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490 Cards in this Set
- Front
- Back
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_______ kidney diseases include ectopic, horseshoe, agenisis, polycystic and cystic.
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developmental
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Nephrotic syndrome is characterized by ______ proteinuria, lipiduria and hypolbuminemia due to increased glomerular permeability resulting in severe edema.
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massive >3.5 g/day
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Nephritic syndrome is characterized by oliguria, ______ hematuria, uremia and ______
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gross, Hypertension
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Ag Ab complexes form due to a strep infection causing inflamation and increased numbers of mesangial cells and PMN's. This reaction compresses the GBM making it more permiable (nephritic syndrome) in this type of glomerulonephritis?
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Acute
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__________ glomerulonephritis is caused by injury resulting in increased glomerular pressure due to macrophage exudate and fibrin causing GBM rupture --> nephritic syndrome
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Crescentic
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Goodpasture's syndrome, SLE, IgA nephropathy and Wegener's granulomatosis are causes of _____ _______
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Crescentic GN
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Which type of GN is noninflammatory, caused by a thickening of the GBM "lumpy-bumpy" due to granular immune complex deposition --> nephrotic syndrome?
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Membranous
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________ is the most common cause of nephrotic syndrome in adults and is non responsive to therapy.
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Membranous GN
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Lipoid nephrosis is the most common cause of nephrotic syndrome in children and is caused by the fusion of podocyte ______.
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processes
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Type of syndrome? Acute and Crescentic GN and Goodpasture's
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nephritic (oligo/hematuria, hypertension)
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________ and ______ are nephrotic (massive proteinuria).
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Membranous GN and Lipid nephrosis
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IgA nephropathy, Lupus nephritis and Membranoproliferative GN are _______ syndromes.
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mixed nephritic/nephrotic
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This is the term used for multiple disease processes which: chronic --> end stage kidney disease, nephrotic/nephritic, do not respond to Tx and cause kidney shrinkage.
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Chronic proliferative GN
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Berger's nephropathy (IgA deposits) and Membranoproliferative GN (duplicate GBM = "tram track") are both examples of ____ _______ _______.
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Chronic proliferative GN
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Berger's nephropathy is the most common cause of GN in s T/F?
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TRUE
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Signs of end stage Gn include: uremia, renal/tubular atrophy, hyalinized _______.
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glomeruli
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Acute, cerescentic, chronic proliferative and membranous GN, lipoid nephrosis and end stage glomerulopathy are all _________ kidney diseases.
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Immunological
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_________ and _____ _____ are example of metabolic kidney diseases.
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diabetes, urinary stones
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Diabetes causes a thickening of the GBM which increases permiability (proteinuria) resulting in _______ syndrome.
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nephrotic
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Increase mesangial matrix --> nodular glomerulosclerosis (Kimmelsteil-Wilson disease) is due to this disease?
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diabetes
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Pathological complications due to diabetes include ischemia (atrophy, arteriosclerosis, papillary necrosis) and a predispostion to _____.
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pyelonephritis (infection)
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T/F kidney stones are usually found in the renal pelvis or bladder.
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TRUE
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Kidney stones hematuria and renal colic and are more commonly found in men/women?
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MEN
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Acute tubular necrosis, Nephroangiosclerosis and Hypertension are all forms of _______ kidney infections.
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Circulatory
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The most common cause of sudden onset renal failure is ATN due to MI's and _____.
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shock (hypovolemic, toxic)
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Which circulatory kidney disease is caused by atherosclerotic plaques which cause infarcts, scaring and fibrosis?
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Nephroangiosclerosis
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Hypertension stimulates arteriole contraction leading to thickening and hyalinization of the vessel walls causing reduced perfusion. _____ is released due to perfusion contributing to further hypertension.
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Renin
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Polynephritis and Cystitis are kidney diseases caused by _______.
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Infection (UTI's)
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Bacteria can reach the UT through ________ or through the urethra (ascending inf.)
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blood (hematogenous)
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Acute pyelonephritis affects the entire kidney while chronic forms abcesses usually durring childhood, pregnancy or in the elderly. T/F
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False - chronic = entire kidney, acute = abscess
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Women are affected with UTI's more than men. T/F
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TRUE
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Predisposing facors to UTI's include: stones, surgery, pregnancy, prostate hyperplasia and ______.
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tumors
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Cystitis, more common in women young and old, is an infection of the _____.
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bladder
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Cranberry juice is a must for newlyweds (Chase) to avoid ______ ______ caused by being "naughty". Infections are also related to pregnancy, urinary stones and cystoscopy.
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honeymoon cystitis
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Acute csytitis shows visible conjestion and mucosal hemorrhaging. T/F
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TRUE
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Chronic cystitis causes ulceration and thickening of the bladder. _____ _______ causes soft yellowish plaques.
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renal malakoplakia
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Renal cell carcinoma, Wilms tumor and Transitional cell carcinoma are kidney diseases due to _______.
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neoplasms/cancer
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Kidney neoplasms are usually benign. T/F
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FALSE malignant (common in older men)
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_______ tumors are the most common in the urinay tract.
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Bladder
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55 year old male presents with hematuria, flank pain and a palpable mass (yellow invading renal vein) with increased EPO levels. He was later diagnosed with ______.
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renal cell carcinoma - characterized by clear polygonal cells
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3 year old presents with a multinodular renal mass replacing his kidney. Surgery and chemo are the treatment for this tumor.
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Wilms
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This hematuria causing tumor of the urinary collecting duct is twice as common as renal cell carcinoma.
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Transitional cell carcinoma
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What two things make up the composition of ?
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Plasma (55%) and Cells (45%)
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What cells are contained in ?
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Erythrocytes, leukocytes, platelets
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What percent of plasma is water?
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92%
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What makes up plasma?
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Water and proteins
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Hematopoesis occurs in __________ in the liver, bone marrow, spleen and lymph nodes?
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Fetus
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Hematopoesis occurs in ____________ in the bone marrow (flat and long bones), the thymus and lymph nodes?
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Children
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Hematopoeisis occurs in ____________ in the bone marrow of flat bones only.
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Adults
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____________ hematopoesis subsides after birth and the __________ _______ remains the primary -forming organ.
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Extramedullary; Bone Marrow
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If hematopoetic bone marrow is destroyed, ___________ _________ may resume in the _______, _______, and _________ _______.
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extramedullary hematopoiesis; spleen, liver, lymph nodes
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Mature cells are descendants of pluripotent hematopoietic stem cells. Two major cell lineages are formed. What two are they and what do they give rise to?
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Lymphoid and Myeloid lineages; Lymphoid -->B and T lymphocytes; Myeloid --> erythrocytes, megakaryocytes, neutrophils, monocytes, eosinophils, basophils.
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Most growth factors (ie interluekins) are produced in the bone marrow. Which one is the exception and where is it formed?
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Erythropoeitin, Kidney
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This cell has an average life span of 120 days, biconcave disk shape, thin center.
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Red Cell
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RBC formation is stimulated by ________ which is produced in the kidney.
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Erythropoeitin
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RBC formation requires these three specific nutrients.
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Iron, Folic Acid, Vitamin B12
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This accounts for 90% of the dry weight of the RBC.
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Hemoglobin
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Adult hemoglobin has __ globin peptides, __ alpha and __ beta.
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4; 2; 2
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Which portion of hemoglobin is the binding portion?
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Heme portion
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Iron deficiency anemia is characterized by _______________.
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Low hemoglobin values
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What part of filtered hemoglobin is converted into blirubin?
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Pyrrole Rings
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When is excreted in the it is called _________ when it is exctreted in the feces it is called ___________.
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urobilinogen; stercobilinogen
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Iron is a component of the _______ moiety of hemoglobin.
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Heme
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Iron is absorbed in the intestine in the ______ form.
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heme
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Iron is absorbed via a receptor mechanism in its _______ form.
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free
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What enzyme transports iron?
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transferrin
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What molecule stores iron?
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ferritin
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What form is iron stored as in the spleen, liver, and bone marrow?
