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 |
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|
Term
| Respiratory acidosis, hypoxemia |
|
Definition
| increase cerebral vessel permeability; enhance cerebral edema |
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|
Term
| Papilledema (of optic disk) |
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Definition
|
|
Term
| Intracranial Hypertension |
|
Definition
| papilledema, bradycardia, projectile vomiting, hypertension |
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Term
|
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 |
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Term
|
Definition
| complication of intracranial hypertension |
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Term
|
Definition
| compression of ACA (anterior cerebral artery) |
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Term
|
Definition
| compression of CN III, PCA (posterior cerebral artery), parasympathetic fibers; eye deviated down and out; mydriasis |
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Term
|
Definition
| coning of cerebellar tonsils; cardiorespiratory arrest |
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Term
|
Definition
| enlargement of ventricles |
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Term
|
Definition
| produced by the choroid plexus; reabsorbed by arachnoid granulations |
|
|
Term
| Communicating hydrocephalus |
|
Definition
| increased production of CSF; decreased reabsorption of CSF |
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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 |
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Term
|
Definition
| no increase in head size; dementia, gait disturbance, urinary incontinence |
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Term
|
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. |
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Term
|
Definition
| failure of fusion of lateral folds of neural plate; increased maternal AFP. Maternal folate level must be adequate BEFORE pregnancy. |
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Term
|
Definition
| absence of brain; maternal polyhydramnios |
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Term
|
Definition
| dimple/tuft of hair overlying L5-S1. Defect in closure of posterior vertebral arch. |
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Term
|
Definition
| cystic mass with meninges |
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Term
|
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 |
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Term
|
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. |
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Term
|
Definition
| In descending order of incidence: Neurofibromatosis, tuberous sclerosis, Sturge-Weber Syndrome |
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Term
|
Definition
| AD; incomplete penetrance; no gender predominance. Cafe au lait macules & neurofibromas |
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Term
|
Definition
| optic gliomas; Lisch nodules; axillary/inguinal freckling. Associated with pheochromocytoma, Wilm's tumor, & juvenile chronic myelogenous leukemia (CML) |
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Term
|
Definition
| bilateral acoustic neuromas; juvenile cataracts; meningiomas |
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Term
|
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 |
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Term
|
Definition
| occur at the SITE of impact (usually cerebellum) |
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Term
|
Definition
| opposite to the site of impact (usually front and temporal lobes) |
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|
Term
|
Definition
| Temporoparietal skull fracture; tear of middle meningeal artery. CT scan is imaging test of choice |
|
|
Term
|
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. |
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|
Term
|
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. |
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Term
|
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. |
|
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Term
|
Definition
| temporary loss of vision; embolic material trapped at bifurcation of retinal vessels (Hollenhorst plaque) |
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|
Term
|
Definition
| contralateral paresis/sensory loss in face/upper extremity; head/eyes deviate to side of the lesion |
|
|
Term
|
Definition
| Contralateral paresis/sensory loss in lower extremity |
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|
Term
|
Definition
| ischemic type; hemorrhagic infarction extending to periphery of cerebral cortex. Emboli most often originate from left side of the heart |
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Term
|
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
|
Definition
| rupture of congenital berry aneurysm (junction of communicating branch with main cerebral artery). Severe occipital headache described as "worst headache ever." |
