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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
Q

What are the four classic symptoms of MI

A

Chest pain
Radiation to L jaw/arm
Dyspnea
Syncope

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26
Q

How does a MI show on an EKG?

A

ST elevation

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27
Q

What are the four cardiac markers?

A

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

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28
Q

What are the 3 common sites for aneurysm development?

What size is at risk for rupture?

A

Abdominal aorta
Iliac artery
cerebral artery
Greater than 1.5 normal size

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29
Q

Define True Aneurysm

Define Pseudo Aneurysm

A

True- all 3 layers of artery involved

Pseudo- not all layers are involved

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30
Q

Aortic dissections create a second lumen between what layers?

A

Intima and Media

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31
Q

Aortic dissections start in ____ and can be seen on ____

A

Aortic arch

Widened mediastinum x-ray

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32
Q

Define Saccular aneurysm and what is it associated with

A

Cerebral aneurysm- Berry aneurysm in Circle of Willis

HTN

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33
Q

What are the classic S/Sx of a Cerebral Aneurysm

A

Tunderclap headache

Worst ever

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34
Q

AAA are more likely to rupture if its greater than what size?

A

5cm

High mortality with rupture, 50% still die in OR

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35
Q

Define Arterio-Venous Fistula

A

Channel connecting hollow organs/cavity

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36
Q

What will be found on examination for Arterio-Venous Fistulas?

A

Palpation will feel thrill

Auscultation will hear bruit

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37
Q

What are the 4 causes of fistulas?

A

Congenital- brain, lung, skin
Inflammation- Chrons Dz
Trauma
Surgical- hemodialysis

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38
Q

How are varicose veins saved from direct damage?

A

Atherosclerosis

HTN

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39
Q

What are 3 complications of varicose veins?

A

Thrombophlebitis
Stasis dermatitis
Stasis ulcer

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40
Q

What are the S/Sx of Giant Cell Arteritis

A

Unilateral temporal headache
Unilateral blurry vision
Unilateral jaw claudication

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41
Q

How is Giant Cell Arteritis diagnosed?

How is it treated?

A

Elevated erythrocyte sedimentation rate for elevated CRPs

Corticosteroids

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42
Q

What type of issue is Raynauds Disease?

A

Functional disturbance causing vasospasms

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43
Q

What is the sequence of colors that skin turn during Raynaud’s Phenomenon

A

White
Blue
Red

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44
Q

Raynaud’s Disease is associated with what predisposing factors?

A 
Smoking
Autoimmune (lupus)
Atherosclerosis
Occupation
Drugs
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45
Q

What are the 3 determinant of BP?

A

Volume
CO
Vascular resistance

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46
Q

What are the contributing factors of HTN?

A

Genetics
Age
Lifestyle
Diet

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47
Q

What are the contributing factors of Secondary HTN?

A

Disease- apnea
Medication-
Physiologic events- pregnancy

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48
Q

What are the 3 types of cardiomyopathy?

A

Dilated- ETOH
Hypertrophic- chronic HTN
Restrictive- scar tissue

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49
Q

How is cardiomyopathy treated?

A

Hear transplant

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50
Q

What are 3 causes of cardiomegaly?

A

Conditioning
MI injury
Chronic HTN

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51
Q

Why does the left ventricle become non-compliant with cardiomegaly?

A

Ischemia

Fibrous changes

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52
Q

What is the sequence of events leading to right sided heart failure from cardiomegaly?

A

Ischemia/fibrous leads to LV non-compliance, back pressure in pulmonary vein causes RV to dilate and fail due to pulmonary HTN

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53
Q

Define Cor Pulmonale

A

R sided heart failure due to pulmonary HTN

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54
Q

What are the common causes of CHF?

A

HTN
Valve Dz
Ischemia
Cardiomyopathy

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55
Q

Rheumatic Heart Dz arises from what?

A

Immune response to Streptococcal infection

Abs react with PTs cells damaging CT in heart/joints/brain

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56
Q

Rheumatic Heart Disease can have an onset as quick as ?

A

Two weeks after Strep Throat

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57
Q

Where does endocarditis effect and what issue does it cause?

A

Left valves

Vegetations and fibrous scars on valves causing stenosis or regurgitation

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58
Q

When are Aschoff Bodies found?

A

Myocarditis from Rheumatic Heart Disease

Lymphocytes and macrophages destroying myocardium

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59
Q

Severe cases of Rheumatic Heart Disease tends to effect what layer of the heart?

A

Pericardium, causes pericardial effusion and fluid build up

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60
Q

What are the Major Criterias for Jones’ RF criteria?

A 
Polyarthritis
Carditis
Chorea
Subcutaneous nodules
Erythema Marginatum
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61
Q

Bacterial Endocarditis is AKA?

A

Infective endocarditis

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62
Q

What is the difference in appearance between RHD and Bacterial Endocarditis?

A

Bacterial causes larger vegetations than RHD, vegetation forms pocket for bacteria and thromboemboli

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63
Q

What are the 3 risk groups for bacterial endocarditis?

A

IV drug users
Prosthetic/Heart valves
RHD

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64
Q

What are the clinical characteristics of bacterial endocarditis?

