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Pathology Block 2 Flashcards

1
Q

What are the known teratogenic causes of congenital heart diseases?

A

Chemical- ETOH= Septal
TORCH- Rubella= PDA
Genetic- Tri21= Both

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2
Q

What is the most common congenital heart disease?

A 
Septal defects (Ventrical Septal defect most common)
L to R shunt
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3
Q

Atrial Septal Defects are caused by what two things?

A

Patent Foramen Ovale

Incomplete septal formation

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4
Q

What are the four parts of Eisenmengers Syndrome in VSD

A 
Inc blood volume and pressure cause:
RVH
Pulmonary HTN
Inc pulmonary resistance
Blood pushed back R/L ventricle
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5
Q

What are the two characteristics of shunts during Eisenmengers Syndrome

A

L to R- reverses

R to L- cyanosis

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6
Q

Septal defects causes what type of auditory identifiable noise?

A

Systolic murmur

Best heard at L sternal border- tricuspid or pulmonic

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7
Q

What type of murmur is heard w/ Patent Ductus Arteriosus

A

Machinery-like- continuous/inc with diastolic phase

Best heard at L sternal border

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8
Q

Patent Ductus Arteriosus is often associated with a _____

A

Thrill

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9
Q

What parts of Esenmengers Sydrome are evident with Patent Ductus Arteriosus

A

Aortic back flow
Pulmonary HTN
Pulmonary HTN causes back flow to aorta
Cyanotic L to R shunt

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10
Q

How are newborns treated for Patent Ductus Arteriosus

A

NSAIDs- prostaglandin inhibitor

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11
Q

What is the most common cause of cyanosis in neonates?

A

Tetralogy of Fallot

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12
Q

Tetralogy of Fallot is AKA ? with ? spell

A

Blue Babies

Tet Spells

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13
Q

Tetralogy of Fallot is a complex malformation with what four typical lesions and which ones lead to cyanosis

A

Pulmonary valve stenosis
R ventricle Hypertrophy (c)
Ventricular Septal Defect (c)
Overriding aorta (c)

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14
Q

How is Tetralogy of Fallot fixed?

A

Surgery or death occurs prior to puberty

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15
Q

Where do coarctations of the aorta typically occur?

A

Distal to origin of L subclavian artery

Approximate site of ligamentum arteriosum

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16
Q

What are the clinical findings of a coarctation of the aorta?

A

BP differences upper/lower extremeties
Systolic ejection murmur at apex
Rib notching

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17
Q

Define Transposition of the Great Arteries and what is the risk of this

A

Great vessels are reversed at their origins

Incompatible w/ postnatal life

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18
Q

What causes more morbidity and mortality in Western society than any other disease?

A

Vascular/Ischemia related diseases

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19
Q

What are the two principle mechanisms of vascular diseases?

A

Narrowing- atherosclerosis, emboli

Weakening- aneurysm, fistula, varicosity

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20
Q

Define Bruit

A

Swishing sound with auscultation from atherosclerosis

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21
Q

What are the two parts of atherosclerosis manifestations?

A

Chronic narrowing- bruit, ischemia, angina, claudication

Acute- infarction

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22
Q

What are the 3 red flags of claudication?

A

Pain at rest
Skin ulcers
Dependent rubor

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23
Q

What are the two types of angina?

A

Stable/Predicatble- pain stops with rest or after Nitro

Unstable- pain at rest, not stopped with Nitro

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24
Q

Define Prinzmetal Angina

A

Angina variant, coronary artery spasm causing transient ischemia, not from obstruction
Chest pain @ rest/sleep w/ smoking as factor

