Type IV (mainly) and type II hypersensitivity. Most common cause of hypothyroidism. Increased incidence in Turner's, Down, and Klinefelter's syndromes. Enlarged gray gland. Lymphocytic infiltrate with prominent germinal follicles.
Term
Reidel's thyroiditis
Definition
fibrous tissue replacement of gland and surrounding tissue. Can produce tracheal obstruction.
Term
Subacute painless lymphocytic thyroiditis
Definition
Autoimmune disease that develops postpartum; progression to hypothyroidism; lacks germinal follicles
Term
Cretinism
Definition
hypothyroidism in infancy or early childhood. Often caused by maternal hypothyroidism before fetal thyroid is developed. Severe mental retardation, increased weight & short stature.
Term
Hashimoto's thyroiditis s/s
Definition
muscle weakness, weight gain, dry brittle hair, periorbital puffiness, hoarse voice, HTN from sodium retention, delayed reflexes
Term
Primary hypothyroidism labs findings
Definition
Decreased serum T4/FT4; increased serum TSH & cholesterol
Term
Myxedema coma
Definition
stupor, hypothermia, hypoventilation, give the patient levothyroxine & corticosteroids
Term
Thyrotoxicosis
Definition
Hormone excess from any cause. Hyperthyroidism is thyrotoxicosis due to excess synthesis of thyroid hormone.
Term
Most common cause of hyperthyroidism & thyrotoxicosis
Definition
Graves' disease
Term
Graves' disease
Definition
anti-TSH receptor antibody, type II hypersensitivity. Unique to Graves' is exophthalmos, pretibial myxedema, thyroid acropachy (digital swelling & clubbing)
Term
Toxic multinodular goiter
Definition
one or more nodules in a multinodular goiter becomes TSH-independent
Term
Thyrotoxicosis s/s
Definition
Weight loss with a good appetite; heat intolerance, diarrhea; oligomenorrhea; lid stare; sinus tachycardia; systolic hypertension; brisk reflexes
Term
Atrial fibrillation
Definition
always order a TSH test to rule out hyperthyroidism
Term
Graves' hyperthyroidism lab findings
Definition
Increased serum T4/FT4 and Iodine 123 uptake. Decreased serum TSH
Term
Euthyroid Sick Syndrome (ESS)
Definition
serum T3 and T4 abnormalities but normal gland function; block in outer ring deiodinase conversion of T4 to T3; T4 converted to inactive reverse T3. Decreased serum T3 and increased reverse T4
Term
Nontoxic goiter
Definition
absolute or relative deficiency of thyroid hormone. Hyperplasia/hypertrophy followed by involution; initially diffuse, then nodular
Term
Toxic nodular goiter
Definition
one or more nodules become TSH-independent
Term
Solitary thyroid nodules in 1)women, 2)man/child, and 3)hx of radiation exposure
Definition
Majority are cold nodules. 1) In women, majority are benign, but 15% malignant. 2) In men/child greater chance of malignancy. 3) Hx of radiation increases risk of malignancy (40%).
Term
Most common benign thyroid tumor
Definition
Follicular adenoma (surrounded by complete capsule)
Term
Papillary carcinoma
Definition
Most common endocrine tumor; most common thyroid cancer. Has psammoma bodies. Multifocal. Orphan Annie nuclei. Lymphatic invasion.
Term
Follicular adenoma
Definition
Most common thyroid cancer presenting as a solitary cold nodule. Hematogenous spread (NOT lymphatic).
Term
MEN IIa
Definition
medullary carcinoma; HPTH (Hyperparathyroidism); pheochromocytoma
Term
MEN IIb (III)
Definition
Medullary carcinoma, mucosal neuromas lips/tongue, pheochromocytoma
Term
Medullary carcinoma
Definition
derives from C cells; calcitonin is the tumor marker; calcitonin is converted into amyloid. Ectopic hormones (ACTH) can produce Cushing syndrome.
Term
Primary B cell lymphoma
Definition
most often derives from Hashimoto's thyroiditis
Term
Anaplastic thyroid cancer
Definition
rapidly aggressive; uniformally fatal. Most often in elderly women.
Term
Superior & inferior parathyroids derived from?
Definition
4th and 3rd pharyngeal pouch
Term
Role of PTH
Definition
increases renal calcium reabsorption; decreases renal phosphorus & bicarbonate reabsorption. Hypocalcemia/hyperphosphatemia increases PTH while hypercalcemia/hypophosphatemia decreases PTH.
Term
Calctriol
Definition
Active Vitamin D; increases calcium/phosphorus reabsorption in bowel; also increases osteoclast production (bone resorption)
Term
Calcitriol feedback
Definition
hypocalcemia increases synthesis, hypercalcemia decreases synthesis
Term
Hypoalbuminemia
Definition
Decreased total serum calcium due to decreased in calcium bound to albumin. Decreased total serum calcium, normal ionized calcium, and PTH
Term
Tetany
Definition
Due to decreased ionized calcium level - causes partial depolarization of nerves and muscles
Term
Most common cause of hypoparathyroidism
Definition
Autoimmune
Term
DiGeorge Syndrome
Definition
failure of descent of 3rd/4th pharyngeal pouches; absent parathyroids and thymus (pure T-cell deficiency)
Term
Most common pathologic cause of hypocalcemia in the hospital
Definition
Hypomagnesemia - cause of hypoparathyroidism
Term
Hypomagnesemia s/s
Definition
diarrhea, aminoglycosides, diuretics, alcohol
Term
Hypoparathyroidism (serum levels)
Definition
Decreased serum calcium, PTH, & vitamin D; increase serum phosphorus
Term
Most common overall cuase of hypocalcemia
Definition
Chronic renal failure; causes hypovitaminosis D
Term
Primary HyperPTH (HPTH) associated with?
Definition
MEN I and MEN IIa
Term
Most common cause of primary HPTH
Definition
benign adenoma - sheet of chief cells with NO adipose
Term
Hypovitaminosis D causes
Definition
Lack of sunlight. Malabsorption (e.g. celiac disease). Cirrhosis. Drugs enhancing CYP system. Chronic renal failure.
