Pathology: Block 3 Flashcards
1
Q
What are the two types of penis malformations and how are they treated?
A
Hypospadias- ventral (most common)
Epispadias- dorsal
Both cause abnormal stream and inc risk of flow obstruction/UTI s so surgical treatment is req’d
2
Q
What are the clinical features of Cryptorchidism
A
Temperature sensitivity causes undescended teste to not develop
10x increase of malignancy even after orchiopexy treatment
3
Q
What are the penile lesions
A
Balantis- inflammation of glans
Phimosis- retraction failure of foreskin, stuck past glans
Paraphimosis- pre-phimosis, foreskin stuck behind glans forming stricture impairing blood flow to glans
4
Q
What types of microbes can cause urethritis?
A
Bacteria
Atypicals
Chemical
5
Q
How is urethritis and Reiter’s Syndrome connected?
A
Chlamydia Abs react w/ urethra, eyes and joints
Can’t see, can’t pee, can’t bend a knee
6
Q
What is epididymitis a complication from?
A
Untreated urethritis or prostatitis
Usually Chlamydia in younger men, Uropathogen in older men
7
Q
How does Epididymitis present?
How is it treated?
A
Testicular pain, not groin pain
WBCs in urine
Younger PT- NSAIDs, ice, elevate scrotum, ABX for presumptive STD
Older PT- NSAID, ice, elevate, ABX for gram neg rods
8
Q
Define Orchitis
A
Epididymo-Orchitis
Inflammation of testes, often from progression from epididymitis that can lead to sterility
9
Q
What microbes can cause prostatitis?
A
Same as UTI- E Coli or Proteus Mirabilis
10
Q
What are the clinical features of prostatitis?
A
Pain during urination
Urgency/frequency
Low fever
11
Q
What is the difference between DRE findings in a prostatitis PT?
A
Acute: tender and enlarged
Chronic: soft and boggy
12
Q
What labs are pulled for prostatitis?
What is the treatment method?
A
UA
Culture
PSA- may be elevated for 1mon after infection
Prolonged ABX treatment x 4-6wks
13
Q
Define Hydrocele
A
Collection of serous fluid in remnant peritoneum (tunica vaginalis) around testicle
Infant: transient and self resolving
Adult: crucial to find cause
14
Q
How does a hydrocele present clinically?
A
Painless unilateral swelling ant/sup to testis
Heavy/uncomfortable scrotum
Swelling that doesn’t involve inguinal canal
15
Q
What separates a hydrocele from an incarcerated inguinal hernia
A
Lack of inguinal canal involvement
16
Q
What will transillumination of the scrotum for a suspected hydrocele show?
A
Blood in scrotum from trauma won’t transilluminate
Confirm w/ US
17
Q
What are the treatment methods for a hydrocele?
A
NSAIDs
Support/elevate
Find and treat underlying cause
Surgical drainage if persistent
18
Q
Define Vericocele
A
Abnormal dilation of testicular veins in sperm cord that can resemble a “bag of worms”
19
Q
What is considered if a varicocele develops on the R side or onset is later in life after puberty?
A
Evaluate for venous occlusion from tumor
20
Q
Where do the L and R testes drain blood into?
A
L: L renal vein
R: inferior/vena cava
21
Q
What are the clincial features of varicoceles?
A
A-Sx
Dull discomfort w/ prolonged standing/exertion
Bag-of-worm in anterior scrotum
22
Q
How are varicocele’s treated?
A
None if A-Sx
Surgical if painful or cause of infertility
23
Q
What are the clinical features of a testicular torsion?
A
Acute pain w/ mild swelling/erythema
N/V
Absent cremastric reflex
US to show lack of flow
24
Q
Characteristics of development of BPH
A
Due to hormonal changes w/ inc age causing nodules to grow in central prostate that compress the urethra
25
What is the difference in presentation of BPH and prostate cancer?
Cancer begins in prostate periphreals w/ late development of urinary Sx
26
How does BPH present in clinic?