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25
What are the four classic symptoms of MI
Chest pain Radiation to L jaw/arm Dyspnea Syncope
26
How does a MI show on an EKG?
ST elevation
27
What are the four cardiac markers?
Troponin 1- most sensitive/specific, 2-6hrs CK-MB- k- brain, m- muscle, 3-12hrs Myoglobin A- 1-2hrs Alaninaminotransferase/LDH- day 2 to wks later
28
What are the 3 common sites for aneurysm development? | What size is at risk for rupture?
Abdominal aorta Iliac artery cerebral artery Greater than 1.5 normal size
29
Define True Aneurysm | Define Pseudo Aneurysm
True- all 3 layers of artery involved | Pseudo- not all layers are involved
30
Aortic dissections create a second lumen between what layers?
Intima and Media
31
Aortic dissections start in ____ and can be seen on ____
Aortic arch | Widened mediastinum x-ray
32
Define Saccular aneurysm and what is it associated with
Cerebral aneurysm- Berry aneurysm in Circle of Willis | HTN
33
What are the classic S/Sx of a Cerebral Aneurysm
Tunderclap headache | Worst ever
34
AAA are more likely to rupture if its greater than what size?
5cm | High mortality with rupture, 50% still die in OR
35
Define Arterio-Venous Fistula
Channel connecting hollow organs/cavity
36
What will be found on examination for Arterio-Venous Fistulas?
Palpation will feel thrill | Auscultation will hear bruit
37
What are the 4 causes of fistulas?
Congenital- brain, lung, skin Inflammation- Chrons Dz Trauma Surgical- hemodialysis
38
How are varicose veins saved from direct damage?
Atherosclerosis | HTN
39
What are 3 complications of varicose veins?
Thrombophlebitis Stasis dermatitis Stasis ulcer
40
What are the S/Sx of Giant Cell Arteritis
Unilateral temporal headache Unilateral blurry vision Unilateral jaw claudication
41
How is Giant Cell Arteritis diagnosed? | How is it treated?
Elevated erythrocyte sedimentation rate for elevated CRPs | Corticosteroids
42
What type of issue is Raynauds Disease?
Functional disturbance causing vasospasms
43
What is the sequence of colors that skin turn during Raynaud's Phenomenon
White Blue Red
44
Raynaud's Disease is associated with what predisposing factors?
``` Smoking Autoimmune (lupus) Atherosclerosis Occupation Drugs ```
45
What are the 3 determinant of BP?
Volume CO Vascular resistance
46
What are the contributing factors of HTN?
Genetics Age Lifestyle Diet
47
What are the contributing factors of Secondary HTN?
Disease- apnea Medication- Physiologic events- pregnancy
48
What are the 3 types of cardiomyopathy?
Dilated- ETOH Hypertrophic- chronic HTN Restrictive- scar tissue
49
How is cardiomyopathy treated?
Hear transplant
50
What are 3 causes of cardiomegaly?
Conditioning MI injury Chronic HTN
51
Why does the left ventricle become non-compliant with cardiomegaly?
Ischemia | Fibrous changes
52
What is the sequence of events leading to right sided heart failure from cardiomegaly?
Ischemia/fibrous leads to LV non-compliance, back pressure in pulmonary vein causes RV to dilate and fail due to pulmonary HTN
53
Define Cor Pulmonale
R sided heart failure due to pulmonary HTN
54
What are the common causes of CHF?
HTN Valve Dz Ischemia Cardiomyopathy
55
Rheumatic Heart Dz arises from what?
Immune response to Streptococcal infection | Abs react with PTs cells damaging CT in heart/joints/brain
56
Rheumatic Heart Disease can have an onset as quick as ?
Two weeks after Strep Throat
57
Where does endocarditis effect and what issue does it cause?
Left valves | Vegetations and fibrous scars on valves causing stenosis or regurgitation
58
When are Aschoff Bodies found?
Myocarditis from Rheumatic Heart Disease | Lymphocytes and macrophages destroying myocardium
59
Severe cases of Rheumatic Heart Disease tends to effect what layer of the heart?
Pericardium, causes pericardial effusion and fluid build up
60
What are the Major Criterias for Jones' RF criteria?
``` Polyarthritis Carditis Chorea Subcutaneous nodules Erythema Marginatum ```
61
Bacterial Endocarditis is AKA?
Infective endocarditis
62
What is the difference in appearance between RHD and Bacterial Endocarditis?
Bacterial causes larger vegetations than RHD, vegetation forms pocket for bacteria and thromboemboli
63
What are the 3 risk groups for bacterial endocarditis?
IV drug users Prosthetic/Heart valves RHD
64
What are the clinical characteristics of bacterial endocarditis?
Rapid onset febrile illness Cardiac murmur Arterial emboli- splinter hemorrhage, Janeway Lesion
65
Myocarditis is usually caused by ?
Viral- coxsackie or enterovirus Occasional parasite- Chagas Rare- RF, SLE
66
How does the heart get damaged during myocarditis?
T lymphocytes are attracted to infected cells that secrete cytokines to kill invaders but damages heart in process
67
What are the clinical features of myocarditis?
Vague, non-specific Sx | Delayed Diagnosis
68
Pericarditis is often associated with what other conditions?
Myocarditis Autoimmune- RHD, SLE Trauma
69
What are the clinical features of pericarditis?
