Diseases Week 4 Flashcards
Chagas’ disease (American Trypanosomiasis)
Causative agent: Trypanosoma cruzi Vector: Triatomine Bug Symptoms: Romana sign (swelling of the child’s eyelid), Chagastic cardiomyopathy, megacolonic colon or esophagous, Acute: often asymptomatic Chronic disease: 20-40% of patients. *US transmission through blood supply or organ donations. Can reappear in chronic inderminate individuals if they become immuncompromised Treatment: Nifurtimox and Benznidazole (induce oxidative stress; requires type I nitroreductase to activate which is only in tyrpansosomes; very toxic)
Lymphatic filariasis (elephantiasis)
Causative agent: nematode Wuchereria bancrofti. Vector: female mosquito Endemic areas: Asia, Africa, Western Pacific, Caribbean, and South America. (Number one cause of global disability) Symptoms: Adults in lymphatics, lymphedema, elephantiasis, hydrocele in men. Social shunning, Tests: blood smear taken at night, serological assay. Treatment: Diethylcarbamazine (DEC) ; MDA has been effective. Lymphadema and elephantiasis are NOT indicaitons for DEC becasue most people w/ lymphadema are not actively infected.
- Cycling, rowing and other activities that require repetitive hip extension while seated may overwhelm the bursa’s ability to dissipate applied stress
Ischial bursitis aka weaver’s bottom
Causative agent - dengue virus and Chikungunya virus Symptoms- biphasic fever, pharyngitis, cough, arthralgias, generalized maculopapular rash but not on palms and soles, Transmission - mosquito borne. Not present outside tropics or in winter months Incubation - 3-8 days Management- prevent mosquitos, manage symptoms
Dengue fever
Casative agent: Orf virus Symptoms - Small pimple on hands with no other symptoms. History of sheep handling. transmission - zoonosis from sheep; especially in spring Management- duration is 30-40 days and resolves spontaneously with only symptomatic care; wearing of gloves.
Ecthyma contagiosum (Orf virus)
Glomus tumor and glomangioma
benign typically painful tumor showing differentiation to the modified smooth muscle cells of the glomus body (AV structure involved in thermoreg) Most often in distal digits.
Limited hip extension during mid-stance, compensated for by hyperextension of trunk. Damage to inferior gluteal nerve and thus parlysis of gluteus maximus.
Gluteal lurch
- Paralyzed gluteus medius and minimus muscles as a result of injury to the superior gluteal nerve - Normal steadying effect of these muscles is lost so when the foot is raised on the normal side, the pelvis falls on that side. - Also caused by congenital dislocation of the hip or nonunion of a fracture of the femoral neck - Supporting mechanism fails & pelvis sinks when an attempt is made to stand on the affected limb
Gluteal limb. Trendelenburg’s sign
Echo virus
Causative agent: echovirus (enterovirus) Symptoms - flu-like process with mild fever, malaise, abdominal cramping, diarrhea, and non-specific maculopapular rash of trunk. Transmission: fecal oral Incubation 3-6 days Diagnosis - clinical course, viral isolation from feces, serology Management - symptomatic meds, hygeine, care with diaper changing
Causative agent: nematode Wuchereria bancrofti. Vector: female mosquito Endemic areas: Asia, Africa, Western Pacific, Caribbean, and South America. (Number one cause of global disability) Symptoms: Adults in lymphatics, lymphedema, elephantiasis, hydrocele in men. Social shunning, Tests: blood smear taken at night, serological assay. Treatment: Diethylcarbamazine (DEC) ; MDA has been effective. Lymphadema and elephantiasis are NOT indicaitons for DEC becasue most people w/ lymphadema are not actively infected.
Lymphatic filariasis (elephantiasis)
Soft tissue characterized by myxoid change involving extracellular mucin accumulation w/ associated cellular proliferation. Most common is ganglion cyst (wrist most common). Ganglion adn digital mucus cysts are the most common mesenchymal lesion of the hand and wrist. history of trauma in 50%
Myxomatous lesions
Hyperthyroidism can cause muscle degeneration and necrosis w/ regeneration. Look for exopthalmic opthalmoplegia. Pts. also get muscle fiber atrophy w/ hypothyroidism.
