internal med Flashcards
beriberi
vit B1 def, can induce dilated cardiomyopathy
Amyloidosis
precipitate restrictive infiltrative cardiomyopathy
furosemide and chlortalidone
provoke gout by reducing uric acid excretion
etacrynic acid (and furosemide)
can lead to temporary or permanent hearing loss
Ivabradine
blocking funny Na-K channel, used to decrease resting sinus heart rate in ischemic heart disease
ST elevation can be caused by
pericarditis
myocarditis
acute pancreatitis
pulmonary embolism
hypertrophic cardiomyopathy
beta-blockers are recommended as first-line therapy
Proarrhythmia
anti-arrhythmic drugs in some cases can cause different type, often worse arrhythmia than the arrhythmia which made the use of these types of drugs reasonable
congenital long QT syndrome
can be associated with deafness
suspected intracardiac thrombus
transesophageal echocardiography
post myocardial infarction, detection of viability
cardiac MRI
mitral valve prolapse
2D, color Dippler-echocardiography
systemic use of nitrates
causes small vein expansion, their arterial effect develop at intracoronary delivery
level of CK
elevated 3hrs after MI
troponin T and troponin I level are slightly earlier and more sensitively to myocardial necrosis
transesophageal and transthoracic echocardiography
TEE is more sensitive and more specific: examines the heart more closely and very little absorption and diffusion medium between the heart and transducer probe
fever and “big silent heart”
typical for pericarditis
vulnerable plaque
high lipid content, the exist of inflammatory cells and thin fibrotic “cap”. Content of whitewash of these plaques are typically low and don’t necessarily cause stenosis in the lumen
cephalic phase
gastric secretion is triggered by stimulation of the taste receptors in the mouth
Menetrier disease
exsudative gastropathy of unknown origin, characterized by diffuse thickening of the gastric wall caused by excessive proliferation of the mucous membrane
loss of protein through gastric lesions, lead to edema formation
complain of epigastric pain and diarrhea
no multiple ulcers in the stomach, unlike ZES
pentagastric test
reveals the acidity of the stomach
NSAIDs
cause gastric mucosal damage by inhibiting the synthesis of protective prostaglandins
chronic NSAID users develop “silent ulcers” and are diagnosed only when complications occur (perforation, bleeding)
PPI
inhibit H+/K+ ATPase
cause inhibition of HCl acid secretion, which leads to an increase in serum gastrin levels
somatostatin
inhibits gastric acid secretion and the release of several GI hormones, including gastrin
hepatic encephalopathy can be provoked by
GI bleeding, aggressive diuretic therapy, spontaneous bacterial peritonitis, after TIPS procedure
hepatic encephalopathy
confusion, increased blood ammonia level, foetor, asterixis
PBC (primary biliary cholangitis)
remains asymptomatic for a long time, pruritus might be the first symptoms, AMA (anti-mitochondrial antibody), inc IgM level, middle-aged women
PSC (primary sclerosing cholangitis)
more frequent in males, can be associated with ulcerative colitis, increase the risk of cholangiocellular carcinoma, ANCA positivity
autoimmune hepatitis
inc serum igG, good response to corticosteroid, affects young women
hepatitis E virus
can be transmitted with consumption of undercooked pork meat, become chronic infection in immunocompromised patients, can cause CNS symptoms
Courvoisier-sign
tactile, not painful enlarged gallbladder
Klatskin tumor
extra-hepatic cholangiocarcinoma arising in the junction of the main right or left hepatic ducts to form the common hepatic duct
Caroli syndrome
congenital cystic dilatation of the intrahepatic biliary tree
typical symptoms: recurring cholangitis, shaking chills, fever
fusiform dilation of intrahepatic bile ducts and bile duct stenosis
Mirizzi’s syndrome
characterized by obstructive icterus and dilated hepatic duct
because the stone in the gallbladder fundus presses the common bile duct
Juxtapapillary diverticulum
Raises the risk of bile duct stone by a supposed bile flow obstruction
doesn’t cause chronic liver disease, endoscopic papillotomy is not contraindicated anymore
SPINK1 gene
encodes a protein called pancreatic secretory trypsin inhibitor
metformin and contrast agent
administration of metformin should be suspended by 2 days prior to the examination
can be continued after 48hrs from the examination only if the GFR is >30ml/min/1.73m2
