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Pathophysiology > Patho Unit 8 > Flashcards

Patho Unit 8 Flashcards

- Understand Alterations of Muscloskeletal Function (Ch 37) - Understand Alterations of the Reproductive System (Ch 32)

1
Q

Pathological Bone Fractures

A
  • Bone breaks because of an underlying disease that has weakened the bone - Cancer and Osteoporosis are examples
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2
Q

Pathological Bone Fractures

A
  • Bone breaks because of an underlying disease that has weakened the bone - Cancer and Osteoporosis are examples
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3
Q

Stress Bone Fractures

A
  • Bone placed under extreme or unusual forces - Motor vehicle accident, falls, sports injuries are examples
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4
Q

Open Bone Fracture

A

Broken bone end protrudes through skin

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5
Q

Closed Bone Fracture

A

No penetration of skin

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6
Q

Comminuted Bone Fracture

A

Multiple bone fractures

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7
Q

Linear Bone Fracture

A

Along the long axis of the bone

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8
Q

Oblique Bone Fracture

A

At an angle to the long axis of the bone

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9
Q

Impacted Bone Fracture

A

Fragments pushed into each other

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10
Q

Spiral Bone Fracture

A
  • Break forms twisted line - Torque on bone - Spiral fracture of tibia is a common ski injury
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11
Q

Transverse Bone Fracture

A

Across the long axis

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12
Q

Greenstick

A
  • Partial break - More common in children
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13
Q

Transchondral

A

Through cartilage or growth plate

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14
Q

Healing Fractures

A

Realign bone fragments to their normal anatomic position (bone reduction) - Closed manipulation - Traction - Surgery: open reduction/internal fixation (ORIF) Splint or cast the fracture - Hold it in place so bone union can occur (plaster /fiberglass)

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15
Q

Fracture Hematoma

A
  • 6-8 hours after injury - Result of blood vessels breaking in the periosteum and the osteons
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16
Q

Callus Formation

A
  • Takes from weeks up to 6 months - Phagocytes remove cellular debris - Osteoblasts synthesize collagen and matrix which mineralizes into a callus
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17
Q

Remodeling

A
  • Takes several months - Callus is replaced with trabeculae (spongy bone) - Spongy bone is then replaced with compact bone
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18
Q

Subluxation

A

Partial loss of contact between articular surfaces of bones

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19
Q

Dislocation

A

Complete loss of contact between articular surfaces of bone

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20
Q

Sprain

A
  • A partial tear of a LIGAMENT (at a joint) - Common in the wrist, elbow, ankle and knee
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21
Q

Strain

A
  • A partial tear of a MUSCLE or TENDON (which can also transverse a joint) - Sudden forced motion causing the muscle to become stretched beyond its normal capacity (local muscle damage)
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22
Q

Avulsion

A

Separation of a tendon or ligament from its bony attachment

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23
Q

Tendinopathy

A

Any disease of a tendon - Slow to heal - Normal, organized collagen replaced with weaker, disorganized collagen

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24
Q

Epicondylopathy

A

A type of tendinopathy, where it attaches to a bony epicondyle such as those on the humerus, radius, and ulna - Tennis Elbow: lateral epicondylopathy - Golfer’s Elbow: medial epicondylopathy

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25
Q

Bursitis

A
  • Inflammation of the bursae - Usually caused by repeated trauma such as forceful rubbing of the bursa - Septic bursitis is caused by a wound infection - Shoulders, elbows, and knees are most common sites (prepatellar, trochanteric, olecranon, subacormial)
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26
Q

Rhabdomyolysis

A

Rapid breakdown of muscle due to severe muscle damage - Muscle injury - Electric shock - Heat stroke - Drugs (esp. statins, cholesterol-lowering drugs) - Malignant hyperthermia Release of intracellular contents - Myoglobinuria - Creatinine Kinase (CK) - Potassium

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27
Q

Malignant Hyperthermia

A
  • Genetic disease that causes a very rapid rise in body temperature in susceptible individuals exposed to certain anesthetics - The fever of malignant hypertension can itself be deadly, but if the patient survives, they may succumb to the overwhelming rhabdomyolysis
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28
Q