Thyrotoxic myopathy
Toxoplasmosis
Causative agent: Toxoplasma gondii Vector: Cat via fecal oocysts via litter box or undercooked meat, or blood transfusion. Epidemiology: 25% of US population. Mostly asymptomatic, but flu-like symptoms are possible Symptoms: neurotropic parasite, intracellular encystment in host muscle and brain cells. Opportunistic: two populations are vulnerable - immunocompromised and pregnant. immunocomprimised - form cerebral abscesses, most common focal brain disorder in AIDS, fever, confusion, headache, seizures, nauseua, poor coordination. Occular toxoplasmosis: most common: red, painful, photophobic eye, “headlight in the fog” lesion with multiple surrounding healed chorioretinal scars in one eye. A fetus if the mother is first infected during that pregnancy: stillbirth or miscarriage, abnormal head size, may be normal at birth with later complications. The earlier in pregnancy the more severe the symptoms. Tests: serological testing is possible, but diagnosis requires some estimate of infx Treat: occular, immunocompromised, and pregnant women with Atovaquone, or sulfadiazine and pyrimethamine.
Causative agent: herpes varicella-zoster virus Symptoms - begin w/ general malaise, mild fever (101-102) and pruritic rash beginning centrally and expanding. Develops from from macule and papule to vesicle in 24 hrs. Drew drop on rose petal. Latent infx may insue (shingles/ herpes zoster). Reye syndrome w/ Aspirin Transmission - nasopharyngeal, skin lesion contact, easily air spread. Peaks in late winter and spring Incubation - 14-16 days communicability - 1-2 days before rash until 5 days after rash crusts diagnose by visual inspection and symptoms, serology management - strict isolation, avoid aspirin, avoid hospitilizaiton exposure to immunocomprimised. active immunization, VZIG to exposed susceptibles and immunocompromised. Oral acyclovir within 24 hrs.
Chicken Pox (varicella)
Causative agent: rubeola, paramyxovirus Symptoms: rhinitis, cough, conjunctivitis, discrete red rash, high fever. Oral lesions of Koplik spots on buccal mucosa. Total illness may last one week Transmission - np droplet, direct contact, peaks in winter and spring and in two to five year cycles Incubaiton - 8-12 days Management - active immunization, may use immune globulin in susceptibles. Isolation, symptomatic meds, vitamin A
Measles
Causative agent: Trypanosome brucei two subspecies: gambiense in West Africa and rhodesiense in East Africa Vector: Tsetse fly Symptoms: Differentiated from T. cruzi by dividing trypanosomes in blood First stage: possible chancre at site of bite, fever, headache, swollen lymph nodes, muscle and joint aches, possibly rash or itchiness Second Stage CNS involvement, neurological symptoms include SOMNOLENCE (extreme sleepiness, esp. at inappropriate times), altered gait, tremors, cranial neuropathies, urinary incontinence. Time scale: gambiense -CNS involvement after 1-2 years, death usually in 3 if not treated rhodesiense: CNS involvement after a few weeks, death in a few months if not treated. Treatment: Suramin, pentamidine, eflornithine, MELASOPROL (only drug once in CNS and vs gambiense. Painful injection and side effects - 5-10% encepalopathy with one half dying.)
African Sleeping Sickness (African Trypanosomiasis)
Can be localized or diffuse. Localized - solitary slow growing painless mass of tendon sheaths of fingers and wrists. Most common mesenchymal neoplasm of hand. Diffuse - usually knee. rare
Tenosynovial giant cell tumor
Smallpox (Variola)
Causative agent: variola poxvirus Transmission: direct contact wit skin lesions and mucous membranes. Incubation: 12 days Management - strict isolation, active immunization, VIG within 24 hrs of contact
- Bruise or contusion of the iliac crest, usually in the anterior part - May also refer to contusions/avulsions of the greater trochanter, ASIS, AIIS or an avulsion of the muscles from the crest should be termed avulsion fractures
Hip pointer
Inclusion Body Myositis
Typically affects pts over 50. Most common inflammatory myopathy in pts over 65. Often begins w. distal muscles in contrast to dermatomyositis and polymyositis. May be asymetric. Unknown pathogenesis. Modest CK increase. No benefit of immunosuppressives.
agressive malignant sarcomas showing endothelial differentiation.
