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219 Cards in this Set

  • Front
  • Back
acute bacterial endocarditis
- infection of endocardium
~ caused by Staph aureus
~ in IV drug users
~ tricuspid valve
subacute bacterial endocarditis
- infection of endocardium
~ caused by Strep virdans
- can happen during dental procedures
- thrombus or vegetation on damaged valve
-complications: thrombus embolizes causing septic infarcts, valvular dysfxn, abscess formation
- asymptomatic for mths
~ #1- MV, #2- AV, #3- AV (#1 in IV drug users)
atherosclerosis
- plaques in vessels
- can calcify and cause rigidity and distortion
~ plaques of cholesterol, foam cells, and calcium
- complications: thrombus, embolization, acute arterial occlusion vessel narrowing and ischemia, calcification of plaques
~ #1- abdominal aorta; also coronary a, circle of willis, ICA, popliteal a.
- M
ischemic heart disease (IHD)
- angina due to interruption of blood flow to myocardium
- caused by coronary artery disease (CAD) (narrowing of coronary arteries)
~ #1 cause of death for men and women in US
- decreased O2 supply due to plaques in coronary aa; acute cessation of circulation when plaques rupture
- stable angina: pain w/ exertion
- unstable angina: pain at rest..MI
- varient/prinzmetal angina: intermittent pain at rest; less common; vasospasm of coronary aa.
ischemia (IHD) vs. infarction (MI)
- ischemia: REVERSIBLE mismatch b/t supply and demand for O2; pain relieved by nitroglycerine (vasodilator)
- infarction: IRreversible mismatch resulting in cell death; pain not relieved
myocardial infarction (MI)
heart attack
- coronary a. occluded by thrombus from atherosclerotic a
- sympt: angina, SOB, diaphoresis, nausea, vomiting,
- consequences: death, arrythmias (most common immediate cause of death), CHF, myocardial rupture...cardiac tamponade...death, thrombus on dead tissue..systemic embolism
Left-sided CHF
- from any heart disease affecting LV
~ dyspnea (exertion), paroxysmal nocturnal dyspnea, orthopnea, tachypnea, pleural effusion, pulmonary edema
Right-sided CHF
- causes: L-sided CHF (#1), L-sided lesions (MS), pulmonary HTN, cardiomyopathy, tricuspid or pulmonary valvular disease
~ peripheral edema (ankles and feet), enlarged liver or spleen, distention on neck veins
valvular stenosis
fibrotic, stiff, thickened valves; resulting in reduced blood flow
valvular regurgitation/insufficiency
valves are unable to close completely
valvular prolapse
- "floppy valves"
~ w/ or w/o regurgitation
~ #1 valvular defect
rheumatic fever
- was the most common cause of valvular disease before antibiotics
- group A strep respiratory infection
- affects all 3 layers of the heart
~ Aschoff bodies - focal necrosis surrounded by a dense inflamm. infiltration
- most common in MV ....MS / MR
acute pericarditis
- inflamm of pericardium
~ caused by virus, bacteria (Staph, Pneum), TB, MI, SLE, or rheumatic fever
- fever, angina, pericardial friction rub on cardiac auscultation
~ consequences: restricted ventricular expansion (prevents normal filling)
cardiac tamponade
- accumulation of fluid in the pericardium
- severe condition
~ can impair ventricular filling and rapidly decrease CO, causing death
~ hypotension, jugular venous distension, distant heart sounds
bacterial pneumonia
- Strep pneumonia (#1)
- Staph aureus
- H. influenza
- Klebsiella pneumonia
- anaerobic bacteria from mouth (aspiration)
- affects pulmonary parenchyma
viral pneumonia
- influenza
- parainfluenza
- adenovirus
- RSV
- affects interstitial tissues (interstitial pneumonia)
- fever, dyspnea, productive cough
lobar pneumonia
- infects entire lobe of lung
- intra-alveolar exudates form dense consolidations
~ Strep pneumonia
bronchopneumonia
- infects DISTAL airways, bronchioles and alveoli
~ patch distribution
~ Staph aureus, H. influenzae, and K. pneumoniae
lung abscesses
- localized suppuration
- causes: bacterial pneumonia, bronchiectasis, aspiration of anaerobic bacteria from mouth (impaired gag reflex, alcoholics), bronchial obstruction (cancer)
- productive cough, foul odor, cyanosis, dyspnea
- most commonly due to alcoholism (aspiration)
TB
- weight loss, anorexia, night sweats, fever, productive cough, hemoptysis
- Ghon's complex = primary lesion + lymph node involvement
- tx: multidrug therapy: rifampin, ethambutol, and isoniazid
COPD (chronic obstructive pulmonary diseases)
- chronic bronchitis
- emphysema
- bronchiectasis
- asthma
chronic bronchitis
- narrowing and obstruction of airways
~ hypersecretion of mucus, chronic productive cough for @ least 3 mths straight for past 2 years
- smoking
~ consequences: cor pulmonale (R-sided hypertrophy) and bronchogenic carcinoma
- thickening of alveolar wall
- hemosiderosis
emphysema
- destruction of alveolar walls by proteases (elastase), released by inflamm. cells
- a-1-antitrypsin normally inhibits elastase
~ smoking inhibits a-1-antitrypsin, allowing elastase to break down alveolar walls
- lungs have decreased elasticity
1. CENTRIlobular emphysema - UPPER lobes, smoking
2. PANacinar emphysema - ENTIRE lung, hereditary a-1-antitrypsin defic
bronchiectasis
- permanent dilation of bronchi
- due to chronic lung infections causing inflamm and necrosis of bronchial wall, cystic fibrosis, lung tumor, chronic sinusitis, Kartagener syndrome
- productive cough, foul odor, hemoptysis, recurrent lung infections, lung abscesses
sarcoidosis
- African-Americans
- non-caseating granulomas; Schaumann and asteroid bodies
- lung disease
- enlarged hilar lymph nodes, uvetitis, erythema nodosum, polyarthritis, hypercalcemia
cystic fibrosis
- nucleotide deletion on c'some 7 causing abnormal Na+/Cl- channels
- #1 hereditary disease in Causasians
- autosomal recessive
- affects all exocrine glands, lungs, pancreas, salivary glands, intestines
- thick secretions or mucous plugs obstruct airways
- ultimately fatal
- sweat test - increased Cl-
- chronic pulmonary disease, pancreatic exocrine insufficiency, meconium ileus (intestinal obstruction in infants and newborns)
atelectasis
- collapse of alveoli
- due to: failure of expansion, bronchial obstruction, external compression