A

Rapid onset febrile illness
Cardiac murmur
Arterial emboli- splinter hemorrhage, Janeway Lesion

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65
Q

Myocarditis is usually caused by ?

A

Viral- coxsackie or enterovirus
Occasional parasite- Chagas
Rare- RF, SLE

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66
Q

How does the heart get damaged during myocarditis?

A

T lymphocytes are attracted to infected cells that secrete cytokines to kill invaders but damages heart in process

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67
Q

What are the clinical features of myocarditis?

A

Vague, non-specific Sx

Delayed Diagnosis

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68
Q

Pericarditis is often associated with what other conditions?

A

Myocarditis
Autoimmune- RHD, SLE
Trauma

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69
Q

What are the clinical features of pericarditis?

A

Acute-> tamponade, prevent proper filling during diastole

Chronic- water bottle silhouette sign on x-ray, friction rubbing

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70
Q

URIs are AKA and are usually caused by ?

A

Common Cold

Rhino Virus

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71
Q

What are the clinical features of URIs?

A

Acute inflammation of nose, throat, sinus w/ rhinorrhea
Non-productive cough
Low fever
Sx for 2-3 days, 7-10 day resolution

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72
Q

Middle Respiratory Syndromes are diseases of what structures?
What PT population is it most common in?

A

Larynx, Trachea, Major bronchi

Children

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73
Q

What are the three main types of middle respiratory syndromes?

A

Croup
Epiglottitis
Bronchiolitis

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74
Q

What is the medical term for the Croup

A

Laryngotracheobronchitis

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75
Q

The Croup usually affects what PTs and is caused by ? microbe?

A

Children under 3 y/o

Parainfluenza or Adeno

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76
Q

When are the S/Sx of the Cropu the worst?

A

Last day of infection

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77
Q

What are the clinical features of the Croup?

A

Barking cough, worse at night

Steeple sign on C-spine x-ray

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78
Q

What is the treatment for the Croup?

A

Supportive
Oral steroids
Nebulized epi (racemic)

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79
Q

What PTs are susceptible for eipglottitis and by what microbe?

A

School age/Early teens
HIB w/out vaccine
Strep/Staph w/ vaccine

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80
Q

What are the clinical presentations of epiglottitis?

A

Rapid onset fever
Painful swallowing/drooling
Sniffing position
Thumbprint sign on C-spine

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81
Q

What is the treatment for Epiglottitis?

A

Admission, abx, steroids
Intubation possible
HIB vaccine

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82
Q

What PTs are susceptible to bronchiolitis and by what microbe?

A

Under 2y/o w/ winter outbreaks

Respiratory Syncytial Virus- kills cells and narrows lumen

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83
Q

What are the clinical features of bronchiolitis?

A

Wheezing
Forceful cough
Low grade fever

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84
Q

Define Stridor

Define Wheeze

A

S- high pitched inspriation

W- course expiration

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85
Q

What are the two types of pneumonia

A

Alveolar- broncho/lobar pneumonia (bacterial)

Interstitial- Bilateral, diffuse, reticular (viral/atypical)

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86
Q

What is the difference between Primary/Community Acquired and Secondary Pneumonia

A

Community- healthy get it from the community

Secondary- nosocomial

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87
Q

What are the pathogens for bacterial pneumonia?

A

Strep Pneumo- +50% of cases
HIB
Staph- rare, lung abscesses
Klebsiella- currant jelly, aspiration/alcoholics
Pseudo Aeruginosa- most common nosocomial/intubated

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88
Q

What are the pathogens of walking pneumonia?

A

Mycoplasma

Barracks, dorms, work crews and remains for weeks/months

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89
Q

What are the clinical features of common pneumonias?

A

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

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90
Q

Pulmonary exposures to fungal pnemonias rarely causes S/Sx in what type of PT?

A

Immuno-competent

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91
Q

Where are fungi endemic?

A

Soil
Construction
Landscape
Farming

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92
Q

How do fungal pneumonias present clinically?

A

Fatigue
HAs
Muscle/joint pain
Solitary nodule -> calcified granuloma

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93
Q

What are the pathogenesis of fungal pneumonias and which ones are the most common?

A

Histoplasmosis- bird shit
Coccidiomycosis- valley fever
Pneumocyctits jiroveci- AIDS

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94
Q

HIV PTs may get secondary fungal pneumonia from ? microbes?

A

Candida

Aspergillus

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95
Q

How do fungal pneumonias appear on chest x-rays?

A

Coin lesion

Multiple nodules

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96
Q

What did the Greeks call TB?

A

Consumption

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97
Q

What type of microbe is TB?

A

Acid-fast bacillus

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98
Q

What is Primary TB?

A

PTs first encounter
Ghon complex
Granuloma calcifies and TB is dormant

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99
Q

What is Secondary TB?

A

Reactivation/reinfection
TB is uncontained
Causes apical penumonias

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100
Q

When is a TB PT highly contagious?

A

PT coughing up TB

Bilateral dissemination

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101
Q

How can TB Pts die?

A

Pulmonary vessel rupture

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102
Q

How is Pulmonary TB diagnosed?

