Clincial Manifestations of disease Flashcards
1
Q
What is WHO’s definition of Health?
A
A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
2
Q
what is Homeostasis?
A
The purposeful maintenance of a stable internal environment maintained by coordinated physiological processes that oppose change.
3
Q
What is pathophysiology?
A
Altered health
4
Q
What is the definiton of pathology?
A
study of the structure and functional changes in cells, tissues, and organs caused by disease
5
Q
What is the defintion of a disease state?
A
Any deviation from or interruption of the normal structure ore function of a part, organ or system of the body manifested by a characteristic set of symptoms or signs
6
Q
What is disease and what are the two groups its divided into?
3
A
- Does not allow the body to function normally
- Can affect individual organs or an entire body system
- Divided into two groups
- Infectious
- Non Infectious
7
Q
What are the different categories of infectious disease and what are some examples?
4
How are they transmitted?
A
Bacterial: Cholera
Viral: Chicken pox (varicella)
Fungal: Tinea
Parasitic: Malaria
Transmitted by a microorganism
8
Q
What are the different categories of non-infectious disease and what are some examples?
3
How are they tranmitted?
A
Genetic or hereditary: Down Syndrome
Congenital: Fetal alcohol syndrome
Environmental: Lung CA (Cancer)
Not transmitted by a microorganism
9
Q
How are pathogens transmitted?
6
A
In the air In water In food In body fluids like saliva, blood, semen By touching By another organism like the mosquito These transmitters are called vectors
10
Q
Name the ways that bacteria can interact in the human body. Remember that these can be overlapping.
4
A
- Some bacteria are entirely adapted to the pathogenic way of life in humans. They are never part of the normal flora but may cause subclinical infection (not part of the body and come in just to be infectious)
- Some bacteria which are part of the normal flora acquire extra virulence factors making them pathogenic (something makes normal floura infectious)
- Some bacteria from the normal flora can cause disease if they gain access to deep tissues by trauma, surgery, lines especially if associated with a foreign body (bacteria get to parts of the body they arent supposed to be through trauma)
- In immuno-crompromised patients many free-living bacteria and components of the normal flora can cause disease (overgrowth) especially if introduced into deep tissues
(overgrowth of normal bacteria in immunocomprimised patients)
11
Q
4 ways pathogens make us sick?
A
- Bacteria produce poisons that cause cell death
- Viruses use our cells to reproduce and then cause cell death
- Fungi grow and produce toxins
- Parasites live and grow in our body destroying tissue
12
Q
What is the definition of a diagnoses?
A
The designation as to the nature or cause of a health problem.
13
Q
What does the diagnostic processs include?
2
A
The diagnostic process includes the history (symptoms) and the physical exam (signs)
14
Q
What is the definition of a differential diagnoses?
A
Weighing competing possibilities and selecting the most likely one but listing in order of likelihood
15
Q
What is the defintion of a working diagnosis?
A
Based on information so far: history, physical exam, and diagnostic testing results currently available
16
Q
What is the defintion of headaches or (cephalgia)?
How is the brain involved in headaches?
A
Is a pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. –The brain tissue itself is not sensitive to pain because it lacks pain receptors.
17
Q
Types of Headaches general classifications?
2
A
Primary
Secondary
18
Q
Types of primary headaches (the most common kind)?
A
Tension
Migraine
Cluster
19
Q
Types of secondary headaches?
What are these based on?
A
- Cervicogenic (whiplash)
- Medication overuse (rebound)
- Birth Control changes
- Sinus symptoms
- TMJ pain (Temporomandibular Joint)
Based on etiology, not symptoms
20
Q
What do you need to ask all patients with a chief complaint of headache?
And what do you do if yes?
A
Is this the worst headache of your life?
Red Flag!!! Subarachnoid hemorrhage
Send to the Emergency Department immediately
21
Q
Other red flags for headaches
5
A
- Fever associated with headache (menigitis)
- Sudden onset of headache (less than 5 = lesions in the brain
Over 65 = cancers or tumors) - Absence of similar headaches in the past
- Worsening pattern
- Change in mental status, personality or change in level of consciousness
22
Q
What questions should you ask for the systemic case history of headaches?
7
A
- Age at onset
- Presence or absence of aura and prodrome
- Frequency, intensity and duration of attack
- Number of headache days per month
- Time and mode of onset
- Quality, site and radiation of pain
- Family history of migraine
23
Q
In review of systems what questions do we want to ask a patient with a headache?
6
A
- Head trauma
- Dizziness/vertigo
- Syncope/LOC (Loss of Consciousness)
- Earaches/drainage/discharge
- Vision status. Eye pain/redness/tearing
- Toothaches
24
Q
What should the physical exam include with your headache patient?
