Blood disorders to skin disorders
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| what is anemia? | decreased amount of hemoglobin per ml of blood
the blood plasma volume is increased and the total blood volume is the same
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| what are the major clinical features of anemia? | pallor of the skin and mucous membranes, weakness, fatigability, dyspnea and palpitation on exertion but not on rest
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| what is pernicious anemia? | chronic autoimmune gastritis decreases gastric secretion of intrinsic factor, atrophy of the gastric mucosa. Deficiency of intrinsic factor impairs intestinal absorption of vitamin B12
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| what are the major complication of pernicious anemia? | degeneration of the spinal cord with motor and sensory deficits
may be complicated by spinal cord degeneration
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| how is pernicious anemia treated? | injections of vitamin B12
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| what do the erythrocytes look like in pernicious anemia? | look larger than normal
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| what is iron deficiency anemia? | more frequent in women than in men, deficiency of body iron stores is caused by chronic blood loss from menorrhagia (pregnancy, lactation, bleeding from carcinoma)
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| what do the erythrocytes look like in iron deficiency anemia? | small, poorly hemoglobinized erythrocytes
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| what is the treatment for iron deficiency anemia? | long term oral iron therapy
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| what is sickle cell anemia? (age) | common hereditary disease of blacks, occurs in children and young adults of both sexes
abnormal hemoglobin which aggregates in filamentous polymers when exposed to low oxygen tension
inherited as a sex linked recessive trait
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| what do erythrocytes look like in sickle cell anemia? | narrow, elongated and often crescentic with pointed end
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| what are the complications of sickle cell anemia? | sickled erythocytes interlock with one another to form logjams in small blood vessels resulting in infarcts in the spleen, bone, brain and other organs
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| what are the common features of leukemia? | enlargement of the spleen, increased white blood cell count, thrombocytoenia with a hemorrhagic diathesis
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| what is leukemia? | in most cases of leukemia the total leukocyte count in the blood is increased
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| what is chronic lymphocytic leukemia? (age) | occurs in elderly adults, usually occurs after age 50
severe leukocytosis composed of mature (structurally normal small) lymphocytes
generalized lymph node enlargement, myelophthisic anemia (bone marrow infiltrated by non red blood cells)
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| what happens if chronic lymphocytic leukemia is untreated? | untreated patients pursue a slow progression over several to many years, most patients survive more than 10 years
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| what is acute granulocytic leukemia? | moderate leukocytosis composed of markedly immature granulocytic or monocytic cells, may occur at any age
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| what are the major complications of granulocytic leukemia? | decreased resistance to bacterial and fungal infections
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| how do you treat granulocytic leukemia? | rapidly clinical progression and poor response to therapy
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| what is non hodgkin's malignant lymphoma? | more common than Hodgkin's disease, occurs at an older average age
usually arises in the lymph nodes, rapid dissemination of tumor tissue is common and many patients have generalized disease by the time the diagnosis is established
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| what is the lesion of non Hodgkin's malignant lymphoma? | rapid dissemination to produce generalized disease, advance cases often have generalized lymph node enlargement
NO REED STERNBERG CELLS
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| what is treatment for Non Hodgkin's malignant lymphoma? | about half the patients are cured by current therapy
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| what is Hodgkin's disease? | often occurs in young adults, most common in young adults ages 20-40, usually arises in the lump nodes presents with cervical lymphadenopathy, spreads slowly and predictably in most patients
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| what are the lesions of Hodgkin's disease? | spreads slowly and predictably in most patients, Reed Sternberg cells are present
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| what are Reed-Sternberg cells? | tumor giant cells with biobed or double nuclei
present in Hodgkin's disease
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| what is the treatment for Hodgkin's disease? | most patients are cured
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| what is multiple myeloma? | multicentric maligant tumor of the bone marrow composed of neoplastic plasma cells, infiltration of red bone marrow by neoplastic plasma cells
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| what age does multiple myloma occurs? | usually occurs in elderly adults, ages 50-70
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| what are the lesions of multiple myeloma? | sheets of neoplastic plasma cells infiltrate the bone marrow
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| what can multiple myeloma cause as symptoms? | destruction of bone tissue may cause pathologic fractures
bone marrow lesions often cause dull back pain, myelopthisic anemia
the urine may contain a small immunoglobulin subunit
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| what is infectious mononucleosis caused by? | Epstein Barr virus
usually occurs before age 30
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| what is infectious mononucleosis? | clinically apparent disease usually occurs in adolescent and young adults
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| how is infectious mononucleosis transmitted? | transmitted by close personal contact, especially kissing
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| what are the symptoms of infectious mononucleosis? | fever, fatigability, sore throat, and cervical lyphadenopathy and leukocytosis with some atypical lymphocytes
convalescence may be protracted
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| what population is Grave's disease more common in? | more common in females than in males and usually occurs before age 50
more common in young women than in elderly men
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| what is Grave's disease? | autoimmune disease
thyroid gland is enlarged and hyper plastic with goiter
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| what happens in Grave's disease? | autoantibodies bind to thyroid epithelial cells and cause an increased synthesis and release of thyroid hormones into the blood
