Term
| what is the most common dissability after heart disease |
|
Definition
|
|
Term
| what are the 3 most common symptoms of joint pathology |
|
Definition
| joint swelling, limitation of motion, pain of motion |
|
|
Term
| what is the most common joint disorder |
|
Definition
|
|
Term
| what is the most important cause of physical dissbility |
|
Definition
|
|
Term
| what are the risk factors for primary osteoarthritis |
|
Definition
|
|
Term
| what are the risk factors for secondary osteoarthritis |
|
Definition
| family history, excess weight, joint injury, complication of other arthritis, repetitive movement, disease |
|
|
Term
| what is the main problem in osteoarthritis |
|
Definition
| degeneration of articular cartilage causes it to get thin and crack |
|
|
Term
| in osteoarthritis once the cartilage cracks what happens |
|
Definition
chondromalacia
subchondral bone exposure > friction > bone eburnation > small fractures |
|
|
Term
|
Definition
| granular appearance cartiladge takes on in osteoarthritis after it cracks |
|
|
Term
|
Definition
| polished ivory look to bone after the subchondrial cartilage has been exposed in osteoarthritis and friction has occured |
|
|
Term
| what are the complications of small fractures after subchondrial cartiladge is exposed in osteoarthritis |
|
Definition
let synovial fluid in causing cysts and osteophytes
dislodge pieces causing joint mice
damage can progress to serious permanent joint deformity |
|
|
Term
| histologically/radiologically, what can be seen in osteoarthritis |
|
Definition
fibrosis
synovitis
cartiladge failure
hyaluronic acid depolymerized
subchondrial cysts
rought eburnated irregular bone
not symmetrical
sublexation
sclerosis
osteophyte |
|
|
Term
|
Definition
| cyst on bone just under cartilage |
|
|
Term
|
Definition
| boen is moved causing decreased joint space |
|
|
Term
|
Definition
whitening at edges of bone on x ray
how bone responds to repetitive movement |
|
|
Term
|
Definition
bone spur from bone on bone
often form due to vertebral disc degeneration |
|
|
Term
| how does it feel when somoene has osteoarthritis |
|
Definition
pain worsens with use in morning
grating feeling |
|
|
Term
| where is osteoarthritis usually located |
|
Definition
asymmetric
knees, hips, hands, spine
lipping of vertebral bodies |
|
|
Term
| where is osteoarthritis most common in women |
|
Definition
heberdens nodes: DIP swelling
bouchards nodes: PIP swelling
knees |
|
|
Term
| where is osteoarthritis most common in men |
|
Definition
|
|
Term
| where in the bone is septic arthritis in kids, what condition does it cause |
|
Definition
growth plate
hematogenous osteomyelitis |
|
|
Term
| where in the bone is septic arthritis in adults, what condition does it cause |
|
Definition
joint cavity
hematogenous infective arthritis |
|
|
Term
| how are septic arthritis microbes introduced |
|
Definition
osteomyelitis spreads
innoculation
soft tissue abscess
trauma
IV drug use |
|
|
Term
| location of septic arthritis |
|
Definition
asymmetric
monoarticular: knee mostly, hip, shoulder, elbow, ankle, wrist, SC |
|
|
Term
| clinical signs of septic arthritis |
|
Definition
extreme acute joint pain
red, inflammed, warm
defmority - can be permanent |
|
|
Term
| what are the two types of septic arthritis |
|
Definition
suppurative arthritis
lyme arthritis |
|
|
Term
| cause of suppurative arthritis in kids |
|
Definition
|
|
Term
| cause of suppurative arthritis in young women |
|
Definition
| if sexually active N. gonorrhea GPC |
|
|
Term
| how does N. gonorrhea septic arthritis present, what is a risk factor |
|
Definition
often with skin rash
increased gonorrhea dissemination with C5-7 deficiency |
|
|
Term
| cause of suppurative arthritis in people with sickle cell |
|
Definition
|
|
Term
| cause of suppurative arthritis in adults |
|
Definition
s. aureus GPC
E. coli GNR
pseudomonas GNR |
|
|
Term
| clinical signs of suppurative arthritis |
|
Definition
| fever, hot, swollen, tender joint |
|
|
Term
| lab signs of suppurative arthritis |
|
Definition
increased WBC, EST
synovial fluid: >50,000 WBC, >90% neutrophils |
|
|
Term
| what causes lyme arthritis |
|
Definition
| borelia burgdorferi spead by ioxdes deer tick |
|
|
Term
| why is lyme arthritis a big concern |
|
Definition
| needs to be tx quickly to prevent rapid destruction |
|
|
Term
| what are the three phases of lyme disease and their timeline |
|
Definition
acute illness - weeks
dissemination - weeks to months
late chronic - 2 to 3 years later |
|
|
Term
| what are the signs of acute illness lyme disease |
|
Definition
| tick bite causes erthematous papule, erthyema, cornicum magrans, lymphadenitis |
|
|
Term
| what are the signs of the dissemination stage of lyme disease |
|
Definition
| meningoencephalitis, cranial neuritis, heart block, pericarditis, myocarditis, hepatomeagly, lymphedema, arrhythmia |
|
|
Term
| what are the signs of the chronic stage of lyme disease |
|
Definition
| destructive chronic arthritis, acrodermatitis atrophicans, neuropathy, papillary synovitis, hyperplasia, fibrin, monocyte increase, onion skin arteries |
|
|
Term
| what causes chronic stage lyme disease |
|
Definition
| borella antigens attack joint |
|
|
Term
| location of lyme arthritis |
|
Definition
| large joints - knee, shoulder, elbow, ankle |
|
|
Term
| how is septic arthritis diagnosed |
|
Definition
50% will have positive blood culture
synovial aspirate |
|
|
Term
| what are the 5 synovial aspirate colors and their meaning |
|
Definition
1. cloudy - gout (urate crystals and WBC)
2. clear - normal or osteoarthritis
3. yellow - TA
4. orange - trauma (due to blood)
5. cloudy - septic or RA |
|
|
Term
| what are the WBC and PMN levels in normal, osteoarthritis, inflammatory arthritis, and septic arthriris joint fluid |
|
Definition
normal WBC <200, PMN <25%
osteoarthritis WBC <2000, PMN <25%
inflammatory arthritis WBC<50,000, PMN >75%
septic arthritis WBC >50,000, PMN >90% |
|
|
Term
|
Definition
women > men
usually 30-40 yo |
|
|
Term
| what disease does RA look like |
|
Definition
|
|
Term
|
Definition
HLA-DRB loci polymorphism on PTPN22 gene stops tyrosine phosphatase so it cannot stop CD4 activity
infections activate T and B cells and anto-CCP is made during inflammatory process |
|
|
Term
| how does RA cause destruction |
|
Definition
gene mutation activates TH1 and TH17 which activates....
...B cells, plasma cells, macrophages, cytokines (recruit more), inflammation. increasing collagenase which destories joint
...RANK which increases osteoclast activity which bridges opposing bones forming fibrous anylosis that ossifies
...accumulation of neutrophils in synovial fluid and surface
rheumatoid factors causes damage |
|
|
Term
| wha are rheumatoid factors, what do they do |
|
Definition
auto IgM that bind Fc on IgG and deposit in joints causing vascular syndromes
acute necrotizing vasculitis, fibrinous pleuritis, keritnoconjunctivitis |
|
|
Term
| what are histological / radiological signs of RA |
|
Definition
panus formation
rice bodies
chronic papillary synovitis
articular cartilage chondrolysis
villous hypertrophy and hyperplasia
bursa formation |
|
|
Term
| pannus: formation, composition, location |
|
Definition
synovium and stroma thicken and become hyperplastic and inflammed
inflammatory cells, granulation tissue, fibroblasts, stroma (B cells, CD4 Th, plasma cells, macrophages) |
|
|
Term
|
Definition
| aggregation of fibrin and synovium in joint space |
|
|
Term
| 5 causes of chronic papillary synovitis |
|
Definition
synovial cell proliferation
increased perivascular inflammation infiltrate (CD4 and macrophages)
increased vascularity (angiogenesis)
neutrophil/fibrin aggregates
increased osteoclast activity causes erosion |
|
|
Term
|
Definition
malaise, low fever
symmetric polyarticular arthritis
aching, stiffness - esp morning
enlarged joints
decreased ROM
ankylosis
swan neck deformity
bouronniere deformity
hammer toe
raynaud phenomenon
chronic leg ulcers
rheumatoid SC nodules |
|
|
Term
| what joints are involved in RA |
|
Definition
| PIP, MCP, spares DIP, sometimes C spine |
|
|
Term
| what is swan neck deformity |
|
Definition
| fingers stuck in swan like position in RA |
|
|
Term
| what is bouronniere deformity |
|
Definition
| bowing of pinkey outward in RA |
|
|
Term
|
Definition
|
|
Term
| clinical presentation of rheumatoid SC nodules |
|
Definition
seen in 25%
firm, non-tender, round
common on finger joints, spine, elbow, dorsal hand |
|
|
Term
| cause of rheumatoid SC nodules |
|
Definition
| central fibrous necrosis and macrophages surrounded by granulation tissue and WBC |
|
|
Term
| what is the minority of prognosis for RA |
|
Definition
| disease stabilizes or regresses |
|
|
Term
| what is the majority of prognosis for RA |
|
Definition
chronic remitting relapsiing course
surgical joint replacement may be needed (often after 15-20 y)
life expectancy reduced by 3-7 y |
|
|
Term
|
Definition
group of multifocal disorders due to enivornment and genetics
HLA PTPN22 genetic susceptibility and infection activation |
|
|
Term
| clinical signs of juvenile RA |
|
Definition
>6 weeks
swelling, pain, decreased function
oligoarthritis in 1-4 joints
possible systemic onset |
|
|
Term
| lab / histological signs of juvenile RA |
|
Definition
ANA seropositive
no RF or rheumatoid nodules |
|
|
Term
|
Definition
| often in large joints - knees, wrists, elbows, ankles |
|
|
Term
| signs of juvenile RA systemic onset (Still's disease) |
|
Definition
high fever
migratory transient skin rash
HSM
serositis |
|
|
Term
| cause of seronegative spondyloarthopathies - microbe hypothesis |
|
Definition
microbe (yersinia/klebsiella) causes immune response that cross reacts with HLAB71
HLAB27, yersinis, and klebsiella have similar proteins |
|
|
Term
| causes of seronegative spondyloarthopathies - enteropathy hypothesis |
|
Definition
| mucosal damage permits leakage of normal bacterial flora into circulation causing joint and initiate immune reaction |
|
|
Term
| three types of seronegative spondyloarthopathies |
|
Definition
ankylosing spondylitis
psoriatic arthritis
reiter syndrome |
|
|
Term
| define ankylosing spondylitis |
|
Definition
anylosing: immobilization of joint
spondylitis: inflammation of spone |
|
|
Term
| signs of ankylosing spondylitis |
|
Definition
|
|
Term
| cause of posriatic arthritis |
|
Definition
| not the same as other seronegative spondyloarthopathies, no HLDB27 involvement |
|
|
Term
| signs of psoriatic arthritis |
|
Definition
erosions
enthopathy: usually at insertion of achilles tendon and plantar fascia |
|
|
Term
|
Definition
| occurs with conjunctivits and uveitis |
|
|
Term
| histological / lab signs of seronegative spondyloarthopathies |
|
Definition
pathological causes in ligamentous attachments to bone rather than synovium
involvement of SI 0 sacroliliitis
no rheumatoid or serological factors
enthuses: changes at tendon and ligament insertions |
|
|
Term
| location of seronegative spondyloarthopathies |
|
Definition
joint inflammation of spine and peripherial joints
involvement of SI joints - sacroilitis |
|
|
Term
| diagnosis of seronegative spondyloarthopathies, why is it a concern |
|
Definition
| enthescopathy: can cause ossification at sites of enthuses |
|
|
Term
| why is RA synovial fluid cloudy or yellow |
|
Definition
| due to B cells, plasma cells, macrophages, cytokines (recruit more immune cells), and inflammation in synovium |
|
|
Term
| what does it mean if someone is RA seropositive |
|
Definition
| they have RA, some other autoimmune disease, or are just a "asymptomatic carrier" |
|
|
Term
| what does it mean if someone is ANA seropositive |
|
Definition
| they have juvenile RA or another autoimmune disease |
|
|
Term
| in general what is seronegative spondyloarthopathy |
|
Definition
| erosion that begins in ligament attached to bone, not syovium |
|
|
Term
| enteropathy: define, what disease is it in, where is it usually located |
|
Definition
insertion of achilles tendon and plantar fascia
ossification
psoriatic arthritis - seronegative spondyloarthopathy |
|
|
Term
| who is at the highest risk for gout |
|
Definition
men>women
30yo +
alcoholic
obese
diabetic
metabolic syndromes
renal failure
increased protein intake |
|
|
Term
|
Definition
chronic renal failure reduces urate excretion
cancer causes high turnover og nucleic acids
primary hyperuricemia 90%
lesh nyhan syndrome
secondary hyperuricemia 10% |
|
|
Term
| how does primary hyperuricemia cause gout |
|
Definition
reduced renal excretion (exacerbated by high protein or alcohol)
uric acid over production (abnormal purine production in salage or de novo pathway) |
|
|
Term
| how does lesh nyhan syndrome cause gout |
|
Definition
decreased salvage pathway enzyme
due to HGPRI gene mutation |
|
|
Term
| how does secondary hyperuricemia cause gout |
|
Definition
chemo, lymphome, leukemia, thiazide diruetics
causes cell lysis releasing urate |
|
|
Term
| what is occuring to cause gout |
|
Definition
| purine breakdown yields monosodium urates which are found in plasma, ECF, synovial fluid. >7mg/dL causes hyperuremia and build up in joints |
|
|
Term
| how do urate crystals cause symptoms |
|
Definition
phagocytosis by PMN cause lysis and release crystals which kill more neutrophils and release lysosomal enzymes, LTB4, prostaglandings, ROS which cause tissue inflammation and injury
phagocytosis by monocytes releases IL-1, TNF, IL-6, IL-8, which recruit more neutrophils and cause release of proteases from cartilage weakining it |
|
|
Term
| what do urate crystals looke like, how are they examined |
|
Definition
light yellow negative biefringent in polarized light
long, slender needles in cytoplasm and synovium |
|
|
Term
| what lab finding can help identify gout |
|
Definition
urate crystals plus...
