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Questions and Answers

What is the pathogenesis (origin or cause) of cholesteatoma?

  • Common superficial skin bacterial infection (S. Aureus) that is highly contagious and frequently seen in healthy children. The bacteria in the epidermis evoke an innate immune response that causes epidermal injury with serous exudate and formation of scale crusts (scabs).
  • A fleshly overgrowth of the conjunctiva, which is the thin clear membrane on the surface of the eye.
  • One of the most common causes of irreversible vision loss in patients over 65 years old; results in central vision loss due to damage to the macula.
  • Chronic inflammation and perforation of the eardrum, with ingrowth of the squamous epithelium or metaplasia of the secretory epithelial lining of the middle ear, promote the formation of a squamous cell nest that becomes cystic. (correct)

What are the main risk factors for the development of a pterygium?

  • Spending a lot of time outdoors without eye protection. It is also more common in older adults and people who live near the equator. (correct)
  • The most common causes of irreversible vision loss in patients over 65 years old, results in central vision loss due to damage to the macula.
  • Common superficial skin bacterial infection (S. Aureus) that is highly contagious and frequently seen in healthy children. The bacteria in the epidermis evoke an innate immune response that causes epidermal injury with serous exudate and formation of scale crusts (scabs).
  • Chronic inflammation and perforation of the eardrum, with ingrowth of the squamous epithelium or metaplasia of the secretory epithelial lining of the middle ear, promote the formation of a squamous cell nest that becomes cystic.

What is the pathogenesis (origin or cause) of macular degeneration?

  • The most common causes of irreversible vision loss in patients over 65 years old, results in central vision loss due to damage to the macula. (correct)
  • Common superficial skin bacterial infection (S. Aureus) that is highly contagious and frequently seen in healthy children. The bacteria in the epidermis evoke an innate immune response that causes epidermal injury with serous exudate and formation of scale crusts (scabs).
  • A fleshly overgrowth of the conjunctiva, which is the thin clear membrane on the surface of the eye.
  • Chronic inflammation and perforation of the eardrum, with ingrowth of the squamous epithelium or metaplasia of the secretory epithelial lining of the middle ear, promote the formation of a squamous cell nest that becomes cystic.

What is the primary pathogenic mechanism in allergic rhinitis (hay fever)?

<p>IgE-mediated immune reaction with an early- and late-phase response, characterized by mucosal edema, erythema, and mucus secretion accompanied by eosinophil-rich leukocytic infiltrates. (B)</p> Signup and view all the answers

What is the most common cause of purulent (suppurative) inflammation?

<p>Infection with bacteria that cause liquefactive tissue necrosis, such as staphylococci, These pathogens are referred to as pyogenic (pus-producing) bacteria. (A)</p> Signup and view all the answers

What are the two major factors that contribute to the clinical features of Klinefelter syndrome?

<p>Aneuploidy and the impact of increased gene dosage by the supernumerary X and the presence of hypogonadism. (A)</p> Signup and view all the answers

What is the primary cause of familial hypercholesterolemia?

<p>Mutations in the LDL receptor (LDLR) gene, encoding for the LDL receptor. (A)</p> Signup and view all the answers

What is the most common serious complication of thrombocytopenia?

<p>Bleeding within the brain. (D)</p> Signup and view all the answers

What is the most common cause of acute tubular necrosis (ATN)?

<p>Sepsis. (C)</p> Signup and view all the answers

What is the primary pathogenic mechanism that contributes to the development of atherosclerosis?

<p>Endothelial injury and dysfunction, which causes increased vascular permeability, leukocyte adhesion, and thrombosis. It is the cornerstone of the response-to-injury hypothesis. (C)</p> Signup and view all the answers

What is the most important modifiable risk factor for the development of atherosclerosis?

<p>Hyperlipidemia, increased LDL, HTN, smoking, DM, inflammation. (C)</p> Signup and view all the answers

What are the two primary types of shock?

<p>Cardiogenic and hypovolemic (D)</p> Signup and view all the answers

What are the two primary types of heart block?

<p>First-degree and third-degree (D)</p> Signup and view all the answers

What is the primary pathologic mechanism in myocarditis?

<p>Necrosis and degeneration of myocytes (A)</p> Signup and view all the answers

What is the primary pathologic mechanism in thrombosis?

<p>Endothelial injury, stasis or turbulent blood flow, and hypercoagulability (C)</p> Signup and view all the answers

What is the most common cause of a true aneurysm, and how is it characterized?

<p>Atherosclerosis; a localized abnormal dilation of a blood vessel or the heart, either congenital or acquired. It can be characterized by a weakening of an intact arterial or ventricular wall, due to the underlying cause. (C)</p> Signup and view all the answers

What is an example of a single-gene disorder that can cause secondary hypertension?