A

Clinical S/Sx

+PPD

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103
Q

How does Pulmonary TB present in Primary and Secondary TB

A

1*- mild, low fever, 95% not diagnosed

2*- non productive dry cough, low fever, hemoptysis and dyspnea late signs

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104
Q

How long does a Pulmonary TB sputum test take to culture?

A

4 wks

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105
Q

Positive PPD is what type of response?

A

T-cell mediated

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106
Q

Pulmonary TB can have what 3 x-ray signs?

A

Hilar lymphadenopathy
Ghon complex
Apical Pneumonia

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107
Q

How are lung abscesses identified?

A

Localized destructive suppurative lesion

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108
Q

How do lung infections present clinically?

A

Suppurative lesion
Malodorous productive cough
Fever

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109
Q

What are the main causes of lung abscesses?

A

Staph Aureus
Klebsiella
Aspiration

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110
Q

How do lung abscesses appear on x-rays?

A

Air-fluid level

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111
Q

What is the Pack year Hx equation

A

of packs per day X # yrs smoked

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112
Q

COPD PTs have a decreased expiratory volume called?

A

Dec FEV1

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113
Q

COPD volume is ___ and but take longer to ___

A

Less than normal

Exhale

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114
Q

What are the 3 entities of COPD

A

Chronic bronchitis
Bronchiectasis
Emphysema

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115
Q

What two processes of chronic bronchitis decreases airway diamete?

A

Metaplasia

Hyperplasia

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116
Q

What is a common complication of chronic bronchitis?

A

Bronchiectasis- permanent dilation of bronchioles from repeated inflammation and fibrous scarring

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117
Q

When is emphysema seen in non-smoking PTs?

A

Genetic deficiency of A1-antitrypsin

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118
Q

Define an Asthma Attack

A

Bronchospasm w/ dyspnea
Wheezing
Cough
Bronchi have chronic inflammation and inc mucus

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119
Q

What is the treatment goal for asthma?

A

Reducing bronchospasms and inflammation

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120
Q

How is mast cell degranulation reduced in asthmatics?

A

Antihistamines

Leukotrienes inhibitors

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121
Q

How are bronchospasms reduced in asthmatics?

How is bronchial inflammation reduced?

A

Bronchodilators

Inhaled steroids

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122
Q

Intrinsic asthma is AKA?

A

Adult onset since there no immune mechanism/non-atopic

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123
Q

Define Extrinsic Asthma

A

Type 1 Hypersensitivity, atopic response to allergen exposure
Childhood onset

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124
Q

Extrinsic asthma involves immune responses with what cells?

A

IgE

Mast

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125
Q

Both intrinsic and extrinsic asthma share what similar issue?

A

Airway constriction

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126
Q

What type of disease is Sarcoidosis

A

Granulomatous dz

T-lymphocytes infiltrate lungs forming granulomas w/o necrosis

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127
Q

What is the incidence rate of Sarcoidosis?

A

10x more in blacks

2x more often in women

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128
Q

What are the clinical features of Sarcoidosis?

A

50% w/out Sx

Low fever, anorexia, fatigue

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129
Q

How does Sarcoidosis appear on chest x-rays?

How is diagnosis confirmed?

A

Pulmonary nodules and hilar lymph nodes resembling pulmonary edema

Biopsy of granulomas

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130
Q

Define ARDS

A

Collection of lung changes after acute lung injury (capillary or aveolar endothelium)
Alveoli fill with fluids or collapse preventing gas exchange

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131
Q

How do ARDS present in clinical features?

A

Severe respiratory distress and hypoxia

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132
Q

Define Neonatal Respiratory Distress Syndrome

A

Micro-atelectasis due to surfactant production not startin until 24-28wks of pregnancy

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133
Q

Define Pneumoconiosis

A

Disease caused by inhaling mineral dusts/fumes

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134
Q

Coal Worker’s Disease is AKA?

What happens in this disease?

A

Anthracosis
Black Lung Disease
C particles build and cause lung destruction/fibrosis

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135
Q

Define Silicosis and its cause

A

Silica crystals from mining/stone work lodging in lungs and killing macrophages leading to fibro-nodular lesions in lung tissue

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136
Q

What is the only form of Pneumoconiosis that is a predisposing factor to lung cancer?

A

Asbestosis -> Mesothelioma

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137
Q

What type of laryngeal carcinomas occur most?

A

Glottic tumors

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138
Q

Laryngeal carcinomas are linked to what 3 things?

A

Smoking
Chronic alcohol
Rare- radiation treatment for neck cancer

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139
Q

What is the leading cause of cancer deaths in males and females across the US?

A

Lung carcinomas

90% of smokers under 40, 70% will have metastesized at time of diagnosis

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140
Q

What are the 4 types of primary lung cancers?

A

Adenocarcinoma
Small cell
Squamous
Large cell

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141
Q

Characteristics of Small Cell tumors

A

Aggressive

Treat w/ chemo only

142
Q

Characteristics of Non-Small cell tumors

A

Treated with surgery and chemo/radiation

143
Q

How doe lung carcinomas present clinically?