10
A
- Obtain blood pressure and pulse
- Listen for bruit (stenosis in the carotid arteries) at neck
- Inspect the head for any trauma, swelling or asymmetry
- Examine the ears for any erythema, swelling, discharge
- Look up the nose for any swelling of the turbinate’s, bleeding, masses
- Tap on the sinuses for any tenderness
- Check for lymphadenopathy,
- Palpate for tenderness of head, neck and shoulder regions
- PERRLA- pupils equal, round, react to light, accommodation
- Good neurological exam
25
Other features suggesting a specific headache source?
| 6
1. Chronic nasal stuffiness or chronic respiratory suggests diagnosis of sinusitis
2. Impaired vision or seeing “holes” around light suggests the presence of glaucoma
3. Visual field defects suggest the presence of a lesion of the optic pathway
4. Sudden, severe, unilateral vision loss suggests the presence of optic neuritis
5. Headache, fatigue, generalized aches and pains, and night sweats in subjects age 55 yo or older suggest presence of temporal arteritis
6. Intermittent headaches with high blood pressure are suggestive of pheochromocytoma (tumor in the adrenal medulla = irregular epi and norepi)
26
Danger signs in physical examination of headaches?
| 3
1. Neck stiffness and especially meningismus (resistance to passive neck flexion) suggests meningitis
2. Papilledema (optic disc swelling caused by increased intracranial pressure)
3. Focal neurologic signs suggest an intracranial mass lesion
27
Fever ranges in:
anus
oral
arm and ear
Temperature in the anus (rectal) ≥ 37.5-38.3 °C (99.5-100.9 °F)
Temperature in the mouth (oral) ≥ 37.7 °C (99.9 °F)
Temperature in the arm (axilla) or ear (otic) ≥ 37.2 °C (99.0 °F)
28
In differential diagnoses of fever what could be some infectious causes?
5
```
Influenza
HIV
UTI
Infectious mononucleosis
Gastroenteritis
```
29
What are some skin inflammations that could causes fever?
| 2
Boils (Furuncle or Carbuncle)
| Abscess
30
What are some immunilogical diseases that could cause fever?
| 4
Lupus erythematosis
Sarcoidosis
Inflammatory bowel diseases
Kawasaki disease
31
What are fever causes that are related to tissue destruction?
4
Hemolysis
Surgery
Infarction
Rhabdomyolysis
32
Drug reactions to fever?
Reactions to incompatible blood products/Drugs
33
What are cancers that can cause fever?
| 3
Kidney cancer
Leukemia
Lymphomas
34
Metabolic disorders that can cause fever?
| 2
Gout (build up of crystals in a joint)
| Porphyria (inherited)
35
Thrombo-embolic processes that can cause fever?
Pulmonary embolism
| Deep venous thrombosis
36
Persistant fever that cannot be explained is called what?
Fever of Unknown Origin
37
What should you think about in kids with fever?
Urinary tract
38
Labs you should test for in fever?
| 4
1. CBC (complete blood count)
2. BMP (Basic metabolic panel) to check electrolytes
3. Consider blood cultures on temps >102
4. UA (Urinalysis) to r/o (rule out) uti’s (urinary tract infections) and to check hydration status
39
What is the defintion of a cough?
Sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes.
40
How can cough be classified?
| 4
duration,
character,
quality and
timing.
41
Infections that could be causing a cough?
| 4
Infections (respiratory tract infections):
1. Common cold (most common)
2. Pneumonia
3. Pertussis
4. Tuberculosis
42
Reactive airway diseases that could be causing a cough?
| 3
1. Cough variant asthma
2. Chronic bronchitis (often referred to as smokers cough)
3. Long term fume inhalation
43
GI causes of cough?
GERD
| unexplained cough
44
Air pollution causes of cough?
| 4
Particulate matter
Tobacco smoke
Dampness in home
Irritant gasses
45
Foreign body cause of cough?
: If the cough started suddenly when the patient was eating
46
ACE inhibitor cough?
Angiotensin-converting enzyme inhibitor are drugs used in diabetics, heart disease and blood pressure.
Cough is a very common side affect especially with increasing doses.
47
Psychogenic cough causes?
More common in children. Emotional & psych problems
48
Post nasal drip cough caused in what?
sinusitis
49
What would be our diagnostic approach to a cough?
| 5
```
CBC (complete blood count)
H pylori if h/o gerd
Sed Rate (inflammation)
CXR (Chest xray)
Spirometry
```
50
Treatment options for cough?
| 3
Often symptomatic
Antibiotics
Corticosteroids
51
What is the defintion of edema?
Palpable swelling produced by expansion of the interstitial fluid volume
52
What could edema be a manifestation of?
| 5
```
heart failure,
cirrhosis,
nephrotic syndrome,
renal failure,
medications,
```
53
The history is very important for edema diagnosis. What could the history point to for causes of edema?
5
```
Coronary disease
ETOH abuse (alcohol)
Hypertension
Hepatic or renal disease
Medications
```
54
What would we do during an exam (ROS) to recognize signs for edema?