Term
Pseudohypoparathyroidsim
Definition
AD disease. End-organ resistance to PTH (also lacks ability to synthesize 1alpha-hydroxylase in proximal tubule). Mental retardation, basal ganglia calcification, short fourth & fifth metacarpals ("knuckle-knuckle-dimple-dimple" sign). Hypocalcemia, normal to increased PTH
Term
Primary PTH hyperplasia
Definition
All four glands involved. Usually chief cell, but can be clear cell hyperplasia (wasserhelle cell)
Term
Primary HPTH
Definition
Renal stones are most common presentation. Peptic ulcer disease (PUD); acute pancreatitis. Osteitis fibrosa cystica, subperiosteal bone resorption, osteoporosis, pseudogout. DIASTOLIC HYPERTENSION.
Term
Primary HPTH findings phrase
Definition
"Stones, bones, abdominal groans, and psychic moans."
Term
Best initial screen for primary HPTH
Definition
Intact serum PTH (iPTH)
Term
Primary HPTH lab findings
Definition
Increased serum calcium & PTH; decreased serum phosphorus/bicarb; chloride/phosphorus ratio >33; decreased serum calcitriol
Term
Differentiate Hypercalcemia from primary HPTH or malignancy
Definition
Serum PTH is increased in primary HPTH. Serum PTH is decreased in hypercalcemia of malignancy.
Term
Familial hypocalciuric hypercalcemia
Definition
AD with 100% penetrance. Mutation causing altered set-point for calcium-sensing receptor on renal tubule and PTH gland; normal to slightly increased serum PTH but very low urinary calcium levels.
Term
Secondary hyperPTH
Definition
compensating for hypocalcemia
Term
Most common cause of hypophosphatemia
Definition
alkalosis; also insulin rx for DKA & primary HPTH
Term
Most common cause of hyperphosphatemia
Definition
renal failure; also normal child, primary hypoPTH & pseudohypoPTH
Term
Adrenal cortex
Definition
Glomerulosa - mineralocorticoids (aldosterone)
Fasciculata - glucocorticoids (cortisol)
Reticularis - sex hormones (testosterone)
Term
Adrenal medulla
Definition
Neural crest origin
Produces catecholamines (Epi and Norepi)
Term
Most common cause of acute adrenocortical insufficiency
Definition
Abrupt withdrawal of corticosteroids
Term
Waterhouse-Friderichsen syndrome
Definition
Causes acute adrenocortical insufficiency. Associated with N. meningitidis sepsis --> DIC --> bilateral adrenal hemorrhage (hemorrhagic infarction)
Term
Most common cause of Addison's disease in the US
Definition
autoimmune
Term
Most common cause of Addison's disease in developing countries
Definition
Miliary TB
Term
Most common cause of Addison's disease in children
Definition
adrenogenital syndrome
Term
Clinical findings of Addison's disease
Definition
Chronic adrenal insufficiency -- diffuse hyperpigmentation (increased ACTH stimulates melanocytes); hypotension & weakness (from sodium loss from mineralocorticoid & glucocorticoid deficiency)
Term
Addison's disease lab findings
Definition
1) Short & prolonged ACTH stimulation test (NO increase in cortisol or 17-OH)
2) Metyrapone test (decreased cortisol leads to increased ACTH but NO increase in 11-deoxycortisol
3) Increased plasma ACTH
Term
Addison's disease electrolyte findings
Definition
Decreased serum sodium, cortisol, & bicarbonate
Increased serum potassium and ACTH.
Hypoglycemia, eosinophilia, lymphocytosis, neutropenia.
Term
Adrenogenital syndrome (congenital adrenal hyperplasia)
Definition
Increased ACTH --> increased 17-KS, testosterone, and DHT leads to ambiguous genitalia in females, precocious puberty in males and females
Term
Decrease in 17-KS, testosterone, and DHT
Definition
delayed menarche and secondary sex characteristics; males develops pseudohermaphroditism
Term
Increased mineralocorticoids
Definition
sodium retention with hypertension
Term
Decrease in mineralocorticoids
Definition
sodium losers with hypotension
Term
Most common cause of adrenogenital syndrome
Definition
Classic 21-hydroxylase deficiency (increase in testosterone & company and decrease in mineralocorticoids and 17-OH. Increased androgens.)
Term
Nonclassic 21-hydroxylase deficiency
Definition
Impaired cortisol synthesis only --> virilization; no sodium wasting
Term
11-hydroxylase deficiency
Definition
impaired cortisol and mineralocorticoid excess (salt retainer); increased androgens
Term
17-hydroxylase deficiency
Definition
impaired cortisol and androgens; increased mineralocorticoid production
Term
17-hydroxyprogesterone screening test
Definition
Increased in 21 and 11-OHase deficiency
Decreased in 17-OHase deficiency
Term
Most common cause of Cushing syndrome
Definition
corticosteroid therapy
Term
Most common pathologic cause of Cushing syndrome
Definition
Pituitary Cushing syndrome ("Cushing Disease")
Term
Pituitary Cushings (levels)
Definition
Increased ACTH AND Cortisol; most common due to pituitary adenoma
Term
Adrenal Cushings (levels)
Definition
Decreased ACTH and increased cortisol; most common an adenoma
Term
Ectopic Cushing (levels)
Definition
Markedly increased ACTH and increased cortisol; usually small cell carcinoma of the lung
Term
Cushing syndrome clinical findings
Definition
weight gain (hyperinsulinism from hyperglycemia); truncal obesity; buffalo hump; thin extremities; purple stria on abdomen (weakened collagen); hypertension; hirsutism;
Term
Cushing Lab Findings
Definition
Increased urine for free cortisol
Low-dose dexamethasone suppression test cannot suppress cortisol in all types. High-dose dexamethasone suppression test can suppress cortisol in pituitary Cushing syndrome but NOT the other types.
Hyperglycemia, Hypokalemia, metabolic alkalosis
Term
Nelson's syndrome
Definition
bilateral adrenalectomy causes enlargement of pre-existing pituitary adenoma
Term
Primary hyperaldosteronism (Conn's syndrome)
Definition
Most often due to benign adenoma.
Hypertension, hypernatremia, hypokalemia, metabolic alkalosis.
No pitting edema
Term
Secondary hyperaldosteronism
Definition
compensation for decreased cardiac output; activation of RAA system and plasma renin activity is increased.
Term
Pheochromocytoma
Definition
Majority benign, unilateral, arise in adrenal medulla (also in bladder, & organ of Zuckerkandl near bifurcation of the aorta).
