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Unit 4 disease charts > 4.5 > Flashcards

4.5 Flashcards

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1
Q

is estrogen high or low in someone with atrophic vaginitis

A

low

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2
Q

why is cervix friable in atrophic vaginitis

A

hypoestrogenic state

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3
Q

why is someone with atrophic vaginitis at increased risk of infections

A

decreased lactobacilli –> increased pH

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4
Q

therapy for atrophic vaginitis

A

intravaginal estrogen products

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5
Q

can lichen sclerosis be spread through sexual contact

A

yes

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6
Q

what is a precursor to osteoporosis

A

osteopenia

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7
Q

what pathologic fractures are most common in osteoporosis

A

vertebral fractures

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8
Q

best diagnostic test for osteoporosis

A

DEXA scan

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9
Q

osteoporosis T score

A

T score -2.5 or less

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10
Q

Initial lifestyle modifications for osteoporosis

A

Vitamin D + calcium supplementation

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11
Q

how much vitamin D is advised

A

800 mg

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12
Q

how much calcium is advised

A

1500 mg

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13
Q

first line MEDICAL management and prevention of osteoporosis

A

bisphosphonates

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14
Q

Osteopenia T score

A

-1 to -2.5

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15
Q

USPSTF advice for screening men for osteoporosis

A

insufficient evidence to screen men

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16
Q

best tool for diagnosis of osteoporosis

A

DEXA

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17
Q

USPSTF recommendations for DEXA scan

A

women 65 and older
younger women at risk
-a personal history of fractures
-low body weight
-smoking
-glucocorticoids
-and early menopause

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18
Q

classification used based on vertebral height lost

A

Genant classification

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19
Q

fractures above what level are suggestive of a malignancy

A

T4

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20
Q

types of compression fractures

A

wedge
crush
burst

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21
Q

what is the most common type of compression fracture

A

wedge

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22
Q

menorrhagia

A

heavy menstrual bleeding that lasts longer than 7 days

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23
Q

women who take estrogen alone and risk of breast cancer

A

lower risk of breast cancer

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24
Q

women who take estrogen + progesterone and risk of breast cancer

A

higher risk of breast cancer

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25
Q

two types of breast implants

A

saline
silicone

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26
Q

which breast implant is safer

A

silicone

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27
Q

when do patients with breast implants need an MRI

A

5 years later
and then every 2-3 years

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28
Q

do breast implants affect a woman’s ability to breastfeed

A

no

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29
Q

ALP tends to be higher in

A

bone disease

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30
Q

if ALP + GGT are high this indicates

A

hepatobiliary issue

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31
Q

BAP

A

bone alkaline phosphatase
measures metabolic status of osteoblasts

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32
Q

should BAP be used for screening of osteoporosis

A

NO – can be used to monitor meds

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33
Q

what is necessary for activation of vitamin D

A

magnesium

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34
Q

functional cells in parathyroid

A

chief cells

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35
Q

blood supply to parathyroid

A

same as for thyroid
inferior thyroid arteries

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36
Q

congenital parathyroid aplasia

A

DiGeorge syndrome - a type of hypoparathyroidism

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37
Q

vitamin D levels at what level indicate risk for osteomalacia

A

< 12

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38
Q

preferred vitamin D supplementation

A

D3 (cholecalciferol)

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39
Q

after starting vitamin D supplementation, when should you recheck serum levels

A

3 months

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40
Q

cancer associated with proliferation of a single clone of immunoglobulin-producing plasma cells leading to increased production of ineffective monoclonal antibodies

A

multiple myeloma

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41
Q

what are the main ineffective monoclonal antibodies in multiple myeloma

A

IgG (60%) and IgA (20%)

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42
Q

most common primary bone malignancy in adults

A

multiple myeloma

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43
Q

risk factors for multiple myeloma

A

older adults (median age 65)
african americans
men

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44
Q

bones BREAK in multiple myeloma

A

Bone pain
Recurrent infections
Elevated calcium
Anemia
Kidney injury

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45
Q

most common symptom of multiple myeloma

A

bone pain; vertebral involvement most common

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46
Q

bone pain in multiple myeloma is due to what type of lesions

A

osteolytic lesions

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47
Q

what will you see on CBC for multiple myeloma

A

Rouleaux formation “stack of coins”

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48
Q

calcium levels in multiple myeloma

A

hypercalcemia!!!!

