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Patho > exam 3 > Flashcards

exam 3 Flashcards

1
Q

atelectasis

definition

A

incomplete expansion of lung, a collapse of a part of the lung

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2
Q

pneumothorax

definition
two types

A

accumulation of air in the pleural space

open or closed

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3
Q

tension pneumothorax

defintion
pathogenesis

A

progressive build up of air within the pleural space due to lung laceration (allow air to escape into pleural space but not to return)

pressure build up will compress lung

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4
Q

spontaneous pneumothorax

definition
risks
symptoms
treatment

A

in absence of blunt or penetrating trauma

smoking, tall stature

rapid onset, sharp chest and shoulder pain, coughing or lifting, dec. or absent breath sounds, tachypnea, diaphoresis

maintain airway, monitor for tension pneumo, pleural decompression if pt becomes cyanotic, hypoxic, and difficult to ventilate

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5
Q

lung cancer: lung carcinoma

definition
mortality

causes

A

smoking related neoplasm, common malignant tumor, mortality in women exceeds breast cancer

genetic, EGFR, industrial exposure to nickel and chromates (4 types)

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6
Q

lung cancer: squamous cell carcinoma

definition
tumor placement
progression

A

most common, metaplastic squamous epithelium to line main bronchi from agents such as cigarette smoke

tumors are central and cause bronchial obstruction

slow growing, possible resection

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7
Q

lung cancer: adenocarcinoma

kind of cells
growth
cause/risk

A

glandular cells (mucous goblet cell, clara cells, type II pneumocytes)

slowest rate of growth

common in women

passive cigarette smoke, common in non smokers, EGFR mutation

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8
Q

small cell carcinoma

AKA
tumor characteristics
cell characteristics

A

(oat)

highly malignant central rapidly growing tumor from bronchial endocrine

dense secretory granules that are also seen increased in bronchial carcinoid tumors (neuroendocrine)

rough, little cytoplasm, nuclei = oat grains

metastasis usually present at dx

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9
Q

lung cancer: large cell anaplastic carcinoma

types
lesion location
cell characteristics
prognosis

A

squamous or adenocarcinoma

lesions are central or peripheral

large cells with nuclear pleomorphism and frequent giant cell forms

poor prognosis and frequently widely disseminated at dx

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10
Q

lung cancer: metastases

A

brain
liver
heart
bone
adrenal/kidney
pleura
hilar and mediastinal lymph nodes

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11
Q

lung cancer: treatment

A

chemo
radiation
surgery
tyrosine kinase inhibitors

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12
Q

genetic bone disorders: achondroplasia

definition
causes

A

dwarfism caused by impaired cartilage proliferation in growth plate

mutation of gene for fibroblast growth factor receptor 3 (FGFR3) - sporadic

increased paternal age

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13
Q

genetic bone disorders: osteogenesis imperfecta

cause
signs

A

mutated gene for collagen #1

multiple fractures, blue sclera, hearing loss

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14
Q

genetic bone disorders: osteopetrosis

definition
causes
treatment

A

thick bones from defected osteoclasts

bone fractures, anemia, cranial nerve plasties

need bone marrow transplant

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15
Q

osteomyelitis

definition
causes
signs
diagnosis
treatment

A

infection of bone marrow and bone

staph aureus (90%), N. gonorrhocae (sexually active young adults), salmonella (sickle cell), pseudomonas (diabetic or IV drug user), mycobacterium tuberculosis (Potts disease)

bone pain with signs of infection (fever, leukocytosis), lytic focus (abscess) of bone on xray

dx by blood culture or bone aspiration

treat with antibiotics

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16
Q

osteoporosis

definition
causes
types
symptoms
diagnosis
treatment

A

reduced bone mass

genetic, diet, decreased estrogen, lack of exercise

primary and secondary

bone pain, fractures in weight bearing areas (vertebrae, hip, distal radius)

DEXA scan, lab test PTH

treat with exercise, vitamin D calcium, biphosphonates (Boniva, induce apoptosis of osteoclasts), SERM (selective estrogen receptor modulator)

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17
Q

RIckets

definition
signs

A

low vitamin D in children under 10

bowlegs, flawed teeth, pigeon breast deformity

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18
Q

osteomalacia

definition
cause
symptoms
treatment
activation

A

low vitamin D in adults

back pain, muscle weakness, fractures

treat with vitamin D and underlying cause

softening of bone due to inadequate mineralization of osteoid

activation: 25-hydroxylationn by liver —> 2-alpha-hydroxylation by kidney

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19
Q

Paget’s disease

definition
age, cause
phases
symptoms
treatment

A

imbalance between osteoclasts and osetoblasts function

late adulthood (>60), idiopathic

3 phases: destructive, mixed, osteosclerotic

bone pain (micro-fx), inc. hate size, hearing loss, lion-like face, isolated elevated alkaline phosphatase

treat with calcitonin and bisphosphonates - goal is to inhibit osteoclasts

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20
Q

compartment syndrome

definition
pathogenesis

A

increased pressure in a muscle compartment of arm or leg

swelling or bleeding within a compartment —> fascia does not stretch = increased pressure on capillaries, nerves, and muscles

crush injury

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21
Q

acute compartment syndrome

definition
causes
symptoms
treatment

A

complication of injury, radius/ulna or tib/fib fx causes significant bleeding in 1 or more compartments

badly bruised muscle, crush injury, sports, MVA, tight casts,

pain, tingling/burning, far gone if numbness and paralysis, reperfusion swelling possible

treat with emergency surgery, stabilize first with IV meds, fasciotomy, skin graft after if needed

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22
Q

chronic compartment syndrome

definition
area
symptoms
treatment

A

pain or cramping with exercise, subsides when activity ends

in leg

numbness, difficulty moving foot, visible muscle bulging

treat with PT, orthotics, anti-inflammatories, fasciotomy (elective surgery)

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23
Q

bone tumors: benign versus malignant

A

benign (not common): osteoma (genetic), chondroma, giant cell tumor

malignant (common): osteosarcoma, chondrosarcoma, Ewing’s sarcoma
often invade long bone and mimic osteomyelitis, lytic tumor with onion skin appearance