Acute-> tamponade, prevent proper filling during diastole | Chronic- water bottle silhouette sign on x-ray, friction rubbing
70
URIs are AKA and are usually caused by ?
Common Cold | Rhino Virus
71
What are the clinical features of URIs?
Acute inflammation of nose, throat, sinus w/ rhinorrhea Non-productive cough Low fever Sx for 2-3 days, 7-10 day resolution
72
Middle Respiratory Syndromes are diseases of what structures? What PT population is it most common in?
Larynx, Trachea, Major bronchi Children
73
What are the three main types of middle respiratory syndromes?
Croup Epiglottitis Bronchiolitis
74
What is the medical term for the Croup
Laryngotracheobronchitis
75
The Croup usually affects what PTs and is caused by ? microbe?
Children under 3 y/o | Parainfluenza or Adeno
76
When are the S/Sx of the Cropu the worst?
Last day of infection
77
What are the clinical features of the Croup?
Barking cough, worse at night | Steeple sign on C-spine x-ray
78
What is the treatment for the Croup?
Supportive Oral steroids Nebulized epi (racemic)
79
What PTs are susceptible for eipglottitis and by what microbe?
School age/Early teens HIB w/out vaccine Strep/Staph w/ vaccine
80
What are the clinical presentations of epiglottitis?
Rapid onset fever Painful swallowing/drooling Sniffing position Thumbprint sign on C-spine
81
What is the treatment for Epiglottitis?
Admission, abx, steroids Intubation possible HIB vaccine
82
What PTs are susceptible to bronchiolitis and by what microbe?
Under 2y/o w/ winter outbreaks | Respiratory Syncytial Virus- kills cells and narrows lumen
83
What are the clinical features of bronchiolitis?
Wheezing Forceful cough Low grade fever
84
Define Stridor | Define Wheeze
S- high pitched inspriation | W- course expiration
85
What are the two types of pneumonia
Alveolar- broncho/lobar pneumonia (bacterial) | Interstitial- Bilateral, diffuse, reticular (viral/atypical)
86
What is the difference between Primary/Community Acquired and Secondary Pneumonia
Community- healthy get it from the community Secondary- nosocomial
87
What are the pathogens for bacterial pneumonia?
Strep Pneumo- +50% of cases HIB Staph- rare, lung abscesses Klebsiella- currant jelly, aspiration/alcoholics Pseudo Aeruginosa- most common nosocomial/intubated
88
What are the pathogens of walking pneumonia?
Mycoplasma | Barracks, dorms, work crews and remains for weeks/months
89
What are the clinical features of common pneumonias?
Fever/chills- high w/ bacteria, low with viral/atypical Dyspnea/Tachypnea- dec O2 Chest pain with cough/deep breath Rales/rhonchi Localized infiltrates on x-ray High CBC w/ bacteria, normal/mild WBC elevation with viral
90
Pulmonary exposures to fungal pnemonias rarely causes S/Sx in what type of PT?
Immuno-competent
91
Where are fungi endemic?
Soil Construction Landscape Farming
92
How do fungal pneumonias present clinically?
Fatigue HAs Muscle/joint pain Solitary nodule -> calcified granuloma
93
What are the pathogenesis of fungal pneumonias and which ones are the most common?
Histoplasmosis*- bird shit Coccidiomycosis*- valley fever Pneumocyctits jiroveci- AIDS
94
HIV PTs may get secondary fungal pneumonia from ? microbes?
Candida | Aspergillus
95
How do fungal pneumonias appear on chest x-rays?
Coin lesion | Multiple nodules
96
What did the Greeks call TB?
Consumption
97
What type of microbe is TB?
Acid-fast bacillus
98
What is Primary TB?
PTs first encounter Ghon complex Granuloma calcifies and TB is dormant
99
What is Secondary TB?
Reactivation/reinfection TB is uncontained Causes apical penumonias
100
When is a TB PT highly contagious?
PT coughing up TB | Bilateral dissemination
101
How can TB Pts die?
Pulmonary vessel rupture
102
How is Pulmonary TB diagnosed?
Clinical S/Sx | +PPD
103
How does Pulmonary TB present in Primary and Secondary TB
1*- mild, low fever, 95% not diagnosed | 2*- non productive dry cough, low fever, hemoptysis and dyspnea late signs
104
How long does a Pulmonary TB sputum test take to culture?
4 wks
105
Positive PPD is what type of response?
T-cell mediated
106
Pulmonary TB can have what 3 x-ray signs?
Hilar lymphadenopathy Ghon complex Apical Pneumonia
107
How are lung abscesses identified?
Localized destructive suppurative lesion
108
How do lung infections present clinically?
Suppurative lesion Malodorous productive cough Fever
109
What are the main causes of lung abscesses?
Staph Aureus Klebsiella Aspiration
110
How do lung abscesses appear on x-rays?
Air-fluid level
111
What is the Pack year Hx equation
of packs per day X # yrs smoked
112
COPD PTs have a decreased expiratory volume called?
Dec FEV1
113
COPD volume is ___ and but take longer to ___
Less than normal | Exhale
114
What are the 3 entities of COPD
Chronic bronchitis Bronchiectasis Emphysema
115
What two processes of chronic bronchitis decreases airway diamete?
Metaplasia | Hyperplasia
116
What is a common complication of chronic bronchitis?
Bronchiectasis- permanent dilation of bronchioles from repeated inflammation and fibrous scarring
117
When is emphysema seen in non-smoking PTs?