<p>Liddle syndrome (B)</p> Signup and view all the answers

What is the most common cause of primary hyperaldosteronism?

<p>Bilateral Idiopathic Hyperaldosteronism (D)</p> Signup and view all the answers

What is the most common cause of acute kidney injury?

<p>Acute tubular ischemia or necrosis (C)</p> Signup and view all the answers

What is the pathogenesis of vesicoureteral reflux (VUR)?

<p>Incompetence of the valvular mechanism at the ureter-bladder junction (B)</p> Signup and view all the answers

What is the most common cause of intrinsic/intrarenal acute kidney injury?

<p>Acute tubular necrosis (A)</p> Signup and view all the answers

What is the most common cause of glomerulonephritis in adults?

<p>Diabetes mellitus (C)</p> Signup and view all the answers

What is the most common cause of benign prostatic hyperplasia (BPH) and what is one of its key risk factors?

<p>The most common cause of BPH is related to aging; one of its key risk factors is DHT. (A)</p> Signup and view all the answers

What is the most common type of cervical cancer and which HPV types are most implicated?

<p>Squamous cell carcinoma; HPV-16 and HPV-18 (C)</p> Signup and view all the answers

What is the name of the pre-malignant lesion characterized by the presence of atypical cells confined to the epithelial layer of the vagina?

<p>Vaginal Intraepithelial Neoplasia (VaIN) (D)</p> Signup and view all the answers

What is the name of the benign breast tumor that is considered to be hormone-sensitive and often increases in size during pregnancy?

<p>Fibroadenoma (C)</p> Signup and view all the answers

What disease is most often characterized by pelvic pain, adnexal tenderness, fever, and vaginal discharge?

<p>Pelvic inflammatory disease (PID) (D)</p> Signup and view all the answers

What is the most common cause of PID, and what other microorganisms may contribute to the infection?

<p>Neisseria gonorrhoeae and Chlamydia trachomatis with other microorganisms such as staphylococci, streptococci, coliforms, and Clostridium perfringens. (A)</p> Signup and view all the answers

What is the most common cause of dementia in older adults?

<p>Alzheimer's disease (D)</p> Signup and view all the answers

What are the two key pathological hallmarks of Alzheimer’s disease?

<p>Amyloid plaques and neurofibrillary tangles. (D)</p> Signup and view all the answers

What is the most common cause of myasthenia gravis?

<p>Anti-ACh receptor antibodies (D)</p> Signup and view all the answers

What is the most common cause of Bell’s palsy?

<p>A virus (D)</p> Signup and view all the answers

What is the most common type of generalized seizure?

<p>Tonic-clonic seizure (A)</p> Signup and view all the answers

What is the hallmark of trigeminal neuralgia?

<p>Sudden, brief, and excruciating facial pain attacks (D)</p> Signup and view all the answers

What is the most common cause of Huntington's disease?

<p>A genetic mutation (A)</p> Signup and view all the answers

What is the pathogenesis of osteomyelitis?

<p>It tends to occlude local blood vessels which causes bone necrosis and local spread of infection. (C)</p> Signup and view all the answers

What is the most common cause of gout?

<p>Hyperuricemia (B)</p> Signup and view all the answers

What are the four main phases of gout?

<p>Asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, chronic tophaceous gout (B)</p> Signup and view all the answers

What is the most common type of joint disease and what is its primary pathogenic mechanism?

<p>Osteoarthritis, cartilage degeneration (B)</p> Signup and view all the answers

What is the most common type of osteoporosis?

<p>Senile and postmenopausal (D)</p> Signup and view all the answers

What is the pathogenesis of rheumatoid arthritis?

<p>A chronic autoimmune disorder that principally attacks the joints, producing a nonsuppurative proliferative and inflammatory synovitis. (B)</p> Signup and view all the answers

What is the primary cause of osteomalacia?

<p>Inadequate concentration of vitamin D, calcium, or phosphorus. (A)</p> Signup and view all the answers

What is the most common cause of fractures, and what are the five stages of bone healing?

<p>Trauma; Hematoma formation, fibrocartilage formation, callus formation, ossification, consolidation/remodeling (D)</p> Signup and view all the answers

What is the main function of vitamin D?

<p>To maintain adequate plasma levels of calcium and phosphorus to support metabolic functions, bone mineralization, and neuromuscular transmission. (D)</p> Signup and view all the answers

What are the most common causes of Cushing syndrome?

<p>Exogenous or endogenous factors (D)</p> Signup and view all the answers

What is the primary pathologic mechanism of type 1 diabetes?