Associated with neurofibromatosis, MEN IIa/IIb & Von Hippel-Lindau disease
Term
Pheochromocytoma unique findings
Definition
Palpitations, paroxysmal hypertension, anxiety, drenching sweats, headache, orthostatic hypotension, chest pain, ileus (inhibits peristalsis)
Term
Best screen to diagnose pheochromocytoma
Definition
Plasma free metanephrines; also 24-hour collection for metanephrine, VMA.
Also find hyperglycemia & neutrophilic leukocytosis (inhibition of neutrophil adhesion molecules)
Term
Neuroblastoma
Definition
Malignant tumor of postganglionic sympathetic neurons. Childhood tumor and cause of hypertension. Located in adrenal medulla. Causes opsoclonus-myoclonus syndrome (paraneoplastic syndrome, myoclonic jerk, chaotic eye movements). "Small cell" tumor with neurosecretory granules. Presence of Homer-Wright rosettes.
Clinical findings: child with abdominal mass + hypertension
Term
Insulinoma lab findings
Definition
Increased serum insulin and C peptide
Term
Glucagonoma
Definition
Malignant tumor of alpha-islet cells. Hyperglycemia and rash (necrolytic migratory erythema)
Term
Insulinoma
Definition
Benign tumor of beta-islet cells; approximately 80% have MEN I syndrome. Fasting hypoglycemia causing mental status abnormalities.
Term
Somatostatinoma
Definition
Malignant tumor of delta-islet cells. Inhibition of gastrin (achlorhydria), CCK, GIP, and secretin
Term
VIPoma (pancreatic cholera)
Definition
Malignant tumor with excessive secretion of VIP. Secretory diarrhea, achlorhydria. Hypokalemia, normal anion gap metabolic acidosis.
Term
Zollinger-Ellison
Definition
Malignant islet cell tumor that secretes gastrin producing hyperacidity; MEN I association. Peptic ulceration, diarrhea, maldigestion of food. Serum gastrin >1000 pg/mL
Term
Most common cause of blindness, peripheral neuropathy, chronic renal failure, and below-knee amputations
Definition
Diabetes Mellitus
Term
Maturity onset diabetes of the young (MODY)
Definition
AD inheritance; not obese; impaired glucose-induced secretion of insulin. Clinical findings include polyuria, polydipsia,, polyphagia, weight loss
Term
HLA association of Type 1 DM
Definition
HLA-DR3 and HLA-DR4
Term
Hyperinsulinemia
Definition
Increased VLDL, hypertension, CAD
Decreased HDL-CH
Term
Nonenzymatic glycosylation (NEG)role in diabetes
Definition
Production of glycosylated HbA1c; hyaline arteriolosclerosis
Term
Gestational diabetes mellitus
Definition
Anti-insulin effect of HPL (human placental lactogen), cortisol, progesterone
Increases risk for RDS (insulin inhibits fetal surfactant production)
Term
Type I Polyglandular syndrome
Definition
Addison's disease, primary hypoparathyroidism, mucocutaneous candidiasis
Term
Type I polyglandular syndrome
Definition
Addison's disease, Hashimoto's thyroiditis, type I DM
Term
Reactive hypoglycemia
Definition
Excess insulin is most common cause; adrenergic symptoms
Term
Fasting hypoglycemia
Definition
Caused by excess alcohol, insulinoma, or cirrhosis. In children, look for inborn errors of metabolism.
Term
Neuroglycopenia
Definition
Dizziness, mental status changes, motor disturbances. Diagnosis - prolonged fast must satisfy Whipple's triad (symptoms occur, hypoglycemia is demonstrated, and symptoms relieved by glucose)
Term
Type I hyperlipoproteinemia
Definition
AR; rare childhood disease; Deficiency of CPL or apo CII
Term
Type II hyperlipoproteinemia
Definition
increased LDL due to decreased LDL receptors; increased cholesterol synthesis and decreased cholesterol excretion in the bile
Term
Familial hypercholesterolemia (Type II hyperlipoproteinemia)
Definition
Achilles tendon xanthomas are pathognomonic; also have xanthelasma (yellow raised plaque on the eyelid)
Term
Type III hyperlipoproteinemia
Definition
deficiency in Apo E; increased chylomicron remnants and IDL; INCREASED CAD risk; palmar xanthomas
Term
Type IV hyperlipoproteinemia
Definition
most common cause is alcohol excess; increased VLDL; eruptive xanthomas; turbid infranate after refrigeration
Term
Type V hyperlipoproteinemia
Definition
increased VLDL and chylomicrons; retinal vessels look like milk (blurry vision)
Term
Medial calcification
Definition
dystrophic calcification in the wall of muscular arteries; no clinical significance
Term
Atherosclerosis
Definition
endothelial cell injury; macrophages & platelets adhere to damaged endothelium; released cytokines cause hyperplasia of medial smooth muscle cells; smooth muscle cells migrate to tunica intima; cholesterol enters smooth muscle cells and macrophages (foam cells); smooth muscle cells release cytokines that produce extracellular matrix (collagen, proteoglycans, elastin); development of fibrous cap
Term
Fibrous cap
Definition
Pathognomonic lesion of atheroscleoris
Term
C-reactive protein
Definition
excellent marker of disrupted fibrous plaques; ruptures plaques produce vessel thrombosis, which leads to acute MI
Term
Sites for atherosclerosis (descending order)
Definition
Abdominal aorta; coronary artery; Popliteal artery; internal carotid artery
Term
Complications of atherosclerosis
Definition
Aneurysms, thrombosis, ischemia
Term
Hyaline arteriolosclerosis
Definition
Associated with DM and hypertension
Term
Hyperplastic arteriolosclerosis
Definition
malignant hypertension; onion-skin appearance (example - renal arteriole effect caused by acute increased in blood pressure)
Term
Abdominal aortic aneurysm
Definition
Most common in men >55; rupture triad is left flank plan, hypotension, and pulsatile mass. Usually located below renal artery orifices
Term
Mycotic (fungal) aneurysm
Definition
Aspergillus, Candida, Mucor
Bacterial: B. fragilis, P. aeruginosa, Salmonella
Term
CNS berry aneurysms
Definition
junction communicating branch with main vessel; rupture releases blood into the subarachnoid space; rupture is sudden onset of severe occipital headache
Term
Syphilitic aneurysm
Definition
aortic arch; tertiary syphilis; vasa vasorum vasculitis (endarteritis obliterans). Plasma cell infiltrate is present in vessel walls. Produces aortic regurgitation & bounding pulses
Term
Aortic dissection
Definition
men age 40-60 y/o with hypertension; or young patients with Marfan or Ehlers-Danlos syndrome. Pathogenesis = cystic medial degeneration (CMD) which is elastic tissue fragmentation; matrix collects in areas of fragmentation in tunica media. Clinical findings = pain that radiates into the back and absent pulse. Cardiac tamponade is the most common cause of death.
