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
2
Q
Pathological Bone Fractures
A
- Bone breaks because of an underlying disease that has weakened the bone - Cancer and Osteoporosis are examples
3
Q
Stress Bone Fractures
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- Bone placed under extreme or unusual forces - Motor vehicle accident, falls, sports injuries are examples
4
Q
Open Bone Fracture
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Broken bone end protrudes through skin
5
Q
Closed Bone Fracture
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No penetration of skin
6
Q
Comminuted Bone Fracture
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Multiple bone fractures
7
Q
Linear Bone Fracture
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Along the long axis of the bone
8
Q
Oblique Bone Fracture
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At an angle to the long axis of the bone
9
Q
Impacted Bone Fracture
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Fragments pushed into each other
10
Q
Spiral Bone Fracture
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- Break forms twisted line - Torque on bone - Spiral fracture of tibia is a common ski injury
11
Q
Transverse Bone Fracture
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Across the long axis
12
Q
Greenstick
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- Partial break - More common in children
13
Q
Transchondral
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Through cartilage or growth plate
14
Q
Healing Fractures
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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)
15
Q
Fracture Hematoma
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- 6-8 hours after injury - Result of blood vessels breaking in the periosteum and the osteons
16
Q
Callus Formation
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- Takes from weeks up to 6 months - Phagocytes remove cellular debris - Osteoblasts synthesize collagen and matrix which mineralizes into a callus
17
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Remodeling
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- Takes several months - Callus is replaced with trabeculae (spongy bone) - Spongy bone is then replaced with compact bone
18
Q
Subluxation
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Partial loss of contact between articular surfaces of bones
19
Q
Dislocation
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Complete loss of contact between articular surfaces of bone
20
Q
Sprain
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- A partial tear of a LIGAMENT (at a joint) - Common in the wrist, elbow, ankle and knee
21
Q
Strain
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- 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)
22
Q
Avulsion
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Separation of a tendon or ligament from its bony attachment
23
Q
Tendinopathy
A
Any disease of a tendon - Slow to heal - Normal, organized collagen replaced with weaker, disorganized collagen
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
25
Bursitis
- 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)
26
Rhabdomyolysis
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
27
Malignant Hyperthermia
- 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
28
Myoglobinuria
- 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
29
Compartment Syndrome
- 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
30
Osteoporosis
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
31
Vitamin D Deficiency
- 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
32
Osteomalacia/Rickets
Diseases that result in inadequate or delayed mineralization of osteoid
33
Paget Disease of Bone (PBD, or Osteitis Deformans)
- 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
34
Osteomyelitis
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
35
Arthropathies
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
36
Osteoarthritis
- 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
37
Rheumatoid Arthritis
- 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
38
Gout and Gouty Arthritis
- 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
39
Hyperuricemia
Abnormal metabolism of purine nucleotides (adenine, guanine) resulting in accumulation and elevation of uric acid in the blood and body fluids
40
Tophi
- Urate crystal granuloma - Subcutaneous nodules that form from a crystal deposition
41
Secondary Muscle Dysfunction
Muscular symptoms arising from a variety of causes, some unrelated to the muscle itself Examples: - Contractures - Stress-induced muscle tension - Disuse atrophy
42
Physiologic Contractures
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
Pathologic Contractures
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
Stress-Induced Muscle Tension
- Neck stiffness, back pain, clenching teeth, hand grip, and headache - Caused by an increased activity of the reticular activating system (RAS; chronic anxiety
45
Disuse Atrophy
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
Fibromyalgia
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
Delayed Puberty
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
Early (Precocious) Puberty
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
Primary Dysmenorrhea
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
Secondary Dysmenorrhea
Painful menses caused by an underlying pelvic disease - Pelvic Inflammatory Disease - Endometriosis - Adhesions - May occur at any time in the menstrual cycle
51
Primary Amenorrhea
Lack on menarche and development of secondary sexual characteristics by age 14 - Lack of menses even with sex characteristics by 16
52
Secondary Amenorrhea
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
Dysfunctional Uterine Bleeding (DUB)
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
Polycystic Ovarian Syndrome (PCOS)
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
Premenstrual Syndrome (PMS)
- 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
Premenstrual Dysphoric Disorder (PMDD)
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
Pelvic Inflammatory Disease (PID)
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
Vaginitis
An infection/inflammation of the vagina commonly caused by sexually transmitted pathogens, bacterial vaginosisCandida albicans
59
Bacterial Vaginosis (BV)
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
Vaginal Infections
- 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
Vulvovestibulitis
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
Cervicitis
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
Endometriosis
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
Endometriosis Theories
- Depressed T-cytotoxic cells tolerate ectopic tissue - Backflow of menstrual tissue (retrograde menstruation) - Spread of endometrial cells through the blood and lymphatics
65
Cervical Cancer
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
Ovarian Cancer
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
Nulliparity
Having borne no children
68
Benign Breast Disease
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
Breast Cancer
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
Urethritis (Penile Disorder)
- 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
Urethral Stricture (Penile Disorder)
- Fibrotic narrowing of the urethra because of scarring - Trauma or untreated urethral infections
72
Phimosis
- Penile foreskin (prepuce) is "too tight" - Can't retract foreskin from the glans of the penis (distal to proximal)
73
Paraphimosis
- 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
Peyronie Disease
- "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
Priapism
- Prolonged penile erection, not associated with sexual arousal - Urologic emergency
76
Varicocele
- "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
Hydrocele
- 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
Spermatocele
- 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
Intrascrotal Disorders
- Vericocele - Hydrocele - Sermatocele - Cryptorchidism - Testicular Torsion - Epididymitis - Testicular Cancer
80
Cryptorchidism (Cryptorchism)
- 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
Testicular Torsion
- 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
Epididymitis
- 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
Testicular Cancer
- 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
Benign Prostatic Hyperplasia
- 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
Prostatitis
- Inflammation of the prostate - Similar symptoms to BPH - Caused by: ascending infections, recurrent UTIs - Can cause fibrosis of the prostate
86
Prostatic Cancer
- 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
STIs/STDs
- 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
Gonorrhea
- 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
Syphilis
- 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
Syphilis Primary Infection
- 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
Syphilis Secondary State
- 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
Syphilis Tertiary Stage
- 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
Syphilis Congenital Infections
- 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
Chlamydia
- 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
Herpes Simples I & II
- 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
Condylomata Acuminata
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
HPV and Cervical Cancer
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
Trichomoniasis
- 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
Scabies
- 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
Pediculosus Pubis
- AKA "crabs" - Phthirus pubis - Primarily transmitted sexually - Causes mild to severe pruritus - Lice and nits are visible to the unaided eye