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|
Term
|
Definition
| microinfarction <1cm; hyaline arteriolosclerosis secondary due to hypertension and/or diabetes |
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|
Term
|
Definition
| CT without contrast is best test |
|
|
Term
| Most CNS infections are due to |
|
Definition
|
|
Term
|
Definition
| inflammation of pia mater; nuchal rigidity; increased CSF protein (bacterial, fungal, some viruses) & decreased CSF glucose (bacterial & fungal) |
|
|
Term
|
Definition
| majority of organisms originate in nasopharynx |
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|
Term
|
Definition
| most often transmitted by fecal-oral route |
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Term
|
Definition
| inflammation of brain; headache, drowsiness, & coma |
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Term
|
Definition
| hematogenous; contiguous spread |
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Term
|
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
|
Definition
| white mater looks like gray mater |
|
|
Term
|
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
|
Definition
| urge incontinence; sexual dysfunction; bowel motility dysfunction |
|
|
Term
|
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
|
Definition
| Cuase encephalitis; mosquito vector; West Nile virus |
|
|
Term
|
Definition
| Most common cause of viral meningitis |
|
|
Term
|
Definition
| Most common viral CNS infection in AIDS; causes encephalitis; intranuclear basophilic inclusions |
|
|
Term
|
Definition
| Causes hemorrhagic necrosis of temporal lobes (meningitis & encephalitis) |
|
|
Term
|
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) |
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|
Term
|
Definition
| Destroys upper and lower motor neurons causing muscle paralysis; post-polio syndrome |
|
|
Term
|
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 |
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|
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
|
Definition
| gram-positive coccus; most common cause of neonatal meningitis |
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|
Term
|
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
|
Definition
| Frontal lobe abscess; occurs in diabetic ketoacidosis; spreads from frontal sinuses |
|
|
Term
|
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
|
Definition
| Helminth (tapeworm/cestode). Pig transmitted disease causing cysticercosis. Larval forms invade brain, producing calcified cysts causing seizures, hydrocephalus |
|
|
Term
|
Definition
| protozoa that causes encephalitis; most common CNS space-occupying lesion in AIDS; ring-enhancing lesions on CT. |
|
|
Term
|
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
|
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
|
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
|
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
|
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
|
Definition
| ABeta is present in cerebral vessels. Risk for cerebral hemorrhage. |
|
|
Term
|
Definition
| alteration in dopaminergic pathways involved in voluntary muscle movment |
|
|
Term
|
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
|
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
|
Definition
|
|
Term
|
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
|
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
|
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
|
Definition
| Most common benign brain tumor in adults. Female predominance (estrogen receptors). Psammoma bodies are present. Associated with neurofibromatosis & hx of radiation |
|
|
Term
|
Definition
| Benign tumor in fourth ventricle of children & the cauda equina in adults. |
|
|
Term
|
Definition
| Malignant small cell tumor of children. Arises from external granular cell layer of cerebellum & often seeds neuraxis & invades fourth ventricle. |
|
|
Term
|
Definition
| front lobe calcifications in an adult |
|
|
Term
|
Definition
| Occurs in AIDS; EBV-mediated cancer |
|
|
Term
| Most common brain malignancy |
|
Definition
|
|
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 |
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|
Term
| Most common cause of peripheral neuropathy |
|
Definition
|
|
Term
|
Definition
| facial muscle paralysis due to inflammation of CN VII. HSV is the most common association. |
|
|
Term
|
Definition
| Ipsilateral weakness upper/lower face. |
|
|
Term
|
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
|
Definition
| Benign tumor of schwann cells. Trigeminal and VIII may be involved. |
|
|
Term
|
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
|
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
|
Definition
| Brachial plexus lesion involving C5 and C6. "Waiter's tip" deformity. |
|
|
Term
|
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
|
Definition
| Elderly; gray-opaque ring at corneal margin; cholesterol deposits in corneal stroma (may indicate hypercholesterolemia) |
|
|
Term
|
Definition
| Conjunctivitis in newborn; Neisseria gonorrhoeae (first week), Chlamydia (second week) |
|
|
Term
|
Definition
| purulent; pain but NO blurry vision; Staph aureus, Strep pneumo, H. influenzae |