<p>The body’s immune system attacks the pancreas’ insulin-producing cells. (A)</p> Signup and view all the answers

Flashcards

Coagulative Necrosis

Dead cells preserved for a few days, structural proteins and enzymes denatured, blocking proteolysis. Eventually the contents are removed via phagocytosis but leaves remnants.

Liquefactive Necrosis

Digestion of dead cells forming viscous liquid (pus), containing leukocytes.

Fat Necrosis

Focal areas of fat destruction, often due to enzymatic release (e.g., from pancreas).

Gangrenous Necrosis

Necrosed limb due to lack of blood supply. May become wet gangrene with bacterial involvement and liquefactive necrosis.

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Caseous Necrosis

Cheese-like necrosis, often in tuberculosis infections.

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Fibrinoid Necrosis

Vascular damage due to immune reactions, antibodies and antigens deposited in artery walls, giving a pink appearance.

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Hypertrophy

Increase in cell size leading to organ enlargement.

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Atrophy

Reduction in organ size due to decrease in cell size or number.

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Hyperplasia

Increase in the number of cells in an organ or tissue.

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Metaplasia

Reversible change where one cell type replaces another. Note: change in cell type, NOT phenotype.

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Dysplasia

Disordered growth, irreversible changes in cell type, often pre-cancerous.

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Necrosis

Pathological cell death due to severe injury, with cellular breakdown, membrane leakage, inflammation and enzymatic digestion.

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Apoptosis

Programmed cell death, removing damaged cells without inflammation.

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Autophagy

Process where a cell recycles its own contents for energy.

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HIV Infection

Viral infection targeting CD4+ T cells. Progresses through stages; Acute, Seroconversion, Latency, to AIDS.

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Acute Viral Infection

Viral infection increasing lymphocytes (lymphocytosis) with variation in leukocyte response by age/type.

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Histamine Reaction

Histamine causes vasodilation and increased vascular permeability, a rapid response to injury.

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Hypersensitivity Reactions

Immune responses resulting in tissue damage. Several types include Type I (immediate), Type II (Antibody-mediated), Type III (immune complex), and Type IV (cell-mediated).

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Abscess

Localized collection of pus, often caused by bacteria, characterized by liquefactive necrosis.

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SLE (Systemic Lupus Erythematosus)

Autoimmune disease with wide-ranging symptoms; autoantibodies target various components. Hallmark is ANAs.

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Malaria

Life-threatening disease caused by Plasmodium parasites, transmitted by mosquitoes. Parasites infect red blood cells.

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Cholesteatoma

Cystic middle ear lesion; keratinizing epithelium fills the cyst.

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Pterygium

Eyelid growth, often in people who spend time outside.

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Macular Degeneration

Common cause of vision loss in older adults. Can be dry (atrophic) or wet (angiogenic).

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Allergic Rhinitis

Hypersensitivity reaction to allergens, causing nasal inflammation.

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Blepharitis

Eyelid inflammation; can be anterior (eyelashes) or posterior (Meibomian glands).

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Otosclerosis

Abnormal bone growth in the middle ear, leading to hearing loss.

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Cataracts

Clouding of the eye lens, often due to aging.

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Turner Syndrome

Genetic disorder in females; missing or altered X chromosome, leading to underdeveloped sexual characteristics.

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Neonatal Respiratory Distress Syndrome

Lung immaturity resulting in surfactant deficiency, lung collapse, and respiratory distress in infants.

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Phenylketonuria (PKU)

Inborn error of metabolism; inability to process phenylalanine, leading to intellectual impairment.

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Familial Hypercholesterolemia

Genetic disorder causing high LDL cholesterol, leading to premature atherosclerosis.

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Klinefelter Syndrome

Genetic disorder in males; extra X chromosome, leading to underdeveloped male sexual characteristics.

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Molluscum

Viral skin infection; firm, pink-to-skin-colored, umbilicated papules.

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Tinea Infections

Superficial fungal skin infections; dermatophytes invade the skin’s outer layer.

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Acne Vulgaris

Skin disorder, often during puberty, characterized by blocked hair follicles, inflammation, and comedones.

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Vitiligo

Loss of skin pigment due to melanocyte damage, resulting in depigmented patches.

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Atopic Dermatitis

Chronic skin inflammation; may be triggered by genetic defects in skin barrier proteins.

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Impetigo

Contagious bacterial skin infection; characterized by vesicles, pustules, and honey-colored crusts.

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Psoriasis

Chronic inflammatory skin disorder; accelerated keratinocyte growth, resulting in thick, scaly plaques.

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Von Willebrand Disease

Inherited bleeding disorder; deficiency or malfunction of von Willebrand factor (vWF) affects platelet function.

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Pernicious Anemia

Megaloblastic anemia caused by autoimmune gastritis, impairing vitamin B12 absorption.

