David Usmle

8/3/2019 David Usmle

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Pathology 245Pathology 245--248248



Asbestosis Asbestosis

Increased risk of Mesothelioma & BrochogenicIncreased risk of Mesothelioma & Brochogenic

CancerCancer

Asbestosis & Smoking = Increased risk of Asbestosis & Smoking = Increased risk of Bronchogenic CancerBronchogenic Cancer

Ferruginous bodiesFerruginous bodies

Ivory white pleural plaquesIvory white pleural plaques



Asbestosis Asbestosis



Neonatal R espirator y Distress Neonatal R espirator y Distress

SyndromeSyndrome

Surfactant deficiency Surfactant deficiency

Alveolar collapse Alveolar collapse Dx: lecithinDx: lecithin--toto--sphingomyelin ratio insphingomyelin ratio in

amniotic fluid (usually <1.5 in NRDS)amniotic fluid (usually <1.5 in NRDS)

Tx: steroids Tx: steroids ² ² before birth; artificial surfactantbefore birth; artificial surfactantfor infantfor infant



K artagener·s SyndromeK artagener·s Syndrome

Immotile CiliaImmotile Cilia

Dynein arm defectDynein arm defect Infertility Infertility

Recurrent Sinusitis,Recurrent Sinusitis,

BronchiectasisBronchiectasis Associated with Situs Associated with Situs

InversusInversus



Lung CancerLung Cancer

Leading Cause of Cancer deathLeading Cause of Cancer death

Dx: cough, hemoptysis, brochial obstruction,Dx: cough, hemoptysis, brochial obstruction,

wheezing, ´coinµ lesion on x wheezing, ´coinµ lesion on x--ray ray Bronchogenic CarcinomaBronchogenic Carcinoma

Carcinoid TumorCarcinoid Tumor

Metastases (Very common: Brain, Bone, Liver)Metastases (Very common: Brain, Bone, Liver)



Lung CancerLung Cancer

SPHERESPHERE of Complicationsof Complications

SSuperior vena cava syndromeuperior vena cava syndrome

PPancoast·s tumorancoast·s tumor HHorner·s syndromeorner·s syndrome

EEndocrine (paraneoplastic)ndocrine (paraneoplastic)

R R ecurrent laryngeal symptom·securrent laryngeal symptom·s

EEffusions (pleural or pericardial)ffusions (pleural or pericardial)



Brochogenic CarcinomaBrochogenic Carcinoma

Peripherally Peripherally

Adenocarcinoma (most common) Adenocarcinoma (most common)

Brochioalveolar Carcinoma (not related to smoking)Brochioalveolar Carcinoma (not related to smoking) Large Cell Carcinoma (undifferentiated)Large Cell Carcinoma (undifferentiated)

SSentrally entrally

SSquamous Cell Carcinomaquamous Cell Carcinoma

SSmall Cell Carcinoma ( mall Cell Carcinoma ( associated with ectopic hormone productionassociated with ectopic hormone production ) )

Both linked toBoth linked to SSmoking moking



Adenocarcinoma = most Adenocarcinoma = most

common for women andcommon for women and

nonnon--smokers.smokers.

Small cell carcinoma =Small cell carcinoma =

neuroendocrine, cells lookneuroendocrine, cells look

like lymphocytes w/ biglike lymphocytes w/ bignucleinuclei



Carcinoid TumorCarcinoid Tumor

Can cause carcinoid syndromeCan cause carcinoid syndrome

Flushing, diarrhea, wheezing, salivationFlushing, diarrhea, wheezing, salivation



Pancoast TumorPancoast Tumor

Apex of Lung Apex of Lung

May cause Horner·s Syndrome (ptosis, myosis,May cause Horner·s Syndrome (ptosis, myosis,

anhidrosis)anhidrosis)



PneumoniaPneumonia

Interstitial (Atypical)Interstitial (Atypical)

Viruses, Mycoplasma, Legionella, Chlamydia Viruses, Mycoplasma, Legionella, Chlamydia