- deficiency of surfactant / hypoventilation of alveoli
Sjogren's syndrome
- autoimmune disease salivary and lacrimal glands
- ANA's against salivary ducts
- triad: xerostomia, RA, kertaoconjunctivitis
- Milkulicz syndrome - enlargement of salivary and lacrimal glands
- lymphocytes
- Warthin's tumor - benign, parotid gland
- pleomorphoic adenoma - benign; most common salivary gland tumor
mucoepidermoid carcinoma
- one of the most common malignant salivary gland tumors
- parotid gland
Mallory-Weiss syndrome
- lacerations in the esophagus due to vomiting (alcoholics)
- causes bleeding at distal esophagus, proximal stomach
- Boerhaave syndrome - esophagus ruptures, causing massive upper GI hemorrhage
esophageal varices
- varices (collateral channels) from portal HTN
- due to blockage of portal vein or liver disease
- rupture of varices cause massive hemorrhage into esophagus and hematemesis (vomiting of blood)
- common in pts with liver cirrhosis
GERD gasteroesophageal reflux disease (reflux eophagitis)
- reflux of gastric contents into lower esophagus
- dysphagia and substernal pain (heartburn)
- chronic or severe can lead to Barrett's esophagus, hemorrhage, or stricture (abnormal narrowing)
- tx: diet, antacids (H2 blockers), protein pump inhibitors
Barrett's esophagus
- replacement of squamous epithelium with metaplastic columnar epithelium
- increased incidence of esophageal adenocarcinoma, stricture, or hemorrhage
peptic ulcer disease
- Helicobacter pylori, long term NSAIDS, acid hypersecretion
- erosion of stomach lining or duodenum (more common) causing hemorrhage and perforations
- NOT a precursor to stomach cancer
- epigastric pain, worse when eating
acute pancreatitis
- early activation of pancreatic enzymes, autodigestion
- due to alcoholism, biliary tract disease, gallstones, cystic fibrosis
- knife-like abdominal pain, radiates to back, nausea, vomiting, jaundice, pale stool
- complications: enzymatic hemorrhagic fat necrosis, hypocalcemia, calcium soap formation
~ increased serum lipase and amylase
~ decreased serum calcium
- severe abdominal pain
jaundice
- excess conjugated/unconjugated serum bilirubin
- 1. hepatocellular jaundice: due to liver disease (cirrhosis, hepatitis)
2. hemolytic jaundice: due to hemolytic anemias
3. obstructive jaundice: due to blockage of common bile duct by gallstones or carcinomas of head of pancreas
cirrhosis
- excessive scarring and nodule formation
~ males; #3 cause of death age 45-65 (after heart disease and cancer)
- causes: alcoholism (#1), viral hepatitis, biliary obstruction, hemochromatosis, drugs, chemical agents, Wilson's disease
- ascites, splenomegaly, jaundice, bleeding disorders, hepatic encephalopathy, portal HTN, A/V shunts, esophageal varices
~ increased serum transaminases (SGOT and SGPT)
- increased hepatocellular carcinoma
~ Wilson's disease: decreased ceruloplasmin (binds copper)...metastatic copper deposits; affects liver (cirrhosis), basal ganglia, cornea (Kayser-Fleischer, green rings)
small intestine diseases
- malabsorption syndromes: celiac spure, Chron's disease
- Peutz-Jeghers syndrome
large intestine diseases
- Hirschsprung's disease
- ulcerative colitis
malabsorption syndromes
- main symptom is steatorrhea (excess fat in feces)
- decrease in nutrients absorbed, including fat-soluble vitamins
celiac spure
- malabsorption and mucosal lesions of sm. intestine
- due to allergy to gluten
- histo: intestinal villa - flat
- weight loss, weakness, diarrhea
- risk of GI lymphoma, MALToma
Crohn's disease
- chronic inflamm bowel disease of entire GI (mostly SMALL intestine)
- textured, COBBLESTONE intestinal mucosa due to submucosal edema
- TRANSMURAL chronic inflamm and edema
- non-caseating granulomas
- SKIP lesions
- AUTOIMMUNE
Peutz-Jeghers syndrome
- dark, freckle spots on skin, lips, and oral mucosa
- interstitial polyps...malignant 10% of the time
- autosomal dominant
Hirschsprung's disease
- congenital disease
- section of aganglionic colon that failed to develop normally
- bowel obstruction
- distention of bowel proximal to affected area
ulcerative colitis
- inflamm bowel disease of colon/lg. intestine
- chronic inflamm and ulceration of COLON and RECTUM
- limited to MUCOSA and SUBMUCOSA (vs. transmural)
- CRYPT abscesses
- chronic, bloddy diarrhea
- complications: toxic megacolon, colon cancer, perforation of colon
glomerulonephritis
- inflamm of glomerulus
- clinical maifestations: nephrotic and nephritic syndrome
nephrOtic syndorme
- caused by glomerulonephritis
1. prOteinuria
2. hypOalbuminemia
3. hyperlipidemia (LDL and cholesterol)
4. severe edema (from decreased colloid osmotic pressure due to decreased serum albumin)
- amylodosis, cancer, diabetes, HIV, glomerulonephritis, leukemia, lymphoma, multiple myeloma, SLE
- loss of appetite, malaise, puffy eyes, abdominal pain, muscle wasting, tissue swelling, frothy urine
nephritic syndrome
- inflamm rupture of glomerular capillaries, leaking blood into urinary space
- post-streptococcal glomerulonephritis - due to group A b-hemoytic strep
- autoantibodies
- oliguria
- hematuria
- HTN
- edema
- azotemia (increased serum urea nitrogen and creatine)
polycystic kidney disease
- cysts and partial replacement of renal parenchyma
- autosomal dominant
- HTN, hematuria, palpable renal masses, erythrocytosis, kidney infection, flank pain
- progression to end-stage renal failure
- associated with berry aneurysms
- autosomal recessive form in infants - serious, rapid, leads to end-stage renal death
nephrosclerosis
- disease of renal arteries
1. benign/arterial nephrosclerosis
2. malignant nephrosclerosis
benign/arterial nephrosclerosis
- atherosclerotic plaques in renal a
- narrowing of arterioles
malignant nephrosclerosis
- due to malignant HTN
- severe HTN, retinal hemorrhages hypertrophy of LV
- rapid deterioration of renal fxn
- may lead to rupture of glomerular capillaries
renal tubule diseases
- acute tubular necrosis
- pyelonephritis
- Fanconi's syndrome
nephrosclerosis
- disease of renal arteries
1. benign/arterial nephrosclerosis
2. malignant nephrosclerosis
acute tubular necrosis
- destruction of renal tubule epithelium