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hemosiderin
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60-80% of total body iron is stored in circulating red cells, the rest is bound to __________ and is stored as __________.
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ferritin; hemosiderin
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T or F: most of the iron released from destroyed red cells (in the spleen) is lost.
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False; most is reutilized
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decrease # of platelets
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thrombocytopenia
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decrease # of neutrophils
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Neutropenia
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Decrease # of leukocytes
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leukopenia
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decrease in all elements
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pancytopenia
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A reduction in Hb content in
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anemia
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This RBC disease is characterized by somnolence (inadequate brain O2), fatigue (inadequate O2), and paleness of skin
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anemia
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This type of anemia characterized by RBC's with normal color and size; could occur due to massive loss.
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normocytic, normochromic anemia
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This type of anemia characterized by small pale RBC's; could occur due to iron deficiency or thalassemaias.
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Microcytic, hypochromic anemia
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This type of anemia characterized by large, normal color RBC's; could occur due to Vitamin B12, folic acid deficiency
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macrocytic, normochromic anemia
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This type of anemia characterized by it's shape (poikilocytosis).
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sickle cell anemia
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variation in SIZE of RBC's
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anisocytosis
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Two types of aplastic anemia.
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Idiopathic, Secondary
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The prognosis for idiopathic aplastic anemia compared to secondary aplastic anemia is __________.
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poorer (a word?)
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This type of anemia is a generalized bone marrow failure (pancytopenia) and is usually accompanied by leukopenia and thrombocytopenia.
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Aplastic anemia
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The symptoms of this anemia are uncontrollable infections (leukopenia) and a bleeding tendency (thrombocytopenia).
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Aplastic anemia
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What is the only treatment for idiopathic aplastic anemia?
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Bone marrow translplant
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T or F: it is necessary to use Ab prophy for those with aplastic anemia.
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TRUE
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The causes of this disease are: metastatic carcinomas, diseminated granulomatous diseases, lymphomas, and other rare diseases (like gaucher's)
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Myelophthisic anemia (aka replacement of marrow by neoplastic cells)
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Inc. bleeding, Inc. infections and presence of a neoplastic population in bone marrow are characteristic of what disease.
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Myelophthisic anemia (aka replacement of marrow by neoplastic cells)
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What is the most common cause of anemia?
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Iron deficiency anemia
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The oral findings of this disease are pallor of soft palate, tongue, sublingual; atrophic tongue, glossodynia (buring sensation)
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Iron deficiency anemia
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This type of anemia: depletion of body iron stores, impaired hemoglobin synthesis
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Iron deficiency anemia
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In iron deficiency anemia the lab shows RBC's to be _________ and contain less ___________
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small; hemoglobin (microcytic, hypochromic)
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T or F: dental pts w/ Iron deficiency anemia usually require treatment modifications.
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false
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This syndrome is associated with dysphagia, anemia (ie iron deficiency), and increased risk of oral SCCA
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Plummer-Vinson syndrome
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T or F: there is no cure for iron deficiency anemia
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false; just replace iron
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Symptoms of this include: immature megaloblasts released into circulation; decreased RBC formation, Macrocytic anemia, hypersegmentation of neutrophils.
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Vit. B12 deficiency (Cobalamin)
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What does Vit. B12 bind to?
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intrinsic factor
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Lack of intrinsic factor causes what?
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pernicious anemia
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The most common cause of B12 deficiency anemia
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pernicious anemia
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T or f: vit b12 deficiency in pernicious anemia can be corrected with oral supplementation of vit b12
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false; must be injected
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What disease: spinal cord neuropathy associated, also could be associated with autoimmunity to parietal cells
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pernicious anemia
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What is the second cause of Vit B12 deficiency?
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Malabsorbtion (stomach resection, celiac disease, crohn's disease)
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What is the a common finding in both folic acid def. And vit b12 def.?
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megaloblastic anemia
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What tx modifications should you take when treating a pt. W/ vit b12 deficiency?
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avoid nitrous (depletes b12 further)
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the medications dilantin, methotrexate, and 5-FU (yes that's F. U.) are causes of what?
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Folic Acid Deficiency
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What symptom does vit b12 def have that folic acid def. Doesn't?
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nuerologic abnormalities (the rest are essentially the same)
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spina bifida, anencephaly are associated w/ what?
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Folic Acid Deficiency
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T or F: Folic acid sups can be taken orally.
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true (vit b12 CAN'T)
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Sickle cell anemia and thallassemia are what class of abnormal hematopoiesis?
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hemoglobinopathies
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Spherocytosis is what class of abnormal hematopoiesis?
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Structural protein defects
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What type of anemia: inherited, point mutation, Hb beta chain, N6 point mutation, result=abnormal hemoglobin
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sickle cell anemia
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T or F: those with the sickle cell train and those with the disease exhibit the same symptoms.
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FALSE
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Sickle cell anemia is most common among what population?
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blacks
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this disease characterized by abnormal Hemoglobin (HbS) that polymerizes at LOW O2 tension; induced by: fever, acidosis, dehydration, hypoxia.
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sickle cell anemia
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In Sickle cell anemia, RBC's are _________ sickled if they are deoxygenated, and they are _________ sickled if HbS polymerizes.
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reversibly, irreversibly
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The onset of symptoms for SC anemia first appear at what age?
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one-two years (when HbF is usually replaced by HbA)
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What disease? Marked underdevelopment, chronic anemia, jaundice, multiple organ infarcts, severe bone, spleen pain, intellectual impariment, recurrent infection, heart failure
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sickle cell anemia
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Dental findings of this disease include: spontaneous necrosis of multiple teeth, enlarged marrow spaces, "hair on end" in x-ray, delayed tooth eruption, osteomyelitis
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sickle cell anemia
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What is the prognosis for sickle cell anemia?
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50% survival past age 50
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How do you treat sickle cell
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mainly avoid triggering factors, Ab prophy, hydroxy urea
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what disease? Genetically inherited, 200 + mutations, quantitative defect of hemoglobin, decreased production of alpha chain, deficient or absent beta chain, end result=defect in AMOUNT of globin chain synthesized
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Thalassemias (in general)
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for the defective thalassemia gene, heterozygotes are thalassemai _________ and homozygotes are thal. ___________.
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minor, major
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Which thalassemia is more common, alpha or beta?
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beta
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What happens when deletion of all alpha globin transcripts occurs?
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fetal demise
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What disease: defect in synthesis of HbA that reduces the rate of globin chain synthesis. NO abnormal hemoglobin is produced (quantitative, not qualitative). Hypochromic, microcytic anemia results, crew-cut skull.
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Thalassemias (in general)
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In thalassemia minor, __ of four chains is missing, in thallassemia major ___ of four genes are missing.
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one; two
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Which thalassemia (alpha or beta) causes more severe anemia?
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beta
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What is the regular name of 'mediterranean anemia"
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thalassemia
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What disease? Mild symptoms, normal life expectancy, microcytic, hypocromic, (defective HbA synthesis, lower conc. Of HbA per RBC), no tx necessary
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Thalassemia minor
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which disease? Severe, high mortality, splenomegaly hemosiderosis, hepatomegaly, jaundice, Inc. hematopoeisis in flat bones, retarted growth, intellectual impairment, SOB (not "son of a bitch", "shortness of breath" chase), due to heart failure
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thallassemia major
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These dental findings are for what disease? Hair on end, chipmunk face, bimaxillary protrusion, teeth spacing, rarefaction of alveolar bone, widened marrow spaces, tooth discoloration (due to excess iron)
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thallassemia major
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T or F: there is an iron deficiency in thalassemia major.
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false; an iron overload, side effect of hemolysis
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What is the most common inherited disease of RBC's in caucasians?
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hereditary spherocytosis
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what disease: splenomegaly, jaundice, anemia, increased fragiligy of RBCs in hypotonic solution, gene mutation in structural membrane proteins (ankrin or spectrin).
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hereditary spherocytosis
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What are the diseases associated with Abnormal hematopoiesis?
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Sickle cell anemia, thalassemia, hereditary spherocytosis
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What are the diseases associated with decreased hematopoeisis?
