Exam 3 Flashcards
Tracheoesophageal Fistula (Atresia)
Congenital abnormality where esophagus communicates with trachea. Most common is where the upper end is a blind pouch.
Causes: Congenital
Symptoms: Newborn choking, excessive salivation, respiratory distres
Treatment: Surgery
Barrett Esophagus
Lower portion of esophagus squamous epithelium is replaced by columnar epithelium.
Causes: Usually from GERD
Symptoms: Symptoms related to GERD, dysphagia, ulcerations
Treatment: Acid pump reducer drugs (Nexium) reduce the acid. Antacids are only temporary (Tums), H-2 blockers (Zantac) blocks the histamine which slows the acid
Achalasia
Esophageal sphincter doesn’t relax during peristalsis so food gets clogged in esophagus and dilates.
Causes: Idiopathic
Symptoms: Progressive dysphagia, regurgitation, bird-beak esophagus (shown from Barium esophageal swallow)
Treatment: Botox, LES dilation
GERD
Reflux of gastric juice into esophagus
Causes: Untreated LES. Associated with hiatal hernia, alcohol, and tobacco
Symptoms: Heartburn which worsens after meals, lying down, and bending, but relieved by antacids. Complications can lead to Barrett esophagus
Treatment: H-2 blockers (Zantac) and lifestyle modifications
Esophageal Carcinoma
Squamous Cell Carcinoma is in upper esophagus. Lesions and ulcers
Adenocarcinoma is lower esophagus from Barrett esophagus
Causes: Barrett esophagus, achalasia, smoking and alcohol
Symptoms: Dysphagia starting with solid foods then liquid, anorexia, hematemesis
Treatment: Chemo, radiation, surgery. BAD prognosis
Acute Gastritis
Acidic damage to the stomach, associated with ulceration and bleeding
Causes: NSAIDs, alochol, smoking
Symptoms: Hemorrhages, neutrophilic infiltration, anorexia, epigastric pain, hematemesis, nausea, vomiting
Treatment: H-2 Blockers (Zantac), acid pump reducer (Prilosec)
Chronic Gastritis
Acidic damage to the stomach. Type A is autoimmune and Type B is caused by bacterial infection
Symptoms: Type A - Chronic mucosal infection and atrophy of mucosal glands, thickened folds in fundus, lymphocyte infiltration, fatigue, autobodies to parietal cells, pernicious anemia. Type B - asymptomatic with peptic ulcer
Treatment: Type A - vitamin B12. Type B - triple therapy
Peptic Ulcer
Holes in stomach
Causes: H. pylori (95%). In duodenum, arises from increased acid and pepsin secretion. In Gastric, arises from decreased mucosal protection
Symptoms: Punched out margins near lesser curvature. In duodenum, there’s hypertrophy of Brunner glands
Treatment: Gastric - pain intensifies after meals, weight loss. Duodenum - pain lessens after meals, weight gain. H-2 Blockers help (Zantac) and triple therapy. D Ulcers don’t lead to carcinoma, G Ulcers do
Gastric Carcinoma
Malignant epithelial cells. Most common in men over 50 and those with blood group A
Causes: Chronic gastritis, peptic ulcers
Symptoms: Weight loss, epigastric pain. Intestinal - lesions with necrotic base and heaped up margins. Diffuse - leather bottle stomach
Treatment: Surgery with or without chemo
Crohn’s Disease
Inflammation of distal ileum (right side abdomen). Corn on the cob
Causes: Idiopathic
Symptoms: Ulcers of mucosal layer and scaring of the small intestine. Precense of granuloma, fistula, and stenosis. String sign on X-Ray after barium swallow. Symptoms like IBD.
Treatment: Cortisol, Humira
Celiac Sprue
Autoimmune disease against gluten
Causes: Idiopathic/autoimmune
Symptoms: Failure to thrive, malabsorption, steatorrhea (pale, frothy stool), chronic diarrhea, dermatitis herpetiformis (blisters over trunk, scalp, and neck). Lab findings include antigliadin and antiendomysial and anti-TTG antibodies.