IV iodinated contrast agents may be nephrotoxic and the deterioration of renal function may lead to accumulation of metformin to toxic levels and lead to lactic acidosis
in severely declined kidney function
thiazide-like diuretics are ineffective, loop diuretics could be used to decrease hypovolemia
MEN1
primary hyperparathyroidism, pituitary adenoma, neuroendocrine tumor of the pancreas
acromegaly
investigate GH concentration during oral glucose tolerance test
Primary aldosteronism and primary hyperparathyroidism cause polyuria
due to prolonged hypercalcemia causes the insensitivity of the vasopressin receptors of the kidney tubules
pheochromocytoma
only in MEN2 and not in MEN1
glycoprotein hormones
TSH, LH, hCG, FSH
chromogranin
protein stored in the secretory granules of neuroendocrine cells
chromogranin A examination is used as a specific serum marker of neuroendocrine tumors, can be found in high concentration in carcinoid tumors, gastrinoma, insulinoma, pheochromocytoma
Nelson disease
aggressive ACTH-producing adenoma evolving after bilateral adrenalectomy performed because of Cushing’s disease
diuretic treatment can cause secondary gout
due to inhibition of the tubular secretion of urate
android obesity
waist to hip ratio >1.0 in men or >0.8 in women in obese individuals
gynoid obesity
waist to hip ratio <1.0 in men or <0.8 in women in obese individuals
exercise in DM
In T2DM: dec blood glucose via decreasing insulin resistance and helps reach the optimal body weight
In T1DM: optimal time to exercise is the afternoon (afternoon down phenomenon), but in case of insulin deficiency, exercise alone doesn’t decrease blood glucose levels, but shifts the metabolism towards ketosis
Charcot joint
severe joint destruction is caused by the overextension of the joint due to lack of pain sensation and the associated trophic disorder
Shilling test
Examine B12 absorption
HAM test
traditional screening method paroxysmal nocturnal hemoglobinuria
beta2-microglobulin
reflect B cell proliferation and immuno reaction
bone marrow PAS stain
traditional bone marrow cytochemistry in ALL
antidote for unfractionated heparin
protamin
CLL
appearance of 5G/L or more CD19/CD5 co-expressed lymphocytes in peripheral blood is the official diagnostic criterium
Alarcon-Segovia diagnostic criteria for mixed connective tissue disorder
serology criterion (positive antibodies to U1 RNP antibodies) + clinical criteria: edema of the hands, synovitis, myositis, Raynaud phenomenon, Sclerodactyly
Schirmer test
For Sjogren’s syndrome: less than 5mm/5mins
Belimumab
The only agent for SLE therapy which inhibits B-cell activating factor
HSP (Henoch-Schonlein purpura)
ANCA-negative, palpable purpura, abdominal angina, age <21, neutrophil granulomcytes in the wall of small vessels
PAN (polyarteritis nodosa)
not ANCA-associated
packed red blood cell transfusion
improve oxygen delivery
oxygen dissociation curve
shifted to the right by acidosis, inc PaCO2 and inc temp
Succinylcholine
depolarizing muscle relaxant
bind to nicotinic ACh receptors of the end plates results in sustained depolarization
SE: muscle pain, bradycardia, malignant hyperthermia
hyperkalemia, extensive burns, muscle dystrophy can leads to inc potassium levels => contraindications
continuous thoracic epidural analgesia
most efficient analgesic method and induces symphaticolysis and improves visceral blood flow
can mask symptoms of acute abdomen, but 24-hourly analgesic breaks can minimize the risks
morphine
contraindicated because of its spasmic effect on the Oddi sphincter
Nitrate
veno- and coronary dilating effect and improves symptoms of cardiac decompensation in acute coronary syndrome and reduces ischemia
its use however is contraindicated in hypotension, because further reduction in diastolic pressure diminished coronary flow
thiopental
barbiturate type IV anesthetic which has a tendency to cumulate: best used for induction or short operation
most common side effects: histamine release => asthma is a contraindication
normal arterial blood gas values
pH 7.35-7.45
PaCO2: 35-45mmHg
PaO2: 80-100mmHg
HCO3-: 22-26mEq/L
high anion gap metabolic acidosis
AG = (Na+K) - (HCO3 + Cl): normal value 8-16mmol/L
in uremia, diabetic ketoacidosis, intoxication of ethylene glycol, paraldehyde, isoniazide, salicylate
mechanical ventilation weaning failure
pulmonary causes: reduction of FRC and dystelectasis