A

Coughing from irritation

Extensions into mediastinum/pleural cavity cause dyspnea

144
Q

Lung ____ are more common than primary lung tumors

A

Metastases due to capillary network making lungs more prone to hematogenous spread

145
Q

Lung metastases have what distinct x-ray image?

A

Cannonball lesions

146
Q

Upper GI tract = ?

Lower GI tract =?

A

Upper- Mouth to duodenum

Lower= Treitz to anus

147
Q

What is the difference between Visceral and Parietal pain?

A

Visceral: Vague, cramp, Colicky spasm preventing PT from sitting still

Parietal: Pin point, PT guards and remains still

148
Q

What causes the different pain in visceral and parietal pain?

A

Visceral- stretching of unmyelinated fibers

Parietal- irritation of fibers innervating lining above pain source

149
Q

When do cleft lip/palate form in pregnancy?

A

1st trimester

150
Q

Cleft lip or palate are genetic issues with what three predisposing risk factors?

A

Smoking
DM
Seizure meds

151
Q

Cleft lip generally occurs where on the mouth?

A

Left of the philtrum, from nasal base to upper gum line

152
Q

What are the characteristics of Aphthous Ulcers?

A

Immune link seen in PTs under 20y/o

Ulcerations on inner mucosal surfaces w/ gray/white center

153
Q

What are the characteristics of Cold Sores?

A

HSV Type 1, vesicles on oral exterior surfaces

154
Q

How are the chances of developing dental caries reduced?

A

Dental care

Flouridation

155
Q

Define Periodontal Disease

A

Inflammation of gingiva and lining extending into root resulting in MORE tooth loss than all other dental Dzs combined

156
Q

How does preiodontal disease progression present?

A

Gums red and tender

Tooth becomes looser and dies

157
Q

Define Sialadentis

A

Inflammation of major salivary gland (Mumps, Staph/Strep, Sjogrens Synd)

158
Q

Define Sialothiasis

A

Stone formation in salivary duct

159
Q

What form of Sialadentis presents with foul tasting discharges?

160
Q

What two conditions can present with painful swollen salivary glands?

A

Sialorrhea

Xerostomia

161
Q

What is the treatment for salivary gland diseases?

A

Acute cases with sour products to stimulate salivation

162
Q

Define Esophageal Atresia

A

Congenitally incomplete lumen, esophagus doesn’t communicate with stomach
Usually fistula present

163
Q

How does a Tracheo-Esophageal fistula present in babies?

A

Frothy/white bubbles
Coughing/choking while feedings
Vomiting
Aspiration

164
Q

What is the most common variation of esophageal atresia and tracheo-esophageal fistula?

A

Atresia with distal fistula

165
Q

Define Achalasia

A

Failure to relax

Disordered peristalsis, incomplete relaxation, high sphincter pressure

166
Q

Achalasia has an unknown etiology except for?

A

Chagas (Trypanosoma)

167
Q

What are the clinical features of Achalasia?

A

Dysphagia for fluids and liquids
Regurgitating undigested food
Bird Beak appearance on x-ray

168
Q

What are the three types of esophageal diverticulum?

A

Zenker- upper esophagus, most common
Midthoracic- traction on esophagus
Epiphrenic- directly above diaphragm

169
Q

How do esophageal diverticulum present clinically?

A

Difficult/painful swallowing
Regurgitating food when bending/lying/standing
Chronic bad breath and cough

170
Q

What causes hiatal hernias?

A

High intrabdominal pressures

171
Q

What are the two types of hiatal hernias?

A

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
Q

GERD is AKA?

A

Peptic Esophagitis

173
Q

Esophageal sphincter tone can be compromised by what two things or decreased by ?

A

Compromised by pregnancy or hiatal hernia

Reduced by smoking, caffeine, acidic/citrus

174
Q

What are the clinical features of GERD?

A

Water brash
Recurrent heart burn
Chronic cough
Sx worse at night and after meals

175
Q

Barretts Esophagitis is predisposed by what two risk factors?

A

Smoking

Alcohol

176
Q

What is the sequence of cell changes in Barrett’s Esophagitis

A

Metaplasia
Dysplasia
Neoplasia
Cancer

177
Q

Define Mallory-Weiss Syndrome

What can cause this?

A

Esophageal tear near gastroesophageal junction from alcohol abuse or forced retching

178
Q

How does pyloric stenosis present

A

Projectile vomiting immediately after feeding

179
Q

What are the characteristics of Acute Gastritis

Can the stomach recover from this?

A

Decreased gastric blood flow
Increased acid production
Exogenous irritants

Stomach can recover if blood flow returns or acidity neutralizes

180
Q

What are the characteristics of Chronic Gastritis?

A

Autoimmune from pernicious anemia

Infection- H. pylori

181
Q

How do NSAIDs cause Gastritis

A

Inhibit prostaglandin synthesis reducing mucous blood blow and BiCarb production

182
Q

What are the clinical features of NSAID Gastritis?

A

Vague epigastric pain
Dyspepsia (indigestion)
Vomiting

183
Q

How is NSAID Gastritis treated?

A

H2 blockers

PPI

184
Q

What happens in the stomach if a PT has Auto-Immune Gastritis?

A

Decreased IF which inhibits absorption of B12

185
Q

A PT with autoimmune gastritis will present with what underlying issue?