Term
Marfan syndrome
Definition
AD disorder; weak elastic tissue due to defect in fibrillin
Term
Superficial varicosities
Definition
Valve incompetence
Term
Phlebothrombosis
Definition
stasis of blood flow most common cause; most often occurs in deep vein of calf
Term
Stasis dermatitis
Definition
orange discoloration and ischemic ulcers around the ankles; sign of DVT.
Term
Diagnosis of DVT
Definition
compression venous untrasonography + serum D-dimer assay
Term
Thrombophlebitis
Definition
pain and tenderness overlying vein; associated with DVT in 20% of cases. Carcinoma of pancreatic head produces superficial migratory thrombophlebitis
Term
Superior vena cava (SVC) syndrome
Definition
compression of SVC by primary lung cancer (small cell carcinoma)
Term
Thoracic outlet syndrome
Definition
compression of neurovascular compartment in the neck; common among weight lifters; tight scalenus muscles
Term
Acute lymphangitis
Definition
Strep pyogenes cellulitis; "red streak"
Term
Nodular lymphangitis
Definition
Caused by sporotrichosis
Term
Turner's webbed neck caused by
Definition
lymphatic abnormality (dilated channels)
Term
Lymphedema
Definition
collection of lymphatic fluid in interstitial tissue or body cavities; can be caused by obstruction
Term
Bacillary angiomatosis
Definition
caused by Bartonella henselae & common in AIDS (simulates Kaposi's sarcoma); benign capillary proliferation involving skin and visceral organs
Term
Angiomyolipoma
Definition
kidney hamartoma composed of blood vessels, muscle, and mature adipose tissue; association with tuberous sclerosis
Term
Angiosarcoma
Definition
Liver angiosarcoma associated with exposure to polyvinyl chloride, arsenic, thorium dioxide
Term
Capillary hemangioma
Definition
Facial lesion in newborns that regresses with age
Term
Cavernous hemangioma
Definition
Most common benign tumor of liver and spleen; may rupture if large
Term
Hereditary telangiectasia (AD)
Definition
dilated vessels on skin and mucous membranes in mouth and GI tract; chronic iron deficiency anemia
Term
Spider telangiectasia
Definition
Arteriovenous fistula (disappears when compressed); associated with hyperestrinism (cirrhosis, pregnancy)
Term
Sturge-Weber syndrome
Definition
Nevus flammeus (birthmark) on face in distribution of ophthalmic branch of cranial nerve V; some show ipsilateral malformation of pia mater vessels overlying occipital and parietal lobes
Term
Von Hippel-Lindau syndrome (AD)
Definition
Cavernous hemangiomas in cerebellum and retina; increased incidence of pheochromocytoma and bilateral renal cell carcinoma
Term
c-ANCA positive
Definition
Wegener's granulomatosis
Term
p-ANCA positive
Definition
microscopic polyangiitis; Churg-Strauss syndrome
Term
Palpable purpura caused by
Definition
small vessel vasculitis
Term
Non-palpable purpura
Definition
Due to thrombocytopenia or vessel instability (scurvy) - not palpable because acute inflammation is not involved
Term
Medium-sized vessel vasculitis clinical findings
Definition
thrombosis, aneurysm formation
Term
Large vessel vasculitis clinical findings
Definition
absent pulse, stroke
Term
Most common cause of secondary hypertension (only 5% of cases)
Definition
renovascular hypertension
Term
Renovascular hypertension
Definition
atherosclerosis in men; fibromuscular hyperplasia in women. Activation of RAA system.
Term
Complication of HTN in descending order
Definition
acute MI, stroke, renal failure
Term
Pathogenesis of HTN almost always involves
Definition
retention of sodium
Term
Takayasu arteritis ("pulseless disease")
Definition
Granulomatous, large vessels (aortic arch vessels); young asian women and children; absent upper extremity pulse, visual defects, stroke
Term
Giant cell (temporal) arteritis
Definition
Granulomatous, large vessel involved superficial temporal and ophthalmic arteries. Adults >50y/o. Temporal headache, jaw claudicatoin, blindness on ipsilateral side, increased sed rate
Term
Polyarteritis nodosa
Definition
Necrotizing medium vessels. Middle-aged men association with hep B. Vessels at all stages of acute and chronic inflammation. Produces aneurysms. Organ infarction in kidneys, heart, bowels, skin, testicle
Term
Kawasaki disease
Definition
Necrotizing medium vessel involving coronary arteries. Children <5y/o. Fever, erythema and edema of hands and feet, rash, cervical adenopathy, abnormal ECG (acute MI)
Term
Thromboangiitis obliterans (Buerger's disease)
Definition
Medium vessels with digital vessels; men 25-50y/o who smoke; resting pain on forefoot, ischemic ulcers or gangrene on foot/toes, Raynaud's phenomenon
Term
Raynaud's disease
Definition
Medium vessels; young women; paroxysmal digital color changes (white,blue,red)
Term
Raynaud's phenomenon
Definition
Medium vessels; adult men and women secondary to other diseases (CREST, SLE)
Term
Wegener's granulomatosis
Definition
necrotizing medium and small vessels involving lung infarctions & renal vessels; childhood to middle age; granulomas in skin, upper respiratory tract (nose deformity), lower respiratory tract (cavitating nodular lesions); necrotizing vasculitis in lungs, kidneys, c-ANCA positive
Term
Microscopic polyangiitis
Definition
Small vessels in skin, lung, brain, GI, postcapillary venules; children and adults; precipitated by drugs, infections, and immune disorders. Vessels as SAME STAGE of inflammation; palpable purpura, glomerulonephritis, p-ANCA
Term
Churg-Strauss
Definition
small vessel involved skin, lung, heart; children and adults; allergic rhinitis, asthma, p-ANCA
Term
Henoch-Schonlein purpura
Definition
small vessels in skin, GI, renal, joints; children and young adults, males > females; IgA-anti-IgA complexes; follows viral URI and group A strep infections; palpable purpura of buttocks and lower extremities; polyarthritis, nephropathy, GI bleeding
Term
Cryoglobulinemia
Definition
small vessel involving skin, GI, renal; adults; associated with HCV, type I MPGN, multiple myeloma; immunoglobulins gel at cold temperatures
Term
Infectious vasculitis
Definition
small vessels of skin; children and adults; Rocky Mountain spotted fever (tick transmits Rickettsia rickettsii); Petechia on palms spread to trunk
Term
Increased afterload of ventricle causes
Definition
concentric hypertrophy. Left ventricular hypertropy (LVH) caused by essential hypertension, aortic stenosis, & hypertrophic cardiomyopathy.