- due to ischemia of renal tubules, from renal tubular injury or problems with vascular flow
- can also be due to toxins or drugs
- most common cause of acute renal failure
- reversible, although fatal
pyelonephritis
- bacterial infection of renal tubules, interstitium, and renal pelvis
- due to G- enteric rods: E.coli (#1), Proteus, Klebsiella, Enterobacter
- endogenous infection
- associated with UTI (acute) and obstruction (chronic)
- vesicoureteral refulx (retrograde)
Fanconi's syndrome
- failure of proximal renal tubules to absorb a.a., glucose, and phosphates
- inherited or acquired
- glycosuria, hyperphosphaturia, hypophosphatemia, aminoaciduria, and systemic acidosis
nephrolithiasis, urolithiasis
- calculi (calcium stones) in kidney or urinary tract (males)
- associated with hyperparathyroidism (Ca2+)
- urinary tract obstruction, severe pain, pyelonephritis
- can also be due to enlarged prostate
urinary tract infection
- G- enteric rods (E.coli)
- frequent urination, dysuria, pyuria (PMNs), hematuria, bacteriuria
- can lead to infection of urinary bladder (cystitis) or kidney (pyelonephritis)
PRIMARY hemostasis disorders
- problems of BLOOD VESSELS or PLATELETS
- EARLY in life
- bleeding in superficial areas
- petechiae
- due to vascular and platelet abnormalities or alterations in plasma proteins for adhesion
- prolonged bleeding times
- vascular abnormalities: scurvy
- platelet abnormalities: thrombocytopenia, thrombocytopenic pupura
scurvy
- vascular abnormality
- vit C defic, decreased collagen synth
- delayed wound healing
- petechiae (purpura <3mm)
- ecchymosis (purpura >1cm)
- gingival bleeding, swelling, and ulcerations
thrombocytopenia
- #1 most common bleeding disorder
- decreased platelets
- increased bleeding time
- mucosal oozing, petechial cutaneous bleeding, hemorrhage into tissues
- due to: aplastic anemia, myelophthisis, splenic sequestration, DIC, idiopathic and thrombotic thrombocytopenic purpura
thrombocytopenic purpura
- purple spots on skin and mucous mem, due to small bleeding vessels
- decreased platelets
1. idiopathic: anti-platelet antibodies destroy platelets; due to viral URI
2. thrombotic: hyaline microthrombi; microangioathic hemolytic anemia; qualitative platelet disorders - Von Willibrand's disease
SECONDARY hemostasis disorders
- due to problems with CLOTTING FACTORS
- LATER in life
- bleeding in deeper areas and larger vessels
- abnormal PTT (partial thromboplastin time; measures BOTH pathways; all factors but 7)
- abnormal PT (prothrombin time; EXTRINSIC only)
- does NOT affect bleeding time
- hemophilias, vit K defic
hemophilia
- deficiency of clotting factors
- affect INTRINSIC pathway
- increased PTT, normal PT, normal bleeding time
- continuous bleeding
- bleeding into joint cavities (hemarthroses) and muscle
- hemophilia A/classic: deficiency of factor 8 (antihemophilic factor); sex-linked recessive (only males)
- hemophilia B/christmas: deficiency of factor 9 (plasma thromboplastin); sex-linked recessive (only males); lower incidence than A
- hemophilia C/Rosenthal's synd: deficiency of factor XI, not sex-linked, less severe bleeding
Vit K deficiency
- malnutrition and malabsorption of fats and warfarin
- decrease in factors 2, 7, 9, and 10 and prothrombin
- increased PT and PTT, normal platelet count
primary and secondary hemostasis disorders
- von Willibrand's disease
- liver disease
- DIC
von Willibrand's disease
- defective vWF
- affects primary hemostasis by affecting platelet adhesion to endothelium
- affects secondary hemostasis by a defective factor 8
- autosomal dominant
- #1 hereditary bleeding disorder
liver disease
- results in a decreased production of coagulation factors and can lead to problems with hemostasis
DIC (disseminated intravascular coagulation)
- clots throughout the vasculature
- uses up all available clotting factors and platelets, resulting in problems with bleeding
- uncontrolled bleeding and clotting
- fibrinolysis
- decreased platelets, clotting factors, and fibrinolytic proteins
- increased PT, PTT
- hypofibrinogenemia
- due to: amniotic fluid embolism, infection, malignancy, major trauma
leukemia
- uncontrolled proliferation of abnormal, monoclonal cell
- bone marrow and blood are saturated with blasts...decreased production of normal RBCs, WBCs, and platelets
- recurrent infections bc of low normal WBC count
- severe anemia, pallor, fatigue bc of low RBC production
- bleeding problems, petechiae
- leukocytosis
- leukocytes in other organs: splenomegaly, hepatomegaly, and lymphadenopathy
- spontaneous bleeding of mucus membranes
- gingival hyperplasia
- mucosal ulcerations
acute leukemias
- rapid onset
- children or over 60
- proliferation of immature blast cells
- fever, weakness, fatigue
- pallor (pale due to decreased oxyHb)
- bone and joint pain
- lymphadenopathy
1. acute lymphocytic or lymphoblastic leukemia
2. acute myelogenous leukemia
acute lymphocytic or lymphoblastic leukemia (ALL)
- children
- #1 malignancy in children
- lymphoblasts as null cells
- high cure rate
acute myelogenous leukemia (AML)
- adults
- most malignant leukemia
- Auer rods in blast cells in blood smear
chronic leukemias
- proliferation of mature cells
- less severe than the acute form
- similar symptoms to acute, but slower onset
- weight loss
1. chronic myelogenous leukemia
2. chronic lymphocytic leukemia
chronic myelogenous leukemia (CML)
- proliferation of myeloid cells (become erythrocytes, granulocytes, and platelets)
- Philadelphia c'some - translocation of c'somes 9 and 22
- prominent splenomegaly
- enlarged liver and lymph nodes
- middle age
chronic lymphocytic leukemia (CLL)
- #1 common leukemia
- least malignant leukemia
- proliferation of abnormal B cells, can't produce Abs
- susceptible to bacterial infections
- over 60
- lymphoblasts as smudge cells in blood smear
Hodgkin's disease/lymphoma
- enlarged lymph nodes
- Reed-Sternberg cells
- spreads from lymph node to lymph node
- enlarged cervical lymph nodes first
- cause is unknown
- before age 30
Non-Hodgkin's lymphoma
- tumor formation in lymph nodes
- do not spread contiguously
- proliferation of abnormal B cells
- after 40
