Pathology Test 2

What is the most common thyroid malignancy? Papillary carcinoma histological features

Papillary carcinoma Optic clear nuclei, intranuclear cytoplasmic inclusions, nuclear grooves, psammoma bodies, lymphatic invasion

Endocrine effects of pineal lesions? Neurologic effects of pineal lesions?

Precocious puberty due to melatonin deficiency increased intracranial pressure from mass effect, non-neoplastic cysts, pineal parenchymal tumors

Other organs that chronic alcoholism can damage

cardiomyopathy, rhabdomyolysis, atrophy of testis, chronic pancreatitis, fetal alcohol syndrome (many malformations and retardation)

Amyloid is not a ______ _______ entity even though it appears uniform. Amyloidosis is a group of diseases that have in common the....

chemically distinct deposition of similar-appearing proteins

What things are part of the local mass effect? Why visual problems?

Radiographic abnormalities of the sella turcica, visual field abnormalities, elevated intracranial pressure, pituitary apoplexy Because of the optic nerves proximity to the pituitary gland

SLE -organ involvement that most commonly leads to death

Renal failure, heart failure, CNS involved, incurrent infections

What is the histology of the anterior pituitary like?

Routine H & E stained section reveal a colorful array based off of 5 cell types. 1) somatotrophs (GH) 2) Lactotrophs/mammotrophs (prolactin) 3) corticotrophs (ACTH/POMC) 4) Thyroptrophs (TSH) 5) Gonadotrophs (FSH & LH)

Secondary hyperparathyroidism -due to what? (general)

conditions causing chronic decreased calcium, which leads to compensatory parathyroid hyperplasia.

Hypoparathyroidism causes? What are the clinical manifestations of hypoparathyroidism? *tetany, neuromuscular irritablility, anxiety depression, confusion, hallucinations, frank psychosis, calcification of the basal ganglia, parkinsonian like movement, increased intracranial pressure with resultant papilledema, prolonged QT interval in the ECG, dental hypoplasia, failure of tooth eruption, defective enamal and root formation*

congenital absence, surgery/radiation, autoimmune, familial

Chronic GVHD

could follow acute symptoms, or may occur insidiously. Skin lesions mimicking SS.

What is the most common cell type in the anteror pituitary? Posterior pituitary -What cells does it contain? -What two hormones does it secrete, -where are they synthesized, -and when are they released?

Somatotrophs, about 50% -modified glial cells (pituicytes) -Oxytocin and ADH (vasopressin) -in the hypothalamus -in response to stimuli like labor, postpartum, dehydration and hypovolemia

What are the symptoms from Vitamin B3 (niacin) deficiency?

THREE Ds: Dermatitis= bilateral and symmetrical lesions are seen where light hits skin. the areas are demarcated, roughened, keratotic, scaly, and could be pigmented or depigmented. Diarrhea=intestinal lesions, with edema and inflammation, problems with the crypts of Lieberkuhn. Dementia=lesions in central nervous system, degeneration of neurons in the brain. Demyelination of the posterior and lateral columns of the spinal cord

What happens in the indirect pathway of graft rejection?

The recipients APC recognize the graft cells and present them to CD4+ T-cells. this causes activation of helper T-cells, and therefore macrophage activation and plasma cell (which are from B-lymphocytes) antibody production

What is feedback inhibition? How can endocrine diseases usually be classified?

The target tissue secretes factors that down-regulate the activity of the gland producing the hormone as either under or overproduction of hormones and the resulting biochemical and clinical consequences. Or diseases associated with development of mass lesions

What are HLAs? The direct pathway is most important for ____-______ ______ rejection The indirect pathway may play a greater role in _______ rejection

They are the major antigenic difference between a donor and recipient that result in rejection of transplants. They are highly polymorphic CTL-mediated acute Chronic

*heterophilic antibodies can react in all sorts of assays like thyroid, tumor, pregnancy, cardiac testing* How can we remedy heterophilic antibody interference?

We can dilute the test results, which should generate the correct result since the heterophilic antibodies are lower in titer and affinity than the animal-based antibodies in the immunoassay

What is the hook effect? Which type of preg. test does it affect?

When hCG levels are so high during pregnancy that they take up all the detection antibody binding sites, therefore you get a false negative both urine or blood

What gives us the best outcome (in terms of Graft failure and acute GVHD)? What is important about calcineurin?

When someone is matched and related, followed by matched and unrelated, followed by mismatched related one of the first immunosuppressors, it blocks IL-2. Was first made as cyclosporin, then made into tacrolimus

The adrenal cortex makes up 80% of the gland and consists of what three parts? What is the adrenal medulla composed of?

Zona Glomerulosa=mineralcorticoids. Zona Fasciculata=glucocorticoids. Zone Reticularis= sex steroids chromaffin cells that synthesize catecholamines, mostly epinephrine

What is amyloid? How are fibrils produced?

a PATHOGENIC protenaceous substance, deposited in the extracellular space in various tissues and organs of the body. Extracellular deposits of fibrillar proteins by the aggregation of misfolded proteins

What is the definition of an autoimmune disease? What is the diagnosis usually dependent on for autoimmune diseases?

a disease that involves immune reactions against self antigens, because of a breakdown of self-tolerance. They can be organ-specific (local damage) or non-specific (systemic damage) based on the site of involvement and presence of auto-antibodies

What is maturation in nevi? What happens if a nevus loses maturation?

a feature of being benign. The most superficial nevus are immature, larger and melanin producing. The deeper cells are mature, smaller, fusiform and do not produce pigment. It probably has turned malignant

What is Eczema? What can it be classified into?

a general term used to describe disorders characterized by red, papulovesicular, oozing, and crusted lesions that with time develop into raised scaling plaques 1) allergic contact dermatitis 2) atopic dermatitis 3) drug-related eczematous dermatitis 4) photoeczematous dermatitis 5) primary irritant dermatitis

What is Xeroderma pigmentosum?

a mendelian recessive genetic disorder with defects in DNA excision repair pathway. Causes increased development of skin cancers in exposed areas.

What is immunologic tolerance? What is central immunologic tolerance for T-cells?

a state of unresponsiveness to an antigen that is induced by exposure to a specific lymphocyte to that antigen. clonal deletion, which is when T-cells in thymus, and B-cells in bone marrow are made sure to be inactive to self-antigens. If they are not they are deleted.

What is latex agglutination

a way to diagnose RA, the rheumatoid factor (RF) antibody that is normally directed against the host, will also be directed against latex particles that we coat with IgG. If we see agglutination we know they have the disease

What do amyloid fibrillar deposits bind? how do amyloid deposits appear and how do we recognize them?

a wide variety of proteoglycans and glycosaminoglycans and plasma proteins sometime insidiously and sometimes mysteriously, we recognize them morphologically because they appear amorphous, eosinophillic, hyaline, and extracellular substance

What is the point of the Low-dose dexamethasone suppression test, and what is important to keep in mind? What is dexamethasone?

To check to see if the person has the normal cortisol diurnal rhythm of high in the morning and low in the evening. Important that the person is not stressed during this test an exogenous steroid that mimics the endogenous feedback of glucocorticoids

Acute GVHD

days to weeks, causes epithelial necrosis primarily in the liver, skin, or gut. Will see jaundice and mucosal ulceration causing bloody diarrhea, maybe a rash

What is common of acute lesions? What about chronic lesions?

days to weeks, inflammation, edema, epidermal and vascular injuries months to years, significant alteration in epidermal growth, or dermal fibrosis

What are the two main diseases of the islet cells? pancreatic endocrine neoplasms -most common in _______ -how do they vary? -Three major clinical syndromes?

diabetes mellitus, pancreatic endocrine neoplasms -adults -single/multiple, benign/malignant, functional/nonfunctional -hyperinsulinism, hypergastrinemia and the Zollinger-Ellison syndrome, MEN syndrome

What is a pustule

discrete, pus-filled raised area

What two questions should a physician ask who is looking to diagnose Cushing's syndrome? What is the purpose of, and what are the initial screening tests for Cushing's?

do they actually have it, and what is the cause? do determine if they actually have it, low-dose dexamethasone suppression test, urinary free cortisol (UFC)

What is the basics of graft vs. Host disease? What are the basics of rejection? Why is bone marrow important in graft vs host disease?

donor immune T-cells attack the recipient tissue patient immune T-cells and antibodies attack the donor graft in a bone marrow transplant, the donor marrow has T-cells at different stages of maturation. Some of them may be mature enough to react and can cause a major rejection

why are wounds harder to heal with scurvy? Where do we get vitamin D? and what type of hormone is it?

due to lack of collagen, so the wound is healed with poor tensile strength and can get infected. it is a steroid hormone, and is synthesized in skin from UV light, metabolized to calcitriol in liver and kidney. Fish liver is a great source, while other foods are supplemented

*fibers can prevent in cancer, while high fat foods can cause it* What are some recommendations for diet to prevent cancer?

eat high fiber foods, vitamins like A,C,E, and folate. moderate in alcohol consumption and salty meats, or nitrite-cured ones

What can Cushing's be confused with?

ectopic ACTH production by a pituitary tumor

What can lead you to believe someone has acromegaly or gigantism? How to perform a glucose suppression test?

elevated plasma GH, that does not suppress in response to rising glucose concentration insert an indwelling IV cannula, take basal blood sample for plasma glucose and GH. Have pt drink 75g glucose in 300mL water. Take blood samples for glucose and GH at 30, 60, 90, 120 minutes

What is a nodule?

elevated, solid area, >5mm diameter

What is a papule?

elevated, solid area, up to 5mm

What are symptoms of aids? *36.7 million world wide cases, mostly women are affected, 1 million deaths per year*

encephalitis, meningitis, retinitis, pneumonia, higher TB risk, tumors, esophagitis, diarrhea

LPS is an example of an ________ What is in anthrax that causes damage? How does our body respond to TB?

endotoxin A and B toxins which cause damage tries to wall it off

What should an adequate diet supply? What is the MDR?

energy, sufficient macros, vitamins and minerals. Should also differ by age, metabolic state and health Minimum requirement of an essential nutrient that maintains normal chemical composition, morphology, and physiology of organs in the body

What is spongiosis What is acanthosis What is erosion? What is ulceration?

epidermal intercellular edema diffuse epidermal hyperplasia, many times from chronic injury discontinuity of the skin with incomplete loss of the epidermis discontinuity of the skin, with complete loss of the epidermis and often of portion of the dermis and subcutis

Psoriasis -morphology

epidermal thickening (acanthosis) with elongation of rete ridges, thinned or absent granular layer with extensive parakeratosis, thin suprapapillary plates. MUNRO MICROABSCESSES=aggregates of neutrophils within parakeratotic scale

What does the basement membrane seperate and what is it composed of mostly? What is the dermis, what is it composed of, and what does it do?

epidermis from dermis, predominantly collagen type IV layer underneath the epidermis. Composed of connective tissue like collagen, elastin. Also nerves and appendageal structures. It protects the body from injury, binds water, aids in thermal regulation, and gives body sensory

How is the prognosis for papillary carcinomas? Follicular carcinoma -Common in what areas? -________ _________ is common -How is it treated?

excellent -areas with dietary iodine deficiency -vascular spread -total thyroidectomy followed by radioactive iodine

What is a macule?

flat, circumscribed, discolored area

What is a vesicle?

fluid filled, raised area, up to 5mm

What kinds of cell irritants and toxins are in tobacco smoke? What kinds of carcinogens? How are they metabolized?

formaldehyde, ammonia, Nitrogen oxides, CO, nicotene Polycyclic hydrocarbons, nitrosamines by the cyt p450 system

What is crusting?

from ruptured vesicles, serum leaking leads to crusting on skin

What factors contribute to Vitamin B12 deficiency? What is Vitamin B12 used to treat?

gastric atrophy, terminal ileal disease, strict vegetarianism, acid-reducing drugs. used in treatment of homocysteinuria, but supplementation does not reduce myocardial infarcts in patients with vascular diseases

Symptoms of malaria *214 million new cases, 0.44 million deaths*

headache, fever, fatigue, pain, chills, sweating, dry cough, splenomegaly, nausea, vomitting

How to diagnose Primary hyperaldosteronism How to diagnose secondary hyperaldosteronism

high aldosterone and low renin concentration. high aldosterone and high renin concentration

What is the normal diurnal rhythm of cortisol like? What about in people with Cushing's syndrome?

highest in the morning and lowest at midnight it is high all the time

Clinical course of hyperaldosteronism

hypertension, which may be the most common cause of treatment-resistant secondary hypertension. Hypokalemia

What is the most common cause of Cushing's syndrome? What is a less common cause?

iatrogenic, which is caused by prolonged use of steroids tumor secreting cortisol or ACTH, can be difficult to diagnose

What is the basis behind urinary free cortisol? How to do a UFC test?

if cortisol is produced in excess it will show up in the urine because it exceeds the plasma binding protein (cortisol binding protein) availability measure over a 24 hr period, cushing's syndrome is excluded if the excretion is <250nmol/24hr

When is thiamine deficiency most commonly seen? Vitamin B2 (riboflavin) -function

in alcoholics or diuretic abuse converted to Flavin Mononucleotide (FMN) and Flavin-adenine dinucleotide (FAD). Important for metabolism, RBC production, and skin integrity *think FMN and FAD from riboFlavin*

difference in hCG during pregnancy and during tumors *different variants of hCG occur also based off of sugar residues or processing by enzymes (called nicked hCG)* When does hyperglycosilated hCG dominate? What does nicked hCG contain?

in pregnancy, the intact hCG dominates, meaning it has both a and B-subunits. In tumors, you see more of the B-subunit only hCG during early pregnancy (3-5 wks) a cut or gap in the backbone of the protein

What might lead to a false negative in UFC test? What else can lead to abnormal results?