A

Pernicious anemia w/ megaloblastic RBCs

186
Q

How will autoimmune gastritis present clinically?

A

Nonspecific neurologic Sx: numbness, tingling, weakness, clumsiness

187
Q

PTs wil autoimmune gastritis will have what type of CBC report?

A

Macrocytic RBCs

Hypersegmented WBCs

188
Q

What is the most common cause of non-erosive gastritis and peptic ulcer disease?

189
Q

What are the 4 predisoposing factors of Infectious Gastritis (H pylori)?

A

Smoking
Emotional stress
Alcohol
Steroid

190
Q

PT that is unresponsive to standard GERD or ulcer treatments need to be evaluated for ? issue

A

Infectious gastritis

191
Q

How is Infectious Gastritis diagnosed?

What is a residual issue with it’s confirmation?

A

Biopsy or Urea Breath test

Once pos, always pos

192
Q

Duodenal ulcers are __ times more common than gastric ulcers?

A

4x

More likely in +50y/o

193
Q

Peptic Ulcer disease is often associated with ? infection

194
Q

How do peptic ulcers present clinically?

A 
Shallow= vague pain and dyspepsia
Deep= melena or hematemesis
Perforation= peritonitis, pnemoperitoeum, pancreatitis
195
Q

What are the differences between PUD presentations?

A

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
Q

Define Hirschsprungs Disease

A

Similar to Achalasia Process
Congenital lack of innervation at sigmoid/rectum
No innervation=permanent spasm=mechanical obstruction=megacolon

197
Q

How is Hirschsprungs Disease presented clinically?

A

Stool/fecal liquid expelled forcefully
Overflow diarrhea
Failure to thrive
Abdominal swelling

198
Q

Define Meckel’s Diverticulum

A

Outpouching of small bowel from remnant of intestine/umbilical connection

199
Q

What is the Rule of 2s for Meckel’s Diverticulum

A

2% of population
Withing 2 feet of ileocecal valve
2 mucosa- gastric and pancreatic

200
Q

Meckel’s Diverticulum is a failed form of what cell process?

201
Q

Meckel’s Diverticulum S/Sx can resemble what other issue?

A

Appendicitis

202
Q

What is the difference between Diverticulosis and Diverticulitis?

A

osis- condition/presence of diverticula

itis- inflammed/infected diverticula

203
Q

How do Colonic Diverticulosis pathogenesis form?

A

Low fiber and sedentary

High intra-colon pressure causing fecal matter to get trapped

204
Q

What is the incidence of Colonic Diverticulosis?

A

Common in industrial nations where diets are high in fiber; tend to be asymptomatic

205
Q

How does Colonic Diverticulitis present clinically?

A

LLQ pain- most common Sx
Fever
Leukocytosis
Tenesmus

206
Q

How is un/complicated colonic diverticulosis

A

Uncomp- Bowel rest, ABX

Comp- Surgery after one complicated or multiple uncomplicated

207
Q

Hemorrhoids are AKA

208
Q

Acute Ischemic Bowel Disease is aka?

A

Mesenteric Ischemia

209
Q

How does Ischemic Bowel Disease present?

A

Sudden GI bleeding/Sepsis
Postprandial pain
Pain out of proportion to exam

210
Q

How does Chronic Ischemic Bowel disease presnt?

A

Atherosclerosis w/out occlusion
Food Fear
Postprandial pain w/ 10-30m onset and peaking at 1-3hrs

211
Q

IBS includes what two diseases?

A

Crohns and Ulcerative Colitis

212
Q

What are the similarities of IBS?

A 
More common in Caucasian
Peak onset 20-30y/o
Familial
Inflammatory mediators
Altered microbiomes
213
Q

Crohn’s Disease is a ___ Dz

A

Right sided, mostly in terminal ileum and proximal colon involving all 3 layers of intestine

214
Q

How does Crohn’s disease present on x-ray?

A

Skip lesions

Cobble Stone

215
Q

Ulcerative Colitis is a __ Dz

A

Left sided in colonic mucosa

216
Q

How does ulcerative colitis present on imaging?

A

Sandpaper- friable
Pseudopolyps
Toxic megacolon

217
Q

How does Ulcerative Colitis present in clinic?

A

Cycle of Sx to no Sx

Diarrhea, rectal bleeding, abd pain

218
Q

Rotavirus affects ___y/o

Norwalk affects ___ populations

A

6mon-2yrs

Ships, nursing homes, delpoyed

219
Q

S/Sx of rotavirus

S/sx of norwalk

A

Watery diarrhea

N/V, diarrhea, abd pain

220
Q

VGE includes what two microbes?

A

Rotavirus

Norwalk virus

221
Q

Bacterial Diarrhea is AKA and includes what two microbes?

A

Enteritis

Bacteria toxins/lytic action

222
Q

Difference between toxic and lytic enteritis?

A

Toxic- food poisoning by Staph A, E Coli, Vibrio from seafood

Lytic- invades mucosa, yersinia, Campylobacter or Salmonella/Shigella

223
Q

What are the clinical features of appendicitis?