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49
Q

serum protein electrophoresis for multiple myeloma

A

monoclonal spike protein - IgG most common

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50
Q

urine protein electrophoresis in multiple myeloma

A

Bence-Jones proteins composed of kappa or lambda light chains

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51
Q

what causes kidney injury in multiple myeloma

A

light chain antibody deposition in kidneys

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52
Q

radiographs for multiple myeloma

A

“punched out” lytic lesions

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53
Q

definitive diagnosis of multiple myeloma

A

bone marrow aspiration –> plasmacytosis (clonal plasma cells) >/= 10%

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54
Q

most effective therapy in multiple myeloma

A

autologous stem cell transplant

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55
Q

low bone turnover + decreased bone mineralization and/or cartilage at the epiphyseal plates

A

vitamin D deficiency

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56
Q

decreased bone (osteoid) mineralization)

A

osteomalacia

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57
Q

decreased cartilage at the epiphyseal plates

A

Rickets

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58
Q

if we have demineralization of the bone osteoid, what do we see in our bones

A

soft bones

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59
Q

malabsorption from what diseases can cause vitamin D deficiency

A

chronic liver or kidney disease
gastric bypass
celiac

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60
Q

most common form of vitamin D deficiency in kids

A

Rickets

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61
Q

most common form of vitamin D deficiency in adults

A

osteomalacia

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62
Q

clinical manifestations of vitamin D deficiency

A

diffuse bone pain and tenderness
proximal muscular weakness
hip pain
bowing of long bones –> antalgic/waddling gait
hypocalcemia

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63
Q

what clinical symptoms are associated with hypocalcemia

A

muscle spasms
cramps
positive Chvostek’s sign
tingling, numbness

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64
Q

Diagnosis of vitamin D deficiency

A

decreased calcium, phosphate, and 25-hydroxyvitamin D levels
Increased alkaline phosphatase
increased parathyroid hormones

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65
Q

what will you see on radiographs for vitamin D deficiency

A

looser lines (zones) – transverse pseudo-fracture lines
often bilateral and symmetrical

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66
Q

management for vitamin D deficiency

A

vitamin D supplementation

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67
Q

when do we commonly see vitamin D deficiency in Rickets in kids

A

between 3 most - 3 years when growth needs are high and decreased sun exposure

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68
Q

common causes of rickets

A

calcipenic - calcium or vitamin D deficiency
phosphopenic - due to renal phosphate wasting

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69
Q

initial clinical manifestations of rickets

A

bowing of forearm bone, knee, costochondral junction

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70
Q

other clinical manifestations in rickets

A

delayed fontanel closure
craniotabes (soft skull bones)
genu varum (bowing of the femur and tibia)
growth delays
delayed dentition
parietal and frontal bossing

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71
Q

Diagnosis for rickets

A

decreased calcium
decreased phosphate
decreased 25-hydroxyvitamin D

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72
Q

what will you see on radiographs for rickets

A

costochondral junction enlargement
long bones have a “fuzzy” cortex
widening of epiphyseal plate

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73
Q

management for rickets

A

vitamin D supplementation

74
Q

screening with mammogram

A

biennial screening (every other year) for women 50-74

75
Q

category 1 mammogram

A

negative

76
Q

category 2 mammogram

A

benign findings noted

77
Q

category 3 mammogram

A

probably benign findings, short term follow up suggested

78
Q

category 4 mammogram

A

suspicious findings; further evaluation noted

79
Q

category 5 mammogram

A

cancer is highly suspected

80
Q

category 6 mammogram

A

known breast cancer

81
Q

category 0 mammogram

A

abnormality noted for which more imaging is recommended

82
Q

fine needle breast aspiration

A

collects sample of cells

83
Q

core needle breast biopsy

A

collects core of tissue

US or MRI guides process

84
Q

open (surgical) breast biopsy

A

removes all or part of abnormality

85
Q

what is the preferred breast biopsy

A

core needle biopsy

86
Q

abnormal bone remodeling in aging bone due to increased osteoclastic and osteoblastic activity

A

Paget’s disease of the bone

87
Q

increased osteoclastic and osteoblastic activity leads to

A

larger and weaker bones

88
Q

clinical manifestations of Paget’s disease of the bone

A

most are asymptomatic
bone pain (MC)
skull enlargement
deafness

89
Q

labs for Paget’s disease of the bone

A

markedly elevated alkaline phosphatase

90
Q

initial test for Paget’s disease of the bone

A

radiograph

91
Q

what will radiographs show for Paget disease of the bone

A

lytic phase: blade of grass or flame shaped
sclerotic phase: increased trabecular markings