Inc freq/urgency at night
| Dec strength of flow
27
How is BPh seen with imaging?
Post void residual US will be inc w/ BPH (norm= 50mL)
28
When/who is penile cancer more likely to be seen in?
Uncircumcised >40y/o in non-US countries from poor hygiene or exposure to HPV
Tx w/ surgery and radiation
29
When/who is testicular cancer most common in?
25-45y/o w/ Seminoma being the most common type that rapidly grows and spreads
30
How are testicular cancers tested and treated?
US
Chest x-ray
Serum tumor markers- HCG, AFP, LDH
Urology referral ASAP for orchiectomy
31
Cancer on the scrotal wall tend to metastesize to ?
Cancer on the testes tend to metastesize to ?
Inguinal nodes
Para-aortic nodes
32
What is the most common type of cancer in males?
Prostate cancer w/ testosterone as the primary stimulant of cancer growth
33
What are the clinical features of prostate cancer?
```
ASx like BPH
DRE to detect nodule
Trans-Rectal US
PSA +4ng
Alkaline phosphatase- indicates metastases to bone/spine
```
34
How is prostate cancer treated?
Dec testosterone w/ anti-androgen meds, estrogen
orchiectomy
Surgery
Chemo/rad
35
Define Vulvovaginitis
Vaginitis
| Inc in PTs w/ ABX, pregnancy, DM or immunodeficiency
36
What are the common infectious agents of vaginitis?
Albicans- most common especially post-ABX
Gardnerella- overgrowth from dec lactobacillus/inc pH
STDs- Cl, Gnr, Syph, HS/PV
37
How are bacterial vaginitis samples identified for diagnosis?
S/Sx of Ablicans and Garderella infections
Clue cells on wet prep
Albicans- itch, discharge, dryness
Gardnerella- bacterial vaginitis, burning, fishy, Clue cells
38
Define PID
Ascending lower genital infection of the uterine cavity, once cervicitis- infection is assumed to be in uterus or higher
39
PID is associated with what STDs?
Chlamydia
Gonorrhoeae
Small risk post-IUD inplantation
40
PID affects what structures and which one is especially vulnerable to PID?
Cervicitis, Endometritis, Salpingitis (cervicitis= assumption infection is superiorly located too)
Fallopian tubes-develop tubo-ovarian abscess
41
How does PID present in clinic?
Abd pain, fever, nausea, discharge/bleeding
Cervical motion tenderness- hallmark finding
Peritonitis- late finding
42
How is PID treated?
High dose, broad spectrum w/ short in patient admission
43
# Define Menorrhea
Define Amenorrhea
Menstrual flow
No menstrual flow
44
# Define Menorrhagia
Define Metrorrhagia
Profuse and heavy
Irregularly timed
45
# Define Metrohenorrhagia
Define Dysmenorrhea
Irregular heavy
Painful menses
46
Dysfunctional uterine bleeding is excessive/irregular bleeding related to hormonal disturbances from what two main causes?
Failure of ovulation and luteal phase
Contraception induced (start or stop phase)
47
Define Leiomyomas
Fibroids
| Benign tumor that appears during reproductive years and more common in AfAm
48
How do large or multiple fibroids present and how are they treated?
Endometrial bleeding and dysmenorrhea
Compression causes urinary Sx and constipation
Myomectomy or hystorectomy
49
Define Leiomyosarcoma
Rare cancer forming directly from myometrium, not from leiomyoma, and frequently recur after removal
50
Define Endometriosis
Ectopic uterine lining located outside of uterus/anywhere in pelvic peritoneum
Doesn't progress to cancer but responds to menstrual cycle hormones
Can cause infertility
51
How does endometriosis present?
How is it treated?
Sx become prominent during reproductive years
Dysmenorrhea and Pelvic pain
Urinary/Bowel Sx associated w/ menses
Tx: regulation w/ OCPs
52
Define PCOS
Enlarged ovaries bilaterally that is a complex hormonal disturbance and not an anatomic abnormality
53
What are the pathophysiologic occurrences that happen during PCOS?