neutrophil infiltrate in synovium! |
|
|
Term
| where is gout normally located |
|
Definition
| 90% monoarticular: 50% being in big toe |
|
|
Term
| what are the 5 phases of gout, how long do each last |
|
Definition
1. asymptomatic: unknown, often waits for males in puberty or post-menopause
2. acute arthritis: hours to weeks
3. intracritical gout: latentency, unknown timing
5. chronic trophaceous gout |
|
|
Term
| signs of acute arthritic gout |
|
Definition
| sudden pain, redness, swelling of joints |
|
|
Term
| signs of chronic trophaceous gout |
|
Definition
trophi
loss of digits
gout nephropathy
chronic trophaceous arthritis
podagra |
|
|
Term
|
Definition
| in chronic gout mass or urate surrounded by fibroinflammatory tissue causes bone erosion |
|
|
Term
| what causes gout nephropathy |
|
Definition
| medullary and intratubular trophi and crystals in caniculi |
|
|
Term
| what causes chronic trophacous arthritis, what is the effect |
|
Definition
| repetitive percipitation causes hyperplastic fibrous synovium leading to inflammation and pannus formation which destories cartilage and erodes bone |
|
|
Term
|
Definition
| inflammation of big toe due to crystal build up |
|
|
Term
| what is the prognosis of gout |
|
Definition
usually get second attack in a year or two
20% die from enal failure |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Ca pyrophosphate crystals due to over production or decreased break down of pyrophosphate due to transporter mutation |
|
|
Term
|
Definition
failure of chondrocytes ro maintain ECM causing Ca pyrophosphate crystals to form and shed from cartilage into joint causing synovitis
crystal arthropathies caused by debris from prosthetic joints
first occurs in menisci/intervetebral disc and articular surface then ruptures causing inflammation |
|
|
Term
| what does the Ca pyrophosphate in pseudogout look like |
|
Definition
rhomboid shaped crystals
positively bifrinegent |
|
|
Term
| how long does pseudogout last |
|
Definition
|
|
Term
| where is pseudogout often located |
|
Definition
acute synovitis
knee most common
monoarticular |
|
|
Term
| what is chronic pyrophosphate arthropathy |
|
Definition
| a type of pseudogout that mimics primary osteoarthritis |
|
|
Term
| where is chronic pyrophosphate arthropathy usually located |
|
Definition
| in knee, hip, wrist, MCP, elbow |
|
|
Term
| what are the three sheaths of skeletal m and what do they cover |
|
Definition
epimysium: entire muscle
perimesium: surrounds bundles of fibers
endomesium: surrounds fibers |
|
|
Term
| what three clinicl changes occur in muscle atrophy |
|
Definition
| decreased muscle mass, strength, bone density |
|
|
Term
|
Definition
| disuse of muscle occurs after immobility and aging |
|
|
Term
|
Definition
|
|
Term
| how does m atrophy show histologically |
|
Definition
|
|
Term
| what are three conditions that cause m atrophy |
|
Definition
cachexia
congestive heart failure
liver disease |
|
|
Term
| define cachexia, what are three causes |
|
Definition
body wasting syndrome, severe generalized atrophy
cancer, chemo, AIDS |
|
|
Term
| what occurs clinically in m hypertrophy |
|
Definition
| increase in mass of a muscle due to increased stimuli |
|
|
Term
| what are some histological signs of hypertrophy |
|
Definition
large fibrils
more numerous fibrils |
|
|
Term
| what are two conditions that cause m hypertrophy |
|
Definition
exercise hypertrophy
acromeagly |
|
|
Term
| what is affected in acromeagly |
|
Definition
|
|
Term
| what are the inflammatory myopathies |
|
Definition
infectious myositis
non-infectious myositis (autoimmune) |
|
|
Term
| what are the non-infectious myopathies |
|
Definition
polymositis
dermatositis
inclusion body myositis |
|
|
Term
|
Definition
| chronic inflammation of the muscles |
|
|
Term
|
Definition
|
|
Term
| where is polymositis located |
|
Definition
| hip, thigh, upper arm, upper back, shoulder, beck |
|
|
Term
| clinical signs of polymositis |
|
Definition
pain, weaness in bilateral proximal muscles (shoulder and palvis)
hip extensors make it difficult to stand from chair or ascend stairs
dysphagia
low fever
peripherial lymphadenopathy |
|
|
Term
| histological signs of polymositis |
|
Definition
endomysial (around fibers) lymphocitic inflammation between muscle fibers
inflammatory cells invade fibers which become more round
skeletal muscle fiber degeneration and regeneration |
|
|
Term
| how is polymositis diagnosed |
|
Definition
CK elevation (marer of m inflammation and damge)
EMG alteration
positive m biopsy |
|
|
Term
|
Definition
CT disease related to polymositis
additionally affects joints, esophagus, lungs, sometimes heart |
|
|
Term
| clinical signs of dermatotositis |
|
Definition
bilateral proximal m weakness and pain
helitrope/iliac rash
peri-orbital edema
telangestica
gottron lesions
small Ca deposits under skin
25% of adult pt prone to cancer |
|
|
Term
| what and where is a helitrope / iliac rash |
|
Definition
| red purple rash on upper eyelid with itching and swelling, esp over upper eyelids in dermatositis |
|
|
Term
| what and where is a guttron lesion |
|
Definition
| scaly red erruptions on knuckles, elbows, knees in dermatositis |
|
|
Term
| histological signs of dermatositis |
|
Definition
inflammatory cells around blood vessels and perimysial (around bundles)
skeletal m fiber degeneration and regeneration
x-ray dystrophic carcifications in m (specks of white) |
|
|
Term
| how is dermatositis diagnosed |
|
Definition
increased CK
EMG abnormalities
liver enzymes (creatining phosphokinase) assess progression
confirmed by m biopsy |
|
|
Term
|
Definition
|
|
Term
| who gets inclusion body myositis |
|
Definition
|
|
Term
| define inclusion body myositis |
|
Definition
| slow progressive m weakness asymmatrical |
|
|
Term
| clinical signs of inclusion body myositis |
|
Definition
slow progressive weakness of mucles
asymmetric distal m weakness
life expectancy isnt significantly effected
may require cane or wheel chair for long distances |
|
|
Term
| histological signs of inclusion body myositis |
|
Definition
cytoplasmic vacolues with basophillic granules and amyloid
inflammatory cells invate m tissue |
|
|
Term
| diagnostic digns of inclusion body myositis |
|
Definition
elevated CK
EMG abnormalities
muscle biopsy |
|
|
Term
| general cause of muscular dystrophies |
|
Definition
| heterogrnous inherited disorders |
|
|
Term
| who gets muscular dystrophies |
|
Definition
|
|
Term
| in general what is the histology of muscular dystrophy |
|
Definition
| replacement of muscle tissue by fibrofatty tissue (distinguishes dystrophies from myopathies |
|
|
Term
| what are the types of muscular dystrophy |
|
Definition
myotonic dystrophy
duchennes
beckers |
|
|
Term
| what is the most common and most severe muscular dystrophy |
|
Definition
|
|
Term
| what is the most common less severe muscular dystrophy |
|
Definition
|
|
Term
| what is the cause of duchenne and backer |
|
Definition
XP21 gene that codes for dystrophin which helps with contraction of actin and myosin (have no dystrophin in duchenne some in becker)
1/3 have de novo mutations
2/3 have obligate female carriers (x-linked) that are usually asymptomatic but may have elevated CK or minor histological changes |
|
|
Term
| what is the timeline of symptoms of duchennes muscular dystrophy |
|
Definition
babies normal at birth
normal eary motor milestones
walking delayed
wheel chair by 10-12yo
can die in 20s from respiratory insufficiency, pneumonia, cardiac decomposition |
|
|
Term
| clinical signs of duchenne MD |
|
Definition
weakness begining in pelvic girdle, ascends to shoulder girdle
pseudohypertrophy of calf muscles
CT making them larger
gower's sign
heart failure, arrhythmia
cognative impairment (maybe MR) |
|
|
Term
|
Definition
fat in CT in calf muscles
elevated CK
variation in muscle fiber sizes
increased endomysial CT
regenerating fibers |
|
|
Term
| timeline of beckers muscular dystrophy |
|
Definition
patients live into 30s
less severe |
|
|
Term
| what causes metabolic myopathy |
|
Definition
glycogen storage diseases
mitochondrial myopathies |
|
|
Term
|
Definition
myasthenia gravis
lambert eaton syndrome |
|
|
Term
| what are the acute inflammaory dermatitis (3) |
|
Definition
hives/uricaria
eczema
erythema multiform |
|
|
Term
| what do hives look like, where are they |
|
Definition
wheel: edema, puritic
trunk, distal extremities, ears |
|
|
Term
| what are the two causes of hives |
|
Definition
IgE activate mast cells in response to antigen and cause vasodilation
hereditary angioedema: activation of complement excites mast cells causing vasodilation |
|
|
Term
| what causes activation of mast cells in hereditary angioedema |
|
Definition
| uncontrolled activation of complement due to opiates, antibiotics, NSAIDS, cold |
|
|
Term
| describe histology of hives |
|
Definition
wide spaces between collagen bundles
eosinophils |
|
|
Term
| who gets hives, how long do they last |
|
Definition
|
|
Term
| what are 7 types of eczema |
|
Definition
contact
atopic
primary irritant
drug induced
excematous
photoexcematous
pithodermatitis |
|
|
Term
| what does contact eczema look like |
|
Definition
filled clear vesicles
itching burning |
|
|
Term
| what causes contact eczema from plants |
|
Definition
|
|
Term
| what causes atopic eczema |
|
Definition
defect in keratin layer
family hx |
|
|
Term
| what does atopic eczema look like |
|
Definition
|
|
Term
| what causes primary irritant eczema |
|
Definition
| trauma or irritation (non-immunologic) |
|
|
Term
| what causes drug induced eczema |
|
Definition
|
|
Term
| what causes excematouos eczema |
|
Definition
|
|
Term
| what causes photoexcematous eczema |
|
Definition
|
|
Term
| what causes pithodermatitis |
|
Definition
| fucocumarin and psoralens from plant and UV light |
|
|
Term
| what does pithodermatitis look like |
|
Definition
|
|
Term
| what is the atopic triangle |
|
Definition
atopic dermatitis
asthma
allergic rhinitis |
|
|
Term
| what does erythema multiform look like |
|
Definition
macular, papular, pustule, etc
characteristic: red macularpapular pale, vesicular, eroded center |
|
|
Term
| what causes erythema multiform |
|
Definition
| hypersensitivity to drug/infection activates CD8 which eats keratinocytes (and basal cells if serious) |
|
|
Term
| what are two complications of erythema multiform, their appearance, and cause |
|
Definition
SJS: CD8 attacks deeper cells on mucosa (conjunctiva, urethra, genital)
toxic epidermal necrolutis: necrosis and sloughing of cutaneous and mucosa due to full epidermal thickness erosion |
|
|
Term
| what are the 4 chronic inflammatory dermatitis |
|
Definition
psoriasis
seborrhetic dermatitis
lichen planus
lupus erythematous |
|
|
Term
| where is psoriasis located |
|
Definition
elbow
knww
scalp
lumbosacral
gluteal fold
glans penis |
|
|
Term
| what does psoriasis look like |
|
Definition
dermacrated, pink silver, loose scales
nails: pitting, yellow brown, anceylysis (seperates from skin)
psoriatic arthritis |
|
|
Term
| what is the cause of psoriasis |
|
Definition
keritnocytes have nuclei and can still divide
increased epidermal turn over on rete causes acanthosis (increased thickness)
thinning of epidermis over papillae into stratum granulosum |
|
|
Term
| what is a clinical way to diagnose psoriasis |
|
Definition
| auzpitz sign: pick the lesion and you will get microbleeds |
|
|
Term
| what are the signs of psoriasis histologically |
|
Definition
thinning of papillar
thickening of rete
munro microabscess: PMN in stratum corneum
Parakaratonic scale: keratinocyte with nuclei allow for division
superificial dermal infiltrate: dermis seen in epidermis |
|
|
Term
| seborrhetic dermaitits: where is it located, what does it look like |
|
Definition
sebaceous glands on scalp, forehead, EAM, nasolabial, pre-sternal
dandruff: cradle cap
eczema like to psoriasis like |
|
|
Term
| what is a histological sign of dermatitis |
|
Definition
| parakytosis: PMN and serum at ostea of hair follicles |
|
|
Term
|
Definition
| wrist, elbow, glans penis, oral mucosa |
|
|
Term
| lichen planus: appearance |
|
Definition
| puritic, purple, polygonal, papular |
|
|
Term
|
Definition
| response to antigens in dermal epidermal junction |
|
|
Term
| lichen planus: histological |
|