Genetic deficiency of A1-antitrypsin
118
Define an Asthma Attack
Bronchospasm w/ dyspnea Wheezing Cough Bronchi have chronic inflammation and inc mucus
119
What is the treatment goal for asthma?
Reducing bronchospasms and inflammation
120
How is mast cell degranulation reduced in asthmatics?
Antihistamines | Leukotrienes inhibitors
121
How are bronchospasms reduced in asthmatics? | How is bronchial inflammation reduced?
Bronchodilators | Inhaled steroids
122
Intrinsic asthma is AKA?
Adult onset since there no immune mechanism/non-atopic
123
Define Extrinsic Asthma
Type 1 Hypersensitivity, atopic response to allergen exposure Childhood onset
124
Extrinsic asthma involves immune responses with what cells?
IgE | Mast
125
Both intrinsic and extrinsic asthma share what similar issue?
Airway constriction
126
What type of disease is Sarcoidosis
Granulomatous dz | T-lymphocytes infiltrate lungs forming granulomas w/o necrosis
127
What is the incidence rate of Sarcoidosis?
10x more in blacks | 2x more often in women
128
What are the clinical features of Sarcoidosis?
50% w/out Sx | Low fever, anorexia, fatigue
129
How does Sarcoidosis appear on chest x-rays? | How is diagnosis confirmed?
Pulmonary nodules and hilar lymph nodes resembling pulmonary edema Biopsy of granulomas
130
Define ARDS
Collection of lung changes after acute lung injury (capillary or aveolar endothelium) Alveoli fill with fluids or collapse preventing gas exchange
131
How do ARDS present in clinical features?
Severe respiratory distress and hypoxia
132
Define Neonatal Respiratory Distress Syndrome
Micro-atelectasis due to surfactant production not startin until 24-28wks of pregnancy
133
Define Pneumoconiosis
Disease caused by inhaling mineral dusts/fumes
134
Coal Worker's Disease is AKA? | What happens in this disease?
Anthracosis Black Lung Disease C particles build and cause lung destruction/fibrosis
135
Define Silicosis and its cause
Silica crystals from mining/stone work lodging in lungs and killing macrophages leading to fibro-nodular lesions in lung tissue
136
What is the only form of Pneumoconiosis that is a predisposing factor to lung cancer?
Asbestosis -> Mesothelioma
137
What type of laryngeal carcinomas occur most?
Glottic tumors
138
Laryngeal carcinomas are linked to what 3 things?
Smoking Chronic alcohol Rare- radiation treatment for neck cancer
139
What is the leading cause of cancer deaths in males and females across the US?
Lung carcinomas | 90% of smokers under 40, 70% will have metastesized at time of diagnosis
140
What are the 4 types of primary lung cancers?
Adenocarcinoma Small cell Squamous Large cell
141
Characteristics of Small Cell tumors
Aggressive | Treat w/ chemo only
142
Characteristics of Non-Small cell tumors
Treated with surgery and chemo/radiation
143
How doe lung carcinomas present clinically?
Coughing from irritation | Extensions into mediastinum/pleural cavity cause dyspnea
144
Lung ____ are more common than primary lung tumors
Metastases due to capillary network making lungs more prone to hematogenous spread
145
Lung metastases have what distinct x-ray image?
Cannonball lesions
146
Upper GI tract = ? | Lower GI tract =?
Upper- Mouth to duodenum | Lower= Treitz to anus
147
What is the difference between Visceral and Parietal pain?
Visceral: Vague, cramp, Colicky spasm preventing PT from sitting still Parietal: Pin point, PT guards and remains still
148
What causes the different pain in visceral and parietal pain?
Visceral- stretching of unmyelinated fibers | Parietal- irritation of fibers innervating lining above pain source
149
When do cleft lip/palate form in pregnancy?
1st trimester
150
Cleft lip or palate are genetic issues with what three predisposing risk factors?
Smoking DM Seizure meds
151
Cleft lip generally occurs where on the mouth?
Left of the philtrum, from nasal base to upper gum line
152
What are the characteristics of Aphthous Ulcers?
Immune link seen in PTs under 20y/o | Ulcerations on inner mucosal surfaces w/ gray/white center
153
What are the characteristics of Cold Sores?
HSV Type 1, vesicles on oral exterior surfaces
154
How are the chances of developing dental caries reduced?
Dental care | Flouridation
155
Define Periodontal Disease
Inflammation of gingiva and lining extending into root resulting in MORE tooth loss than all other dental Dzs combined
156
How does preiodontal disease progression present?
Gums red and tender | Tooth becomes looser and dies
157
Define Sialadentis
Inflammation of major salivary gland (Mumps, Staph/Strep, Sjogrens Synd)
158
Define Sialothiasis
Stone formation in salivary duct
159
What form of Sialadentis presents with foul tasting discharges?
Bacterial
160
What two conditions can present with painful swollen salivary glands?
Sialorrhea | Xerostomia
161
What is the treatment for salivary gland diseases?
Acute cases with sour products to stimulate salivation
162
Define Esophageal Atresia
Congenitally incomplete lumen, esophagus doesn't communicate with stomach Usually fistula present