incomplete collection if urine depressed or stressed patients, severe illness, alcoholism (pseudo-cushing's syndrome)

Skeletal changes seen with primary hyperparathyroidism

increased bone resorption from increased osteoclast activity, increased formation of bony trabeculae from increased osteoblast activity, this results in widely spaced and thin trabeculae. Marrow with hemorrhage, cyst formation, fibrosis. Masses with giant cells and hemorrhagic debris

What lab tests to diagnose pheochromocytomas? What treatment? (if benign, if multifocal)

increased urinary excretion of free catecholamines and their metabolites, like vanillylmandelic acid and metanephrins surgical excision if benign, long-term treatment for hypertension if multifocal

What is the process of suppuration?

increased vascular permeability, leukocyte invasion ESPECIALLY of neutrophils, this results in pus, abscess results from accumulation of pus in a confined space

How is the Insulin Hypoglycemia test/Insulin stress test (IST) performed?

insulin is administered IV to lower blood glucose below 40, you do this while monitoring serum cortisol. Serum glucose and cortisol are taken basally before the insulin, and also at 30,45,60, 90 min after insulin injection

What is the endocrine system? What is endocrine signaling?

integrated and distributed group of organs that orchestrate a state of metabolic equilibrium secreted molecules, mostly hormones, act on target cells distant from their site of synthesis, they are carried there in the blood

How in influenza taken in? 4 attributes of parasites

it has a hemoglutin on its capsid, which has tropism for the host sialyc acid of the respiratory tract. They bind to one another and influenza enters virulence, invasiveness, toxin production, hypersensitivity

Vitamin B5 (pantothenic acid) does what? (component of ______-____ that helps with produciton of _____ from ____ and ______)

it is a component of acetyl-CoA, helps in production of energy from fats and sugars

What is important about rituximab? Rejection can be ______ or ______ mediated

it is anti-CD20 and is a MAB, so it doesnt shut off plasma cells, just B-cells Cell, antibody

What hematological effects of infection are seen?

leukocytosis (increase in neutrophils and other leukocytes), which means they "shift to the left". Anemia. Coagulation since fibrin can be an acute phase protein

What is parathyroid activity controlled by? what do decreased and increased levels of free calcium result in?

levels of free calcium in the blood stream decreased= PTH synthesis and secretion. Increase= inhibits PTH secretion by feedback loop

Chronic alcoholism issues? -Liver -CNS -Neuropathy?

liver: acute hepatitis, steatosis, cirrhosis. CNS: wernicke's and Korsakoff's syndromes, cerebellar degeneration due to associated thiamine deficiencies Peripheral Neuropathy: thiamine deficiencies

Where is localized amyloidosis most commonly seen? What is endocrine amyloid?

lung, larynx, skin, bladder, tongue, eye microscopic deposits of localized amyloid seen in endocrine tumors most commonly like thyroid gland, pancreatic islets. derived from polypeptide hormones. Seen in Type II diabetics

Describe MHC class II Describe MHC class III

made up of DP (BaBa), DQ (Ba), DR (BBBa), should know that they have alpha and beta chains compliment

What does the pineal gland produce? What does melatonin do and when are its levels highest?

melatonin serotinin derivative that inhibits GnRH release, its levels are highest in the dark

Effects of lead (______ ______ anemia, brain ______ and _______ especially in children, _______ _______ causing _____ and ______ drop. Inflammation of the GI tract called "______-_______" on _______ ______. __________ nephritis, lead-protein complexes in ______ cells, increased chance of ______ ______ and ______. "________ ______")

microcytic hypochromic anemia, brain edema and demyelination especially in children, demyelinating neuropathy causing wrist and foot drop. Inflammation of GI tract "lead-line" on gingival margin. Tubulointerstitial nephritis, lead-protein complexes in tubular cells, increased renal adenoma and carcinoma "saturnine gout"

Chronic rejection basics GVHD basics

months to years. gradual narrowing of graft vessels from T-cells releasing cytokines immunologically competent cells are transplanted into a immunosuppressed host, and recognize the host alloantogens and attack.

How does Chlamydia cause damage? What is important about mycoplasma?

most common cause of female sterility from pelvic inflammation and fallopian tube scarring. It can also cause scarring of the eye/conjunctiva leading to blindness can cause pneumonia, "walking pneumonia." Does so by P1 adhesion, which blocks the ciliary action in the respiratory mucosa

What happens clinically with insulinomas that is strange lab findings in insulinoma treatment?

most demonstrate excessive insulin secretion, but few people have hypoglycemia high levels of insulin, and high insulin-to-glucagon ratio surgical removal of tumor

what are four major ways we deal with infections?

neutralization/inactivation of toxin by antibodies, cytotoxic/cytolytic reactions against infectious organism, delayed type hypersensitivity results in mobilization of phagocytes to the area, granulomas localize the infection (TB and mycobacterium)

Transthyretin (TTR)? B2-microglobulin

normal serum protein that binds and transports thyroxine and retinol. a mutant form of it is common in familial amyloid component of MHC class I and normal serum protein. seen as AB2m in amyloidosis. Complicates the course of patients on long term hemodialysis

Junctional nevi pic

notice it is flat

Compound or dermal nevi

notice it is raised

Histological picture of maturation

notice the large nests up top, but smaller ones below it

How to perform the oral glucose tolerance test? What does it mean if the OGTT results are... ->200 ->140 but <200 What does it mean if fasting glucose levels are >110 but <126?

obtain basal blood sample after overnight fast, patient ingests 75g glucose in 250-300mL water, blood sample taken after 2hr. -diabetes -impaired glucose tolerance -impaired glucose tolerance

Where is ABO blood groups expressed in the body? What is hyperacute rejection?

on the surface of RBCs and endothelial cells pre-existing antibodies react to donor tissue, happens within minutes or hours

Marismus and Kwashiorkor can ________ with each other Generalized facts about kwashiorkor and marismus -growth? -organs? -anemia? -immune system? -skin?

overlap. -retardation of growth -atrophy and hypoplasia -hypochromic and microcytic -impaired immune system -dyspigmentation, scaling, and ulceration

What clinical effects are there of pituitary adenomas? Prolactinomas -What defines it? -what symptoms? -What causes? -How to treat it?

overproduction of hormone based on type of adenoma -Most common type, increased prolactin secretion -amenorrhea, galactorrhea, decreased libido/infertility -drugs, estrogens, renal failure -surgery or bromocriptine

What do craniopharyngiomas look like in adults?

papillary, lack keratin, calcification of cysts

What factors can alter nutritional threshold

physiological factors (excersize, pregnancy, aging), composition of diet, route, rate, and time, disease states

What is the penial gland? What doers the pineal body consist of?

pine-cone shaped midline structure. can be seen in X-rays because it is often calcified lobar parenchyma of epithelial pinealocytes and glia

What is an example of acute eczematous dermatitis? how do these lesions progress over time?

poison ivy they become less wet, fail to ooze, and become more scaly

Clinical outcome of amyloidosis What are new therapeutic strategies aimed at?

poor, people with immune derived form = 2 year survival so the myeloma form is worse. Reactive systemic amyloidosis has a better outlook correcting protein misfolding and inhibiting fibrillogenesis

MEN1A involves what three organs, and what are some facts about each?

primary hyperparathyroidism (hyperplasia and adenomas), Endocrine tumors of the Pancreas (leading cause of morbidity and mortality in people with MEN1, aggressive and metastatic. gastrinomas and insulinomas), Anterior Pituitary tumors (prolactinoma is the most common)

What are the symptoms of TB? *8.6 million chronic cases active, 1.2-1.45 million deaths per year*

productive cough, poor appetite, night sweats, weakness, fever, dry cough, weight loss, GI issues, chest pain

what is colonization? What is subclinical infection? What is a clinical infection?

proliferation of a parasite in a host without causing a disease (normal flora) host undergoes injury, but remains free of symptoms (as is the case for 90% of TB infected people) disease and damage to host (as is the case for 10% of TB infected people)

pathophysiology of kwashiorkor

protein deficiency with adequate caloric intake. Increased insulin secretion but adipose tissue is preserved. Mobilization of amino acids from skeletal muscle to liver. decreased plasma aa, decreased protein synthesis, decreased lipoproteins, edema and fatty infiltration of liver

What are the renal effects of infection? What about the hepatic effects?

proteinuria, glycosuria, azotemia, oliguria increased protein synthesis

What is part of the acute phase response to infection? What are the cardiovascular effects of infection?

pyrogens, cytokines, compliment, C-reactive protein, opsonins, fibrinogen, ceruloplasmin changes in HR, BP, hypotension, shock. Seen in sepsis

What is the RDA? What is the MDT? What is the EAR?

recommended daily allowance: ranged form 1.5-10 times the MDR, provides a margin of safety to cover virtually the whole healthy population max daily tolerance: max quantity someone can have in a day without disturbing normal structure or function Estimated average requirement: estimated adequacy of nutrient for half the healthy individuals of a given age and sex

What does elaboration of cytokines cause?

recruitment of activated macrophages and inflammatory damage, or extracellular structural changes

What are some attributes of infectious agents?

replicate either in the environment, or in a host (in cells, just extracellular). Usually provoke a host response. Could be acellular, unicellular, or multicellular

diabetes mellitus can lead to increased risk of... What are the three ways to diagnose diabetes mellitus?

retinopathy, renal failure, neuropathy, atherosclerosis 1) classical symptoms and signs of the disesase, along with a random plasma glucose level >2hrs after last meal of over 200mg/dL. 2) A fasting (8hr) glucose value of >126mg/dL on more than one occasion. 3) test after pt has ingested 75-g glucose, and get a result of >200mg/dL called the ORAL GLUCOSE TOLERANCE TEST

What is dyskeratosis? What is acantholysis?

abnormal keratinization occuring prematurely in cells below stratum granulosum, an example is squamous cell carcinoma loss of intercellular connections between keratinocytes, they may break apart from one another

What is peripheral immunologic tolerance for T-cells? What happens to a B-cell that is different from T-cells?

activation induced cell death, or it can result in clonal anergy (inactivation), or T-cell mediated suppression by regulatory T-cells from T-cells reacting to self antigens along with Co-stimulatory molecules they can undergo receptor editing to rearrange their antibody if they fail either central or peripheral tolerance

Vitamin C -What is it used for in the body?

activation of prolyl and lysyl hydroxylase, which allows for the hydroxylation of procollagen. Vitamin C also plays a role in maintaining iron in its reduced state, and helping in its absorption. It is a powerful antioxidant and reducing agent, involved in many redox reactions.

What is the principal cause of early graft failure? What are the basics of acute rejection?

acute rejection it is mediated by T-cells and antibodies that are activated by alloantigens in the graft. Days or weeks.

What is clinically apparent hypercalcemia?

seen in malignancies, solid tumors can release PTH related protein (PTHrp), this causes PTH levels to be low to undetectable because our body thinks it already has enough. So PTH levels will be low in nonparathyroid diseases

pregnancy tests for hyperglycosylated hCG are more _________ since it appears in _______ pregnancy Which is more sensitive, urine or blood pregnancy tests? So when would blood/serum testing be prefered?

sensitive, early blood in a hospital setting so we dont end up doing any procedures on a pregnant woman

What do craniopharyngiomas look like in children?

adamantinomatous, squamous epithelium, wet keratin, calcification, cysts contain "machine oil"

How to treat primary Hyperaldosteronism How to treat secondary hyperaldosteronism

adenomas=surgical excision, hyperplasia=medical treatment correction of underlying cause that is stimulating the renin-angiotensin system

How does a virus with a capsule enter the cell? What about one with an envelope?

adherence, then is engulfed by cell and surrounded by a vesicle as it is endocytosed adheres, its envelope then fuses with the cell membrane and the genetic material is entered into the cell

What kind iatrogenic agents can cause issues? What kinds of damage can antineoplastic agents cause?

adverse drug reactions that can exaggerate normal effects, or unpredictable responses to normal doses causing anaphylaxis Damage to bone marrow (anemia, thrombocytopenia, leukopenia), damage to lymphocytes (immunosuppression), mutagenic and carcinogenic

Who is exposed to asbestos and what does it cause?

shipyard workers, construction. It causers lung cancer and mesothelioma and works synergistically with tobacco smoke

What are C-cells in the thyroid gland? What are goitrogens

aka parafollicular cells, they secrete calcitonin which lowers serum calcium levels by promoting bone absorption of calcium and inhibiting bone resorption by osteoclasts chemical agents that inhibit the function of the thyroid gland by suppressing T3/T4, examples include propylthiouracil, iodides in large doses and vegitables

What are the clinical criteria for diagnosing SLE?

alopecia, joint issues (arthritis), serositis (pleuritis and pericarditis), renal disorder, neurological disorder, hemolytic anemia, leukopenia, lymphopenia, thrombocytopenia

What happens in the direct pathway of graft rejection?

an APC in the graft will either activate CD4+ T-cell by presenting its MHC II or a CD8+ T-cell by presenting its MHC I. This causes activation of our immune system, blood supply to the organ to be cut off, and damage

What are 5 major things that affect resistance? *also Chediak-Higashi, hormones, aging, nutritional status*

anatomical barriers, immunoglobin deficiency, congenital thymic aplasia, Job syndrome, Chronic granulomatous disease (no neutrophil oxidative burst)

What are the immunological criteria for diagnosing SLE?

antinuclear antibody, anti-dsDNA antibody, anti-Sm antibody, anti-phospholipid antibody, low compliment, direct Coombs test

What can happen in excess vitamin A?

skin desquamation, alopecia, Headache, hyperexcitability, increased intracranial pressure with bulging fontanelles in children. Mental disturbance, neural crest defect in babies. Nausea, vomiting diarrhea

Herbicides *fungicides, rodenticides and fumigants can also cause issues*

arsenicals and organic compounds can cause issues

What kinds of things are direct damage caused by autoantibodies? What about indirect damage?

autoimmune hemolytic anemia in SLE. Or cytotoxic/suppressor T-cells causing damage. NOT ALL autoantibodies become pathogenic by deposition of immune complexes, subsequent activation by compliment syndrome, and chemotaxis of leukocytes

How is tobacco related to cancer? What happens in COPD?

smokers have a tenfold risk of lung cancer and over 80% of lung cancers are in smokers. loss of alveolar structure leads to loss of gas exchange

What triggers autoimmunity in some poeple (genes)? Other than genes, what can lead to autoimmunity?

some individuals have genetic susceptibility, which makes them fail self-tolerance. They therefore create self-reactive lymphocytes environmental factors, infections or tissue injury

Response to infection -neoplasia What three infectous diseases cause the most worldwide damage? Which one of those is the most deaths?

some viruses can cause this like HPV (16 & 18) TB (most deaths), malaria, HIV.