92
Q

what will skull radiographs for Paget disease of the bone show

A

cotton wool appearance

93
Q

first line for treating Paget’s disease of the bone

A

bisphosphonates - Zoledronate has greater efficacy

calcium and vitamin D supplementation recommended

94
Q

is Paget disease of the breast a type of breast cancer

A

yes

95
Q

what will you see on PE for Paget disease of the breast

A

chronic eczematous itchy scaly rash on the nipples and areola (may ooze)

96
Q

most accurate biopsy for breast cancer

A

open biopsy

97
Q

most common carcinoma for vaginal cancer

A

squamous cell carcinoma

98
Q

risk factor for vaginal cancer

A

HPV types 16 and 18

99
Q

most common symptom of vaginal cancer

A

abnormal vaginal bleeding

100
Q

most common site for vaginal cancer

A

posterior wall of the upper 1/3 of the vagina

101
Q

definitive diagnosis of vaginal cancer

A

biopsy

102
Q

most common type of cancer of the vulva

A

squamous cell carcinoma

103
Q

risk factor for cancer of the vulva

A

HPV types 16 and 18

104
Q

most common site for cancer of the vulva

A

labia majora

105
Q

what will you see on PE for cancer of the vulva

A

red or white ulcerative or raised crusted lesion

106
Q

most common skin cancer

A

basal cell carcinoma

107
Q

squamous cell carcinoma in situ (has not invaded the dermis)

A

Bowen’s disease

108
Q

major risk factor for squamous cell carcinoma

A

sun exposure

109
Q

squamous cell carcinoma is often preceded by

A

actinic keratosis

110
Q

clinical manifestations of squamous cell carcinoma

A

erythematous, elevated thickened nodule with white scaly or crusted, bloody margins
may present as a non healing ulceration

111
Q

most common cause of skin cancer related death

A

melanoma

112
Q

major risk factor for melanoma

A

UV radiation

113
Q

most common type of melanoma

A

superficial spreading

114
Q

where is superficial spreading melanoma most commonly found

A

trunk in men
legs in women

115
Q

melanoma that most commonly arises in chronically sun-damaged or sun-exposed areas the skin in older individuals such as the face

A

lentigo maligna

116
Q

most common melanoma found in darker-pigmented individuals

A

acral lentiginous

117
Q

clinical manifestations of basal cell carcinoma

A

small raised (dome shaped) papule that are pink, white or flesh colored
Translucent, waxy, or pearly quality with raised “rolled” borders
central depression
with overlying telangiectatic present on head and face

118
Q

describe inheritance of osteogenesis imperfecta

A

autosomal dominant

119
Q

what is abnormal in osteogenesis imperfecta

A

type 1 collagen

120
Q

clinical manifestations of osteogenesis imperfecta

A

severe premature osteoporosis –> multiple recurrent spontaneous fractures
Presenile deafness

121
Q

what might you see on PE in osteogenesis imperfecta

A

blue tinted sclera
brown teeth

122
Q

management for osteogenesis imperfecta

A

bisphosphonates
PT
surgery

123
Q

most common primary bone malignancy in children and young adults

A

osteosarcoma

124
Q

what bone is most commonly affected on osteosarcoma

A

distal femur

125
Q

where does osteosarcoma most commonly metastasize

A

lungs

126
Q

clinical manifestations of osteosarcoma

A

bone pain that is worse at night

127
Q

radiographs for osteosarcoma

A

hair on end or sunburst appearance

128
Q

definitive diagnosis for osteosarcoma

A

biopsy

129
Q

labs for osteosarcoma

A

increased alkaline phosphatase

130
Q

second most common primary bone malignancy in adolescents and young adults (after osteosarcoma)

A

Ewing sarcoma

131
Q

peak incidence of Ewing sarcoma

A

10-15 years

132
Q

Ewing sarcoma is due to translocation between what chromosomes

A

11 & 22

133
Q

Ewing sarcoma originates from what cells

A

mesenchymal progenitor cells

134
Q

most common location for Ewing sarcoma

A

diaphysis of long bones – femur most common then pelvis

135
Q

common sites for metastasis for Ewing sarcoma

A

bone
bone marrow
lung

136
Q

common cause of death for Ewing sarcoma

A

METs to lungs

137
Q

clinical manifestations of Ewing sarcoma

A

localized bone pain and swelling

138
Q

PE for Ewing sarcoma

A

palpable soft tissue mass
local tenderness
joint swelling

139
Q

what will radiographs show for Ewing sarcoma

A

multilayered periosteal reaction with an “onion skin/peel” appearance
destructive lytic lesions have a “moth-eaten” appearance
Codman’s triangle (can also be seen in osteosarcoma)