163
How does a Tracheo-Esophageal fistula present in babies?
Frothy/white bubbles Coughing/choking while feedings Vomiting Aspiration
164
What is the most common variation of esophageal atresia and tracheo-esophageal fistula?
Atresia with distal fistula
165
Define Achalasia
Failure to relax | Disordered peristalsis, incomplete relaxation, high sphincter pressure
166
Achalasia has an unknown etiology except for?
Chagas (Trypanosoma)
167
What are the clinical features of Achalasia?
Dysphagia for fluids and liquids Regurgitating undigested food Bird Beak appearance on x-ray
168
What are the three types of esophageal diverticulum?
Zenker- upper esophagus, most common Midthoracic- traction on esophagus Epiphrenic- directly above diaphragm
169
How do esophageal diverticulum present clinically?
Difficult/painful swallowing Regurgitating food when bending/lying/standing Chronic bad breath and cough
170
What causes hiatal hernias?
High intrabdominal pressures
171
What are the two types of hiatal hernias?
Sliding- stomach slides through hiatus forcing gastroesophageal junction into the chest Rolling- para-esophageal, fundus rolls up next to esophagus leaving gastroesophageal junction in abdomen but stomach can become strangulated
172
GERD is AKA?
Peptic Esophagitis
173
Esophageal sphincter tone can be compromised by what two things or decreased by ?
Compromised by pregnancy or hiatal hernia | Reduced by smoking, caffeine, acidic/citrus
174
What are the clinical features of GERD?
Water brash Recurrent heart burn Chronic cough Sx worse at night and after meals
175
Barretts Esophagitis is predisposed by what two risk factors?
Smoking | Alcohol
176
What is the sequence of cell changes in Barrett's Esophagitis
Metaplasia Dysplasia Neoplasia Cancer
177
Define Mallory-Weiss Syndrome | What can cause this?
Esophageal tear near gastroesophageal junction from alcohol abuse or forced retching
178
How does pyloric stenosis present
Projectile vomiting immediately after feeding
179
What are the characteristics of Acute Gastritis | Can the stomach recover from this?
Decreased gastric blood flow Increased acid production Exogenous irritants Stomach can recover if blood flow returns or acidity neutralizes
180
What are the characteristics of Chronic Gastritis?
Autoimmune from pernicious anemia | Infection- H. pylori
181
How do NSAIDs cause Gastritis
Inhibit prostaglandin synthesis reducing mucous blood blow and BiCarb production
182
What are the clinical features of NSAID Gastritis?
Vague epigastric pain Dyspepsia (indigestion) Vomiting
183
How is NSAID Gastritis treated?
H2 blockers | PPI
184
What happens in the stomach if a PT has Auto-Immune Gastritis?
Decreased IF which inhibits absorption of B12
185
A PT with autoimmune gastritis will present with what underlying issue?
Pernicious anemia w/ megaloblastic RBCs
186
How will autoimmune gastritis present clinically?
Nonspecific neurologic Sx: numbness, tingling, weakness, clumsiness
187
PTs wil autoimmune gastritis will have what type of CBC report?
Macrocytic RBCs | Hypersegmented WBCs
188
What is the most common cause of non-erosive gastritis and peptic ulcer disease?
H. Pylori
189
What are the 4 predisoposing factors of Infectious Gastritis (H pylori)?
Smoking Emotional stress Alcohol Steroid
190
PT that is unresponsive to standard GERD or ulcer treatments need to be evaluated for ? issue
Infectious gastritis
191
How is Infectious Gastritis diagnosed? | What is a residual issue with it's confirmation?
Biopsy or Urea Breath test | Once pos, always pos
192
Duodenal ulcers are __ times more common than gastric ulcers?
4x | More likely in +50y/o
193
Peptic Ulcer disease is often associated with ? infection
H pylori
194
How do peptic ulcers present clinically?
``` Shallow= vague pain and dyspepsia Deep= melena or hematemesis Perforation= peritonitis, pnemoperitoeum, pancreatitis ```
195
What are the differences between PUD presentations?
Inner wall of duodenum/stomach= pain w/out bleeding/perf Bleeding when ulcer erodes into vessel, occult stool blood(slight) or melena/hematochezia (heavy) Perforation= no blood vessel involved so no bleeding is evident
196
Define Hirschsprungs Disease
Similar to Achalasia Process Congenital lack of innervation at sigmoid/rectum No innervation=permanent spasm=mechanical obstruction=megacolon
197
How is Hirschsprungs Disease presented clinically?
Stool/fecal liquid expelled forcefully Overflow diarrhea Failure to thrive Abdominal swelling
198
Define Meckel's Diverticulum
Outpouching of small bowel from remnant of intestine/umbilical connection
199
What is the Rule of 2s for Meckel's Diverticulum
2% of population Withing 2 feet of ileocecal valve 2 mucosa- gastric and pancreatic
200
Meckel's Diverticulum is a failed form of what cell process?
Apoptosis
201
Meckel's Diverticulum S/Sx can resemble what other issue?
Appendicitis
202
What is the difference between Diverticulosis and Diverticulitis?
osis- condition/presence of diverticula | itis- inflammed/infected diverticula
203