What is dimorphic growth? Helminths (parasitic worms) -disease is often from?

something grows differently in low temp (filamentous growth) vs high temp (yeast-like growth) -response to pathogen and is proportionate to the number of organisms in that persons body

What do you see in untreated cases of graves disease?

symmetrical diffuse hyperplasia of thyroid, it is soft, follicular epithelial cells encroaching on colloid making it pale and with scalloped margins

Basic concept of the renin-angiotensin system

sympathetic stimulation, hypotension, or decreased sodium delivery-->renin produced--> angiotensin I converted to Angiotensin II through ACE--> multiple organ effects, including adrenal cortex aldosterone secretion

How do normal immunometric assays work? What is important about heterophilic antibodies? (false/high positive results

the antigen is trapped between a detection antibody and a capture antibody. They can interfere with immunometric assays by binding between the detection and capture antibodies, which will result in a false/high negative result

Why are thrombi important for bacterial infection? What is a gram positive species? What is a gram negative species?

the bacteria can proliferate in them, then travel to other parts of the body where they can cause systemic symptoms bacteria with a thick peptidoglycan coat, stains purple in crystal violet thin layer of peptidoglycan, so it doesnt stain. But does have a thick layer of LPS

*prions in the CNS will resemble amyloid proteins* Misfolded proteins are often unstable and self-associate, leading to... two categories of amyloid pathogenesis

the formation of oligomers and fibrils that are deposited in tissues 1) normal proteins, that have the tendancy to fold wrong, join together and form fibrils, when they are produced too much. (AL and AA protein) 2) mutant proteins that are prone to misfolding and subsequent aggregation (ATTR protein)

What chromosome is MHC on? Describe MHC class I gene

the short arm of chromosome 6 composed of B, C, and A

What is important about superficial fungal infections? What is important about tinea captits? Tinea barbe?

they are confined to the stratum corneum, and are caused by dermatophytes that grow in soil and on animals usually in children, forms hairless patches, or erythema, crust formation and scales infection of the beard of adults

What kinds of things are arthropods? What is parasitism?

they are ectoparasites like lice, bedbugs, fleas, stinging insects, mosquitos. Can carry disease interactions that exploit the living environment of one creature

What does it mean if someone has impaired glucose tolerance and what are they at a higher risk for? how many of them will progress to diabetes?

they have a mild disorder of carbohydrate metabolism, rather than diabetes. It increases their risk of getting atherosclerosis. 2-4%

what is Hyperkeratosis? What is parakeratosis?

thickening of the stratum corneum by abnormal keratin, WITH NO NUCLEI RETENTION RETENTION OF NUCLEI, in stratum corneum

What is lichenification?

tree bark looking skin from chronic injury

Familial medullary thyroid cancer -What is it?

variant of MEN2A, person has predisposition to medullary thyroid cancer, but no other manifestations of MEN2A or MEN2B

Morphological changes of primary hyperparathyroid adenomas

well circumscribed, encapsulated, tan/brown nodule, non neoplastic parathyroid tissue separated by fibrous capsule is present, composed of MOSTLY chief cells, and a FEW oxyphil cells, adipose tissue is inconspicuous

What is a Suprabasal blister? What is a subepidermal blister?

where a portion of the epidermis including the stratum corneum, forms the roof, but the basal layer remains attached to the underlying dermis. Example is pemphigus vulgaris the entire epidermis separates from the dermis, examples are bullous pemphigoid and dermatitis herpetiformis

What is scaling?

white, silvery scale on someones skin

How does primary hyperparathyroidism affect the urinary tract? Where can it cause calcification?

Urinary tract stones, nephrocalcinosis=calcification of renal interstitium and tubules stomach, lungs, myocardium, blood vessels

Why could kwashiorkor be confused with proper nourishment? How does it affect the skin?

becasue of edema, hypopigmentation and hemmorrhagic skin lesions are also present

What are the results of PTH secretion? What is incidental hypercalcemia?

bone releases calcium, kidney returns calcium and makes Vitamin D3, intestine absorbs more calcium from primary hyperparathyroidism, serum PTH levels are inappropriately elevated for serum calcium levels

How can we detect the presence of heterophilic antibodies? What can blocking antibodies do?

by analyzing a specimen by a different method, since heterophilic antibodies will demonstrate variable reactivity in different assays block the heterophilic antibodies, so when you test a specimen with or without blocking antibodies you will get different results

What is anterior pituitary hormone production controlled by, and how does it get to the anterior pituitary? Same thing for the posterior pituitary?

by factors secreted by the hypothalamus, carried there by a portal vascular system it secretes two peptide hormones, synthesized in the hypothalamus which are then stored in axon terminals. Released in response to stimuli

Genetic alteration and pituitary adenomas -Sporadic -familial

-(95%), G-protein mutations in the alpha subunit interfere with its intrinsic GTPase activity -MEN1, CDKN1B, PRKAR1A, AIP

How do these hypothalamic hormones affect ANTERIOR pituitary hormones? -TRH -PIF (dopamine) -CRH -GHRH -GIH (somatostatin) -GnRH

-+ secretion of TSH - - secretion of Prolactin -+ secretion of ACTH -+ secretion of GH - -Secretion of GH -+ secretion of FSH - + secretion of LH

Insulinoma -What is the whipple triad of symptoms?

-1)blood glucose levels below 50. 2) CNS manifestations. 3) relieved by feeding or parenteral administration of glucose

Reactive systemic amyloidosis -protein -referred to as _______ amyloidosis -what diseases, and group of people is it common in? -Can be seen with what cancers?

-AA -Secondary -TB, osteomyelitis, rheumatoid arthritis and other connective tissue and bowel disorders. Heroin abusers. -Renal cell carcinoma and hodgkin's lymphoma

Familial medeterranean fever -what protein -characterized by what? -what does this gene encode?

-AA -autoinflammatory condition from overproduction of IL-1, fever and inflammation of serosal surfaces -protein called pyrin

Hereditary amyloidosis -Familial mediterranean fever -Familial amyloidotic neuropathies systemic senile amyloidosis

-AA protein with SAA precursor -ATTR protein with transthyretin precursor ATTR protein with transthyretin precursor

Hemodialysis associated amyloidosis -what protein -what diseases -long term dialysis (>20yrs) can develop amyloid where?

-AB2m from B2-microglobulin -renal disease -in synovium, joints, tendon sheaths

Pemphigus -morphology

-ACANTHOLYSIS is common in all pemphigus. Suprabasalar lesions are most common although they can occur at any level, superficial dermal lymphocyte infiltrate, eosinophils

What tumor type and the associated syndrome of... -Corticotrophs -somatotrophs -lactotrophs -gonadotrophs -thyrotroph

-ACTH cell adenoma, cushing syndrome -GH cell adenoma, gigantism and acromegaly -prolactin cell adenoma, galactorrhea, amenorrhea, sexual dysfunction, infertility -null cell/oncocytic adenoma, hypogonadism, mass effects, hypopituitarism -TSH cell adenoma, hyperthyroidism

hypercortisolism (cushing syndrome) -endogenous (ACTH-dependent or independent)

-ACTH-dependent= pituitary adenoma causing cushing disease, or ectopic ACTH, small cell carcinoma or carcinoids (paraneoplastic syndrome). ACTH-independent= could be adrenal adenoma, adrenal carcinoma, cortical hyperplasia

Vitamin B1 deficiency (BeriBeri) -cerebral

-AKA wenicke-korsakoff syndrome. dementia, ataxia, ophthalmoplegia. Characterized by ganglion cell degeneration, focal demyelination, punctuate hemorrhages in the third and fourth ventricals, and aqueduct

Primary amyloidosis -protein -pt hase some kind of ______ cell _______ -disease seen in? How can we diagnose amyloidosis

-AL -plasma cell dyscrasia -multiple myeloma by running a serum protein electrophoresis

Folic acid -considered part of the __-______ -function? -deficiency?

-B-complex -transfer of 1-carbon units in DNA synthesis and DNA methylation -megaloblastic anemia, seen in alcoholics, fetal anencephaly

Acoustic Neuroma -what is it? -what are the symptoms?

-Benign neoplasm of the 8th cranial nerve, ovoid mass within the vestibular division near the labyrinth end -reduced touch sensation in the posterior ear canal, tinnitus, sensorineural hearing loss, vertigo

Response to infection -pseudomembranous inflammation (what can C. difficile do? What does it look like? what does it contain? What is it associated with?)

-C. diff (gram positive rod and obligate aerobe) produces two toxins that cause pseudomembranous colitis. Looks like yellow and white exudates distributed on the surface of the colon to form a pseudomembrane. Contains mucin and neutrophils. Associated with damage of crypt epithelial cells

response to infection -necrotizing inflammation (what can C. perfringens cause? what results in general? What does it resemble?)

-C. perfringens (gram positive rod), can cause gas gangrene with characteristic extensive necrosis of skeletal muscle, gas production and sparse inflammation. Severe tissue damage results from toxins and very few inflammatory cells to stop them. May resemble an infarct or ischemic injury

acute rejection -acute cellular rejection

-CD8 T-cells destroy graft cells, or CD4+ cells secrete cytokines and induce inflammation which damages the graft. The T-cells can also react against graft vessels leading to vascular damage

air polutants: -products of incomplete pyrolysis -volatile organic compounds

-CO, sulfer and nitrogen oxides, semivolatile organic compounds like polycyclic hydrocarbons -formaldehyde, benzene, styrene derivatives

Vitamin B1 deficiency (BeriBeri) -wet (______ involvement with ____ called ______ BeriBeri, ________ w/ or w/out ________, predominantly in the ______ _______, leads to ______ _______)

-CV involvement with edema (cardiac beriberi), dilation with or without hypertrophy, predominantly in right ventricle, leads to cardiac failure

Cushing Syndrome: Morphology -Adrenals (cortical atrophy, diffuse hyperplasia)

-Cortical atrophy= when etiology is exogenous glucocorticoids, suppression of endogenous ACTH. Diffuse hyperplasia= ACTH-dependent Cushing syndrome, both glands enlarged, with expanded zona reticularis and zona fasciculata

Clinical course of cushing syndrome

-Develops slowly over time, hypertension and weight gain followed by central pattern of adipose tissue deposition causing truncal obesity, moon face, buffalo hump. Decreased muscle mass and weakness, glucose intolerance, osteoporosis, thin and fragile skin, bruising, poor wound healing, abdominal striae, increased infection, Hirsutism

Actinic Keratosis -morphology (what is elastosis? Also, _______, cytologic ______ of the lower most ______ layer, which is associated with _________ or _______ ______)

-ELASTOSIS= blue green fibers in upper dermis, from sun damaged fibroblasts. Also, parakeratosis cytologic atypia of the lower most epidermal layer which is associated with hypertrophic or atrophic epidermis.

Goiter -What is it? -Most common manifestation of _______ disease -Degree of thyroid enlargent is proportional to what?

-Enlargement of the thyroid -thyroid -level and duration of thyroid hormone deficiency

Innate Immunity -What things protect our body (innate immunity wise?) -How does inflammation protect us?

-Epithelial barriers block microbe entry, phagocytic cells, neutrophils, macrophages, dendritic cells, natural killer cells, plasma proteins (like the compliment system) -inflammation to recruit & activate phagocytic cells, anti-viral dendtritic & NK cells

Prions -What is there likely mechanism of pathogenesis?

-Formation of insoluble aggregates of intracellular protein with modified tertiary structure continuously produced in cells. It turns PrP into a different conformation so that they are protease resistant and can no longer be broken down.

Characteristic antibodies in autoimmune diseases -all autoimmune diseases? -SLE? -Sjogren's -Progressive SS?

-Generic ANA (indirect IF) -dsDNA and RNP (called the Smith antigen) -RNP (SS-A or B) -DNA topoisomerase I

Lichen planus -sometimes associated with what diseases? What are blistering (bullous) diseases?

-HBV, HCV, HIV, drugs conditions where vesicles and bullae are the primary feature of the disease, these blisters can occur at any layer of skin. Can be fatal.

Grave's disease -What is Thyroid-stimulating immunoglobulin? -Increases the risk of getting... -What lab findings?

-IgG antibody that binds to the TSH receptor and mimics the action of TSH -SLE, Type 1 DM -elevated T3/T4, but depressed TSH levels, diffuse and increased uptake of iodine

Medullary carcinoma -What is it? -Can be _______ or ________ -What mutation can cause this? -What is familial associate with?

-Neuroendocrine neoplasm derived from the parafollicular cells, or C-cells and therefore secrete calcitonin, ACTH, and VIP -sporadic, familial -point mutation in RET oncogene -MEN2A or MEN2B syndromes, younger age, bilateral and multicentric, C-cell hyperplasia

MEN2A/Sipple syndrome -What mutation -What is it characterized by?