Definition
ciyatte (colloid) bodies
lymphocyte infiltrate
hypergranulosis
zigzag/sawtooth at epidermal dermal jucntion |
|
|
Term
| what causes ciyatte bodies, what disease is it in |
|
Definition
lichen planus
kerinocytes look like stratum spinosum and cause necrosis |
|
|
Term
| what conditiosn is erythema multiforme associated with |
|
Definition
any age
infection: HSV, histoplasmosis, coccidiomycosis, thyphoid, leprosy
drug: sulfa, penicillin, barbituates, antimalarials
malignancy: carcinomas, lymphomas
vascular disease: lupus erythematosus, polyarteritis nodosa |
|
|
Term
| what are the three types of blisters |
|
Definition
phemphigus vulgaris
bullous phemigod
dermatitis herpatiformis |
|
|
Term
| what does phemigus vulgaris look like |
|
Definition
superficial vesicles
bulle that rupture easy and dry and crust |
|
|
Term
| where is phemigus vulgaris located |
|
Definition
mucosa and skin
scalp, face, axilla, groin |
|
|
Term
| what cause phemigus vulgaris |
|
Definition
| igG atttach desmogleins (cement) |
|
|
Term
| phemigus vulgaris histologu |
|
Definition
acanthosis: cells that look like row of tombstomes
IgG in fish net pattern |
|
|
Term
| who gets phemigus vulgaris |
|
Definition
|
|
Term
| where is bullous phemigod located |
|
Definition
mucosa and skin
inner thigh, flexors, forearm, axillae, groin
30% oral |
|
|
Term
| what does bullous phemigod look like |
|
Definition
bullae with clear fluid
dont rupture easy
dont scar if they dont rupture |
|
|
Term
| what causes bullous phemigod |
|
Definition
| IgG attacks hemidesmosomes so basal cells detech from BM |
|
|
Term
| histology of bullous phemigod |
|
Definition
IgG in linear pattern
spans entire epidermis (subepidermal non-acanthotic blister
eosinophils |
|
|
Term
| who gets bullous phemigod |
|
Definition
|
|
Term
| what does dermatitis herpatiformis look like |
|
Definition
blister
uticaria in grouped vesicles |
|
|
Term
| what causes dermatitis herpatiformis |
|
Definition
| auto IgA associated with celiac disease |
|
|
Term
| histology of dermatiti herpatiformis |
|
Definition
|
|
Term
| what are the 5 benign neoplasma |
|
Definition
nevocellular/melanocytic nevi
acanthosi nigrans
keritocanthoma
seborrhetic keratitis
actintic keratois |
|
|
Term
| what do nevoceullular/melanocytic nevi look like |
|
Definition
tan turns to brown
uniform pigment papule
well defined border |
|
|
Term
| what caue nevocellular/melanocytic nevi |
|
Definition
highly dendeitic ingle cell melanocytes turn to aggregate round nest cell melanocytes
found on rete ridges
congenital or acquired |
|
|
Term
| what are the three types of nevocellular nevi |
|
Definition
junctional
dysplastic
compound |
|
|
Term
| describe a junctional nevi |
|
Definition
flat
grows into dermis
turns into compound |
|
|
Term
|
Definition
in dermis
raised dome
matures into melanin containing cords of nevus cells |
|
|
Term
| what are the two types of dysplastic nevi, describe each |
|
Definition
sporatic: rarley malignant
familial: malignant/heratiable melanona
both have 100% risk of melanoma |
|
|
Term
|
Definition
large >5mm
hundreds of lesions in non-sun areas |
|
|
Term
| describe acanthosis nigrans |
|
Definition
velvet thick pigmented
could have skin tags |
|
|
Term
| where is acanthosis nigrans |
|
Definition
| flexors: neck, groin, anogenital, axillae |
|
|
Term
| what are the two types of acanthosis nigrans and the causes |
|
Definition
benign: obesity and insulin resistance, endocrine abnormalities, drugs (steroids)
malignant: middle aged, tumor makes epidermal GF |
|
|
Term
| what does keritocanthoma look like |
|
Definition
crater with keratin mass in center over epidermal hyperplasia
can cause squamous cell carcinoma |
|
|
Term
| where is keritocanthoma located |
|
Definition
|
|
Term
| what is the timeline of keritocanthoma |
|
Definition
3-4 wk grows to 3cm
3-4 mo resolves |
|
|
Term
| what does seborrhetic keratosis look like |
|
Definition
light yellow tan
increased thickness
greasy crust
black dermatocration (stuck on)
verrucous: wart like surface
hyperpigmented |
|
|
Term
| seborrhetic keratosis histology |
|
Definition
horn cyst cells with heratin
normal cells |
|
|
Term
|
Definition
| sudden development of many srborrhatic keratosis that turned malignant due to previous malignancy (like renal cell carcinoma) |
|
|
Term
| what does actinic keratosis look like |
|
Definition
cutaneous horns
ill defined acule or papule
hyperkeritosis |
|
|
Term
| who gets actinic keratosis, where, complications |
|
Definition
elderly
sun exposed areas
premalignant squamous cell carcinoma |
|
|
Term
| histology actinic keratosis |
|
Definition
parakeratosis
dysplasia in lower epidermis |
|
|
Term
|
Definition
| seborrhetic dermatitis with dandruff, diarrhea, and failure to thirve |
|
|
Term
| what are the three malignant neoplasms |
|
Definition
squamous cell carcinoma
basal cell carcinoma
malignant melanoma |
|
|
Term
| appearance squamous cell carcinoma |
|
Definition
red, scaline, plaque turns to
nodular, hyperkeritotic, red
may ulcerate, cutaneous horns, leukoplakia |
|
|
Term
| histology squamous cell carcinoma |
|
Definition
atypical epithelium extends into dermis
dysplasia in ALL layers
keratin pearls
intracellular bridges
mitotic figures |
|
|
Term
|
Definition
| <5% metastasize before found |
|
|
Term
|
Definition
| sun, fair skin, carcinogens, burns, arsenic, chronic ulcer, osteomyelitic, chew, xeroderma pigmentosum |
|
|
Term
| appearance basal cell carcinoma |
|
Definition
sun exposed area
slow growing
locally agressive
rodent ulcer: distinct border, grows at skin
pealry papule with telengectasis |
|
|
Term
|
Definition
ulcer
nest of blastoid cells
palaside border |
|
|
Term
|
Definition
excision cures 50%
rarley metastasis |
|
|
Term
|
Definition
| sun, fair skin, immune deficiency, xeroderma pigmentosum |
|
|
Term
| malignant melanoma appearance |
|
Definition
asymptomatic or puritic
>1cm
ABCDE |
|
|
Term
| two types malignant melanoma and their prognosis |
|
Definition
vertical - worse, stage by depth (breslow, clark)
horizontal - better |
|
|
Term
| histology and appearance of vertical malignant melanoma |
|
Definition
| nodular aggregate of celanoma cells spread from lesion |
|
|
Term
| histology of horizontal melanoma |
|
Definition
irregular nest of melanoma cells
inflammed dermis |
|
|
Term
| three types of horizontal melanoma |
|
Definition
lentigo maligma "hutchinsons freckle"
superificial spreading
acral-lentiginous |
|
|
Term
| lentigo maligma: who gets, prognosis, location |
|
Definition
face and neck
elderly
in situ for years |
|
|
Term
| sperificial spreading MM: who gets, prognosis |
|
Definition
caucasian
in situ for months |
|
|
Term
| acral lentiginous: who gets, location |
|
Definition
dark skin
hands, feet, sublingual |
|
|
Term
| what disease is from epidermal malnutrition |
|
Definition
|
|
Term
|
Definition
| hyperkeratosis in stratum corneum due to epidermal malnutrition |
|
|
Term
|
Definition
little to no inflammation
loss of basket weave of stratum corneum |
|
|
Term
| types of icthyosis, which is most common |
|
Definition
icthyosis vulgaris - common
x linked
congenital ichthyosiform erythroderma
lamellar ichthyosis |
|
|
Term
| icthyosis vulgaris: cause |
|
Definition
| dominant or acquired from sarcoidosis, HIV infection, hypothyroid |
|
|
Term
|
Definition
|
|
Term
| congenital erytheoderma cause, appearance |
|
Definition
homozygous recessive
colloidan baby |
|
|
Term
|
Definition
|
|
Term
|
Definition
hyperlinear palms
fish like scales from hyperkeratosis |
|
|
Term
|
Definition
disorder of sebaceous follicles
adrenergic homrones: cause abnormal kertinization of follicles which block sebaceous ducts causing microcomedo and comedone
hereditary: less in asian and dark skin
peopinibacterium acnes: bacterial lipases convert lipids in serum to proinflammatory FA |
|
|
Term
|
Definition
mold
moderate
cystic
sequale |
|
|
Term
| signs of mild acne vulgaris |
|
Definition
comedones
occasional papule or pustule |
|
|
Term
| signs of moderate acne vulgaris |
|
Definition
more inflammation
lesions heal with scars |
|
|
Term
| signs of cystic acne vulgaris |
|
Definition
large deep many papules or pustules
often on trunk (not really a cyst) |
|
|
Term
| signs of sequale acne vulgaris |
|
Definition
trunk involvement
prone to heal with atrophy or pitted scars on face
hypertonic keloids on back
post inflammation hyperpigmentation |
|
|
Term
|
Definition
begins in adolescence
open comdeones
closed comedones
papules
pustules |
|
|
Term
| what is an open comdeone, what is in it |
|
Definition
black head
sebum, keratin, oxidized melanin causes blockage |
|
|
Term
| what is a closed comdeone |
|
Definition
|
|
Term
| what are the two epidermal appendage disorders |
|
Definition
|
|
Term
|
Definition
| idiopathic, no inheritence |
|
|
Term
| what percipitates rosacea |
|
Definition
sun, face washing, cosmetics
NOT alcohol, stress, food, smoking, cafiene |
|
|
Term
|
Definition
|
|
Term
| descripe rhinophyma, who gets it |
|
Definition
middle aged men
disfiguring sebaceous hyperplasia |
|
|
Term
|
Definition
facial erythema and telangiectasis (rosy cheeks)
usually do not develop inflammatory lesions typical of rosacea |
|
|
Term
|
Definition
lesions on flush areas (cheeks, nose, forehead, chin)
blepharoconjunctivitis |
|
|
Term
| who gets verrucae, what is the prognosis |
|
Definition
common in school aged kids
resolve alone except in adults and compormised |
|
|
Term
|
Definition
infection of keratinocytes confined to epidermis
HPV usually 12, 18
skin to skin transmission |
|
|
Term
| what predisposes to verrucae |
|
Definition
| HIV, transplants, chemo, pregnancy, handling raw meat |
|
|
Term
|
Definition
black dots: not in all types but used to distinguish from callus
absent fingerprint lines |
|
|
Term
| types of warts and their description |
|
Definition
filiform: thread like
plannar: flat
plantar: foot surface
condyloma acuminatum: genital |
|
|
Term
|
Definition
enhanced pigment transfer from melanocytes
accentuated by sun
idiopathic |
|
|
Term
|
Definition
| resolves on own or with DC or hormones |
|
|
Term
| melasma is associated with |
|
Definition
| pregnancy, contraceptives, hydantions |
|
|
Term
|
Definition
|
|
Term
| cause of epidermal melasma |
|
Definition
| increased melanin deposition in lower epidermal layers |
|
|
Term
|
Definition
melanin pigment incontience
macrophages in papillar dermis phagocytes melanin from epidermal cells |
|
|
Term
|
Definition
local hyperplasia of melanocytes
does not darker in sun |
|
|
Term
|
Definition
|
|
Term
|
Definition
cafe au liat spots: oval tan brown macules or patches
rete ridges elongated and thin |
|
|
Term
| sign of neurofibromatosis type I |
|
Definition
| too many cafe au lait spots (in lentigines) |
|
|
Term
| what are other names for solar lentigines |
|
Definition
|
|
Term
| cause of solar lengitines |
|
Definition
age
sun exposure
increased melanocytes and melanophages |
|
|
Term
| what are the 6 cells/components of bone turn over |
|
Definition
matrix: type 1 collagen
cytokiines and GF deposited at some point and are liberated when needed vi osteoclast
resistant acid phosphatases
osteoblasts and osteoclasts |
|
|
Term
| osteoblast: function, origin |
|
Definition
build bone
come from mesenchymal cells |
|
|
Term
| osteoclast: function, origin |
|
Definition
reabsorb bone
monocyte cell line in marrow |
|
|
Term
|
Definition
| ruffled border to cause acidic area where they make contact and resorb bone |
|
|
Term
| what are the 10 signalers in bone turn over |
|
Definition
IL1
IL6
TNF
RANK Ligand
M CSF
estrogen
PTH
osteoprotagerin
calcitonin
bisphosphates |
|
|
Term
| what is the function of IL1 IL6 TNF in bone turn over |
|
Definition
| stimulate reabsorption by stimulating osteoblasts which turn on osteoclast |
|
|
Term
| what is the function of RANK L and M CSF in bone turn over |
|
Definition
| made on osteoblast and presented to osteoclast to tall them to resorb bone |
|
|
Term
| what is the function of estrogen in bone turn over |
|
Definition
|
|
Term
| what is the function of PTH in bone turn over |
|
Definition
|
|
Term
| what is the function in calcitonin in bone turn over |
|
Definition
not much unless it is from another species
inhibits osteoclast |
|
|
Term