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24
Q

bone tumors: treatment

A

radiation, chemo, surgery

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25
Q

bone tumors: chondrosarcoma

area
prognosis
treatment

A

cartilage, pelvis

5 years with surgery

chemo

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26
Q

bone tumors: osteosarcoma

cells involved
risks
area
test results
treatment

A

osetoblasts (bone forming)

men 10-20 years old, Paget’s disease = increased risk

60% by knee

xray shows elevation of periosteum (Codman triangle or sunburst growth pattern)

treat with surgery and chemo

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27
Q

bone tumors: Ewing sarcoma

who is affected
sign

A

children under 20 years old

blue due to sheets of primitive cells which store a large amount of glycogen

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28
Q

osetoarthritis

aka
definition
risk
cause
area
symptom
types
treatment

A

degenerative joint disease or “wear and tear disease”

most common joint disease, joint space narrowing with osteophytes and floating cartilage

60+

trauma, obesity

weight bearing joints and small joints of the hands and feet

morning stiffness that gets worse

primary and secondary

treat with NSAIDs, cox 2 inhibitors, surgery

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29
Q

SHORT ANSWER: rheumatoid arthritis

definition
pathogenesis

A

chronic systemic disease of unknown etiology with symmetric inflammation of joints

  1. chronic inflammation by autoantibodies and thickening of synovial membrane which leads to pannus formation (inflammatory granulation tissue)
  2. increasing degrees of inflammation destroys cartilage and ankylosis (fusion) of joint
  3. autoimmune, IgM in blood (rheumatoid factor), women, HLA-DR4 gene
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30
Q

rheumatoid arthritis

symptoms
diagnosis

A

morning stiffness resolved with activity, PIP joints, wrist, elbow, ankle, knee, rheumatoid nodules present

joint space narrowing, loss of cartilage, osteopenia on xray
lab IgM against FC portion of IgG, neutrophils, high protein in synovial fluid

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31
Q

rheumatoid arthritis: treatments

DMARD (disease-modifying antirheumatic drugs)

A

shown to alter the disease course and improve radiographic outcomes

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32
Q

rheumatoid arthritis: treatments

methotrexate (MTX)

A

now considered the first line DMARD agent for most patients with RA. the anti-inflammatory effects of MTX in RA appear to be related at least in part to interruption of adenosine and possible effects on TNF pathways (tumor necrosis factor alpha; mediate joint damage)

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33
Q

rheumatoid arthritis: treatments

Enbrel (Ethanercept)

A

binds TNF in the circulation and in the joint, preventing interaction with cell surface TNF receptors thereby reducing TNF activity

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34
Q

rheumatoid arthritis: treatments

Remicade (Infliximab)

A

mono-therapy or in combo with MTX, binds to TNF in joint and in circulation, preventing its interaction with TNF receptors on surface of inflammatory cells, and eventually clearing TNF from the circulation

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35
Q

rheumatoid arthritis: treatments

Humira (adalimumab)

A

fully human anti-TNF monoclonal antibody with high specificity for TNF

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36
Q

rheumatoid arthritis: treatments

Orencia (abatacept)

A

class of agents known as T-cell costimulatory blockers (antigen-presenting cells and T lymphocytes)

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37
Q

rheumatoid arthritis: treatments

Rituxan (rituximab)

A

monoclonal antibody that binds to CD20 molecule (marker) on B cell surface leading to removal of B cells from circulation

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38
Q

rheumatoid arthritis: treatments

depletion of B cells

A

has reduced signs and symptoms and slowed radiographic progress

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39
Q

rheumatoid arthritis: treatments

Anakinra (Kineret)

A

human recombinant IL-1 receptor antagonist (hu rIL-1 ra) is approved for RA, used alone or in combo with DMARDs other than TNF blocker

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40
Q

JAK-STAT pathway

A

sends signals involving bone marrow and immune system activation

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41
Q

rheumatoid arthritis: treatments

Xeljanz (tofacitinib)

A

small new molecule that enters a cell and binds to ATP binding site on enzyme Janus Kinase (JAK), which prevents JAK from activating STAT and sending important messages to the nucleus of immune system cells

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42
Q

rheumatoid arthritis: treatments

kevzara (sarilumab)

A

injectable interleukin-6 (IL) receptor blocker. it stops the IL-6 signal mediated pathways. IL-6 mediated signaling through these receptors. IL-6 is a pro-inflammatory cytokine produced by a variety of cell types including T and B cells, lymphocytes, monocytes, fibroblasts

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43
Q

scoliosis

definition
who does it affect
signs

A

abnormal lateral curvature of the spine; large curves cause pronounced disabilities

4% of people, idiopathic in adolescent girls

one shoulder higher than the other and tilted pelvis

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44
Q

gout

definition
diagnosis
treatment for acute
treatment for chronic
colchicine
probalan

A

deposit of uric acid crystals (monosodium urate) in small joints of hands and feet causing inflammation

joint fluid test, urate crystals, blood uric acid levels

NSAIDS, corticosteroid (prednisone)

block uric acid production = xanthine oxidase inhibitor including allopurinol (zyloprim, aloprim) and febuxostat (uloric)

pain relieves by preventing polymerization of tubulin

improves kidneys abilities to remove uric acid

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45
Q

gout: primary

pathogenesis

A

most common, idiopathic pathogenesis for hyperuricemia

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46
Q

gout: secondary

secondary to…
signs

A

leukemia, Lesch-Nyhan syndrome

presents with mental retardation and self-mutilation, renal insufficiency

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47
Q

diagnosis of muscle disease

A

toxin, drug, autoimmune, destruction characterized by release of CK

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48
Q

dermatomyositis

definition
symptoms
lab findings
treatment

A

inflammatory disorder of skin and skeletal muscle, idiopathic

rash on upper eyelids, red papules on elbows, knuckles, knees

increased CK and anti-Jo-1 antibody

treat with corticosteroid

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49
Q

polymyositis

definition
symptoms

A

inflammatory disorder of skeletal muscle

proximal muscle weakness, endomysial inflammation (CD8+ T cells) with necrotic muscle fibers