```
High LH, low FSH
Multiple cystic follicles but anovolulatory- infertile
Oligomenorrhea
Excessive androgen= hirsutism
Insulin dysfunction= obesity
```
54
Due to the rapid onset of ruptured ectopic pregnancies, what must be checked on all female PTs w/ CCO abd pain?
HcG
| US to ID ectopic pregnancy
55
What are the weight and time frames for the criteria of abortion?
500g or 20wks gestation
56
What are the 4 types of abortions?
Complete- fetus and placenta fully expelled, normal menses resumes
Incomplete- products remain
Missed- fetal death in utero, reqs surgery
Threatened- bleeding but cervix is dilated, pregnancy may continue
57
Define Toxemia of Pregnancy
Preeclampsia and Eclampsia
| Abnormal function of placenta or abnormal materno-placental interactions
58
Pre-Eclampsia is a Triad of Sxs at what point of pregnancy?
Especially 1st pregnancy
34th week
HTN, Edema, Porteinuria
59
What are the S/Sx of eclampsia
Rare
Pre-Eclampsia Sxs
Seizures
Comas
60
How is Pre/Eclampsia treated/cured?
Delivery
| Mg sulfate IV may prevent seizures but delays delivery
61
What is the majority of the cause of the 3% of GI cancers in women >60y/o
HPV- 90% are SCC and often with co-existing vaginal or cervical cancer
62
How does Vulvar Carcinoma appear?
Warty, leukoplakia white patches that need biopsy to confirm Dx
63
What are the primary risk factors that predispose cervical carcinoma?
```
HPV is 1*
Early age of intercourse
Multiple partners
STDs- HSV or Syphilis
Smokers
```
64
What screening method has reduced incidences of cervical carcinomas?
Papanicolaou- ID of early dysplasia (Cervical Intraepithelial Neoplasia)
65
If female PT has suspicious PAP results, what is the next step?
Colposcopy w/ biopsy
66
How are early cervical carcinoma lesions treated?
Cryotherapy or Loop Electrosurgical Excision Procedure
67
What is the most common of the GYN cancers?
Endometrial Carcinomas- primarily post-menopausal women and strong associated w/ estrogen exposure
68
What are the risk factors of endometrial carcinoma?
What is not a risk factor that is odd from other cancers?
Estrogen supplements/producing tumor
No pregnancy
Early menarche/late menopause
Obesity, DM, HTN
Smoking
69
How does endometrial carcinomas present?
How is it treated?
Abnormal uterine bleeding
Post-menopause vaginal bleeding is cancer until proven otherwise
Treated w/ hysterectomy, radiation/chemo
70
What is the second most common GYN cancer?
Ovarian cancer BUT #1 most deadly
Most are surface epithelial tumors
71
What are the risk factors of Ovarian Cancer
What are two protective factors?
+ FamHx
Nulliparous
High fat diet
Anovulation
Multiparous, oral contraceptives
72
What are the 3 types of tissue in breasts?
What do they respond to?
Lactiferous, Fatty, CT
Hormones
73
What happens to breast tissue during menopause?
Lactiferous tissue replaced with fatty tissue and atrophy of ductal structures
74
Define Amastia
Congenital absence of breast
| Complete lack of tissue, nipple or areola
75
Define Polythelia
Supernumerary nipples w/out breast tissues/glands that can occur anywhere along milk line but often misidentified as mole/birthmark
76
Define Polymastia
More than 2 breasts
Supernumerary- anywhere along milk line
Accessory- tissue w/out nipple in axilla, often confused as breast cancer metastasis
77
Who are acute mastitis almost exclusively seen in?
Lactating women
| From incomplete emptying of milk from duct with skin Staph/Strep
78
How does acute mastitis present?
How is it treated
Erythema and edema
Pain/tender
Continue/inc breast feeding
ABX
Warm compress
Post feeding cleaning
79
Who is chronic mastitis seen in?