| what is the function of bisphosphates in bone turn over |
|
Definition
|
|
Term
| 5 bone congenital diseases |
|
Definition
bone dystrophies
bone dysplasia
acondroplasia
osteogenesis imperfecta
osteopetrsis / marble bone disease / albers-schonberg disease |
|
|
Term
|
Definition
| congenital malformations: defect in nuclear proteans and transcription factors (usually homeobox genes and some cytokines) |
|
|
Term
| 4 examples of bone dysostoses |
|
Definition
failure of development: rib, phalanx, clavicle
supernumerary bones: extra ribs and digits
syndactyly: fusion of digits
craniorachischisis: failure of skull / spinal column to close |
|
|
Term
| what is a complication of craniorachischisis |
|
Definition
| CNS and meningies herniate through opening causing meningomyelocele or meningoencephalocele |
|
|
Term
|
Definition
| mutation in matrix or cell signaling affects all cartiladge and bone |
|
|
Term
| 4 examples of bone dysplasias |
|
Definition
achhondroplasia
thanatrophic dwarfism
osteogensis inperfect
osteopetrosis |
|
|
Term
| in genera, what is achondroplasia |
|
Definition
| disorder of structure of growth of cartilage causing chondrodysplasia |
|
|
Term
| what is the most common disease of the growth plate |
|
Definition
|
|
Term
| what is the inheritence of achondroplasia |
|
Definition
|
|
Term
| what causes achondroplasia |
|
Definition
inherited fibroblast GF receptor 3 mutation
receptor has influence on matrix, inhibits cartilage proliferation to keep growth in check
point mutation causes activation that supresses growth in bones formed by endochondral ossification (esp long bones) |
|
|
Term
| 13 signs of achondroplasia |
|
Definition
large head
frontal bossing
hypoplastic nose bridge
base of skull underdeveloped
posterior elements of spine underdeveloped
narrow spinal canal
narrow neural foramina
short tubular bones
bowing tibia, femur, humerus
premature deposition of bone seals growth plate
zone of proliferation and hypertrophy in growth plates narrowed and disorganized
clusters of chondrocytes instead of growth plate columns |
|
|
Term
| what are the two types of achondroplasia |
|
Definition
homozogyous achondroplasia
thanatrophic dwarfism |
|
|
Term
| cause of homozygous achondroplasia and inheritence |
|
Definition
two abnormal FGFR3 genes
autosomal domonant |
|
|
Term
| thanatophoric dwarfism: cause, clinical signs |
|
Definition
frameshift or point mutation in FGFR3 that is more severe, often due to offspring of two dwarves
most common form of lethal dwarfism, respiratory insufficiency due to underdeveloped thoracic cavity |
|
|
Term
| in general, what is osteogenesis imperfecta |
|
Definition
| disorder of type I collagen synthesis causing too little bone resulting in skeletal fragility |
|
|
Term
| what is the most common genetic disease of the skeleton |
|
Definition
|
|
Term
| what are the main areas of the body affected in osteogenesis imperfecta |
|
Definition
90% in osteoid protein in bone
joints, EYES, ears, skin, TEETH |
|
|
Term
| cause of osteogenesis imperfecta |
|
Definition
| mutation in type I collagen synthesis a1 (COL1A1 CH17) or a2 (COL1A1 CH7) chain triple helix mutation or both |
|
|
Term
| what are the two types of mutation s in osteogenesis imperfecta |
|
Definition
null allele effect (1/2 normal collagen): mutant gene not transcribed or mutant chain degraded
dominant negative: more severe chain abnormalities compormise function usually due to glycine substitution. most severe in C terminus, less severe in smaller AA still allowing helix |
|
|
Term
| what is the most common cause of osteogenesis imperfecta and its inheritence |
|
Definition
type I
autosomal dominant |
|
|
Term
| what is the most severe form of osteogenesis imperfecta and its inheritence |
|
Definition
type II
autosomal recessive |
|
|
Term
| what is the intermediate and least common form of osteogenesis imperfecta and its inheritence |
|
Definition
type IV
autosomal dominant |
|
|
Term
| signs of osteogenesis imperfecta type I |
|
Definition
diagnosed middle age due to osteopenia and fracture history
normal stature in 50%
hearing impairment in 25%
skeletal fragility
blue sclerae |
|
|
Term
| why is sclerae blue in osteogenesis imperfecta |
|
Definition
| translucent sclera so can see choroid |
|
|
Term
| signs of osteogenesis imperfecta type II |
|
Definition
excessive fragility especially during birthing, often die in utero or within days of birth
blue sclerae |
|
|
Term
| signs of osteogenesis imperfecta type III |
|
Definition
growth retardation (<4ft)
multiple fractures (~200 as adult)
limb bowing
blue sclera
hearing impairment |
|
|
Term
| signs of osteogenesis imperfecta type IV |
|
Definition
moderate skeletal fragility
short stature
intermediate symptoms |
|
|
Term
| signs of osteogenesis imperfecta upon birth |
|
Definition
big forehead
deafness
white of eye blye
poor teeth
barrel chest
round back |
|
|
Term
| in general, what is osteopetrosis |
|
Definition
| decreased bone reabsorption causes radiodense bones (bone keeps getting built) |
|
|
Term
|
Definition
carbonic anhydrase II deficiency osteoclasts
mutation in CIC-7 osteoclasts
macrophage colony stimulating factor (M-CSF) deficiency |
|
|
Term
| explain how carbonic anhydrase deficiency causes osteopetrosis |
|
Definition
needed by osteoclast for renal tubular cells to excrete H+ and acidify area
mutation prevents acidification of resorption put and solubulization of hydroxtapatite favoring bone building |
|
|
Term
| explain how mutation in CIC-7 osteoclasts cause osteopetrosis |
|
Definition
Cl- channel gene helps proton pumo of ATPase on osteoclast ruffled border
osteoclasts cannot acidify resbsorption pit favoring bone building |
|
|
Term
| how does M-CSF mutation cause osteopetrosis |
|
Definition
osteoblasts cannt make M-CSF for osteoclast differentiation
osteoclasts are reduced |
|
|
Term
|
Definition
high bone densiry
fragile bones
erlenmeyer fkast long bones
rugger hersey vertebraw (also hyperparathyroidism)
bones of skull thick and sclerotic
CN compression, blindness, deafness
hair on calvarium (skull hematopoesis)
primary spongiosa persists and fills medullary cavity leaving no room for hematopoietic marrow leading to anemia |
|
|
Term
| treatment of osteopertrosis |
|
Definition
marrow transplant - not effective in dosorders where osteoclasts are dysfunctional
high dose vitamin D
INFy stimulates osteoclast superoxide |
|
|
Term
|
Definition
| increased porosity of skeleton that esults from decreased bone mass causes predisposition to fracture |
|
|
Term
| what are the risk factors for osteoperosis |
|
Definition
post menopausal
white
female
(men and african americans start out with higher level of bone density to begin with) |
|
|
Term
| what are 6 causes of osteoperosis |
|
Definition
receptor mutation
decreased physical activity
post-menopause
vitamin D deficiency
aging
prolonged glucocorticoids |
|
|
Term
| what receptor mutations lead to osteoperosis |
|
Definition
| vit D, estrogen, IGF-a, COL1A1 |
|
|
Term
| why does osteoperosis happen post menopause |
|
Definition
| decreased estrogen decreases IL1, 6, TNF which increases RANK and RANKL which increases bone reabsorption, osteoblast activity goes down and osteoclast up |
|
|
Term
| how does age cause osteoperosis |
|
Definition
decreased replication of osteoprogenitor cells
decreased osteoblast activity
reduced physical activity |
|
|
Term
| how do glucocorticoids cause osteoperosis |
|
Definition
stimulate bone reabsorption
reduce bone formation on cortical and trabecular surfaces |
|
|
Term
| how can glucocorticoid osteoperosis be avoided |
|
Definition
keep therapy short term
bisphosphate administration minimizes bone loss |
|
|
Term
| clinically, how can glucocorticoid therapy be distinguished |
|
Definition
| osteoperosis develops rapidly |
|
|
Term
| what are the osteoperosis tests, which is better, why |
|
Definition
bone density testing - better, more acurate
heel ultrasound - fast, cheap, not acurate |
|
|
Term
| what is the WHO recomendation on osteoperosis testing |
|
Definition
| recommends density test in all women >65 and younger women with risk factors |
|
|
Term
| what does bone density testing measure, why |
|
Definition
| hip, vertebrae, and wrist because they are most prone to fracture |
|
|
Term
| what are the components of a bone density testing reading |
|
Definition
T score: compares to young adult mean, more usefuk
Z score: compares to others in same age group |
|
|
Term
| what is a normal bone density test |
|
Definition
| T > -1 within one standard deviation of young adult mean |
|
|
Term
| what is a low / osteopenic bone density test |
|
Definition
T = -1 to -2.5 with no predisposition to fracture
>2.5 standard deviations below mean |
|
|
Term
| what is a severe / osteoperosis bone density test |
|
Definition
| >2.5 standard deviation below young adult mean and one or more osteoporotoc fractures |
|
|
Term
|
Definition
vertebral compression fracture leading to lumbar lordosis/kyphoscoliosis
wrist, femur neck, head of vertebrae are most common fractures due to aging
complications of pulmonary embolism and pneumonia
Ca P, and alkaline phosphatase levels (not diagnostic) |
|
|
Term
| how is osteoperosis prevented |
|
Definition
exercise
Ca
vit D
bisphosphonates
estrogen replacing agents |
|
|
Term
|
Definition
| multisystemic disease unknown cause likley autoimmune |
|
|
Term
| who is most at risk for sarcoidosis |
|
Definition
| adults <40, danish, swedish and US blacks 10x>US whites |
|
|
Term
|
Definition
| noncaseating granuloma in many organs and tissues |
|
|
Term
| regions of involvement in sarcoidosis and the frequency |
|
Definition
noncaseating epitheloid granulomas
hilar lymphadenopathy 75-90%
lung involvement 90%
spleen involvement 75%
bone involvement 20%
skin lesions 33-50%
eye, eye gland, salivary glands 20-50%
muscle |
|
|
Term
| what are the components of a noncaseating granuloma |
|
Definition
multinucleated giant cells
schaumann bodies: laminated concentration of Ca and protein
asteroid bodies: stellate inclusions inside giant cells |
|
|
Term
| what is the major presenting manifestation in most sarcoidosis cases |
|
Definition
|
|
Term
| what occurs in spleen in sarcoidosis |
|
Definition
| small granulomas coalesce to form small nodules |
|
|
Term
| what occurs in bone in sarcoidosis |
|
Definition
granulomas produce PTH like hormone, TNF, IL6 enhancing vitamin D activation increasing osteoclast activity
enhances bone rabsorption that is most detectable in hands in eet
high Ca levels in serum |
|
|
Term
| what are signs of sarcoidosis in xray |
|
Definition
fine reticular patterns
total destruction of phalanges seen in advanced stages |
|
|
Term
| what occurs in skin in sarcoidosis |
|
Definition
| erythematous plaques, scaling, lesions of mucous membrane |
|
|
Term
| what occurs in eye in sarcoidosis |
|
Definition
| corneal opacities, glaucoma, total vision loss |
|
|
Term
| what occurs in muscle in sarcoidosis |
|
Definition
| weakness, ache, tenderness, fatigue |
|
|
Term
| causes of vitamin d deficiency |
|
Definition
inadequate sun exopsure
decreased intake, absorption, metabolism
poor Ca or P homeostasis
rare in developing countries, elderly most susceptible |
|
|
Term
| what occurs as a result of a vitamin d deficiency |
|
Definition
decrease in Ca and P absorption in gut
hypocalcemia increases PTH activating renal a-hydroxylase which causes Ca absorption in gut, Ca reabsorption in kidney, and P excretion in kidney
Ca serum levels are near normal, hypophosphatemia causes impaired bone mineralization |
|
|
Term
| what are the two types of vitamin d deficiency, what is the difference |
|
Definition
osteomalacia: growth plates closed so bone isnt deranged but osteoid matrix is inadequatly ineralized and susceptible to fracture
ricketts: deficiency before plates close so epiphyseal cartiladge is inadequatly calcified causing dernaged bone growth |
|
|
Term
| what are the areas most susceptible to fracture in osteomalacia |
|
Definition
| vertebral bodies, femoral neck |
|
|
Term
| histology signs of osteomalacia, distinguish from osteoperosis and osteopenia |
|
Definition
| unmineralized osteoid visible on H&E aranged around mineralized trabeculae (rather than loss of skeletal mass like in osteoperosis and osteopenia) |