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50
Q

types of open soft injuries

A

amputation
avulsion
crush injury
puncture
abrasion
laceration

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51
Q

myasthenia gravis: pathogenesis

A

autoantibodies against acetylcholine receptors

hypersensitivity-II

antibodies block neuron transmission, antibodies synthesized by thymus gland

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52
Q

myasthenia gravis: treatment

A

anti-cholinerterase to prevent acetylcholine breakdown at NMJ, blood transfusion, immunosuppressive drug, surgery on thymus gland

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53
Q

myasthenia gravis: diagnosis

A

tensilon test, presence of autoantibodies

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54
Q

myasthenia gravis: symptoms

A

muscular weakness (especially extraocular and facial muscles), ptosis, easily fatigues, inability to chew

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55
Q

Lambert-Eaton syndrome

pathogenesis
treatment

A

secondary to small cell carcinoma, antibodies against presynaptic calcium channel of NMJ, impaired acetylcholine release

treat the cancer

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56
Q

muscular dystrophy

cause
symptom
sign

A

genetic defect (autosomal or sex linked), heterogeneous

progressive muscle wasting

elevated CK level

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57
Q

duchenne muscular dystrophy

who does it affect
pathogenesis
mild form

A

most common, sex-linked - boys, death in late teens of early 20s

deficiency of dystrophin, holds together other structural proteins, degeneration of skeletal muscle cells

Becker’s dystophy - mutated dystrophin, better prognosis, death around 40

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58
Q

botulism

cause
pathogenesis
symptom
treatment

A

food poisoning from old canned food

toxin binds to acetylcholine nerve endings at presynaptic terminal and blocks release

muscle paralysis

treat with anti-toxins but must be administered quickly

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59
Q

congenital skin disorder: birth mark or nevus greater than 1 cm

definition

A

benign neoplasm of melanocytes

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60
Q

congenital skin disorder: melasma

who does it affect
signs
treatment

A

women who are pregnant or taking oral contraceptives or HRT, worsened by sun

well circumscribed, hyperpigmented patches (cheek and forehead) (“mask of pregnancy”)

treat with sunscreen

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61
Q

congenital skin disorder: ichthyosis congenita (fish skin)

definition

A

heterogeneous group of diseases with striking thickening of the stratum corneum

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62
Q

congenital skin disorder: albinism

definition
physiological cause
cure

A

congenital lack of pigmentation

enzyme defect impairs melanin production from tyrosine (usually) and phenylalanine

no cure

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63
Q

congenital skin disorder: vitiligo

definition
treatment

A

localized loss of skin pigmentation due to autoimmune destruction of melanocytes

treat with cortisol

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64
Q

burns: 3 factors for burn extent

A

temperature of agent
concentration of heat
duration of contact

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65
Q

burns: Jackson’s theory

3 zones

A

zone of coagulation: nearest the heat source, suffers the most damage (clotted blood and thrombosed blood vessels)

zone of stasis: surrounding zone of coagulation, decreased blood flow

zone of hypermia: area around burn with increased blood flow

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66
Q

burns: electrical burn

wound
resistance
contact

A

entrance/exit wound

dry skin= inc. resistance (bone, muscle)
wet skin= decreased resistance (vessels, nerves)

inc. contact = inc. injury

dec. point of contact = inc. concentrated energy = inc. injury

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67
Q

burns: chemical burns

acid and base

A

acid: thick, insoluble mass, coagulation necrosis (limit burn damage)

alkalis (base): destroy cell membrane through liquefaction necrosis (deeper tissue penetration and burn)

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68
Q

burns: classification

degrees
rule of palms/nines

A

1st degree: superficial, red, painful, dry (no blisters), erythema, swelling

2nd degree: partial thickness, red or white, painful, wet (blisters), involving epidermis

3rd degree: leathery skin (charred, white, dark brown), minimal pain, dry, full thickness with massive necrosis of epidermis and parts of dermis

rule of nines: large area
ant/post head - 9%, ant/post trunk - 36%, ant/post UE - 18%, perineum - 1%, ant/post LE - 36%

rule of palms: irregular or splash burns, <10% BSA, hand = 1% BSA

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69
Q

bacterial infections: impetigo

definition
who does it affect
infectious bacteria

A

superficial infection, macules to pustules in face, honeycomb scab

staph. aureus or strep pyogenes

children

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70
Q

bacterial infection: carbuncle

definition
treatment

A

red, swollen, painful cluster of boils (infected hair follicle with pus) connected under skin

treat with antibiotics and drainage

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71
Q

bacterial infection: staph. scalded skin syndrome

definition
infectious bacteria
treatment

A

sloughing of skin with erythematous rash and fever, significant skin loss

staph. aureus

treat with oral or cream antibiotic

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72
Q

bacterial infection: acne

definition
pathogenesis
treatment

A

chronic inflammation of hair follicles

propiobacterium acnes produces lipases that break down sebum, releasing pro-inflammatory fatty acids, pustule or nodule formation

treat with benzoyl peroxide (antimicrobial) and vitamin A derivatives (Accutane)

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73
Q

viral infections

A

mesels
chicken pox
herpes zoster (vesicles)
human papillomavirus (HPV, wart)

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74
Q

psoriasis

definition
signs
classification
treatment

A

papules and plaque with silvery scaling

lesions involve extensors surfaces of elbows and knees, scalp and sacrum, most often non-pruritic (no itch), psoriatic arthritis (RA like lesions on fingers)

HLA-C, may be autoimmune

treat with corticosteroids, MTX, or other immuno-modulators

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75
Q

scleroderma

definition
who does it affect
classification
symptoms and signs
treatment

A

vasculopathy and excessive collagen deposition in skin and internal organs (lung, heart, GI, kidney)