How do Colonic Diverticulosis pathogenesis form?
Low fiber and sedentary | High intra-colon pressure causing fecal matter to get trapped
204
What is the incidence of Colonic Diverticulosis?
Common in industrial nations where diets are high in fiber; tend to be asymptomatic
205
How does Colonic Diverticulitis present clinically?
LLQ pain- most common Sx Fever Leukocytosis Tenesmus
206
How is un/complicated colonic diverticulosis
Uncomp- Bowel rest, ABX | Comp- Surgery after one complicated or multiple uncomplicated
207
Hemorrhoids are AKA
Piles
208
Acute Ischemic Bowel Disease is aka?
Mesenteric Ischemia
209
How does Ischemic Bowel Disease present?
Sudden GI bleeding/Sepsis Postprandial pain Pain out of proportion to exam
210
How does Chronic Ischemic Bowel disease presnt?
Atherosclerosis w/out occlusion Food Fear Postprandial pain w/ 10-30m onset and peaking at 1-3hrs
211
IBS includes what two diseases?
Crohns and Ulcerative Colitis
212
What are the similarities of IBS?
``` More common in Caucasian Peak onset 20-30y/o Familial Inflammatory mediators Altered microbiomes ```
213
Crohn's Disease is a ___ Dz
Right sided, mostly in terminal ileum and proximal colon involving all 3 layers of intestine
214
How does Crohn's disease present on x-ray?
Skip lesions | Cobble Stone
215
Ulcerative Colitis is a __ Dz
Left sided in colonic mucosa
216
How does ulcerative colitis present on imaging?
Sandpaper- friable Pseudopolyps Toxic megacolon
217
How does Ulcerative Colitis present in clinic?
Cycle of Sx to no Sx | Diarrhea, rectal bleeding, abd pain
218
Rotavirus affects ___y/o | Norwalk affects ___ populations
6mon-2yrs | Ships, nursing homes, delpoyed
219
S/Sx of rotavirus | S/sx of norwalk
Watery diarrhea | N/V, diarrhea, abd pain
220
VGE includes what two microbes?
Rotavirus | Norwalk virus
221
Bacterial Diarrhea is AKA and includes what two microbes?
Enteritis | Bacteria toxins/lytic action
222
Difference between toxic and lytic enteritis?
Toxic- food poisoning by Staph A, E Coli, Vibrio from seafood Lytic- invades mucosa, yersinia, Campylobacter or Salmonella/Shigella
223
What are the clinical features of appendicitis?
Vague peri-umbillical pain to RLQ @ What iMcBurney's Pt
224
What are the two classifications of peritonitis?
Infectious- rupture | Sterile/chemical- pancreatic enzyme, bile, post surgical
225
Sterile Peritonitis healing often occurs with what side effect?
Fibrous Adhesions
226
What is the key Sx of peritonitis?
Rebound tenderness
227
Ileus is associated with what two diseases?
Peritonitis | Spinal cord injury
228
Ileus is often seen after ___
Surgery | Causes lack of emulsion and seen by air-fluid level on x-ray
229
What is the most common form of bowel obstruction?
Inguinal hernia
230
Define Intussusception
One segment of bowel telescopes into adjacent segment
231
How does Intussusception present?
Intermittent/colicky ab pain
232
Define Volvulus
Bowel twists itself in middle aged/elderly PTs
233
Define Celiac Sprue
Gluten sensitive intropathy
234
Define Tropical Sprue
Bacterial pathogen in tropical travelers
235
Define Whipple Disease
Rare overgrowth of Tropheryma Whipple in small bowel causing malabsorption
236
Most cancers of the oral cavity/tongue are what type of cell?
Squamous
237
What type of cells are seen in upper/middle carcinoma and lower esophagus?
Upper/middle- squamous | Lower- adenocarcinoma (Barretts precursor)
238
Gastric Neoplasm is usually from ? and is featured by ? sensation
H Pylori | Early satiety
239
Intestinal neoplasms start as ? and 95% are ?
Polyps | Adenocarcinomas
240
How do intestinal neoplasms present in clinic?
Occult bleeding Weight loss Constipation
241
What gives feces the brown color?
Bilirubin processed into stercobilinogen
242
Jaundice is a ______ not a ____
Manifestation of hyperbilirubinemia | Not a disease
243
When do jaunidce symptoms become evident?
>3mg
244
What are 3 causes of jaundice?
Pre-hepatic- elevated indirect/unconjugated bilirubin Heptaic- elevated indirect/unconjugated bilirubin Post-Hepatic- direct conjugated bilirubin
245
Define Pre-Hepatic Jaundice
Inc bilirubin production | Malaria, sickle, anemia
246
Define Hepatic Jaundice
Impaire uptake/conjugation in liver Hepatocellular Hepatocyte injury or Gilberts Dz/Tylenol OD
247
Define Post-hepatic Jaundice
Decreased excretion of conjugated bilirubin Cholestatis Gallstone obstruction
248
How does cholestatis appear clinically?
Alcoholic feces- pale/cream colored feces | Brown foamy urine
249
What viruses can cause hepatitis?
A B C D E | Epstein Barr, Herpes, Cytomegalo
250
What are the 3 phases of hepatitis?
Acute- w/ or w/out jaundice Chronic- may transmit, possible cirrhosis Fulminant- necrosis, fatal
251
What are the 3 phases of Hep B
Preicteric- weak, jaundice Icteric- jaundice w/ elevated liver enzyme Convalescent- most recover
252
What form of hepatitis has "blood and body fluid" transmission?
Hep B
253
What is the hallmark of Hep C?
Persistant/chronic infection
254
``` Hep A transmission route Hep B route Hep C route Hep D route Hep E route ```