Angiosarcoma
- Athletes and women are more likely to develop - Trauma in buttock is associated w/ hypertrophy & spasm of the piriformis compresses sciatic nerve (50% of cases) - Common fibular division splits & goes through piriformis where it is compressed (12% of cases)
Pyriformis syndrome
Spinal Muscular Atrophy
Group of mainly autosomal recessive motor neuron diseases that present in childhood or adolescence. Most forms are associated with mutations affecting survival moror neuron 1 (smn1) - patients expereince loss of motor neurons leading to muscle atrophy and weakness. Most common SMA is Werdnig-Hoffmann disease
Dermatofibrosarcoma protuberans (DFSP)
Intermediate malignancy prone to local recurrences. tumor of skin containing cellular elements that resemble both fibroblasts and histiocytes (tissue macrophages).
River Blindness or Robles Disease Vector: Blackfly Causative agent: Onchocera volvulus Symptoms: lives in subcutaneous tissues and often causes subcutaneous nodules. Typically found in skin and lymphatics. Eye and skin disease. Hyperpigmented skin. Severe itching, eye lesions, and skin lesions. Inflammatory response often caused by bacterium Wolbachia pipientis, a symbiont of the worms. Keratitis (inflammation of cornea) that is deep and chronic can lead to permanent blindness, and the opacity of the affected area. In chronic infection destruction of elastic fibers in the skin. Positive diagnosis w/ skin snip method. Treat with Ivermectin. Remember IVERmectin for rIVERblindness. Can add doxy for Wolbachia pipentis. MDA can be effective
Onchocerciasis
Neuritis of the sciatic nerve characterized by intense pain at the back of the leg and/or thigh Can also be caused by pressure on a root of the nerve, e.g., from a herniated disc
Sciatica
Causative agent: Leishmania spp. Vector: Sandfly Endemic areas: East Africa, Asia, and Latin America Three types: Cutaneous (most common), Mucocutaneous (rare), and Visceral (most lethal) Symptoms: Cutaneous - One or more skin sores. Often volcano like. Can be painful or painless. Some w/ local swollen glands. Mucocutaneous - very rare but results from metastasis of an untreated cutaneous case Visceral - also called kala-azar. Life threatening. Weight loss SPLENOMEGALY and hepatomegaly, swollen glands, low blood counts. HIV opportunistic infx. Tests: Consult CDC, microscopic detection of the organism in blood or tissue sample. Treatment: Sodium stibogluconate and meglumine antimoniate. (IM with high amt of resistance); Miltefosine (high toxicity, good for resistant strains); Liposomal Amphotericin B (visceral form, nephrotoxity and infusion toxicity)
Leishmaniasis
Leishmaniasis
Causative agent: Leishmania spp. Vector: Sandfly Endemic areas: East Africa, Asia, and Latin America Three types: Cutaneous (most common), Mucocutaneous (rare), and Visceral (most lethal) Symptoms: Cutaneous - One or more skin sores. Often volcano like. Can be painful or painless. Some w/ local swollen glands. Mucocutaneous - very rare but results from metastasis of an untreated cutaneous case Visceral - also called kala-azar. Life threatening. Weight loss SPLENOMEGALY and hepatomegaly, swollen glands, low blood counts. HIV opportunistic infx. Tests: Consult CDC, microscopic detection of the organism in blood or tissue sample. Treatment: Sodium stibogluconate and meglumine antimoniate. (IM with high amt of resistance); Miltefosine (high toxicity, good for resistant strains); Liposomal Amphotericin B (visceral form, nephrotoxity and infusion toxicity)
Rhadomyoma
benign tumor of skeletal muscle. very rare
Gluteal lurch
Limited hip extension during mid-stance, compensated for by hyperextension of trunk. Damage to inferior gluteal nerve and thus parlysis of gluteus maximus.