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aplastic anemia, replacement of marrow by neoplastic cells, iron deficiency anemia, vitamin B12 (perniciuos anemia) & folic acid deficiency, protein deficiency
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Anemia due to loss will be ______chromic and _______cytic.
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normo; normo
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Immune hemolytic anemias can be caused by what 2 types of antigens?
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autoantigen (anti-self) or alloantigen (anti-foreign)
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what disease? Maternal abs cross placenta into fetal circulation, rh incompatibilities
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erythroblastosis fetalis
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what disease? attach to rbc surface, act as hapten, produciton of antibodies, rbc hemolysis
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drug-related hemolytic anemia
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what disease? Abs recognize self-antigens on rbc's, unknown cause
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autoimmune hemolytic anemia
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what disease is worldwide, the most common cause of hemolytic anemia?
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anemia secondary to malaria
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What is another name for polycythemia?
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erythrocytosis
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what disease? Hypertension, increased hemoglobin, elevated hematocrit, red complexion, headaches, splenomegaly, increase incidence towards clotting
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Polycythemia Vera (aka primary)
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How do you treat polycythemia?
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phlebotomy, anti-leukemia
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what disease? Non-neoplastic, high altitude causes it, anoxia, inc. erythropoeitin, compensatory increase in rbc
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secondary polycythemia
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What types of luekopenia are there?
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Neutropenia, lyphopenia, selective lymphopenia
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causes of ________ include: (cancer tx), radiation, aplastic anemia cyclic neutropenia, metastatic dx to bone marrow
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leukopenia
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A patient with neutropenia has a high risk of __________ infection, while a patient with lymphopenia has a high risk of _________________ infections
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bacterial; bacterial, viral, fungal, parasitic
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What types of WBC disorders are there? (4)
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leukopenia, leukocytosis, leukemias and lymphomas, multiple myeloma
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An increase in WBC's above 10,000 per mL is what?
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leukocytosis
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what type of leukocytosis occurs in reaction to an acute bacterial infection?
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Granulocytosis (neutrophilia)
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what type of leukocytosis occurs in reaction to allergies (hay fever, asthma) and skin disieases or parasitic infections
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eosinophilic leukocytosis
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What type of leukocytosis occurs in rxn to vial infections & chronic infections (tb), and some autoimmune disorders
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lymphocytosis
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Leukocytosis is often accompanied by ___________, a lymph node enlargement.
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lymphadeopathy
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What is a common symptom in all of the following: URTI, infectious MONO (hopefully paul doesn't have this, cuz I heard you get it from kissing lots of hot s), AIDS, cat-scratch disease, TB, metastatic cancers
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lymphadeopathy
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Malignant disease that involves wbc precursorsin bone marrow and associated w/ malignant wbc's in peripheral .
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leukemia
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malignant wbc's in lymph nodes or other solid organs or tissues
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lymphoma
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T or F: bone marrow biopsy must be performed to confirm diagnosis of leukemia
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true
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T or F: most cases of luekemias are caused by HTLV-1.
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False; most cases are unknown
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Why does anemia, recurrent infection and bleeding occur in leukemia, a WBC disorder?
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because the malignant cells overtake the RBC, WBC and platelet precursors in the marrow
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What is the most common eventual cause of in patients w/ leukemias?
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uncontrollable infection
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As a result of leukemia, what lab findings do you find in the PERIPHERAL ?
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immature cells (due to pancytopenia in the marrow)
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Flow cytometry and cluster of differentiation are lab procdures to detect what?
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leukemias
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What are the two major types of leukemias?
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myeloid (granulocytic-monocytic) and lymphoid (lymphocytic)
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What are the most common leukemias?
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Acute LymphoBLASTIC leukemia (ALL); Acute Myelogenous leukemia (AML); Chronic myelogenous leukemia (CML); Chronic LymphoCYTIC leukemia (CLL)
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What disease? Bimodal peaks--first in children under age 5, then in elderly; Most common malignant tumor in children under age 5; overall 20% of leukemias, most responsive to therapy
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ALL
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Symptoms of this disease: sudden onset, fatigue, fever, bleeding, flu-like symptoms, bone pain, lymphadenopathy (generalized), splenomegaly, hepatomegaly, child age less than 5
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ALL
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What lab findings in ALL?
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elev. WBC, immature WBC's (blasts) in and marrow
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T or F: with Tx, ALL never comes back
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false; 50-75% remission (w/out chemo, 3-6 mos)
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What are the 3 steps of chemotherapy?
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Induction, Cosolidation, and Maintenance
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Which step of chemo is to achieve a complete remission?
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consolidation
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What type of chemo is used to prepare a patient for bone marrow transplant?
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conditioning chemo
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What disease? Massive infiltration of the bone marrow with immature myeolblasts (immune cells) with immature blasts that spill over into peripheral , fatigue, pallor, diffuse BOGGY gingival enlargement, peak age 60
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AML
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What is the most common leukemia overall?
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AML
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_________ leukemia occurs in middle aged men showing signs of pancytopenia, spleno-hepato-megaly and lymphadenopathy. TRAP- tartrate resistant acid phosphatase- stains for the diseased cells.
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Hairy cell
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What disease? adults, fatigue, infections, splenomegaly, thrombosis, anorexia
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CML
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What do 90% of patients with CML have in common?
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the Philadelphia Chromosome
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50% of pts w/ CML progress to an _________ phase while the other 50% progress straight to a ________ ________.
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accelerated(before blast crisis); blast crisis
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Tx for CML:
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Bone marrow translplant; Gleevec (tyrosine kinase inhibitor)
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What disease? B-cell proliferation --> slow progressive autoimmune hemolytic anemia.
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CLL
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What disease? Old ppl (>50 yrs), cells indistinguishable from normal mature lymphocytes, slowly progressive, progonsis 7-10 yrs, chemo not indicated (NO Tx)
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CLL
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T or F: All lymphomas are malignant
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TRUE
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When a lymphoma is spread to other organs in the body (not lymphoid tissue) what is this spread called?
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extranodal spread of lymphoma
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What are the 2 main categories of lymphomas?
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Hodgkins Disease & Non-Hodgkin's Lymphoma (NHL--not to be confused with the National Hockey League--who cares about hockey anyway?)
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T or F: lymph nodes are always involved in lymphomas
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FALSE
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Immunohistochemistry and Flow cytometry are methods to detect what disease?
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lymphoma
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HIV & EBV, environmental causes, gene translocations, antigenic stimulation, are supposed etiology factors for what disease?
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Lymphomas
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Which NHL is the most common and is slow-growing (indolent)?
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Follicular lymphoma
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Follicular, Mantle Cell, Diffuse large B-cell, Burkitt's, and Extranodal NK/T cell lymphomas are what class of lymphoma?
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Non-Hodgkin lymphomas (NHL's)
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|
|
Which NHL appears to be related to EBV, associated w/ children, max. & man. Involvement, and an endemic african variant (also curable)?
|
Burkitt lymphoma
|
|
|
Which NHL can appear as an ulcer on the hard palate?
|
extranodal NK/T cell lymphoma
|
|
|
What disease? Bimodal distribution (25 & 55), Reed-Sternberg Cells (bilobed/multilobed nucleus w/ clear zones), involves a single node or chain of nodes, possible EBV related.
|
Hodgkins disease
|
|
|
What is the most important in determining prognosis for hodgkins disease?
|
staging (lower stages have best prognosis)
|
|
|
Matching Types of Hodgkins: 1. lymphocyte predominant 2. Lymphocyte depleted 3. Mixxed cellularity 4. nodular sclerosing ---- a. most common b. worst prognosis c. best prognosis d. common in elderly
|
1.c 2.b 3.d 4.a
|
|
|
Dental diagnosis of a cervical lymphadenopathy could mean presence of __________.
|
a lymphoma (or a hicky on chase's neck)
|
|
|
Dental diagnosis of intraoral bleeding, fever, malaise, tiredness, boggy gumms (generalized!!!!) could mean presence of __________.