- Burkitt's lymphoma: EBV; translocation of C-myc gene from c'some 8 to 14;
African type - mandible and maxilla; U.S. type - abdomen; histo starry sky
multiple myeloma
- plasma cell neoplasm causes proliferation of monoclonal plasma cells
- produce non-fxnl Ig's
- monoclonal IgG spike
- Bence-Jones proteins in urine
- "punched out" radiolucencies in bones
hypothyroidism
- decreased metabolism, weight gain, retarded growth
- enlarged face, tounge, eyelids, larynx, and hands
- mental and physical slowness
- decreased heart rate
- sensitive to cold
- goiter
1. Hashimoto's thyroiditis (autoimmune against thyroid; F)
2. Myxeema (adults; F; due to tx for hyperthyroidism)
3. Creatinism (children; due to embryonic malformation and iodine def; mental retardation and dwarfism; macroglossia, prolonged retention of teeth, delayed eruption)
hyperthyroidism / thyrotoxicosis
- increased metabolism, weight loss
- irratability, nervousness, tremor
- tachycardia, arrhythmias, palpitations
- goiter
- early loss of primary teeth, early eruption of permanent
1. Grave's disease (autoimmune antibodies bind TSH..constant release of T3 and T4; exopthalamos; F)
2. Plummer's disease ( nodular growth or adenoma; elderly F)
- epi may cause thyrotoxic crisis in pts with hyperthyroidism
hyperparathyroidism
- hypercalcemia, hypophosphatemia, increased serum alkaline phosphatase
- loss of bone density, metastatic calcifications, kidney stones
- ground glass bone in x-ray
- symptoms: bones, stones, moans, abdominal groans
- primary: caused by a parathyroid adenoma
- SECONDARY: due to chronic renal disease or renal failure (no vit D..low calcium absorption...activates PTH)
hypoparathyroidism
- accidental surgical removal of parathyroid gland during thyroid surgery
- DiGeorge's syndrome (rare)
- hypocalcemia
- increased neuromuscular excitability and tetany
growth hormone deficiency
- due to decreased GHRH from hypothalamus, decreased GH from ant. pit., or decreased response of cells to GH
- dwarfism: smaller maxilla and mandible, delayed eruption of permanent teeth
excessive growth hormone
1. gigantism: before epiphyseal plate closure; enlarged mandible
2. acromegaly: after epiphyseal plate closure; gradual enlargement of hands, feet, skull
diabetes insipidus
- polyuria (large amnts of dilute urine)
- polydipsia
1. central: deficiency of ADH due to damage to hypothalamus
2. nephrogenic: decreased sensitivity of kidney tubules to ADH; sex-linked or lithium
Sheehan's disease
- lack of anterior pituitary functioning, causing decreased FSH, LH, TSH, ACTH, etc
- due to necrosis of ant. pit. after complicated childbirth
pheochromocytoma
- benign tumor of adrenal chromaffin cells
- if from extra-adrenal chromaffin cells, called paraganglioma
- increased epi and norepi
- associated with Sturge-Weber syndrome and multiple endocrine neoplasia (MEN) type IIa and IIb
- secondary HTN
- increased heart rate, palpitations
neuroblastoma
- malignant catecholamine -producing tumor of immature medullary cells
- #1 malignant tumor in children
- increased epi and norepi
- amplification of N-myc oncogene
Addison's disease
- primary: adrenal cortex damage (has increased ACTH); secondary: due to decreased ACTH from pituitary
- decreased steroid hormone secretion (cortisol), causes increase in ACTH
- darker pigmentation of skin and mucosa from increased melanin due to increased MSH and ACTH
- poor response to stress
- anemias, GI problems, hypotension, weakness
- decreased cortisol and serum Na+, increased serum K+
- tx: cortisol
diabetes mellitus
- hyperglycemia
- polyuria
-polydipsia
- polyphagia
- blurred vision, weakness, weight loss (only I)
- complications: retinopathy, nephropathy, peripheral neuropathy, cardiovascular disease (#1 cause of death for diabetics), increased perio disease, increased candidiasis
Type I diabetes / juvenile-onset / insulin-dependent
- autoimmune destruction of b-cells..no insulin production
- before 25
- severe hyperglycemia and ketoacidosis
- tx: insulin and diet control
Type II diabetes / adult-onset / non-insulin-dependent
- decreased sensitivity of peripheral insulin receptors, insulin receptor dysfxn, or decreased production of insulin
- after 40
- obese
- more prevalent than type I
- tx: diet control
- diabetic shock: don't have enough carbs after insulin injection...very low blood glucose
decreased bone mass
- osteogenesis imperfecta
- osteoperosis
- osteomalacia
increased bone mass
- osteopetrosis
- rickets
- paget's disease
osteoporosis
- decrease in bone mass
- increased osteoclasts and decreased osteoblasts
- due to: change in serum calcium/phosphorus or vit D due to parathyroid disorder, decreased estrogen, physical inactivity, hypercorticism, or hyperthyroidism
- compression fractures
Vit D deiciency
- failure of new bone to mineralize
- abnormal growth of epiphyseal plates
- growth retardation
1. osteomalacia: adults, F; defective calcification of osteoid matrix
2. rickets: children; inadequate calcification; increased thickness in epiphyseal growth plates; skeletal deformities
- delayed tooth eruption, malocclusion
- abnormal formation of dentin
Scurvy
- Vit C defic
- impaired osteoid matrix formation
- subperiosteal hemorrhage
- osteoporosis
- epiphyseal cartilage is not replaced by osteoid
osteogenesis imperfecta / brittle bones
- defective type I collagen formation
- fragile bones and deformed skeleton
- fractures
- blue sclerae
- dentinogenesis imperfecta
osteopetrosis / Albers-Schonberg disease / marble bone
- abnormal osteoclasts
- defective bone remodeling
- increased bone density (into bone marrow space)
- severe defects in infants: anemia and infections; deafness, blindness, paralysis (narrowed cranial nerve foramen); life-threatening; delayed eruption of teeth
- less severe in adults
Paget's disease (osteitis deformans)
- abnormal bone remodeling
- increased serum alkaline phosphatase
- cotton wool x-ray
- complications: osteosarcoma, fractures, heart disease, deafness, blindness
- spaces b/t teeth
osteomyelitis
- infection of bone
- Staph aureus and Strept
- pain
- systemic signs of infection
fibrous dysplasia
- replacement of normal bone with irregular bone containing fibrous c.t.