|
|
Term
|
Definition
| Watery exudates; adenovirus (pink eye & preauricular lymphadenopathy); HSV-1 leads to keratoconjunctivitis with dendritic ulcers noted with fluorescein staining. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| severe keratoconjunctivitis in pts who do not clean contact lenses properly |
|
|
Term
|
Definition
| Infection of eyelid most commonly due to S. aureus |
|
|
Term
|
Definition
| Granulomatous inflammation involved meibomian gland in eyelid; usually disappear on own |
|
|
Term
|
Definition
| Periorbital redness & swelling often secondary to sinusitis. S. pneumo & H. influenzae. Fever, proptosis, periorbital swelling, ophthalmoplegia (eye movement impaired) & normal retinal exam |
|
|
Term
|
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
|
Definition
| Raised, triangular encroachment of thickened conjunctiva on nasal side of conjunctiva. Due to excessive exposure to wind, sun & sand. |
|
|
Term
|
Definition
| Yellow-white conjunctival degeneration at junction of cornea and sclera on temporal side of conjunctiva. Does not grow into cornea like pterygium. |
|
|
Term
|
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
|
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
|
Definition
| pale optic disk; optic neuritis or glaucoma |
|
|
Term
|
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
|
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
|
Definition
| Most common cause of blindness in AIDS; occurs when CD4 T helper cell count <50. Cotton-wool exudates and retinal hemorrhages |
|
|
Term
|
Definition
| Opacity in the lens; caused by advanced age, diabetes mellitus, infection, corticosteroids; common in congenital infections (CMV & rubella) |
|
|
Term
|
Definition
| retinoblastoma in children; malignant melanoma in adults |
|
|
Term
|
Definition
| Increased endolymph in inner ear & loss of cochlear hairs. Dizziness, vertigo, tinnitus, sensorineural hearing loss. |
|
|
Term
|
Definition
| Weber test: lateralizes to normal ear (contralateral ear is affected) |
|
|
Term
|
Definition
| most common cause of conduction deafness in elderly; due to fusion of middle ear ossicles |
|
|
Term
|
Definition
| Weber test: lateralizes to affected ear |
|
|
Term
|
Definition
| Most common cause of conduction deafness in children; Strep pneumo |
|
|
Term
|
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
|
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
|
|
Term
|
Definition
| Secondary hypopituitarism, Central diabetes insipidus (ADH), increased prolactin, precocious puberty, visual field defects, mass effects (obstructive hydrocephalus) |
|
|
Term
|
Definition
| Midline above quadrigeminal plate. Releases melatonin (chemical messenger of darkness). Commonly undergoes dystrophic calcification. |
|
|
Term
|
Definition
| Paralysis of upward gaze (Parinaud's syndrome); obstructive hydrocephalus (compression of aqueduct of Sylvius in third ventricle) |
|
|
Term
|
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
|
Definition
| Most common cause of hypopituitarism in children. Benign pituitary tumor derived from Rathke's pouch remnants |
|
|
Term
|
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
|
Definition
| hemorrhage into preexisting adenoma |
|
|
Term
|
Definition
| autoimmune destruction of pituitary gland; occurs during or after pregnancy |
|
|
Term
|
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
|
Definition
| storage of ADH and release of oxytocin |
|
|
Term
|
Definition
| most common pituitary tumor. Causes secondary amenorrhea + galactorrhea. In men it causes impotence due to loss of libido & headache. |
|
|
Term
|
Definition
| stimulates gluconeogenesis & increases amino acid uptake in muscle; stimulates IGF-1 in liver |
|
|
Term
|
Definition
| stimulates bone, cartilage, soft tissue growth |
|
|
Term
|
Definition
| Increased linear/lateral bone growth in children. Epiphyses NOT fused. |
|
|
Term
|
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
|
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
|
Definition
| decrease total serum T4 but NOT FT4; alterations in TBG alter total serum T4 but have no effect on FT4 and TSH |
|
|
Term
|
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
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| located in the anterolateral neck |
|
|
Term
|
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
|
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
|
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
|
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
|
Definition
| stupor, hypothermia, hypoventilation, give the patient levothyroxine & corticosteroids |
|
|
Term
|
Definition
| Hormone excess from any cause. Hyperthyroidism is thyrotoxicosis due to excess synthesis of thyroid hormone. |
|
|
Term
| Most common cause of hyperthyroidism & thyrotoxicosis |
|
Definition
|
|
Term
|
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
|
Definition
| Weight loss with a good appetite; heat intolerance, diarrhea; oligomenorrhea; lid stare; sinus tachycardia; systolic hypertension; brisk reflexes |
|
|
Term
|
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
|
Definition