|
myeloid leukemias
|
|
|
Dental diagnosis of intraoral boggy red soft tissue mass (Localized!!!!) could mean presence of ____________
|
a lymphoma
|
|
|
Dental diagnosis of a destructive bone lesion could mean presence of ________
|
a lymphoma
|
|
|
What complications of leukemia/lymphoma tx are there in dentistry?
|
oral mucositis, viral, bacterial, fungal infextions,
|
|
|
As a long term side effect of tx for lymphomas/leukemias, lichenoid lesions (in the mouth) suggest onset of ______________.
|
Graft v. Host disease
|
|
|
T or F: some multiple myelomas are benign.
|
FALSE
|
|
|
What WBC disorder involves malignant plasma cells?
|
Multiple myeloma
|
|
|
What disease? s (45-50 yrs), NOT in children, bone destruction, punched out radiolucencies
|
Multiple myeloma
|
|
|
What disease? Bone pain & destruction, hypercalcemia, metastatic calcification, renal damage, bone fractures
|
Multiple myeloma
|
|
|
What disease? Lab findings: monoclonal Ig spike, Bence-Jones Protein, Abnormal plasma cells, amyloid deposition, light chain proteinuria
|
multiple myeloma
|
|
|
What other variants of Multiple myeloma are there?
|
solitary myeloma, extramedullary plasmacytoma (soft tissue), monoclonal gammopathy of undetermined significance (MGUS)
|
|
|
What disease? Bone destruction, punched out radiolucencies, soft tissue lesions, children.
|
Langerhans cell histiocytosis
|
|
|
Which laboratory evaluation? In vivo assessment of platelet response to vascular injury, normal=several minutes, elevated=defect in platelet # or function
|
Bleeding Time
|
|
|
What is the normal platelet count?
|
150,000-450,000 platelets/mm3
|
|
|
What lab evaluation? Time needed for plasma to clot in presence of exogenous source of thromboplastin and calcium
|
PT (prothrombin time)
|
|
|
What lab evaluation? Tests adequacy of Extrinsic and common coagulation pathways
|
PT (prothrombin time)
|
|
|
Deficiency of factors V, VII, or X, prothrombin, or fibrinogen is a diagnosis of ____________ Prothrombin time (PT)
|
increased
|
|
|
What lab evaluation? Time required for plasma to clot
|
Partial thromboplastin time (PTT)
|
|
|
Assesses the integrity of the INTRINSIC and common clotting pathways
|
PTT
|
|
|
Increased PTT is shown with a defect of factors __,___,___,___,___,___,prothrombin, fibrinogen or acquired antibody that interferes with intrinsic pathway.
|
V,VIII (especially, emphasized in class!), IX, X, XI, XII
|
|
|
What is the international normalized ratio (INR)?
|
PT/reference lab control plasma (normal = 1.0, elevated # equals clotting problem)
|
|
|
What are 3 mechanisms of vascular bleeding disorders?
|
Trauma, Vessel wall weakness, immune mechanisms
|
|
|
Scurvy, Amyloid, chronic systemic steroid use, inherited conditions infectious causes, and aging can all cause what type of bleeding disorder?
|
Vascular disorder
|
|
|
What bleeding disorder? Autoimmune vasculitidies, allergic rxns.
|
Immune mechanisms
|
|
|
What bleeding disorder? Petechiae & eccymoses, skin, mucous membranes, after minor trauma/spontaneously; normal platelet count, PT & PTT bleeding time
|
Vessel wall weakness & immune-related bleeding disorder
|
|
|
This type of bleeding disorder can be qualitative or quantitative
|
Platelet-related bleeding disorders
|
|
|
What platelet level characterizes thrombocytopenia?
|
<100,000/mm3
|
|
|
What occurs when platelet levels reach below 20,000/mm3?
|
Sponaneous bleeding, elevated bleeding time
|
|
|
Petechiae, and ecchymoses (skin+mucous membranes) are signs of what bleeding disorder?
|
thrombocytopenia
|
|
|
The etiology of this disease is: Decreased production of platelets, Increased loss of platelets
|
thrombocytopenia
|
|
|
Aplastic anemia, leukemia, infecious agents (ie rubella), and (interfere w/ megakaryocytes) are contributory to ______________.
|
decreased platelet production
|
|
|
Autoimmune destruction, SLE, HIV,Heparin-induced thrombocytopenia, all contribute to _________.
|
increased platelet loss (via DESTRUCTION)
|
|
|
Hypersplenism leads to _____________.
|
increased platelet loss (via REMOVAL)
|
|
|
DIC (yes, that's right), (Shock, infection tumors, injured endothelial cells, activation of coagulation system, widespread thrombi, fibrinolysis, bleeding) all contribute to __________.
|
Increased platelet loss (via CONSUMPTION)
|
|
|
Two forms of Qualitative platelet bleeding disorders:
|
Acquired; congenital
|
|
|
Aspirin, NSAIDS, ESRD (accumulation of metabolites) and Plavix all lead to ___________
|
qualitative (acquired) platelet related bleeding disorder
|
|
|
________ clotting factor deficiencies are caused by inadequte production, excessive consumption, inhibition by anticoagulants.
|
Acquired
|
|
|
Why does chronic liver disease cause inadequate production of clotting factors?
|
All clotting factors (except von willenbrand's factor) are produced in the liver, thus, liver disease will cause a decrease in these
|
|
|
Why is chronic liver disease also known as hypofibrinogenemia
|
Because fibrinogen is the most abundant clotting factor produced in the liver
|
|
|
What does the anticoagulant coumadin do?
|
prevents vitamin K utilization in the liver (decreases clotting factors)
|
|
|
DIC is responsible for what clotting factor disease?
|
Acquired, excessive consumption of platelets
|
|
|
What are 2 anticoagulants that inhibit coagulation factor production?
|
Heparin and Warfarin
|
|
|
Hemophilia A & B are what type of bleeding disorders?
|
congenital clotting factor defeiciency
|
|
|
What clotting factor is congenitally deficient in Hemophilia A?
|
Factor VIII
|
|
|
What disease? Defeiciency of Factor VIII, -linked recessive, males, females carriers, 1:5000 males, 30% are new mutations
|
Hemophilia A
|
|
|
T or F: Hemophilia is an "all or nothing" disease that has no variance in severity.
|
FALSE
|
|
|
What percent of Factor VIII must be present (at least) to not have severe bleeding?
|
1%
|
|
|
T or F: petechiae are present in Hemophilia A
|
FALSE
|
|
|
If a patient presents with normal bleeding time and normal prothrombin time(PT), normal platelet count, and prolonged partial thromboplastin time (PTT), what disease does he have?
|
Hemophilia A
|
|
|
What pathway does the PTT test for?
|
Intrinsic pathway
|
|
|
What is the leading cause of for hemophiliacs?
|
AIDS
|
|
|
What is the treatment for hemophilia A?
|
recombinant factor VIII
|
|
|
What disease? AKA Christmas Disease, Deficiency of Factor IX, X-linked recessive
|
Hemophilia B
|
|
|
Hemophilia B is ______ common than Hemophilia A
|
10 times less (also less severe)
|
|
|
Where is Vonwillenbrand factor produced?
|
endothelial cells
|
|
|
T or F: von willenbrand disease usually reuslts in mild clinical bleeding problems
|
TRUE
|
|
|
If a patient comes into your office drunk as and is yellow from hepatitis, why would you be careful in treating him?
|
because both of these problems could cause bleeding problems (decreased coagulation factors). not the fact that he's drunk as . (that was to throw you off)
|
|
|
When should you schedule a patient who is on renal dialysis (if given standard heparin)?
|
The day after dialysis.
|
|
|
How long should a patient have NOT taken aspirin prior to surgery (dental tx)?