- ground glass x-ray
1. monostotic (asymptomatic)
2. polystotic
3. McCune Albright's syndrome: polystotic with cafe au lait spots and endocrine abnormalities (precocious puberty)
osteochondroses
- osteonecrosis of epiphyseal plates or ossification centers
- reossification and necrosis
- children and adolescents
- young boys; sports
1. Legg-Calve-Perthes disease: epiphyseal plates of femur
2. Osgood-Schlatter disease: tibial tuberosity (knee)
3. Scheuermann's disease: vertebral endplates
4. Kohler's: foot
5. Freiberg's: second toe (F)
6. Panner's: elbow
Langerhans cell granulomatosis (histocytosis X)
- group of diseases caused by proliferation of langerhans cells
- causes bone lesions
- langerhan's cells with Birbeck granules and eosinophils
1. Letterer-Siwe disease: acute, disseminated, fatal in infants
2. HandSchuller-Christian disease: chronic, disseminated, before 5, bone lesions (loose teeth), exophthalmous, diabetes insipidus
3. eosinophilic granuloma of bone: localized, least severe, can heal w/o tx, young adults, loose teeth in mandible
osteosarcoma (osteogenic sarcoma)
- #1 true primary bone tumor (#2 - chondrosarcoma)
- increased serum alkaline phosphatase
- codman's triangle on x-ray
- children and adolescents
metastatic carcinoma
most common bone tumor
multiple myeloma
most common primary bone tumor
osteochondroma
most common benign bone tumor
Ewing's sarcoma
- extremely anaplastic
- small- cell malignant tumor
- long bones or pelvis
- before 20
- intermittent pain, fever, and swelling
achondroplasia
- delayed or abnormal growth of cartilage (shortened skeleton)
- dwarfism with short extremities
- mandibular prognathism
osteochondroma
- bony growths surrounded by cartilage
- most common benign bone tumor
- before 30
- distal long bones
chondrosarcoma
- malignant cartilaginous tumor
- men; 30-60
- second most common true primary bone tumor (excluding multiple myeloma) (#1- osteosarcoma)
- pelvis, spine, femur, scapula
rheumatoid arthritis
- autoimmune
- women, 20-50
- inflamm of synovial membrane
- granulation tissue - PANNUS - destroys cartilage...fibrotic changes and ankylosis
- scarring, contracture, and deformity
- swollen joints, anywhere in body
osteoarthritis
- most common arthritis
- unknown cause
- women after 50
- degeneration of articular cartilage
- OSTEOPHYTES
- stiff, painful joints (hand and weight-bearing)
- Heberden's NODES: distal interphalangeal
- Bocard's nodes: proximal
myasthenia gravis
- autoimmune to Ach receptors at NMJ
- muscle weakness, inability to maintain long muscle contractions
- eyes: diplopia, ptosis
- neck: dysphagia, problems swallowing and speaking
- tx: cholinesterase inhibitors, auto-immune therapy
rhabdomyoma
- benign tumor of skeletal muscle
leiomyoma
- benign tumor of smooth muscle
- #1 tumor in women
- #1 pelvic tumor
- uterus
- increase in size with estrogen
rhabdomyosarcoma
- malignant tumor of skeletal muscle
- #1 sarcoma in children
- head and neck area
seborrheic keratosis
- round, brown, flat wart
- benign
- middle aged to older
verruca vulgaris
- common wart
- HPV
- benign
- contact or inoculation transmission
actinic keratosis
- dry, scaly plaques with red base
- similar to actinic cheilosos (vermillion border)
- due to sun damage
- dysplactic lesion
- may be premalignant
nevus
- common mole (nevocellular nevus)
- benign, pigmented tumor of melanocytes, deep in c.t.
1. junctional: confined to epidermal-dermal jxn, only type considered pre-malignant
2. compound: epidermal-dermal jxn and in dermis
3. intraepithelial: w/in dermis, usually not pigmented
psoriasis
- scaly, white plaques
- rapid proliferation of the dermis
- autoimmune
keloids
- progressively enlarging scar
- abnormal accumulation of collagen at site of injury
- African-Americans
erythema multiforme
- red, ulcerative lesions on skin and oral mucosa
- round, bull's eye
- due to allergic rxn (Type III)
- due to drugs, infections, HSV, mycoplasma
- Stevens-Johnson syndrome: severe case, lesions on skin, mucosa, eyes, and genital area
- tx: corticosteroids
pemphigus
- ulcerative lesions on skin and oral mucosa
- autoimmune against HEMIdesmosomes of EPIDERMIS cells
- ACANTHOLYSIS (epidermal cell detachment) seen in Tzanck smears
- life-threatening if un-tx.
- positive Nikolsky sign (rubbing causes exfoliation)
- tx: corticosteroids
pemphigoid
- ulcerative lesions on skin and oral mucosa
- autoimmune against BASAL cells (DESMOSOME attachment to basement membrane)
- entire epithelium separates from c.t.