|
|
Term
| what would the Ca and P levels be like in osteomalacia |
|
Definition
low vitamin D, low ionized Ca by 40%, low P
later: elevated PTH and normal Ca
increased alkaline phosphatase in 94% due to upregulation from Ca and P levels |
|
|
Term
| what test can be done to confirm osteomalacia |
|
Definition
| decalcified bone biopsy: give tetracycline and if there is no space between the two doses you get no gap and they have osteomalacia |
|
|
Term
| what are the histological signs of rickets |
|
Definition
overgrowth of epiphyseal cartiladge cells with projection of irregular cartilage masses into marrow
deposition of osteoid matrix into cartilage remnants
enlargment and expansion of osteochondral junction
overgrowth of capillaries and fibroblasts due to microfractures
inadequate calcification of epiphyseal cartilage causing deranged bone growth |
|
|
Term
|
Definition
occipital flat
parietal buckle inward
frontal bossing: excess osteoid/square head
soft spot slow to close
bony necklace |
|
|
Term
| signs of rickets in chest |
|
Definition
rachitic rosary: overgrowth of cartilage or osteoid at costochondral junction
pigeon brest deformity due to pull of respiratory muscles
harrisons groove; from inward pull od diaphragm |
|
|
Term
| what are ambulatory signs of rickets |
|
Definition
mottledn enamel due to dentin effects
deformities mostly in spine, pelvis, long bone
bowing of legs, bulging of wrists, big lumpy joints |
|
|
Term
| what is the cause of hyperparathyroidism |
|
Definition
| uncontrolled PTH (maybe parathyroid tumor) |
|
|
Term
| how is hyperparathyroidism diagnosed |
|
Definition
| x-ray pattern virtually diagnostic: thinned cortices in radial middle phalangies of the index and middle finger |
|
|
Term
| 4 signs of hyperparathyroidism |
|
Definition
generalized osteotis fibrosa cystica
dissecting osteitis
peritrabecular fibrosis
cystic brown tumor |
|
|
Term
| what is dissecting osteitis |
|
Definition
| osteoclasts tunnel through trabecular |
|
|
Term
| what is peritrabecular fibrosis |
|
Definition
| marrow replaced by fibrovascular tissue |
|
|
Term
| what causes cystic brown tumor, what are the concerns with this |
|
Definition
brown due to hemosiderin deposition
bone loss perdisposes to microfracture and secondary hemorrhage so macrophages come and make mass of reactive tissue |
|
|
Term
| what is the cause of renal osteodystrophy |
|
Definition
chronic renal failure is ALWAYS complicated by wide spread bone disease
kidney can no longer regulate Ca and P metabolism causes hyperphosphatemia and secondary hyperparathyroidism that increases osteoclast activity |
|
|
Term
| explain the pathology of renal osteodystrophy |
|
Definition
kidney cannot get rid of P causing secondary hyperparathyroidism and increasing osteoclast activity
hypocalcemia causes kidney damage and stops vitamin D activation so Ca cannot be absorbed
metabolic acidosis: stimulates Ca hydroxyapetite release from matrix and bone reabsorption |
|
|
Term
| what is aluminum bone disease, and the cause |
|
Definition
may come from dialysis
Al interferes with deposition of Ca hydroxyapatite causing deposition of amyloid in bone (long term hemodialysis leads to B2-microglobulin) |
|
|
Term
| in general, what is paget's disease |
|
Definition
| collage of matrix maddness: gain in bone mass but new bone is highly disorganized |
|
|
Term
| risk factors of paget's disease |
|
Definition
mid adult and likleyhood increasing with age
white female
england, france, austria, germany, australia, new zeland, US
rare in japan, china, africa, scandinavia |
|
|
Term
| what are the stages of pagets and the activities in each |
|
Definition
osteolytic: increased osteoclast activity,lytic lesions
mixed osteoclastic-osteoblastic: ends facoring bone formation
osteosclerotic: quiescent, lack of remodeling causes deformity |
|
|
Term
|
Definition
paramyxovirus infection
osteoclasts hyperresponsive to vit D and RANKL
antigens found to measles, RSV
particles like necleocapsids in cytoplasms and nuclei of paget osteoclasts |
|
|
Term
| how does paramyxovirus cause pagets |
|
Definition
| induces secretion of IL6 which happens in pagets disease |
|
|
Term
| how does measles cause pagets |
|
Definition
| virus transcripts in affected osteoclasts |
|
|
Term
| most common affected bone in pagets |
|
Definition
| vertebrae, humerus, femur head, femur, tibia |
|
|
Term
| what are the signs in bone in pagets |
|
Definition
pain, deformity, chalk stick, compression fracture, neoplasm
platybasia: compression of posterior fossa sutures
teeth problems
lentiasi ossea: lion shaped head, large head difficult to hold up
secondary osteoarthritis |
|
|
Term
| what are the non bone signs of pagets |
|
Definition
CN compression
deafness
blindness
hypertrophic heart with high output failure
hypervascularity causes shunt leading to heart failure |
|
|
Term
| pagets increases tumor probability, what are the two types of tumors and their defining characteristics |
|
Definition
benign: giant cell reparative granuloma, extraosseous hematopoietic masses
malignant: OSTEOSARCOMA, malignant fibrous histocytoma, chondrosarcoma |
|
|
Term
| what are some radiologic signs of pagets |
|
Definition
mosaic lamellar bone: haphazard cement lines
lytic lesions: nelarged misshapen bone
large, numerous osteoclast nuclei
marrow replaced by loose CT and reformed in osteosclerotic stage
large bones with thick trabecular |
|
|
Term
| what will the blood levels of Ca and P look like in pagets |
|
Definition
| increased alkaline phosphate |
|
|
Term
| what does the bone scane look like in pagets |
|
Definition
| hydrpxyproline: areas of bone remodeling |
|
|
Term
|
Definition
|
|
Term
|
Definition
fracture
corticosteroids
thrombosis and embolism
vessel injury
vascular compression
venous HTN |
|
|
Term
| associated conditions with osteonecrosis |
|
Definition
pregnancy, trauma, corticosteroids, infection, dysbarism, radiation therapy, CT disorders, gauchers disease
sickle cell, anemia, alcohol abuse, chronic pancreatitis, tumors, epiphyseal disorders |
|
|
Term
|
Definition
cancellous bone and marrow involvement
chest pain
predisposition to osteoarthritis |
|
|
Term
| what is the cause of 10% of all joint replacements |
|
Definition
| osteonecrosis via osteoarthritis |
|
|
Term
|
Definition
medullary infarction: most stable
subchondral infarction |
|
|
Term
| subchondral infarction: shape, location, composition |
|
Definition
wedge: due to vessel pattern
over articular cartilage getting nutrients from synovial fluid
dead bone with necrotic adipocytes around it |
|
|
Term
| pathogenesis of subchondrial infarction |
|
Definition
frequently reuptues releasing FA and binding Ca causing Ca soaps
creeping substitution: osteoclasts reabsorb dead bone, osteoblasts cannot keep up replacement so articular cartilage collapses and soloughs off |
|
|
Term
|
Definition
| inflammation of bone and marrow ususlly due to infection (or secondary infection like TB, but usually primary infection) |
|
|
Term
| causes of osteomyelitis and where they get picked up |
|
Definition
staph aureus: most common, injury
E. coli, pseudomonas: GU tract
H. influenza, GBS: neoates infector
salmonella: sickle cell pt |
|
|
Term
| routes of infection for osteomyelitis |
|
Definition
hematogenous spread- most common
extension from contigous site
direct implantantion (prostetic) |
|
|
Term
| what is the pathology of osteomyelitis in kids |
|
Definition
spreads to subperiosteum causing it to lift
interrupting blood supply causing necrosis and sequestration
rupturing periosteum causing abscess in soft tissue |
|
|
Term
| what is the pathology of osteomyelitis in infants |
|
Definition
epiphyseal infection usually
spreads to joints causing septic/suppurative arthritis |
|
|
Term
| what is the pathology of oseeomyelitis in adults |
|
Definition
necrosis due to inflammatory reaction within 48h
inflammatory cells attract cytokines stimulating osteoclasts to resorb bone increasing fibrous tissue causing sclerotic rim around lesion on x-ray
involucrum: reacrive bone in a sleeve of dead bone |
|
|
Term
| what are clinical and x-ray signs of osteomyelitis |
|
Definition
sclerotic rim around lesion: fibrous tissue
involucrum: reactive bone in sleeve of dead bone
malaise, fever, chills, leukocytosis
infants: just fever |
|
|
Term
| what are the diagnostic tests for osteomyelitis |
|
Definition
blooc culture: only finds 50% of microbes
biopsy: do whtn culture is negative or antibiotics are not working |
|
|
Term
| what is the prognosis of osteomyelitis |
|
Definition
5-25% persist and cause chronic infection: falure ups, pathologic fracture, secondary amyliodisis, endocarditis, sepsis, squamous cell carcinoma in sinus, sarcoma (rare)
CAUSES CANCER! |
|
|
Term
| TB sometimes spreads to bone, where does it go, why is it a big concern |
|
Definition
very destructive
usually in spine (pott disease), knee, hip |
|
|
Term
|
Definition
|
|
Term
|
Definition
| malignant tumor from mesenchymal tissue |
|
|
Term
|
Definition
| benign tumor of osteoblasts |
|
|
Term
|
Definition
| cartiladgenous malignant tumor |
|
|
Term
| what type of bone tumors cause pain |
|
Definition
benign pressing on something - uncommon
growing lesions
agresive osteoblastoma
giant cell tumor
malignant tumor: fast growht, destruction
pathologic fracture complication - benign or malignant
signigicant loss of tissue due to tumor |
|
|
Term
| who is at risk for metastasis to bone |
|
Definition
|
|
Term
| what is the most common location and presentation of metastasis to bone |
|
Definition
multi focal lesions in ribs, vertebrae, pelvis, cranium, proximal long bones
AXIAL |
|
|
Term
| what is the uncommon location and presentation of metastasis to bone |
|
Definition
solitary lesions
thyroid, lung, kidney |
|
|
Term
| what are the cancers that usually metastasize to bone |
|
Definition
prostate
thyroid
lung
kidney
breast |
|
|
Term
| where does cancer from bone metastasize to |
|
Definition
|
|
Term
| who usually gets bone tumors |
|
Definition
| teens and twenties (first 3 decades) |
|
|
Term
| are bone tumors usually benign or malignant |
|
Definition
|
|
Term
| where do most primary bone tumors originate (benign or malignant) |
|
Definition
| distal femur, proximal tibia |
|
|
Term
| what are two characteristics of bone cancer that are unique and important |
|
Definition
de-differentiation to more anaplastic (agressive) type
high grade sarcome comes from damaged bone |
|
|
Term
| what are two examples of tumor de-differentiation |
|
Definition
enchondroma
low grade chondrosarcoma transforming into high grade |
|
|
Term
| what are 3 examples of high grade sarcome coming from damaged bone |
|
Definition
bone infarct site
radiation osteitis
paget's disease |
|
|
Term
| what are the characteristics of a non-growing lesion |
|
Definition
|
|
Term
| what are the characteristics of a slow growing lesion |
|
Definition
well demarcated zone of bone destruction without sclerotic rim
provoke focal cortical thinking (solid periosteal reaction)
with continued growth such lesions may show cortical expansion |
|
|
Term
| what are the characteristics of a rapidly growing lesion |
|
Definition
penetrate through cortex causing seperation of periosteum (codman's triangle)
hair on end or sunburst pattern
moth eaten appearance |
|
|
Term
| osteoma: locations, associated conditions, malignant or benign |
|
Definition
mandible usually, skull, long bone
often seen with clonic polyposis (familial adenomatous polyposis) which is cardner syndrome
osteome usually comes before radiological signs of clonic polyposis
benign |
|
|
Term
| osteoid osteoma: malignant or benign, clinical signs, epidemology |
|
Definition
benign
painful, worse at night
males > females (2:1) |
|
|
Term
| osteoid osteoma: pathology |
|
Definition
releases COX causing pain (relieved by aspirin)
growth in diaphysis of long bone (<2cm lesion of cortex)
Xray shows central radionuclency surrounded by sclerotic rim |
|
|
Term
| lesions in intramedullary diaphysis |
|
Definition
eqings sarcoma
enchondroma |
|
|
Term
| lesions in cortex diaphysis |
|
Definition
|
|
Term
| lesions in metaphysis cortex |
|
Definition
|
|
Term
| lesions in metaphysis intramedulary |
|
Definition
osteosarcoma
chondrosarcoma
osteoblastoma |
|
|
Term
