Gen Diagnosis Flashcards
NBCE Part 2
Classic Sequence of Case History
CC, PI, PMH, FH, Social Hx, ROS
Which is not considered a quality of pain?
a. intermittent
b. sharp
c. deep
d. burning
a. intermittent (timing or frequency of pain)
Pneumonic for attributes of pain
OPQRST Onset Provocation Quality Radiation Severity Timing
Difference between a sign and a symptom
Symptoms= abnormalities perceived by pt Sign= abnormalities perceived by Dr.
What provides the most information regarding the pt?
a. inspection
b. palpation
c. percussion
d. auscultation
a. inspection
(it enables pt to seek physical “signs.”)
It also enables Dr. to observe and recognize a wide variety of conditions based on his knowledge and experience.
BP cuff size determination for accurate BP (correct ratios)
Correct ratio of length of bladder in cuff to circumference of the extremity is 80-100%
(<80% will give falsely elevated BP)
WIDTH of bladder=40% of length
What specific effect does an increase in one degree of temperature have on heart rate?
increases heart rate 10 beats/min
The organ/tissue that is responsible for most body heat (skin, heart, liver, brain, intestines)
Liver
body heat is produced from chemical reactions; most cellular metabolism occurs in liver = max temperature gradient
Ideal body weight calculation (estimate) Female average build
100 pounds for first 5 feet
+5 pounds for each additional inch
+2 pounds for each pregnancy
Subtract/ or add 10% of total to adjust for small/ large frame
Which type of mandibular motion would be palpated in a normal TMJ?
IASS= Inferior, anterior, smooth, symmetrical
TMJ biomechanics can be determined by palpation of mandibular motion anterior to tragus.
Normal motion= smooth, symmetric, inferior to anterior.
Pain on palpation of the supraorbital notch indicates:
A normal finding (elicits pain from emerging
supraorbital nerve)
Used by anesthetists to arouse moribund p[t
Which muscle pulls the condyloid process forward?
External pterygoid
Clicking and crepitation of the jaw occurs with a spasm of which muscle?
External pterygoid
What is the last fontanelle to close on an infant, and when does it close?
Anterior fontanelle persists until 18-24 mo.
Other fontanelles typically close by 2 months of age. Delayed closures: ricketts, hypothyroidism, increase ICP, and some bone disorders
Light palpation of the cranium reveals respiratory pulsations of what rate?
10-14 cycles/min.
Brain & spinal cord normally exhibit a slow, worm-like pulsation. Represents a coiling/uncoiling of the hemispheres and a longitudinal movement of the spinal cord w/i the spinal dura. It is result of the pull of the dural membranes, flow of CSF, & motility of the CNS
What non-neurologial condition is a nodding movement of the head associated with?
Aortic Insufficiency
(causes high jugular regurgitant waves
which may result in head nodding that is synchronized with the arterial pulse)
Common test for distance visual acuity
Snellen chart (test of macular function)
Ishihara color Charts are used for:
testing colorblindness (red/green)
Which auditory acuity test compares air conduction to bone conduction?
Rinne test compares air conduction to bone conduction (normal= air is longer than bone.)
Sensorimotor loss- air is also longer than
bone
Conductive loss- sound is heard longer
through the bone than air.
Normal tympanic membrane appearance
Translucent, pearly gray membrane at end of ear canal.
The handle of malleus appears in center.
A bright triangular cone of light reflects on this membrane (called the “light reflex”)
What does transillumination of the skull reveal?
Method of examination by passage of light through tissues or a body cavity.
Used to identify:
Tissue density, fluid in sinuses,
fluid inside the skull, fluid outside the skull,
Three Muscles of Mastication
Masseter
Pterygoid
Temporalis
(insert on the mandible and affect chewing)
Number of teeth an adult has in full dentition
32 permanent teeth
(4 incisors, 2 canines, 4 premolars, 6 molars including wisdom teeth, in each jaw)
Children: 10 decidous teeth (6 mo-24 mo)
A bluish black line on the gum margin suggests:
Lead poisoning [adults]
(20% of adult patients with lead poisoning)
But uncommon to find in child w/lead poison
Whitish pseudomembrane on buccal mucosa, resembling milk curd, when peeled off leaves a raw erythematous bleeding area suggests:
Candidiasis (moniliasis; thrush)
Common in immunosuppressed/ chronically ill, especially HIV/ AIDS
Purpose and normal findings of a trachial tug
To determine if trachea is fixed in the mediastinum. FIXATION IS ABNORMAL= Neoplasm, TB, or aneurysm.
Normal findings:
1-2 cm of upward motion
Uncomfortable to pt
Vascular pulsations
Fay’s sign
Digital compression of the carotid bulb may cause pain to spread in the distal branches of the external jaw, ear or temple.