Myoglobinuria

A
  • O2-carrying protein of muscle (myoglobin) found in urine - Dark urine (only 200g of muscle damage required) - Causes acute renal failure due to precipitated myoglobin obstructing the renal tubules
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29
Q

Compartment Syndrome

A
  • Result of increased pressure with a muscle compartment - Fibrous, deep fascia surrounds muscle tissue and separates the muscles into compartments - Increased pressure in a compartment results in diminished capillary blood flow, tissue hypoxia, and necrosis
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30
Q

Osteoporosis

A

A disease in which bone tissue is normally mineralized, but the density is decreased and the bone lacks structural integrity - Bone densitometry used to measure - Potential causes include decreased levels of estrogen or testosterone, decreased activity level, inadequate vitamin D, C, or Mg++ - Usually asymptomatic until fractures occur

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31
Q

Vitamin D Deficiency

A
  • Osteomalacia (adults) and Rickets (children) - Lowers absorption of calcium from intestines - Osteoid is laid down, but calcification doesn’t occur (soft bones) - Signs & Symptoms: pain, bone fractures, vertebral collapse, and bony malformations
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32
Q

Osteomalacia/Rickets

A

Diseases that result in inadequate or delayed mineralization of osteoid

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33
Q

Paget Disease of Bone (PBD, or Osteitis Deformans)

A
  • Cause is unknown - Results in a state of increased metabolic activity (excessive bone remodeling) - Manifested by disorganized, thickened but soft bones (vertebrae, skill, and pelvis) - Thickened bone can cause abnormal bone curvatures, brain and nerve compression, impaired motor function, and deafness
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34
Q

Osteomyelitis

A

Bone infection; most often caused by S. aureus - An open wound is most common, but it can also be caused by a blood-borne infection - Acute and chronic inflammation, fever, pain, and necrotic bone - Treatment: antibiotics, debridement, surgery, and hyperbaric oxygen therapy

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35
Q

Arthropathies

A

A group of diseases which destroy the joints Differentiated by: - The presence or absence of synovial membrane inflammation - The presence or absence of systemic signs and symptoms - The findings from synovial fluid analysis

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36
Q

Osteoarthritis

A
  • Degenerative joint disease - Atypical inflammatory process (can affect only one side or one side more than the other) - The primary defect is loss of articular cartilage, leaving underlying bone unprotected - This results in sclerosis of the underlying bone and formation of bone spurs (osteophytes) - Signs & symptoms: pain, stiffness, enlargement, tenderness, limited range of motion, deformity - Joint fluid contains Proteoglycan fragments from articular cartilage breakdown - Subluxation can result
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37
Q

Rheumatoid Arthritis

A
  • Chronic systemic, inflammatory autoimmune disease - The prototypical inflammatory joint disease - Affects more women than men - Presence of RF and elevated Erythrocyte Sedimentation Rate - Signs & symptoms: similar to osteoarthritis, synovial fluid will be different (inflammatory exudate), morning stiffness (at least 1 hour), swelling of soft tissue (3 or more joints), radiographic evidence of erosions in the joints of hands, nodules on the bones
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38
Q

Gout and Gouty Arthritis

A
  • Hyperuricemia - High levels of uric acid eventually precipitate out of solution forming crystal deposits - These uric acid crystals trigger the acute inflammatory response - Tophi - Uric acid stones often form in the kidney - People with gout have 1000x greater risk of developing kidney stones
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39
Q

Hyperuricemia

A

Abnormal metabolism of purine nucleotides (adenine, guanine) resulting in accumulation and elevation of uric acid in the blood and body fluids

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40
Q

Tophi

A
  • Urate crystal granuloma - Subcutaneous nodules that form from a crystal deposition
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41
Q

Secondary Muscle Dysfunction

A

Muscular symptoms arising from a variety of causes, some unrelated to the muscle itself Examples: - Contractures - Stress-induced muscle tension - Disuse atrophy

42
Q

Physiologic Contractures

A

Muscle fiber shortening without an action potential (malignant hyperthermia) - Caused by failure of the calcium pump to replace calcium in the sarcoplasmic reticulum - Also by heat, illness, or drugs

