Pt 1 Boards: Pathology

What is Arteriosclerosis/Atherosclerosis?

Patchy thickening (atheromas - fatty streaks) of subintimal wall (medium & large arteries), arterial wall becomes thick & loses elasticity, dystrophic calcification (thrombus)

What are the risk factors for Arteriosclerosis/Atherosclerosis?

Hypertension (over 45 years-old), ↑ serum lipids, smoking, DM, morbid obesity & ♂, female rate ↑ after menopause,

65 both ♂ & ♀, LDL

160 mg/dL, familial type III hyperlipoproteinemia

What is the main cause of ischemic heart disease & cerebrovascular disease?

Arteriosclerosis/Atherosclerosis

What is the major cause of death related to Arteriosclerosis/Atherosclerosis?

Stroke

What is the stroke treatment window?

Within 5 hours

What are the types of Arteriosclerosis?

Mönckeberg, Obliterans, Peripheral

What is Mönckeberg arteriosclerosis?

Calcified tunica media, medium sized arteries (femoral, radial & uterine)

What is Obliterans arteriosclerosis?

Proliferation intima, small vessels, obliterates artery

What is Peripheral arteriosclerosis?

Arteriosclerosis of extremities

What arteries are commonly involved in arteriosclerosis?

Aorta, Circle of Willis, Internal carotid, Vertebrobasilar, Coronary, Celiac & mesenteric, Renal, Iliofemoral

What can atherosclerosis of the Aorta cause?

Atherosclerotic aneurysms, cholesterol embolism

What is an Aneurysm?

Localized dilation: wall of artery, vein or heart

What is a Dissecting Aneurysm?

Longitudinal cleavage of the arterial media by a column of blood

What is associated with a Dissecting Aneurysm?

“Tearing pain”, acute onset (retrosternal)

What is the most common location for a dissecting aneurysm?

Abdominal aorta

What percentage of patients with dissecting aneurysm have hypertension?

70%

What is an Abdominal Aortic aneurysm?

Can be asymptomatic, lumbar vertebrae pressure

What aneurysm is associated with the Circle of Willis?

BERRY aneurysms

What do Berry aneurysms cause?

Subarachnoid & intracerebral hemorrhage

What population is Berry aneurysm associated with?

Hereditary → males

What does Internal carotid disease cause?

Chronic cerebral ischemia, strokes, transient ischemic attacks (TIA’s)

What does Vertebrobasilar disease cause?

Cerebellar & brain stem ischemia & infarction

What does Coronary artery disease cause?

Myocardial infarction, chronic myocardial ischemia, angina, chronic heart failure, arrhythmias & heart block

What does Celiac & mesenteric artery disease cause?

Intestinal ischemia & infarction (ischemic colitis)

What does Renal artery disease cause?

Renal artery stenosis, renovascular hypertension, renal ischemia & infarct

What does Iliofemoral artery disease cause?

Peripheral vascular disease, intermittent claudication, gangrene

What is Hypertension?

Patient wakes up with throbbing headache - typically occipital region

What is the definition of sustained hypertension?

Sustained elevation of systemic arterial blood pressure (diastole above 90mm)

What percentage of people have blood pressure over 140/90?

50%

What are the types of Hypertension?

Essential, Secondary, Benign, Malignant

What is Essential hypertension?

Over 40 years old, etiology unknown

What is Secondary hypertension?

Caused by sodium retention & ↑ peripheral resistance

What is Benign hypertension?

Earliest phase of hypertension

What is Malignant hypertension?

Papilledema, retinal hemorrhages, exudates, b/p usually 200/150 mm Hg, fibrinoid necrosis of tunica media, intimal fibrosis, narrowing vessel, acute ischemia to tissue vessel feeds

What is Hypertensive heart disease?

Systemic hypertension = ↑ work for left ventricle, causes hypertrophy, eventual FAILURE

What is Hypertensive renal disease?

↓ GFR, fibrosis, loss of nephrons, eventual renal failure

What is Hypertensive cerebral disease?

Thrombosis & strokes

What is Hypertensive retinal disease?

Papilledema, retinal hemorrhages, fluffy exudates (cotton wool spots)

What is Patent Ductus Arteriosus (PDA)?

Congenital failure of closure between the pulmonary artery & aorta (up to 80% premature)

What is Cor Pulmonale?

Right ventricular ↑ secondary to lung malfunction

What disorders are included in Cor Pulmonale?

EMPHYSEMA, chronic bronchitis, cystic fibrosis, etc.

What are the components of Tetralogy of Fallot?

D - extrotation of the aorta, R - right ventricular hypertrophy, I - intraventricular septal defect, P - pulmonary artery stenosis

Mnemonic for Tetralogy of Fallot?