Indicative of: carotid arteritis
Wry neck
Examination of the wry neck will reveal spasm of:
Sternocleidomastoid
Scalenes
Upper trapezius
Which muscle is not spasmodic in torticollis?
a. sternocleidomastoid
b. scalenes
c. platysma
d. trapezius
c platysma
Which exam procedure best identifies restriction of air flow in tracheobronchial tree? a. inspection b. palpitation c. percussion d auscultation
d. auscultation Breath sounds: Normal- loud and high-pitched Best heard over the manubrium Expiratory phase is longer than inspiration, with a definite pause between the phases.
Normal respiratory rate
12-20/ min.
Ratio of respirations: heartbeat= 1 : 4
Purpose of percussion of the thorax
Determine Air - tissue ratio
Percussion is transmitted to underlying tissue & then reflected to examiners tactile and auditory senses. (depends on air:tissue)
Normal= resonant, high amplitude, low-pitched note.
DULLNESS= air tissue is filled with fluid
Percussion of posterior lung field will normally reveal:
Resonance (normal)
Abnormal: Hyperresonance is seen in destruction of the alveoli
Which examination procedures are necessary to determine tactile fremitus?
a. inspection & breath sounds
b. palpation & voice sounds
c. percussions & voice sounds
d. auscultation & breath sounds
b. palpation & voice sounds
Pt’s voice causes vibrations in the bronchial air column called “vocal fremitus.”
When palpated by Dr becomes “tactile” frem.
Fremitus determines density of lung tissue:
Vocal Decreased/ absent= airway blockage
Vocal Increased= consolidation/ inflammed
Purpose of palpation of the thorax during respiration
Determine respiratory excursion (involves both inspection and palpation.)
Should be symmetrical.
Asymmetrical excursion= lesion on lagging side of the chest wall, pleura, or upper lobe of the lung.
Succussion splash
Normal Abdominal sound: (audible splash sound caused by combination of air and fluid in stomach.)
Abnormal if REALLY loud: increased fluid indicating obstruction in the stomach/ gut, or gastric dilatation.
Cause of abdominal Murmur
Turbulent blood flow in a dilated, constricted, or tortuous artery.
Cause of Peristaltic sounds
intestinal activity
What does an abdominal Friction Rub during respiration indicate?
Peritoneal inflammation (peritonitis)
Define causes the following Abd. sounds:
Succussion splash
Peristaltic sounds
Murmur
Friction rub (during respiration)
Succussion splash: combination of air & fluid
in normal stomach.
Peristaltic sounds: normal intestinal activity
Murmur: turbulent blood flow in dilated,
constricted, or tortuous artery
Friction rub: peritoneal inflammation
(peritonits)
A high-pitched continuous murmur in the RUQ abdomen (Cruveilhier-Baumgarten murmur) is diagnostic of:
Portal Hypertension
The murmur becomes louder during the forced expiratory phase of the Valsalva maneuver
Percussion of the umbilicus that illicits hyperresonance is diagnostic of:
Ascites
(severe ascites causes the gas-filled loops of bowel to float to the surface which results in hyperresonance to periumbilical percussion)
The kidney punch test will identify all of the following except?
a. musculoskeletal disease
b. intrinsic renal disease
c. acute pyelonephritis
d. renal abcess
e. perinephritis
b. intrinsic renal disease (will not be painful
to a kidney punch)
The blow of the punch must be started 6” above the kidney. A stronger punch will cause pain in a normal kidney. To differentiate musculoskeletal dz from renal lesions the “thumb pressure test” is diagnostic. (slowly releasing the thumb pressure on the kidney will be painful in musculoskeletal dz but not in renal disease.)
Which structure, in its normal state, cannot be inspected, palpated, percussed, or auscultated?
(liver, kidney, pancreas, spleen, abd. aorta)
Pancreas
(How is the Pancreas like a faithless woman? B/c all day long it lies in the arms of the duodenum and at night it gives its tail to the spleen.)
Tenderness and rigidity during palpation of LUQ abd. would indicate all except?
a. pancreas
b. ruptured spleen
c. gastric ulcer
d. acute perinephritis
e. acute cholecystitis
e. acute cholecystitis (right side)
Differential diagnosis of LUQ AP would include: pancreas, spleen, stomach, and
L kidney.
RUQ AP- gall bladder (acute cholecystitis)
During a routine rectal exam, a RIGHT-handed examiner may fail to detect a small lesion in which quadrant! (clock times)
12 to 3 o’clock
(Imposs to examine the entire circumference of the rectal wall due to limitation in wrist ROM. Proper procedure to complete wrist supination is for examiner to turn his back towards pt which will allow complete examination of this quadrant.)
Normal size of a prostate
Young adult- walnut
Older male w/ enlarged prostate- lemon
Which structure is normally palpated posteriorly on rectal exam?
a. prostate
b. pyriformis
c. bladder
d. seminal vesicles
b. pyriformis muscle (POSTERIOR)
* Prostate, bladder, & seminal vesicles are all palpated ANTERIOR.