- NO acantholysis
- positive Nikolsky sign
- blindness due to ocular lesions
- tx: corticosteroids
lichen planus
- skin lesions: clusters of purple papules
- oral lesions: white intersecting Wickman's striae on buccal mucosa
- histo: saw-tooth rete ridges and Civatte bodies
- self-limiting w/in a few years
Peutz-Jeghers syndrome
- small, melanotic, freckle lesions
- on skin, orla mucosa, lips, hands, feet
- interstitial polyps, may develop into a GI carcinoma
- autosomal dominant
lysosomal (lipid) storage diseases
- autosomal recessive
- deficiency of lysosomal enzymes
1. Gaucher's disease
2. Tay-Sachs disease
3. Niemann-Pick disease
Gaucher's disease
- lysosomal/lipid storage disase
- autosomal recessive
- deficient GLUCOCEREBROSIDASE
- accumulation of glucocerebroside
- affects MACROPHAGES
Tay-Sachs disease
- lysosomal/lipid disease
- autosomal recessive
- defieient HEXOSAMINIDASE A
- accumulation of G M2 GANGLIOSIDE
- affects NEURONS
- motor and mental deterioration
- blindness
- dementia
- Ashkenazi Jews
Niemann-Pick disease
- lysosomal/lipid disease
- autosomal recessive
- deficient SPHINGOMYELINASE
- accumulation of sphingomyelin
- affects NEURONS
glycogen storage diseases (glycogenoses)
- autosomal recessive
-buildup of glycogen
1. von Gierke disease (type I): deficient G-6-P; liver
2. Pompe disease (type II): deficient a-glucosidase (acid maltase); heart
3. Cori disease (type III): deficiet debranching enzyme (amylo-1,6-glucosidase); heart, liver, skeletal muscle
4. Brancher glycogenosis (type IV): deficient branching enzyme; liver, heart, skeletal muscle, brain
5. McArdle syndrome (type V): deficient muscle phosphorylase; skeletal muscle
Marfan's syndrome
- c.t. disease
- autosomal dominant
- defective microfibril glycoprotein - fibrillin
- tall, hyperextended joints, mitral valve prolapse, dilation of ascending aorta, spider-like fingers, lens dislocation
Ehlers-Danlos syndorme
- c.t. disease
- autosomal dominant or recessive
- defects in collagen
- hypermobile joints, stretchable skin, bruises easily
- Gorlin's sign (touch tounge to nose or elbow)
- TMJ subluxation (dislocation)
- fragile oral muosa
Down Syndrome (trisomy 21)
- most common c'somal disorder
- affects autosomes
- meiotic non-disjunction in the mother
- mental retardation, congenital heart defects
- increased risk of leukemia and severe infections
- macroglossia, delayed eruption, and hypodontia
Edwards syndrome
- trisomy 18
- micrognathia, small head, mental retardation, heart defects, rocker bottom feet
- prognosis - months
Patau's syndrome
- trisomy 13
- celft lip and palate, mental retardation, microencephaly, microphthalmia, polydactyly, heart defects
- meiotic non-disjunction
- more severe than trisomy 21
- die w/in months due to congenital heart disease
Kleinfelter's syndrome
- common cause of male hypogonadism
- 2 or more X and 1 or more Y
- ususally XXY
- meiotic non-disjunction
- gynecomastia, tall stature, and lower IQ
- diagnose at puberty
- associated with increased maternal and paternal age
Turner's syndrome
- amenorrhea
- only 1 X; XO
- under-developed female genitalia, short stature, webbed neck, sterile, coarctation of aorta
- NO mental retardation
- diagnosed at birth or puberty
Treacher Collins syndrome (mandibulofacial dysostosis)
- autosomal dominant, rare
- abnormal development of first and second brachial arches
- underdeveloped zygomas and mandible
- deformed ears
- cleft palate
- small or absent parotid glands
bacterial meningitis
- pyogenic, suppurative infection
- E.coli in newborns
- H. influenzae in infants and children
- N. meningitis in young adults
- Strep. pneumoniae and Listeria monocytogenes in older adults
- severe headaches, irritability, fever, stiff neck
- fatal if un-tx
- spinal tap: cloudy CSF under increased pressure, increased protein, decreased glucose
viral meningitis
- due to CMV, herpes virus, rabies, or HIV
- CSF: mononuclear cells, high protein, normal glucose
demyelinating and degenerative diseases
- multiple sclerosis
- amyotrophic lateral sclerosis (Lou Gehrig's)
- alzheimer's disease
- parkinson's disease
- huntington's disease
multiple sclerosis
- most common demyelinating disease
- forms plaques of demyelinated neurons
- women, 20-50
- affects any neuron (esp. optic nerve)
- triad: scaning speech, intention tremor, nystagmus
amyotrophic lateral sclerosis (Lou Gehrig's disease)
- rapid degeneration of motor neurons in spinal cord and corticospinal tract
- men, 50s
- rapidly progressive muscle atrophy due to denervation
- fasciculations, hyperreflexia, spasticity, pathologic reflexes
- death w/in a few years due to respiratory failure or infection
Alzheimer's disease
- most common cause of dementia in elderly
- degeneration of neurons in cerebral cortex
- amyloid plaques and neurofibrillary tangles
- years to develop
- loss of cognition, memory, and ability to communicate
- motor problems, contractures (shortening of muscle), and paralysis
Parkinson's disease
- degeneration of neurons of basal ganglia (substantia nigra and striatum)
- Lewy bodies
- involuntary and voluntary mvmts are affected
- pin-rolling tremor, slow mvmts, shuffling gait, muscular rigidity
Huntington's disease
- causes dementia
- autosomal dominant
- degeneration of striatal neurons, affects cortical and basal ganglia function
- affects movement and cognition
- ultimately fatal
carcinoma
malignant tumor of epithelial cells
sarcoma
malignant tumor of mesenchymal cells
lymphoma
malignant tumor of lymphoid cells
teratoma
malignant tumor of all 3 developmental germ layers
premalignant tumor
- non-invasive neoplasm
- may become malignant
- dysplasia (disordered cells): potential to invade, but has not yet invaded; reversible
- hyperplasia (increase in number)
- metaplasia (replacement)
- carcinoma in situ: anaplastic cells confined w/in epithelium of origin; no invasion of basement membrane; very likely to invade
oral cancer: squamous cell carcinoma
- #1 oral cancer
- tumor of keratinocytes
- poor prognosis
- males over 50
- metastasis via lymphatic system to cervical lymph nodes
- risk: smoking, chewing tobacco, excessive alcohol nutritional deficiencies
- high risk sites: vermillion border (#1), lateral and ventral tounge, floor of mouth, soft palate, tonsillar pillars, buccal mucosa
skin cancer (basal cell carcinoma)
- #1 cancer in the US
squamous cell carcinoma
- tumor of keratinocytes
- sun-exposed skin
- indurated, crusting ulcer with raised margins
- risk of metastasis lower than oral squamous cell carcinoma
basal cell carcinoma
- tumor of basal cells
- sun-exposed areas (head and neck)
- most common type of skin cancer
- good prognosis, metastasizes slowly
- nevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome): basal cell carcinomas, odontogenic keratocysts, bone abnormalities, calcifications of cranium
malignant melanoma