140
Q

lab values in Ewing sarcoma

A

increased ESR, leukocytosis
LDH carries prognostic significance

141
Q

when should kyphoplasty be performed (time period)

A

within 8 weeks of fracture

142
Q

when should A1C be drawn in diabetic patients

A

twice per year for screening

143
Q

goal of A1C levels in diabetic patients

A

<7%; 53 mmol/mol

144
Q

what A1C level is diagnostic for diabetes

A

> 6.5%; 48 mmol/mol

145
Q

screening A1C for nondiabetics

A

adults 35-70 who are overweight or obese every 3 years

146
Q

what is A1C

A

glycated hemoglobin; average blood glucose concentration over the course of RBC lifespan (120 days)

147
Q

ovaries stop functioning before 40 years old

A

primary ovarian insufficiency

148
Q

young women with primary ovarian insufficiency are at an increased risk of developing

A

hypothyroidism; they should have TSH screen yearly

149
Q

common causes of primary ovarian insufficiency

A

chemotherapy
radiation
Turner’s syndrome

150
Q

what testing should women with primary ovarian syndrome undergo

A

karyotype testing; to see if underlying genetic abnormality

151
Q

excess parathyroid hormone

A

hyerparathyroidism

152
Q

what is the most common cause of hypercalcemia

A

hyperparathyroidism

153
Q

most common cause of hyperparathyroidism

A

parathyroid adenoma

154
Q

What medication can cause hyperparathyroidism

A

lithium

155
Q

clinical manifestations of hyperparathyroidism

A

usually asymptomatic
may have sign of hypercalcemia

156
Q

clinical manifestations of hypercalcemia

A

bones - bone pain
stones - kidney stones
moans - abdominal pain
psychic undertones - psychosis, decreased DTR

157
Q

triad for diagnosis of hyperparathyroidism

A

hypercalcemia + increased intact PTH + decreased phosphate

158
Q

what else will you see for diagnosis for hyperparathyroidism

A

increased vitamin D; increased 24-hour urine calcium excretion

159
Q

what may you see on bone scan for hyperparathyroidism

A

osteopenia

160
Q

management for hyperparathyroidism

A

parathyroidectomy is definitive
calcium and vitamin D post parathyroidectomy to prevent hyperparathyroidism supplementation
Bisphosphonates

161
Q

2 most common causes of hypoparathyroidism

A

post neck surgery (thyroidectomy, parathyroidectomy)
autoimmune destruction of parathyroid gland

162
Q

clinical manifestations of hypoparathyroidism

A

most are aysmptomatic
may have signs of hypocalcemia

163
Q

clinical manifestations of hypocalcemia

A

increased muscle contraction (Trousseau sign - carpopedal spasms when blood pressure cuff is inflated & Chvostek sign - tapping the cheek causes facial spasm)

164
Q

triad for diagnosing hypoparathyoidism

A

decreased calcium + decreased PTH + increased phosphate

165
Q

what may you see on EKG for hypoparathyroidism

A

prolonged QT interval (increased risk of arrhythmia)

166
Q

management for hypoparathyroidism

A

calcium supplementation + activated vitamin D

if acute symptomatic – IV calcium gluconate

167
Q

gold standard testing for calcium levels

A

ionized calcium

168
Q

when do you use corrected calcium to measure calcium levels

A

in patients with hypoalbuminemia

169
Q

uterine herniation into the vagina

A

uterine prolapse

170
Q

what causes uterine prolapse

A

weakness of pelvic support structures

171
Q

when does uterine prolapse most commonly occur

A

after childbirth

172
Q

posterior bladder herniating into the anterior vagina

A

cystocele

173
Q

small bowel herniating into upper vagina

A

enterocele

174
Q

distal sigmoid colon or rectum herniating into the posterior distal vagina

A

rectocele

175
Q

what is removed in a total hysterectomy

A

cervix and uterus

176
Q

what is removed in a partial hysterectomy

A

upper part of the uterus is removed but the cervix is left in place

177
Q

what is ligated in hysterectomy due to blood supply

A

suspensory ligament (contains ovarian vessels)

178
Q

procedure to remove tissue from the endometrium

A

endometrial ablasion

179
Q

chronic, non-infectious inflammation of the bladder

A

interstitial cystitis

180
Q

clinical manifestations of interstitial cystitis

A

suprapubic pain
urinary frequency
dysuria
hematuria
possible weight loss

181
Q

treatment for interstitial cystitis

A

PT
bladder re-training
meds for pain or antidepressants

Unit 4 disease charts (9 decks)

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