cardiac causes: decompensation, since spontaneous breathing increases right heart preload and left heart afterload
energetic causes: muscle weakness
Thrombolysis
indication: in AMI within 12hrs, ischemic stroke within 3 hrs, pulmonary embolism
not contraindicated in ages above 75 or in menstrual bleeding
distributive shock
sepsis, toxic shock syndrome, chemical intoxications, anaphylaxia, neurogenic shock, endocrine shock (thyrotoxicosis, diabetic ketoacidosis)
aspirin intoxication
causes CNS stimulation, vasoconstriction in the inner ear and decoupling of intracellular oxidative phosphorylation
severe cases: cerebral and pulmonary edema, platelet dysfunction and inc bleeding time
most common symptoms: hyperpnea, tachycardiac, hyperthermia or hypotonia, arrhythmias, N/V, GI bleeding, perforation, pancreatitis, hepatic failure
CNS Sx: tinnitus, dec consciousness, seizure
blood gas values: respiratory alkalosis with high anion gap acidosis
Gardner syndrome
predisposes to GI polyposis doesn’t predispose to pheochromocytoma
compound heterozygosity
two different mutations are present on the two different alleles of the same gene in AR inherited diseases
genomic imprinting
in the pathogenesis of Prader-Willi syndrome, Angelman syndrome and Beckwith-Wiedemann syndrome
Trinucleotide repeat disorder
fragile X syndrome
myotonic dystrophy
Huntington’s disease
Friedreich’s ataxia
Associated with breast cancer
Li-Fraumeni syndrome (mutation of p53)
Mutation of BRCA1/2 gene
Cowden syndrome (mutations of PTEN)
von Hippel-Lindau disease
renal cancer, pancreatic cysts and cancer, retinal and cerebellar hemangioblastomas
associated with chromosomal instability arising from deficient DNA repair
ataxia teleangiectasia, Bloom syndrome, xeroderma pigmentosum and Fanconi anemia
Fragile X syndrome
moderate mental retardation in affected boys and mild mental retardation in affected girls
caused by mutations of FMR1 gene, belongs to trinucleotide repeat disorders
enlarged testicles is a characteristic of the disease in affected boys
tumor growth depends on
time of cell cycle, growth fraction (proliferating tumor cell ratio), time to duplicate tumor volume and tumor cell loss (cell death rate)
RECIST-staging system
RECIST (response evaluation criteria in solid tumors) is used for evaluating the therapeutic response in solid tumors
Forrest-Classification
evaluate the bleeding activity of the ulcer
Bismut-Classification
provide an anatomical description of hilar biliary tract cancer
Duke classification
staging of colorectal carcinoma
Adalimumab
human monoclonal antibody used to treat IBD and has no indications in treatment of solid tumor
targeted therapies
imatinib: GIST (gastrointestinal stromal tumor)
sorafenib: hepatocellular carcinoma, kidney cancer
cetuximab: colorectal carcinoma, NSCLC
sunitinib: kidney cancer, GIST
most common primary tumor site in Krukenberg tumor
gastric cancer
NPI
Nottingham prognostic index below 3: excellent prognosis below 3.14: good prognosis 3.14-5.4: moderate long-term prognosis >5.4: poor prognosis
breast cancer that typically affects both sides
Lobular carcinoma
Colorectal cancer staging
TNM staging
MAC (Modified Astler-Coller) classification
Dukes classification
FIGO position
ovarian cancer
Imatinib (Glivec)
For GIST and CML
DeGramont chemotherapy protocol
used in colorectal cancer, not breast cancer
Trastuzumab
in HER-2 positive tumors
Gleason-score
for prostate cancer
non-seminomas
chemotherapy sensitive and less responsive to radiotherapy
isolated ascites
pathological fluid accumulation occurs only in the abdominal cavity without being part of a generalized edema
Bernstein test
To confirm that retrosternal pain is caused by reflux disease
serves for the evaluation of the esophageal acid sensitivity
ZES (Zollinger-Ellison syndrome)
associated with hyperparathyroidism
Repair of an inguinal hernia
Lichtenstein surgery
Trendelenburg test
assess the condition of the valves in the greater saphenous vein
Perthes test
assess the rate of blood flow towards the deep veins (clinical test for assessing the patency of the deep femoral vein)
After placing a rubber compression band on the leg of the standing patient, ask the patient to walk, and emptying of the superficial beins means a good flow towards the deep veins (negative Perthes test)
Homan’s sign
Sign of deep-vein thrombosis when dorsalflexion of the foot induces calf pain
surgical indication
immediate (vital) indication: medical condition where the life of the patient can only be saved with an immediate surgery