| lesions in metaphyseal exostosis |
|
Definition
|
|
Term
|
Definition
chondroblastoma in open growth plate
giant cell tumor: often crosses into metaphysis, only in closed growth plate |
|
|
Term
| what condition is similar to osteoid osteoma |
|
Definition
|
|
Term
| where does osteoblastoma occur |
|
Definition
| vertebrae or metaphysis of long bone |
|
|
Term
|
Definition
dull pain, not relieved by aspirin
no sclerotic rum (growing too fast) |
|
|
Term
| who gets osteochondroma(exostosis), what bones |
|
Definition
adolescents
long bones esp at knee |
|
|
Term
| physiology of osteochondroma |
|
Definition
come from metaphysis near growth plate of tubular bones of endochondral origin
made of BONE and CARTILAGE
usually solitary lesion |
|
|
Term
| clinical signs of osteochondroma |
|
Definition
asymptomatic or painful
produce deformity |
|
|
Term
| is osteochondroma malignant or benign |
|
Definition
benign
but it can undergo malignant transformation |
|
|
Term
|
Definition
| easy to excise because it is solitary and on top of bone but dont unless painful |
|
|
Term
| what os osteocondromatosis |
|
Definition
multiple hereditary exostosis
osteochondroma with multiple often symmetric lesions
more likey to transform and be malignant |
|
|
Term
| chondroma malignant or benign, location |
|
Definition
benign
hayline cartilage
endochondrial origin bones (hands, feet) |
|
|
Term
| endochondroma: define, location, age range |
|
Definition
condroma of the medullary cavity
20-50yo
most common intraosseous tumor |
|
|
Term
| what is the most common intraosseous tumor |
|
Definition
|
|
Term
| define endochondromatosis, associated conditions |
|
Definition
multiple endochondroma
soft tissue hemangioma of endothelial cell orogin |
|
|
Term
|
Definition
epiphysis
epiphyses: iliac crest |
|
|
Term
| pathology chondroblastoma |
|
Definition
disorder apparent in chondroblasts
cellular tomor with little hayline matrix
when calcifies looks like chicken wire |
|
|
Term
|
Definition
painful due to joint effusions causing limited mobility
x-ray: spotty calcifications in apiphysis |
|
|
Term
| who gets giant cell tumor |
|
Definition
|
|
Term
| giant cell tumor: location, malignant or benign |
|
Definition
epiphysis but can spread to metaphysis
usually around knee
benign but can metastazise |
|
|
Term
| composition of giant cell tumor |
|
Definition
| osteoclast like giant cells and stroma |
|
|
Term
| signs of giant cell tumor |
|
Definition
x-ray: expanding lytic lesions, demacrated, not sclerotic (cell in bone)
red brown mass with cystic degeneration |
|
|
Term
| what is giant cell tumor often confused with, why |
|
Definition
| red brown mass with cystic degeneration looks like brown tumor of hyperparathyroidism. here its due to high vascularization |
|
|
Term
| prognosis of giant cell tumor |
|
Definition
surgical removal leaves with 40-60% reoccurance
4% spread to lungs |
|
|
Term
| what is a fibrous cortical defect |
|
Definition
| not neoplasm! developmental defect in 30-50% of kids >2yo |
|
|
Term
| signs of small fibrous cortical defect |
|
Definition
<0.5cm
bilateral
maybe multiple
usually asymptomatic
spontaneously resolve in a few years replaced by normal bone |
|
|
Term
| signs of large fibrous cortical defect |
|
Definition
5-6cm
aka non-ossifying fibroma
metaphyseal lesion with rim of sclerotic bone
usually involves cortex |
|
|
Term
| what is the most common primary malignant tumor of bone |
|
Definition
|
|
Term
| who gets osteosarcoma, where |
|
Definition
teenagers
usually around knee (sometime hip) |
|
|
Term
| where does osteosarcoma come from |
|
Definition
| malignant mesenchymal tumor that makes bone matrix |
|
|
Term
|
Definition
agressive
can become very large |
|
|
Term
| radiograph signs of osteosarcoma |
|
Definition
codmans triangle: as tumor penetrates it seperates periosteum
sunburst pattern
bone destruction |
|
|
Term
|
Definition
|
|
Term
| location of chondrosarcoma |
|
Definition
AXIAL
pelvic bones, spine, shoulder, ribs, long bones |
|
|
Term
|
Definition
atypical chondrocytes and chondroblasts with multiple nuclei in lacuna
produce neoplastic cartilage |
|
|
Term
| what are the grades of chondrosarcoma, how are they identified |
|
Definition
more radiolucent higher grade
slow growing: reactive thickening of cortex
fast growing: no time for reaction, cortex destoried |
|
|
Term
|
Definition
|
|
Term
| signs of ewing sarcoma on xray |
|
Definition
| concentric onion skin layering of periosteum |
|
|
Term
| clinical signs of ewing sarcoma |
|
Definition
|
|
Term
| location of ewing sarcoma |
|
Definition
| DIAPHYSIS of femur, pelvis, tibia |
|
|
Term
| histological signs ewing sarcoma |
|
Definition
homer wright rosettes: tumors cells in circle around fibrillary space due to neural differention
sheets of undifferentiated blue cells resembling lymphocytes |
|
|
Term
|
Definition
translocation of EWS gene to a member ot ETS family transcription factors and EWS acts as an oncogene activating chimeric protein stimulating cell proliferation
t(11;22) |
|
|
Term
| what condition is ewing sarcoma similar to, what is the difference |
|
Definition
primitive neuroectodermal tumor (PNET)
ewing is less differetiated, everything else is the same |
|
|
Term
| prognosis of ewing sarcome |
|
Definition
used to be poor
now 75% 5 year survival with chemo
50% long term cure |
|
|
Term
|
Definition
poverty
ignorance: switching baby to rice milk
chronic alcoholism: not buying groceries, malabsorption
self imposed: anorexia, dieting
malabsorption: GI disease, acquired, inherited
drugs
total parentral nutrition |
|
|
Term
| define primary malnutrition |
|
Definition
|
|
Term
| define secondary malnutrition |
|
Definition
| cannot be absorbed, utilized, stored, or used faster than consumed |
|
|
Term
| what are the three most common causes of secondary malnutrition |
|
Definition
GI disease
chronic wasting disease
acute critical illness |
|
|
Term
| what causes protein energy malnutrition, what is the main sign to start looking at protein |
|
Definition
inadequate protein or calorie intake
weight <80% normal |
|
|
Term
|
Definition
| calorie deficiency > protein deficiency |
|
|
Term
| what organ system is affected by marasmus, why does it cause symptoms |
|
Definition
somatic organs
they are degraded for AA and fat |
|
|
Term
|
Definition
reduced midarm circumference
loss of muscle and SC fat
growth retardation except in head because body spares brain
weight 60% normal
anemia
vitamin deficiency
immune deficiency mostly T cell
normal serum albumin |
|
|
Term
|
Definition
| protein deficiency > calorie deficiency |
|
|
Term
|
Definition
classic; baby weaked too early and fed carb based diet (rice milk)
GI malbsorption
burns
nephrotic syndrome |
|
|
Term
|
Definition
reduced serum albumin causes generalized dependant edema
hepatomeagly and fatty liver
weight 60-80% normal
skin lesions: altered pigment and peeling (flaky paint)
hair color and texture changes
apathy, appetite loss
immune deficiency less prominent than marasmus
small bowel villous atrophy causes diccaridase deficnecy (lactose intolerance) and malabsorption |
|
|
Term
| why is secondary PEM seen in |
|
Definition
chronically ill or hospitalized (cancer pt)
if seen in healthy suspect anorexia/bulemia |
|
|
Term
|
Definition
|
|
Term
| what is the cause of cachexia |
|
Definition
TNF acts as cachexin and stimulates acute phase response and uses up SC fat and reduces appetite
proteolysis inducing factor acts as cachexin and reduces appetite |
|
|
Term
| 2 eating disorders, define each |
|
Definition
anorexia: self induced starvation
bulemia: binge eating followed by vomiting/laxatives |
|
|
Term
| what is the main difference physiologically between anorexia and bulemia |
|
Definition
bulemia has a better prognosis
weight and gonadotropin levels remain near normal |
|
|
Term
|
Definition
amenorrhea
decreased T3/4: cold intolerance, bradycardia, constipation
laungo hair
yellow skin due to excess carotene
loss of bone density due to low estrogen |
|
|
Term
| why is amenorrhea important sign of anorexia |
|
Definition
it happens in most pt
anorexia should always be in amenorrhea ddx |
|
|
Term
|
Definition
50% get amenorrhea
electrolyte imbalance
pulmonary aspiration
esophageal and stomach rupture |
|
|
Term
| complications of eating disorders |
|
Definition
anemia
lymphopenia
hypoalbumina
hypokalemia: cardiac arrhythmia and sudden death |
|
|
Term
| what are the fat and water soluble vitamins |
|
Definition
|
|
Term
| what is the most common cause of fat soluble vitamin deficiency |
|
Definition
| malabsorption in intestinal disease |
|
|
Term
|
Definition
animal derived: liver, egg, milk
polyvitamins/B-carotene: yellow or leafy green veggies |
|
|
Term
| what are forms of vitamin A |
|
Definition
| retinol, retinal, retinoic A, retinoids |
|
|
Term
| which form of vitamin A isnt really one, why |
|
Definition
| retinoids: structurally related, no vitamin A activity |
|
|
Term
| where is vitamin A stored, how long is the reserve |
|
Definition
|
|
Term
| explain absorption and distribution of vitamin A |
|
Definition
absorbed in villi and into chylomicron which goes to APO E recepto on liver
binds retinol binding protein in retinyl ester form for transport
oxidized at tissue to retinoic acid |
|
|
Term
|
Definition
part of rhodopsin in rods and idopsins in cones
epithelial differentiation
enhance immunity esp in measles and diarrhea diseases |
|
|
Term
| risk factors for vitamin A deficiency |
|
Definition
infants: poor absorption
kids: stores depeleted in infection
malabsorption syndromes: celiac disease example
bariatric surgery
use of mineral oil laxatives |
|
|
Term
| signs of vitamin A deficiency |
|
Definition
night blindnes
squamous metaplasia esp mucosa (and its complications like blindness)
immune deficiency |
|
|
Term
| what are the complications of squamous metaplasia |
|
Definition
xeropthalmia: dry eye due to replacement of lacrimal epithelium with kertinized
biot spots: keritanized plaqye due to epithelial replacement
keritomalacia: softening and destruction of cornea due to keratin
blindness
increased respiratory infection and UTI and renal stones |
|
|
Term
| signs of acute vitamin A toxicity |
|
Definition
headache
dizzy
vomiting
stupor
blurred vision
teratogen |
|
|
Term
| signs of chronic vitamin A toxicity |
|
Definition
weight loss due to anorexia, vomiting, nausea
bone and joint pain due to retinoic acid stimulating osteoclasts
teratogen |
|
|
Term
| signs of vitamin D deficiency |
|
Definition
rickets in kids
osteomalacia in adults |
|
|
Term
| signs of vitamin E deficiency |
|
Definition
| spinocerebellar degeneration |
|
|
Term
| signs of vitamin K deficiency |
|
Definition
|
|
Term
| signs of B1 deficiency, aka |
|
Definition
thiamine
dey and wet beriberi, werinke and korsakoff |
|
|
Term
| signs of B2 deficiency, aka |
|
Definition
riboflavin
cheilosis, stomatitis, glossitis, dermatitis, corneal vascularization |
|
|
Term
| signs of niacin deficiency |
|
Definition
| pellatra- dermatitis, dementia, diarrhea |
|
|
Term
| signs of B6 deficiency, aka |
|
Definition
pyridoxine
cheilosis, glossitis, dermatitis, peripherial neropathy |
|
|
Term
|
Definition
| combined system disease - anemia, posterolateral spinal cord degeneration |
|
|
Term
|
Definition
|
|
Term
|
Definition
milk and animal products
fruit and veggies |
|
|
Term
|
Definition
hydroxylation of procollagen: stabilizes helix and cross links in collage (esp in vessels)
antioxidant: direct and assist in vitamin E production |
|
|
Term
| risk factors for vitamin C deficiency |
|
Definition
food fads
dialysis patients
anorexia
elderly
alcoholic |
|
|
Term
|
Definition
bleeding and petechiae due to poor vessel support
impaired wound healing
decreased periosteum in joints |
|
|
Term
| signs of vitamin C toxicity |
|
Definition
water soluble and mostly excreted in urine so uncommon
uricosuria: high uric acid
increased Fe absorption |
|
|
Term
| signs of folate deficiency |
|
Definition
anemia
neural tube defects |
|
|
Term
| signs of pantotenic acid deficiency |
|
Definition
|
|
Term
| signs of biotin deficiency |
|
Definition
|
|
Term
| 4 ways we define or qualify obesity |
|
Definition
adipose levels high enough to cause adverse health effects
BMI (weight/height) >30 kg/m2