4x more likely in women, familial incidence

HLA-DQB1 and autoantibodies = autoimmune

skin edema then induration (hardening), inc. collagen fibers in dermis, thinning of epidermis, atrophy of dermal appendages, hyalinization and destruction of arterioles, and variable mononuclear infiltrates (T cells)

treat with anti-inflammatories, immunosuppressants, anti-fibrotic agents

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76
Q

skin cancer: basal cell carcinoma

definition
prognosis
risks
area
sign
treatment

A

most common malignant, basal cells

good prognosis

UVB induced DNA damage and prolonged exposure to sunlight, albinism, xeroderma pigmentosum

upper lip

elevated nodule with central dome shapes, “pink-pearl like papule”

treat with surgery, metastasis is rare

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77
Q

skin cancer: squamous cell carcinoma

definition
sign
risks
treatment

A

malignant proliferation of squamous cells

keratin pearls, bleeds, small, red, firm, ulcerating nodule on face

UVB induced DNA damage and prolonged exposure to sunlight, albinism and xeroderma pigmentosum, arsenic exposure

treat with surgery, metastasis is rare

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78
Q

malignant melanoma

definition
risks

A

malignant neoplasm of melanocytes (most common cause of death from skin cancer)

UVB DNA damage, sunlight, albinism, xeroderma pigmentosum

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79
Q

malignant melanoma: radial growth

definition
metastasis

A

discolored macule, horizontal growth of atypical cells in epidermis, does NOT metastasize

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80
Q

malignant melanoma: vertical growth

definition
metastasis

A

nodular, into dermis

does metastasize and probability is directly proportional to depth of invasion

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81
Q

malignant melanoma: lab finding and prognosis

A

presence of S-100 tumor marker

metastatic and modular = prognosis

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82
Q

malignant melanoma: treatment

A

surgical excision and sentinel lymph node biopsy for stage 1B and higher, chemo, consider IL-2 for metastatic

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83
Q

malignant melanoma: abcs

A

asymmetry of pigmented lesion
borders are irregular
color varies from dark brown to dark black to red
diameter of lesion, worry when it is bigger than 6 mm

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84
Q

hair diseases: hirsutism

cause
definition
signs
treatment

A

hormonal or idiopathic

soft, fine, unpigmented hair into coarse and pigmented hair by androgen

inc. bulk, dec. voice from inc. sensitivity to high androgen and low estrogen

treat with oral contraceptives

85
Q

hair diseases: alopecia

who does if affect
cause
treatment

A

males

from increased dihydrotestosterone (DHT)

treat with finasteride

86
Q

stomatitis

definition
causes
who does it affect

A

inflammation of oral cavity

alcohol (moonshine, whiskey), tobacco, stress; infectious agents:
herpes virus (HSV-1) - vesicles in oral mucosa with shallow, painful, red ulcers, virus remains dormant in ganglia of trigeminal nerve, stress/hormones reactivate, lead to vesicles on the lips (cold sores)
oral candidiasis (thrush) - local white membranous lesion caused by Candida albicans

infants, children, immuno-compromised, diabetes

87
Q

oral cancer

type
cause
area
leukoplakia
erythroplakia

A

squamous cell carcinoma

tobacco

floor of mouth

white plaque which cannot be scraped away

red plaque, vascularized

88
Q

atresia

definition
with fistula
sign
treatment

A

esophagus ends in blind pouch

tapers at proximal end

fluids come out via nose, mouth causing respiratory distress

treat with surgery

89
Q

achalasia

definition
pathogenesis
cause

A

inability to relax the lower esophageal sphincter (LES)

loss of ganglion cells —> progressive dilation of esophagus

South American parasite Trypanosoma cruzi infection in Chagas disease

90
Q

hiatal hernia

definition

A

protrusion of abdominal contents through abdominal wall to thoracic cavity

91
Q

GERD

definition
symptom
cause

A

reflux of gastric juice into esophagus, incompetent LES and hiatal hernia

burning relieved by antacids

excessive alcohol, tobacco

92
Q

Barrett’s esopahgus

pathogenesis
treatment

A

late complication of GERD, lower portion, squamous cell lining replaced by columnar epithelium, glandular metaplasia due to GERD

treat with antacids, H-2 blocker, acid pump reducer drugs

93
Q

acute gastritis

definition
cause
treatment

A

acidic damage to stomach, short duration

NSAIDs, heavy alcohol, burn patients, increase intracranial pressure, increased stimulation of vagus nerve

treat with H-2 blocker or acid pump reducer

94
Q

chronic gastritis

definition

A

chronic mucosal inflammation and mucosal gland atrophy

95
Q

chronic gastritis: type A

classification
cause

A

autoimmune = anitbodies to parietal cells, lack of gastric acid secretion

thyroiditis/Addison’s disease, aging, gastric ulcer, gastric carcinoma

96
Q

chronic gastritis: type B

cause
pathogenesis
treatment

A

helicobacter pylori bacteria and common form

aid in development of adenocarcinoma of stomach and gastric lymphoma

treat with triple antibiotic to treat H pylori

97
Q

peptic ulcer

area
cause
symptom
complications

A

lesser curvature

H pylori (95%)

not dependent on increased gastric acid secretion

epigastric pain resolves with meals

complications: hemorrhage, hematemesis, melena, iron deficiency anemia

98
Q

gastric carcinoma

definition
risks

A

malignant proliferation of surface epithelial cells

50+ years old, men, blood group A, japan, finland, iceland, decreased in US

99
Q

gastric carcinoma: intestinal

definition
area

A

more common

large, irregular ulcer with heaped up margins

lesser curvature of antrum

100
Q

gastric carcinoma: diffuse

definition
treatment

A

signet ring cells that diffusely infiltrate gastric wall (leather bottle stomach)

treat with surgical resection with or without chemo

101
Q

hirschsprungs disease

definition
cause
symptoms
treatment

A

megacolon proximal to rectal narrowing

congenital failure of ganglion cells

failure to pass meconium, chronic constipation, acute enterocolitis, rupture of colon

treat with resection of involved bowel

102
Q

diverticulosis

definition
area
risks
symptoms

A

outpouching of colonic mucosa through weak area in wall

sigmoid, multiple

older persons, constipation and low fiber

asymptomatic

103
Q

diverticulitis

definition
signs
treatment

A

fecal matter trapped in pouches and incite inflammation

inflammation, perforation, bright red rectal bleeding

treatment with resection of involved bowel

104
Q

hemorrhoids

definition
cause
symptoms
treatment

A

swollen veins in anus or rectum

idiopathic

bright red bleeding and painful stool

treat with stool softener, high fiber, rectal ointment

105
Q

angiodysplasia

definition
who does it affect

A

localized vascular lesion in colon and unexplained bleeding in old people

106
Q

ischemic bowel disease

definiton
cause

A

decreased blood flow in intestine due to atherosclerotic occlusion of at least 2 of the major mesenteric vessels