absolute surgical indication: disease is to be treated surgically, although not necessarily immediately
Inguinal hernia
Lateral (indirect): prone to incarceration since the hernia has to pass through the long, curvy and relatively narrow inguinal canal => develop in the persisting tunica vaginalis (congenital hernia) and thus the hernia sac can reach the scrotum itself
medial (direct) hernias: only a short hernial sac, orifice is usually wide
intermittent pain or discomfort associated with inguinal hernias is caused by the stretching of the mesentery of the trapped bowel loop
Requirements of primary wound healing
Sharp wound edges, non-tight edhes, lack of foreign or contaminated parts in the cavity
Classic signs of inflammation
tumor, rubor, calor, dolor, functio laesa
bulge, erythema, warm, pain and loss of function
Post-thrombotic syndrome
chronic insufficiency of venous circulation in the lower extremities, which develops years after DVT
GEA & EST
GEA: gastroenteroanastomosis
EST: endoscopic sphincterotomy
“Resectability” and “Operability”
resectability is related to the tumor: resectable or unresectable (technically cannot be removed by the surgeon)
Operability: refers to the patient
varies from patient to patient, depending on the patient’s condition and reserves and the progression of the disease
Symptoms of post-thrombotic syndrome
progressive edema, indurations, thickening of the subcutaneous tissue, development of secondary varicosity, crural ulcers due to impaired localized tissue nutrition, brownish pigmentation caused by hemosiderin deposition, eczema and dermatosis
treatment of secondary varicosity
crossectomy, stripping, subfascial ligature of perforator veins
degloving injury
skin and its underlying tissues are torn off the fascia
significant amount of bleeding can develop into the recessed area and the blood supply to the skin above the injury is severed, therefore skin necrosis is common
Bennett fracture
Fracture of the base of the first metacarpal bone which extends into the carpometacarpal joint
intra-articular fracture is the most common type of fracture of the thumb
V-shaped phlegmon
the type of pyogenic tenosynovitis extending between the thumb and the little finger
because the tendon sheaths reach the level of the wrist, but on the 2nd-4th fingers, they extend only to the distal palmar crease
Triangular fibrocartilage complex
cartilage structure located on the small finger side of the wrist that, cushions and supports the small carpal bones in the wrist
Cubital tunnel syndrome
area of sensory innervation and muscles of motor innervation by the ulnar nerve are affected
Dupuytren’s contracture
One or more fingers become permanently bent in a flexed position
usually begins as small, hard nodules just under the skin of the palm, then worsens over time until the fingers can no longer be straightened
cannot be treated with conservative methods (splinting, cast fixation and redressing bandaging techniques)
Periappendicular infiltration
Complicated form of advanced appendicitis, which requires 5-7 days to develop
Anus preternaturalis
colostomy
UICC
international anti-cancer organization (Union Internationale Contre le Cancer)
Blumer’s shielf
hard resistance that is palpable in the pouch of Douglas with rectal examination in advanced gastric cancer
it develops as a result of the fact that the tumor has metastasized to the peritoneum => patient already has ascites, which is the consequence of peritoneal cancer
PTC: percutaneous transhepatic cholangiography
penetrating an intrahepatic bile duct through the skin
complications of GERD
esophagitis
peptic stricture
esophageal ulcer: bleed, penetrate, perforate
Barrett’s esophagus: can lead to esophageal adenocarcinoma
lung infections due to aspiration
Schatzki ring: narrowing of the lower esophagus that can cause difficulty swallowing
reglux laryngitis
esophageal motility disorders
reflux stomatitis
Terminal ileum resection
anaemia (due to vit B12 def) and loss of biliary acids (absorbed primarily in terminal ileum)
Tenesmus
continual or recurrent inclination to evacuate the bowels
choledochus
common bile duct
Heller operation
an operation for achalasia of the cardia (can try Botox injections or balloon dilatation before)
Torek operation
resect the thoracic part of the esophagus, can be used in esophageal perforation
Decortication