Autoimmune disease caused by immune mediated loss of function of the AChR. Associated w/ thymic abnormalities. Muscle weakness may be generalized or localized to extraocular muscles. Diagnose w/ autoantibodies or electrophys testing. Treatment - antichoinesterases, immunosuppresants, plasmpapheresis in acute cases, thymectomy in those w/ thymic tumors.
Myasthenia gravis
Myxomatous lesions
Soft tissue characterized by myxoid change involving extracellular mucin accumulation w/ associated cellular proliferation. Most common is ganglion cyst (wrist most common). Ganglion adn digital mucus cysts are the most common mesenchymal lesion of the hand and wrist. history of trauma in 50%
Common warts, plantar warts, flat (juvenile) warts, genital warts, condylomata
Causative agent: Human papilloma virus Symptoms - small skin growth that gradually enlarges. relatively few symptoms, hyperkeratinization, cauliflower like appearance. Incubation: 3 months to many years Management: liquid nitrogen, various acids, laser, surgical, podophyllum
- Common in individuals who run and kick hard (baseball, basketball, football and soccer) - Parts of the proximal attachment to the ischial tuberosity may tear (avulsion) - Twice as common as quadriceps strains.
Hamstring
Kaposi’s sarcoma
malignant vascular tumor caused by human herpes virus 8. HHV 8 w/ a cofacter results in endothelial proliferation. Four types exist: 1.)Chronic KS (Classic or European) - Eastern European and Ashkenazi Jews or Mediterranean. Not associated w/ HIV. SQ tissues of lower extremeties and are asymptomatic 2.)Lymphadenopathic KS - endemic in Africa and afflicts young males and children. lymph and occasional organ involvement. Agressive 3.)Transplant-Associated KS - occurs in the setting of a solid organ transplant w/ longterm immunosuppression. 4.)AIDS-associated (epidemic) KS: originally found in 1/3 or AIDS pts, but now only 1% due to antiretrovirals. Can involve lymph nodes and organs.
X-linked gene that encodes for dystrophin protein is mutated. Lack of dystrophin protein adjacent to sarcolemma leads to loss of ability to transfer contractile force to connective tissue. BMD pts have some dystrophin PTs present with milder and later symptoms than DMD. Eventually muscles become almost completely replaced by CT. Survive into 40s and beyond. Elevated creatine kinase is marker. Female carriers have high ck and cardiomyopathy
Becker’s MD
Dengue fever
Causative agent - dengue virus and Chikungunya virus Symptoms- biphasic fever, pharyngitis, cough, arthralgias, generalized maculopapular rash but not on palms and soles, Transmission - mosquito borne. Not present outside tropics or in winter months Incubation - 3-8 days Management- prevent mosquitos, manage symptoms
Hemangioma
Benign tumor of skin blood vessels that is most often found in skin.
One of the most common sarcomas of adulthood; typically arises in the deep soft tissues of the proximal extremities and retro peritoneum. Morhpolgical variants: 1.)well-differentiated (indolent w/ local recurrence - use surgical excision) 2.)Myxoid/round cell liposarcoma (intermediate malignancy) 3.) pleomorphic liposarcoma (aggressive tumor, frequently mets)
Liposarcoma
Palmar fibrous proliferation can cause skin puckering and progressive flexure contracture. Similar pathogensis possible on plantar and penis (peyroinie disease)
Palmar fibromatosis (Dupuytren’s contracture)
Leiomyoma
benign tumor of smooth muscle. Most commonly of uterus - present in 77% of women “uterine fibroids” Leiomyomas of the GI are usually well circumscribed tumors.
Most common soft tissue tumor of adults; various subtypes: conventional (most common - well circumscribed encapsulated mass of mature adipose tissue), angiolipoma, spindle cell lipoma/pleiomorphic, myolipoma, chondroid lipoma, angiomyolipoma (kindey), and myelolipoma. treatment - surgical excision Note: patients on long term coricosteroid therapy can get overgrowth of mature adipose tissue in the face (moon face) and on the back (buffalo hum), called “steroid lipomatosis”
Lipoma
Hamstring
- Common in individuals who run and kick hard (baseball, basketball, football and soccer) - Parts of the proximal attachment to the ischial tuberosity may tear (avulsion) - Twice as common as quadriceps strains.