RVH cause by pulmonary hypertension and pulmonary artery stenosis
Term
Increased preload of ventricle causes
Definition
Eccentric hypertrophy (dilation AND hypertrophy); mitral valve or aortic valve regurgitation; left-to-right shunting of blood (VSD); tricuspid valve or pulmonary valve regurgitation cause right ventricle eccentric hypertrophy
Term
What is an S4 heart sound?
Definition
Blood entering noncompliant ventricle
Term
Consequences of hypertrophy
Definition
HF, S4, angina (LVH)
Term
Left-sided HF
Definition
Systolic dysfunction is most common cause; forward failure --> pulmonary edema (from back up)
Term
Most common cause of diastolic dysfunction is
Definition
hypertension (also aortic stenosis)
Term
Systolic dysfunction
Definition
decreased ventricular contraction; characterized by low ejection fraction (<40%)
Term
Diastolic dysfunction
Definition
characterized by normal EF (stiff ventricle) and an S4 atrial gallop due to increased resistance to filling in late diastole. Increased in left atrial pressure and pulmonary congestion.
Term
Heart failure cells
Definition
alveolar macrophages with hemosiderin; from pulmonary edema (rupture of pulmonary capillaries may occur from increased hydrostatic pressure)
Term
S3 heart sound
Definition
First cardiac sign of LHF; sudden rush of blood entering a volume overloaded left or right ventricle
Term
Paroxysmal nocturnal dyspnea (PND) / orthopnea
Definition
increased venous return to right side of the heart at night when patient is supine; raising head on pillows increases effect of gravity on reducing venous return to the heart
Term
BNP (brain natriuretic peptide)
Definition
useful in confirming/excluding LHF; secreted in response to volume expansion and pressure overload in teh ventricle
Term
Right heart failure
Definition
Backward failure --> increased in venous hydrostatic pressure; caused by decreased contraction, noncompliant right ventricle, increased afterload, or increased preload. LHF is most common cause of RHF. Increased venous neck distension, hepatomegaly (and nutmeg liver), dependent pitting edema, ascites
Term
Causes of high output failure
Definition
Increased in stroke volume (hyperthyroidism); decreased in blood viscosity (decreased TPR); arteriovenous fistula (increases venous return to the heart)
Term
Most common site of coronary artery thrombosis
Definition
Left anterior descending coronary artery
Term
Angina pectoris
Definition
most common manifestation of coronary artery disease; age most important risk factor; males>females
Term
Most common type of angina
Definition
Stable angina
Term
Stable angina
Definition
exercise-induced substernal chest pain; subendocardial ischemia with ST-segment depression
Term
Prinzmetal's angina
Definition
Vasospasm with transmural ischemia and ST-segment elevation; use calcium channel blockers to vasodilate
Term
Unstable angina
Definition
angina at rest; multivessel disease; disrupted plaques
Term
Sudden cardiac death
Definition
unexpected death w/in 1 hour after symptoms; coronary artery thrombosis usually NOT present; severe CAD, disrupted plaques, ventricular fibrillation is cause of death
Term
Mitral valve prolapse sudden death
Definition
arrhythmias from mitral regurgitation or CHF
Term
Acute MI
Definition
Caused by rupture of disrupted plaque --> platelet thrombus (thromboxane A2 contributes)
Term
Contraction band necrosis
Definition
caused by reperfusion; hypercontraction myofibrils due to influx of calcium
Term
Gross and microscopic findings of MI during 0-24 hrs
Definition
No gross changes; coagulation necrosis within 12-24 hrs; neutrophils begin to enter area from periphery
Term
Gross and microscopic findings of MI during 1-3 days
Definition
pallor of infarcted tissue; myocyte nuclei and stiations disappear; neutrophils are abundant and lyse dead cells
Term
Gross and microscopic findings of MI during 3-7 days
Definition
Red granulation tissue surrounds area; macrophages begin to remove necrotic debris; most DANGEROUS TIME FOR RUPTURE
Term
Gross and microscopic findings of MI during 7-10 days
Definition
necrotic area is bright yellow; granulation tissue and collagen formation are well developed
Term
Gross and microscopic findings of MI during 2 months
Definition
infarcted tissue replaced by white, patchy, noncontractile scar
Term
Most common cause of death in acute MI
Definition
ventricular fibrillation
Term
When is myocardial rupture most common?
Definition
at 3-7 days post MI
Term
Posteromedial papillary muscle rupture
Definition
RCA thrombosis; mitral regurgitation
Term
Fibrinous pericarditis
Definition
early (acute inflammation) and late (autoimmune) complication after an acute MI
Term
ECG findings in acute MI
Definition
inverted T waves, elevated ST segment, Q waves
Term
How do you detect cardiac reinfarction?
Definition
Reappearance of CK-MB after 3 days
Term
CK-MB
Definition
Appears 4-8 hours post-MI; peaks at 24 hrs; disappears w/in 1.5-3 days; used in conjunction with troponins
Term
Cardiac Troponins I and T
Definition
Appear w/in 3-12 hrs; peak at 24 hrs; disappears w/in 7-10 days (can't detect reinfarction)
Term
Highest PO2 content in fetal circulation
Definition
Umbilical vein
Term
Left-to-right shunt Reversal
Definition
occurs when pressure in the right ventricle overrides the left ventricular pressure. Cyanosis (Eisenmenger syndrome) and clubbing develop.
