Term
| most common cause of an infarct |
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Definition
| complex atheroma - atheroma with either a defect in the endothelial surface (an ulcer or fissure), or hemorrhage into the plaque. Thrombus forms at the ulcer surface |
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Term
| What is an atheroma, what part of the vessel does it form in? |
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Definition
| fatty streaks with chronic endothelial injury, causing increased lipid permeability and recruiting macrophages, a few T lymphocytes, and platelets. These lesions have lipid with foamy macrophages, smooth muscle cells, and fibrosis. This happens predominantly in the thickened intima, but the media, particularly the inner part, also becomes involved. |
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Term
| Most common site of atheroma formation? |
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Definition
| abdominal aorta, below renal arteries. Other common sites (descending order): proximal coronary arteries, popliteal arteries, carotids (at the bifurcation), & circle of Willis. Areas of turbulence are more likely sites. |
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Term
| Where are diabetics more likely to have vessel disease |
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Definition
| popliteal and iliac regions |
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Term
| Where are those with hypertension more likely to have disease resulting from atheroma? |
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Definition
| Renal disease or stroke. The renal disease is usually microvascular / arteriolosclerosis (see below). |
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Term
| Define Arteriosclerosis, what does it commonly cause? |
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Definition
| hyaline thickening of arterioles, especially in the kidney. This can be seen in the elderly, but is more common in patients with diabetes or hypertension. A common cause of chronic renal failure. |
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Term
| What porion of the lumen is usually occluded when sequalae are seen |
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Definition
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Term
| What does the term angina refer to? |
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Definition
| Pain due to decreased blood flow to an area or tissue. |
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Term
| Coronary heart disease causes what % of heart disease? |
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Definition
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Term
| Mönckeberg's medial calcific sclerosis |
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Definition
| Calcification of the arterial media. Does not cause lumen narrowing or other problems but can be seen on X-rays. |
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Term
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Definition
Central (or visceral) obesity plus at least two of:
Hypertension
High triglycerides
Diabetes type II
Low HDL |
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Term
| Developmental anomalies are present in % of spontaneous abortions & stillbirths, and % of neonatal deaths |
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Definition
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Term
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Definition
| several anomalies, some of which cause other anomalies |
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Term
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Definition
| multiple related anomalies, but not one caused by another. |
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Term
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Definition
| breakdown of a previously normal structure (amniotic bands). |
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Term
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Definition
| Epithelium and connective tissue surrounding the sac. |
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Term
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Definition
| Fetal connective tissue, vessels etc.. nearby |
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Term
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Definition
neutrophils in membranes, often chorionic plate & umbilical cord.
Usually due to ascending bacterial infection. Membranes are opaque. Seen with premature rupture of membranes. Causes potentially fatal fetal infection. |
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Term
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Definition
| Green discoloration - - fetal distress causes defecation in utero. Aspiration can be serious. |
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Term
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Definition
vernix forms nodules on membranes and cord; can peel off. Implies lack of amniotic fluid (oligohydramnios), meaning either loss of amniotic fluid or lack of fetal urination.
Differential diagnosis - squamous metaplasia - does not peel off - harmless. |
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Term
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Definition
| amniotic epithelium is denuded & adheres to fetal surfaces, causing disruption, deformation, & malformation. |
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Term
| Umbilical cord insertions |
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Definition
Marginal insertion - at edge of disk - 5-7% of cases, mild risk of vessel rupture.
Velamentous insertion - into sac away from disk. Vessels in sac wall are not protected by Wharton's jelly. Can rupture or be compressed. |
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Term
| What can a small placental disk cause |
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Definition
| uteroplacental insufficiency, can cause IUGR, fetal stress or death. |
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Term
| What causes a large placental disk |
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Definition
| maternal diabetes, fetal hydrops (edema), syphilis. |
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Term
| Three terms for placental invasion of the uterus |
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Definition
Placenta accreta - adheres to myometrium rather than endometrial decidua
Placenta increta - interdigitates with myometrium.
Placenta percreta - invades through myometrium to serosa. Causes hemorrhage or uterine rupture. 10% fetal or maternal mortality. |
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Term
| What is an abruption and what does it cause? |
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Definition
| premature separation of placenta from uterine wall. Causes retroplacental hematoma & placental insufficiency. |
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Term
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Definition
placenta implanted over cervical os. Increased maternal age & smoking are risk factors.