Treatment: Gluten-free diet
Acute Appendicitis
Inflammation of the appendix
Causes: Obstruction of the appendix by a fecalith, inflammation, foreign body, or neoplasm. Affects mostly 10-30 year olds
Symptoms: Swollen appendix, neutrophilic infiltration. RLQ pain (McBurney’s point), fever, vomiting, pain by hip
Treatment: Appendectomy
Colorectal Adenocarcinoma
Carcinoma arising from colonic or rectal mucosa;
3rd most common site of cancer. Peak incidence
is 60-70 years of age.
Causes: Adenomatous polyps, ulcerative colitis, P53 mutation, DNA mismatch repair, low fiber
Symptoms: Pallor, weight loss, intermittent diarrhea, LLQ pain. Positive stool guaiac test, increased serum CEA
Treatment: Surgical resection, chemotherapy
Adenomatous Polyps
Tubular Adenomas (75%): Most common. Appear as peducular mass on the membrane. Malignancy potential is low Tubulovillous Adenomas (15%): Similar in appearance to tubular adenomas, except their surface has finger-like projections. Malignancy potential is intermediate Villous Adenomas (10%): Flattened with large finger-like villi. High malignancy potential
Causes: Somewhat genetic
Symptoms: Asymptomatic to rectal bleeding
Treatment: Aspririn, NSAIDs, Colonoscopic removal
Ulcerative Colitis
Chronic inflammation and linear ulcerations with megacolon and pseudopolyps. Mucosal layer is red and granular. Meat loaf
Causes: Idiopathic
Symptoms: Tenesmus (urge to defecate ineffectively), diarrhea with blood, toxic megacolon (leads to gangrene), increased risk for colorectal adenocarcinoma. Lead-pipe appearance
Treatment: Antidiarrheals, cortisol, DMARDs
Diverticulosis
Presence of multiple diverticula usually in sigmoid colon
Causes: Increased pressure in bowel and bowel wall weakness
Symptoms: Asymptomatic, some abdominal discomfort
Treatment: High-fiber diet, laxatives
Diverticulitis
Inflammation of diverticula
Causes: Impacted fecal material causes inflammation
Symptoms: Fever, LLQ abdominal pain, bright red blood in stool
Treatment: Antibiotics, high-fiber diet
Hirschsprung Disease
Megacolon proximal to rectum. No ganglion cells of Auerbach and Meissner plexuses
Causes: Failure of neural crest cell migration
Symptoms: Failure to pass meconium, chronic constipation
Treatment: Surgery
Pneumothorax
Accumulation of air in the pleural space.
Causes: Rupture of some sort
Symptoms: Trachial deviation, chest pain, dyspnea
Treatment: Needle decompression
Lung Carcinoma
Causes: cigarette smoking, air pollution, radiation, asbestos, nickel, chromium
Squamous cell: most common, tumors are centralized
Adenocarcinoma: most common in non-smokers, slow growth rate, peripheral tumors
Small cell (oat cell): highly malignant, small round cells with neuclei resembling oat grains
Large cell: pleomorphic giant cells, peripheral lesions, undifferentiated, poor prognosis
Polymyositis
Inflammation of skeletal muscles
Causes: Idiopathic, CD8+ T-cell injury
Symptoms: Necrotic muscle cells, gradual proximal muscle weakness, muscle atrophy, endomysial inflammation (CD8)
Treatment: Corticosteroids, immunosupression
Dermatomyositis
Inflammation of skin and skeletal muscles
Causes: Idiopathic, immune complex deposition in blood vessels
Symptoms: Necrotic muscle cells, rash of the upper eyelids (heliotrope), red papules on the elbows, knuckles, and knees (Gottron papules), rash similar to lupus, proximal muscle weakness
Treatment: Corticosteroids, immunosupression
Abrasion
Scrapes
Avulsion
Skin peeling off