107
Q

SHORT ANSWER
inflammatory bowel disorder: pathogenesis of Crohn’s disease

A

inflammation of the distal ileum (s. intestine) which affects the right side of abdomen

108
Q

Crohn’s disease

symptoms and signs
scans
treatment

A

patchy, inflammation may skip areas

ulceration of mucosal layer and scarring of the s. intestine

string signs on barium xray (granuloma, fistula, stenosis)

treat with cortisol, humira, remicade (DMARDs)

109
Q

SHORT ANSWER
inflammatory bowel disorder: pathogenesis of ulcerative colitis

A

recurrent chronic inflammation of large intestine and affects left side

110
Q

ulcerative colitis

signs and symptoms
treatment
risks

A

involves whole area, megacolon and pseudopolyps, deep linear ulceration and mucosal layer is red

treat with anti-diarrheals, cortisol, immunosuppressants

higher risk of colorectal adenocarcinoma

111
Q

large intestinal infection - Shigella, Norwalk virus

AKA

A

cruise ship fever

112
Q

appendicitis

definition
who does it affect
symptoms
treatment

A

inflammation of appendix

older children/young adults

nausea, vomiting, low-grade fever, rebound tenderness, pain in McBurney’s point (RLQ)

treat with surgery

113
Q

intestinal obstructions: adhesions

A

tumor

114
Q

intestinal obstructions: volvulus

A

twisting of a portion of GI tract about itself

115
Q

intestinal obstructions: intussusception

A

proximal segment of bowel forward into distal segment, pulled forward by peristalsis, caused by tumor

116
Q

celiac sprue

classification
tests
risk
symptoms

A

hypersensitivity to dietary grain, HLA-B8 and HLA-DW3, antibodies against gliaden

antibody test, biopsy, presence IgA and anti-tissue transglutaminase

T1D

steatorrhea (fat in stool), chronic diarrhea, bloating

117
Q

colon cancer polyps: hyperplastic

A

anywhere along length of bowel and no significance

118
Q

colon cancer polyps: inflammatory

A

granulation tissue, caused by inflammation that occurs with IBD

119
Q

colon cancer polyps: hamartomatus - juvenile

A

children, s. and l. bowel, most commonly rectum

more = inc. risk of progression to carcinoma

120
Q

colon cancer polyps: hamartomatus - Peutz-Jeghers

A

autosomal dominant, s. and l. bowel, GI tract, hands, mouth, lips, genitals

inc. risk of colorectal, breast, gynecologic cancer

121
Q

colon cancer polyps: adenomatous - tubular adenoma

malignancy potential

A

most common, small and peduncular

slight increased risk of developing malignancy, but malignant potential is low

122
Q

colon cancer polyps: adenomatous - tubulovillous adenoma

malignancy potential

A

5-10%, similar to tubular

surface covered with finger-like projections

intermediate malignancy potential

123
Q

colon cancer polyps: adenomatous - villous adenoma

malignancy potential

A

1%, somewhat flattened surface

highest associated malignant potential with 30% becoming malignant

124
Q

colon cancer

tissues affected
commonality among cancers
age
genetic cause
signs
testing
goal
area of colon

A

colonic or rectal mucosa

3rd most common cancer site

peak at 60-70 years old

p53 gene, mismatch repair genes in DNA

de novo at a relatively young age, right sided

colonoscopy beginning at 50, fecal test, blood test

goal is to remove polyps before carcinoma develops

entire colon

125
Q

left sided colon cancer

A

“napkin-ring” lesion, LLQ pain, blood streaked stool

126
Q

right sided colon cancer

A

raised lesion, iron deficiency anemia, vague pain

127
Q

colon cancer: staging

A

T - depth of invasion; tumors limited to mucosa

N - spread to regional lymph nodes

M - distant spread; most commonly involves liver

128
Q

colon cancer: treatment

A

chemo and surgery

129
Q

jaundice

definition
three types

A

yellow discoloration of skin, sclarae, tissues by hyperbilirubinemia

pre-hepatic (unconjugated), hepatic (mixed), post-hepatic (conjugated)

130
Q

hepatitis A

type of virus
method of transmission
antigen-antibody test results
complications
prevention of disease after exposure
immunization

A

RNA
fecal-oral, contaminated food or water
anti-HAV
no carriers or chronic liver disease
gamma globulin
yes

131
Q

hepatitis B

type of virus
method of transmission
antigen-antibody test results
complications
prevention of disease after exposure
immunization
particles

A

DNA
blood or body fluids
HbsAg + (infected) and lack anti-HBs, lack HbsAg (immune) and have anti-HBs
10% become chronic carriers and may develop chronic liver disease
Hep B immunoglobulin
yes

dane particles: HBsAg (surface antigen), HBcAg (core antigen), HBeAg (extra antigen)

132
Q

hepatitis C

type of virus
method of transmission
antigen-antibody test results
complications
prevention of disease after exposure
immunization

A

RNA
blood or body fluids
HCV RNA (active infection) and anti-HCV denotes infection
75% become carriers and many develop chronic liver disease
new drugs
no

133
Q

hepatitis D

who does it infect
cause
pathogenesis

A

only infects those with acute or chronic HBV infection

needle sharing

delta virus cannot produce its own coat and uses HBsAg produced by HBV

134
Q

hepatitis E

transmission
prevention
immunization

A

oral fecal

no prevention after exposure

no immunization

135
Q

hepatitis G

A

does not lead to chronic hepatitis and no known relationship with hepatocellular carcinoma