|
3 days if possible
|
|
|
Bleeding time from aspirin use should be less than ____ minutes to be ok for Tx
|
20
|
|
|
Aspirin is a(n) ______________ platelet inhibitor
|
irreversible
|
|
|
NSAIDS are a(n) ____________ platelet inhibitor
|
reversible
|
|
|
T or F: Plavix is a concern for inc. bleeding during Tx
|
FALSE
|
|
|
________ heparin patients must be hospitalized for Tx, while __________ heparin patients are generally not a concern
|
standard; low molecular weight
|
|
|
For warfarin patients, INR must be below __________for minor surgeries
|
2.5-3.5
|
|
|
Desmopressin, factor VIII, XI concentrates are used in hospital based Tx for patients with _____________
|
hemophilia
|
|
|
Develpomental bone disorders include achondroplasia, osteogenesis imperfecta and ________.
|
osteopetrosis
|
|
|
Achondroplasia cuases dwarfism, a defect in endochondral ossification. It is autosomal nt and caused by a mutation in ________, a gene coding for collagen.
|
FGFR3
|
|
|
Why are flat bones (eg. Calvarium) not affected by achondroplasia?
|
flat = intramembranous not endochondal ossification
|
|
|
This bone disease is a genetic defect of type __ collagen resulting in fragile bones, blue sclera, floppy mitral valve and dentinogenesis imperfecta.
|
1, Osteogenesis imperfecta
|
|
|
Of the four types of osteogenesis imperfecta type __ is most common and type ___ is lethal.
|
1,2
|
|
|
Osteopetrosis is a defect in _________ function resulting in defective bone remodeling causing dense, weak and painful bones. Bone marrow transplants result in normal function of these cells,
|
osteoclast
|
|
|
________ can be pyogenic (staph aureus) or tuberculous (of thespine - Pott's disease), and forms "islands of necrotic bone" (sequestrum) normally found at the ______ of long bones.
|
Osteomyelitis, metaphesis
|
|
|
Osteomeyelitis is caused by bacteremia, bone fracture, surgery, spread from adjacent tissue and ______ _______ leading to infections of the mandible a common site due to limited flow.
|
dental infections
|
|
|
Radiographs, especially __________, reveal the sequestrum and irregular radiolucencies of osteomyelitis and are used in conjuction with histologic examinations and ____ _____ for diagnostic purposes.
|
CT scans, bone scans
|
|
|
The distinguishing symptoms of osteomyelits include tooth mobility and _______ _______.
|
altered sensation
|
|
|
Tx for osteomyelitis includes antibiotics, debridement, decortication and hyperbaric O2. T/F
|
TRUE
|
|
|
Avascular necrosis is a bone ______ secondary to a circulatory disturbance caused by trauma, emboli, endodartitis (from chemo/rad.s) or idiopathically. Examples include ___________, ischemic / aseptic necrosis and NICO.
|
infarction, osteonecrosis
|
|
|
Clinically avascular necrosis is commonly found in ____ bones of children and _____ ______ of the elderly.
|
carpal, femoral heads
|
|
|
Osteoporosis, rickets, osteomalacia and hyperparathyroidism are forms of ________ disturbances.
|
metabolic
|
|
|
The etiology of primary osteoporosis is unknown while secondary is caused by inadequate vit. __ and ___ intake, immobilization and some medications.
|
D, Ca+
|
|
|
Overall aposition < resorption in osteoporosis leading to thin, brittle bones prone to fracture. T/F
|
TRUE
|
|
|
Risk factors of osteoporosis include: = Female (Asian), __________, inactivity, heredity and dietary deficiency. T/F
|
post-menopausal *also excessive corticosteroids
|
|
|
Diagnosis of osteoporosis is made via bone ____ tests and _____. Treatment includes biphosphonates (dec. osteoclast activity), calcitonin, Ca+ and ________ supplementation.
|
density, x-rays, estrogen
|
|
|
Inadequate bone mineralization due to a vitamin D disturbances (affects phosphate/Ca+ metabolism) in _______ is termed osteomalacia and in children ________.
|
adults, rickets
|
|
|
Reduced absorption of Ca+ and PO4 lowers serum levels. The body compensates for this by releasing _____ causing resorption of bone.
|
PTH --> inc Ca+(serum) along with inc renal Ca+ retention and excretion of PO4.
|
|
|
Rachitic rosary, craniotabes, bow legs and fractures are endochondral ossification disturbances due to _______.
|
Rickets
|
|
|
Osteomalacia --> soft bones, fractures and muscle weakness due to?
|
decreased serum Ca+
|
|
|
______ dental eruption and ______ mineralized teeth are caused by Rickets.
|
delayed, poorly
|
|
|
List in order from most to least common etiologies of hyperparathyroidism: parathyroid - hyperplasia, adenoma, carcinoma and chronic renal disease.
|
parathyroid-- 1. adenoma 2. hyperplasia 3. carcinoma ****chronic renal is a secondary cause
|
|
|
Clinical signs of hyperparathyroidism include renal stones, painful bones (cysts, __________ - giant cell aggregates), ________ moans (ulcers) and psychic groans (seizures) do to Ca+/PO4 imbalance.
|
brown tumors of hyperPTH, abdominal
|
|
|
_____________ could be the first manefestation of hyperfarathyroidism.
|
CGCG central giant cell granuloma
|
|
|
Treatment for hyperthyroid includes surgical removal of the affected gland (neoplasia) or 3-4 glands due to ______.
|
hyperplasia
|
|
|
A 45 year old British patient presents with thick skull, deafness, back pain and bowed legs. Lab tests show elevated serum alkaline phosphatase and normal Ca+/PO4. The bone biopsy shows mosaic "reversal lines" and a "cotton wool" appearance is found on his ceph. He is suffering from _______.
|
pagets disease (>40 yrs old)
|
|
|
Peget's disease also causes enlargement of the maxilla, spacing of teeth and an increased risk of _________.
|
osteosarcoma -- assume if >50 yrs old
|
|
|
Comminuted fractures have multiple fracture lines and fragmentsC. T/F
|
TRUE
|
|
|
Complicated fractures are ________.
|
infected
|
|
|
Hematoma formation --> granuloma tissue --> bony callus = steps of fracture healing. T/F
|
TRUE
|
|
|
_______ tumors of the bone include, osteochondroma, chondroma and osteoma.
|
Benign
|
|
|
________ is a shaped benign growth of both bone and cartilage with the marrow space contiunous with the rest of the bone.
|
Osteochondroma
|
|
|
Chondromas are benign growths of cartilage found mostly in small bones. Some undergo malignant transformation especially in the ____________.
|
maxilla and mandible
|
|
|
Osteomas are a benign growth of bone often found in the head and neck. T/F
|
True - often found in the sinuses
|
|
|
CGCG are painless, _______, well demarcated radiolucencies found in the mand/maxilla anterior to the first molars caused by overproliferation of giant cells and fibroblasts.
|
solitary
|
|
|
Malignant tumors of the bone include osteosarcoma, chondrosarcoma and ______ sarcoma. Miscellaneous tumors include ________ _______, lymphomas and Langerhans cell histiocytosis.
|
Ewings, Multiple myeloma
|
|
|
Head and neck osteosarcoma etiology is mostly unknown although irradiation and Pagets increase risk. These are characterised by their "____-____" lytic appearance and peripheral "sunray" periosteal reaction.
|
moth-eaten
|
|
|
T/F Teeth near underlying osteosarcomas are usually vital.
|
True
|
|
|
________ are malignant tumors of cartilage-producing cells affecting __ to __ year old patients and have a tendency to metstasize to the lungs. Tx = surgery.
|
Chondrosarcoma, 35-60
|
|
|
Cartilagenous lesions of the jaw (anterior maxilla) are usually benign. T/F
|
False - all should be considered malignant until proven benign
|
|
|
"Small round blue cell" tumors (gene rearrangement) are found in a biopsy of the _______ of a childs tibia suffering from ______ _______.
|
diaphysis, Ewings sarcoma
|
|
|
Which is most common in children osteosarcoma or Ewings?
|
osteosarcoma = #1, Ewings = #2
|
|
|
Tx for Ewings includes surgical excision, chemo and _______, known as the big three.
|
radiotherapy
|
|
|
Most common metastatic cancers to attack bone are ______ and ______.
|
breast and prostate.