medical procedure involving the surgical removal of the surface layer, membrane or fibrous cover of an organ
Mitral stenosis treatment
mitral commissurotomy and prosthetic heart valve implantation
mitral regurgitation treatment
implantation of artificial chordae and the use of annuloplasty rings
polyneuropathy
more commonly cause lower limb hypesthesia/paresthesia and rarely manifests in lower limb weakness
Parinaud’s syndrome
inability (paresis or palsy) of upgaze and it often comes with retraction nystagmus
a sign of compression of the quadrigeminal lamina
Strumectomy
surgical removal of all or a portion of a goitrous tumor
Suxamethonium (same as succinylcholine)
neuromuscular blocker family of medication and of depolarizing type
depolarization is caused by succinylcholine mimicking the effect of acetylcholine but without being rapidly hydrolysed by acetylcholinesterase
highly potent agonist at the NMJ nicotininc acetylcholine receptors
PEEP (positive end expiratory pressure)
decrease venous return due to increased mean intrathoracic pressure
altered left ventricular geometry
circulating, negative inotropic mediators
Agoraphobia
fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong
Transcortical aphasia
disables spontaneous speech, but have echolalia
TMS and TDCS
TMS: transcranial magnetic stimulation
TDCS: transcranial direct current stimulation
WAIS
Wechsler Adult Intelligence Scale
verbal and performance IQ
The level of intelligence measured by it predicts the level of life competence
tests
Rorschach probe: projective test MMPI: personality inventory BPRS: clinical rating scale Raven matrices: measure intellectual performance Szodi test: projective personality
For dementias
MMSE, clock drawing test, WAIS for level of cognitive decline
Perceptions without objective stimuli
hallucination
Alexithymia
personal trait characterized by the subclinical inability to identify and describe emotions experienced by one’s self or others.
The core characteristics of alexithymia are marked dysfunction in emotional awareness, social attachment and interpersonal relating
characterized by difficulties in expressing and verbalizing emotions
Delusions of infestation
a condition where an individual has a firmly fixed false belief that they have an infection
aka Ekbom symptom
Rumination
focused attention on the symptoms of one’s distress, and on its possible causes and consequences
can also be the action of chewing the cud
negativism
behaviour that is the opposite of that suggested by others
in active negativism: the individual does the opposite of what is asked for. can be associated in psychosis
In passive negativism: the person fails to cooperate, this occurs in schizophrenia and depression
Delusion of the double
Capgras syndrome
Pseudologia Fantastica
aka pathological lying, deception syndrome, mythomania
Fregoli syndrome
false identification of strangers as familiar people
can be seen in a motor disorder in schizophrenia
catatonia, negativism, waxy flexibility, automatic obedience
Nihilistic delusions
specific psychopathological entities characterized by the delusional belief of being dead, decomposed or annihilated, having lost one’s own internal organs or even not existing entirely as a human being
Cotard syndrome
rare condition marked by the false belief that you or your body parts are dead, dying or don’t exist
Bleuler’s 4 A’s in schizophrenias
disturbance of affect, association, ambivalence and autism
phobia
claustophobia (fear of closed spaces)
acrophobia (fear of heights)
hydrophobia (fear of water)
arachnophobia: fear of spiders
delirium tremens
signs of autonomic hyperactivity: hypertension, fever, tachycardia, global confusion, disorientation, perceptual disorders as a result of withdrawal from alcohol
Wernicke’s encephalopathy
consequence of long-term alcohol abuse
associated with periaqueductal gray hemorrhages at the level of lamina quadrigemina
symptoms: sudden onset, nystagmus and ophthalmoplegia, confusion along with somnolence, lesions of the mammillary bodies
polysomnography
sleep study, a test used to diagnose sleep disorders
Rapid cycling in bipolar disorder
4 episodes within one year
cyclothymia and dysthymia
cyclothymia: mood disorder causes emotional ups and downs that are less extreme than bipolar disorder
dysthymia
chronic form of mild depression
Narcomania
a pathological craving for or addiction to narcotics or alcohol
Hypochondriasis
illness anxiety disorder
Ambivalence