A

Vague peri-umbillical pain to RLQ @ What iMcBurney’s Pt

224
Q

What are the two classifications of peritonitis?

A

Infectious- rupture

Sterile/chemical- pancreatic enzyme, bile, post surgical

225
Q

Sterile Peritonitis healing often occurs with what side effect?

A

Fibrous Adhesions

226
Q

What is the key Sx of peritonitis?

A

Rebound tenderness

227
Q

Ileus is associated with what two diseases?

A

Peritonitis

Spinal cord injury

228
Q

Ileus is often seen after ___

A

Surgery

Causes lack of emulsion and seen by air-fluid level on x-ray

229
Q

What is the most common form of bowel obstruction?

A

Inguinal hernia

230
Q

Define Intussusception

A

One segment of bowel telescopes into adjacent segment

231
Q

How does Intussusception present?

A

Intermittent/colicky ab pain

232
Q

Define Volvulus

A

Bowel twists itself in middle aged/elderly PTs

233
Q

Define Celiac Sprue

A

Gluten sensitive intropathy

234
Q

Define Tropical Sprue

A

Bacterial pathogen in tropical travelers

235
Q

Define Whipple Disease

A

Rare overgrowth of Tropheryma Whipple in small bowel causing malabsorption

236
Q

Most cancers of the oral cavity/tongue are what type of cell?

237
Q

What type of cells are seen in upper/middle carcinoma and lower esophagus?

A

Upper/middle- squamous

Lower- adenocarcinoma (Barretts precursor)

238
Q

Gastric Neoplasm is usually from ? and is featured by ? sensation

A

H Pylori

Early satiety

239
Q

Intestinal neoplasms start as ? and 95% are ?

A

Polyps

Adenocarcinomas

240
Q

How do intestinal neoplasms present in clinic?

A

Occult bleeding
Weight loss
Constipation

241
Q

What gives feces the brown color?

A

Bilirubin processed into stercobilinogen

242
Q

Jaundice is a ______ not a ____

A

Manifestation of hyperbilirubinemia

Not a disease

243
Q

When do jaunidce symptoms become evident?

244
Q

What are 3 causes of jaundice?

A

Pre-hepatic- elevated indirect/unconjugated bilirubin
Heptaic- elevated indirect/unconjugated bilirubin
Post-Hepatic- direct conjugated bilirubin

245
Q

Define Pre-Hepatic Jaundice

A

Inc bilirubin production

Malaria, sickle, anemia

246
Q

Define Hepatic Jaundice

A

Impaire uptake/conjugation in liver
Hepatocellular
Hepatocyte injury or Gilberts Dz/Tylenol OD

247
Q

Define Post-hepatic Jaundice

A

Decreased excretion of conjugated bilirubin
Cholestatis
Gallstone obstruction

248
Q

How does cholestatis appear clinically?

A

Alcoholic feces- pale/cream colored feces

Brown foamy urine

249
Q

What viruses can cause hepatitis?

A

A B C D E

Epstein Barr, Herpes, Cytomegalo

250
Q

What are the 3 phases of hepatitis?

A

Acute- w/ or w/out jaundice
Chronic- may transmit, possible cirrhosis
Fulminant- necrosis, fatal

251
Q

What are the 3 phases of Hep B

A

Preicteric- weak, jaundice
Icteric- jaundice w/ elevated liver enzyme
Convalescent- most recover

252
Q

What form of hepatitis has “blood and body fluid” transmission?

253
Q

What is the hallmark of Hep C?

A

Persistant/chronic infection

254
Q 
Hep A transmission route
Hep B route
Hep C route
Hep D route
Hep E route
A 
Fecal-oral
Blood and body fluid
Blood transmission
Blood and body fluid
Fecal-oral
255
Q

Hep D is dependent on ?

A

Hep B co-infection

Higher progression to fulminant

256
Q

Where is Hep E found in the world?

A

Asia
Africa
S. America

257
Q

What are the ABCs of Cirrhosis?

A

Alcohol with Hep B and Hep C a close Second

258
Q

Cirrhosis is synonymous for?

A

End stage liver Dz

259
Q

What is the progression of portal cirrhosis?

A

Necrosis, fibrosis, nests of regenerating liver cells

260
Q

Define Primary Biliary Cirrhosis

A

Autoimmune middle age women 30-65

Scarring of bile ducts cause cirrhosis

261
Q

Define Secondary Biliary Cirrhosis

A

Stone in bile duct

262
Q

Define Sclerosing Cholangitis

A

Men under 40

Ulcerative colitis

263
Q

What is the term for Fattly Liver Diz

A

Steatohepatitis

Chronic alcohol causes increased FA production and altered cell membrane decreases lipid exportation

264
Q

Non-ETOH Fatty Liver Dz is caused by ? 3 things?

A

Obesity
DM
HTN

265
Q

Dilation of portal veins cause what 3 things?

A

Ascites- hypoalbuminemia
Splenomegaly
Venous congestion- esophageal varices, Caput Medusa

266
Q

Portal vein is a confluence of what two structures?

A

Splenic vein

Superior mesenteric vein

267
Q

How is Gilbert Syndrome identified?

A

Intermitent Jaundice

268
Q

How is an Alpha1-Antitrypsin deficiency identifed?