- tumor of melanocytes or nevus cells
- most severe form of skin cancer
- rare intraorally
- related to sunburns in childhood
- 4 types:
1. superficial spreading: most common, any age, caucasians; flat, irregular shape and color, black/brown
2. nodular: raised/nodular area, black/blue or blue/red, worst prognosis, vertical growth
3. lentigo maligna: elderly, pre-existing lentigo maligna, large, flat, tan
4. acral lentiginous: least common, palms, soles, under nails, african-americans
-growth:
a. rapid/initial phase: growth in all directions, esp. lateral; no metastasis
b. vertical/later phase: deep growth, metastasis
bronchogenic carcinoma (lung cancer)
- #1 cancer death in men and women
- risk - smoking
1. squamous cell carcinoma - most common form; hilar mass w/ central cavitation
2. adenocarcinoma - peripheral of lung
3. small (oat) cell carcinoma - most malignant form; rapid metastasis; worst prognosis; short, blunted anaplastic cells
- metastasis: brain, liver, adrenal gland
colon and rectal cancer
- most common form - adenocarcinoma
- sigmoid colon or rectal areas
- from villous adenomas
- blood in stool and rectal bleeding
breast cancer
- most common form - adenocarcinoma from ductal epithelium
- #2 most common cancer death in women
- 1/2 have estrogen-receptor proteins
- risk: age, family history, obesity, early menarche, late menopause, pregnancy
prostate cancer
- most common form - adenocarcinoma from glandular epithelium
- #2 most common cancer death in men
- high PSA (prostate specific antigen)
- high serum alkaline (ACID)? phosphatase
gingival hyperplasia causes
- lymphoproliferative diseases
- calcium channel blockers
- phenytoin (dilatin)
- cyclosporin
diseases that cause increased alkaline phosphatase
- hyperthyroidism
- paget's disease
- osteosarcoma
- multiple myeloma
von Hippel-Lindau disease
- autosomal dominant
- c'some 3, VHL gene
- hemangiomas (retina and cerebellum)
- cysts and adenomas (liver, kidney, adrenal glands, pancreas)
toxic epidermal necrolysis
- aka TEN/Lyell's synd
- multiple large blisters that coalesce and slough off skin and mucous membranes
acanthosis nigricans
- velvety hyperkeratosis and pigmentation of skin
- axilla, neck, flexures, anogenital region
- marker of visceral malignancy (gastric carcinoma, breast, lung, uterine cancer)
- in diabetics
- acanthosis
xanthoma
- yellow papule/nodule composed of focal dermal collections of lipid-laden histiocytes
- eyelids, tendons, joints
- associated with hypercholesterolemia
hypovolemic shock
- due to decreased blood volume
- ex: hemorrhage, dehydration, vomiting, diarrhea, fluid loss from burns
cardiogenic shock
- due to pump failure (LV), sudden decrease in CO
- ex: massive MI, arrhythmia
distributive shock - septic
- due to infection (G-)
- causes vasodilation
distributive shock - neurogenic
- due to CNS injury
- causes vasodilation
distributive shock - anaphylactic
- due to type I hs, histamine release, vasodilation
- ex: anaphylactic allergic rxn
rheumatic fever
- acute inflamm. disease
- due to group A beta strep
- due to cross-reactivity, not direct effect, of bacteria
- type III hs
- skin, joints, heart, brain
- Aschoff bodies: focal myocardial inflamm, fragmented collagen and fibrinoid
- Aschoff myocytes: multi-nucleated giant cells
- Antischkow cells: large, unusual cells
- increased ASO and ESR
- Jones criteria: major: carditis, arthritis, chorea, erythema marginatum, subcutaneous nodules; minor: fever, arthralgias, EKG changes, history of rheumatic fever
- tx: penicillin
rheumatic fever
PECCS FEVERSS
Polyarthritis
Erythema marginatum
Chorea
Carditis
Subcutaneous nodules

Fever
Erythema marginatum
Valve damage
ESR
Red-hot (polyarthritis)
Subcutaneous nodules
St. Vincent's dance (chorea)
emphysema
- type of COPD
- pink puffer
- dyspnea, labored breathing, no productive cough, no cyanosis, barrel chest
- PO2 near normal
- increased TLC and RV
- decreased FEV1/FVC
restrictive lung diseases
- decreased lung compliance
- decreased all lung volumes
- increased FEV1/FVC
chronic bronchitis
- type of COPD
- blue bloater
- productive cough, wheezing, ausculation (noisy chest)
- increased PO2, cyanosis
idiopathic pulmonary fibrosis
- chronic inflamm and fibrosis of alveolar wall
- progression: alveolitis, fibrosis, fibrotic lung
- death w/in 5 yrs
interstitial fibrosis
- due to fibrosing alveolitis
- thickened/fibrotic alveolar interstitium (space b/c alveolus and capillary)
- results in restrictive lung diseae
- idiopathic or secondary to ct disorders (SLE, PAN, RA)
lobar pneumonia
- Pneumococcus
- exudate w/in alveolus and consolidation
- middle age
bronchopneumonia
- Staph. aureus, H. influenza, Klebsiella, Strep. pyogenes
- bronchiole and alveolar infiltrates, patchy
- infants and elderly
interstitial pneumonia
- RSV, adenovirus, mycoplasma, legionella
- diffuse, patchy infiltrates w/in interstitium
- young children
achalsia
- decreased peristalsis - propulsion of food down the esophagus
- failure of lower esophageal sphincter to relax
- birds beak on barium swallow
- nerve-related
- dsyphagia and regurgitation
- tx: botox, dilation
tropical spure
- malabsorption syndrome
- unknown cause
- ppl in tropics
- steatorrhea, diarrhea, weight loss, sore tounge (decreased vitB)
whipple's disease
- due to tropheryma whippelii
- middle aged men
- skin darkening, inflamed joints, diarrhea
- fatal w/o tx
chronic pancreatitis
- due to alcoholism, hyperipidemia, hyperparathyroidism
- abdominal pain, nausea, vomiting, fatty stool
- complications: pseudocyst, pancreatic abscess, ascites
kernicterus
- high levels of bilirubin in the brain in newborn infants
- form of crippling - athetoid cerebral palsy
acute nephritic syndrome
- ex: acute post-strep glomerulonephritis
- boys 3-7, or any age
- acute glomerular inflamm, sudden hematuria, RBC casts, proteinuria
rapidly progressive nephritic syndrome
ex: rapidly progressive glomerulonephritis
- uncommon, age 50-60
- glomeruli are destroyed
- results in renal failure
chronic nephritic syndrome
- aka chronic glomerulonephritis
- due to SLE, Goodpasture's syndrome, acute GN, slowly progressive disease, inflamm of glomeruli
- eventual renal failure
sickle cell anemia
- autosomal recessive
- abnormal HbS (valine for glutamic acid)
- heterozygote - trait, less severe
- homozygote - disease, more severe
- fibrous precipitates, decreased fxn of RBCs
- sickle cell pain crisis, hemolytic crisis, splenic sequestration crisis, aplastic crisis
thalassemias
- Hb synthesis disorders
- autosomal recessive
- decreased globin chain synth..abnormal Hb..decreased RBCs..chronic anemia
pernicious anemia
- B12 defic
- autoimmune gastritis - failure to produce intrinsic factor
- anti-intrinsic factor and anti-parietal cell antibodies
- megaloblastic , macrocytic anemia
- abnormal schilling test - impaired B12 absorption
- hypersegmented neut.