-RET proto-oncogene -pheochromocytoma, medullary carcinoma, parathyroid hyperplasia

MEN2B -What mutation -what is it characterized by?

-RET proto-oncogene, but is different from MEN2A -thyroid carcinomas, pheochromocytomas, neuromas or ganglioneuromas involving the skin, oral mucosa, eyes, respiratory tract, GI tract. Marfanoid habitus (skeletal issues)

Genetic mutation associated with -Papillary carcinomas -Follicular carcinomas -Anaplastic carcinomas -medullary carcinomas

-RET/PTC rearrangements and BRAF mutations -RAS adn PIK3CA mutations, and PAX8-PPARG fusions -inactive p53 or activation of beta-catenin -RET mutations

Acute otitis media -what bacteria are common? -What are the symptoms? -what it the treatment?

-S. Aureus, Strep. pneumoniae, H. Influenzae, Group A strep -severe earache, hearing loss, fever, bulging tympanic membrane, purulant otorhea follows rupture of tympanic membrane -Myringotomy

SLE varients -Discoid lupus

-SLE like disease limited to skin. 35% have ANAs, 5-10% can later develope systemic disease

Acute eczematous dermatitis -morphology

-SPONGIOSUS of the epidermis that can result in intraepidermal vesicles or blister formation. Superficial perivascular lymphocyte infiltration, dermal edema, eosinophils.

Bullous Pemphigoid -morphology

-SUBEPIDERMAL and NONACANTHOLYTIC blisters (another difference to PV), eosinophils are present in blisters, superficial and deep infiltrate with lymphocytes, eosinophils, and neutrophils

Systemic Sclerosis -GI presentations -Musculoskeletal -heart

-Submucosal fibrosis and atrophy, which makes esophagus a rigid pipe and not distensible -synovial hyperplasia and inflammation followed by fibrosis, joint destruction is NOT common -patchy myocardial fibrosis

What types of graft rejection are there?

-T-cell mediated rejection (CMR), B-cell antibody mediated rejection (AMR), NK, B-cells, neutrophils, macrophages, mast cells, platelets, cytokines, complement. Reactivation of CMV or BK virus, EBV, or PTLD

Cannabis -What yields high effect and what yields mellow effect? -What are its medical uses? -What are some issues with its usage?

-THC is high, CBD is mellow -glaucoma, chemotherapy-induced nausea, psycho-social disorders of childhood -behavioral and psychological changes, increasing usage with increasing dosage will lead to unanticipated side effects

Hyperthyroidism -What are causes of secondary? What are cardiac manifestations of hyperthyroidism?

-TSH-secreting pituitary adenoma earliest and main feature, increased CO with tachycardia, palpitations, arrhythmias

Immune system defense mechanism for.. -protozoa -Helminths -fungal

-Tdth cells, antibodies -antibodies, granulomatous -Tdth cells, granulomatous

Hyperthyroidism -What is apathetic hyperthyroidism? -What lab findings can help us diagnose hyperthyroidism?

-Thyrotoxicosis occuring in the elderly where typical features are blunted, diagnosis is made during lab work-up for weight loss or worsening CV disease -low TSH, elevated T3/T4, radioactive iodine uptake test

Serous otitis media -what can cause obstruction of the tube? -what symptoms?

-URTI, pressure changes, hypertrophic adenoids, tumors -hearing loss, fullness, discomfort in ear

Prokaryotes -what are they? -How do chlamydia and rickettsia get their energy?

-Unicellular organism that lacks a membrane bound nucleus, mitochondria, or other organelles -they hijack the host ATP machinery to get their energy. They are obligate intracellular organisms.

Impetago -what is it? -What is it caused by? -What does it look like?

-a highly contagious, common superficial bacterial infection, usually affects those in poor health. -beta-hemolytic streptococci and staph aureus -erythematous macule developing into small pustules that break, leaving shallow erosions covered by dry serum

Sinusitis -what is a SINUS POLYP? -what kinds of infections can cause it? and who are these common in?

-a mass formed by edematous tissue -fungal infections like aspergillosis, phycomycosis (mucormycosis). Seen in diabetics and immune compromised patients

Systemic Lupus Erythematosus -What is it clinically? -What is it immunologically? -Who does it affect more, men or women?

-a multisystem autoimmune disease, that is unpredictable, remitting and relapsing. Could involve any organ in the body -it is associated with an array of autoantibodies, classically including antinuclear antibodies (ANAs) -women

Dermatofibrosarcoma protuberans -what is it? (a well differentiated form of ________, grows ______, it is locally _______, rarely ______) -morphology (________ in ________ pattern (spokes on a bike wheel), thin overlying _______, extensions into _________ ________, _______ ______)

-a well differentiated form of fibrosarcoma, grows slowly, locally aggressive, rarely metastesize -fibroblasts in storiform pattern (spokes on bike wheel), thin overlying epidermis, extensions into subcutaneous tissue. Cellular neoplasm

Pseudo-cushing's syndrome -what do these patients show? -what makes them different than people with true cushing's syndrome? -What can lead to the normalization of their issue?

-abnormal diurnal variation in cortisol levels -they will increase CRH, ACTH, and cortisol in response to a hypoglycemic stimulus -alcohol abstinence

Hyperthyroidism -What is a thyroid storm?

-abrupt onset of hyperthyroidism, results from acute elevation of catecholamine levels, which could be from infection, surgery, cessation of antithyroid medication, stress

Erythema multiforme -morphology

-accumulation of lymphocytes along DERMOEPIDERMAL junction, this causes degenerating and necrotic keratinocytes. Superficial perivascular lymphocytic infiltrate with dermal edema.

Fibroepithelial Polyp -what are its other names? -what is its lesion like? -what does it look like microscopically?

-acrochordon, squamous papilloma, skin tag -soft, flesh-colored, bag-like, attached to the skin by a slender stalk -fibrovascular cores covered by benign squamous epithelium

Vitamin B1 (thiamine) -What does it do in the body normally? -What happens in deficiency?

-acts as a co-enzyme for decarboxylation of pyruvic acid and participates in the synthesis of fat from carbs. maintains normal nerve conduction -pyruvic acid accumulates in tissue and blood

Urticaria -A common type of _____ _____ -what are its features? -Who does it affect mostly?

-acute dermatitis -pruritic edematous plaques and papules called wheals, can cause angioedema, which is a deeper edema of the dermis and subcutaneous fat -all ages, but mostly 20-40y.o.

Erythema multiforme -Uncommon type of _____ _____ that can affect people of any age -What infections is it associated with? -What drugs?

-acute dermatosis -HSV, mycoplasms, histoplasmosis, coccidiomycosis, typhoid, leprosy -sulfonamides, penicillin, barbituates, salicylates, antimalarials, hydantoins

Tonsillitis -What is it? -what are the symptoms? -What do you see microscopically?

-acute inflammation of the palatine tonsils, caused by streptococcal infections, and rarely viral ones -swollen, edematous, hyperemic tonsils. Also, sore throat, pain, fever, malaise, headache, vomiting -large germinal centers (which contain B and T-cells)

Adrenal Cortical Neoplasms -What two cancers and who are they most common in? -Mostly _______ and rarely _________ -What is it associated with?

-adenomas (30-40y.o's) and carcinomas (children) -sporadic, familial -Li-Fraumeni syndrome, autosomal-dominant Beckwith-Wiedemann syndrome

Natural toxins -mycotoxins -phytotoxins -animal toxins -methanol

-alkaloids or aflatoxin (most potent natural carcinogen) -cycasin=AMF, safrole=cancer, solanine=neurotoxin -venoms and poisons -metabolized to formaldehyde and formic acid, which causes necrosis of the retinal ganglion cells, and blindness

Allergic rhinitis -What is it cause by? -What is seen? -What is an example of seasonal allergic rhinitis?

-allergic reaction to environmental agents like pollen -eosinophils in mucinous discharge and in edamatous nasal mucosal tissue -hay fever, allergic reaction to pollens

Anaplastic (undifferentiated) carcinoma -mortality rate? -a quarter of patients have a history of... -another quarter harbor a... -what do the neoplastic cells express?

-almost 100% -well-differentiated thyroid carcinoma -concurrent well-differentiated tumor in the resected specimen -epithelial markers like cytokeratin, but are usually negative for markers of thyroid differentiation

Systemic (generalized) amyloidosis -immunocyte dyscariasis with amyloidosis -Reactive systemic amyloidosis -Hemodialysis-associated amyloidosis

-also called PRIMARY AMYLOIDOSIS, associated with multiple myeloma. AL is major protein. precursor is Ig light chains -SECONDARY AMYLOIDOSIS, seen in chronic inflammatory conditions, AA is protein involved, precursor is SAA -Seen in chronic renal failure, AB2m is major protein, precurson is B2-microglobulin

Thyroid -location in the body? -What does it store and what element composes them?

-anterior to upper trachea and esophagus, just below the level of cricoid cartilage -thyroid hormones that are composed of 65% iodine

acute rejection -antibody mediated rejection

-antibodies bind to vascular endothelium and activate compliment via the classical pathway. The resultant inflammation and endothelial damage cause graft failure

Immune system defense mechanism for.. -bacteria -virus -mycobacterial

-antibodies, compliment lysis, inflammation -antibodies (immune complex), T-cells -Tdth cells, granulomatous

Acute eczematous dermatitis -pathogenesis

-antigens at the epidermal surface are taken up by langerhans cells, which migrate into lymphatics, and drain into lymph nodes. They are presented to naive CD4+ T-cells, which are activated to develope into effector and memory T-cells, which migrate to skin and produce cytokines, which leads to inflammation and recruitment of inflammatory cells

Vitamin E (tocopherols) -function -deficiency Vitamin K -function -deficiency

-antioxidant, scavenges free radicals -spinocerebellar degeneration, which occurs with fat malabsorption or genetic abnormalities -cofactor in hepatic carboxylation of procoagulants -bleeding with hypoprothrombinemia, can occue with liver disease, deranged fat metabolism, antibiotic use

Multinodular goiter morphology -_______ enlarged glands -cut surface will show? -________-rich follicles intermixed with areas of ______ ______

-asymmetrical enlarged glands -irregular nodules with hemorrhage, fibrosis, cystic change, calcification -colloid, follicular hyperplasia

Squamous cell carcinoma -morphology: ______ ______ ________ cells at all levels of the ________ -What if confined within the epidermis? -What if it invades through the basal membrane?

-atypical enlarged hyperchromatic cells at all levels of the epidermis, -if confined within the epidermis=in situ. -invasive

Primary Hyperaldosteronism -What happens? (autonomous overproduction of _________, can be ______ or ______ causing nodular ______ _______, which is the most common. Or it can be from an ______________ ___________. Or it can be ________ remediable ___________. -What is the result? (excess _______ suppresses the ________-_________ system and decreases plasma ______)

-autonomous overproduction of aldosterone, can be bilateral and idiopathic causing nodular adrenal hyperplasia, which is the most common. Or it can be from adrenocortical neoplasm. Or it can be glucocorticoid remediable hyperaldosteronism -excess aldosterone suppresses renin-angiotensin system and decreased plasma renin

Adrenogenital syndrome: Congenital adrenal hyperplasia -What is it? -What is it defined by? -Who should you suspect this in?

-autosomal-recessive, inherited metabolic disorder -deficiency or lack of particular enzyme involved in the biosynthesis of cortical steroids (mostly 21-hydroxylase) -any neonate with ambiguous genitalia

Acute otitis media -What is it caused by? -How do microorganisms get to the middle ear? -What age group?

-bacterial or viral infection of middle ear, secondary to upper respiratory tract infection. Often suppurative -via the eustacian tube -<3 years of age

Pemphigous Vulgaris -_____ cell layer still attached to dermis -most important feature is ________

-basal -acantholysis

Parathyroid -Chief cells -Oxyphil cells

-basic cell type, contain granules of PTH, express a calcium sensing receptor, synthesize and secrete PTH due to low calcium -appear at puberty, single or in small clusters. Have many mitochondria, but secratory granules are absent

Pseudohypoparathyroidism -Why does it occur? -What are the serum PTH levels like?

-becasue of end-organ resistance to the actions of PTH -normal and elevated

Insulinoma -*most common pancreatic endocrine neoplasm* -generally ________ -most are ________, ______ in size, _________, pale to red-brown nucleus -What do they look like histologically?

-benign -solitary, small, encapsulated -bland and look like giant islets, maybe extracellular amyloid

Benign fibrous histiocytoma (dermatofibroma) -what is it? (benign dermal _______ of _______ and ________) -where is it seen? -What does it look like?(______, ___ to _____, under ___ in size)

-benign dermal neoplasm of fibroblasts and histiocytes -in adults, on legs of young to middle-aged women -firm, tan to brown, under 1cm in size

Laryngeal papilloma -What is it? -What do you see microscopically? -What do you see clinically?

-benign epithelial neoplasm on the true vocal cord, from HPV 6 & 11 -multiple finger-like projections of stratified squamous epithelium supported by THIN FIBROVASCULAR CORES -cauliflower-like projection

Papillomas -What are they? -What are INVERTED PAPILLOMAS -Most common where and in who?

-benign squamous epithelial neoplasms, forming papillary projections on the mucosal surface -endophytic, often dysplastic, can give rise to Squamous cell carcinoma -adult males, most commonly in the middle turbinate

Dermatofibroma -Metastatic or benign? -morphology (______-shaped ______ arranged in a well-defined mass in the ___-_____. _______ ______. Overlying _______ ________ is seen.)

-benign, -spindle-shaped fibroblasts arranged in well-defined mass in the mid-dermis. foamy histiocytes. Overlying epidermal hyperplasia is seen.