Term
Most common congenital heart disease in children
Definition
Ventricular septal defect
Term
Ventricular septal defect
Definition
defect in membranous septum
Term
Most common congenital heard disease in adults
Definition
Atrial septal defect
Term
Atrial septal defect
Definition
patent foramen ovale; fixed splitting of S2
Term
Patent Ductus arteriosus
Definition
associated with congenital rubella, RDS, complete transposition; machinery murmur during systole and diastole; closed with indomethicin
Term
Most common cyanotic congenital heart disease
Definition
Tetralogy of Fallot
Term
Tetralogy of Fallot
Definition
Ventricular septal defect; pulmonary stenosis; right ventricular hypertrophy; overriding aorta; degree of pulmonary valve stenosis correlates with presence or absence of cyanosis.
Cardioprotective shunts are ASD and PDA
Term
Tet spells (hypoxic spells)
Definition
Sudden increase in hypoxemia; squatting increases systemic vascular resistance, increased PaO2
Term
Infantile (preductal) coarctation of aorta
Definition
Associated with Turner's syndrome
Term
Adult coarctation of aorta
Definition
Disparity between upper/lower extremity blood pressure >10mmHg; hypertension due to activation of RAA system
Term
Acute rheumatic fever occurs
Definition
after group A strep pharyngitis; 5-15 y/o
Immune-mediated type II hypersensitivity reaction; cell-mediated immunity type IV. Migratory polyarthritis most common initial presentation. Myocarditis is most common cause of death. RF endocarditis most commonly involved the mitral valve and then the aortic valve. Mitral regurg occurs in acute attack, but mitral stenosis occurs in chronic disease.
Term
Diagnosis of acute rheumatic fever (Jones criteria)
Definition
One major & two minor
Major: carditis, migratory polyarthritis, chorea, erythema marginatum, subcutaneous nodules
Minor: previous RF, arthralgia, fever, increased acute phase reactants.
Term
Rheumatic fever lab tests
Definition
Increased ASO and DNase B titers.
Term
Mitral valve stenosis
Definition
Most common cause is recurrent RF.
Atrial fibrillation is common.
Pulmonary venous hypertension --> RHF.
Opening snap followed by an early to mid-diastolic rumble.
Term
Mitral valve prolapse
Definition
Most common cause of mitral regurgitation.
Association with Marfan and Ehlers-Danlos syndromes.
Myxomatous degeneration; excess dermatan sulfate.
Systolic click followed by murmur.
Increased preload alters click and murmur relationship to S1/S2.
Term
Mitral valve regurgitation
Definition
pansystolic murmur; S3/S4; no increase intensity with deep held inspiration
Term
Aortic valve stenosis
Definition
ejection murmur; S4; decreased intensity with decreased preload; increased intensity with increased preload.
Most common valvular lesion causing syncope and angina with exercise.
Microangiopathic hemolytic anemia with schistocytes and hemoglobinuria.
Term
Isolated AV root dilation is most common cause of
Definition
aortic regurgitation
Term
Aortic valve regurgitation
Definition
Increase pulse pressure.
Early diastolic murmur; bounding pulses; S3, S4; no increased intensity with inspiration.
Hyperdynamic cirulation.
Austin flint murmur (diastolic murmur) is sign for AV replacement.
Term
Tricuspid valve regurgitation
Definition
Functional stretching is most common cause in adults (RHF, pulmonary HTN, right ventricular infarction)
Infective endocarditis in IV drug abuse; carcinoid heart disease.
Pansystolic murmur; S3/S4; increase intensity with deep held inspiration.
Term
Pulmonary valve regurgitation
Definition
pulmonary hypertension
Term
Carcinoid heart disease
Definition
Due to liver metastasis from carcinoid tumor of small intestine; Serotonin causes fibrosis of tricuspid and pulmonary valves. Produces TV regurgitation and PV stenosis.
Term
Most common cause of infective endocarditis
Definition
Streptococcus viridans
Term
Most common pathogen producing infective endocarditis in IV drug abuse
Definition
Staph aureus
Term
Most common pathogen producing nosicomial and prosthetic valve infective endocarditis
Definition
Staph epidermidis
Term
Most common pathogen producing infective endocarditis in ulcerative colitis/colorectal cancer
Definition
Streptococcus bovis
Term
Infective Endocarditis
Definition
Fever is the most consistent sign. Other signs include microembolization (splinter hemorrhages), and immunocomplex vasculitis (glomerulonephritis)
Positive blood culture in majority of cases.
Term
Libman-Sacks endocarditis
Definition
associated with SLE; mitral valve involved (sterile vegetations over the mitral valve surface and chordae)
Term
Nonbacterial thrombotic endocarditis (marantic)
Definition
Paraneoplastic syndrome; sterile vegetations
Term
Most common cause of myocarditis and pericarditis
Definition
Coxsackievirus
Term
Most common cause of mycarditis leading to CHF in Central/South America
Definition
Chagas' disease
Term
Myocarditis lab findings
Definition
Increased CK-MB and troponins I and T; detect antibodies of pathogens
Term
Pericarditis
Definition
Precordial rub; pain relieved by leaning forward & increases when leaning back.
Friction rub. Serum CK-MB normal.
Young woman with pericarditis and effusion most likely has SLE. Associated with pericardial effusion.
Term
Pericardial effusion on inspiration
Definition
neck vein distension; decreased systolic blood pressure > 10 mmHg
Term
Constrictive pericarditis
Definition
TB is most common cause worldwide.
incomplete filling of chambers; pericardial knock
Term
Dilated Cardiomyopathy
Definition
Most common cardiomyopathy.
Myocarditis is most common cause.
Can be caused by doxorubicin and daunorubicin.
Global enlargement of the heart.
Term
Hypertrophic Cardiomyopathy
Definition
Most common cause of sudden death in young individuals.
Disproportionately greater hypertrophy of interventricular septum than the free left ventricular wall (may obstruct outflow tract).
Obstruction BELOW the aortic valve.
Decreased preload increases murmur intensity opposite of those for AV stenosis (i.e. when standing up, Valsalva, etc)
Harsh systolic ejection murmur (heart at left sternal border).
Sudden death due to ventricular tachycardia/fibrillation.
Treat with beta-blockers.
Term
Restrictive Cardiomyopathy
Definition
Least common. Low-voltage ECG (clinical finding).
Decreased ventricular compliance caused by amyloidosis, mycardial fibrosis, or radiation.
Term
Most common tumor of the heart
Definition
Metastasis > primary tumors
Term
Cardiac myxoma
Definition
Most common primary adult tumor and most commonly found in the left atrium. Benign primary mesenchymal tumor. Can embolize or cause syncopal episodes by blocking mitral valve orifice.