136
Q

alcoholic liver disease: alcoholic fatty liver

definition
treatment

A

accumulation of fat in hepatocytes

treat with abistinence

137
Q

alcoholic liver disease: alcoholic hepatitis

definition
signs

A

acetaldehyde mediates damage, swelling of hepatocytes with formation of Mallory vodies

necrosis, hepatomegaly, inc. liver enzymes

138
Q

alcoholic liver disease: alcoholic cirrhosis

A

most advanced, fatty liver may become brown, shrunken, irregular nodularity with hobnail appearance and fibrosis of liver with loss of hepatic architecture

139
Q

cirrhosis

definition
classification
risks
causes

A

disorganization of hepatic architecture with scarring and nodule formation

micro-, macro-, or mixed macro-micronodules forms

inc. risk of hepatocellular carcinoma

prolonged alcohol intake, drugs, chemical agents
viral hepatitis, biliary obstruction, and hemachromotosis
Wilson’s disrease

140
Q

biliary cirrhosis: primary

classification
risks
cause

A

autoimmune

female, 40+

unknown cause, anti-mitochondrial antibody present

141
Q

biliary cirrhosis: secondary

cause

A

duct obstruction by gallstone, yellow green liver

142
Q

hemochromatosis

pathogenesis
classification

A

excess iron —> deposit in tissue and organ damage

autosomal recessive (Hfe, chr. 6)

143
Q

hemochromatosis: primary

cause
symptoms
lab test finding

A

defect in Fe absorption

triad of cirrhosis, diabetes, inc. skin pigmentation

inc. serum iron, reduction ion total iron binding capacity

144
Q

hemochromatosis: secondary

cause
treatment

A

chronic transfusions, ineffective erythropoeisis and multiple transfusions (thalassemia major)

treat with weekly phlebotomy and low iron diet

145
Q

Wilson’s disease

definition
symptoms
treatment

A

autosomal recessive of copper metabolism, deposits in tissues, free radicals lead to tissue damage

anemia, dementia, Kayser-Fleischer ring, copper in urine

treat with copper chelater, low copper diet

146
Q

portal hypertension

definition

A

portal vein obstruction —> varices in esophagus and developing ascites

147
Q

portal hypertension: pre-hepatic

A

portal and splenic vein obstruction by thrombosis

148
Q

portal hypertension: intrahepatic

A

intrahepatic vascular obstruction by cirrhosis or tumor

149
Q

portal hypertension: post-hepatic

A

venous congestion in distal hepatic venous circulation or thrombolytic hepatic vein occlusion (Budd-Chiari syndrome)

150
Q

Reye’s syndrome

pathogenesis
symptoms

A

rare childhood disease with small fat vacuoles in liver, after influenza or varicella, aspirin makes it worse

hypoglycemia, elevated liver enzymes, nausea, coma, death

151
Q

primary sclerosing cholangitis

due to…?
symptoms

A

ulcerative colitis

inflammation, fibrosis (onion skin), biliary cirrhosis

152
Q

cholelithiasis

definition
symptoms
risks

A

stones in gallbladder (cholesterol or pigment), usually mixed with cholesterol and calcium salts (seen on xray)

asymptomatic, may present with biliary colic

fat forty fair female febrile

153
Q

acute cholecystitis

definition
symptoms

A

inflammation of gallbladder

pyogenic

nausea, vomiting, fever, leukocytosis, RUQ and epigastric pain

154
Q

chronic cholecystitis

definition
treatment

A

thickening of gallbladder wall as a result of extensive fibrosis

treat with antibiotics and ERCP

155
Q

benign liver tumors: hemangioma

definition

A

benign tumor of the liver

156
Q

benign liver tumors: hepatocellular adenoma

cause

A

caused by oral contraceptives

157
Q

malignant liver tumors: hepatocellular carcinoma

definition
cause

A

most common primary malignancy of liver

preexisting HBV, contamination of nuts and grains (aflatoxin B1, causes point mutations of p53)

158
Q

malignant liver tumors: cholangrocellular carcinoma

where in the world
cause
tissue affected

A

far East, river fluke infection (rice fields), intrahepatic biliary epithelium

159
Q

malignant liver tumors: angiosarcoma

definition
cause

A

rare malignant vascular tumor

PVC and arsenic exposure

160
Q

63 year old man with left eyelid droopiness, shortness of breath over last 2 months, 40 year heavy smoker, ptosis and miosis of left eye, dry skin of left face. CXR shows irreg. mass in apex of left lung. need biopsy, prognosis not good

A

bronchogenic carcinoma

161
Q

71 year old man with water retention. well hydrated, intake does not match output. shortness of breath, down 15 lbs over 3 months. 2.5 packs per day for 50 years. CXR shows central coin lesion. small round cells on biopsy

A

bronchogenic carcinoma

162
Q

22 year old man in ER with severe chest pain and shortness of breath. Tall and thin. dec breath sounds, dec tactile fremitus, hyperresonance to percussion over right chest. normal ECG. CXR shows deep sulcus sign over right costophrenic angle and tracheal deviation. put on O2 and place chest tube

A

pneumothorax

162
Q

2 month old male in ER by adoptive parents. fussy and cries with touch to the L arm, which is hypoactive. multiple fx, no bruising (no child abuse), blue sclerae

A

osteogenesis imperfecta

163
Q

32 year old woman with intermittent double vision in afternoons and evenings. ptosis of both eyes that worsens when asked to keep eyelids open. symptoms improve after edrophonium administration. may have a thymoma

A

myasthenia gravis

164
Q

15 year old boy in ER with tib/fib fx after a fall. broken several bones before, mother has bone disease, hearing loss, facial asymmetry, hepatosplenomegaly. labs show anemia and xrays show fx and erlenmeyer flask deformity

A

osteopetrosis

165
Q

68 year old woman with aching LBP. feels she is getting shorter and slightly hunched forward. xray shows compression fx of L4, dec. bone mass

A

osteoporosis

166
Q

74 year old with bone pain in L thigh, hearing loss over 6 months. labs show inc. serum alkaline phosphate with normal CA2+, phosporus, PTH. xray shows thickening and lucency of bone