Anorexia nervosa -*associated with other psychological disease like OCD, depression, bipolar, substance abuse, anxiety* -*associated with professions like dancers, actors, athletes* -When is its onset?

-bimodal, early and late adolescence

Posterior pituitary syndromes -Involve ADH, which normally does what? -How does it play into diabetes insipidous?

-binds to cell receptors in the kidney collecting ducts and promotes water reabsorption -it is from an ADH deficiency, can be central or nephrogenic, results in loss of large amounts of dilute urine, hypernatremia, polydipsia

Zollinger-Ellison syndrome -What do they look like histologically? -The majority of them are locally _______ or have already....

-bland, like insulinomas -invasive, metastesized at the time of diagnosis

Metals that can cause issues -arsenic -cadmium -chromium -nickel -uranium -mercury

-cancers of skin, liver and lung -cancers of prostate and kidney -respiratory primary tumors (nasal, lung, sinus) -respiratory primary tumors -lung cancers -neuronal toxicity "minimata disease"

Pheochromocytoma -what is it? -mostly _______ -What is the "rule of 10s" -can be _______ or _________

-catecholamine producing neoplasm composed of chromaffin cells -benign -10% are extra-adrenal, 10% are bilateral, 10% are malignant, 10% are not associated with hypertension -sporadic or familial

Verrucae (warts) -Common in _____ and ______, caused by ____ -How is it resolved? -what is the most common? -Where is it seen mostly? -What are the features?

-children and adolescents, HPV -it is self-limiting and regresses spontaneously -Verruca Vulgaris -mostly on hands and periungal areas -tan, dome-shaped up to 1cm with rough surface

When is protein-energy undernutrition seen in: -developing countries -developed countries -affluent societies

-children severely affected, but also about a quarter of adults -mostly seen in hospital patients, about 1/3 of patients are affected -seen in drug addicts, alcohol, or eating disorders

Air polutants -semivolatile organic compounds -What other air pollutants are carcinogenic?

-chlorinated hydrocarbons, polychlorinated biphenyls, organophosphates -radon & daughters found beneath buildings, asbestos in buildings causes pneumoconiosis and cancer.

Sjogren's syndrome -defintion -*could be primary, or associated with other AI disorders like RA* -pathogenesis (dysregulation of.... with ______ ______ formation) -what antibodies will patients with primary have?

-chronic disease characterized by dry eyes and dry mouth due to immune mediated destruction of lacrimal and salivary glands -dysregulation of T and B-cell activation, with immune complex formation -autoantibodies to RNP antigens SS-A and B

Actinic Keratosis -what is it related to? -features? -Where on body? -can lead to what?

-chronic exposure to sunlight -tan-brown, red or skin-colored, rough surface -face, arms, dorsum of hands, lips -so much keratin production that it turns into a cutaneous horn, can lead to squamous cell carcinoma

Psoriasis -Common _____ _______ ________ that affects all ages and about 1-2% of people in the US -What diseases can it be associated with? -what sites on the body?

-chronic inflammatory dermatosis -arthritis, myopathy, enteropathy, HIV, spondylosis -skin of elbows, knee, scalp, lumbosacral area, glans penis

Response to infection -angioinvasion

-colonization of blood vessel walls, may cause thrombosis, can result in infarction of tissue supplied by infected vessel

Erythema Nodosum -most ______ -associated with what? -involves what part of the body? -What do the lesions look like?

-common -infections, drugs, sarcoidosis, inflammatory bowel disease, malignancies -LOWER LEGS -poorly defined, tender, erythematous plaques and nodules, associated with systemic symptoms

-What is tinea corporis? -what is it predisposed by? -What do the lesions look like?

-common infection of any body surface, that affects all ages -predisposed by heat and humidity. -expanding, round, erythematous plaque with elevated scaly borders

Seborrheic Keratosis -*common in middle-aged or older* -where on body? -what to plaques look like?

-common on trunk, but can be head, neck, or extremities -round, flat, coin-like, tan to dark brown, looks stuck on

Bulimia Nervosa/binge eating -*associated with other things like OCD, depression, bipolar, substance abuse, anxiety* -what does it involve?

-compensatory behavior to avoid weight gain. Like vomiting, enemas, fasting, diuretics, excessive excersize

Primary Hypothyroidism -can be... -lab findings

-congenital, acquired from surgery radiation or drugs, or autoimmune which is most common in places where iodine is sufficient aka hashimoto thyroiditis -elevated TSH, low T4

amyloid -how does it look in electron microscope -in x-ray crystallography? -with stain?

-continuous, nonbranching fibrils -characteristic CROSS-B-PLEATED SHEET CONFORMATION -congo red stain will turn it apple green. Also a birefringence of amyloid

Vitamin B2 (riboflavin) -deficiency (C,C,S,G,D)

-corneal vascularization, cheilosis, stomatitis, glossitis, dermatitis

Adrenocortical hyperfunction -can cause what? Adrenocortical hypofunction -Can cause what?

-cushing syndrome, hyperaldosteronism, adrenogenital or virilizing syndrome -primary hypoadrenalism, secondary hypoadrenalism

Secondary Hyperaldosteronism -What happens? (decreased renal _______, as in ______ ________. (C,c, ns, p)) -What does this result in? (activation of the ______-______ system, leading to increased levels of plasma _____)

-decreased renal perfusion, as in arterial hypovolemia. CHF, cirrhosis, nephrotic syndrome, pregnancy -activation of the renin-angiotensin system, leading to increased levels of plasma renin

Adrenocortical insufficiency: Secondary hypoadrenalism -What is it? -From what?

-decreased stimulation of adrenals -due to a deficiency of ACTH, disease or suppression of hypothalamus or pituitary, prolonged administration of glucocorticoids

What kind of skin manifestations are common with SLE? -degeneration of... -what do you see at dermo-epidermal junction? -what does it look like grossly?

-degeneration of basal epidermis w/ edema and degeneration of dermal collagen, with vasculitis. -IF immunoglobulin and complement at dermo-epidermal junction. -Grossly looks like red skin rash, and a malar (butterfly) rash on face.

Lichen planus morphology -interface dermatitis -saw-toothing -COLLOID or CIVATTE BODIES?

-dense lichenoid infiltrate along the dermoepidermal junction associated with degenerated and necrotic keratinocytes -zig zag contour of dermoepidermal interface -anucleate necrotic keratinocytes in the papillary dermis

Epithelial Cysts (Wen) -common lesion, that is found in what layers? -What qualities? -What happens if they are ruptured?

-dermal or subcutaneous -moveble, firm nodules. Filled with keratin and lipid debris. -create intense, inflammation

Hypopituitarism -75% of parenchyma is lost because of a __________ ________ -What is it caused by?

-destructive process - Tumors, brain injury, surgery or radiation, pituitary apoplexy, ischemic necrosis (sickle cell, sheehan postpartum syndrome), empty sella syndrome, infection, hypothalamic lesion

Hashimoto thyroiditis -Morphology

-diffuse, enlarged, intact capsule. Pale yellow-tan, nodular cut surface that is firm. Mononuclear inflammatory infiltrate with well formed germinal centers, atrophic follicles, Hurthle cell change and fibrosis

Meniere Disease -what is it? -Most common cause of...

-disorder of the cochlear labyrinth, characterized by accumulation of endolymph in the membranous labyrinth of the inner ear -dizziness

Adrenogenital syndromes -What are they? (disorders of ______ _______ such as _______, _______. Caused by ________ ______ disorders -What happens? (under the control of _______, _______ produce _______) -What are adrenal causes of adrenogenital syndrome? (__________ _______, which is probably a _______, __________ __________ _________)

-disorders of sexual differentiation such as virilization, feminization, caused by primary adrenal disorders -under the control of ACTH, adrenals produce androgens -adrenocortical neoplasms, which is probably a carcinoma. Congenital adrenal hyperplasia

Clinical manifestations of hypopituitarism -GH deficient -LH and FSH deficient -TSH deficient -ACTH deficient -Prolactin deficient

-dwarfism -amenorrhea, infertility -hypothyroidism -hypoadrenalism -failure to lactate postpartum

Dermatitis Herpetiformis -morphology

-early lesions show fibrin and neutrophils accumulating at the tips of dermal papillae. This forms microabscesses, with microblisters at dermo-epidermal separations. These microblisters coalesce to form subepidermal blisters

Systemic Sclerosis -Skin presentations

-edema and chronic inflammation followed by dermal fibrosis, atrophy, and fixation of skin to subcutaneous tissue. Also Raynaud's phenomenon is common which can be provoked by cold. Skin looks taut and shiny

Grave's disease -Most common cause of... -Characterized by a triad of what three findings? -Who is it seen in mostly?

-endogenous hyperthyroidism -Hyperthyroidism w/ enlargement of thyroid, infiltrative opthalmopathy with resultant exophthalmos, localized infiltrative dermopathy -women between 20-40

Erythema multiforme -pathogenesis *chronic inflammatory diseases exhibit their signs for months to years and often result in roughened skin surface*

-epidermal cell damage, epithelial cells killed by CD8+ cytotoxic T cells.

Verrucae (warts) -morphology

-epidermal hyperplasia, koilocytosis=cytoplasmic vacuolization and pale halos surrounding infected nuclei. Course keratohyaline granules inside cells

Tinea pedis -What is it? -Where can it spread?

-erythema and scaling in web spaces, that can be superinfected by bacteria -nails (onychomycosis) and will produce discoloration and thickening of the nail plate

Crack/cocaine -What does it cause effect wise? -What problems can it cause?

-euphoria w/ constant craving -respiratory suppression, cardiovascular hypertension, arrhythmias, myocardial infarcts. Pregnancy complications like premature labor, abruptio placentae, retarded fetal development.

hypercortisolism (cushing syndrome) -What is it characterized by? -Exogenous

-excess cortisol or by any condition producing elevated glucocorticoid levels -administration of exogenous glucocorticoids ("iatrogenic" cushing syndrome)

Pancreas -has _______ and ______ components, which is more common and what is the endocrine part made of? what are the 4 main cell types and 2 rare cell types of the islets of langerhans?

-exocrine, endocrine, exocrine, pancreatic islets of langerhans B-cells, alpha-cells, delta cells, PP cells. Rare= D1 cells, enterochromaffin cells

Other forms of thyroiditis: Riedel Thyroiditis -*unknown etiology* -What is it? -What does it simulate? -may be associated with?

-extensive fibrosis involving the thyroid and contiguous neck structures -thyroid carcinoma -idiopathic fibrosis in other sites in the body such as the retroperitoneum

Multinodular goiter -most ______ thyroid ______ -virtually all long standing simple goiters progress to this because of.. -how does it present clinically? -_______ or ________ hyperthyroidism

-extreme, enlargements -recurrent episodes of hyperplasia and involution -cosmetic effects or mass effects like airway obstruction, dysphagia, superior vena cava syndrome -Euthyroid, subclinical

Lichen planus -Where are common spots for lesions?

-extremities like wrist an elbows, glans penis "Wrist, wenis, penis"

Otosclerosis -_____ and ______ tendency, it affects _____ twice as much -what are the initial symptoms?

-familial, sporadic, males -unable to hear whispers, or someone speaking from a distance

SLE -serosal surfaces -Joints

-fibrinous exudates on mesothelial surfaces, later become thickened and fibrous -synovial edema (non-specific mononuclear infiltrate in synovium), usually not associated with striking anatomic changes

SLE -Heart What does mononuclear mean?

-fibrinous pericarditis, non-specific MONONUCLEAR cell infiltrate, valvular disease (libman-sacks), endocarditis (could produce heart failure) an immune cell with only one nucleus, so this does not include neutrophils and eosinophils

Systemic Sclerosis (scleroderma) -pathogenesis -presence of what antibody?

-fibroblast activation with excessive fibrosis is the hallmark -anti-DNA topoisomerase I

What is verruca plana? What about verruca plantaris and palmaris? What about condyloma accuminatum?

-flat wart on face and dorsum of hands, usually smaller than V. Vulgaris on soles of feet and palms of hands respectively on genital areas, perianal, rectum. Soft, tan, cauliflower-like

Serous otitis media -What is it? -What is the fluid like?

-fluid collection in the middle ear due to incomplete resolution of acute otitis media, or obstruction of eustachian tube -watery transudite, mucoid, mucopurulent

Vitamin B12 (cyanobalamin) -function -deficiency -When would you see decreased absorption?

-folate metabolism and DNA synthesis, maintenance of spinal cord tract myelinization. -combined system disease (megaloblastic anemia and posterolateral spinal tract degeneration) -absorption decreases in old age.

Primary Hypoadrenalism: Acute adrenocortical insufficiency -when is it seen in newborns?

-following prolonged and difficult delivery with considerable trauma and hypoxia and in patients maintained on anticoagulant therapy

Vitamin A (1=retinol, 2=dehydroretinol) -Physiological functions

-forms photosensitive pigment in rods and cones, it is essential for normal vision in reduced light. Maintenance of growth and differentiation of certain types of epithelium. Also increased immune system

Hyperthyroidism -causes elevated levels of what? -What are causes of primary?

-free T3 and T4 -diffuse hyperplasia, toxic multinodular goiter, toxic adenoma, iodine-induced hyperthyroidism, neonatal thyrotoxicosis

Response to inflammation -granulomatous infection (from what? What happens? What diseases?)