Older non-lactating women w/ unknown etiology
| Biopsy to r/o cancer
80
Define Gynecomastia
Male breast enlargement
Infants- from maternal estrogen
Teens/young male- puberty
Older- obesity, cirrhosis, estrogen secreting tumor, Klinefelter's Syndrome
81
What medications can cause gynecomastia?
Cimetidine- long term PUD
| Anabolic steroids- converted to estrogen during metabolic breakdown
82
Define Fibrocystic Change
Fibrotic and cystic changes from tissue due to over response to hormones and aging, Sx improve post menopause
83
What are the clinical features of Fibrocystic Changes
Pain and Nodularity lumps
Sx vary w/ cycle
US/Mammogram reveal cysts and calcifications
84
How are Fibrocytic Changes treated?
Support
Dec caffeine
OCPs may stabilize cycle variability
Fine needle aspiration/excision of cysts
85
What is the most common benign tumor of female breasts?
Fibroadenoma- post puberty but young from over response to inc estrogen
86
What are the clinical features of Fibroadenoma
Mobile nodule that varies w/ cycle and during pregnancy
| Painless- separates this from fibrocystic changes
87
How are Fibroadenoma treated?
Eval w/ US and mammography
88
Typically lumps are ? size before they can be palpated
2-2.5cm
89
S/Sx of breast cancer
```
Lumps
Painless
Nipple discharge- worry w/ spontaneous and unilateral
Peau d'Orange
Retraction
```
90
Bloody or serous nipple discharge is associated with ?
Ductal Carcinoma
91
Define Galactorrhea
Bilateral milky discharge no associated w/ cancer from high prolactin levels from pituitary adenoma
92
Breast cancer risks increase with ? exposure
Estrogen- inc risk with early menarche, nulliparity or late menopause
Post-menopause inc risk
93
What are half or more of breast cancers located?
Upper lateral quadrant
94
Hyperpituitarism is AKA ?
Pituitary adenoma- common pathology that secrete functional hormones
95
Define Lactotropic Adenoma
Prolactoma- 30% of pituitary tumors
Present w/ amenorrhea, glactorrhea or infertility due to inhibition of LH and ovulation
Males have dec libido and Sx of impotence
96
How is lactotropic adenoma treated
Bromocriptime
97
Define Somatotropic Adenoma
Growth hormone
Pre-puberty= gigantism
Post-puberty= acromegaly
98
Define Corticotropic adenoma
ACTH
| Cushing's from over stimulation of adrenal cortex
99
What are the causes of Hypopituitarism
Congenital- empty sella syndrome; dwarf; hypogonadism
Tumor- dec circulation and destruction of pituitary
Circulatory distrubance- Sheehan Syndrome- post partum ischemia
Trauma- basal skull injury
100
How does hypopituitarism present in clinic?
Weak
Cold intolerant
Poor appetite/weight loss
HOTN
101
Hypopituitarism and Hyperpituitarism have the same Sx with what exceptions that HYPO has?
Cold intolerant
HOTN
Men- impotence/libido loss
Women- amenorrhea
102
Diabetes Ins. can be caused what three things?
```
Damage to:
Hypothalamus
Pituitary stalk
Tumors of post. pituitary
Causes: intercranial tumor, infection of meninges, intracranial hemorrhage, basilar skull fx
```
103
What is the normal regulation of ADH with high/low serum NA
High Na/Low BP- inc ADH production, kidneys retain more water to dilute serum
Low Na/High BP- dec ADH production, kidneys retain less water to concentrate serum and dec intravascular press
104
What are the clinical features of DI?
Polyuria: 5-6L/day of hypotonic urine w/ no change on water restriction
Polydipsia
NO POLYPHAGIA
105
What causes Thyrotoxicosis
Excess production of T3/T4 from:
Graves
Idiopathic nodular hyperplasia
Tumor- thyroid adenoma
106
What are the clinical features of Hyperthyroidism?