Most reliable sign of puberty in male
Testicular growth (first clinical indication of onset of male puberty) W/i the next 2 years there is an increase in penile length and growth of pubic hair. Followed by: increase in long bone growth, muscle mass, prostate size and enlargement of larynx.
An underdeveloped scrotum suggests:
An imperfect descent of the testes known as “cryptorchism.”
Normally testes descend during the 8th fetal month. Cryptorchism occurs in 5% of male infants. Undescended testicles will typically descend during the following year. If they remain undescended, the defect will lead to testicular atrophy & increased risk of testicular cancer. Spermatogenesis cannot occur at the temperature w/i abd. cavity
Hernia definition and most common type
Protrusion of peritoneum through a weak point in the abdominal wall.
MOST COMMON: “INDIRECT” hernia which descends through the inguinal canal into the scrotum.
Less common: “direct” hernia which does not
enter the scrotum
Femoral hernia: occurs at the fossa ovalis
where the fem. artery exits the abd.
Ventral hernia: protrudes into anterior abd
wall.
Umbilical hernia: rare, occurs at umbilicus
Most common type of HA
Muscle TENSION HA
Characterized by inability to relax the muscles of the neck and head.
“Classic” Migraine symptoms
Unilateral HA
Preceded by aura (flashing lights 1/2 hour of
before pain.)
N/V with severe pain
Last for 2-3 days
Worsens when taking BCPs
“Common” migraine- No pre-HA aura
“Hemiplegic” & Opthalmoplegic- severe form
“Basilar artery” migraine- more severe neuro symptoms including tinnitus, hearing loss, diplopia, dysarthria, ataxia, & motor symptoms
Cluster Headache Symptoms
Occurs in paroxysms, bursts, or “clusters”
Severe, burning, UNILATERAL
Nocturnal and SHORT duration
Pain so severe that pt feels better with
movement than lying down.
No aura
Predominantly occurs in male smokers
Classic Triad of Intracranial Pressure
symptoms
- HA
- Vomiting
- Papilledema
(other symptoms of IC tumors may include:
sz, mental confusion, hyper-reflexia)
Horner’s Syndrome
definition/ symptom triad
Interruption of the sympathetic nerves to the eye results in Horner's Syndrome: 1. Miosis 2. Anhydrosis 3. Ptosis (Some sources also include enopthalmos.)
Cotton wool spots on the retina suggest:
Ischemic infarct of the nerve fiber
Caused by occlusions of the arterioles and capillaries leading to infarcts of the nerve fiber layer of the retina.
Papilledema
definition & progression of disease
Optic disc swelling from Increased ICP.
Pathological process:
venous stasis>engorgement>swelling
EARLY signs: congestion, capillary dilation with redness of the disc, engorgement of veins, loss of venous pulsation, blurring of disc margins, and SPLINTER HEMORRHAGES
**CHRONIC SIGNS: above symptoms subside &
GLIOTIC CHANGES become apparent
over the optic nerve head.
Funduscopic exam of chronic papilledema would reveal:
a. splinter hemorrhages
b. drusen bodies
c. gliotic change
d. neovascularization
e. severe cupping of the disc
c. gliotic changes (CHRONIC)
* splinter hemorrhages also associated with papilledema, but with earlier occurrence in the patho process & subside when condition becomes chronic, showing only gliotic changes over the optic nerve head .
Drusen bodies occur with aging and are not result of papilledema.
Neovascularization refers to formation of new blood vessels, commonly seen in diabetes.
Physiologic cupping of the disc is an anatomical variant.
SEVERE cupping- seen in glaucoma
Glaucoma
Condition in which increased intraocular pressure (IOP) damages the optic nerve.
IOP represents a balance between aqueous humor formation and its outflow through the canal of Schlemm.
*Usually caused by an abnormal in drainage.
*2nd leading cause of blindness
Argyll Robertson pupils
Argyll Robertson pupils of tabetic neurosyphilis are SMALL (miotic,) IRREGULAR, and often UNEQUAL in size.
They react little/ or not at all to light, but constrict promptly when eyes converge on a near object.
This type of sensory dissociation also occurs in diabetes, encephaltis, and mid brain neoplasms.
The paralysis of one or more ocular muscles result in:
a. astigmatism
b. nystagmus
c. binocular vision
d. diplopia
d. diplopia
(Ocular muscles must coordinate eye movement to maintain binocular vision. Misalignment of the eyes due to muscle weakness will cause the visual image to reflect incorrectly on the retina= double vis)
*Strabismis (cross-eyed) is a type of ocular muscle weakness.
Classic triad of Meniere’s Syndrome
- Vertigo
- Tinnitus
- Deafness
(Labyrinth disease i/w both auditory and vestibular functions are disturbed. Consists of recurrent vertigo accompanied by tinnitus and deafness. Tinnitus & deafness may be absent in early attacks, but occur as the disease progresses.)