Term
Rhabdomyoma
Definition
Most common primary tumor of the heart in infants and children (association with tuberous sclerosis).
Hamartoma arising from cardiac muscle
Term
Hamartoma
Definition
Benign, focal malformation that resembles a neoplasm in the tissue of its origin. Not malignant, and it grows at the same rate as the surrounding tissues. It is composed of tissue elements normally found at that site, but which are growing in a disorganized mass. SCRAMBLED tissue
Term
Most common cause of fever 24-36 hrs after surgery
Definition
Resorption atelectasis
Term
Resorption atelectasis
Definition
airway obstruction by thick secretions prevents air from reaching alveoli.
Clinical findings = fever & dyspnea, absent breath sounds, absent vocal vibratory sensation (tactile fremitus), dullness to percussion
Term
Compression atelectasis
Definition
air or fluid in pleural cavity under increased pressure collapes small airways beneath pleura (ex. tension pneumothorax or pleural effusion)
Term
Surfactant
Definition
Synthesized by type II pneumocytes
cortisol increases synthesis, insulin inhibits synthesis
Decreases surface tension
Term
RDS
Definition
Grunting, tachypnea, intercostal retractions.
Chest radiograph shows a ground glass appearance.
Term
Most common cause of pulmonary edema
Definition
Left-sided heart failure
Term
Acute respiratory distress syndrome (ARDS)
Definition
Noncardiogenic pulmonary edema resulting from acute alveolar-capillary damage.
Risks: sepsis, gastric aspiration, severe trauma
Alveolar macrophages release cytokines chemotactic to neutrophils and the neutrophil damages type I and II pneumocytes
Lab: severe hypoxemia NOT responsive to O2 therapy & increased A-a gradient
Term
Mucor species in the lung
Definition
Wide-angled hyphae w/o septa.
Setting: diabetics, immunosuppressed patients.
Vessel invader and produces hemorrhagic infarcts in the lung.
Invades the frontal lobes in patients with diabetic ketoacidosis.
Term
Most common cause of atypical pneumonia
Definition
Mycoplasma pneumoniae
Term
Atypical pneumonia
Definition
Interstitial pneumonia; no signs of consolidation
Term
Most common pathogen causing pneumonia in AIDS
Definition
Pneumocystis jiroveci
Term
Tuberculosis
Definition
Acid fastness due to mycolic acid.
Cord factor is virulence factor.
PPD does not distinguish active from inactive TB.
Term
Primary TB
Definition
Upper part of the lower lobes or lower part of the upper lobes. Ghon complex (caseous necrosis) in hilar lymph nodes.
Term
Reactivation TB
Definition
Upper lobe cavitary lesions b/c ventilation is greatest in the upper lobes. Cavitary lesion due to release of cytokines from memory T cells.
Term
Clinical findings of TB
Definition
drenching night sweats, fever, weight loss
Term
Most common extrapulmonary site in TB
Definition
kidneys
Term
Most common TB in AIDS caused by
Definition
Mycobacterium avium-intracellulare
Term
Lung abscesses
Definition
Most often due to aspiration of oropharyngeal material
Mixed aerobic/anaerobic infection
Chest x-ray shows cavitation and fluid level.
Term
Most common site for aspiration
Definition
Superior segment, right lower lobe
Term
Pulmonary infarction
Definition
Sudden onset of dyspnea and tachypnea
Fever, pleuritic chest pain (on inspiration)
Pleural friction rub, Pleural effusion
Expiratory wheezing
Most common symptom/sign = respiratory alkalosis and hypoxemia
Normal ventilation scan & abnormal perfusion scan; increased D-dimers
Term
Cor pulmonale
Definition
combination of pulmonary hypertension and right ventricular hypertrophy leading to right-sided heart failure
Term
Goodpasture syndrome
Definition
Hemoptysis followed by renal failure (anti-GBM)
Term
Main cause of secondary pulmonary hypertension
Definition
Respiratory acidosis and hypoxemia --> causes smooth muscle hyperplasia and hypertrophy
Term
Pulmonary hypertension
Definition
Atherosclerosis of main pulmonary arteries.
Exertional dyspnea most common symptom.
Tapering of pulmonary arteries on chest x-ray.
Term
restrictive lung diseases
Definition
Characterized by reduced total lung capacity in presence of normal or reduced expiratory flow rate.
Decreased compliance and increased elasticity.
All volumes and capacities are decreased.
Fibrosis, Pneumoconionses, Sarcoidosis, etc
Term
Interstitial fibrosis
Definition
Alveolitis - leukocytes release cytokines and stimulate fibrosis
Term
Pneumoconiosis
Definition
Inhalation of mineral dust.
Paricle size 1-5 um: bifurcation respiratory bronchioles and alveolar ducts.
Particle size <0.5 um: alveoli
Term
Coal Worker's Pneumoconiosis (CWP)
Definition
anthracotic pigment; also element of obstructive lung disease.
Simple: fibrotic opacities <1cm in upper lobes
Complicated: Progressive massive fibrosis - larger than 1-2cm with or without necrotic centers. "Black lung disease"
NO RISK FOR LUNG CANCER OR TB
Term
Dust cells
Definition
Alveolar macrophages with anthracotic pigments
Term
Caplan syndrome
Definition
pneumoconiosis and cavitating rheumatoid nodules in lungs
Term
Silicosis
Definition
Quartz sources: foundries (casting metal), sandblasting, mines
Opacities contain collagen and quartz.
Concentric layers of collagen with or w/o central cavitation.
"Egg-shell" calcification in hilar nodes (dystrophic calcification)
INCREASE RISK LUNG CANCER AND TB
Term
Asbestosis
Definition
Serpentine - curly & flexible fibers
Amphibole - straight & rigid (mesothelioma)
Deposits in respiratory bronchioles, alveolar ducts and alveoli (deposits in entire respiratory unit)
Term
Ferruginous bodies
Definition
Iron-coated asbestos fibers; golden, beaded appearance in sputum
Term
Asbestos-related disease
Definition
Most common lesions are benign pleural plaques.
Diffuse interstitial fibrosis with or w/o pleural effusions.
BRONCHOGENIC CARCINOMA (most common asbestos-related cancer)
No risk for TB
Term
Malignant mesothelioma
Definition
NO relationship with smoking.
From serosal cells lining pleura.
Encases the lung and locally invades the subpleural lung tissue.
Occurs 25-40 yrs after asbestos exposure.