43
Q

Pathologic Contractures

A

Muscle fiber shortening caused by muscle spasm or weakness - For example, muscular dystrophy or spinal cord injury - Heel cord contractures after spinal injuries and muscular dystrophy are examples as well

44
Q

Stress-Induced Muscle Tension

A
  • Neck stiffness, back pain, clenching teeth, hand grip, and headache - Caused by an increased activity of the reticular activating system (RAS; chronic anxiety
45
Q

Disuse Atrophy

A

Reduction in muscle the normal size of muscle cells due to prolonged inactivity and muscular deconditioning - Bed rest, trauma, casting, or nerve damage - Treatment: isometric movements and muscle-lengthening exercises

46
Q

Fibromyalgia

A

Chronic non-inflammatory musculoskeletal syndrome - Diffuse, chronic pain - Vague symptoms: increased sensitivity to touch, fatigue, and sleep disturbances, often misdiagnosed as chronic fatigue syndrome - “Tender points” are found in predictable patterns - Etiology is unknown: suspects include viral illness, certain medications, physical or emotional trauma

47
Q

Delayed Puberty

A

Diagnosed if no signs of secondary sexual characteristics at 13 in girls, 14 in boys - 95% of cases are a physiologic “constitutional” delay: (Hormone levels are normal, Hypothalamic - Pituitary - Gonadal pathway is intact, Tends to be familial and gender related) - More common in boys - The other 5% are caused by disruption of the Hypothalamic - Pituitary (FSH & LH) - Gonadal pathway or a systemic disease

48
Q

Early (Precocious) Puberty

A

Onset of puberty before: - 6 in black girls, 7 in white girls, 9 in blys - More common in girls - Most cases are idiopathic Newer theories - Obesity-related - Better nutrition

49
Q

Primary Dysmenorrhea

A

Painful menses not related to a pelvic disease - Excessive endometrial prostaglandin secretion during the uterine cycle - Decreases with age - Symptoms: backache, pelvic pain, vomiting, diarrhea, syncope, and headache - Treatment: oral contraceptives and prostaglandin inhibitors

50
Q

Secondary Dysmenorrhea

A

Painful menses caused by an underlying pelvic disease - Pelvic Inflammatory Disease - Endometriosis - Adhesions - May occur at any time in the menstrual cycle

51
Q

Primary Amenorrhea

A

Lack on menarche and development of secondary sexual characteristics by age 14 - Lack of menses even with sex characteristics by 16

52
Q

Secondary Amenorrhea

A

The absence of menstruation for 3 or more cycles or 6 months in women who have previously menstruated - Pregnancy is the most common cause - Dramatic weight loss, excessive exercise, overproduction of prolactin

53
Q

Dysfunctional Uterine Bleeding (DUB)

A

Abnormal uterine bleeding from disturbances of the menstrual cycle - usually anovulation - DUB is a diagnosis of exclusion - Failure to ovulate due to age, stress, or endocrinopathy are the most common causes - Common: “someone in the symphony is out of tune”; progesterone/estrogen imbalance leading to incomplete sloughing of endometrium - Occurs mostly in adolescents and perimenopausal

54
Q

Polycystic Ovarian Syndrome (PCOS)

A

The most common endocrine disturbance in the US (5-10%), usually affecting younger women - It is familial, and is the leading cause of anovulation, and thus infertility - Hypertension - Dyslipidemias - Hyperinsulinemia (leads to increased levels of androgens) - Manifests as polycystic ovaries, infertility, hirsuitism (abnormal hairiness), acne, thyroid disease, Cushing syndrome, and often progresses to diabetes mellitus

55
Q

Premenstrual Syndrome (PMS)

A
  • Cyclic, physical, psychologic, or behavioral changes that impair interpersonal relationships and/or activities - Occurs in the luteal phase - Results from abnormal tissue response to the normal fluctuations of the menstrual cycle (>200 symptoms)
56
Q

Premenstrual Dysphoric Disorder (PMDD)

A

The most severe form of PMS - Effectively treated by antidepressants (SSRIs) - Dysphoria is the set of emotional disturbances in the disease - The effectiveness of SSRIs suggests a disorder of decreased synaptic levels of serotonin