A patient complains of an auditory loss of sounds. She does not complain of sound distortion. These symptoms suggest what type of hearing loss?
a. conductive hearing loss
b. sensory hearing loss
c. neural hearing loss
d. central hearing loss
a. conductive
The transmission of sound through the external auditory canal or the middle ear is conduction. Obstruction in this pathway will reduce ALL sounds heard.
DISTORTION occurs in sensorineural hearing loss
First manifestation of Leprosy
Nasal involvement (nodules/ulceration/
perforations)
Mycobacterium leprae proliferates at lower body temperatures. It multiples rapidly in the cooler nasal sites around the nares & nasal mucosa.
Most common cause of epistaxis
Nose picking!!!!
Most frequently originates in anterior nasal septum (Kiesselbach’s triangle) due to picking.
Persistent cough with sputum production for at least 3 months in 2 consecutive years fits criteria for what diagnosis?
Chronic Bronchitis
usually resulting from exposure to bronchial irritants) (Dad has this but is in denial
A chronic, necrotizing infection of the bronchi and bronchioles associated with abnormal dilation
Bronchiectasis
(has become less prevalent with era of antibiotics)
Occurrence implies an underlying abnormal physiology that impairs airways or predisposes pt to vulnerable infections
An exaggerated bronchoconstrictor response to a variety of stimuli inducing paroxysmal airflow limitation with dyspnea & wheezing:
a. emphysema
b. bronchial asthma
c. bronchitis
d. bronchiectasis
b. Bronchial asthma
(dz characterized by increased irritability of the tracheobronchial tree>paroxysmal narrowing of the bronchial airways> causing disabling attacks of dyspnea & wheezing.)
A clinical presentation of Horner’s syndrome with ipsilateral ulnar pain suggests:
a. Klumpke’s paralysis
b. Erb’s palsy
c. Pancoast’s syndrome
d. neurovascular compression syndrome
e. Brown-Sequard’s syndrome
c. Pancoast’s syndrome
* Pancoast’s tumor is an apical neoplasm of the lung, which expands to obstruct the sympathetic ganglia and brachial plexus> which result in Horner’s syndrome and shoulder pain which radiates into the ulnar nerve distribution.
A symptom of ischemic heart disease characterized by paroxysmal attacks of exertional chest pain:
Angina pectoris (chest pain resulting from oxygen deficiency in the heart muscle; relieved by NTG & rest)
Cor pulmonale definition
RV enlargement resulting from disorders that effect the lung.
AKA: “pulmonary heart disease”
(caused by chronic lung disease by increasing pulmonary vascular resistance)
Right sided heart failure. 1st sign is fatigue
What part of the ECG waveform represents ventricular depolarization?
QRS=ventricular depolarization
P= atrial depolarization (increase in heart
permeability to sodium)
T= ventricular REpolarization (REst)
Coarctation of Aorta definition & signs
Congenital narrowing of the aortic lumen.
Classic signs:
1. Disparity in BPs & pulses in the extremities
2. HTN occurs in the arterial system proximal
to the constriction with hypotension distally
3. Most common site is just distal to the Left
subclavian artery.
4. ECG is normal in children, so is CXR
5. In adult:varying degrees of LV hypertroph
What determines the clinical manifestations of heart failure?
Depends on which ventricle has failed and severity and duration of the failure.
LV failure-dominated by pulmonary symptoms
RV failure-dominated by systemic venous congestion of visceral organs and peripheral edema.
* Fatigue/ weakness- common to BOTH
Stroke (CVA) definition & common causes
Most common causes: Atherosclerosis, brain hemorrhage & obstruction (blood clot)
Results from a sudden stoppage of the blood or hemorrhage into the brain.
Hypoxia>cell death (infarction)
Hemiparesis, Dysphagia
Contributing factors: smoking, HTN, obesity
Classic presentation of Hodgkin’s disease
Painless cervical & mediastinal adenopathy
Dry, NP cough
Night sweats & persistent fever
Extensive excoriations
Discrete rubbery nontender lymph nodes in neck, axilla, and inguinal/femoral region.
CXR shows mediastinal mass
*Reed-Sternberg cells found in periph blood
smears and bone marrow
Alcohol abuse- former or current
Most common cause of hypochromic, microcytic anemia
Iron deficiency anemia
(RBCs have a subnormal average cell Hgb concentration (hypochromic) and a reduced MCV (microcytosis)
Most common cause of anemia throughout the world.
Most common cause of increased bleeding time
Aspirin ingestion
Bleeding time begins to correct after 48 hours, lasting up to 7 days.
