Path II test 2 Flashcards
What are signs of pancoast tumor?
Tumor in the apex of the lung infiltrates brachial plexus.
Sx: pain numbness and weakness of affected arm (TOS)
Also may be involved with adjacent vertebrae and ribs
Horners syndrome
Tumor extension of pancoast tumor Involves cervical and thoracic nerves -ipsilateral miosis -ptosis -facial anhidrosis
Superior Vena Cava Syndrome
Tumor extension of pancoast tumor Obstruction of venus drainage -dilation of neck veins -neck and facial edema -redness -
Potential complications of OM
Rupture TM Mastoiditis Infx to cochlea Infxn to CNS and meninges hearing loss delayed/abnormal speech acquisition Bullous myringitis Cholesteatoma
Meniere’s disease:
Triad?
Causes?
Who?
“Endolympyhatic Hydrops”
- Vertigo
- Tinnitus
- SNSL
Caused by pressure and volume changes in endolymph of vest. appararatus
Idiopathic
20-50 yo;
Acoustic Neuroma
Progressive Unilateral hearing loss
Benign tumor CN 8
Invasion/compression of internal auditory meatus, cerebellum. brain stem
-tinnitus, dizziness, otalgia, trigem neur, hemiparesis/paralysis of CN 7
What is Choleastoma/where is it
Epidermoid cyst lined with keratinizing squamous or columnar epithelium (mucous producing) and filled with amorphous debris and sometimes cholesterol
Arises in middle ear, tympanic membrane or adjacent struct., mastoid
What does progressive enlargement of choleastoma do?
What is sequlae?
Causes erosion into soft tissues and bones: ossicles labyrinth, adjacent bone, surronging soft tissue
Sequlae:
grow into ossicle/labyrinth = deafness
Facial paralysis
Infection and intercranial abscess
How do you get choleastoma ?
cpngenital or acquired
Often from chronic OM
Maybe TM perforation or chronic retraction
What is otitis Externa?
How might it present?
Risks to get it?
“swimmers ear” infx external ear canal
- local furuncle: S aureous
- diffuse generalized infxn: bacterial
Risks:
Allergies, eczema, psoriasis seb. derm; decreased canal acidity, injury, chemical irritants
Malingnant Otitis Externa: what/where
who?
Appearance?
SSX
Osteomylitis of temporal bone
P. aueroginosa…often beginning with otitis externa
Elderly, diabetic, immunocompromised
Granulation tissue in external canal/jxn of bony margin of temporal bone with cartilage portion of pinna
Foul smelling, purulent otorrhea and severe otalgia
Scleritis vs conjunctivitis
scleritis vessels do not constrict with phenylephrine, vessels are not displaced by cotton swab.
More dangerous than conjunctivitis, can be from systemic dz like RA.
Not normally infection agent, unlike conjunctivitis
Maybe uvea infxn
Conjuntivitis
has rich distribution of lymphatic channels
May heal without incident
Maybe allergic, infectious, granulatomous
What is glaucoma
Optic nerve issues
collection of conditions leading to change in visual fiesld and optic cup
Elevated intraocular pressure
Lack of drainage of aqueous humor from ant. chamber
Optic nerve:
diffuse loss of ganglion cells
thinning of retinal nerve fiber layer
cupping and atrophy
Open angle glaucoma
Canals of schlemm/trabecular netwrks are open/accessible
resistance to aq. humor drainage in open angle: fluid pressure up
What glaucoma is more common and what causes it?
population?
what happens?
Primary…idiopathic…associated with MYOC gene sometimes.
eyes with shallow anterior: hyperopia
drainage blocked by narrow canal…iris bulges forward
Iris bombe/shadow/cresent shadow
lens epithelium maybe damaged: slit-lamp exam
corneal edema/bullous keratopathy
Secondary glaucoma
clogged trabecular network with open angle:
debris…various cells/proteins etc
Many types of closure:
neovascular: fibrovascular membrane…chronic retinal ischemia
ciliary body tumors…mechanical compression
necrotic tumors: neovascularization…retinoblastomas
Diabetic retinopathy, CRVO, ocular ischemia
Preproliferative Diabetic retinopathy
What? Presentation? Risks?
Thickening of basement membrane of retinal BV
Common microaneurysms
Exudates result from hyperpermeable vasculature
Microocculsions of small vessels occur
Macular edema…vision loss
retinal detachment
What is normal response to Acute blood loss?
Volume rapidly restored shifting h2o from intersitium
Hemo-dilution lowers hematocrit
lower Oxygenation of tissues = EPO from renal JGA cells
BM ups erythropoiesis
BM can increase production 7-8 fold
Fe recycling Acute blood loss
Blood smear after loss?
Internal: can recycle from blood
External: Nope
Immediate: normocytic; normochromatic
Later: Lots of reticulocytes…larger; polychromatic
Dog story
scientists bled out 30% of some dogs’ blood and replaced it with transfused blood, but the dogs all died. But then they repeated and transfused with saline, and the dogs lived. This is because the saline allows the fluid shift from the intra and intercellular spaces to return. Transfusing blood first made the dogs hyperosmotic which sucked out the remaining intercellular fluid.
Why hemolytic anemia is dangerous
gallstones, pulmonary HTN, and jaundice, in addition to general anemia symptoms like SOB and fatigue.
Coomb’s test
Direct Coomb’s test:
Warm AIHA, IgG ab chronic dz like SLE and RA
Indirect Coomb’s test:
Cold AIHA, IgM, acute, self limiting, acute dz like mycoplasma, mono, and viral