```
Slowly appearing Sxs EXCEPT during thyroid storm w/ Graves Dz
Restless/nervousness
Tremors
Excess sweating
Heat intolerant
HIGH T3/4, Low TSH
```
107
How is Hyperthyroidism treated?
RI 131 ablation
| Surgery
108
Who is more likely to have Graves Dz?
How is it characterized?
10x in women
Thyrtoxicosis
Exophthalmos
Dermopathy- pretibial myxedema (dough like skin)
109
What are the 3 types of hypothyroidism?
Thyroiditis- Hashimoto
Thyroidectomy
Iodine deficiency
110
Thyroiditis is most common ? and associated with ?
Hypothyroidism in US
| Associated w/ other auto immune dz like Sjogren's Syndrome
111
Iodine deficiency is rare in Western culture but is associated with ?
Goiters
| Cretinism for deficiency during pregnancy
112
What are the clinical features of hypothyroidism?
Slowing of all metabolic processes
Slow, sleepy, weight gain
Low T3/4, HIGH TSH
113
How is hypothyroidism treated?
Synthetic Thyroid supplements for remainder of life
114
What is the pathophysiology behind a nodular goiter?
I deficiency prevents thyroid from producing T3/4 so thyroid undergoes hyperplasia to inc T3/4 production and pituitary overproduces TSH to further promote hyperplasia
115
What are the thyroid hormone levels with a nodular goiter?
How is it treated?
Normal/Low T3/4
High TSH
Subtotal thyroidectomy
116
Thyroid neoplasms are more common in ? and primarily associated with ?
Females
| Neck irradiation
117
Define Follicular Adenoma
Benign tumor presenting as solitary nodule but can't be differentiated from normal tissue on R123 scan so Dx req'd by biopsy
118
Define Papillary Thyroid Carcinoma
80% of malignant thyroid nodules
| Hormonally inactive tumor and seen as a "cold" nodule
119
Define Follicular Thyroid Carcinoma
15% malignant in female over 40, most are inactive "cold" nodules
Hormonal active 'hot" nodule seen on radioactive scans
120
What are the majority of hyperparathyroidisms from?
Inc PTH secretion from benign parathyroid adenoma, usually just one of four
2* cause from end-stage renal failure
121
Excessive PTH stimulates what type of bone cell?
Osteoclast activity with Ca reabsorption
122
What are the clinical features of hyperparathyroidism?
ASx
Pathological Fx
Multiple kidney stones
High Ca, Low PO4
123
How is hyperparathyroidism treated?
Surgical excision of primary tumor
| Kidney transplant if renal failure, causes PTH glands regress to normal
124
What is hypoparathyroidism usually caused by?
Accidental removal/damage during thyroid surgery causing dec PTH secretion which allow ostoblasts to inc Ca deposits in bone
125
What are the clinical features of hypoparathyroidism?
Neuromuscular excitability Muscular contraction Sx
Twitching hands/face
Chcostek's Sign- facial twitch from tapping facial nerve
Trousseaus Sign- wrist/hand spasm triggered by BP cuff inflation
126
What will the lab results be for a PT with hypoparathyroidism?
Low Ca
High PO4
Ca/Vit D supplements
Synthetic PTH supplementation
127
What causes Cushing's Syndrome (Hypercorticolism)
Pituitary adenoma- excess ACTH= Cushing's Dz
Adrenocortical tumor- excess corticosteroids= Cushings Synd.
Exogneous glucocorticoids- prolonged steroid tx of autoimmune disorder
128
What are the clinical features of Cushing's Syndrome?
```
Central, truncal obesity
Moon face and Buffalo Hump
Facial redness
Cutaneous striae
Dec muscle mass
Facial hair and acne
Thin scalp hair
```
129
How is hypercortisolism treated?
Excision
Medical suppression of endocrine stimulation
If caused by exogenous steroids- gradual taper and cessation
130
What was the primary cause of Addison's before modern ABX were used?
Lav results will show what high/low abnormalities?
TB
Low- Na Cl
High- K
131
When do Addison's Sx aren't visible/notable until how much damage has occured?