Other causes of increased bleeding time:
Hemophilia, thrombocytopenia, vit K deficenc
Polycythemia vera will DECREASE bleeding
time
Plummer-Vinson syndrome triad
- Esophageal web
- iron-deficiency anemia
- Hypochloric gastritis
Most common in middle aged women
AKA: Patterson-Kelly syndrome
Chronic solitary lesions that occur in any level of the GI tract exposed to the aggressive action of gastric secretions is known as:
Peptic ulcer disease (gastric & duodenum)
Most common GI disease in clinical practice
IBS (irritable Bowel Syndrome)
3 Lab findings suggestive of Stomach cancer
- Iron deficiency anemia
- Elevated levels CEA (*malig. tumor marker)
- Occult blood in stool
Other s/s:
Severe epigastric pain after eating
Pain unrelieved with antacids
Weight loss/ Strength loss
Epigastric mass painful to palpation
Barium contrast XRay= irreg ulcer base w/i a mass
*7th leading cause of cancer is U.S.
Very imp. to accurately assess abd. pain:
Clinical manifestation so “silent” that dx is
made later stage.
A palpable mass usually a sign of incurability
What are the 2 major inflammatory bowel disorders?
- Crohn’s disease
2. Ulcerative colitis
4 common malabsorption disorders
- Whipple’s disease
- Celiac sprue
- Tropical sprue
- B-12 deficiency
Classic triad of Reiter’s syndrome
- urethritis
- arthritis
- conjunctivitis
Most common cause of arthritis in young men.
Clinical course lasts several weeks to mo.
Which is not a manifestation of uremic syndrome?
a. acidosis
b. autointoxication
c. elevated BUN & creatinine
d. reduced GFR
e. CNS hyperactivity
e. CNS hyperactivity
Uremic syndrome is a functional failure of the renal system i/w the GFR is reduced.
It is a condition of chemical autointoxication from acidosis, and elevated BUN/ creatinine.
Causes CNS HYPOactivity=confusion>coma>sz
“Shock bladder” Cause and description
Seen in SCI lesions of sudden onset.
Atonic (flaccid) distended bladder with
overflow incontinence.
Detrusor muscle suffers the effect of the spinal shock.
As effect of shock subsides: musc.>spastic.
If destruction of SC has occurred from trauma the bladder will remain flaccid.
Most common cause of involuntary loss of urine in women
Stress Incontinence (involuntary loss of urine during coughing, straining, sneezing, lifting, or any maneuver which increases intra-abdominal pressure.
Addison’s disease (cause & S/S)
Rare disorder caused by chronic destruction of the adrenal cortex. (which secretes Mineralocorticoids [aldosterone] and glucocorticoids [cortisol.] Clinical s/s are result of these hormone deficiencies.
S/S: Fatigue, anorexia, wt loss, bronzing of skin and mucosa, Hypotensive, Low serum Na+, Cl, and bicarbonate levels w/ elevated K+
Cushing’s disease (cause & S/S)
A group of clinical abnormalities caused by HYPERfunction of the adrenal cortex. Most
s/s result from hypersecretion of cortisol.
Classic symptoms:
"moon facies"
Truncal obesity w/ purple striae
"Buffalo humps" (dorsal cervical fat pads)
Elevated BP
Xrays show gen. ostepenia
UA shows elevation of 17-hydroxysteroids
and 17 ketosteroids
Graves’ disease
Type of hyperthyroidism Bilat. exopthalmos Goiter (enlarged thyroid) Pre-tibial myxedema Nervous/ perspiring Tacchycardia and widened pulse pressure
DeQuervain’s thyroiditis
Acute viral infection of thyroid that is self-
limiting.
Clinical symptoms: Sore throat (neck) and
low grade fever
Hashimoto’s thyroiditis
AUTOIMMUNE disorder
Most common cause of primary
hypothyroidism
Causes CHRONIC INFLAMMATION of the thyroid resulting in hypothyroidism.
Freq. coexists with Addison's diseaseMyxedema
Severe form of adult hypothyroidism that results from deposition of mucopolysacchar-ides in the skin and other tissue.
Clinical finding:
Skin is dry, scaling, & cool, dull & thick
Hair is coarse & sparse
Periorbital edema
Sluggish & irritable
DTR reflexes show a delay in relaxation phase known as “hung up.”
Temporal loss of eyebrows
Lab findings: Low T-4, elevated TSH
Most common onset of Type I DM (IDDM)
Puberty
Type II (adult onset) most commonly occurs after age 40 Aggravating factors in Type II: obesity, preg.
Course, dry, brittle hair is associated with what disorder?
Hypothyroidism
Thyroid hormone has a profound effect on growth & dev. It stimulates body metabolism.
Hypothyroid disorders:coarse, dry, brittle hair
Hyperthyroid disorders: hair is silky & thin
Most frequently affected muscles in Myasthenia gravis
OCULAR MUSCLES are most freq. effected
Caused by a defect of neurotransmission due to antibodies at the acetylcholine receptor sites.
Characterized by fluctuating weakness in facial, oropharyngeal, neck, & limb muscle.