|
|
|
Osteosarcomas are more common than mateastatic carcinomas (to bone) in adults. T/F
|
False - metastatic to bone = #1 in adults --> uncommon to jaws but of those which do 80% to mandible.
|
|
|
A malignant glandlike tumor found in the mandible of a 65 year old patient is most likely a ________.
|
metastatic adenocarcinoma
|
|
|
A patient complains of morning joint pain, stiffness, crepitus and swelling due to to the breakdown of articular cartilage and formation of bone cysts, spurs and sclerosis. The patient is most likely suffering from_______.
|
osteoarthritis
|
|
|
Osteoarthritis is a ________ joint disease usually found in _________ joints due to wear and tear and inflamation.
|
degenerative, weight-bearing (knee, hip, vertebrae)
|
|
|
Rheumatoid arthritis is a systemic __________ disease affecting small _______ joints found 4:1 in women age 25-50.
|
autoimmune, synovial
|
|
|
Pathogenesis of RA is as follows: inflamation of joint --> ingrowth of vessels --> proliferation of synovial cells --> _______ ______ --> cartilage destruction --> ______ ______. Osteophytes, aka Heberden nodes (distal phalanges), and eburnation of bone also occurs.
|
granulation tissue (pannus), joint spacing
|
|
|
Juvenile RA affects small joints. T/F
|
False - affects large joints
|
|
|
Infectious arthritis is caused by what diease?
|
Lyme
|
|
|
Hyperuricemia (purine metabolism) --> excess uric acid --> crystalization in joints, tissues and kidneys --> phagocytosis of crystals = cell lysis --> inflamation. This pathogenesis is charactieristic of _______?
|
gout
|
|
|
Gout primarily affects males/females and is genetic/hormonal?
|
Males 95%, both genetic and hormonal
|
|
|
Gout develops __ to __ years after the onset of hyperuricemia commonly in the ___ ___.
|
15-30, big toe
|
|
|
Gout can be classified as acute or chronic. Acute causes pain for 2-3 days while chronic is less painful but displays joint _______ and subcutaneous uric acid deposits called ______.
|
deformation, tophi
|
|
|
GH and prolactin are secreted by the _____ pituitary and are (acidophilic/basophilic).
|
anterior; acidophilic
|
|
|
ACTH, FSH, LH and TSH are secreted by the _____ pituitary and are (acidophilic/basophilic).
|
anterior, basophilic
|
|
|
ACTH is a ________troph, TSH is a ______troph, and FSH and LH are ____trophs.
|
acth corticotroph, tsh thyrotroph, fsh and lh gonadotroph
|
|
|
ADH and oxytosin are released from the ______ and produced in the ________.
|
posterior pituitary; hypothalamus
|
|
|
Hyperpituitarism is usually caused by an ______ of the ______ lobe of the pituitary
|
adenoma; anterior
|
|
|
Adenomas of the pituitary produce an excess of multiple hormones secreted by that part of the pituitary
|
false (amost true), usually produces excess of one type of hormone
|
|
|
Pituitary adenomas are present in ___% of autopsied people.
|
25%
|
|
|
_________ is the most common hyperfunctioning pituitary andenoma causing amenorrhea, loss of libido, infertility and glactorrhea.
|
Prolactinoma
|
|
|
Somatotrophic adenoma before poohberty causes ______; after pooberty ______.
|
before gigantism; after acromegaly
|
|
|
Cushings disease is condidered a _____ adenoma causing an increased production of _____.
|
corticotroph, glucocorticoids (as happens in hyperproduction of ACTH)
|
|
|
Pituitary _______ include prolactinoma, GH (somatotroph) and corticotroph adenomas as well as null-cell, gonadotroph, thyrotroph and mixed adenomas. These are all forms of hyper-hypo-pituitarism?
|
adenomas, hyper**
|
|
|
_________ syndrome is a partial pituitary hypofunction caused by herniation of arachnoid matter into the sella usually due to a membrane defect. It is usually seen in obese women with _________ pregnancies.
|
Empty sella syndrome, multiple
|
|
|
Anterior pitutitary hypofunction due to postpartum ischemic necrosis-
|
Sheehan's Syndrome
|
|
|
_______ resembles an ameloblastoma derived from remnant ectodermal tissue of ______ pouch causing a slow growing neoplasm.
|
Craniopharyngioma, Rathke's
|
|
|
Most frequesnt cause of hypopituitarism is ________.
|
non-secretory pituitary adenomas
|
|
|
An abrupt enlargement of a pituitary adenoma due to acute hemorrhage within the tumor is calld a ______.
|
pituitary apoplexy
|
|
|
No signifiact clinical abnormalities are shone due to abnormal amounts of which hormone? (hint: posterior pituitary)
|
oxytocin
|
|
|
ADH oversecretion is most often due to
|
ADH producing tumor such (eg. oat cel carcinoma of the lung)
|
|
|
Over secreation of ADH causes __________ a syndrome that results in renal retention of water with an inablilty to diulte causing hyponatremia (low Na+)
|
Syndrome of inappropriate ADH (SIADH)
|
|
|
Destruction of the posterior pituitary leads to ADH undersecretion causing _______.
|
diabetes insipidus
|
|
|
The thyroid gland stores _________ which is converted to T3 and T4 under the influence of TSH. Parafollicular (C-cells) synthesize and secrete _______.
|
thyroglobulin, calcitonin (inc. Ca+ absorption)
|
|
|
Warm skin, sweating, heat intolerance, hypermotility of GI tract, increased apetite, osteoporisis, iritabitly, tachycardia, arrhythmias, exopthalmos, fine oily hair and muscle weakness are symptoms of ________.
|
hyperthyroidism
|
|
|
The most common causes of hyperthyroidism include: Graves disease (most common), excess ingested TSH, goiters and _______.
|
adenomas
|
|
|
A patient suddenly manifests high fever, tachycardiam arrhythmias and hypertension due to hyperthyroidism. The patient is suffering from a ________.
|
thyroid storm
|
|
|
what should you do in a thyroid storm (sudden attack of hyperthyroidism)
|
stop dental proceedure, give O2, take vitals, give nitroglycerin and call 911
|
|
|
Which is not a form of Hypothyroidism: Hashimotos, cretinism, myxedema, Grave's disease.
|
Graves = hyper
|
|
|
Cells of the thyroid are ineffiecient in converting iodine to thyroid hormone causing enlargement. Thyroid tissue is then replaced by lymphocytes causing inflamation and primary hypothyroidism in this disease.
|
hashimotos thyroditis
|
|
|
______thyroidism in infancy due to dietary iodine deficiency causes wide set eyes, coarse facial features, protruding tongue and umbilicus and severe mental retardation (think eric) are manifestations of ________.
|
hypo-, cretinism
|
|
|
______ is a kind of an version of cretinsm (lethargy,mental slowness, cold intolerance, broad face, tongue enlargement, coarse dry hair)
|
myxedema
|
|
|
Cretinism occurs in ______ while myxedema in _______. Both are forms of ____thyroidism.
|
infants, late childhood-adult, hypo
|
|
|
______ is the most common cause of primary (endogenous) hyperthyroidism.
|
graves disease
|
|
|
Graves disease is manifested in 3 ways: pretibial myxedema (thickening of the skin over legs and dorsal foot), bulging eyes (exopthamos), and ________.
|
thyroxicosis (hyperthyroidism)
|
|
|
Graves disease is (hyper/hypo)secretion of what hormone and is most common in which gender
|
hyperthyroidism, female 7:1
|
|
|
HLA-DRS is to _____ as HLA DR3 is to _____
|
non-specific lyphoid thyroiditis ; graves disease
|
|
|
Either sporadic or endemic hyperplasia of the thyroid is referred to as a ______ goiter.
|
Diffuse non-toxic goiter
|
|
|
The most common cause of hypthyroidism in usa is?
|
hashimotos thyroditis
|
|
|
Types of thyroiditis include non-specific, hashimoto's, subacute granulomatous and ______.