inability to make decisions
a division of all states or operations of mind into contradictory tendencies
Pick disease
aka frontotemporal dementia or frontotemporal lobar degeneration (affects parts of the brain that control emotions, behaviour, personality and language)
Conversion disorder
resemble a somatic illness
in definite connection with some outside event (psychotrauma)
Freudian primary illness-benefit: the patient can escape from a conflict
Freudian secondary illness-benifit: evoke increased attention and sympathy of others
patient cannot control these symptoms
limb paralyses and sensory deficits don’t follow anatomical innervations
Dissociative fugue
sudden and unplanned travel away from home
inability to recall past events or important information from the person’s life
confusion or loss of memory about his or her identity, possibly assuming a new identity to make up for the loss
Adaptation disorder (Adjustment disorder)
symptoms (stress, feeling sad/hopeless, physical symptoms) that can occur after you go through a stressful life event
trichotillomania
patients are unable to resist pulling out their own hair
pyromania
the person commits arson intentionally for pleasure
kleptomania
an irresistible urge to steal worthless objects
Akathisia
movement disorder characterized by a feeling of inner restlessness and inability to stay still
early adverse effect of antipsychotic medication
tardive dyskinesia
permanent side effect of antipsychotic medications that involve involuntary muscle
rapid blinking, waving of the arms or hands, sticking out the tongue
Trancranial megnetic stimulation
Can be used in depression and in the presence of acoustic hallucinations
Disengagement
describes the traits of a family or the current type of family interaction or functioning
disengaged families lack intimacy between the members
countertransference
occurs when a therapist transfers emotions ot a person in therapy
Tranference
process of projecting one’s feelings toward an important figure in your life onto someone else
Unconditional positive regard
means that the therapist accepts the client totally for who he or she is without evaluating or censoring, and without disapproving of particular feelings, actions, or characteristics
“I’ll accept you as you are”
Person-Centered therapy
By Carl Rogers
Congruence (Genuineness): the ability for the therapist to be genuine, no façade, require self-awareness, deliberate self-disclosure. Therapist’s openness and genuinessness to relate to clients without hiding behind a professional facade
unconditional positive regard
empathy: ability to understand what the client is feeling
Oezema
disease of the nose in which the bony ridges and mucous membranes of the nose waste away
it’s a form of atrophic rhinitis
involves foul-smelling lesion of the mucosa
unknown etiology
becomes better with aging
Osteoma
Most common benign tumor of the nose and paranasal sinuses
should be surgically removed
Pollakiuria
benign idiopathic urinary frequency
refers to frequent daytime urination in children without specific cause
can be caused by urine retention in the bladder and urethritis
continent urinary diversion
performed by incorporating segments of both the small and large intestine into the urinary tract to create a urinary reservoir in the suitably selected patient
E.g. Orthotopic bladder formation (bladder replacement from an isolated intestinal tract) and Mainz II pouch
urologic procedure
internal urethrotomy: incision of the urethral stenosis
epicystostomy: percutaneous bladder puncture
Nephroptosis
rare condition where a person’s kidney drops down into the pelvis when they stand up
Verruca vulgaris
common warts, which are caused by infection with HPV
Anergy
Describes a lack of reaction by the body’s defense mechanisms to foreign substances
Condyloma acuminatum
single genital wart, usually due to HPV 6 and 11
Promiscuous
having multiple sexual partners
White dermographism
blanching response resulting from capillary vasoconstriction after skin stroking and more pronounced in patients with atopic dermatitis
pityriasis rosea
exact cause of pityriasis rosea is unknown but most likely due to a viral cause
acute, self-limited, exanthematous skin disease by slightly inflammatory, oval, papulosquamous lesions on the trunk and proximal areas of the extremities
Sezary syndrome
aggressive form of cutaneous T-cell lymphoma
occur when T cells become cancerous, typically affect the skin