90% of adrenal cortex is destroyed
132
What are the clinical features of Addison's Dz
```
Slow insidious onset w/ progressive weakening/fatigue
Weight loss
Fatigue
Bronzing Pigmentation
HOTN and syncope
```
133
What will the lab results for Addison's Dz show?
ACTH administration should trigger corticosteroid release while Addison's Dz will have diminished/no response
134
How is Addison's treated?
Life long corticosteroid supplementation
135
What is Pheochromocytoma linked with?
Family association w/ Multiple Endocrine Neoplasia (MEN)
Tumor secreting catecholamines (Epi/NorEpi)
136
What are the clinical features of Pheochromocytoma?
Sx Triad: HA, Diaphoresis, and Tachycardia
Paroxysmal HTN
BUT: many PTs don't present with Sx Triad
137
What are the lab results of Pheo?
Inc Epi/NorEpi
24hr Vanillylmandelic Acid Test
(break down metabolite of Epi/NorEpi)
138
How is Pheo treated?
Surgical resection
| Only time HTN can be treated is with surgery
139
Define Neuroblastoma
Malignancy of neonate/peds under 5 from undifferentiated adrenal medulla cells that gow and metastasize rapidly
140
What are the clinical features of Neuroblastoma?
| What's the test and Tx?
Large abd tumor
VMA urine test elevated
Tx w/ surgery, chemo/rad
141
What is the most common site for tumors to be in the human body?
Skin
142
# Define Macule
Define Patch
Flat lesion <2cm "Freckle"
Similar to macule but larger than >2cm
143
# Define Papule
Define Nodule
Elevated skin induration <1cm
Larger than papule, 1-5cm
144
# Define Tumor
Define Vesicle
Nodule >5cm of SCC
Fluid filled elevation <1cm
145
# Define Bullae
Define Pustule
Vesicle >1cm "Burns"
Vesicle filled w/ pus "Impetigo"
146
# Define Ulcer
Define Crust
Epidermal defect "chancre"
Skin covered w/ dried blood/plasma "healing"
147
# Define Excoriation
Define Fissure
Superficial skin defect from scratching
Sharp edged defect into deeper layers "Athletes foot"
148
# Define Wheal
Define Scales
Elevated itchy/transient lesion w/ erythema "bite"
Flakes removed w/ scraping "Seborrheic Dermatitis"
149
Define Nevus
Most common congenial anomaly of normal skin elements arranged in abnormal manners- flat macules/slightly raised papules
150
Define Melanotic Nevi
Common brown birthmarks and moles
151
Define Port-Wine Stain
Nevus Flammeus- clustered capillary venules imparting deep red color usually on face/neck/torso
152
Define Strawberry Hemangiomas
Vascular malformation of entire capillary causing raised papule w/ intense red color on face/neck/torso
153
Characteristics of 1st degree burns
Mild erythema/edema (sunburn) of epidermis that heals quickly
154
Characteristics of 2nd degree burn
Partial burn sparing dermis and forming bulla resulting in thinner new skin
155
Characteristics of 3rd degree burns
Full through Epi/dermis and into muscles/fat causing scars from healing process
156
What kind of 3rd degree burn can heal w/out intervention?
Welder's burn
157
Difference between Trench Foot and Frostbite?
Trench- wet but not freezing, necrosis with blisters and ulcers
158
What issue can arise from electrical burns?
Deep thrombus
Compartment syndrome
Arrythmias
Rhabdo
159
What causes ionizing radiation
Occupational exposure
| Medicine- CT, Xray, Radiation
160
What kind of dermal appearance does lightning strikes make?
Lichtenberg marking
161
What acute viral Dzs are common in kids?
Measles
Chicken pox
Post viral rash- exanthems
162
Common warts come from what virus?
Verruca Vulgaris from HPV
| Hands/feet warts are different than HPV
163
What are the 3 major types of skin infections?