skin fold measurements
body circumferences / hip to waist ratio |
|
|
Term
| 7 peripherial or afferent regulators of energy |
|
Definition
leptin
adiponectin
cytokines
chemokines
stored hormones
gherlin
peptide Yy |
|
|
Term
| 5 energy regulators adipose releases |
|
Definition
leptin
adiponectin
cytokines
chemokines
stored hormones |
|
|
Term
| what type of molecule is leptin |
|
Definition
|
|
Term
|
Definition
| reduced food intake and increased energy expendurature |
|
|
Term
| function of adiponectin, cytokines, chemokines, and stored hormone in adipose |
|
Definition
| regulate metabolism, nutrition, and inflammation |
|
|
Term
|
Definition
|
|
Term
| explain the changes in gherlin levels |
|
Definition
rises before meals
falls 1-2 hours later |
|
|
Term
|
Definition
|
|
Term
| where is peptide YY made, what sitmulates |
|
Definition
| endocrine cells of ileum and colon in response to food |
|
|
Term
|
Definition
|
|
Term
| what is the efferent regulator of energy blanace |
|
Definition
| hypothalamus arcuate nucleus |
|
|
Term
| what are the 4 neuron regulator of energy paths of the arcuate nucleus, what do they do |
|
Definition
POMC and CART neurons cause energy expendature and weight loss
NPT and AhRP neurons cause food intake and weight gain |
|
|
Term
| define: POMC, CART, NPY, AhRP |
|
Definition
pro-opiomelanocortin neuron
cocaine and aphmetamine regulated transport neuron
neuropeptide Y neuron
aqouti-released peptide neuron |
|
|
Term
| what are the three causes of obesity |
|
Definition
leptin pathway mutation
total adipocyte number is determine as kid so more build up means more obesity
decreased gherlin degration |
|
|
Term
| what are 4 leptin mutations causing obesity |
|
Definition
melanocortin receptor 4 (MCR4) mutation
leptin recptor resistance / high leptin blood levels |
|
|
Term
| what is an exam finding that can determine that someone is more at risk for obesity complications |
|
Definition
| central / visceral obesity |
|
|
Term
| 11 complications of obesity |
|
Definition
hypertriglyceridemia
cancer
insulin resistance
hyperinsulinemia (diabetes II)
metabolic syndrome
non-alcoholic steatohepatitis
cholelithiasis
hypoventilation syndrome w/ hypersomnolence
osteoarthritis
elevated markers of inflammation (CRP) |
|
|
Term
| when someone has obesity and gets hyperTG what can this cause |
|
Definition
| low HDL and coronary artery disease |
|
|
Term
| what are the common obesity associated cancers in men |
|
Definition
esophageal
thyroid
colon
kidney |
|
|
Term
| what are the common obesity associated cancers in women |
|
Definition
esophageal
endometrial
gallbladder
idney |
|
|
Term
| signs of metaoblic syndrome |
|
Definition
visceral obesity
abnormal glucose and lipid metabolism
HTN
pro-inflammatory state |
|
|
Term
| what is non-alcoholic steatohepatitis, what are complications |
|
Definition
fatty liver disease
fibrosis and chirrosis |
|
|
Term
| why do people with obesity get cholelithiasis |
|
Definition
| increased cholesterol causes changes in biliary excretion |
|
|
Term
| signs of hypoventilation syndrome w/ hypersomnolence |
|
Definition
apenic pause
polycythemia
right sided heart failure |
|
|
Term
| why is it so important to be on the watch for environmental and occupational hazards |
|
Definition
preventible
patients will seek advice
may show up in trends in the community |
|
|
Term
| what does the effect of an environmental exposure depend on |
|
Definition
amount,timing, pattern, duration
route (inhaled, absorbed, IV)
half life
storage location |
|
|
Term
| where is dignxin stored, for how long |
|
Definition
|
|
Term
| how long is silicia stored |
|
Definition
|
|
Term
| polycyclic aromatic hydrocarbons: where are they found, who is at risk, what is the side effect |
|
Definition
soot
chimney sweeps
scrotal cancer |
|
|
Term
| vinyl chloride: who is at risk, what is the side effect |
|
Definition
plastic industry
angiosarcoma of the liver |
|
|
Term
| uranium/radon gas: who is at risk, what is the side effect |
|
Definition
miners and some natural areas
lung cancer |
|
|
Term
| B-naphthylamine: who is at risk, what is the side effect |
|
Definition
dye makers, rubber workers
bladder cancer |
|
|
Term
| carbon tetrachloride: who is at risk, what is the side effect |
|
Definition
| dry cleaners, liver and kidney toxicity |
|
|
Term
| organophosphates: who is at risk, what is the side effect |
|
Definition
farmers
irreversible cholinesterase inhibitors |
|
|
Term
| what is the normal breakdown process of alcohol |
|
Definition
ethanol is metabolized by alcohol DH into acetaldehyde which is broken by aldehyde DH into acetic acid
the process makes the byproduce NADH |
|
|
Term
| why are some people unable to handle alcohol as well as others |
|
Definition
many asians have aldehyde DH mutation so they flush after a glass due to acetaldehyde build up
women have alcohol DH levels lower than men so ethanol builds up |
|
|
Term
| how can a habitual drinker be identified (before liver or highly notible damage) |
|
Definition
| cytochrome P450 enzymes in cells will begin helping with breaking dowh ethanol into acetaldehyde |
|
|
Term
| how much alcohol does it take for inebriation and serious effects (name them) in the occasional drinker |
|
Definition
200 mg/dL (6oz)
300-400 mg/dL causes coma, respiratory arrest |
|
|
Term
| how much alcohol does it take for inebriation in habituial drinkers |
|
Definition
|
|
Term
| what changes occur in the liver of a habitual drinker |
|
Definition
fatty change in the liver
acute alcoholic hepatits
alcoholic chirrhosis |
|
|
Term
| how does alcohol cause fatty change in the liver |
|
Definition
excess NADH stimulates lipid synthesis
FA oxidation in mitochondria decreased
acetaldehyde forms adducts with tubulin decreasing lipoprotein transport from liver
peripherial fat catabolism increased |
|
|
Term
| what are signs of acute alcoholic hepatitis |
|
Definition
| fever, liver tenderness, jaundice |
|
|
Term
| how does alcohol cause acute alcoholic hepatitis |
|
Definition
| fat accumulation and alcoholic haylin (mallory bodies) build up, neutrophils surround them and allow for necrosis via ethanol metabolites |
|
|
Term
| where does acute alcoholic hepatitis cause necrosis and fibrosis usually begin |
|
Definition
|
|
Term
| how do ethanol metabolites cause necrosis |
|
Definition
glutathionine depletion
mitochondrial injury
altered metabolism of methionine
cytokine release from Kupuffer cells |
|
|
Term
| what are clinical signs of alcoholic chirrhosis |
|
Definition
| weaness, muscle wasting, acites, GI hemorrhage, coma |
|
|
Term
| what are cellular signs of alcoholic chirrhosis |
|
Definition
perisinusoidal fibrosis: collagen deposition b Ito cells in spaces of disse
depleted liver stores of a-tocopherol
micronodules of regenerating hepatocytes surrounded by bands of collagen |
|
|
Term
| what are two ways habitual alcohol affects the cns |
|
Definition
changes membrane fluidity altering signal transduction causing depressive effect and addiction
thiamine deficiency (due to poor nutrition) |
|
|
Term
| what are 4 general signs of thiamine deficiency |
|
Definition
nerve degeneration
reactive gliosis
cerebellar and peripherial nerve atrophy |
|
|
Term
| what are two diseases caused by thiamine deficiency |
|
Definition
| wernicke and korsakoff syndromes |
|
|
Term
| signs of wernicke syndrome |
|
Definition
ataxia, disturbed cognition, opthalmoplegia, nystagmus
confusion, apathy, disorientation |
|
|
Term
| signs of korsakoff syndrome |
|
Definition
| severe memory loss (retrograde amnesia), inability to acquire new information, confabulation |
|
|
Term
| what are the effects of chronic alcohol on the cardiovascular system |
|
Definition
cardiomyopathy and heart dilation
hypertension, anemia
caputmedusa, esophageal varicies |
|
|
Term
| why does alcohol cause HTN |
|
Definition
| ethanol triggers catecholamine release |
|
|
Term
| why does alcohol cause anemia |
|
Definition
|
|
Term
| what are the effects of moderate alcohol on the cardiovascular system |
|
Definition
| moderate consumption has protect effect (increased HDL, decreased platelet aggregation) |
|
|
Term
| why does alcohol cause venous conditions like caput medusa and esophageal varicies |
|
Definition
| portal vein obstruction via chirrhosis leads to portal vein Htn and increased pressure on venous channel causing dilation of abdominal end esophageal vessels (which can rupture and cause quick death) |
|
|
Term
| affects of chronic alcohol on GI |
|
Definition
acute gastritis
acute and chronic pancreatitis
pancreatic acinar destriction causes malabsorption, vitamin deficiency
GI hemorrhages after chirrhosis |
|
|
Term
| alcohol effect on skeletal muscle |
|
Definition
| toxin: weakness, pain, myoglobulin breakdown |
|
|
Term
| what are the affects of chronic alcohol on the reproductive system |
|
Definition
testicular atrophy
descreased fertility
increased spontaneous abortion
fetal alcohol syndrome |
|
|
Term
| signs of fetal alcohol syndrome |
|
Definition
microcephaly
facial dysmorphology
malformations of brain, cardiovascular, GU |
|
|
Term
| what is the most common preventable illness in the US |
|
Definition
|
|
Term
| why does alcohol cause fetal alcohol syndrome |
|
Definition
| ethanol induces apoptosis of CNS cell precursors |
|
|
Term
| why does alcohol cause cancer |
|
Definition
| acetaldehyde is a tumor promoter |
|
|
Term
| what cancers does ethanol cause |
|
Definition
oral cavity, pharynx, esophagus, liver, breast
hepatocellular carcinoma (synergistic with hep B and C) |
|
|
Term
| why does alcohol cause hepatocellular carcinoma |
|
Definition
| inhibits detoxification of chemical carcinogens |
|
|
Term
|
Definition
methanol
isopropanol
ethylene glycol |
|
|
Term
|
Definition
| solvents, paint remove, methylated spirits |
|
|
Term
| how does methanol cause problems |
|
Definition
| metabolized to formaldehyde by alcohol DH and formic acid which causes metabolic acidosis |
|
|
Term
| signs of methanol poisoning |
|
Definition
nausea, vomiting, abdominal pain, blurred vision (snow storm)
30 mL can cause death
10 mL can cause blindness |
|
|
Term
| how does isopropanol cause damage, where |
|
Definition
| ADH metabolizes to acetone and damages gastric mucosa |
|
|
Term
| what is a lethal dose of ethylene glycol |
|
Definition
|
|
Term
| how is ethylene glycol broken down in the body |
|
Definition
| alcohol DH metabolizes into aldehydes, glycolate, oxalate, and lactate |
|
|
Term
| signs of ethylene glucol toxicity |
|
Definition
| renal failure due to Ca oxylate crystals in tubules (show in urine) |
|
|
Term
| how can you tell if someone has ethylene glycol toxicity |
|
Definition
florescein detectable with UV light, examine oral cavity
Ca oxylate in urine |
|
|
Term
| what is the treatment for all ethanol substitute toxicities, why |
|
Definition
| administer ethanol so alcohol DH is used to break it down and avoids making toxic byproducts of other substancs |
|
|
Term
| what drugs are CNS stimulants |
|
Definition
|
|
Term
| signs of chronic CNS stimulant abuse |
|
Definition
| insomnia, anxiety, paranoia, hallucinations, dilated cardiomyopathy, nasal septum perforation (can be from infection), increases risk of athlerosclerosis!, compounds risk of MI if a smoker |
|
|
Term
| signs of acute CNS stimulant overdose |
|
Definition
| seizure, cardiac arrhythmia, respiratory arrest, increases risk of athlerosclerosis! |
|
|
Term
| what drug is an abused narcotic |
|
Definition
|
|
Term
|
Definition
sedation, mood change, nausea, supression of anxiety
chronic: tolerance, dependance
susceptability to infection |
|
|
Term
| what infections do heroin uses often have |
|
Definition
skin (track marks)
heart valves: especially tricuspid (S. aureus)
liver
lungs |
|
|
Term
| why should you never buy the cheap crap when you get drugs from your dealer |
|
Definition
| because the cheap ones are cut with talcum power which accumulates in lungs, liver, kidney causing granuloma, pulmonary abscess, pulmonary edema, amyloidosis, and focal glomerulosclerosis |
|
|
Term
| what are three hallucinogens |
|
Definition
delta-9-tetrahydrocannabinol (THC)
phencyclidine (PCP)
LSD |
|
|
Term
| side effects or complications of THC |
|
Definition