-from host cells reacting to poorly digested foreign antigens, it is our body trying to wall off the infection. Small nodules appear comprised of macrophages with epitheliod appearance, which can turn into giant cells mixed with lymphocytes, plasma cells, and PMNs. Can be from TB, leprosy, syphilis, dusts or metals, fungi, histoplasmosis, or schistosomiases

What is... -allotransplant -autotransplant -isotransplant -xenotransplant

-from one unrelated human to another -from yourself -from a twin -from an animal

Response to infection -Cytopathic effect/inflammation

-from viral mediated cell injury, can result in formation of viral aggregates visible as inclusion bodies by light microscopy. Formation of blisters by viral infection and damage to epithelial cells

Adrenal cortical neoplasm carcinomas -More likely _________ -What are they like? -Tendency to invade what? -Regional and distant _________ are common

-functional -large, invasive tumors that efface the native adrenal gland, cut surface with necrosis, hemorrhage, and cystic change -adrenal vein, vena cava, lymphatics -metastesis

Pancreatic Endocrine Neoplasms -what impacts the prognosis -what three criteria for malignancy?

-functional status (is it benign or malignant) -metastesis, vascular invasion, local infiltration

Zollinger-Ellison syndrome -What is their usual origin? -Mostly ______ and ________ -about a quarter arise with other ______ _______

-gastrinomas, which are gastrin-producing tumors that arise in the pancreas or the wall of the duodenum -sporadic, single -endocrine tumors

Systemic Sclerosis (scleroderma) -what is it? -What does it affect?

-generalized disorder of connective tissue characterized by excessive fibrosis throughout the body. -skin mostly, but could also affect visceral organs, this can cause death

Multiple Endocrine Neoplasia -Group of ______ ______ diseases, resulting in proliferative lesions of multiple _______ _______ -What makes them different than other sporadic tumors? (occur at a ______ age, arise in multiple _____ _____, often _______, preceded by an ________ stage of _______ ________ in the cell of origin, usually more _______ and _______

-genetically inherited diseases resulting in proliferative lesions of multiple endocrine organs -occur at younger age, arise in multiple endocrine organs, often multifocal, preceded by an asymptomatic stage of endocrine hyperplasia in the cell of origin, usually more aggressive and recurring

Hashimoto Thyroiditis -*most common type where iodine levels are sufficient* -What is it characterized by? -Who does it affect most? -Elevated serum levels of...

-gradual thyroid failure because of autoimmune destruction of the thyroid gland -adult females -antibodies to thyroglobulin, thyroid peroxidase, TSH receptors

Dermatitis Herpetiformis -What happens in direct immunofluorescence?

-granular deposits of IgA at tips of dermal papillae, as well as antigliadin antibodies to dietary gluten, which cross-react to anchoring fibrils in skin

Opiods -what issues can it cause addicts? *other recreational drugs can cause very strange side effects*

-granulomas at injection site, venous infections, bacterial endocarditis w/ septic emboli. Pulmonary talcosis, renal amyloidosis, glomerulosclerosis

Pituitary adenoma -Most common cause of ________ -Where? -May be ______ or _______ -What age group?

-hyperpituitarism -anterior lobe -functional or nonfunctional -35-60y.o.

Pheochromocytoma clinical course -it is a cause of surgically correctable _________ -what other symptoms? -__________ cardiomyopathy

-hypertension -paroxysmal episodes, high BP -catecholamine

Obesity -diseases associated with it?

-hypertension, coronary artery disease and other heart diseases, cholesterol cholelithiasis, pickwickian syndrome, increased osteoarthritis

Hypothalamic suprasellar tumors -What can they cause? What are craniopharyngiomas?

-hypo or hyperfunction of anterior pituitary, diabetes insipidous, gliomas, craniopharyngiomas slow growing intracranial tumors, commonly cystic and multiloculated, arise from remnants of craniopharyngeal ducts and/or rathkes cleft

Goiter -What is the pathogenesis -What happens if the compensatory response is inadequate?

-impaired synthesis of thyroid hormone, causes a compensatory rise in serum TSH level, hypertrophy and hyperplasia of thyroid follicular cells to ensure a euthyroid metabolic state. -in case the compensatory responses are inadequate the result is goitrous hypothyroidism

organic compounds -vinyl chloride -benzene -beta-naphthylamine -methanol

-in plastic industries, causes angiosarcoma of the liver -leukemia -dye and rubber industries, bladder carcinoma -wood-alcohol, necrosis of retinal ganglion cells, blindness

Pituitary gland -located where -what components? -how is it connected to the hypothalamus What does the hypothalamus link and through what?

-in the sella turcica, which is a cavity in the sphenoid bone -anterior and posterior -by the pituitary stalk nervous system to endocrine system via the pituitary gland

Secondary hyperparathyroidims -Minor causes -treatment

-inadequate intake of calcium, steatorrhea, Vitamin D deficiency -dietary vitamin D supplementation and phosphate binders

Adrenal Cortical Neoplasm Adenomas -How are they found? -What are they composed of?

-incidentally during autopsy or imaging because they are usually clinically silent -well-encapsulated, nodular, yellow cut-surface from abundant lipids, composed of cells normally in adrenal cortex

Primary Hypoadrenalism: Acute adrenocortical insufficiency -due to what? (increased demand for ______ from _______, in individuals with chronic ________ _______ or in patients maintained on __________ ________) -from what specifically? (massive _________ ________, bacterial infection usually of __. _________, ________)

-increased demand for steroids from stress, in individuals with chronic adrenocortical insufficiency or in patients maintained on exogenous corticosteroids -massive adrenal hemorrhage, bacterial infection usually N. meningitidis, septicemia

Pathophysiology of marasmus

-increased glucagon secretion, mobilization of free fatty acids and amino acids from adipose tissue and muscle for oxidative metabolism. Total body wasting and emaciation due to decreased protein synthesis and basal metabolic rate, increased consumption of adipose tissue and muscle

Hypothyroidism Cretinism -Develops when? -Characterized by what?

-infancy or early childhood -short stature, mental retardation, coarse facial features

Viruses -What are they

-infectious agents that attach to and invade host cells, contain DNA and RNA, few or no synthetic enzymes or other agents for replication. Can also have a protein capsid or an envelope

Sinusitis -What is it? -Area over the sinus may be...

-inflammation of paranasal sinuses, usually accompanies rhinitis. Can be acute or chronic; infectious, irritative, or allergic -painful and swollen, MOST COMMON!

Causes of Hypothyroidism -Thyroiditis (what is it, what does it cause, what are the different types?)

-inflammation of thyroid gland that causes primary hypothyroidism, includes hashimoto thyroiditis, subacute thyroiditis, subacute lymphocytic (painless) thyroiditis, infectious

Panniculitis -What is it and what does it affect?

-inflammatory condition of the subcutaneous tissue that affects either 1) connective tissue septa between fat lobules. or 2) fat lobules themselves

Primary hypoadrenalism clinical symptoms -________ onset -what are the initial manifestations? -______ disturbances, impaired ____________ -What symptoms have to do with electrolytes? -what is seen ONLY in primary adrenal disease?

-insidious -progressive weakness and easy fatigue -GI, gluconeogenesis -hyperkalemia, hyponatremia, volume depletion, hypotension -hyperpigmentation of the skin due to elevated levels of POMC, which is derived from ACTH and MSH (melanocyte stimulating hormone)

What hormone and function do they do? -Beta cells -alpha cells -delta cells -PP cells -D1 cells -Enterochromaffin cells

-insulin, reduces blood glucose -glucagon, raises blood glucose -somatostatin, suppresses insulin and glucagon -pancreatic polypeptide, stimulates gastric and intestinal enzymes and inhibits intestinal motility -VIP, increases glucose levels and stimulated GI fluid secretion -serotonin, carcinoid syndrome

Insulin Hypoglycemia test/Insulin stress test (IST) -What does it test? -who is it contraindicated in?

-integrity of the HPA axis -people with epilepsy or heart disease

Systemic Sclerosis (Scleroderma) -lung -Kidney

-interstitial fibrosis, pulmonary hypertension with right sided heart failure -concentric proliferation of small and medium arteries. Renal failure without hypertension

Vitamin D -functions in the body -What is it useful to treat?

-intestinal absorption of calcium and phosphate, bone mineralization -psoriasis, MS, and TB as adjuvant treatment

Response to infection -mononuclear inflammation

-invoked by viruses, intracellular bacteria, intracellular parasites, helminths. Mixture of host cells that may include lymphocytes, plasma cells, and macrophages. The proportion of these cells depends on the pathogen

Vitamin B1 deficiency (BeriBeri) -dry

-involves neuromuscular system, polyneuropathy and muscle atrophy. usually symmetrical and appears on legs

Carcinoma of the thyroid -What are risk factors -major subtypes

-ionizing radiation, iodine deficiency, genetic factors -papillary, follicular, anaplastic, medullary (in order of commonness)

Zollinger-Ellison syndrome -Described as ______ cell lesions -what is it characterized by? -major symptom is ______ ______ that are unresponsive to treatment

-islet -hypersecretion of gastric acid and severe peptic ulceration -peptic ulcers

Nasopharyngeal carcinoma -What happens as the tumor enlarges? -How do we treat it?

-it causes obstruction of the eustachian tube with subsequent serous otitis media and hearing loss, epitaxis, nasal obstruction, pain -it is radiosensitive, treated with radiotherapy, often combined with chemotherapy

Vitiligo -morphology Melanocytic Nevi -*congenital or acquired* -all have a common clinical appearance which is...

-it developes over time, but histologically appears normal -tan to brown, uniform pigmentation, small (<6mm), flat to elevated, well defined rounded borders

V. Cholerae -How does it work?

-it elaborates a toxin in the intestine that causes diarrhea but does not actually invade the tissue. Toxin is composed of A (enzymatic) and B (binding) subunits. Subunit A affects adenylate cyclase so NaCl goes into the gut lumen

Diffuse Non-Toxic (simple) goiter/colloid goiter -Endemic goiter

-it is when goiter is in more than 10% of the population, usually in areas with low iodine levels. Particularly dietary substances, referred to as goitrogens

Vitamin B6 (pyroxidine) -What is its function -What is seen in its deficiency?

-its derivatives serve as a coenzyme of intermediary metabolism -peripheral neuropathy, cheilosis, glossitis, dermatitis. It can interfere with thiamine synthesis, which can indirectly result in pellagra

RA -pathogenesis -how is the pathogenesis in a genetically predisposed individual?

-joint inflammation that is immunologically mediated. People have a genetic predisposition. -the disease is initiated by activation of CD4+ helper T-cells responding to the insult. The activated T-cells produce antibodies that acitvate macrophages which come in and release degrative enzymes, and B-cells which produce antibodies

Epidermis -contains what cells? -Why does it have an undulating appearance? What are melanocytes?

-keratinocytes, epidermal dendritic langerhans cells (antigen presenting), melanocytes, myelinated axons -due to rete ridges/pegs Cells that produce a brown pigment called melanin, important for protection from UV rays

Malignant melanoma -morphology

-large cells with irregular nuclei, clumped chromatin, red nucleoli. Can grow individually or in nests at all levels of epidermis (radial) and dermis (vertical) *pic is of cherry red nucleoli*

Erythema Nodosum -Morphology

-lesions show widening of connective tissue septa due to edema, fibrin, and neutrophils, lymphocytes, histiocytes, giant cells, septal fibrosis. Typically no vasculitis

Squamous cell carcinoma -What does it look like clinically? (lesions can vary from _____ defined ____ ____ ____ that are __ ____, to nodular lesions with _______ and _______ that are invasive) -what about in the oral mucosa? (the tumor appears as a white ______)

-lesions vary from sharply defined red scaling plaques that are in situ, to nodular lesions with hyperkeratosis and ulceration that are invasive -the tumor appears as a white thickening

Bullous Pemphigoid -Direct immunoflourescence appearance? -Pathogenesis

-linear deposition of immunoglobulin and complement at the dermo-epidermal junction (looks like ribbon candy). -autoantibodies directed against hemidesmosomes, which attach basal cells to the dermis. Called Bullous pemphigoid antigens 1 and 2.

Other forms of panniculitis -Erythema induratum -Facticial Panniculitis -Deep mycotic infections -*Systemic lupus erythematosus*

-lobar panniculitis with necrotizing vasculitis (unlike Erythema nodosum), granulomatous inflammation and necrosis involving fat lobules -from trauma or injection of toxic substance -in immunocompromised

Adrenocortical insufficiency: Primary hypoadrenalism -From what? -What two patterns?

-loss of adrenal cortex, congenital, autoimmune, infection -Acute or chronic

Adaptive immunity -What are the protectors? -how do adaptive immunity receptors compare to innate ones?

-lymphocytes, antibodies. -Receptors in adaptive are more diverse than innate and are not specific for microbes. They recognize foreign substances, including pathogens

Vitamin B3 (niacin) -physiologic function (makes ____ and ____, which are _____ for many important _____ reactions in the body. Also maintains integrity of _______, _____ ______, and _______) -what can it naturally be synthesized from, with what cofactors, and what can block it? (________, with ________, ________, and _______ cofactors. Excess _______ can block this, which is seen in ______)

-makes NAD and NADP coenzymes for many important redox reactions in the body. maintains integrity of skin, gut mucosa, and nerves. -tryptophan, with pyridoxine, riboflavin, and thiamine cofactors. Excess leucine can block this. Seen in pellegra *think Nad from Niacin, or B3 gets you 3 ATP*

Dermatitis Herpetiformis -Rare disorders that affect _____ often between 30-40y.o. -Associates with what diseases? -What do lesions look like and resemble?

-males -celiac disease, so they respond to a gluten free treatment -grouped in vesicles and papules, look like herpes. Erythematous, pruritic base

Psoriasis -pathogenesis -What do treatments focus on?

-malfunction of the immune system, T-cells release cytokines which promotes inflammation. Dead skin grows faster than it can be shed -inactivating the T-cells, causing hyperproliferation of the skin

Nasopharyngeal carcinoma -What is it? -What is it caused by? -What are the three histological varients?