Impairs delivery, causes bleeding, abruption, & IUGR. 10% perinatal mortality. |
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Term
| Placental Parenchymal hypermature villi |
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Definition
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Term
| Placental Parenchymal hypomature villi |
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Definition
| maternal diabetes, Rh incompatibility. |
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Term
| Placental Parenchymal Inflammation chronic |
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Definition
| chronic villitis (plasma cells, lymphocytes) can be due to TORCH organisms (Toxoplasma,Other, Rubella, Cytomegalovirus, Herpes simplex), but often of unknown cause. Can be seen with stillbirth or IUGR. |
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Term
| Placental Parenchymal Inflammation acute |
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Definition
| acute villitis (neutrophils) seen with Listeria. |
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Term
| Fraternal (dizygous twins) |
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Definition
| Can have 1 or 2 placental disks. If together, they are dichorionic diamniotic. |
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Term
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Definition
| can be dichorionic diamniotic or monochorionic monoamniotic, but ~90% are monochorionic diamniotic (2 amniotic sacs but no chorionic layer between them). Any twins are at increased risk of deformations, velamentous insertion, or a single umbilical artery. Monozygous twins also have an increased risk of perinatal death, particularly the uncommon monochorionic monoamniotic twins. They can be conjoined. There can be twin-twin transfusions, with blood shunting from one circulation to the other in the placenta. |
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Term
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Definition
| a malignant tumor differentiating like villous epithelium. Makes HCG. |
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Term
| Complete mole 46XX from paternal chromosome only |
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Definition
| More common in Asians. First noted as a pregnancy, uterus grows too rapidly, HCG is way too high for dates. No fetus - most of the chorionic villi are enormously enlarged. 10-20% recurrence, possibly as a choriocarcinoma. |
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Term
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Definition
| Triploid (an extra set of chromosomes from either parent). Fetus present but small, HCG is elevated. Some villi are edematous. Uncommonly recurs or transforms into choriocarcinoma. |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| Malignant hyperthermia - rare metabolic disorder from exposure to succinyl choline / volatile anesthetics. Cocaine & thyrotoxicosis can cause similar changes. |
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Term
| Hyperacute transplan rejection |
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Definition
| Preformed antibodies to an antigen in the transplant, causing an immediate type II reaction with complement fixation on the graft endothelium and immediate thrombosis & infarction. |
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Term
| What is diagnostic for acute humoral transplant rejection |
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Definition
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Term
| Sjögren syndrome characteristic serology |
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Definition
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Term
| Scleroderma characteristic serology |
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Definition
| Anti-topoisomerase 1 for scleroderma and anticentromere antibodies for CREST syndrome. |
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Term
| Dermatomyositus/polymyositus mechanism mechanism and serology |
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Definition
| Lymphocytic infiltrate in muscle, causing weakness &, in dermatomyositis but not the otherwise similar polymyositis, a red-purple "heliotrope" rash on the face, upper chest, & shoulders. Serology: Jo-1 antibodies helpful if present, but are present in only a quarter of cases. Dermatomyositis is often cancer associated in the elderly. |
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Term
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Definition
| most common. It is from immunoglobulin light chains & is found in myelomas in which the light chain is not fully digested. Usually presents after the myeloma, but occasionally is present first. |
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Term
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Definition
| present in chronic inflammatory diseases, it is a breakdown product of SAA. Less common since the introduction of effective antibiotics. |
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Term
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Definition
| from transthyretin - causes mostly cardiac amyloid in old men, but there are familial forms with a mutated transthyretin that can cause either cardiac or other localization (particularly amyloid in nerves). |
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Term
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Definition
| deposits in joints of hemodialysis patients. |
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Term
| Vitamin B1 defiency (Thiamine) |
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Definition
Wet beriberi – high output heart failure
Dry beriberi - peripheral neuropathy
Wernicke-Korsakoff syndrome - memory loss, confusion, & ataxia (poor coordination, including eye movements), mostly in alcoholics |
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Term
| Vitamin B2 (Riboflavin)deficiency |
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Definition
| nonspecific changes - skin scaling, cheilosis. |
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Term
| Vitamin B3 (niacin) deficiency |
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Definition
| pellagra: dermatitis, dementia, & diarrhea. |
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Term
| Vitamin B6 (pyridoxine) deficiency |
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Definition
| Deficiency like riboflavin deficiency plus neuropathy. |
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Term
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Definition
| megaloblastic anemia. Also neural tube defects in developing fetus. |
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Term
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Definition
| Deficiency causes megaloblastic anemia & neuropathy |
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