Patchy, inflammation in interstial areas at alveolar wallsPatchy, inflammation in interstial areas at alveolar walls

BronchopneumoniaBronchopneumonia

S. aureus, H. flu., Klebsiella, S. pyogenesS. aureus, H. flu., Klebsiella, S. pyogenes

Patchy, inflammation into alveoliPatchy, inflammation into alveoli

L

obarL

obar Pnuemococcus most oftenPnuemococcus most often

ConsolidationConsolidation



A lzheimer·s Disease A lzheimer·s Disease Most common cause of dementia in elderly Most common cause of dementia in elderly Plaques (BetaPlaques (Beta--amyloid core) & Neurofibrillary amyloid core) & Neurofibrillary

Tangles Tangles

May cause amyloid angiopathy (intracranialMay cause amyloid angiopathy (intracranialhemorrhage)hemorrhage)



Pick ·s DiseasePick ·s Disease

Progressively degenerative neurological diseaseProgressively degenerative neurological disease with no known prevention, or cure with no known prevention, or cure

Pick Bodies (Intracytoplasmic inclusion bodies)Pick Bodies (Intracytoplasmic inclusion bodies)

Specific to Frontal and Temporal Lobes inSpecific to Frontal and Temporal Lobes inCerebral CortexCerebral Cortex



Huntington·s DiseaseHuntington·s Disease

Atrophy of caudate nucleus Atrophy of caudate nucleus

Chorea & dementiaChorea & dementia

Autosomal Dominant Autosomal Dominant ² ²Chromosome 4Chromosome 4 Loss of GABAergic neuronsLoss of GABAergic neurons

Expansion of Expansion of C AGC AG repeatsrepeats

´́CCaudate losesaudate loses A A Ch andCh and GG ABAµ ABAµ



Park inson·s DiseasePark inson·s Disease

TR A P TR A P (You are TRAPped in your Body)(You are TRAPped in your Body)

T Tremor at Restremor at Rest

R R igidity (Cogwheel)igidity (Cogwheel)

A A kinesiakinesia

PPostural instability ostural instability

Depigmentation of substantia nigraDepigmentation of substantia nigra Loss of dopaminergic neuronsLoss of dopaminergic neurons

Lewy BodiesLewy Bodies



S pinocerebellar Motor NeuronS pinocerebellar Motor Neuron

Degenerative DiseasesDegenerative Diseases

Amyotrophic lateral sclerosis ( Lou Gehrig·s Amyotrophic lateral sclerosis ( Lou Gehrig·s

Disease)Disease)

Both Upper andL

ower motor neuron signsBoth Upper andL

ower motor neuron signs PolioPolio

Lower motor neuron signsLower motor neuron signs

Werdnig Werdnig--Hoffman DiseaseHoffman Disease Floppy baby at BirthFloppy baby at Birth

Tongue fasciculations Tongue fasciculations



Intracranial HemorrhageIntracranial Hemorrhage

Epidural hematomaEpidural hematoma Middle meningeal artery rupture, lucid interval, ´biconvex diskµMiddle meningeal artery rupture, lucid interval, ´biconvex diskµ

Subdural hematomaSubdural hematoma

Rupture of bridging veins, delayed Sx, crescentRupture of bridging veins, delayed Sx, crescent--shapedshapedhemorrhagehemorrhage

Subarachnoid hemorrhageSubarachnoid hemorrhage Usually ruptured anuerysm or Arteriovenous Malformation,Usually ruptured anuerysm or Arteriovenous Malformation,

´worst headache of my lifeµ´worst headache of my lifeµ

Parenchymal hematomaParenchymal hematoma HTN, amyloid angiopathy, diabetes, tumorHTN, amyloid angiopathy, diabetes, tumor



Berr y A neur ysmBerr y A neur ysm

Occur at the bifurcations in theOccur at the bifurcations in theCircle of WillisCircle of Willis

Most Common Complication =Most Common Complication =Rupture = subarachnoidRupture = subarachnoidhemorrhage/strokehemorrhage/stroke