Term
Berylliosis
Definition
Increased risk for lung cancer.
Exposure in nuclear and aerospace industry.
Term
Sarcoidosis
Definition
Most common noninfectious granulomatous disease of lungs. Disorder in immune regulation. CD4 T cells interact with an unknown antigen. Causes noncaseating granulomas. Lung is the primary target organ. Granulomas located in interstitium and mediastinal & hilar nodes.
Granulomas contain multinucleated giant cells and laminated calcium concretions (Schaumann bodies).
Dyspnea is most common symptom.
Skin nodules have granulomas on biopsy. Also affects the liver.
Increased ACE
Hypercalcemia due to hypervitaminosis D.
Diagnosis of exclusion (rule out other granulomatous diseases).
Term
Idiopathic pulmonary fibrosis
Definition
Alveolitis leading to interstitial fibrosis; honeycomb lung
Term
Collagen vascular diseases with interstitial fibrosis
Definition
Systemic sclerosis, SLE (esp young woman with pleural effusion), RA
Term
Byssinosis
Definition
Textile factory workers (cotton, linen, hemp products).
Exposure to bacterial endotoxin from gram negative bacteria growing on the cotton. Workers feel better over the weekend, dyspnea reappears when return to work on Monday ("monday morning blues")
Term
Drugs associated with interstitial fibrosis
Definition
Amiodarone, Bleomycin & bulsulfan, Cyclophosphamide, MTX, methysergide, nitrosourea and nitrofurantoin
Term
Radiation-induced lung disease
Definition
Acute pneumonitis 1-6 months after therapy. Fever, dyspnea, pleural effusions, infiltrates on chest x-ray
Term
Obstructive lung diseases
Definition
Obstruction to airflow out of the lungs.
Emphysema, Chronic bronchitis, asthma, bronchiectasis
Term
Emphysema
Definition
Smoking is most common cause.
Targets respiratory unit.
Increased compliance, decreased elasticity (does re-coil to expel air).
Cigarette smoke is chemotactic to neutrophils; inactivates anti-elastases and glutathione, destroying elastic tissue.
Air trapping behind collapsed distal terminal bronchioles.
"Pink puffers" b/c blowing off excess CO2. Normal to decreased arterial Pco2 (respiratory alkalosis)
Term
Centriacinar emphysema
Definition
Most common in smokers.
Destruction of the distal terminal bronchioles and respiratory bronchioles; occurs in upper lobe
Term
Panacinar emphysema
Definition
targets distal terminal bronchioles and the entire respiratory unit. Affects lower lobe. Associated with AAT deficiency (AD, homozygous ZZ type is most dangerous).
Absent alpha1-globulin peak on SPE
Term
Chest x-ray in emphysema
Definition
Hyperlucency, increased AP diameter, vertically oriented heart, depressed diaphragms
Term
Chronic bronchitis
Definition
Productive cough at least 3 months for 2 consecutive years.
Most common cause is smoking.
Hypersecretion of mucous glands.
Blue bloaters; retain CO2 and develop cyanosis.
Patients tend to be stocky and obese; horizontally oriented heart
Chronic respiratory acidosis and hypoxemia
Term
Asthma
Definition
Episodic and reversible airway disease.
Primarily targets bronchi and terminal bronchioles.
Wheezing; increased anteroposterior diameter.
Term
Bronchial asthma
Definition
Initially present with respiratory alkalosis.
Normal pH or respiratory acidosis indicates need for intubation.
Term
Bronchiectasis
Definition
permanent dilation of bronchi and bronchioles.
Cystic fibrosis is most common cause.
Absent dynein arm in cilia.
Dilated bronchi extend to periphery.
Productive cough, hemoptysis.
Term
Cystic fibrosis
Definition
Autosomal recessive
Three nucleotide deletion on chromosome 7 coding for phenylalanine.
Defective CFTR for Chloride is degraded in the Golgi.
Loss of NaCl in sweat, loss of NaCl in luminal secretions (dehydrated).
Nasal polyps present.
Most common cause of death is respiratory infections.
Chronic pancreatitis producing malabsorption and type I diabetes.
Males infertile > females.
Meconium ilius; rectal prolapse (from straining)
Serum immunoreactive trypsin is excellent screen at birth.
Term
Most common cause of lung cancer
Definition
Cigarette smoking
Other causes: radon gas, asbestos, some metals, etc
Term
Which lung cancers are centrally located?
Definition
Squamous cell and small cell carcinomas;
Also, less common includes bronchial carcinoid and large cell carcinoma
Term
Which lung cancer is peripherally located?
Definition
Adenocarcinoma
Also, bronchial hamartomas and some large cell carcinomas
Term
Primary lung cancer by specific type in decreasing incidence:
Definition
Adenocarcinoma
Sq cell carcinoma
Small cell lung carcinoma
Large cell carcinoma
Bronchial carcinoid
Term
Common sites for lung cancer metastasis
Definition
Hilar lymph nodes most common, then adrenal gland, liver, brain, bone
Term
Solitary pulmonary lung nodules
Definition
Most often are granulomas, then malignancy, then bronchial hamartoma.
Term
Most common lung cancer
Definition
Metastasis (breast being primary)
Cough is the most common symptom.
Term
Eaton-Lambert syndrome
Definition
Antibody directed against calcium channel in muscle. Associated with small cell carcinoma of lung.
Term
Most common site for mediastinal masses
Definition
anterior compartment
Term
Adenocarcinoma of lung
Definition
Peripheral, most common in women, some association with smoking
Bronchioloalveolar carcinoma: derives from Clara cells; malignant cells spread along alveolar walls; radiologically mimic lobar pneumonia.
Term
Bronchial carcinoid
Definition
most common primary lung tumor in children; low-grade and of neuroendocrine origin
Term
Symptoms in thymomas
Definition
Most often associated with myasthenia gravis
Term
Most common overall cause of pleural effusion
Definition
CHF
Term
Most common cause of pleural fluid exudate
Definition
Tuberculosis and malignancy
Sometimes: acute inflammation, infarction, pneumonia, metastasis
Term
Tension pneumothorax
Definition
penetrating trauma to lungs; check valve type of pleural tear
Increase in pleaural cavity pressure with each breath.
Trachea deviates to contralateral side.
Term
Most common congenital disorder of oral cavity
Definition
cleft lip/palate (failure of fusion of facial processes)
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