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| what are the signs of Grave's disease? | eyes are forwardly protruded or exophthalmos
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| what population is idiopathic Cushing's syndrome more common in? | more frequent in women than in men
usually occurs between ages 20 and 40
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| what is idiopathic Cushing's syndrome? | adrenal cortical hyperplasia, excessive secretion of adrenocorticotropin (ACTH) with resultant hyperplasia of the adrenal cortices
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| what are the symptoms of idiopathic Cushing's syndrome? | moon face, hypertension and osteoporosis
increased plasma levels of cortisol, increased susceptibility to infections
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| what is iarogenic Cushing's syndrome? | caused by therapeutic administration of large doses of synthetic glucocorticoids
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| what are the symptoms of iarogenic Cushing's syndrome? | obesity of the head (moon face) and trunk
increased susceptibility to infections
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| when does juvenile diabetes mellitus begin? | usually begins before age 20
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| what is juvenile diabetes mellitus? | autoimmune disease with descrutionof the beta cells of the pancreatic islets of Langerhans
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| what are the symptoms of juvenile diabetes mellitus? | hyperglycemia, severe insulin deficiency with resultant hyperglycemia and glycosuria and polyuria
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| what happens in untreated patients with juvenile diabetes mellitus? | untreated patients may develop ketosis, acidosis and coma
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| when does adult diabetes mellitus happen? | usually begins in a obese person over age 40
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| what are the symptoms of adult diabetes mellitus? | hyperglycemia and glycosuria especially after a meal
glomerulosclerosis with proteinuria and slowly progressive renal failure
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| what are the predisposing factors of adult diabetes mellitus? | heredity and obesity
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| what is adult diabetes mellitus? | insulin deficiency impairs the transfer of glucose from extracellular fluids into cells resulting in hyperglycemia which in turn causes the sugar to spill into the urine
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| what is diabetic ketoacidosis? | caused by severe insulin deficiency
glycosuria with resultant polyuria
increased fat catabolism with ketosis
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| what is diabetic glomerulosclerosis? | occurs in both juvenile and adult diabetes mellitus
may cause proteinuria with nephrotic syndrome
slowly progressive renal failure
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| how is monoglism or down's syndrome caused? | trisomy of chromosome 21
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| what are the symptoms of monogolism or down's syndrome? | wide set eyes with oblique palpebral fissures
small brain with mental deficiency and decreased number of neurons
simplified gyral pattern
single traverse palmar crease in each hand
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| what is the common cause of cerebral palsy? | anoxia occurring before, during or shortly after childbirth
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| what are the symptoms of cerebral palsy? | bilaterally symmetrical brain lesions with loss of neurons and gliosis
shrunken firm cerebrall gyri and loss of fibers
most patients have normal mental capacity
often causes spastic weakness of the LOWER limbs
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| what causes an infarct of the brain? | occlusive thrombosis of a sclerotic cerebral artery
cerebral arteriosclerosis plus an acute event such as arterial thrombosis of hypotension
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| what is more common, cerebral hemorrhage or infarct of the brain? | infarct of the brain
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| what are the symptoms of infarcts of the brain? | liquefactive necrosis of the brain tissue
most patients survive the acute event but some are left with permanent neurologic deficit such as aplastic hemiplegia
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| what does an infarct of the basal ganglia produce? | permanent contralateral spastic hemiparesis or hemiplegia
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| what causes cerebral hemorrhage? | combination of hypertension and cerebral arteriosclerosis
hematoma in the basal ganglia
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| what are the symptoms of cerebral hemorrhage? | headache, coma and grossly bloody cerebrospinal fluid
sudden onset of severe headache promptly followed by coma
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| what is glioblastoma multiforme composed of and occur in? | atypical astrocytes and usually occurs in the cerebrum of adults
rapidly growing solid tumor that increases intracranial pressure
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| what is the outcome of globlastoma multoforme? | rapid growth with death in a few months to 2 years after clinical onset
causes death within 2 years after clinical onset
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| what is meningioma? | arises in the meninges
slowly growing tumor
cured by excision
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| when does multiple sclerosis begin? | usually begins before age 40
common disease more frequent in omen than in men and usually begins before the age of 50
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| what is multiple sclerosis? | multole foci of demylination (plaques) with initial preservation of axons
involves the brain and spinal cord
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| what is the outcome of multiple sclerosis? | erratic clinical course with remission and exacerbation
most patients survive more than 10 years after clinical onset
most patients live several decades after clinical onset
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| what age does parkinson's disease begin? | common disease of elderly persons
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| what happens in Parkinson's disease? | loss of pigmented neurons from the substantial nigra
deficiency of dopamine in the brain
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| what are the symptoms of Parkinson's disease? | masklike facies and resting tremors of the fingers, shuffling gait and pill rolling tremors of the fingers
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| when is alzheimer's disease common? | common disease of persons over age 80
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| what does the brain look like in alzheimer's disease? | decreased brain weight, loss of cerebral neurons
narrow cerebral gyri and wide sulci
degeneration and final loss of scattered neurons
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| what is the outcome of Alzheimer's disease? | slow but relentless mental deterioration over several (2 to 10) years
memory loss intellectual deterioration and final dementia
intellectual deterioration with eventual dementia