- Contusion & tearing of muscle fibers thigh hematoma (collection of blood); pain and stiffness
Charliehorse
- Common because of the stretching mechanism secondary to tethering of the vessel at the adductor hiatus or by direct contusion by the posterior tibial plateau - Also common - fractures of the distal femur or the tibial plateau - Immediate surgery is the only treatment option in open knee dislocation with an associated popliteal artery injury because a popliteal artery injury is limb threatening - Supracondylar fracture of the femur may injury popliteal artery
Damage to popliteal artery.
Malignant peripheral nerve sheath tumor (MPNST)
Highly malignant sarcoma that usually arises in association w/ the major nerve trunks. Close to 50% have NF1.
caused by repeated minor trauma. typically of interdigital plantar nerve between third and fourth toes.
Motor neuroma
Mononucleosis
Causative agent: Epstein-Barr virus, herpes virus 4 Symptoms- Increased posterior cervical lymph nodes, tender enlarged spleen, atypical lymphocytes, extreme tiredness, possible maculopapular rash on trunk, jaundice, sore throat, adolescent Transmission: close contact, pharyngeal secreations, non-seasonal Tests: rapid mono test, hetertrophile antibody Management: symptomatic treatment, avoid contact sports, possible steroids, observe for jaundice
Polymyositis
Immunologic disease with immunologic injury and damage to small bv and capillaries in the skeletal muscle. Pathogenesis is believed to be caused by CD8+ T-cells. Clincal manifestations are muscle weakness w/o rash. Patients will have elevated CK. Treat with immunosuppressive agents.
malignant vascular tumor caused by human herpes virus 8. HHV 8 w/ a cofacter results in endothelial proliferation. Four types exist: 1.)Chronic KS (Classic or European) - Eastern European and Ashkenazi Jews or Mediterranean. Not associated w/ HIV. SQ tissues of lower extremeties and are asymptomatic 2.)Lymphadenopathic KS - endemic in Africa and afflicts young males and children. lymph and occasional organ involvement. Agressive 3.)Transplant-Associated KS - occurs in the setting of a solid organ transplant w/ longterm immunosuppression. 4.)AIDS-associated (epidemic) KS: originally found in 1/3 or AIDS pts, but now only 1% due to antiretrovirals. Can involve lymph nodes and organs.
Kaposi’s sarcoma
Rhabdomyolysis
Rhabdomyolysis is the breakdown of muscle fibers that leads to the release of muscle fiber contents (myoglobin) into the bloodstream. Myoglobin is harmful to the kidney and often causes tubular necrosis. (myoglobinuria)
X-linked gene that encodes for dystrophin protein is mutated. Lack of dystrophin protein adjacent to sarcolemma leads to loss of ability to transfer contractile force to connective tissue. DMD pts have little or no dystrophin. Pts present around age 5 with weakness in pelvic girdle followed by pectoral girdle. Duck like gait and gower’s maneuver (need to use hands on knees to stand up. Also pseudohypertrophy of calves. Life expectancy of 35yrs. Death via respiratory insufficiency or cardiomyopathy. Elevated creatine kinase is marker. Female carriers have high ck and cardiomyopathy
Duchenne’s Muscular Dystrophy
Lipoma
Most common soft tissue tumor of adults; various subtypes: conventional (most common - well circumscribed encapsulated mass of mature adipose tissue), angiolipoma, spindle cell lipoma/pleiomorphic, myolipoma, chondroid lipoma, angiomyolipoma (kindey), and myelolipoma. treatment - surgical excision Note: patients on long term coricosteroid therapy can get overgrowth of mature adipose tissue in the face (moon face) and on the back (buffalo hum), called “steroid lipomatosis”
Poplitieal aneurysm
Aneurysm in popliteal artery behind knee. Treat with open surgery. Internal graft is an option for patients w/ weak cardiopulmonary systems.
Leiomyosarcoma
Malignant tumor showing smooth muscle differentiation . Increased nuclear pleomorphism and mitotic activity when compared to leiomyoma.