A

Paget’s disease

167
Q

5 year old boy with skeletak deformities. short pale boy with sternal protrusion, thinning of occipital and parietal bones with square head, rachitic rosary. well nourished and no prior medical issues. suggest vitamins and exposure to sunlight

A

Rickets and osteomalacia

168
Q

19 year old man in ER with R lower thigh pain after fall. xray shows fx in a stalk of bone growth protruding from end of femur. autosomal dominant. biopsy to show endochondral ossification over medullary cavity, no atypical cells

A

osteochondroma

169
Q

13 year old boy with pain and swelling in left knee. no trauma and no fever. labs show inc. serum alkaline phosphate, xray shows a mass with sunburst growth pattern and periosteal elevation by mass, aka codman triangle. will need chemo, sx, oncologist

A

osteosarcoma

170
Q

11 year old boy in ER with painful swollen mass in right leg, no trauma. xray shows lytic tumor with onion skin appearance in medullary cavity of R femur. admit to oncology

A

Ewing sarcoma

171
Q

44 year old woman with chronically swollen finger joints over 6 months. most severe in morning, but resolves in a few hours. swollen PIP and MCP joints of hands and subcutaneous nodules over both elbows. labs show IgM directed against Fc of IgG. refer to rheumo

A

RA

172
Q

74byear old woman with stiffness and paon on both knees, worse later in day after walking. bilateral swollen knees with mild joint effusion and crepitus with flexion. bony nodules on DIP and PIP joints

A

osteoarthritis

173
Q

45 year old obese man in ER with swollen, tender big toe on R foot. no trauma. lots of alcohol night before. aspirate of synovial fluid from metatarsophalangeal joint of R big toe demonstrates neutrophils along with needle shapes, negatively birefringent crystals. prescribe indomethacin

A

gout

174
Q

6 year old boy with severe muscle weakness, esp. of thighs. maternal uncle died of muscle disease as a kid. enlarged calves and dec strength in proximal muscles of LE. uses arms to get up. Labs show inc. serum CK

A

Duchenne MD

175
Q

28 year old man with generalized muscle stiffness. mother suffers from disease with similar symptoms. delayed relaxation of hand muscles after prolonged grip, weakness of distal muscles in limn. testicular atrophy and frontal baldness. prescribe phenytoin

A

myotonic dystrophy

176
Q

55 year old woman with muscle weakness andrash. inc difficulty rising from chairs and climbing stairs over 3 months. malar rash on face. erythema on neck ans shoulders, periorbital edema and purplish eyelids. hands has scaly patches over dorsum of proximal interphalangeal abd metacarpophalangeal joints bilaterally. look at serum and aldolase, muscle biopsy

A

myositides (polymyositis and dermatomyositis)

177
Q

24 year old african american with irreg depigmented patches on hands and mouth. hashimotos. biospy shows no melanin pigment and absence of melanocytes. recommend sunscreen, inc risk of skin cancer

A

albinism and vitiligo

178
Q

10 year old boy with pruritic, vesicular rash. was in woods yesterday during summer camp. topical corticosteroid cream and avoid certain plants

A

allergic contact dermatitis

179
Q

1 year old female with rash. 3 episodes over 6 months. itchy, red, patchy, on face, wrists, elbows, knees. father has seasonal allergies and asthma. crusty scaly erythematous plaques on skin. topical corticosteroids and moisturizer

A

atopic dermatitis (eczema)

180
Q

34 year old woman with chronic skin rash of well-demarcated coral-colored plaques with silvery scales over scalp, elbows, and knees. removing scales results in pinpoint bleeding. arthritic symptoms. biopsy shows acanthosis with Munro microabscesses, parakeratosis, and elongation of rete ridges

A

psoriasis

181
Q

67 year old man with hard, red, ulcerated nodule on back of L hand. biopsy shows cellular atypia and anaplasia in epidermis and dermis, hyperkeratosis with keratin pearls. has cancer but simple excision will cure

A

squamous cell carcinoma of skin

182
Q

62 year old woman with raised ulcerated lesion on R cheek. used to be a gardener and does as a hobby now. pearly, ulcerated papule with overlying telangiectasias. biopsy shows clusters of cells with dark blue nuclei surrounded by palisading basal cells. cured with sx excision

A

basal cell carcinoma

183
Q

48 year old man with irreg. shaped lesion on extensor surface of L forearm. changed from light brown to dark reddish purple and is more raised. poorly defined, hyperpigmented, multicolored nodule. L axillary lymphadenopathy. biopsy shows nests of atypical pigmented cells in dermis. refer to oncology

A

malignant melanoma

184
Q

newborn boy choking and coughing up breast milk on first attempt to feed. excessive salivation and is slightly blue. look for fluid and electrolyte imbalance and gastric air bubble

A

tracheoesophageal fistula

185
Q

45 year old man with 3 year hx of gastroesophageal reflux with inc heartburn and regurgitation. antacids and proton pump used to help. endoscopy shows orange gastric type epithelium extending upward from stomach into distal esophagus

A

Barrett esophagus

186
Q

55 year old white man at Gi with difficulty keeping down both solids and liquids over last several months. regurgitated small amounts of undigested food after almost every meal for three weeks. substernal pain even hours after small meals. barium esophagography shows bird beak at LES. botulinium toxin can be injected for relief

A

achalasia

187
Q

42 year old african american man with heartburn 30 mins after most meals, worse with lying down after eating. tx with baking soda with good results. no regurgitation or dysphagia. prescribe omeprazole (proton pump inhibitor)

A

GERD

188
Q

56 year old man with dec ability to swallow solid foods. avoiding large meals and lost 30 lbs over 6 months. smoked two packs a day for 20 years and heavy alcohol use. pain in throat when swallowing and coughing up small amounts of blood sometimes. cervical lymphadenopathy and hepatomegaly, hoarse voice

A

esophageal carcinoma

189
Q

66 year old woman in ER with several bouts of bloody vomit. hx shows epigastric pain. osteoarthritis, high dose motrin daily