6
```
HEENT (Head, ears, eyes, nose & throat)
Respiratory
CV (Cardiovascular)
Abdominal
Extremities
Edema 1+ to 4+
```
55
What would ACUTE ONSET UNEXPLAINED UNILATERAL LEG EDEMA tell us??
SHOULD RAISE THE POSSIBILITY OF DEEP VEIN THROMBOSIS
56
What are questions to ask if you suspect DVT?
| 4
History of long drive or flight
History of tobacco use
History of birth control use
Recent surgery
57
What would you do for workup of edema? (tests or labs)
| 6
1. CBC (Complete Blood Count)
2. CMP (checks electrolytes and lft’s)
3. TSH (Thyroid)
4. EKG
5. CXR
6. Duplex US (Ultrasound) if concerned about DVT (Deep Vein Thrombosis)
58
What is clinical weight loss defined as?
What are the two kinds?
Defined as loss of 5% over six months
Voluntary
Involuntary
59
What does involuntary weight loss usually indicate?
Progressive involuntary weight loss often indicates a serious medical or psychiatric illness.
60
What thyroid issues could be causes of weight loss?
Hyper/Hypothyroidism
61
Dental probelms can cause weight loss
statement
62
Gastrointestinal diseases that can cause weight loss
| 8
1. Anorexia
2. Abdominal Pain
3. Dysphagia
4. Dysmotility
5. Diarrhea
6. Malabsorption
7. Chronic inflammation
8. Obstruction
63
Drugs that can cause weight loss?
OTC/herbal medications
Prescription drugs
Substance Abuse
64
What kind of substance abuse can causes weight loss?
| 5
ETOH, Cocaine, Opiates, Amphetamines
| Heavy tobacco use
65
What system diseases can causes weight loss?
Advanced cardiac, pulmonary and renal disease
66
What virus can cause weight losS?
HIV
67
Cancer and other malignancies can causes weight loss
statement
68
Physical exam procedures to do for weight loss?
| 8
1. Overall appearance
2. Affect (how are they reacting to their symptoms)
3. Skin Changes
4. Lymphadenopathy
5. Cardiopulmonary status
6. Hepatosplenomegaly
7. Abdominal mass
8. Rectal exam with positive stool hemoccult
69
Work up with weight loss? (labs and tests)
| 8
1. CBC with differential
2. CMP (Complete Metabolic Panel)
3. TSH (Thyroid Stimulating Hormone)
4. Hemoglobin A1C
5. UA (Urinalysis)
6. Stool hemoccult
7. ESR (indicator of inflammation) and/or C reactive protein
8. Consider CXR
70
Differential diagnosis of vague neurological complaints?
| 3
Dizziness
Fainting
Numbness/Weakness
71
Questions to ask patients with syncope?
1. Was loss of consciousness complete?
2. Was LOC transient with rapid onset and short duration?
3. Did the patient recover spontaneously and w/o sequelae
4. H/o syncope, heart disease, diabetes, dehydration, or stress
72
What physical exam procedures should we do for neuro symptoms?
7
```
Higher functions
Cranial nerves
Sensory system
Motor system
Reflexes
Cerebellum
Orthostatics
```
73
Workup for Vague neurological complaints?
| 9
1. CBC
2. CMP (glucose)
3. TSH
4. UA
5. HgbA1c
6. HCG (if appropriate)
7. CXR
8. EKG
9. Pulse Ox
74
Definition of inflammation?
Localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful, especially as a reaction to injury or infection
Its the body's attempt at self-protection
75
What should we do first in cases of inflammation to begin the healing process?
3
Remove harmful stimuli to begin the healing process
- Damaged cells
- Irritants
- pathogens
76
Three main processes that happen in inflammation?
| 3
1. Arterioles dilate
2. Capillaries become permeable
3. Neutrophils and possibly some macrophages migrate out of the capillaries and venules and move into interstitial spaces
77
What are the two kinds of inflammation?
Acute and Chronic
78
Characteristics of acute inflammation?
| 2
1. Rapid onset and quickly becomes severe
| 2. Only present for a few days and can persist for a few weeks
79
Characteristics of Chronic inflammation?
| 2
1. Long-term inflammation
| 2. Last for several months and years
80
Five cardinal signs for differential diagnosis of inflammation?
5 cardinal signs (PRISH)
- Pain
- Redness
- Immobility
- Swelling
- Heat
81
In differential diagnoses try to differentiate infection vs?
inflammation
82
In differential diagnoses try to differentiate trauma vs?
overuse
83
Unilateral inflammation situations?
| 2
Long drive, tobacco use and birth control think DVT
| Consider Cellulitis
84
Bilateral inflammation situations?
| 2
Rhabdomyolysis
| Immune disorders
85
Workup of inflammation?
| 5
```
CBC
Sed Rate/ c reactive protein
CMP
UA
Plain films
```