DRIP

What valves are affected in Rheumatic Fever?

MITRAL & Aortic valves

Which valve is typically involved first in Rheumatic Fever?

Mitral valve

What type of anemia is Iron Deficiency anemia?

MICROCYTIC Hypochromic

Who commonly gets Iron Deficiency anemia?

♀, child bearing years

What causes chronic hemorrhage anemia?

Cancer, ulcers, gastritis

What does a GUIAC test detect?

“Occult” or hidden blood

What is seen on a GUIAC test?

“Frank” blood

What type of anemia is Pernicious anemia?

Macrocytic normochromic

What vitamin deficiency causes Pernicious anemia?

B12

What causes Pernicious anemia?

Loss parietal cells, ↓ vitamin B12 absorption

What develops in Pernicious anemia?

Reticulocytosis

What neurologic finding occurs in Pernicious anemia?

Posterolateral sclerosis end stage (glove & stocking paresthesia)

What vitamin is Folate?

B9

What is the triphasic color change?

Pallor, cyanosis, rubor

What is associated with Tetralogy of Fallot?

DRIP

What is associated with Portal hypertension?

Esophageal varices

What causes ulcerations in stomach?

Helicobacter pylori

What disease has no Meissner’s & Auerbach’s?

Hirschsprung’s

What causes Macrocytic normochromic anemia?

B12 (& Folate too)

What is Air emboli associated with?

Deep sea diving

What is Idiopathic dilated cardiomyopathy (DCM)?

Most common form of non-ischemic cardiomyopathy

What occurs in Idiopathic dilated cardiomyopathy (DCM)?

Gradual cardiac failure with hypertrophy/dilation of heart

What causes Idiopathic dilated cardiomyopathy (DCM)?

VIRAL MYOCARDITIS (coxsackievirus), hemochromatosis, chronic anemia, alcoholism, sarcoidosis, pregnancy (3rd trimester)

What is Hypertrophic diastolic disorder?

Heavy muscular hyper-contracting heart

What causes Hypertrophic diastolic disorder?

Congenital, Friedreich’s Ataxia, glycogen storage disease, infants of diabetic mothers

What is Restrictive diastolic disorder?

Diastole & left ventricular filling impeded

What causes Restrictive diastolic disorder?

Amyloidosis, radiation-induced fibrosis, found in children

What are the types of Angina?

Typical or Stable, Unstable or Crescendo, PRINZMETAL

What is Typical or Stable angina?

Activity, emotional excitement, or other increased cardiac work

What is Unstable or Crescendo angina?

Close to MI, increased frequency, prolonged duration

What is PRINZMETAL angina?

Occurs at REST - Coronary artery spasm

What are Myocardial Infarctions?

Ischemic Heart Disease

What is a Transmural infarct?

Full or nearly full thickness of the ventricular wall

What is a Subendocardial infarct?

Inner ⅓ or at most ½ of the ventricular wall

What is Achalasia?

Impaired esophageal peristalsis/lower esophageal sphincter contraction

What are the notes associated with Achalasia?

20-40, dysphagia-solids & liquids, chest pain, regurgitation, nocturnal cough

What is Plummer Vinson aka Paterson-Kelly syndrome?

Mucosal membrane across lumen

What is the note associated with Plummer Vinson syndrome?

“Webs in your pipes”

What are Esophageal varices?

Varicosities in the esophagus

What are Esophageal varices associated with?

PORTAL Hypertension

What is Gastroesophageal Reflux “GERD”?

Incompetence of lower esophageal sphincter

What are the notes associated with GERD?

Reflux gastric contents, Barrett’s esophagus

What is Esophageal Diverticula aka Zenker’s?

Outpouching of the mucosa & submucosa posteriorly

What are the notes associated with Esophageal Diverticula?

Fills with food, possible regurgitation when bending or lying down

What is MALLORY-WEISS?

Laceration of distal esophagus & proximal stomach during vomiting, retching, or hiccups

What is associated with MALLORY-WEISS?

Hemorrhage - ALCOHOLICS

What is the most common Peptic ulcer?

Duodenal

Where are Duodenal ulcers located?

Beginning of small intestine

What are the symptoms of Duodenal ulcers?

Burning or gnawing pain, vomiting

Where are Gastric ulcers located?

Along the lesser curvature of the stomach

What causes Gastric ulcers?

HELICOBACTER PYLORI & NSAIDS

Where does stomach Cancer occur most frequently?

Greater curvature

What are signs of stomach Cancer?

“UNEXPLAINED” weight loss, unrelenting pain

What are “MALLORY bodies”?

Alcoholic hepatitis

What is Hepatitis?

Inflammation of the liver