-malignant epithelial neoplasm of the nasopharynx -EBV -Squamous cell carcinoma, nonkeratinizing carcinoma, undifferentiated carcinoma

Esthesioneuroblastoma -what is it? -small cells arranged in _______. ________ formation with areas of ________ materal often present -What is its pathogenesis

-malignant neoplasm arising from the olfactory epithelium -sheets, rosette, neurofibrillary -arises high in nasal cavity, as it enlarges it destroys adjacent structures, and the patient develops a nasal obstruction, epistaxis, and pain

Vitamin D -deficiency caused from what? -what does it cause? -Subclinical deficiency?

-malnutrition and lack of sunlight -rickets in children, osteomalacia in adults from failed mineralization. -presents as hypocalcemia, with bone and muscle pain, seen in aging populations with indoor sedentary lifestyle

basal cell carcinoma -morphology (may resemble ______ _______, tumor _______ showing _______ ________

-may resemble basal keratinocytes, tumor island showing palisading peripherally

Malignant melanoma morphology -radial growth phase -vertical growth phase -how do we predict the probability of metastesis

-melanoma cells grow horizontally along the epidermis and superficial dermis, no metastatic potential -melanoma cells grow vertically deeper into the dermis, have no maturation, acquire a metastatic potential -By looking at the BRESLOW thickness= thickness in mm that the melanoma goes down, the thicker the worse

Otosclerosis -what is it? -it is the most common cause of....

-metabolic disorder of bone modeling of inner ear otic capsule, which forms the medial wall of the middle ear. It causes bone resorption of the otic capsule, with growth of new sclerotic bone, this fixes the stapes to the oval window -progressive conductive hearing loss in adults with normal tympanic membranes

Pituitary adenoma -What are the different types -What are they classified based off of? and how are they detected?

-microadenomas (<1cm), macroadenomas (>1cm, silent and hormone negative) -on basis of hormone produced by neoplastic cells, detected by immunohistochemical stain

Other types of thyroiditis: Subacute Lymphocytic (painless) thyroiditis -*middle aged women* -What is it characterized by? -What is postpartum thyroiditis

-mild painless symmetric thyroid enlargement, with or without transient overt hyperthyroidism -occurs rarely (5%) in postpartum women, circulating anti-thyroid peroxidase antibodies or a family history of other autoimmune disorders. Most are euthyroid by 1 year, and the rest may eventually progress to overt hypothyroidism over a 10-year period

Scleroderma varients -Limited scleroderma

-mild skin involvement, viscera involvement later on. CREST syndrome: Calcinosis of subcutaneous tissue, Raynaud's, Esophageal dysfunction, Sclerodactyly, Telangiectasia of skin. Anticentromeric antibody is common

Basal cell carcinoma -how common? -what does the lesion look like? (______ _______, that rarely _______, but can ulcerate and invade into underlying _______ and ______)

-most common -pearl papules, that rarely metastasize, but can ulcerate and invade into underlying tissue and bone

Pharyngitis -caused by what? -Symptoms? -What can beta-hemolytic group A strep cause?

-mostly by viruses, sometimes by bacteria -sore throat, pain when swallowing, fever, lymph node swelling, leukocytosis -aka strep throat, can cause serious, immune-mediated complications in susceptible individuals, such as POST-STREPTOCOCCAL GLOMERULONEPHRITIS, and RHEUMATIC FEVER

Diffuse Non-Toxic (simple) goiter/colloid goiter -Sporadic goiter

-mostly females, peaks at puberty and young adulthood, ingestion of substances that interfere with thyroid hormone synthesis, hereditary enzymatic defects.

Solitary nodule -Common causes? -What makes them more likely to be neoplastic? -______ is a critical part of evaluation

-mostly non-neoplastic, but can be neoplastic mostly from benign tumors. -if someone is younger, male, history of radiation, cold on radioactive studies -FNA

Erythema Multiforma -What does it present with clinically?

-multiform lesions including macules, papules, vesicles, bullae. as well as a TARGET LESION with a red macule and a pale center.

Melanocytic Nevi morphology -junctional nevi -compound nevi -dermal nevi

-nests of melanocytes along dermo-epidermal junction, it is FLAT -nests of melanocytes along dermo-epidermal junction, it is RAISED -nests in dermis only, raised

Pemphigus vulgaris -what will you see on direct immunofluorescence?

-netlike pattern of intercellular IgG deposits, we use antibodies against desmoglein 3, which attaches keratinocytes to one another

Insecticides -organochlorines like DDT, chlordane= -organophosphates like paration, malathion = -carbamates like aldicarb =

-neurotoxicity, hepatotoxicity -neurotoxicity -neurotoxicity

Follicular Adenomas -*discrete solitary* -What do the majority present as? -What is surgical removal necessary for?

-nonfunctional, unilateral painless mass. They are encapsulated and contain colloid -to evaluate integrity of the capsule, critical in distinguishing follicular adenoma from follicular carcinoma

V. Cholerae -what is it? -How do we treat it?

-often fatal, diarrheal disease spread by fecal oral route, that causes dehydration and electrolyte imbalance -just by giving them saline to overcome the electrolyte disturbance

Hypothyroidism Myxedema -Common in who? -what do these patients present with?

-older children or adults, insidious onset -listless, cold-intolerant, overweight, constipated, no sweat, cool/pale skin because of decreased blood flow, reduced CO, shortness of breath decreased excersize capacity, increased cholesterol and LDL levels, accumulation of matrix in skin, subcutaneous tissue, and a number of visceral sites resulting in non-pitting edema, broadening and course facial features

Bullous pemphigoid -who does it affect? -where on body? -What are lesions like?

-older individuals mostly -inner thighs, forearm, axillae, groin and lower abdomen, sometimes oral disease -lesions are TENSE, and filled with clear fluid. This means they do not rupture as easily as PV

Primary hyperparathyroidism parathyroid carcinomas -may involve _____ gland -What does it look like? -what are its criteria for malignancy? -amount of local recurrence and distant dissemination by case number?

-one -gray-white irregular mass, exceeding 10g, cytologically similar to adenomas -invasion of surrounding tissue and metastesis -1/3 of cases for each

-What molecular abnormalities are associated with aggressive behavior?

-over expression of cyclin D1, mutations of p53, epigenetic silencing of RB1

Other forms of thyroiditis: subacute -Most common cause of thyroid ______ -more common in _______ -What is it triggered by? -________, and usually diminishes in 2-6 weeks, followed by recovery

-pain -women -viral infections like coxsackie, mumps, measles, adenovirus -transient

Hashimoto Thyroiditis clinical course -_______ enlargement of the thyroid -Increased risk of....

-painless -other autoimmune diseases of endocrine and nonendocrine origins, B-cell non-hodgkin's lymphomas, especially marginal zone lymphomas of MALT tissues, papillary carcinomas

SLE -Libman-sacks -kidneys

-part of heart issues with SLE, chordae tendoni get little growths on them -one of the most important clinical features, renal failure is the MOST COMMON CAUSE OF DEATH, immune complex (DNA-anti-DNA complexes) glomerulonephritis.

Vitiligo -wht is it? -Where does it involve mostly? -What do lesions look like? -how is it different from albinism?

-partial or complete loss of melanocytes within the epidermis -hands, wrists, avillae, perioral, periorbital, anogenital skin -asymptomatic, flat, well-demarcated macules can be large or small. -in vitiligo, melanocytes are absent. But in albinism they are present, but do not produce melanin

Vitamin B3 (niacin) deficiency -what is it called? -What is it from? 1) low ________ 2) ________ disease 3)_________ syndrome (where ______ is converted to ________ 4)__________ therapy (interferes with ________ synthesis)

-pellegra -1)low tryptophan 2)Hartnup disease 3) carcinoid syndrome (trp converted to serotonin) 4)isoniazid therapy (interferes with niacin synthesis)

Chronic otitis media -what is it? -how does the ear epithelium play into this? -What symptoms?

-persistent perforation of the eardrum, with recurrent middle ear infections -epithelium at the edge of perforation may grow into mastoid cavity to form a CHOLESTEATOMA, it expands and damages middle ear structures -dizziness if semicircular canals are damaged, sensorineural deafness, facial weakness, lateral sinus thrombosis, abscesses, meningitis

Secondary hypothyroidism -From what -What lab findings

-pituitary failure or hypothalamus failure -low TSH, low T4

Interpreting the results of a glucose suppression test for gigantism or acromegaly -normal people? -in people with acromegaly or gigantism? -What other diseases can this be common in?

-plasma GH falls to <4mU/L by 120 min in normal people -the GH will not fall -people with severe liver or renal disease, heroin addicts

Immunosuppressive agents -what general issues -What does cyclosporin cause? -What does azathioprine cause?

-predisposition to opportunistic microbial infections, graft vs. host disease, immunoblastic lymphomas. -nephrotoxicity -interstitial pneumonia

Primary Hypoadrenalism: chronic adrenocortical insufficieny (addison disease) -What is it caused from in general? -When do symptoms appear? -Most common cause? -infection wise? -metastatic neoplasms -genetic causes?

-progressive destruction of adrenal cortex -When 90% of cortex is destroyed -autoimmune adrenalitis -fungi, TB -lung and breast are most common -Congenital adrenal hypoplasia

Protein-energy undernutrition -definition -marasmus -kwashiorkor

-progressive loss of both lean body mass and adipose tissue, resulting from the insufficient intake of protein and or calories -deficiency of calories -deficiency of protein, despite adequate other calories

MEN1/Wermer syndrome -what is it? -what is it casued by? -how do we detect it?

-rare heritable autosomal dominant disorder -germline mutations in the MEN1 tumor suppressor gene on chromosome 11 -screening of at risk family, surveillance for specific neoplasms starts at age 8 for parathyroid lesions

Posterior pituitary syndromes -What are syndromes of inappropriate amounts of ADH secretion marked by? -Can be caused from what?

-reabsorption of excessive amounts of free water, water retention, hyponatremia, cerebral edema -excess CNS production, or ectopic secretion by small cell carcinoma of lung

MEN2A and 2B, familial medullary thyroid cancer -How do we screen and detect?

-routine genetic testing to identify RET mutation carriers, chemical testing. Individuals who carry the mutation can undergo thyroidectomy and hormone maintenance

Sjogren's syndrome -clinical manifestations

-salivary/lacrimal destruction by lymphoplasmacytic infiltrate, often with germinal centers and fibrosis. This results in drying of membranes leading to ulceration and often secondary infection, sometimes even nasal septum perforation. Also, extraglandualr disease affecting skin, kidney, and muscle

squamous cell carcinoma -how common? -what are predisposing factors?

-second most common tumor from sun exposure -sunlight is major, others are carcinogens, ulcers, radiation, tobacco, immunosuppression

Somatotropinoma -What defines it? -What is it in children vs adults? -What is the treatment?

-second most common type, excessive GH -Children=gigantism, adults= acromegaly -surgery or somatostatin analogs

Lichen planus -What is it? -What are the lesions like? (normal and oral)

-self-limiting disorder of skin and mucous membranes -itchy, violaceous, flat. They could coalesce to form plaques. Papules have white dots or lines called WICKHAM STRIAE. If mucosal they are white and reticulated with no wickham striae.

Seborrheic Keratosis -morphology -What is Leser-Trelat sign?

-sheets of basal epidermal cells with melanin pigment and hyperkeratosis in the form of keratin filled cysts called HORN CYSTS -con occur in large numbers, which is part of paraneoplastic syndrome, it is commonly linked to adenocarcinoma of the stomach

Laryngeal Papilloma -What is it usually in adults? -What about in children? -Often associated with a change in _____

-single lesion -multiple lesions, called JUVENILE LARYNGEAL PAPILLOMATOSIS -voice

Dysplastic Nevi -Where is it -what syndrome can make the chance of malignancy increase? -Morphology

-skin -heritable melanoma syndrome -compound nevus with architectural and cytologic abnormalities. Very large nevus nests that fuse with one another. Irregular hyperchromatic nuclei. Lymphocyte infiltrate in upper dermis with fibrosis around the rete ridges

Malignant melanoma -affects what places? -Mostly on ____-_____ areas

-skin, oral, anogenital, esophagus, meninges of eye. Can affect acral skin and nails in darker skinned individuals -Mostly on sun-exposed areas

Pheochromocytoma morphology -physically? (small circumscribed lesions confined to the _____ _____, large _____ masses) -cut surfaces (________/________ with _______ and ______) -composed of polygonal _______ cells clustered with ________ cells into small nests or alveoli by a rich vascular network -What is malignancy diagnosis based on?

-small circumscribed lesions confined to the adrenal gland, large hemorrhagic masses -yellow/tan with hemorrhage and necrosis -spindle, sustentacular -metastesis

ACTH cell adenomas -What are they usually at time of diagnosis? -marked by excessive production of ______ -What disease?

-small microadenomas -ACTH -hypercortisolism (cushing's disease)

SLE -blood vessels

-small vessel vasculitis and fibrinoid necrosis, produces dysfunction of affected organs. This is because of neutrophils in blood vessels

Where would you see people exposing themselves to -arsenic -cadmium -chromium -nickel -uranium -mercury

-smelters, miners -smelters wielders -smelters wielders -smelters, steel workers -miners -chlorine-alkali workers

Morphology of pituitary adenomas -physical features -What are they called when infiltrating neighboring tissues? -What are they composed of? -features of an atypical adenomas

-soft and well-circumscribed -invasive adenomas -sheets/cords of uniform polygonal cells with no reticulin network, so the reticulin stain is important -mitotic activity is brisk, nuclear p53 immunoreactivity is high, exhibition of aggressive behavior

Hearing loss -What is conductive hearing loss? and two examples -What is sensorineural hearing loss? and two examples

-sound waves are prevented from reaching the fluids of the inner ear by a lesion anywhere between the auricle and footplate of the stapes. Otitis media, otosclerosis -disease condition in the inner ear or the 8th cranial nerve. Meniere disease, acoustic neuroma

Adrenal medulla -what is it composed of? -What does it produce? -What are the important diseases that can happen to it?