Primary: normal skin from pus forming Pyogenic Bacteria: Ataph A, Strep Pyogenes
Secondary: impedes healing (eczema) and may be nosocomial w/ ABX resistance
Systemic: blood borne/bacterial endocarditis in debilitated or immunocompromised PTs
164
What causes a "Honey Crusted" lesion
Impetigo- Staph or Strep
| Highly contagious found in kids on mouth/nose
165
Define Folliculitis
Infection in hair follicles by Staph A causing furuncles and carbuncles
166
Define Furuncle
Boil
| Pustule involving single hair and surrounding tissue w/ pointed appearance
167
Define Carbuncle
Enlarged furuncle involving multiple hair shafts and tissue in head or neck
Male > Female
168
Thrush usually also presents with what secondary agent?
Intertrigo- dermatitis at body folds
169
Dermatophytes AKA ?
Tinea that live in the dead outer layer of keratin skin/hair/nails causing itching and scratching
170
Characteristics of "classic" ringworm
Semicircular shape w/ erythematous edge and central clearing
171
```
What are the names of tinea on:
Body
Groin
Foot
Scalp
Hand
Nail
```
```
Corporis
Cruris
Pedis
Capitis
Manum
Unguium
```
172
Characteristics of Eczema
Inflammatory skin disease w/ non-specific lesions of localized edema, papules and vesicles usually w/ itching
173
What are the two major forms of eczema?
Exogenous: environmental/contact dermatitis
Endongenous: immune basis like Atopic dermatitis on face, elbows and knees and associated w/ nasal/respiratory allergies
174
# Define Seborrheic dermatitis
How is it managed?
Chronic Dz presenting w/ redness, flakes, scaling and itching in areas of skin that are higher in oil
Topical steroids and Sulfur based shampoo
175
Characteristics of psoriasis
T lymphocyte mediated autoimmune disorder involving keratinocytes
Symmetrical patches of plaques coveed by silvery scale and generally non-pruitic
176
Where is Psoriasis usually seen?
Extensor surfaces- elbows and knees but also scalp and nails
177
What are the 4 warning signs of cancer
Persistent non-healing
Friable
Irregular shape/margins
Atrophic/keratotic margins
178
What are the ABCDEs of skin neoplasms
```
Asymmetry
Borders
Color
Diameter
Evolving
```
179
What are the four types of Epithelial Tumors
Seborrheic Keratosis- stuck on appearance
Actinic Keratosis- scaly surface
BCC- rolled up w/ pearl color
SCC- recurrent bleed/crust
180
Characteristics of Seborrheic Keratosis
Benign easily removed tumor that's brown and flat
| Treated w/ cryotherapy
181
Characteristics of Actinic Keratosis
Pre-cancer from sun exposure and may precede SCCs
182
What appearance does Actinic Keratosis have and how is it treated?
Red macules w/ rough/scaly surface
| Treated w/ cryotherapy and Antineoplastic solution to desquamate large areas (5-Fluorouracil)
183
Characteristics of BCCs
How are they treated
Common malignant skin tumors in sun exposed areas that's elevated w/ central depression
Rarely metastases, excision/cautery destruction
184
Characteristics of SCC and how are they treated?
Invasive tumor on sun exposed areas
Full depth excision
185
What are the 3 types of benign pigmented tumors
Ephelis- freckle that is hyperreactive to UV light
Lentigo- unresponsive to UV light
Melanotic nevus- over abundance of melanocytes
186
Define Malignant melanoma
Half originate from freckles/pre-existing nevi
| Half originate from existing skin
187
What are the 3 types of malignant melanomas
Lentigo Maligna- flat macule from freckle/nevus that is localizes for more than decade then invades
Superficial Spreading- majority of melanomas, irregular shape, border and usually on legs of women and backs of men
Nodular melanoma- rapid growth and infiltration w/ low survival
188
Define Achondroplasia
Dwarfism
| Impaired endochondral ossification in long bones
189
How does Achondroplasis present clinically and get sub-divided into two categories??