|
Reidel's
|
|
|
Non-specific lymphoid thyroiditis is commonly found in (males/females) and shows mild gland enlargement with no ________ centers.
|
germinal
|
|
|
What autoimmune disease increases the risk of b-cell lymphoma, is more commonly found in females and is characterized histologically by Hurthle cells?
|
hashimotos thyroditis
|
|
|
Auto antibodies associated with Hashimotos include: anti- thyroid, thyroglobulin, TSH and iodine _________.
|
receptors
|
|
|
T/F de Quervain's thyroiditis is synonymous with subacute (granulomatous) thyroiditis, causing acute onset granulomatous inflamation.
|
TRUE
|
|
|
Fibrous tissue replaces normal thyroid tissue in ________ thyroiditis.
|
Reidel's
|
|
|
Thyroid neoplasms are usually benign? T/F
|
TRUE
|
|
|
Benign thyroid adenomas cause papillary change. T/F
|
false
|
|
|
Of the four main subtypes of thyroid carcinomas, papilary, follicular, medullary and anaplastic, which is most common?
|
Papilary 75-80%
|
|
|
Papilary projections containing ground glass, clear "orphan annie" nuclei are seen in _______ which typically has a good prognosis even when adjacent lymph nodes are invloved.
|
papillary carcinoma
|
|
|
Prognosis for papillary carcinoma of the thyroid is ______, anaplastic (undifferentiated) carcinoma of thyroid is _____.
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good, poor
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Medulary carcinoma arises from ________ cells causing secretion of calcitonin. It normally presents as a neck mass in 50-60 years of age and can be associated with
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parafolicular (C-cells), MEN syndrome Iia and IIb (III)
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Uniform folicles invading surrounding tissue and "cold" nodules are characterisitc of _______.
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follicular carcinoma of the thyroid
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T/F The parathyroid is stimulated hormonally?
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False - [Ca+] decrease --> stimulates osteoclasts, increased renal asn GI absorption Ca+, inc vit D synthesis
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Primary hyperparathyroidism is most often caused by ____ or _____ of the glands.
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adenoma, hyperplasia
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Stones groans moans and bones refers to what disorder
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primary hyperparathyroidism
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Increased serum phosphorus and decreased serum alkaline phosphatase occur in hyperparathyroidism. T/F
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False - other way around
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The most common cause of secondary hyperparathyroidism is ________.
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renal failure
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Hypoparathyroidism is less common and usually caused iatrogenically, or in rare instances by DiGeorge's syndrome and is accompanied by two signs _______ and ______.
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Chvostek's (unilateral spasm in face by tapping on facial nerve), Trouseau's (hand/arm in tetany position similar to nerve compression)
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The adrennal cortex secretes __________, _________, and ________
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glucocorticoids (cortisol), Mineralcorticoids (aldosterone), androgens
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Which is not a form of adrenal hyperfuction: Cushing's, Hyperaldosteronism (Conn's), Virilism, Addison's
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Addison's is hypo
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Cushings disease is an increased production of _____, that cuases adrenal (atrophy/hypertrophy)
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glucocorticoids, atrophy or hypertrophy (****depending on whether it is caused by exogenous corticosteroids being administered (atrophy) or an adrenal or ectopic tumor producing ACTH (hyperplasia))
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Which is not a symptom of Cushing's: moon face, buffalo hump, weight gain, extremity muscle wasting, stretch marks, osteoporosis, menstrual abnormalities, hirsutism, mental disturbances, hypertension, glycosuria, increased ACTH.
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increased ACTH, Cushing's = dec. ACTH (hypo)
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The most common form of Cushing's is caused by _________.
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exogenous steroid medications
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cushing's syndrome can be caused by adrenal tumor producing cortisol. This causes nodular hyperplasia.
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true; true
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Hyperaldosteronism causes Na+ retention, K+ excretion and hypertension. T/F
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TRUE
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An example of _____ hyperaldosteronism is Conn's syndrome which is due to _______ serum renin caused by negative feed back of hypertension.
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primary, decreased
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secondary aldosteronism is due to renal ischemia, edema or nephroticsyndrome and exhibits _______ serum renin.
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increased *** opposite of primary
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Adrenal virulism is caused by ____ defects or a ____ of the adrenal cortex producing virulism in females and precocious pubecent males.
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enzymatic, tumor (virulism = hyper-aldosteronism)
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Adrenal hypofunction (hypocorticism) is characterized by a ____ of glucocorticoids and often mineralcorticoids.
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deficiency
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Which is not a symptom of Addison's disease: somnolence, cardiac problems, hyperpigmentation, adrenal hypertrophy, weight loss, amenorrhea, loss of pubes (hotcoles still dosen't have any) and muscle weakness.
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Hypertrophy is wrong. Addison's = hypocorticism = atrophy of adrenals
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Tb was once the most common cause of Addison's but now it is due to _________ adrenal atrophy.
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idiopathic/autoimmune
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Which two diseases are asssociated with adrenal hypofuncion
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addisions' and waterhous-friderichsen disease
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Waterhous-friderichsen disease is caused by a _____ collapse often associated with ___.
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vascular, DIC (sepsis from meningococcal meningitis)
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The rule of tens applies to ___________ which is overproduction of epinephrine, norepinephrine and VMA that causes hypertension.
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pheochromocytoma (rule = 10% bilateral, 10% children, 10% malignant)
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Pheochromocytoma can be corrected surgically. T/F
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TRUE
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________ is a highly malignant catacholamine-producing tumor of early childhood (0-3 yrs) presenting as an ________ mass causing hypertension.
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neuroblastoma, abdominal
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Multiple endocrine neoplasia (MEN) syndromes are autosomal ______ in which one or more endocrine organs is ________.
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dominant, hyperfunctional
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MEN 1 is commonly called _____, linked to chromosome ___ , which causes tumors of the 3 p's: pituitary, _______ and pancrease.
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Wermer syndrome, 11, pancrease (not penis, perv)
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More than one of the following are involved: pituitary, parathyroid, pancreatic islets, adrenal cortex
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MEN I (wermer syndrome)
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Sipple syndrome is also called ____. Nearly all have medullary carcinoma of the ______ which is usually multifocal and aggressive.
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MEN II, thyroid
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MEN II (Sipple) is linked to chromosome 10 and causes ____ of the parathyroid (hyperparathyroidism).
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hyperplasia
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MEN Iib (MEN III) is simliar to MEN ___, but does not cuase hyperparathyroiditis. It is linked to mutations of the ret proto-oncogene and include pheocytochroma, medullary carcinoma and _______.
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Iia (Sipple), oral mucosal neuromas
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The enzymes ______, _____ and _______ are synthesized in pancreatic acini and are released in an inactive form.
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amylase, lipase, peptidase (trypsin, chymotrypsin)
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____________ stimulates secretion of pancreatic enzymes.
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CCK (cholecystokinin)
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_________ stimulates the release of bicarbonate.
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Secretin
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t/f Pancreatic enzymes are found in trace amounts in the normally; elevated levels of these enzymes can be an indicator of pancreatic disease.
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True; True
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Cystic fibrosus affects mucous secretions and plugs ducts. This leads to ____ of the pancrease resulting in ________.
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atrophy, malabsorptioin
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Pacreatitis is inflamationof the endocrine pancrease. T/F
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False - exocrine**
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Fat necrosis, pseudocysts and calcium soaps (hypercalcemia) result from the autodigesttion of the pancrease due to ____ _______.
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acute pancreatitis
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Increased serum ________ and _______is indicitave of acute pancreatitis.
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amylase, lipase
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80% of the cases of acute pancreatitis are due to _______ and _______; the cause of the other 20% is ___________
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gallstones, excessive alcohol; idiopathic
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70-80% of chronic pancreatitis is associated with _________ or __________ leading to progessive fibrosis and calcification causing ________.
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alcohol abuse, cholecystitis, malabsorption
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Chronic pancreatits may also cause destruction of the islet cells leading to secondary _____.
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diabetes
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Systenic organ failure, DIC, abscesses, pseudocysts and duodenal obstruction are characteristic of _______.