Myasthenia Gravis
Antibodies bind to acetylcholine receptors at NMJs, so muscles don’t work
Causes: Hypersensitivity II, autoimmune
Symptoms: Eye drooping, facial muscles relaxed, speech affected. Diagnosed by tensilon test
Treatment: immunosupression, blood transfusions, anticholinesterase
Lambert-Eaton Syndrome
Antibodies against presynaptic calcium channels at NMJ
Causes: Small cell carcinoma
Symptoms: Proximal muscle weakness
Treatment: Treating the cancer
Myotonic Dystrophy
Autosomal dominant disorder. Results in increased CTG repeats
Causes: Genetic
Symptoms: Myotonia (can’t relax muscles), atrophy, facial muscle weakness, cataracts, testicular atrophy, baldness, hatchet face
Treatment: Phenytoin
Duchenne Muscular Dystrophy
X-linked recessive disorder. No dystrophin means the structural proteins in the membrane aren’t held together. Only affects males
Causes: Genetic
Symptoms: Weakness in proximal muscles of extremities (usually pelvis), eventual immobilization, pseudohypertrophy of calves, Gower’s maneuver. Increased serum CK. Affects respiratory muscles
Treatment: Glucocorticoids, poor prognosis, death at 25
Becker Muscular Dystrophy
Similar to Duchenne
Causes: Genetic
Symptoms: Similar to Duchenne. Mutated dystrophin
Treatment: Death at around 40
Botulism
Food poisoning from Clostridium botulinum, mostly from canned foods
Causes: Old canned food
Symptoms: The toxin binds to ACH receptors, resulting in paralysis of skeletal and respiratory muscles
Treatment: Antitoxins
Albinism
Inability of melanocytes to produce melanin
Causes: Genetic, enzyme deficiency tyrosinase
Symptoms: Hypopigmentation
Treatment: None
Vitiligo
Autoimmune destruction of melanocytes
Causes: Autoimmune
Symptoms: Flat lesions of pigment loss (MJ)
Treatment: Corticosteroids
Melasma
Hyperpigmented patches usually on cheeks and forehead
Causes: Pregnancy, oral contraceptives
Symptoms: Mask of pregnancy
Treatment: Sunscreen
Ichthyosis Congenita
Fish Skin
Causes: Congenital
Symptoms: Hard, thickened skin
Treatment: Salicylic acid
Jackson’s Theory
Zone of Coagulation: Area in a burn nearest the heat source that suffers the most damage as evidenced by clotted blood and thrombosed blood vessels
Zone of Stasis: Area surrounding zone of coagulation characterized by decreased blood flow
Zone of Hyperemia: Peripheral area around burn that has an increased blood flow
Allergic Contact Dermatitis
Type IV Hypersensitivity
Causes: Allergens
Symptoms: Edema within epidermis, vesicles, thickening of epidermis
Treatment: Corticosteroids
Eczema
Dermatitis except cause unknown
Scleroderma
Thickening and hardening of the skin
Causes: Autoimmune, presence of HLA-DQB1 and autoantibodies
Symptoms: Thickened skin exhibits (a) a
increase in collagen fibers in the dermis; (b) thinning of the epidermis, (c) atrophy of dermal appendages; (d) hyalinization and destruction of arterioles and (e) variable mononuclear infiltrates, consisting primarily of T cells
Treatment: anti-inflammatories, immunosuppresives
Psoriasis
Red patches with silver scales
Causes: Idiopathic, autoimmune, genetic
Symptoms: No itching, positive Auspitz sign, nail discoloring, psoriatic arthritis (usually fingers)
Treatment: Corticosteroids, UVB light exposure
Basal Cell Carcinoma
Most common skin cancer
Causes: Chronic exposure to light
Symptoms: Elevated nodule with central dome-shaped papule
Treatment: Surgical excision
Squamous Cell Carcinoma
Malignant proliferation of squamous cells