A

Non-smoking emphysema

269
Q

What are the characteristic findings of Hemochromatosis?

How is it treated?

A

Pigmentary cirrhosis
Bronze diabetes
CHF

Blood letting/Frequent phlebotomy

270
Q

Copper eye ring of Wilson’s Disease is AKA?

How is this treated?

A

Kayser-Fleischer ring

Chelating agents

271
Q

Difference between Cholelithiasis and Choledocholithiasis

A

thiasis- stones in gallbladder/biliary ducts

docho- stones in common bile ducts

272
Q

What are gallstones that are yellow, black, or brown?

A

Yellow- cholesterol
Black- bilirubin
Brown- cholesterol and calcium

273
Q

What are the 4 F’s of cholesterol stones?

A

Forty
Fat
Fertile
Female

274
Q

What causes black bilirubin stones?

A

hemolytic Dz

275
Q

What causes brown cholesterol and calcium stones?

A

Biliary parasites

276
Q

Define Biliary Colic

A

Chronic cholecystitis

No fever or leukocytosis

277
Q

How does acute cholecystitis present?

A

RUQ pain after fatty meal
Fever and leukocytosis
Murphys sign- exhale, press, inhale= pain

278
Q

Hepatocellular carcinomas has what pathogenic origins?

A

Hep B and C

Chronic liver diseases

279
Q

50% of all liver cancers produce ____ which is usefule for early diagnosis

A

Alpha-Fetoprotein

280
Q

How does the pancreas excrete the exocrine juices?

A

Ampulla of Vatar
Amylase- for starch and lipase
Protease- protein

281
Q

What are the exocrine cells of the pancreas?

What are the endocrine cells?

A

Acinar cells

Islets of Langerhans

282
Q

What do A B and D cells of the pancreas produce?

A

A- glucagon
B- insulin
D- somatostatin and pancreatic peptide

283
Q

How do gallstones cause acute pancreatitis?

How does alcohol cause it?

A

Obstruction near Ampulla of Vater force bile into pancreas

Damages acinar cells causing unregulated enzyme release

284
Q

What are the 3 rare causes of pancreatitis?

A

Trauma
Meds
Hyperlipidemia

285
Q

What kind of pain does pancreatitis present with?

A

Epigastric
Boring through them
Worse when supine, better sitting up

286
Q

Define Cullens Sign

Define Grey/Turners Sign

A

Cullen- echymosis in periumbilical region

Grey- ecchymosis in posterior flanks

287
Q

What lab result will be altered in pancreatitis?

A

Serum lipase 3x normal

288
Q

What are some compliations of Pancreatitis?

A

Peritonitis
Pseudocyst
Abscess
Transient DM

289
Q

Chronic pancreatitis is usually seen in what PT population?

A

Middle age men w/ alcohol abuse

290
Q

What is the treatment for mild pancreatitis?

A

Pancreatic rest, no ETOH

NPO or clear liquids only for 48hrs

291
Q

What are the requirements to discharge a PT home who has mild pancreatitis?

A

PO tolerant

Pain controlled

292
Q

How does pancreatic adenocarcinoma present?

A

Smokers
Older males w/ jaundice
Weight loss
New onset DM

293
Q

What are the two types of Islet Cell tumors?

A

Insulinoma- B cell tumor causing hypoglycemia

Gastroinoma- reverts cells to revert back to fetal function

294
Q

Define Zollinger Ellison syndrome

A

Excess gastric acid and intractable peptic ulcers (refractory to standard ulcer meds)

295
Q

What are the meanings of the roots of diabetes mellitus?

A

Diabetes- to pass through

mellitus- sweet

296
Q

DM is a disturbance in what two things

A

Insulin deficiency

Insulin resistance

297
Q

What are the two classifications of DM?

A

Type 1- insulin dependent/juvenile-onset

Type 2- non-insulin dependent/adult onset

298
Q

What are the two subgroups of Type 1 DM?

A

1A- autoimmune destruction

1B- virus damage

299
Q

What are the two primary defects of Type 2 DM?

A

Peripheral tissue resistance to insulin

Declining B cell secretion

300
Q

Serum insulin levels in Type 2 DMs will be ?

301
Q

What are the Polys of DM?

A

Plyuria
Polydipsia
Plyphagia

302
Q

Fasting glucose should be above ?

A

126mg

Pre-Diabetic= 110-125

303
Q

What are the long term risks of DM?

A

Atherosclerosis
Renal ischemia
Retinopathy
Peripheral neuropathy

304
Q

What is normal urine production amount?

What is normal GFR?

A

1.5L/day

90-120ml/min

305
Q

Define Azotemia

A

Uremia

BUN elevation from decreased excretion into urine caused by decreased GFR

306
Q

Define Acute Renal Failure

A

Oliguria or Anuria often with azotemia

307
Q

What can cause renal failure?

A

Glomerular or intestinal injury (acute tubular necrosis)

Trauma directly doesn’t cause it, resulting shock does

308
Q

What are the characteristics of a Solitary Kidney?

A

1 : 800 mostly males, usually L is missing or Horseshoe Kidney

309
Q

What are three causes of Glomerular Diseases?