Associated with polycystic Associated with polycystic

kidney disease, Ehler·skidney disease, Ehler·s--Danlos,Danlos,MarfansMarfans



Multiple SclerosisMultiple Sclerosis



Multiple SclerosisMultiple Sclerosis

MMyelinyelin SSheath destructionheath destruction

Periventricular plaques, preservation of axons,Periventricular plaques, preservation of axons,

loss of oligodendrocytes, increased IgG in CSFloss of oligodendrocytes, increased IgG in CSF Most often affects women in 20·s & 30·sMost often affects women in 20·s & 30·s

Classic Triad of MS is aClassic Triad of MS is a SINSIN

SScanning Speechcanning Speech IIntention Tremorntention Tremor

NNystagmusystagmus



Demyelinating/dysmyelinatingDemyelinating/dysmyelinating

diseases diseases

Progressive multifocal leukoencephalopathy Progressive multifocal leukoencephalopathy

Associated with JC Virus, 2 Associated with JC Virus, 2--4% of AIDS patients4% of AIDS patients

Postinfectious encephalomyelitisPostinfectious encephalomyelitis

Metachromatic leukodystrophy Metachromatic leukodystrophy

A sphingolipidosis A sphingolipidosis

GuillainGuillain--Barre SyndromeBarre Syndrome




GBS destroys the protective covering of theGBS destroys the protective covering of the

peripheral nerves (myelin sheath), disabling theperipheral nerves (myelin sheath), disabling the

nerves from transmitting signals to the muscles.nerves from transmitting signals to the muscles.




MMotor effect isotor effect is MMore severe than Sensory ore severe than Sensory

Symmetric ascending muscle weaknessSymmetric ascending muscle weakness

Possible facial facial diplegia & autonomicPossible facial facial diplegia & autonomicdysfunctiondysfunction

Associated with infections, inoculations & stress Associated with infections, inoculations & stress

Dx: increased CSF protein with normal cell count,Dx: increased CSF protein with normal cell count,papilledemapapilledema



PoliomyelitisPoliomyelitis

Poliovirus (fecalPoliovirus (fecal--oral)oral)

Destroys anterior horn cellsDestroys anterior horn cells Sx: H/A, fever, Ab pain, sore throat, LMNSx: H/A, fever, Ab pain, sore throat, LMN

lesions (muscle weakness & atrophy,lesions (muscle weakness & atrophy,

fasciculations, fibrillation, hyporeflexiafasciculations, fibrillation, hyporeflexia ) )



SeizuresSeizures

Epilepsy = disorder of recurrent seizuresEpilepsy = disorder of recurrent seizures

Causes: genetic, infection, metabolic, tumors,Causes: genetic, infection, metabolic, tumors,trauma, stoketrauma, stoke



SeizuresSeizures

Partial Siezures = 1 area of BrainPartial Siezures = 1 area of Brain

Simple PartialSimple Partial -- awareaware

ComplexP

artialComplexP

artial ² ² impaired awarenessimpaired awareness Generalized Siezures = diffuseGeneralized Siezures = diffuse

Absence Absence ² ² blank stareblank stare

MyoclonicMyoclonic ² ² quick, repetitive jerksquick, repetitive jerks

Tonic Tonic--clonicclonic ² ² altering of stiffness & mov·taltering of stiffness & mov·t

Atonic Atonic ² ² ´drop seizuresµ´drop seizuresµ



Aphasia Aphasia

Broca·sBroca·s Expressive = nonfluent, intact comprehensionExpressive = nonfluent, intact comprehension

Broca·s area = inferior frontal gyrusBroca·s area = inferior frontal gyrus

Wernicke·s Wernicke·s Receptive = fluent, impaired comprehensionReceptive = fluent, impaired comprehension

Wernicke·s area = superior temporal gyrus Wernicke·s area = superior temporal gyrus

BroBroca·s isca·s is BroBroken speech;ken speech; W Wernicke·s isernicke·s is W Wordy butordy butmakes no sensemakes no sense

W Wernicke·s = ´ernicke·s = ́W What?µhat?µ



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