Dermatomyositis
Immunologic disease with immunologic injury and damage to small bv and capillaries in the skeletal muscle. Activated B and T cells and antibodies with complement are involved w/ capillary damage. Clincal manifestations are muscle weakness and skin rash. Classic rash is a violaceous discoloration of upper eyelids associated w/ periorbital edema, accompanied by a scaling erythemetous eruption or dusky red patches over knuckles, elbows, and knees (Gottron papules). *Check for malignancies (15-25% have underlying) Patients will have elevated CK. Treat with immunosuppressive agents.
Neurofibroma
present as discrete localized masses - most commonly as cutaneous neurofibroma or in a peripheral nerve as a solitary neurofibroma. The presence of multiple suggest NF1 (tumor suppressor mutation).
Measles
Causative agent: rubeola, paramyxovirus Symptoms: rhinitis, cough, conjunctivitis, discrete red rash, high fever. Oral lesions of Koplik spots on buccal mucosa. Total illness may last one week Transmission - np droplet, direct contact, peaks in winter and spring and in two to five year cycles Incubaiton - 8-12 days Management - active immunization, may use immune globulin in susceptibles. Isolation, symptomatic meds, vitamin A
benign typically painful tumor showing differentiation to the modified smooth muscle cells of the glomus body (AV structure involved in thermoreg) Most often in distal digits.
Glomus tumor and glomangioma
- Uncommon because of its deep location in the popliteal fossa and posterior compartment - Causes: deep lacerations and posterior dislocation of the knee joint - Paralysis of the muscles in the posterior compartment of the leg and intrinsic muscles of the sole of the foot will occur.
Injury to tibial nerve
skin spider-like vascular malformations seen in association w/ estrogen excess (pregnancy, cirrhosis)
Spider angiomas
Dermatofibroma
Benign tumor of skin containing cellular elements that resemble both fibroblasts and histiocytes (tissue macrophages).
Causative agent: Epstein-Barr virus, herpes virus 4 Symptoms- Increased posterior cervical lymph nodes, tender enlarged spleen, atypical lymphocytes, extreme tiredness, possible maculopapular rash on trunk, jaundice, sore throat, adolescent Transmission: close contact, pharyngeal secreations, non-seasonal Tests: rapid mono test, hetertrophile antibody Management: symptomatic treatment, avoid contact sports, possible steroids, observe for jaundice
Mononucleosis
Enterovirus D-68
Causative agent: Enterovirus D-68 Symptoms - non-specific respiratory virus with possible exanthem. Most severe with asthma. Peaked in mid-August this year. Transmission - respiratory secretions, Incubaiton - 1-5 days Diagnosis - clinical course, serology, episodes of paralysis in arms and legs? management - symptomatic meds, hygeine, admission to hospital w/ child w/ asthma and serious respiratory Sx
Causative agent: Trypanosoma cruzi Vector: Triatomine Bug Symptoms: Romana sign (swelling of the child’s eyelid), Chagastic cardiomyopathy, megacolonic colon or esophagous, Acute: often asymptomatic Chronic disease: 20-40% of patients. *US transmission through blood supply or organ donations. Can reappear in chronic inderminate individuals if they become immuncompromised Treatment: Nifurtimox and Benznidazole (induce oxidative stress; requires type I nitroreductase to activate which is only in tyrpansosomes; very toxic)
Chagas’ disease (American Trypanosomiasis)
Casative agent: HSV 1 and 2 virus Symptoms - Stinging erythemetous lesion develops at junction of skin and lip (Also gingiva, tongue, and genital region). Proceeds to crusted sore. Lasts up to 10-12 days. No systemic symptoms. Transmission - direct contact, sexual and birthing contacts, associated with stress incubation - 2 days to 2 weeks, latent and recurrent Management - drying agents, acyclovir ointment locally, acyclovir, famiciclovir, valaciclovir, penciclovir - oral and IV protect newborns from exposure, special drug precautions during pregnancy.
cold sore, herpetic gingivostomatitis, genital herpes, whitlow (tip of finger)
Typically affects pts over 50. Most common inflammatory myopathy in pts over 65. Often begins w. distal muscles in contrast to dermatomyositis and polymyositis. May be asymetric. Unknown pathogenesis. Modest CK increase. No benefit of immunosuppressives.
Inclusion Body Myositis