``` Fecal-oral Blood and body fluid Blood transmission Blood and body fluid Fecal-oral ```
255
Hep D is dependent on ?
Hep B co-infection | Higher progression to fulminant
256
Where is Hep E found in the world?
Asia Africa S. America
257
What are the ABCs of Cirrhosis?
Alcohol with Hep B and Hep C a close Second
258
Cirrhosis is synonymous for?
End stage liver Dz
259
What is the progression of portal cirrhosis?
Necrosis, fibrosis, nests of regenerating liver cells
260
Define Primary Biliary Cirrhosis
Autoimmune middle age women 30-65 | Scarring of bile ducts cause cirrhosis
261
Define Secondary Biliary Cirrhosis
Stone in bile duct
262
Define Sclerosing Cholangitis
Men under 40 | Ulcerative colitis
263
What is the term for Fattly Liver Diz
Steatohepatitis | Chronic alcohol causes increased FA production and altered cell membrane decreases lipid exportation
264
Non-ETOH Fatty Liver Dz is caused by ? 3 things?
Obesity DM HTN
265
Dilation of portal veins cause what 3 things?
Ascites- hypoalbuminemia Splenomegaly Venous congestion- esophageal varices, Caput Medusa
266
Portal vein is a confluence of what two structures?
Splenic vein | Superior mesenteric vein
267
How is Gilbert Syndrome identified?
Intermitent Jaundice
268
How is an Alpha1-Antitrypsin deficiency identifed?
Non-smoking emphysema
269
What are the characteristic findings of Hemochromatosis? How is it treated?
Pigmentary cirrhosis Bronze diabetes CHF Blood letting/Frequent phlebotomy
270
Copper eye ring of Wilson's Disease is AKA? | How is this treated?
Kayser-Fleischer ring Chelating agents
271
Difference between Cholelithiasis and Choledocholithiasis
thiasis- stones in gallbladder/biliary ducts | docho- stones in common bile ducts
272
What are gallstones that are yellow, black, or brown?
Yellow- cholesterol Black- bilirubin Brown- cholesterol and calcium
273
What are the 4 F's of cholesterol stones?
Forty Fat Fertile Female
274
What causes black bilirubin stones?
hemolytic Dz
275
What causes brown cholesterol and calcium stones?
Biliary parasites
276
Define Biliary Colic
Chronic cholecystitis | No fever or leukocytosis
277
How does acute cholecystitis present?
RUQ pain after fatty meal Fever and leukocytosis Murphys sign- exhale, press, inhale= pain
278
Hepatocellular carcinomas has what pathogenic origins?
Hep B and C | Chronic liver diseases
279
50% of all liver cancers produce ____ which is usefule for early diagnosis
Alpha-Fetoprotein
280
How does the pancreas excrete the exocrine juices?
Ampulla of Vatar Amylase- for starch and lipase Protease- protein
281
What are the exocrine cells of the pancreas? | What are the endocrine cells?
Acinar cells | Islets of Langerhans
282
What do A B and D cells of the pancreas produce?
A- glucagon B- insulin D- somatostatin and pancreatic peptide
283
How do gallstones cause acute pancreatitis? How does alcohol cause it?
Obstruction near Ampulla of Vater force bile into pancreas Damages acinar cells causing unregulated enzyme release
284
What are the 3 rare causes of pancreatitis?
Trauma Meds Hyperlipidemia
285
What kind of pain does pancreatitis present with?
Epigastric Boring through them Worse when supine, better sitting up
286
Define Cullens Sign | Define Grey/Turners Sign
Cullen- echymosis in periumbilical region Grey- ecchymosis in posterior flanks
287
What lab result will be altered in pancreatitis?
Serum lipase 3x normal
288
What are some compliations of Pancreatitis?
Peritonitis Pseudocyst Abscess Transient DM
289
Chronic pancreatitis is usually seen in what PT population?
Middle age men w/ alcohol abuse
290
What is the treatment for mild pancreatitis?
Pancreatic rest, no ETOH | NPO or clear liquids only for 48hrs
291
What are the requirements to discharge a PT home who has mild pancreatitis?
PO tolerant | Pain controlled
292
How does pancreatic adenocarcinoma present?
Smokers Older males w/ jaundice Weight loss New onset DM
293
What are the two types of Islet Cell tumors?
Insulinoma- B cell tumor causing hypoglycemia Gastroinoma- reverts cells to revert back to fetal function
294
Define Zollinger Ellison syndrome
Excess gastric acid and intractable peptic ulcers (refractory to standard ulcer meds)
295
What are the meanings of the roots of diabetes mellitus?
Diabetes- to pass through | mellitus- sweet
296
DM is a disturbance in what two things
Insulin deficiency | Insulin resistance
297
What are the two classifications of DM?
Type 1- insulin dependent/juvenile-onset Type 2- non-insulin dependent/adult onset
298
What are the two subgroups of Type 1 DM?
1A- autoimmune destruction | 1B- virus damage
299
What are the two primary defects of Type 2 DM?
Peripheral tissue resistance to insulin | Declining B cell secretion
300
Serum insulin levels in Type 2 DMs will be ?
Normal
301
What are the Polys of DM?
Plyuria Polydipsia Plyphagia
302
Fasting glucose should be above ?
126mg | Pre-Diabetic= 110-125
303
What are the long term risks of DM?
Atherosclerosis Renal ischemia Retinopathy Peripheral neuropathy
304