A

Immunologic Dz
Metabolic Disorder
Circulatory disturbances

310
Q

What are the characteristics of Nephritic Syndrome?

A

Ritic- HTN, Hematuria
Edema, proteinuria, hypoalbuminemia
Acutely caused post glomerulonephritis/lupus

311
Q

What are the characteristics of Nephrotic Syndrome?

A

No HNT or Hematuria
Membranous nephropathy
Focal glomerulosclerosis
Lipoid nephrosis

312
Q

What causes Acute Glomerulonephritis?

A

Post Strep Glomerulonephritis after GBAHS

Ag-Ab trapped in basement membrane

313
Q

Acute Glomerulonephritis is what type of glomerular disease?

A

Nephritic
HTN and Hematuria
Facial edma and Oliguria

314
Q

What is the most common examples of crescentic glomerulonephritis

A

Goodpasture Syndrome

315
Q

Crescentic glomerulonephritis is what type of glomerular disease?

316
Q

Membranous nephropathy is what type of glomerular disease?

A

Nephrotic
Most common nephrotic syndrome in kids
Hyperlipidemia
Lipiduria

317
Q

What is the most common nephrotic syndrome in adults?

A

Focal Segment Glomerulosclerosis

318
Q

What is the most important metabolic disease that affects the kidneys?

319
Q

Thickening of glomerular membranes from DM causes what 3 changes?

A

Increased permeability- proteins leak out
Renal ischemia/papillary necrosis
Polynephritis

320
Q

What are the 4 main types of stones?

A

Ca- 75%
Struviate- Staghorn calculi (chronic UTIs and prone to urosepsis)
Uric acid- gout
Cystine- metabolic error

321
Q

Symptoms of renal stones are dictated by what two things?

A

Size

Location in tract

322
Q

Migrating kidney stones trigger what events?

A

Renal colic- wrap around pain
Flank pain
hematuria

323
Q

Stone size less than __ mm have a __ pass rate

324
Q

What is the most common site of obstruction by kidney stones?

A

Ureterovesical junction

Blockage causes secondary UTIs and pyelonephritis

325
Q

Define hydronephrosis

A

Renal pelvis and calyces dilate due to increased urine pressure due to outflow obstruction

326
Q

Hydronephrosis is a common sequel to _____ thus making it not a true ______

A

Stone obstruction

True metabolic renal disorder

327
Q

What causes nephroangiosclerosis

A

Chronic hypoperfusion
Atherosclerosis
heavy scarring leads to renal insufficiency

328
Q

1/3 of all end stage renal diseases are caused by ?

A

HTN resulting in chronic renal ischemia

329
Q

What is the most common form of UTI?

330
Q

Descending UTIs are caused by what process?

A

Hemtagogenous spreading

331
Q

What are the two common forms of UTIs

A

Cystitis

Pyelonephritis

332
Q

What are the clinical features of Cystitis?

What must always be ordred with these Sx?

A

Frequency
urgency
Dysuria

Urine culture

333
Q

What is the treatment for UTIs?

A

Phenazopyridine

Pyridium or OTC Azo

334
Q

What is the most common etiology of Polynephritis?

A

Ascending infections

335
Q

Pyelonephritis w/ urethral obstruction is triaged as ?

A

Urological emergency

336
Q

What are the S/Sx of pyelonephritis

A

CVA tenderness
Fever/Chill
N/V

337
Q

What PT population has the highest risk for renal and bladder carcinoma?

338
Q

What is the most common type of renal cell carcinoma?

A

Clear cell

339
Q

What is the red flag of renal cell and bladder carcinoma?

A

Painless hematuria

340
Q

What are the clinical features of Acute Glomerulonephritis?

A

HTN
Hematuria
Edema on face
Oliguria

341
Q

What glomerular disease is Rapidly Progressive Glomerulonephritis?

A

Crescentic Glomerulonephritis

342
Q

How is Crescentic Nephritis marked?

What is the resulting end point?

A

Severe damage with WBC exudate in urinary space

Acute renal failure

343
Q

What Immunologice Glomerular disease is in adults and kids?

A

Membranous- adults
Focal- most common nephrotic syndrome in adults

Lipoid- kids

344
Q

How do Membranous and Focal Segmental appear in adults?

A

Membranous- Generalized edema and proteinuria

Focal- Proteinuria and unresponsive to steroids

345
Q

UTIs are usually caused by what type of microbes?

A

Gram Neg enteric bacteria

346
Q

Pyelonephritis is inflammation of the entire kidney which includes what three parts?

A

Parenchyma
Calyces
Renal pelvis

347
Q

Difference in PT populations for Renal Cell Carcinoma and Urinary Bladder Carcinoma?

A

Majority, middle aged men, clear cell most common

UBC- Older, males more likely
Earlier Sx onset, higher recurrence

348
Q

How are RCCs diagnosed?

How are UBCs diagnosed?

A

US and CT

Cytoscopy and biopsy

349
Q

Pancreatic Adenocarcinoma are ranked as # ?? for cancer related deaths in US

350
Q

What type of pancreatic tumor is the majority of tumors?

A

Pancreatic head

IPAP (212 decks)

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