Most frequently recurring symptom in Multiple Sclerosis (MS)
#1 MUSCLE WEAKNESS #2 Ocular disturbance Paresthesia, gait ataxia, & scanning speech are less common.
MS is a slowly progressive neurolog. dz characterized by: numerous areas of demyelation and sclerosis in the CNS.
S/S: diverse due to dissemination of these lesions.
NO CLASSIC FORM of MS b/c clinical manifestations depend on neural tissue affected.
Most frequently identified opportunistic infection associated with AIDS
PNEUMOCYSTIS CARINII PNEUMONIA (most common infection that is diagnostic for AIDS)
Oral candidiasis is most common infection occurring in AIDS pts, but is not diagnostic for AIDS.
Kaposi sarcoma malignancy is also a condition closely associated w/ AIDS, but is NOT an opportunistic infection.
Cause of immunosuppression seen in AIDS patients
Destruction of the T-4 lymphocytes
(AIDS is characterized by opportunistic infections & malignancies caused by
severe depression of the cell mediated immune system. Immunosuppression is caused by the selective destruction & depletion of T-4 lymphocytes.)
Megaloblastic anemia
Result of folic/ or B-12 deficiencies.
Important to determine WHICH:
SCHILLING test: determines if B-12 deficient, If normal Schilling> Treat with folic acid.
Incorrect treatment of B-12 with folic acid will improve the anemia, but NOT stop the progression of neuro deficits/damage=
called “masking”
Schilling Test
Identifies B-12 deficiency
What condition is associated with:
wrist drop & foot drop with a flapping tremor
Chronic alcoholism
(causes morphological degeneration of medial & superior parts of cerebellum.
Perkinje cells are lost from the outer parat of the cerebellum> trunchal ataxia & a wide based stance & gait “drunken sailor gait.”
Alcoholic periph neuropathy can result> mild paresis of lim muscles, partic. extensors.
Clinical presentation of protein deficiency seen in kwashiorkor
4 H=Hepatomegaly/Hypotension/Hypothermia/
Hair dry & brittle
Ascites
Peripheral edema
Skin lesionsAcute, contagious childhood disease, usually causing painful enlargement of the salivary glands (can also cause sterility in men)
Mumps
Caused by paramyxovirus, usually acquired by droplet infection.
S/S Inflammation/ swelling of parotid glands, and less often other salivary glands.
Peak incidence: 5-15 y/o
Acute, contagious childhood disease characterized by morbilliform rash, photophobia, coryza, conjunctivitis, swollen lymph nodes, Koplik spots
Rubeola
Clustered, white lesions on the buccal mucosa (opposite upper 1st & 2nd molars) that are pathognomonic for measles
Koplik’s spots/ Koplik’s sign
Prodromic viral enanthem of measles manifestion
Occur 2-3 days BEFORE measles rash itself.
Another name for the common measles
RUBEOLA/ “Hard Measles”
Coryza
Inflammation of the mucous membranes lining the nasal cavity
Causing: running nose, nasal congestion and loss of smell.
morbilliform rash
Erythematous, maculopapular rash of measles.
Red, raised, papules (little blisters)
Name of “3 day measles”
Rubella/ “German measles”
Less severe than rubeola.
Causes severe congenital deformities.
S/S: morbilliform rash, post. lymph swelling
Name of “3 day measles”
RUBELLA/ "German measles"
Less severe than rubeola.
Causes severe congenital deformities.
S/S: morbilliform rash
swelling of posterior lymph nodesCommon name for Variola (s/s)
Smallpox
Characterized by vesicular rash & pustules covering the skin and mucous membranes
Common name for Varicella (s/s)
Chickenpox
S/S: general rash rapidly progressing from a macular to a vesicular stage, without forming pustules. Described as the “dew drop on a rose petal” lesion.
Clinical triad of Infectious Mono
- Fever
- Lymphadenopathy
- Pharyngitis
With transient appearance of heterophil antibodies & an atypical lymphocytosis.
(Self-limiting illness caused by Eppstein-Barr virus)
Bence Jones proteins
Abnormal light chains produced by incomplete immunoglobulin synthesis.
Commonly FOUND IN URINE of pt’s with MULTIPLE MYELOMA.
A lab report reveals an increased urobilinogen & increased conjugated serum bilirubin. These findings suggest:
a. biliary obstruction
b. overuse of antibiotics
c. hemolytic anemia
d. hepatitis
c. HEMOLYTIC ANEMIA
Biliary obstuction, overuse of ATB, & hepatitis> DECREASE in urinary urobilinogen.
(bili is a waste product produced by the breakdown of RBCs. Most occurs extravasc- ulary (spleen, liver, bone marrow) but 10% occurs intravascularly. This unconjugated bili is then conjugated (becomes water soluble) for excretion in bile. When bile enters large intestines it is further degraded to urobilinogen. 99% is excreted in feces & 1% enters portal blood which eventually is excreted by kidneys into urine.