hidradenitis suppurativa (acne inversa)
inflammatory skin disease that affects apocrine gland-bearing skin in the axillae/groin/under the breasts
recurrent boil-like nodules and abscesses that culminate in pus-like discharge, difficult-to-heal open wounds and scarring
Methimazole
treat hyperthyroidism, also used before thyroid surgery or radioactive iodine treatment
Can cause aplasia cutis
thelarche
occurs for a low amount of estrogen
present also in testicular feminization
usually this is the first somatic change during puberty
Female pseudohermaphroditism
individual with ovaries but with male secondary sexual characteristics or external genitalia
can be caused by androgen-producing tumors, CAH
male pseudohermaphroditism
individuals whose gonads are testes but whose secondary sexual characteristics or external genitalia resemble those of a female
usually a AR genetic defects
testicular feminization
androgen insensitivity
pubertal preaecox
precocious puberty
Adenomyosis
endometrial tissue infiltrates the myometrium deeply, causing dysmenorrhea and hypermenorrhea
Dysmenorrhea
painful periods or menstrual cramps
Menorrhagia
Heavy menstrual bleeding
Hypermenorrhea : longer menstruation with more bleeding than usual
Hypomenorrhea
Regular, but shorter menstruation with light bleeding
Oligomenorrhea
more than 35 days between two menstruation
Polymenorrhea
less than 21 days between two menstruation
Metrorrhagia
irregular bleeding, which can last long
Postpartum galactorrhea-amenorrhea syndrome
Chiari-Frommel syndrome
Stein-Leventhal syndrome
PCOS: polycystic ovary syndrome
POPs
Progesteron-only pill
Clomiphene citrate
for ovaluation induction
widely used to treat infertility
SERM: selective estrogen receptor modulator
competitive inhibitors of estrogen binding to estrogen receptors
Cyproteron-acetate
Anti-androgen used in hypersexuality in males, as a palliative in prostatic carcinoma and in combination with estrogen, for the therapy of severe acne and hirsutism in females
LNG-IUS (Levonorgestrel-releasing Intrauterine system)
effectiveness are almost as high as the effectiveness of tubal ligation
release usually daily 20ug progestin
commonly cause strophic endometrial changes
primarily affects menstrual bleeding patterns and amenorrhea
CTG
cardiotocography: monitor fetal heartbeat
Spinnbarkeit test
Spinnbarkeit mucus: stretchy, egg white quality of cervical fluids around ovulation
Sims Huhner test (postcoital test)
test in the evaluation of infertility
evaluate the sperm’s interaction within cervical mucus postcoitally
Parlodel
Aka Bromocriptine
treat hyperprolactinemia or pituitary gland tumor that produces too much growth hormone
Oradexon
Aka Dexamethasone
can treat infertility with increased testosterone and/or DHEAS
Pyelectasia
dilatation of the renal pelvis
vena cava inferior syndrome
when the pregnant woman lays back the uterus overlies and compresses the vena cava inferior
due to decline in venous backflow, a fast maternal BP drop occurs, dizziness, sweating and tachycardia may lead to collapse
decrease in the placental circulation causes fetal bradycardia
can cause faintness of the pregnant woman
IDDM
insulin-dependent diabetes mellitus
Menstrual regulation
Menstrual extraction, another type of manual vacuum aspiration
induction of uterine bleeding that has been delayed either to 14 days beyond expected onset or 42 days from the start of the last menstrual period
Synclitism
parallelism between the pelvic plane and the plane of the fetal head
in asynclitism, the sagittal suture is in the transverse diameter of the pelvic inlet and not between the symphysis pubis and sacral promontory
Naegele obliquity
presentation of the anterior parietal bone to the birth canal during vaginal delivery with the biparietal diameter being oblique to the brim of the pelvis
is a type of asynclitism
Litzmann obliquity
posterior asynclitism
can lead to cephalopelvic disproportion and normal vaginal delivery cannot take place
Deflexion presentations
When the head is hyperextended: brow presentation and face presentation
Apraxia
motor disorder caused by damage to the brain in which the individual has difficulty with the motor planning to perform tasks or movement when asked, provided that the request or command is understood and the individual is willing to perform the task
amaurosis fugax
transient monocular blindness