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acute pancreatitis
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Chronic pancreatitis displays pseudocysts and duct obstruction (same as acute) but also causes secondary diabetes and ________.
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malabsorption
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_____% of pancreatic neoplasms are malignant and rarely occur under age _____.
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95%, age 40
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A patient presents with abdominal pain radiating to the back, obstrutive jaundice; distended palpable gallbladder and weight loss. What do you suspect?
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pancreatic cancer
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Adenocarcinomas are usually located at the _____ of the pancrease tending to obstruct the ______ causing jaundice. They also metastasize _____.
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head, common bile duct, early
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90% of insulinomas, also called ____ _____ tumors, are (malignant or benign) and show signs similar to diabetes.
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beta cell tumors, benign
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|
|
The most common endocrine tumor is insulinoma. T/F
|
TRUE
|
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Glucagonoma is also called an ______ _______ tumor and is usually (benign or malignant)
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alpha cell tumor; benign
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One of the most best indicators for pancreatic tumors is ______.
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jaundice
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Zollinger Ellison syndrome is caused by ____________ usually due to a gastrinoma.
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recurrent peptic ulcers
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Somatostatinomas are ____ cell tumors and present with mild diabetes, malabsorption, etc.
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Delta
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Diabetic synptoms include the 3 P's: polydipsia (thirst), polyuria and ______.
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polyphagia - hotcoles is a phag
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|
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type of diabetes: Sudden onset (90% have complications in first two years)
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type 1
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type of diabetes: after age 30
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type 2
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type of diabetes: obese
|
type 2
|
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type of diabetes: no endocrine cell antibodies
|
type 2
|
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type of diabetes: amyloidosis
|
type 2
|
|
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type of diabetes: low insulin levels
|
type 1
|
|
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type of diabetes: normal body weight
|
type 1
|
|
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type of diabetes: normal to increased insulin levels
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type 2
|
|
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type of diabetes: antibodies to beta cells
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type 1
|
|
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type of diabetes: familiary history more common
|
type 2 (60%) - type 1 is only (20%)
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Ketoacidosis is common in type ____ diabetes but not in type ____.
|
ketoacidosis - common in I, not in 2
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|
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Less complications are seen in type ___ diabetes
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2
|
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there is a _____% concordance in twins with type 1 diabetes and a ____% concordance in twins with type II
|
50% (type I), 90% (type II)
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|
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Type 2 diabetes show increased insulin resistance in ____ and _____.
|
fat, muscle especially
|
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Pancreatic carcinoma, chronic _________, endocrine diseases, steroids, bronze disease, cushing's syndrome, acromegaly, glucagonoma and _________ can cause seconday diabetes
|
pancreatitis, pregnancy
|
|
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Complications of poorly controlled diabetics include kidney, cardiovascular, eye hemorrhages and nervous system problems. T/F
|
True; True
|
|
|
________ necrosis / polynephritis is often a result of diabetes.
|
Papillary
|
|
|
Cariovascular problems caused by diabetes include atherosclerosis, peripheral vascular insufficiency (gangrene) and more commonly _____.
|
MI's
|
|
|
|
|
|
|
Amyloidosis is common in type __ diabetes; and fibrosis is common in type ___.
|
II, I
|
|
|
t/f it is more common to see a hypoglycemic diabetic patient than hyperglycemic?
|
true (according to dr hess)
|
|
|
How can you assess if a patient is well controlled diabetic?
|
acts them what their Hba1c is (yes, "acts" was written for you coles)
|
|
|
Normal fasting glucose level is _____ mg/dl
|
60-100
|
|
|
A glucose level of ______ is considered elevated and _______ severely elevated.
|
180-240, >250
|
|
|
Define HbA1c?
|
% of glycosylated hemoglobin
|
|
|
What are the normal values of HbA1c?
|
normal is below 6.5%
|
|
|
Elevated A1c is ______ and severley elevated is ______
|
8.5-10%, and 10.5-14%
|
|
|
Which of the following will NOT help better manage a diabetic patient? Morning appointments, asking what symptoms they show when hypoglycemic, checking if their A1c level is elevated, providing insulin before treatment.
|
you shouldn't give them insulin (duuh mas) and elevated glucose levels are what you want, not elevated Hba1c. Hba1c should be as low as possible
|
|
|
The kidney basement membrane becomes thicker and less permeable with poorly controlled diabetes. T/F
|
false ; becomes thicker, but more permeable -->nephrotic syndrome
|
|
|
_____________ disease (diffuse glomerulosclerosis) is common in people with long standing diabetes and affects the ________ (which organ of the body)
|
Kimmelsteil wilson, kidney
|
|
|
Which of the following is not an anatomic change in diabetic patients: cataracts, peripheral neuropathy, fatty change in liver, xanthoma, abcesses/fungal lesions, gangrene.
|
all are symptoms
|
|
|
Which is not a symptom of hyperglycemia: thirst, polyurea, hunger, blurred vision, sweating, nausea and drowsyness.
|
sweating is a sign of hypo-glycemia
|
|
|
Which is not a symptom of hypoglycemia: sweating, anxiety, tremors, nausea, confusion and headache.
|
all are symptoms
|
|
|
Most common cause of immune nephrotic syndrome in adults
|
Membranous Nephropathy
|
|
|
Most common nephrotic syndrome in children
|
Lipoid Nephrosis
|
|
|
Most common glomerulonephritis
|
Bergers Nephropathy
|
|
|
Most common sudden onset renal failure
|
Acute Tubular Necrosis
|
|
|
Most common tumor of urinary tract
|
Transitional Cell Carcinoma
|
|
|
Most common primary kidney cancer
|
Renal Cell Carcinoma
|
|
|
Most common childhood renal tumor
|
Wilms Tumor
|
|
|
Most common presenting symptom of transitional cell carcinoma
|
Hematuria
|
|
|
Most common iron deficiency
|
Anemia
|
|
|
Most common increased loss
|
Iron Deficiency Anemia
|
|
|
Most common inherited RBC disease in whites
|
Hereditary Spherocytosis
|
|
|
Most common cause of in leukemias
|
Infection
|
|
|
Most common childhood leukemia and malignant tumor in children
|
ALL
|
|
|
Most common leukemias
|
ALL, CLL, AML, CML
|
|
|
Most common leukemia overall and leukemia in s
|
AML
|
|
|
Most common non-hodgkins lymphoma
|
Follicular Lymphoma
|
|
|
Most common cause of associated with hemophilia A
|
HIV
|
|
|
Most common primary bone malignancy
|
Osteosarcoma
|
|
|
Most common second most common after osteosarcoma in children
|
Ewings Sarcoma
|
|
|
more common than osteosarcomas in s
|
Metastasis to Bone
|
|
|
Most common metastasis to bone
|
Breast/ Prostate
|
|
|
Most common infectious arthritis
|
Lyme Disease
|
|
|
Most common hyperpituitarism in anterior lobe
|
Adenoma
|
|
|
Most common hyperfunctioning pituitary adenoma
|
Prolactinoma
|
|
|
Most common hypopituitarism
|
Nonsecretory Adenoma
|
|
|
Most common ADH oversecretion
|
ADH Producing Tumor
|
|
|
most sensitive indicator of hypothyroidism
|
TSH
|
|
|
Most common primary hyperthyroidism
|
Graves Disease
|
|
|
Most common hypothyroid in U.S.
|
Hashimoto's Thyroiditis
|
|
|
Most common primary hyperparathyroidism
|
Parathyroid Adenoma or Hyperplasia
|
|
|
secondary hyperparathyroidism
|
Renal Failure
|
|
|
Cushing syndrome
|
Exogenous Corticosteroid Medications
|
|
|
Often associated with Berry aneurysm of the circle of Willis this autosomal nt kidney disorder involves multiple cysts --> hypertension, hematuria, secondary polycythemia and possible renal failure.
|
polycystic kidney disease
|
|
|
Which is not a sign of renal failure: azotemia (retained N), uremia, acidosis, hypercalcemia, hyperkalemia.
|
hypercalcemia - HYPOcalcemia is correct
|