A

acute and chronic gastritis

190
Q

65 year old man with epigastric pain after meals. hx shows heavy smoker and lost 10 lbs in 4 months due to dec appetite connected with pain with meals. no frank blood in stool, but has been darker. upper endoscopy and proton pump inhibitor

A

peptic ulcer disease

191
Q

54 year old japanese american man with gnawing epigastric pain. lost 20 lbs over 2 months and been vomiting after meals. not relieved by OTC antacids. supracalvicular lymph node swelling and darkened, thickened skin in flexural area of arms and legs. upper endoscopy and biopsy

A

gastric carcinoma

192
Q

25 year old woman with intermittent bouts of diarrhea and RLQ pain not associated with meals. constipated for several days. temp of 100, several oral ulcers, palpable RLQ mass. episodes of migrating joint pain and periodic burning sensation in eyes with blurred vision, but eye exam is normal. perianal region is normal, but guaiac test is positive. upper GI series needed

A

Crohn disease

193
Q

23 year old Irish immigrant with diarrhea with 4 weeks. 10+ bowel movements a day, stool is soft, pale, large, floating, greasy, and foul smelling. lost 7 lbs over last month with inc appetite. loss of muscle mass and marked pallor, distended abdomen and hyperactive bowel sounds. serum shows antigliadin antibodies

A

Celiac Sprue

194
Q

2 day old baby with Downs has failed to pass meconium, distended bowel consistent with obstruction. possible bowel perforation with peritonitis

A

Hirschsprung disease

195
Q

65 year old man with mild aching LLQ pain. constipated, loose stools every other day of 5 days. vomited three times, low grade fever, palpable LLQ mass with tenderness, positive stool guaiac test. no free abdominal air. start antibiotics, need high fiber diet

A

diverticulosis and diverticulitis

196
Q

32 year old woman with blood tinged diarrhea. four episodes of loose stool per dat with intermittent rectal bleeding over two weeks. frequently sits on toilet with urge to defecate but has no movement. LLQ tenderness and red blood visible on digital rectal exam. need sigmoidoscopy

A

ulcerative colitis

197
Q

55 year old man with family hx of colon cancer for annual screening. fecal test is positive. sigmoidoscopy shows several pedunculated polyps are seen and biopsied

A

adenomatous polyps of the colon

198
Q

55 year old white man with weakness and fatigue. intermittent rectal bleeding and loose stools, lost 15 lbs over two months, family hx of colon cancer. marked pallow and + stool guaiac test. Labs show iron deficiency anemia and elevated CEA levels. need colonoscopy and biopsy

A

colorectal adenocarcinoma

199
Q

13 year old girl in ER with RLQ pain, nausea, vomiting. 12 hours ago has vague colicky periumbilical pain. low grade fever and tenderness in RLQ on palpation. labs show mild leukocytosis

A

acute appendicitis

200
Q

50 year old man in ER with abdominal discomfort. dull RUQ ache for a week and low grade fever, malaise. urine become darker even with good hydration. yellow discoloration of skin and yellowing of whites of eyes. liver is tender and enlarged, appreciable ascites and asterixis. labs show conjugated and unconjugated bilirubin, inc urine bilirubin, and inc AST and ALT

A

jaundice

201
Q

30 year old man with abdominal pain and dark urine. RUQ pain over 6 months. jaundice, hepatomegaly. not safely sexually active. IV drug use. serum shows inc ALT and AST

A

viral hepatitis

202
Q

52 year old man with fatigue, bloating, loss of sex drive. come on slowly over last year and is a recovering alcoholic. painful swelling of bilateral breasts, ascites, scleral icterus, jaundice, several capillary telangiectasias on face, 3+ ankle edema bilaterally. start diuretic therapy and encourage to not drink alcohol

A

hepatic cirrhosis

203
Q

48 year old woman with nausea and abdominal pain after a weekend of binge drinking. fairly regularly over 15 years. lost appetite, jaundiced, mild hepatomegaly with palpation. serum shows AST:ALT of 2.5 with leukocytosis. elevated serum ALP. liver biopsy to show macrovesicular fat, neutrophil infiltration with hepatic necrosis, Mallory bodies, and micronodular cirrhosis. recommend to stop drinking alcohol

A

alcoholic liver disease

204
Q

55 year old man with weakness, fatiguability, weight loss, anorexia. thirstier and urinating more frequently than usual. scleral icterus, jaundice, hyperpigmentation of skin on trunk and extremities. serum shows elevated LFTs, iron, dec TIBC, transferrin sat of 85%, ferritin level of 1500 ug/L. need weekly phlebotomy and deferoxamine and family members should get tested.

A

hemochromatosis

205
Q

8 year old boy with strange, jerky movements and drastic behavior and personality changes. more emotionally liable and out of context statements that are incomprehensible. brownish ring around sup and inf poles of cornea. tremor in both arms and hands. labs show dec serum ceruloplasmin and elevated copper, amino acids, and glycogen in urine. start on penicillamine to inc urinary excretion of chelated copper

A

Wilson disease

206
Q

45 year old woman with spitting up red blood. recent hemorrhoids with red blood found on toilet paper after bowel movements. no sig. alcohol use, hx of hepatitis, or drug use. BP 100/5-. has pallor, ascites, marked splenomegaly. varices around navel and visible external rectal hemorrhoids. labs show normal LFTs but hypersplenism

A

portal hypertension

207
Q

48 year old woman with gallstones with 1 day hx of nausea, vomiting, abdominal pain (severe, epigastric and RUQ). temp of 101.1, inspiratory arrest on RUQ palpation. serum shows inc ALP, leukocytosis, mild hyperbilirubinemia. start on antibiotics, will need sx

A

acute and chronic cholecystitis

208
Q

60 year old native american woman with 3 month hx of severe RUQ pain. birthed five children, is post menopausal, taking HRT. pain exacerbated after she has greasy food. drinks a bit on weekends and feels abdominal pain shortly afterwards. mild tenderness in RUQ. need ultrasound

A

cholelithiasis (gallstones)

Patho (3 decks)

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