A lab report reveals an increased urinary glucose but a normal serum glucose. What do these findings suggest?
a. gestational diabetes
b. diabetes insipidus
c. renal glycosuria
d. diabetes mellitus
c. RENAL GLYCOSURIA
(presence of abnormally increase glucose in the urine is found in a variety of conditions.)
BUT when NORMAL SERUM glucose level occurs with it: it suggests that the kidney has lowered renal threshold for glucose & is known as “renal glycosuria.”
Red cell casts in urine suggest pathology of:
a. kidney
b. ureters
c. bladder
d. urethra
a. KIDNEY
(Presence of red cell casts in urinary sediment is ALWAYS a pathologic condition as it indicates GLOMERULAR INFLAMM. & bleeding.)
Which of theses affects hematopoiesis?
a. multiple myeloma
b. leukemia
c. chronic anemia
d. acute blood loss
e. all of the above
e. ALL OF THEM effect the formation & development of RBCs.
A WBC count of 250,000 with 90% slightly mature lymphocytes would indicate:
a. acute nonlymphocytic leukemia
b. chronic myelocytic leukemia
c. acute lymphocytic leukemia
d. chronic lymphocytic leukemia
e. leukopenic leukemia
d. CHRONIC LYMPHOCYTIC LEUKEMIA (Nl. WBC 10K, nl lymphocyte 20-40%) 250K WBC=leukemia 90% lymphs= lyphocytic Mature cells=chronic (immature=acute) LeukoPENIA- refers to abnormally low wbc
What morphological term refers to variation in RBC size?
a. spherocytes
b. anisocytes
c. elliptocytes
d. drepanocytes
e. dacrocytes
b. ANISOCYTES (abn. variation in rbc size)
All other cytes refer to abnormal shape. sphero= round ellipto= oval drepano= sickle dacro= tear drop
A predominance of blastic wbcs reported with the finding of Auer rods would indicate:
a. ALL (acute lymphoblastic leukemia)
b. AML (acute myeloblastic leukemia)
c. CML (chronic myelocytic leukemia)
d. CLL (chronic lymphocytic leukemia)
b. AML (acute myeloblastic leukemia)
BLASTIC wbcs in periph. smear=ACUTE leuk
In chronic leukemia more mature cells seen.
Auer rods are cytoplasmic inclusions that DO NOT APPEAR in the LYMPHocyte series. Therefore, blastic wbc in presence of Auer rods is diagnostic for acute myeloblastic leukemia.
What is the expected TIBC level in a pt demonstrating decreased levels of blood serum iron and ferritin?
a. high
b. unaffected
c. low
d. unpredictable
a. HIGHER TIBC
TIBC is an indirect test which measures unbound transferrin. Transferrin is the transport protein which carries ferritin (storage form of iron.) When ferritin levels are decreased, as seen in iron deficiency states, unbound levels of transferrin increase. The transferrin has no ferritin to bind with. Therefore, in decreased levels of blood serum & ferritin, unbound transferrin increases= high TIBC levels.
A 38 y/o male pt presents with s/s of anemia. His lab results show target cells, microcytosis, and anisopoikilocytosis. A subsequent hgb. electrophoresis shows 10% Hgb F. These findings suggest:
a. sideroblastic anemia
b. thalassemia major
c. thalessemia minor
d. sickle cell anemia
c. THALESSEMIA MINOR (by exclusion)
Target cells & presence of Hgb are common to all of these anemias with exception of sideroblastic anemia.
Sideroblastic anemia-high serum iron & siderocytic cells (stainable iron w/i the cell)
Sickle cell anemia would show presence of Hgb. S in electrophoresis.
Thalessemia MAJOR- would demonstrate a much higher Hgb F on electrophoresis.
What are Major Histocompatibility gene complexes (MHC,) what are they called in humans, and what do they do?
They are surface antigens that are coded at birth.
In humans the MHC is called “HLA”
These surface antigens predispose the individual to a variety of diseases, including autoimmune disorders.This occurs as the T cell recognizes the antigen as normal or abnormal. If the T cells determines that the antigen is an invader, the cell initiates an autoimmune response. This response represents a loss of tolerance of “self” at the level of the T cell.
HLA-B27 is most useful in the diagnosis of which of the following disorders?
a. myesthenia gravis
b. ankylosing spondylitis
c. rheumatoid arthritis
d. psoriasis
e. Goodpasture’s syndrome
b. ANKYLOSING SPONDYLITIS (HLA-B-27)
( found in 90% of pts with AS. Those who
possess antigen have 120X chance of dev.)
Research has identified many HLA antigens & associated them with the relative risk of dev. specific diseases.
Myesthenia gravis HLA-B8
Psoriasis HLA-A13 & B-12
Rheumatoid arthritis HLA-Dw4/DR4
Goodpasture’s syndrome HLA-DR2
Process of separating the charged constituents of a solution by means of an electric current.