57
Q

Pelvic Inflammatory Disease (PID)

A

An acute, inflammation of the upper genital tract (uterus, uterine tubes, and/or ovaries) - Often caused by STIs - Frequently initiated by gonorrhea and chlamydia - Considered a “polymicrobial” infection - Complications: tubonecrosis, pelvic adhesion, infertility, ectopic pregnancy, and chronic pelvic pain - Signs & Symptoms: purulent vaginal discharge and severe pelvic tenderness

58
Q

Vaginitis

A

An infection/inflammation of the vagina commonly caused by sexually transmitted pathogens, bacterial vaginosisCandida albicans

59
Q

Bacterial Vaginosis (BV)

A

Associated with an imbalance in the bacteria that are normally found in a women’s vagina - Associated with bacterium of the Gardnerella species, and there is a characteristic “fishy smell”

60
Q

Vaginal Infections

A
  • Normally the acidic nature of the vagina provides some protection; maintained by cervical secretions and normal flora - Alterations of pH may predispose a women to infection - Use of soaps, hygiene sprays, douching, deodorant pads or tampons
61
Q

Vulvovestibulitis

A

AKA Vulvitis or Vestibulitis - Inflammation of the skin (dermatitis) of the vulva and often the perianal area - It is commonly caused by contact with soaps, detergents, lotions, hygienic sprays, menstrual pads, perfumed toilet paper, or tight-fitting, nonabsorbent clothes - It can also be caused by vaginal infections and STIs that spread to the labia

62
Q

Cervicitis

A

Inflammation of the cervix - Mucopurulent cervicitis (MPC) usually caused by one or more STIs - Causes the cervix to become red and edematous - Mucopurulent exudate drains from the cervical opening - Signs & Symptoms: pelvic pain, bleeding, and dysuria - Lab ID followed by antibiotic therapy

63
Q

Endometriosis

A

Functioning endometrial tissue outside the uterus - Associated with early menarche, infertility, frequent menstruations, pelvic pain, and nulliparity - Ectopic tissues respond to hormonal stimulation - Bleeding causes pain and possibly pelvic adhesion - Sites: ovaries, peritoneal surfaces, uterus, bladder, uterine tubes and uterine ligaments - It is often confused with early PID

64
Q

Endometriosis Theories

A
  • Depressed T-cytotoxic cells tolerate ectopic tissue - Backflow of menstrual tissue (retrograde menstruation) - Spread of endometrial cells through the blood and lymphatics
65
Q

Cervical Cancer

A

Causes & Risk Factors - HPV, STDs, early sexual activity, multiple sex partners, smoking, diet, and vitamin deficiencies Signs & Symptoms - Pain and abdominal swelling, post menopausal bleeding Testing - Pap smear and HPV testing

66
Q

Ovarian Cancer

A

Mortality rates are very high because of the scarcity of early symptoms and the lack of a good screening test Risk Factors - Not well understood - Sibling with Ovarian or Breast cancer - Nulliparity

67
Q

Nulliparity

A

Having borne no children

68
Q

Benign Breast Disease

A

Palpable lumps in the breast that fluctuate with the menstrual cycle - Types: cystic, fibrous, and epithelial proliferative - Treatment: cyst drainage, surgical excision, and pain relief - It doesn’t increase cancer risk, but it can make diagnosis more difficult

69
Q

Breast Cancer

A

Multifactorial disease - Lifetime risk is 1 in 8 - Hormonal: long term estrogen exposure appears to increase risk (hormonal replacement therapy, early menarche, nulliparity, late menopause, certain “high dose” oral contraceptives) - Familial: 2-3x higher risk if a primary relative - Environmental: ionizing radiation, high fat diet - Reproductive: the protective effect of an early first full-term pregnancy

70
Q

Urethritis (Penile Disorder)

A
  • Inflammation of the urethra without bladder involvement - Usually caused by STIs - Non sexual origins can be due to urologic procedures, insertion of foreign objects, anatomical abnormalities, or trauma
71
Q

Urethral Stricture (Penile Disorder)

A
  • Fibrotic narrowing of the urethra because of scarring - Trauma or untreated urethral infections
72
Q