-special neural crest cells called chromaffin cells, and their supporting (sustentacular cells) -catecholamines like epinephrine and norepinephrine -neoplastic ones like pheochromocytoma and neuroblastoma

SLE -spleen -lung

-splenomegaly and capsular thickening, follicular hyperplasia, central arteries producing onionskin lesions (thickening around it) -pleural effusions and pleuritis, interstitial pneumonitis w/ edema and hemorrhage, interstitial fibrosis

Prions -What common diseases? -What are they?

-spongiform encephalopathies, kuru, Jakob-Creutzfeld disease. -proteinaceous particles that resist inactivation by procedures that modify RNA or DNA like sterilization

Primary hyperparathyroidism hyperplasia -_______ and a component of _____ syndrome -how do the glands look? -weight? fat is ______

-sporadic, MEN -could be all four, or could be asymmetric with the sparing of 1 or 2 glands -rarely exceeds 1g -inconspicous

Primary hyperparathyroidism adenomas -95% are ______, _______, and associated with ________ ___ and ______ mutations -5% are familial associated with ______ and ______ syndromes

-sporadic, monoclonal, cyclin D1 and MEN1 -MEN1 and MEN2A

Hypothyroidism -Definition -*very common, up to 4%* -more common in ________ -can result from a defect anywhere in the...

-structural or functional derangement that interferes with the production of adequate levels of thyroid hormone -women -hypothalamic-pituitary-thyroid axis

Erythema multiforme -lesions are often _______ -what is stevens-johnson syndrome?

-symmetrical -febrile form of the disese, hemorrhagic crusts on the lips, and oral mucosa. Often results in life threatening sepsis. Could also involve conjunctiva, urethra, genitals, anus

Senile systemic amyloidosis -defintion -morphology -gross? -histology?

-systemic deposition of amyloid in elderly pts, normal TTR protein -Kidneys, liver, spleen, lymph nodes, adrenals, thyroid all typically involved. -Gross: enlarged and firm with waxy appearance. -Histo=congo red stain turns them apple green

Rheumatoid arthritis -basic definition -how does it progress/result in? -how prevelent, and who is it most common in?

-systemic, chronic inflammatory disease affecting many tissues. usually attacks joints to produce a nonsuppurative, proliferative synovitis -progresses to destroy articular cartilage and underlying bone, this results in disabling arthritis -about 1% prevelence, more common in women

Insulin Hypoglycemia test/Insulin stress test (IST) -how do normal people respond? -how do people with Cushing's syndrome respond?

-their serum cortisol will peak at about 60-90 min of hypoglycemia -they will show little or no increase in cortisol, although they reach the right amount of hypoglycemia

Thyroid hormones -how are they produced? -What do they bind to in blood? -what happens in the periphery? -Which has greater affinity? -What do they cause in the body?

-thyroid follicular cells convert thyroglobulin into T4 and lesser amounts of T3 -reversibly to thryoglobulin and transthyretinin -T4 is deiodinated to T3 -T3 -increases protein synthesis, catabolism of carbs and fats, brain development in the fetus and neonate

Hyperthyroidism -neuromuscular system? -Increased BMR which causes?

-tremor, hyperactivity, emotional lability, anxiety, inability to concentrate, and insomnia. proximal muscle weakness and decreased muscle mass (thyroid myopathy) -heat intolerance, sweating, weight loss despite increased appetite

Exogenous estrogens -What detrimental effects? -What beneficial effects?

-twofold risk of endometrial carcinoma, breast cancer is also more common. Venous thrombosis w/synthetic estrogens, as well as vaginal adenosis and clear cell adenoma(thing that happened to daughters after mothers given estrogen), and gallbladder disease -prevention of osteoporosis, reduction of myocardial infarctions

Urticaria -pathogenesis commonly -IgE-independent urticaria?

-type I hypersensitivity reaction, IgE gets produced because of exposure to certain antigens, then IgE-dependent mast cell degranulation occurs. -results from exposure to substances that directly incite mast cell degranulation

Nasopharyngeal carcinoma -which histological variant is the most common? -what group of people is it most common in?

-undifferentiated carcinoma -young and middle-aged males

Papillomas -symptoms -What if they are neglected

-unilateral nasal obstruction, pain, epistaxis, discharge -they have significant growth potential so they can extend to orbit, middle ear, nasopharynx, and cranial base

Parathyroid glands -*most people have 4 glands, but people can have up to 6* -location? -odd locations? -How do parathyroid hormone receptors act?

-upper and lower poles of thyroid lobe -carotid sheath, anterior mediastinum, intrathyroidal -via GTP-binding alpha subunit

Meniere Disease -who does it affect? -Symptoms?

-usually just one ear involved, (15% of the time its both), 20-50y.o., M=F -episodic rotational vertigo, sensorineural hearing loss, tinnitus, sensation of fullness in affected ear

Urticaria -how long does it last? -what is it commonly called? -what sites in the body does it develop in?

-usually under 24hrs, but could last days or months -hives -sites exposed to pressure

SLE -course

-very variable, some people may go into complete remission and some cases can be fatal in months. usual course is remission and exacerbations overy many years with 80% 10 year survival.

Acute rhinitis -What is it caused by? -Manifestation of the ______ ______ -what are symptoms?

-viruses -common cold -hyperemia, edema, exudation of serous and mucinous fluid

Psoriasis -lesions -Whole body erythema is called? -nail changes

-well-demarcated, pink plaques covered by loose silver-white scales that bleed easily when removed, called the AUSPITZ SIGN. New lesions develop at the site of trauma KOEBNER PHENOMENON. -erythroderma -30% of pts, discoloration, onycholysis, thickening, crumbling

Tertiary hyperparathyroidism -What is it? -What is the treatment?

-when parathyroid activity becomes autonomous and excessive with resultant hypercalcemia -parathyroidectomy

Hyperthyroidism -ocular changes -GI changes -Skeletal system

-wide staring gaze and lid lag -hypermotility, malabsorption, diarrhea -osteoporosis and increased risk of fractures

What are clinical warning signs that a mole is malignant melanoma?

1) change in color, size, shape. 2)itching or pain 3)new pigmented lesion developed 4)irregular notched borders 5)variation of color (black, brown, red, blue, gray)

What are the three mechanisms of tissue damage , and facts about them

1) direct contact by infectious agent, causes direct cell death. 2) toxin release by infectious agent, can kill cells at a distance or release enzymes that digest tissue components or damage blood vessels, causing ischemic damage. 3) induction of host response, that attacks parasite, while at same time hurting host

What two types of adaptive immunity are there? (and facts about them)

1)Humeral immunity= B-lymphocytes and plasma cells, antibodies protect against extracellular microbes. 2) Cell mediated immunity= T-cells protect against intracellular microbes

How to do/interpret the dexamethasone suppression test

1mg dexamethasone given orally to the patient at 23:00, cortisol blood test is performed at 8:00-9:00, if the cortisol has suppressed to <50nmol/L, it excludes Cushing's syndrome

How to diagnose cushing syndrome

24-hour urine free cortisol concentration is increased, loss of normal diurnal pattern of cortisol secretion, Dexamethasone suppression test

how many clinical or immunologic criteria need to be met in order to diagnose SLE? What are antinuclear antibodies directed against and detected by?

4 directed against nuclear components in different diseases, they are detected by indirect immunofluorescence or ELISA, based on characteristic patterns

How many categories of glomerular lesions are there? Classes of lupus nephritis -I -II -III -IV -V

5 -normal by light and IF microscopy -mesangial lupus GN -focal proliferative GN -Diffuse proliferative GN -Membranous GN

What are the fat soluble vitamins? What can happen in vitamin A deficiency?

A,D,E,K caused by malnutrition, especially of fat. Results in night blindness (nyctalopia), xerophthalmia, bitot's spots on conjunctiva, keratomalacia and blindness. Follicular hyperkeratosis, frequent respiratory and UT infections, squamous metaplasia, impaired embryonic development.

If it is a plasma cell disorder, which amyloid protein should you think? Amyloidosis in the heart

AL could occur in any form, mostly seen in senile systemic amyloidosis, deposits begin as focal subendocardial accumulations between myocardium muscle fibers, and end up replacing the whole heart

Three most common amyloid proteins and what they are derived from?

AL (amyloid light chain) is derived from Ig light chains in plasma cells. AA(amyloid-associated) is derived from a unique non-Ig protein in the liver. AB amyloid is produced from B-amyloid precursors and is found in cerebral lesions of people with alzheimers

What diseases are part of hyperpituitarism? What diseases are part of hypopituitarism

Adenomas, hyperplasia, carcinomas, hormone secretion by nonpituitary tumors, certain hypothalamic disorders ischemic injury, surgery, radiation, inflammation, nonfunctional pituitary adenomas

What is pemphigus? Pemphigus vulgaris -*most common* -involves mucosa and skin of what? -what are primary lesions?

Autoimmune disorder resulting from loss of intracellular attachments in the epidermis and mucosa -scalp, face, axilla, groin, trunk -vesicles and bullae, that rupture easily leaving shallow erosions covered with dried serum and crust

Why are responses to grafts even stronger than those to pathogens? What are the basics of hyperacute rejection?

Because the frequency of T-cells that can recognize the foreign antigen in a graft is higher than the amount for any specific microbe Antigens on the graft endothelium are recognized by antibodies as soon as blood flow is restored to the newly implanted organ. This causes very fast compliment activation and destruction of the graft

How do our suppressor T-cells work? What is IL-2 produced by and what will it go on to activate?

By blocking the important cytokine IL-2 Produced by helper T-cells, goes on to activate Delayed Type Hypersensitivity T-cells (Tdht), CD8+ T-cells, CD4+ T-cells, B-cells

What are accelerated acute and acute rejection? What is chronic rejection?

CD4+ T-cell controlled, B-cell antibody and CD8+ T-cell mediated. Happens in days- 3 months, but could also initiate years post treatment Mixed CD4+ T-cell and B-cell antibodies. 3 months - 10 years

What is necessary for a CD8+ T-cell to be activated? What about a CD4+ T-cell?

CD8, MHC class I molecule, TCR, co-stimulatory peptide CD4, MHC class II molecule, TCR, co-stimulatory peptide

What does ricketsia cause? What allows mycobacteria to resist antibiotics?

Causes rocky mountain spotted fever, causes capillary leakage, rash and bleeding a lipid coat

Secondary hyperparathyroidism -main cause and what happens

Chronic renal failure is the most common, decreased phosphate excretion leads to elevated phosphate serum levels that depress serum calcium levels. Made worse by renal loss of a-1-hydroxylase which is necessary for the synthesis of the active form of Vit D, thereby reducing intestinal absorption of calcium levels

What is affected most by a vitamin C deficiency? What happens in a vitamin C deficiency?

Collagen Scurvy: -hemorrhagic diathesis= may involve any tissue in the body, but mostly in skin, gingiva, and periosteum. bleeding occurs from ruptured capillaries because of loose endothelial cells. anemia is common -Skeletal lesions= seen at the ends of growing tubular bones. Also mess up in growth plates because of disrupted osteoid matrix

What cells are antigen presenting cells? What does the T-cell response require?

Dendritic cells, B-cells, macrophages antigen, co-stimulatory molecule, IL-2 later down the line

Lesions of the hypothalamus can lead to...

Disruption of function of hypothalamic pituitary axis, which can cause hypopituitarism and hyperprolactinemia, can lead to visual field defects

what is a plaque?

Elevated, flat-topped area, >5mm

What will a nuclei look like if it is reactive against ds-RNA?

Homogenous or diffuse

Three diseases of parathyroid Primary hyperparathyroidism -What is it? -Important cause of incidental ________ -Higher incidence in _______ -Causes?

Hyperparathyroidism (primary or secondary), hypoparathyroidism, Tumors -autonomous, spontaneous overproduction of PTH by parathyroid tissues -hypercalcemia -women -adenoma (85%), hyperplasia, carcinoma

What kind of harm can antimicrobial agents cause? What damage does acute alcoholism cause?

Hypersensitivity reactions, antibiotic resistant strains CNS; leads to unopposed excitatory pathways due to inhibition of gamma-aminobutyric acid membrane receptors. Stupor at high doses. Also liver steatosis and alcoholic gastritis

What do naive B-cells have on their surface and what does this mean? What kind of molecule is IgM? How many IgG are needed to activate compliment?

IgM, it is the first immunoglobin produced in an infection Pentamer 2

Difference between ionizing and UV radiation Things that play into radiation injuries

Ionizing has an INDIRECT effect, and causes generation of free radicals from radiolysis of intracellular water. UV radiation causes DIRECT modification of DNA type and dose of radiation, sensitivity of tissues (faster dividing are affected more), vascularization and oxygenation of tissues, DNA repair

What is a wire-loop lesion? SLE variants -Drug-induced lupus

MAJOR indicator for SLE, it is creted by subendothelial deposits -ranges from asymptomatic positive ANAs to mild multisystem disease. Usually no renal or CNS involvement and no anti-dsDNA. Anti-histone antibodies are very common. Some frequent drugs are procainamide, alpha-methyl dopamine, isoniazid, diphenylhydantoin

What is important about heterophilic antibodies (false low/negative result) How can people get heterophilic antibodies?

More uncommon type of interference by heterophilic antibodies, they bind the capture antibody completely and prevent the detection antibody from binding, therefore we get a low/negative result Contact with farm animals

What is affected by bihormonal adenomas? What are non-functioning adenomas?

PRL and G-cells 25-30% of all pituitary tumors, presentation is by mass effect