| absolute or relative deficiency of thyroid hormone. Hyperplasia/hypertrophy followed by involution; initially diffuse, then nodular |
|
|
Term
|
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
|
Definition
| Most common endocrine tumor; most common thyroid cancer. Has psammoma bodies. Multifocal. Orphan Annie nuclei. Lymphatic invasion. |
|
|
Term
|
Definition
| Most common thyroid cancer presenting as a solitary cold nodule. Hematogenous spread (NOT lymphatic). |
|
|
Term
|
Definition
| medullary carcinoma; HPTH (Hyperparathyroidism); pheochromocytoma |
|
|
Term
|
Definition
| Medullary carcinoma, mucosal neuromas lips/tongue, pheochromocytoma |
|
|
Term
|
Definition
| derives from C cells; calcitonin is the tumor marker; calcitonin is converted into amyloid. Ectopic hormones (ACTH) can produce Cushing syndrome. |
|
|
Term
|
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
|
Definition
| increases renal calcium reabsorption; decreases renal phosphorus & bicarbonate reabsorption. Hypocalcemia/hyperphosphatemia increases PTH while hypercalcemia/hypophosphatemia decreases PTH. |
|
|
Term
|
Definition
| Active Vitamin D; increases calcium/phosphorus reabsorption in bowel; also increases osteoclast production (bone resorption) |
|
|
Term
|
Definition
| hypocalcemia increases synthesis, hypercalcemia decreases synthesis |
|
|
Term
|
Definition
| Decreased total serum calcium due to decreased in calcium bound to albumin. Decreased total serum calcium, normal ionized calcium, and PTH |
|
|
Term
|
Definition
| Due to decreased ionized calcium level - causes partial depolarization of nerves and muscles |
|
|
Term
| Most common cause of hypoparathyroidism |
|
Definition
|
|
Term
|
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
|
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
|
|
Term
| Most common cause of primary HPTH |
|
Definition
| benign adenoma - sheet of chief cells with NO adipose |
|
|
Term
|
Definition
| Lack of sunlight. Malabsorption (e.g. celiac disease). Cirrhosis. Drugs enhancing CYP system. Chronic renal failure. |
|
|
Term
|
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
|
Definition
| All four glands involved. Usually chief cell, but can be clear cell hyperplasia (wasserhelle cell) |
|
|
Term
|
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
|
|
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
|
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
|
Definition
Glomerulosa - mineralocorticoids (aldosterone)
Fasciculata - glucocorticoids (cortisol)
Reticularis - sex hormones (testosterone) |
|
|
Term
|
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
|
|
Term
| Most common cause of Addison's disease in developing countries |
|
Definition
|
|
Term
| Most common cause of Addison's disease in children |
|
Definition
|
|
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
|
|
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
|
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
|
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
|
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
|
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
|
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
|
Definition
| Increased serum insulin and C peptide |
|
|
Term
|
Definition
| Malignant tumor of alpha-islet cells. Hyperglycemia and rash (necrolytic migratory erythema) |
|
|
Term
|
Definition
| Benign tumor of beta-islet cells; approximately 80% have MEN I syndrome. Fasting hypoglycemia causing mental status abnormalities. |
|
|
Term
|
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
|
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
|
|
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
|
|
Term
|
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
|
Definition
| Excess insulin is most common cause; adrenergic symptoms |
|
|
Term
|
Definition
| Caused by excess alcohol, insulinoma, or cirrhosis. In children, look for inborn errors of metabolism. |
|
|
Term
|
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
|
Definition
| dystrophic calcification in the wall of muscular arteries; no clinical significance |
|
|
Term
|
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
|
Definition
| Pathognomonic lesion of atheroscleoris |
|
|
Term
|
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
|
Definition
| junction communicating branch with main vessel; rupture releases blood into the subarachnoid space; rupture is sudden onset of severe occipital headache |
|
|
Term
|
Definition
| aortic arch; tertiary syphilis; vasa vasorum vasculitis (endarteritis obliterans). Plasma cell infiltrate is present in vessel walls. Produces aortic regurgitation & bounding pulses |
|
|
Term
|
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
|
Definition
| AD disorder; weak elastic tissue due to defect in fibrillin |
|
|
Term
|
Definition
|
|
Term
|
Definition
| stasis of blood flow most common cause; most often occurs in deep vein of calf |
|
|
Term
|
Definition
| orange discoloration and ischemic ulcers around the ankles; sign of DVT. |
|
|
Term
|
Definition
| compression venous untrasonography + serum D-dimer assay |
|
|
Term
|
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
|
Definition