Causes: Excessive exposure to UV light, defective DNA repair mechanisms
Symptoms: Small red firm ulcerating nodules on face
Treatment: Metastasis is rare, surgery
Malignant Melanoma
Malignant neoplasm of melanocytes
Causes: Excessive exposure to UV light, genetic, albinism
Symptoms: a) Radial growth: discolored macule, horizontal growth of nests of atypical cells within epidermis, lymphocytic infiltrate and melanin containing macrophages in dermis, does not metastasize; (2) Vertical growth: nodular appearance, growth into underlying dermis, does metastasize and metastatic probability is directly proportional to depth of invasion
Treatment: Surgical excision, IL-2 treatment
Hirsutism
Soft, fine hair transformed to coarse, thick hair
Causes: High androgen
Symptoms: deep voice, muscle bulk, clit enlargement
Treatment: Oral contraceptives
Alopecia
Autoimmune destruction of hair follicles
Causes: Autoimmune
Symptoms: Hair loss
Treatment: Immunosuppresives, topicals
Achondroplasia
Form of dwarfism
Causes: Mutation of gene FGFR3 (Fibroblast growth factor receptor 3)
Symptoms: Cartilage proliferation in growth plate, dwarfism
Treatment: None
Osteogenesis Imperfecta
Brittle bone disease
Causes: Deficient synthesis of type 1 collagen, autosomal dominant
Symptoms: Multiple fractures, blue sclerae, hearing loss
Treatment: Pneumatic bracing
Osteopetrosis
Thick bones
Causes: Defective osteoclasts
Symptoms: Multiple fractures, anemia, cranial nerve palsies
Treatment: Bone marrow transplant
Osteomyelitis
Infection of bone and bone marrow
Causes: Usually bacterial (S. aureus, gonorrhea, salmonella, TB), needles
Symptoms: Bone pain with systemic signs of infection, abscess of bone on X-ray
Treatment: Antibiotics
Osteoporosis
Decrease in bone mass/porous bone
Causes: Genetic, diet and exercise, decreased estrogen
Symptoms: Multiple fractures, spine curving/shortening, DEXA shows low bone mass
Treatment: Bisphosphonates, SERM, calcium and vitamin D
Rickets and Osteomalacia
Softening of bones. Rickets is children, osteomalacia is adults
Causes: Vitamin D deficiency which results in low calcium and phosphate serum levels
Symptoms: Rickets - bowlegged, pigeon breast, shortened stature. Osteomalacia - diffuse back pain, muscle weakness
Treatment: Vitamin D
Paget’s Disease
Increase in both osteoclasts and osteoblasts
Causes: Idiopathic
Symptoms: Microfractures, bone pain, lion-face, hearing loss, bowleg, kyphosis (hunch back)
Treatment: Calcitonin, bisphosphonates
Osteoma
Most common benign tumor in bone
Causes: Lateral part of growth plate displacement
Symptoms: Extra cartilage from bone growth covers bone
Treatment: Surgery if symptomatic
Chondrosarcoma
Malignant tumor of cartilage commonly found in pelvis
Treatment: Surgery, chemo
Osteosarcoma
Malignant tumor from osteoblasts affecting 10-20 yr old males. 60% of tumors in knee. Codman triangle
Treatment: Surgery, chemo
Ewing’s Sarcoma
Childhood tumor. Blue due to primitive cells. Affects males
Osteoarthritis
Most common joint disease
Causes: Mechanical wear and tear
Symptoms: Polishing of bone, joint stiffness that worsens, affects hips knees and fingers and toes
Treatment: NSAIDs, COX-2 inhibitors, Voltaren, surgery
Rheumatoid Arthritis
Systemic inflammation of joints
Causes: Idiopathic
Symptoms: Cartilage is destroyed and replaced with pannus, joint deformity, rheumatoid nodule, most severe in morning but gets better, swan neck deformity. Lab findings: autoantibodies