marijuana smoke carcinogens do not induce cancer but induce lung damage simillar to tobacco
intoxication impairs cognative and motor function |
|
|
Term
|
Definition
| inebiration, disorientation, numbness, mystagmus, coma in high doses |
|
|
Term
|
Definition
| death in high doses, psychic effects, visual illusions |
|
|
Term
| what routes of exposure cause lead poisoning |
|
Definition
|
|
Term
| where does lead go in the body, what problems does it cause there |
|
Definition
mostly bone and teeth where it competes for Ca binding causing lead lines of x-ray
soft tissues or filtered in kidney causing hyperpigmentation (blue) gum tissue |
|
|
Term
| 4 ways lead interferes with the body |
|
Definition
interferes with heme synthesis
interferes with membrane Na/K pumps
competes with Ca in bone
interferes with nerve transmission |
|
|
Term
| what is the consequence of lead interferance with nerve transmission |
|
Definition
| abnormal brain development |
|
|
Term
| what is the consequence of lead interfering with Na/K pumps |
|
Definition
| shortens RBC survival causing hemolytic anemia |
|
|
Term
| how does lead interfere with heme synthesis, what is the clinical result |
|
Definition
has affunity for sulfhydryl groups
accumulates in mitochondria forming ringed sideroblasts and blocks ferliochetlase which normally incorporates Fe into heme causing Fe overload in the marrow and sideroblastic anemia |
|
|
Term
| what diseases cause sideroblastic anemia |
|
Definition
lead poisoning
thiamine deficiency |
|
|
Term
| what are the carcinogens in tobacco smoke, which is most potent |
|
Definition
| tar, polycyclic aromatic hydrocarbons, benzopyrene (most potent), nitrosamine |
|
|
Term
| how does benzopyrene cause carcinogenesis |
|
Definition
| intercolates between DNA strands causing mutation |
|
|
Term
| what does nicotine cause to happen in the body |
|
Definition
gangloside stimulation and depression
tumor promotion |
|
|
Term
| what parts of smoke cause cillia toxicity and irritation |
|
Definition
| formaldehyde, oxides of nutrogen |
|
|
Term
| what are the pulmonary signs in a smoker |
|
Definition
irritants cause inflammation and increased mucous production
recruitment of leukocytes to lung
carcinogenic constituents
chronic bronchitis and emphysema |
|
|
Term
| what are cardiovascular signs in a smoker |
|
Definition
decreased myocardial oxygen supply
MI
systemic athlerosclerosis |
|
|
Term
| what cancers are caused by smoking |
|
Definition
| lung, larynx, trachea, esophageal, pancreas, bladder |
|
|
Term
|
Definition
|
|
Term
|
Definition
increases risk of spontaneous abortion and preterm birth
intrauterine growth retardation causes low birth weight |
|
|
Term
| effects of secondary hand smoke |
|
Definition
increased asthma and respiratory illness in kids
1.3x rosk of lung cancer |
|
|
Term
| what are 4 sources of outdoor airpollution and what polutants for each |
|
Definition
fossil fuel combustion: CO, hydrocarbons, NO2, particulates
photochemical reactions: ozone
power plants: SO2 and particulates
waste incerinators/smelters: acid aerosols, metals, mercury vapor, organic compounds |
|
|
Term
| how does SO2 pollution caus eproblems |
|
Definition
| H+ and sulfites cause local irritations |
|
|
Term
| how does ozone cause problems |
|
Definition
| cough, chest discomfort, lung inflammation, asthmatics very sensitive |
|
|
Term
| how does NO2 cause problems |
|
Definition
| dissolves in airway making nitric and nitrous acids |
|
|
Term
| wht are 4 indoor air polluters and their sources |
|
Definition
wood smoke
formaldehyde: textiles, pressed wood, furinature
bioaerosols: contaminated heating and cooling
radon: natural decay product emit a raiation (uranium rocks breaks to radium which breaks to radon gas) |
|
|
Term
| how does radon gas (a-radiation) effect the body |
|
Definition
|
|
Term
| give an example of a bioserosol and the complications |
|
Definition
legionella pneumo in heating and cooling of public buildings
allergens cause allergic rhinitis and exacerbate asthma |
|
|
Term
| what does formeldahyde pollution do to the body |
|
Definition
acute eye irritation
exacerbate asthma |
|
|
Term
| what does wood smoke pollution do to the body |
|
Definition
| increase respiratory infections |
|
|
Term
| where does CO come from, how is it detected |
|
Definition
combustion, cigarette smoke
difficult detection: odorless and colorless, O2 meter may think its O2 |
|
|
Term
| how does CO cause problems |
|
Definition
competes with O2 dor Hb binding with 200x inc in affinity causing hypoxia
inhibits cytochrome oxidaze in ETC |
|
|
Term
| low levels of CO: signs, how much |
|
Definition
2-4 ppm
reduced exercise capacity |
|
|
Term
| high levels of CO: signs, how much |
|
Definition
>9 ppm
headache, dizzy, loss of motion control
cherry red skin, mucosa, blood (due to carboxyHb) |
|
|
Term
|
Definition
|
|
Term
| pathogenic effet of chloroform (Carbon tetrachloride) |
|
Definition
| CNS depression, liver necrosis |
|
|
Term
|
Definition
| block ctochrme oxidadae causing rapid death due to hypoxia |
|
|
Term
| signs of low dose mercury exposure |
|
Definition
| intention tremor, memory loss, gingivitis, skin rash, nephrotic syndrome |
|
|
Term
| what are petroleum distillates |
|
Definition
| kerosine, benzene, gasoline |
|
|
Term
| what as signs of petroleum distillate toxicity |
|
Definition
| respiratory depression, GI inflammation, pneumonitis |
|
|
Term
| signs of polychlorinated biphenyl toxicity |
|
Definition
| insidious development o chloracne, vsual loss, impotence |
|
|
Term
| signs of organophosphate toxocity and MOA |
|
Definition
neurotoxicity via acetylcholinesterase inhibition: muscle weakness, cardiac arrhythmia, resporatory depression
inhibits RBC or plasma cholinesterase |
|
|
Term
| route of organophosphate exposure |
|
Definition
|
|
Term
|
Definition
| used in manufacturing, degresing, dry cleaning, paint remover, aerosol |
|
|
Term
| general signs of acute exposure of volitile compound |
|
Definition
| headache, dizzy, liver / kidney toxicity |
|
|
Term
| general signs of chronic low exposure to volatile compound |
|
Definition
carcinogenesis
reproductive effects |
|
|
Term
| methylene chloride: location, route of exposure |
|
Definition
paint removes, aerosol, gasolene, mineral oil, turpentine
lungs |
|
|
Term
|
Definition
| metabolized by CP450 into CO2 and CO |
|
|
Term
| methylene chloride signs of toxicity |
|
Definition
CNS depression, dizzy, incoordination
contact dermatitis: usually from kerosine |
|
|
Term
| where are polycyclic aromatic hydrocarbons made |
|
Definition
| combustion of fossil fuels, high temp, processing of coal and oil, iron and steel foundries, cigarettes |
|
|
Term
| route of exposure of polycyclic aromatic hydrocarbons |
|
Definition
|
|
Term
| hazards of polycyclic aromatic hydrocarbons |
|
Definition
|
|
Term
| organochlorines: soources, route of exposure |
|
Definition
| insecticides, environment, bioaccumulatre |
|
|
Term
| organochlorines: storagein body, hazards |
|
Definition
fat, human milk
estrogenic |
|
|
Term
| what is an example of a organochlorine and the hazards |
|
Definition
| DDT: reproductive defects in birds, none in humans but suspected |
|
|
Term
| carbamates: MOA of toxocity, effect |
|
Definition
reversible inhibitor of cholineserase
neurotoxicity |
|
|
Term
| carbamate example and effect |
|
Definition
sevin (carbaryl)
poisons mititoc spindle (mutagen and teratogen) |
|
|
Term
| where is dioxin found, how is it made |
|
Definition
| herbacide, agent organge, paper pulp + chlorine incerination |
|
|
Term
| signs of acute dioxin toxicity |
|
Definition
chloracne
fetotoxicity
immunotoxicity
leukemia, lymphoma, sarcoma |
|
|
Term
| signs of chronic dioxin exposure |
|
Definition
induces CP450
increases estrogen metabolism
decreased thyroxine |
|
|
Term
| signs of rodenticide toxicity |
|
Definition
| induces strychnine causing respiratory failure and warfarin causing hemorrhage |
|
|
Term
| what emits non-ionizing radiation, what are the characteristics |
|
Definition
long wavelength, low frequency
electric power, radio waves, microwaves, infrared, UV light |
|
|
Term
| effects of non-ionizing radiation |
|
Definition
vibration and rotation of atoms
only cause cancer at very high levels |
|
|
Term
| what emits ionizing radiation, what are the chacacteristics |
|
Definition
short wavelength, high frequency electromagnetic waves or particles
x-ray, gamma ray, cosmic ray |
|
|
Term
| effects of ionizing radiation |
|
Definition
| ionize molecules and eject electrons |
|
|
Term
| two major health effects of UV radiation |
|
Definition
premature aging of skin
skin cancer |
|
|
Term
| why is skin cancer rates increasein |
|
Definition
| ozone depletion by CFCs increase UVB and UVC |
|
|
Term
| how does UVB and UVA cancer damage |
|
Definition
|
|
Term
| 7 changes induces by UV radiation |
|
Definition
solar elastosis (wrinkling)
injury to langerhans and keratinocytes
damage DNA
pigmentation changes
edema
erythema
acute inflammation |
|
|
Term
|
Definition
histamine release from dermal mast cells
arachidonic acid metabolites
pro-inflammatiory cytokines (IL-1) |
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|
Term
| which UV causes pigmentation change, how |
|
Definition
UVA oxidizes melanin
increases menalocytes
elongation and extension of dendtiric processes
transfer of melanin to keritanocytes |
|
|
Term
|
Definition
| pyrimidine dimers, DNA breaks, DNA proteins cross link inducing mutations (usually in p53) |
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|
Term
| how does UV damage langerhans and keritanocytes |
|
Definition
induces apoptosis (thymidine dimers detected)
RAS signaling activated |
|
|
Term
| how does UV cause solar elastosis |
|
Definition
degeneration of elastin and collagen causes increased expression of elastin and MMP degradtion of collagen and indroduction of TIMP
generates ROS |
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|
Term
| what does ionizing radiation to do the body |
|
Definition
cells in G2 (esp rapidly dividing ones) are pushed into mitosis
produces ROS increasing cell injury |
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|
Term
| how is the severity of ionizing radiation determined |
|
Definition
single high dose is worse than fractioned
whole body is worse than partial |
|
|
Term
| how much ionizing radiation is needed to cause cancer |
|
Definition
|
|
Term
| causes of acute radiation syndrome |
|
Definition
had whole body radiation
dose dependant
radiation therapy |
|
|
Term
| subclinical radiation syndrome: exposure amount, symptoms, prognosis |
|
Definition
<200 rad
mild nause and vomiting, lymphocytes <1500
100% survival |
|
|
Term
| hematopietic radiation syndrome: exposure amount, symptoms, prognosis |
|
Definition
200-600 rad
intermitent nausea and vomiting
petechiae, hrmorrhage, neutrophil and platelet depression (peaks 2 wek), lymphocytes <1000 uL
infection, may need marrow transplant |
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|
Term
| GI radiation syndrome: exposure amount, symptoms, prognosis |
|
Definition
600-1000 rad
nausea, vomiting, diarrhea
hemorrhage and infection in 1-3 wks
neutrophil and platelet depression severe
<500 uL lymphocytes
shock and death in 10-14 days even with replacement therapy |
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|
Term
| CNS radiation syndrome: exposure amount, symptoms, prognosis |
|
Definition
>1000 rad
intractivle nausea, vomiting
confusion, somnolence convlsions,
coma in 15 min - 3h
lymphocytes absent
death in 14-36h |
|
|
Term
| what are delayed radiation injuries |
|
Definition
infertility
cataracts
fibrosis of skin, GI, GU, vagina |
|
|
Term
| why does radiation cause delayed fibrosis |
|
Definition
| up regulation of chemokines and growth factors involved in fibroblast activation and of chemokines which recruit inflammatory cells |
|
|
Term
| significance of thermal injury depends on |
|
Definition
burn depth
%of surface involved (rule of 9s)
internal injuries from fumes
promptness of care |
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|
Term
| when do burns become fatal, why |
|
Definition
| >50% of body cause shift in body fluids that cause hypovolemic shock |
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