Electrophoresis- is used to separate serum proteins, lipoproteins, isoenzymes, hemoglobins, and other classes of macromolecules.
- What are protein molecules that have a
known antibody activity? - How can they be isolated?
- Name the 5 distinct classes.
- Immunoglobulins (Ig)
- Electrophoresis of the serum separates
them into 5 Distinct Classes based on
structural & antigenic properties:
IgG 80-85%(secondary, but powerful defense
IgA 10-15% (mucosal imm. environ. microorg)
IgM 5-10% (primary defense)
IgE small % (Hypersensitivity, allergy, asthma)
IgD mystery, unknown purpose
A normal electrophoresis would demonstrate that more than 80% of immunoglobulins are:
a. IgA
b. IgE
c. IgG
d. IgM
c. IgG
Electrophoresis of serum will identify:
IgG 80-85%(secondary, but powerful defense
IgA 10-15% (mucosal imm. environ. microorg)
IgM 5-10% (primary defense)
IgE small % (Hypersensitivity, allergy, asthma,
hayfever)
IgD mystery, unknown purpose
A chronic hypersensitivity would cause an increase in which of the following immunoglobulins:
a. IgA
b. IgD
c. IgE
d. IgG
e. IgM
c. IgE
IgA- mucosal immunity (environmental microorganisms
IgD- mystery, purpose unknown
IgE-hypersensitivity reactionsallergies,asthma
IgG-dev. late in immune response to newly introduced antigen, secondary but powerful defense
IgM- acts as primary defense
What kind of an antibody is the rheumatoid factor?
It is an antibody against altered gamma globulin (IgG)
The presence of 20% atypical lymphocytes along with a positive test for heterophile antibodies would suggest which of the following?
a. viral hepatitis A
b. viral hepatitis B
c. cytomegalic virus
d. infectious mononucleosis
d. Infectious mono
(classic s/s: atypical lymphocytes. The Epstein-Barr Virus (causative agent of infectious mono) is the heterophile antibody (Paul-Bunnell antibody.)
Atypical lymphs are found in all the other answers. These reactive lymphocytes are
<10% in hepatitis, 20-70% in CMV, and
>10% in infectious mono.
What is the cause of the reversal of the A/G ratio in multiple myeloma?
a. an absolute increase in globulins
b. an absolute decrease in globulins
c. a relative increase in globulins
d. a relative decrease in globulins
a. an absolute increase in [ABNORMAL] globulins
Which liver enzyme most specifically indicates alcohol induced hepatitis?
GGPT is enzyme of choice for identifying alcohol abuse.
Increased 60-80% of persons with a high consumption of alcohol, even in the absence of other signs of liver damage.
(SGOT, SGPT, & LDH are found in conditions of liver damage, GGPT is specific for alcohol abuse)
Enzyme most indicative of biliary obstruction
ALKALINE PHOSPHATASE (ALP) is most specific/ best measure of bile duct obstruction b/c it exists mainly in the biliary tract, liver, epithelium, & osteoblasts. (LDH, SGOT, & SGPT will also elevate in bile duct obstruction but more variable.)
Impaired renal function will cause a serum increase in what 3 nitrogenous wastes?
- BUN (blood urea nitrogen)
- uric acid
- creatinine
(Kidney is primary organ that excretes nitrogenous waste products. Impaired renal function leads to increased serum levels due to failure to filter them into the urine.)
A pt presents with tetany, stridor, and wheezing. Lab results identify low serum calcium and normal alkaline phosphatase. Which is the most probable diagnosis? a. hyperthyroidism b. hypoparathyroidism c. Paget's disease d ricketts e. osteitis fibrosa cystica
b. HYPOPARATHYROIDISM
(Parathyroid gland regulates calcium production, Ca+ imbalances cause tetany
Addison’s disease will commonly cause what 2 electrolyte abnormalities?
HYPONATREMIA & HYPERKALEMIA
(in absence of adrenal steroids which occurs in Addison’s disease, reabsorption of sodium is impaired & inversely the retention of potassium is increased.)
An adolescent presents a history of periodic attacks of flaccid paralysis lasting a few minutes to hours. Which of the following is the most appropriate laboratory test?
a. blood potassium level
b. Schilling test
c. glucose tolerance
d. CSF colloidal gold
a. serum potassium level.
Calcium pyrophosphate dihydrate (CPPD) crystals in a drop of synovial fluid is diagnostic for_________.
PSEUDOGOUT (chondrocalcinosis)
What are the tophi in gout typically composed of?
SODIUM Urates
Which of the following is a characteristic laboratory finding in degenerative joint disease of the hip?
a. cartilage debris may be found in the
synovial fluid
b. the synovial fluid has low viscosity & poor
mucin clotting
c. rheumatoid factor is isolated
d. serum alkaline phosphatase is moderately
elevated
e. ESR is moderately elevated.
A. cartilage debris may be found in the
synovial fluid.