| compression of neurovascular compartment in the neck; common among weight lifters; tight scalenus muscles |
|
|
Term
|
Definition
| Strep pyogenes cellulitis; "red streak" |
|
|
Term
|
Definition
|
|
Term
| Turner's webbed neck caused by |
|
Definition
| lymphatic abnormality (dilated channels) |
|
|
Term
|
Definition
| collection of lymphatic fluid in interstitial tissue or body cavities; can be caused by obstruction |
|
|
Term
|
Definition
| caused by Bartonella henselae & common in AIDS (simulates Kaposi's sarcoma); benign capillary proliferation involving skin and visceral organs |
|
|
Term
|
Definition
| kidney hamartoma composed of blood vessels, muscle, and mature adipose tissue; association with tuberous sclerosis |
|
|
Term
|
Definition
| Liver angiosarcoma associated with exposure to polyvinyl chloride, arsenic, thorium dioxide |
|
|
Term
|
Definition
| Facial lesion in newborns that regresses with age |
|
|
Term
|
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
|
Definition
| Arteriovenous fistula (disappears when compressed); associated with hyperestrinism (cirrhosis, pregnancy) |
|
|
Term
|
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
|
Definition
|
|
Term
|
Definition
| microscopic polyangiitis; Churg-Strauss syndrome |
|
|
Term
| Palpable purpura caused by |
|
Definition
|
|
Term
|
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
|
|
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
|
|
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
|
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
|
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
|
Definition
| Medium vessels; young women; paroxysmal digital color changes (white,blue,red) |
|
|
Term
|
Definition
| Medium vessels; adult men and women secondary to other diseases (CREST, SLE) |
|
|
Term
|
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
|
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
|
Definition
| small vessel involved skin, lung, heart; children and adults; allergic rhinitis, asthma, p-ANCA |
|
|
Term
|
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
|
Definition
| small vessel involving skin, GI, renal; adults; associated with HCV, type I MPGN, multiple myeloma; immunoglobulins gel at cold temperatures |
|
|
Term
|
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
|
|
Term
|
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
|
Definition
| decreased ventricular contraction; characterized by low ejection fraction (<40%) |
|
|
Term
|
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
|
Definition
| alveolar macrophages with hemosiderin; from pulmonary edema (rupture of pulmonary capillaries may occur from increased hydrostatic pressure) |
|
|
Term
|
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
|
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
|
Definition
| most common manifestation of coronary artery disease; age most important risk factor; males>females |
|
|
Term
| Most common type of angina |
|
Definition
|
|
Term
|
Definition
| exercise-induced substernal chest pain; subendocardial ischemia with ST-segment depression |
|
|
Term
|
Definition
| Vasospasm with transmural ischemia and ST-segment elevation; use calcium channel blockers to vasodilate |
|
|
Term
|
Definition
| angina at rest; multivessel disease; disrupted plaques |
|
|
Term
|
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
|
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
|
|
Term
| When is myocardial rupture most common? |
|
Definition
|
|
Term
| Posteromedial papillary muscle rupture |
|
Definition
| RCA thrombosis; mitral regurgitation |
|
|
Term
|
Definition
| early (acute inflammation) and late (autoimmune) complication after an acute MI |
|
|
Term
|
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
|
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
|
|
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
|
|
Term
|
Definition
| patent foramen ovale; fixed splitting of S2 |
|
|
Term
|
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
|
|
Term
|
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
|
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
|
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
|
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
|
|
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
|
|
Term
|
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
|
|
Term
| Most common pathogen producing infective endocarditis in IV drug abuse |
|
Definition
|
|
Term
| Most common pathogen producing nosicomial and prosthetic valve infective endocarditis |
|
Definition
|
|
Term
| Most common pathogen producing infective endocarditis in ulcerative colitis/colorectal cancer |
|
Definition
|
|
Term
|
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
|
|
Term
| Most common cause of mycarditis leading to CHF in Central/South America |
|
Definition
|
|
Term
|
Definition
| Increased CK-MB and troponins I and T; detect antibodies of pathogens |
|
|
Term
|
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
|
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
|
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
|
Definition
Most common primary tumor of the heart in infants and children (association with tuberous sclerosis).