Phimosis

A
  • Penile foreskin (prepuce) is “too tight” - Can’t retract foreskin from the glans of the penis (distal to proximal)
73
Q

Paraphimosis

A
  • Foreskin is retracted and can’t be reduced (proximal to distal) causing constriction around the penis - Most commonly caused by poor hygiene or chronic infections
74
Q

Peyronie Disease

A
  • “Bent-nail syndrome” - Slow development of fibrous plaques (thickening) in the erectile tissue of the corpus cavernosa causing a lateral curvature of the penis during erection - Occurs in middle-aged men and causes painful erections and intercourse
75
Q

Priapism

A
  • Prolonged penile erection, not associated with sexual arousal - Urologic emergency
76
Q

Varicocele

A
  • “Bag of worms” - Inflammation of the venous plexus in the spermatic cord (varicose vein) - Caused by inadequate or absent valves in the spermatic veins - Can interfere with spermatogenesis and cause infertility - 90% found on the left side
77
Q

Hydrocele

A
  • Scrotal swelling due to collection of fluid within the tunica vaginalis - Imbalance between fluid secretion and reabsorption - Neonates: due to late closure of the tunica vaginalis (communicating hydrocele) - Use of transillumination for diagnosis
78
Q

Spermatocele

A
  • Cyst located between the head of the epididymis and the testis - Is usually asymptomatic or causes just mild discomfort - Milky fluid and does not cover the entire anterior scrotal surface
79
Q

Intrascrotal Disorders

A
  • Vericocele - Hydrocele - Sermatocele - Cryptorchidism - Testicular Torsion - Epididymitis - Testicular Cancer
80
Q

Cryptorchidism (Cryptorchism)

A
  • Failure of the testes to descend into the scrotum - Caused by a developmental delay, mechanical factor, or a deficiency in gonadotropin stimulation - Untreated cases can lead to infertility or neoplastic susceptibility (50x greater)
81
Q

Testicular Torsion

A
  • Rotation of spermatic cord - This interrupts blood supply by twisting the arteries and veins - Onset can be spontaneous (winter syndrome), or due to trauma or heavy physical exertion - Symptoms: tender, high-riding testis, thickened spermatic cord and absent cremasteric reflex - Must be surgically repaired within 6 hours
82
Q

Epididymitis

A
  • Inflammation of epididymis; usually due to a sexually transmitted microorganism in young males - Microorganisms ascend through Vas Deferens - Can cause abscess formation and scarring - Can be caused by chemical inflammation from the reflux of sterile urine into the ejaculatory duct
83
Q

Testicular Cancer

A
  • Rare (1%), but most common tumors in young adult men, 95% cure rate - 90% are germ-cell tumors - Due to the population manifesting the disease, it is believed that high levels of androgens contribute to the carcinogenesis - Dull gradual pain gives the patient a dull ache or a “testicular heaviness” sensation
84
Q

Benign Prostatic Hyperplasia

A
  • Enlarged prostate compresses the prostatic urethra and causes bladder outflow obstruction - Symptoms: urge to urinate frequently, delay starting urination, and decreased force of the urinary system - Treatment: removal of hyperplastic tissue, drugs to relax the smooth muscle, or drugs to interrupt prostate gland hormone secretions
85
Q

Prostatitis

A
  • Inflammation of the prostate - Similar symptoms to BPH - Caused by: ascending infections, recurrent UTIs - Can cause fibrosis of the prostate
86
Q

Prostatic Cancer

A
  • 29% of all cancer deaths in men (rarely < 40) - Many men harbor undetected prostate cancer foci (15-30% at age 50 and 80% at 80) - 95% of prostate neoplasms are peripheral adenocarcinomas - Prostatic cancer is asymptomatic until its advanced stages; symptoms are similar to BPH - Test: ultrasound, digital exam, and PSA blood test
87
Q

STIs/STDs

A
  • Caused by bacterial, viral, protozoan, parasitic, and fungal agents - The increased rate of STIs is due to increased premarital sex, increased divorce rate, multiple sexual partners, and bisexuality (eg: increased sexual partners and exposure) - Generally, the viral STIs are considered incurable
88
Q