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| what is Duchenne progressive muscular dystrophy? (age) | inherited as a sex linked recessive trait and occurs only in males
onset in early childhood with death in adolescence or young adulthood
shrinkage and final disappearance of skeletal muscle fibers
symptoms (if present) usually begin after age 50
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| what are the symptoms of Duchenne progressive muscular dystrophy? | weakness and atrophy of skeletal muscles
may involve myocardium
death before age 30
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| what is more common, degenerative joint disease of rheumatoid arthritis? | degenerative join disease
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| who gets denotative join disease more commonly? | elderly persons
predisposing factors include obesity and excessive use of a joint
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| what joints usually get degenerative joint disease? | involves the hips and knees more severely than the shoulders and elbows
involves larger weight bearing joints and spares the smaller joints of the hands and feet
involves the knees more severely than the elbows
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| how does denotative joint disease progress? | central erosion of articular cartilages, exposing dense bone
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| rheumatoid arthritis is more frequent in what population? | more frequent in females than in males and usually begins before age 50
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| what do untreated cases of rheumatoid arthritis progress into? | fibrous or bony ankylosis of involved joints
often progresses to bony fusion (ankylosis) of involved joints
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| what are the symptoms of rheumatoid arthritis? | rheumatoid factor is usually present in the serum
granulation tissue (pannus) extends from the inflamed synovium over the articular cartilages causing peripheral erosion of the articular cartilages
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| where does osteochondroma arise from? | more often arises from the lower metaphysics of the demur (knee region) than from the external surface of the skull
cartilage capped bony nodule on the external surface of the involved bone
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| when do you get osteochondroma? | usually arises before age 30
occurs in children or adolescents
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| where does osteosarcoma arise from? | arises in the metaphysics of a long tubular bone, often int he region of the knee (distal part of the femur or the proximal part of the tibia)
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| what is osteosarcoma composed of? | markedly atypical bone forming cells
early hematogenous metastases in the lungs
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| what is chondrosarcoma? | occurs in mid adult life
grows slowly but often recurs after local excision
hemtogenous metastases occur late in the course
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| what causes dermatophytoses? | fungi that grow in the epidermal keratin layer causing pruritus
often involves toes (athlete's foot) or groin (jock itch)
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| what is pruritus? | itch
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| who usually gets impetigo? | usually occurs on exposed skin areas, especially the face and hands of young children
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| what does impetigo usually look like? | acute purulent inflammation of the epidermis with formation of honey yellow crust on the skin surface that is pruritus (itchy)
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| what causes verruca vulgaris? | caused by the type 2 human papillomavirus infection of the epidermis
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| what does verruca vulgaris look like? | squamous papilloma covered by thick layer of keratin
usually growls slowly, persists for several months to several years and finally regress and disappears
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| what causes basal cell carcinoma and where does it usually occur? | caused by chronic solar irradiation, usually occurs in the face
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| what is more frequent, squamous carcinoma of the skin or basal cell carcinoma? | basal cell carcinoma
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| what does basal cell carcinoma usually look like? | slowly growing firm pearly bump which finally ulcerates centrally leading an elevated pearly margin
usually begins as a firm pearly bump which eventually ulcerates centrally
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| what is the growth like in basal cell carcinoma? | growth is slowly but invasive and neglected cases may produce extensive local tissue destruction
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| does basal cell carcinoma metastasize? | NOOOOO
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| who is malignant melanoma more frequent in? | more common in whites than blacks
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| what is malignant melanoma composed of? | composed of atypical melanocytes
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| what do early lesions of malignant melanoma look like? | early lesions are flat pigmented areas and later become elevated and nodular
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| what is the spread of malignant melanoma look like? | slow radial spread usually precedes vertical growth to produce a nodular mass
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| what happens in neglected cases of malignant melanoma? | neglected cases often produce widespread lymphatic and hematogenous metastases
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| what is poison ivy dermatitis? | slowly developing dermatitis limited to skin areas that contacted the poison ivy plant
slowly developing but resistant dermatitis lasting up to three weeks
pruritus (itching)
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| who usually gets acne vulgaris? | common skin disease that begins in puberty
more frequent and severe in males than females
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| where does acne vulgaris usually reside? | lesions begin at puberty and involve mainly the face
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| what happens during acne vulgaris? | bacterial infection of the comedones may progress to small abscess
comedones are blocked and distended hair follicles with their sebaceous glands
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| what can happen during healing of acne vulgaris | healing of more severe lesions often leaves permanent pitted scars
several lesions, especially those complicated by bacterial infections may heal to leave permanent pitted scares
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| when does psoriasis usually occur and in who? | usually begins before age 40
more common in whites than in blacks
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| what does psoriasis look like? | slightly elevated pink papules and plaques covered by silvery scales
lesions are covered by silvery scales caused by abnormal keratinization
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| what is the course of psoriasis? | chronic course with remissions and exacerbations
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