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Thrombocytopenia

Low platelet count, increasing the risk of bleeding.

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Sickle Cell Disease

Inherited blood disorder affecting hemoglobin, causing rigid red blood cells.

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Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency

Inherited enzymatic deficiency, rendering red blood cells vulnerable to oxidative stress.

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Anemia of Chronic Disease

Anemia associated with chronic inflammation, often linked to conditions like chronic kidney disease.

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Antiphospholipid Syndrome (APS)

Autoimmune disorder; presence of antiphospholipid antibodies, causing a prothrombotic state.

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RAAS System

Hormonal system regulating blood pressure; renin, angiotensin, and aldosterone work together.

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Atherosclerosis

Plaque buildup in arteries, restricting blood flow. Initiated by endothelial injury and LDL oxidation.

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Hypersensitivity Pneumonitis

Immunological lung inflammation triggered by inhaled organic antigens.

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Atopic Asthma

Asthma caused by IgE-mediated hypersensitivity reactions to environmental allergens.

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Atelectasis

Lung collapse due to airway obstruction or external pressure, reducing lung function.

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Myocarditis

Inflammation of the heart muscle; can be caused by viral infection.

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Thrombosis

Formation of blood clots within blood vessels.

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Aneurysm

Localized dilation of a blood vessel; can be true (involving all vessel layers) or false (hematoma).

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Secondary Hypertension

High blood pressure caused by another underlying condition, e.g., kidney disease, endocrine disorders.

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Hypertrophic Cardiomyopathy

Thickening of the heart muscle, affecting pumping ability. Genetic defects are very common.

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Study Notes

Necrosis

  • Coagulative Necrosis: Dead cells are preserved for a few days, enzymes are blocked, and the cells are eventually removed by phagocytosis. Ischemia causes this in most organs except the brain.
  • Example: Infarct
  • Liquefactive Necrosis: Digestion of dead cells transforms tissue into a viscous liquid (pus). Caused in the brain (and CNS) during ischemia as opposed to other organs.
  • Example: Ischemic CVA
  • Fat Necrosis: Focal areas of fat destruction, often from enzyme release (e.g., pancreatitis) and in breast tissue injury.
  • Example: Breast indentation, pancreatitis
  • Gangrenous Necrosis: A limb with lost blood supply, more liquefactive necrosis when bacterial enzymes work along with the body's inflammatory response.
  • Example: Wet gangrene
  • Caseous Necrosis: Often seen in TB infections; a friable white "cheeselike" area with granulomas.
  • Example: Tuberculosis
  • Fibrinoid Necrosis: Vascular damage from immune reactions, antibody-antigen complexes causing a pink appearance on H&E stain.
  • Example: Malignant HTN

Cellular Adaptation

  • Hypertrophy: Increased cell size leading to enlarged organs, like cardiomyopathy, uterine enlargement during pregnancy.
  • Atrophy: Reduced size of an organ caused by decreased cell size and number due to loss of blood supply, innervation or lack of workload (skeletal muscle).
  • Hyperplasia: Increased cell number in an organ or tissue, such as during menstruation or liver regeneration (hormonal hyperplasia), PCOS, Hepatic Regeneration.
  • Metaplasia: Reversible cell change where one cell type is replaced by another.
  • Example: Smokers losing cilia
  • Dysplasia: Disordered growth; irreversible changes in cell type (Example: HPV causing epithelial cells into cancerous cells)

Cellular Damage

  • Necrosis: Severe injury, breakdown of cellular proteins, leakage, inflammation, and enzymatic digestion.
    • Biomarkers are specific enzyme releases to help the body diagnose it.
      • Troponin(cardiac), alkaline phosphatase (bile duct), transaminases (hepatocytes)
    • Cellular swelling, nuclear changes (pyknosis, karyorrhexis, karyolysis), Disrupted plasma membrane, enzymatic digestion, often adjacent inflammation
    • Pathologic and irreversible
  • Apoptosis: Cellular suicide; programmed cell death to prevent replication of damaged cells; no collateral damage.
    • Intrinsic Pathway(Mitochondrial): most common; loss of survival signal, DNA damage, and misfolded proteins trigger release of caspases
    • Extrinsic Pathway(death receptor-initiated): Activated by plasma membrane death receptors
    • Execution Pathway: The intrinsic and extrinsic pathways combine for final apoptosis process
    • Cellular shrinkage, nuclear fragmentation, intact membrane with disoriented structures, and intact cellular contents, no inflammation, often physiologic (DNA damage then pathological).
  • Autophagy: A cell "eating" its own contents due to age, dysfunction, repair needs, nutrient deprivation or need for energy. Fusion of autosomes and lysosomes.
    • Dysregulation in many diseases (cancer, IBS, neurodegenerative disorders)

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