What is normal urine production amount? | What is normal GFR?
1.5L/day | 90-120ml/min
305
Define Azotemia
Uremia | BUN elevation from decreased excretion into urine caused by decreased GFR
306
Define Acute Renal Failure
Oliguria or Anuria often with azotemia
307
What can cause renal failure?
Glomerular or intestinal injury (acute tubular necrosis) | Trauma directly doesn't cause it, resulting shock does
308
What are the characteristics of a Solitary Kidney?
1 : 800 mostly males, usually L is missing or Horseshoe Kidney
309
What are three causes of Glomerular Diseases?
Immunologic Dz Metabolic Disorder Circulatory disturbances
310
What are the characteristics of Nephritic Syndrome?
Ritic- HTN, Hematuria Edema, proteinuria, hypoalbuminemia Acutely caused post glomerulonephritis/lupus
311
What are the characteristics of Nephrotic Syndrome?
No HNT or Hematuria Membranous nephropathy Focal glomerulosclerosis Lipoid nephrosis
312
What causes Acute Glomerulonephritis?
Post Strep Glomerulonephritis after GBAHS | Ag-Ab trapped in basement membrane
313
Acute Glomerulonephritis is what type of glomerular disease?
Nephritic HTN and Hematuria Facial edma and Oliguria
314
What is the most common examples of crescentic glomerulonephritis
Goodpasture Syndrome
315
Crescentic glomerulonephritis is what type of glomerular disease?
Nephritic
316
Membranous nephropathy is what type of glomerular disease?
Nephrotic Most common nephrotic syndrome in kids Hyperlipidemia Lipiduria
317
What is the most common nephrotic syndrome in adults?
Focal Segment Glomerulosclerosis
318
What is the most important metabolic disease that affects the kidneys?
DM
319
Thickening of glomerular membranes from DM causes what 3 changes?
Increased permeability- proteins leak out Renal ischemia/papillary necrosis Polynephritis
320
What are the 4 main types of stones?
Ca- 75% Struviate- Staghorn calculi (chronic UTIs and prone to urosepsis) Uric acid- gout Cystine- metabolic error
321
Symptoms of renal stones are dictated by what two things?
Size | Location in tract
322
Migrating kidney stones trigger what events?
Renal colic- wrap around pain Flank pain hematuria
323
Stone size less than __ mm have a __ pass rate
5 | 98%
324
What is the most common site of obstruction by kidney stones?
Ureterovesical junction | Blockage causes secondary UTIs and pyelonephritis
325
Define hydronephrosis
Renal pelvis and calyces dilate due to increased urine pressure due to outflow obstruction
326
Hydronephrosis is a common sequel to _____ thus making it not a true ______
Stone obstruction | True metabolic renal disorder
327
What causes nephroangiosclerosis
Chronic hypoperfusion Atherosclerosis heavy scarring leads to renal insufficiency
328
1/3 of all end stage renal diseases are caused by ?
HTN resulting in chronic renal ischemia
329
What is the most common form of UTI?
Ascending
330
Descending UTIs are caused by what process?
Hemtagogenous spreading
331
What are the two common forms of UTIs
Cystitis | Pyelonephritis
332
What are the clinical features of Cystitis? | What must always be ordred with these Sx?
Frequency urgency Dysuria Urine culture
333
What is the treatment for UTIs?
Phenazopyridine | Pyridium or OTC Azo
334
What is the most common etiology of Polynephritis?
Ascending infections
335
Pyelonephritis w/ urethral obstruction is triaged as ?
Urological emergency
336
What are the S/Sx of pyelonephritis
CVA tenderness Fever/Chill N/V
337
What PT population has the highest risk for renal and bladder carcinoma?
Smokers
338
What is the most common type of renal cell carcinoma?
Clear cell
339
What is the red flag of renal cell and bladder carcinoma?
Painless hematuria
340
What are the clinical features of Acute Glomerulonephritis?
HTN Hematuria Edema on face Oliguria
341
What glomerular disease is Rapidly Progressive Glomerulonephritis?
Crescentic Glomerulonephritis
342
How is Crescentic Nephritis marked? | What is the resulting end point?
Severe damage with WBC exudate in urinary space Acute renal failure
343
What Immunologice Glomerular disease is in adults and kids?
Membranous- adults Focal- most common nephrotic syndrome in adults Lipoid- kids
344
How do Membranous and Focal Segmental appear in adults?
Membranous- Generalized edema and proteinuria Focal- Proteinuria and unresponsive to steroids
345
UTIs are usually caused by what type of microbes?
Gram Neg enteric bacteria
346
Pyelonephritis is inflammation of the entire kidney which includes what three parts?
Parenchyma Calyces Renal pelvis
347
Difference in PT populations for Renal Cell Carcinoma and Urinary Bladder Carcinoma?
Majority, middle aged men, clear cell most common UBC- Older, males more likely Earlier Sx onset, higher recurrence
348
How are RCCs diagnosed? | How are UBCs diagnosed?
US and CT | Cytoscopy and biopsy
349
Pancreatic Adenocarcinoma are ranked as # ?? for cancer related deaths in US
4 - 5
350
What type of pancreatic tumor is the majority of tumors?
Pancreatic head

IPAP (212 decks)

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