caused by thromboembolisation of the ophthalmic artery (Terminal branch) from the ulcerated plaque of the ipsilateral internal carotid artery
Parinaud-syndrome
disturbance of gaze (vertical upwards) with vertical nystagmus
Weber syndrome
alternating motor brainstem syndrome: ipsilateral oculomotor nerve lesion, contralateral hemiparesis
Ticlopidine
Anti-platelet drug as ADP (adenosine diphosphate) receptor inhibitor
useful for preventing strokes and coronary stent occlusions
Diaschisis
sudden change of function in a portion of the brain connected to a distant, but damaged, brain area
Thalamic lesions
ventrolateral nucleus: cloely related to the cerebellum, its damage causes hemihypesthesia with hemihyperkinesis (choreoathetosis-like involuntary movements)
thalamic hand: basic joints are in flexion while the interphalangeal joints are in extension
thalamic pain: burning, shooting pain that is difficult to localise and occurs in attacks
Gerstmann syndrome
Left-to-right confusion, finger agnosia, agraphia and acalculia
abdominal lancinating pain
symptom of syphilis when granulomatous inflammation infiltrate posterior roots of thoracic spine and ganglion coeliacum and cause pain with sharp quality and very short duration
Vegetative symptoms
Weight loss and anorexia (loss of appetite), insomnia, fatigue and low energy, inattention
Cervicogenic headache
pain that develops in the neck, though a person feels the pain in the head
Meralgia paresthetica
numbness or pain in the outer thigh not caused by injury to the thigh, but injury to a nerve that extends from the spinal column to the thigh
Prosopalgia
facial or Trigeminal neuralgia
Causalgia
severe burning pain in a limb caused by injury to a peripheral nerve
known as complex regional pain syndrome type II
median nerve lesion often causes causalgia
Froment’s sign
physical examination of the hand to test for palsy of the ulnar nerve which results in reduced functionality and muscle weakness of the pinch grip
it tests the strength of the adductor pollicus of the thumb, which is innervated by the ulnar nerve and is weakened in ulnar nerve palsy
Neuromyelitis optica
aka Devic disease
autoimmune disorder in which WBCs and antibodies primarily attack the optic nerves and the spinal cord, but may also attack the brain
the damage to the optic nerves produces swelling and inflammation that cause pain and loss of vision
the damage to the spinal cord causes weakness or paralysis in the legs or arms, loss of sensation and problems with bladder and bowel function
presence of aquaporin-4 antibodies in serum
Adrenoleukodystrophy
rare genetic condition that causes the buildup of VLCFAs (very long chain fatty acids) in the brain
When VLCFAs accumulate, they destroy the protective myelin sheath around nerve cells, responsible for brain function
Convulsive syncope
Like syncope, can precede by fainting sensation, pallor or sweating
during the unconsciousness, a brief tonic phase, myoclonic or clonic jerking can occur
in contrast to grand mal, convulsive syncope never begins with a tonic phase (starts with a loss of muscle tone)
tongue biting can also occur in convulsive syncope, but it never affects the lateral part of tongue, rather the tip of tongue (apical tongue biting)
Disulfiram
support the treatment of chronic alcoholism by producing an acute sensitivity to ethanol
the first medication approved by the FDA to treat chronic alcohol dependence
Epilepsy
recurrent unprovoked epileptic seizures
however, epileptic seizures can occur in healthy people (known as the provoked seizure)
Eaton-Lambert syndrome
neuromuscular presynaptic disorder with paraneoplastic etiology
production of antibodies against a presynaptic calcium-ion channel protein
plasmapheresis or immunosuppression can be effective in the treatment of this disease
Drusen
small yellow deposits of fatty proteins (lipids) that accumulate under the retina
Ectropion
condition in which your eyelid turns outward and leaves the inner eyelid exposed and prone to irritation
tearing (epiphora) is the consequence
Odds ratio
typically used in case-control studies
the odds of a certain exposure given an event v.s. the odds of exposure in the absence of that event
if odds-ratio is exactly 1, then there is no relationship between the risk factors and the disease
can be calculated from contigency tables
Stochastic effects
those affects the frequency and probability of which increases on elevating the doses, more precisely the dose equivalent value