Hamartoma arising from cardiac muscle |
|
|
Term
|
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
|
|
Term
|
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
|
Definition
| air or fluid in pleural cavity under increased pressure collapes small airways beneath pleura (ex. tension pneumothorax or pleural effusion) |
|
|
Term
|
Definition
Synthesized by type II pneumocytes
cortisol increases synthesis, insulin inhibits synthesis
Decreases surface tension |
|
|
Term
|
Definition
Grunting, tachypnea, intercostal retractions.
Chest radiograph shows a ground glass appearance. |
|
|
Term
| Most common cause of pulmonary edema |
|
Definition
|
|
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
|
|
Term
|
Definition
| Interstitial pneumonia; no signs of consolidation |
|
|
Term
| Most common pathogen causing pneumonia in AIDS |
|
Definition
|
|
Term
|
Definition
Acid fastness due to mycolic acid.
Cord factor is virulence factor.
PPD does not distinguish active from inactive TB. |
|
|
Term
|
Definition
| Upper part of the lower lobes or lower part of the upper lobes. Ghon complex (caseous necrosis) in hilar lymph nodes. |
|
|
Term
|
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
|
Definition
| drenching night sweats, fever, weight loss |
|
|
Term
| Most common extrapulmonary site in TB |
|
Definition
|
|
Term
| Most common TB in AIDS caused by |
|
Definition
| Mycobacterium avium-intracellulare |
|
|
Term
|
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
|
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
|
Definition
| combination of pulmonary hypertension and right ventricular hypertrophy leading to right-sided heart failure |
|
|
Term
|
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
|
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
|
Definition
| Alveolitis - leukocytes release cytokines and stimulate fibrosis |
|
|
Term
|
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
|
Definition
| Alveolar macrophages with anthracotic pigments |
|
|
Term
|
Definition
| pneumoconiosis and cavitating rheumatoid nodules in lungs |
|
|
Term
|
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
|
Definition
Serpentine - curly & flexible fibers
Amphibole - straight & rigid (mesothelioma)
Deposits in respiratory bronchioles, alveolar ducts and alveoli (deposits in entire respiratory unit) |
|
|
Term
|
Definition
| Iron-coated asbestos fibers; golden, beaded appearance in sputum |
|
|
Term
|
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
|
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
|
Definition
Increased risk for lung cancer.
Exposure in nuclear and aerospace industry. |
|
|
Term
|
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
|
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
|
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
|
Definition
Most common in smokers.
Destruction of the distal terminal bronchioles and respiratory bronchioles; occurs in upper lobe |
|
|
Term
|
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
|
Definition
| Hyperlucency, increased AP diameter, vertically oriented heart, depressed diaphragms |
|
|
Term
|
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
|
Definition
Episodic and reversible airway disease.
Primarily targets bronchi and terminal bronchioles.
Wheezing; increased anteroposterior diameter. |
|
|
Term
|
Definition
Initially present with respiratory alkalosis.
Normal pH or respiratory acidosis indicates need for intubation. |
|
|
Term
|
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
|
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
|
Definition
Metastasis (breast being primary)
Cough is the most common symptom. |
|
|
Term
|
Definition
| Antibody directed against calcium channel in muscle. Associated with small cell carcinoma of lung. |
|
|
Term
| Most common site for mediastinal masses |
|
Definition
|
|
Term
|
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. |
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Term
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Definition
| most common primary lung tumor in children; low-grade and of neuroendocrine origin |
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Term
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Definition
| Most often associated with myasthenia gravis |
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Term
| Most common overall cause of pleural effusion |
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Definition
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Term
| Most common cause of pleural fluid exudate |
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Definition
Tuberculosis and malignancy
Sometimes: acute inflammation, infarction, pneumonia, metastasis |
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Term
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Definition
penetrating trauma to lungs; check valve type of pleural tear
Increase in pleaural cavity pressure with each breath.
Trachea deviates to contralateral side. |
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Term
| Most common congenital disorder of oral cavity |
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Definition
| cleft lip/palate (failure of fusion of facial processes) |
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