Gonorrhea

A
  • Bacterium Neisseria gonorrheae - Gram (-) diplococcus - Produces and endotoxin that damages the mucosa of the uterine (fallopian) tubes - Manifestations: urethritis, cervicitis (mucopurulent discharge), anorectal infection, pharyngitis, conjuctivitis, may be asymptomatic - Complications: epididymitis, lymphangitis, salpingitis, infertility, disseminated blood infection, neonatal blindness - Treated with antibiotics, resistant strains becoming more common
89
Q

Syphilis

A
  • Bacterium Treponema pallidum - Gram (-) helical (spirochete) - Moves in a corkscrew fashion - Not found in environment - Must multiply within a living host, difficult to culture and isolate in the lab - Organism rapidly destroyed by heat, cold, or drying
90
Q

Syphilis Primary Infection

A
  • Sexual transmission occurs through broken skin or mucus membranes coming into contact with an open skin lesion - Chancre: painless lesion, may occur internally, develops 10-90 days after infection - 1/3 of individuals contacting active lesions will acquire the disease - Can also be transmitted congenitally or from IV drug use (rare)
91
Q

Syphilis Secondary State

A
  • If untreated 1/4 of cases will progress - Characterized by the systemic dissemination of the organism - Lymphadenopathy, malaise, fever, pharyngitis, skin rash - Skin lesions will last up to 8 weeks, but relapses can occur up to 4 years
92
Q

Syphilis Tertiary Stage

A
  • Usually occurs 10-30 years after the secondary stage - Patients exhibit neurological, cardiac and cutaneous involvement - Large skin lesions (gummas) - Degeneration of spinal cord (neurosyphilis) - Mimics meningitis (thickening of the meninges) - Destruction of elastic tissue of the aorta
93
Q

Syphilis Congenital Infections

A
  • Passes from mother to child - Can occur starting at 18 weeks gestation - Perinatal death in up to 40% of cases - Bone, neural, and cutaneous abnormalities - TORCH panel for expectant mothers (toxoplasmosis, HBV, syphilis, rubella, cytomegalovirus, herpes simplex)
94
Q

Chlamydia

A
  • Chlamydia trachomatis - Gram (-) coccus - Most common bacterial STI - Obligate intracellular bacterium - Exists as an extracellular elementary body - Attaches to a receptor host cell and enters by exocytosis - Once inside, it replicates and forms many elementary bodies - Manifests with purulent discharge, cervicitis, urethritis, prostatitis, in newborns congenital infections cause conjunctivitis
95
Q

Herpes Simples I & II

A
  • Viruses Herpes simplex type I or type II - Painful blister-like lesions on external genitalia and genital tract - Treatment: Acyclovir - Complications: spontaneous abortions, neonatal morbidity and mortality from CNS infection
96
Q

Condylomata Acuminata

A

Genital Warts - Caused by HPV (6 and 11) - Appear several weeks to several months after contact - Soft, skin-colored single or clustered growths - Can cause cervical, anorectal, and penile cancers - High transmission rates

97
Q

HPV and Cervical Cancer

A

Persistent HPV infection causes essentially all cervical cancers - 150 related viruses, 40 types are STIs - Treatment: Gardisil vaccinates against 16 and 18 (70% of cervical cancers), 6 and 11 (genital warts)

98
Q

Trichomoniasis

A
  • Trichomonas vaginalis - Sexually transmitted protozoan parasite - Causes erythema of the vaginal wall, discharge (yellow-green), pruritis (itching), painful intercourse, and dysuria - Diagnosed by performing a wet-prep of vaginal fluids
99
Q

Scabies

A
  • Sarcoptes scabiei: human itch mite - Burrows into upper layer of skin and lays eggs - Causes intense itching and pimply rash - Transmitted by direct contact - Crusted scabies is a severe form that occurs in immunocompromised individuals - Thick skin crusts contain mites and eggs, highly infectious and must be treated aggressively
100
Q

Pediculosus Pubis

A
  • AKA “crabs” - Phthirus pubis - Primarily transmitted sexually - Causes mild to severe pruritus - Lice and nits are visible to the unaided eye

Pathophysiology (11 decks)

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