- yellow skin, stomatitis, glossitis, subacute degen of SC
- also strict vegetarians and gastric and ileal resection
folate defic
- megaloblastic, macrocytic anemia
- hypersegmented neut
- lack of folate..delayed DNA replication
- due to: diet, malabsorption, pregnancy, dilantin
iron defic
- hypochromatic, microcytic anemia (small, pale RBCs)
- due to chronic blood loss, causes decreased bone marrow stones and decreased serum ferritin
- due to dietary defic
- pallor, fatigue, SOB, glossitis, koilonychias
primary polycythemia / polycythemia vera
- myeloproliferative disease
- genetic
- decreased sensitivity of myeloid precursors to erythropoietin
- erythrocytosis, leukocytosis, thrombocytosis, splenomegaly, decreased or normal erythropoietin
secondary polycythemia
- increased RBCs, secondary to increased erythropoietin
- due to: renal disease (PKD, renal cell ca), chronic hypoxia (pulmonary disease, smoking, high altitude, CHF), tumors (hepatocellular ca, meningoma, pheochromocytoma, cerebellar hemangioma, adrenal adenoma), androgen therapy, and Bartter syndrome
- plethora (red skin and mm), deccreased blood viscosity, no splenomegaly
PAN
- only autoimmune disease and only c.t. disease thats more common in men
- blood vessel disease
- inflamm and damage of small and med vessels, decreased blood supply to organs
- antigen implicated: HepB, sulfa drugs, penicillin
polymyalgia rheumatica and temporal arteritis
- closely related and occur together
-PR: pain and stiffness around large muscles; neck, shoulder, hips
- TA: inflamm of lg. arteries, esp. temporal; headaches, visual changes
ankylosing spondylitis
- inflamm of spine and large joints
- stiffness, pain
- HLA-B27
- men
Reiter's syndrome
- HLA-B27
- triad: arthritis, eye inflamm, urethritis
Behcet's syndrome
- in Turkey and Japan
- chronic, relapsing inflamm disease
- mouth sores, skin blisters, genital sores, swollen joints, CNS involvement, hypopyon (pus-like fluid in anterior chamber of eye), pyodermas (pus-producing skin disease)
osteitis fibrosa cystica
- brown tumor = von Recklinghausen disease of bone
- bone lesion in hyperparathyroidism
- cystic spaces with multinucleated osteoclasts, fibrous stroma, brown discoloration from hemorrhage
- increased PTH, Ca2+, and alkaline phosphatase
- decreased phosphorus
benign, mesenchymal tumors
-leiomyoma
- rhabdomyoma
- lipoma
- fibroma
- chondroma
- osteoma
malignant, mesenchymal
- leiomyosarcoma
- rhbdomyosarcoma
- liposarcoma
- fibrosarcoma
- chondrosarcoma
- osteosarcoma
cancer in women
- incidence:
1. breast
2.lung
3. colorectal
4. uterine

-death:
1. lung
2. breast
3. colorectal
4. leukemia and lymphoma
cancer in men
- incidence:
1. prostate
2. lung
3. colorectal
4. urinary tract

- death:
1. lung
2. prostate
3. colorectal
4. leukemia and lymphoma
brain tumors in adults
- glioblastoma multiforme: most common primary brain tumor
- meningioma: 2nd most common primary brain tumor, from arachnoid
- pituitary adenoma: secretes prolactin, bitemporal hemianopia
brain tumors in children
- craniopharyngioma: benign, bitemporal hemianopia, from Rahke's pouch
- low-grade astrocytoma: posterior fossa
- medulloblastoma: malignant cerebellar tumor, form of neuroectodermal tumor
- ependymoma: in 4th ventricle, causes hydrocphalus
keratoacanthoma
- common, low-grade malignancy
- from pilosebaceous glands and resembles SCC
- causes: sunlight, chemical carcinogens, trauma, HPV, genetic factors, immunocompromised
- on face, neck, dorsum of upper extremities
- solitary, firm, round, skin colored/red papules; progress to dome shaped nodules w/ smooth shiny surface and keratin plug
- rapid growth, spontaneous resolution
- can progress to invasive or metastatic carcinoma (rare)
superior vena cava (SVC) syndrome
- decreased venous return from above heart
- facial swelling, cyanosis, dilation of head and neck veins
- due to compression of SVC
- related to malignancy - central bronchiogenic carcinomas (small cell and squamous cell)
- causes:
1. malignancy: bronchiogenic carcinoma, lymphoma, leiomyosarcoma, plasmacytoma
2. infection: TB, syphilis, histoplasmosis
3. other: goiter, thrombus, indwelling IV lines, pacemaker wires
hypertrophic pulmonary osteoarthropathy
- unknown cause
- clubbing of fingers and toes, enlargement of extremities, painful joints
- new periosteal bone
- associatd with bronchiogenic carcinoma (not squamous cell), benign mesothelioma, diaphragmatic neurilemmoma
gastric cancer
- risks: H. pylori, nitrosamines, salt, achlorhydria, chronic gastritis
- adenocarcinoma
- distal stomach
- local spread...lymph node (Virchow's node - supraclavicular node with metastatic gastric carcinoma)...distant metastasis (Krukenberg tumor - bilateral ovaries)
gastric lymphoma
- associated with H. pylori
- MALToma
- better prognosis than adenocarcinoma