Body habitus out of proportion
Shortened legs/arms with small face- endochondral ossification
Trunk and upper cranium develop normal= intermembraneous ossification
190
Osteogenesis inperfecta is a defect in production of ?
Type 1 Collagen
191
Define Osteomyelitis
Bone infection from Staph A
192
How does Osteomyelitis present in adults and kids?
Adults- complicated open Fx
Kids: Bacteremia seeding of metaphysis
193
Who is the "classic PT" of osteoporosis
Caucasian woman w/ slender/small frame
194
What are the risk factors for osteoporosis
Age/Gender- elder women
Dec estrogen post-menopause
Dec mobility
Poor diet/malabsorption
195
What are the clinical features of osteoporosis?
What imaging modality is used to see this dz?
Femoral neck Fx
Wedge Fx- Kyphosis/Dowager Hump
DEXA scan
196
What meds can be given for osteoporosis
Alendronate
Ibandronate
Zoledronic acid
197
What are the S/Sx of osteoporosis
```
Bone pain/tenderness
Fx w/ little/no trauma
Loss of height
Neck/lower back pain
Stooped posture
```
198
Define Osteomalacia
Rickets
| Softening of bones from inadequate Ca mineralization, Vit D and/or PO4
199
What are the clinical features of Osteomalacia
Bow legs
Breast bone projection
Scoliosis
200
How is osteomalacia treated?
Vit D
Ca
PO4
Braces on bones
201
Define Paget's Dz
Osteitis Deformans
M/W over 40 esp w/ British/European ancestry
Irregular bone restructuring leading to thickened/deformed bones
202
What are the clinical features of Pagets Dz?
Affects skull, prox femur and axial skeleton often w/ bowlegs
X-rays show lytic lesions from excessive remodel (honeycome/cottonwool appearance)
203
How are Paget's and Osteoporosis similar and different?
Similar- treatment
Different- Paget's has high vascularity around bone deformities causing increased bleeding risk during ortho surgery
204
What are the 4 steps of bone healing
Hematoma- 2-3 days, proliferation of inflammatory cells and vessels, chondro/osteoblasts appear
Fibrocartilage- 1 wk, trabeculae built
Bone callus- 2-4wks, encircles Fx site, new bone formed, excess bone removed
Remodeling- occurs only after normal movement resume
205
What factors promote Fx healing
Immobilization
Alignment
Blood supply
Diet
206
What action can delay early fracture healing processes?
Motion between fragments
207
What is the most common joint disease?
Osteoarthritis- DJDz
208
Dejenerative joint disease involves what types of joints?
Weight bearing- knees, hips, vertebrae
| Finers
209
What two processes can accelerate joint surface cartilage wearing away?
Injury
| Mechanical stress
210
What type of ortho changes can PTs with osteoarthritis present with?
Soft/thin cartilage
Exposed subchondral bone
Narrow joint spaces
Osteophytes
211
PTs with osteoarthritis may present with what curious presentation?
Gross x-ray deformities w/ only minor Sx
212
How does osteoarthritis present clinically?
```
Initial stiffness/pain
Cool to touch
Crepitus
Bouchard nodes- proximal
Heberden nodes- distal
```
213
How is osteoarthritis treated?
Remaining active
| NSAIDs
214
Difference between RA and Osteoarthritis?
RA spares weight bearing axial skeleton
215
Clinical features of RA
Symmetrical joint inflammation
Ulnar deviation
Finger Z deformity
Rarely elbow and ankle involvement
216
RA can present with what four extra-articular manifestations?
Anemia
Pericarditis
Episcleritis
Skin lesions
217
How is RA treated?
Lab test for rheumatoid factor may show but is not specific so-
NSAIDS
DMARDs
218
What diseases/issues can lead to uric acid accumulating
Obese
ETOH
Renal Dz
Diuretics
219
How does gout present clinically?
Podagra- swelling/redness of great toe
Systemic fever
Leukocytosis
Malaise
220
Gout PTs may have what derm S/Sx
Tophi on ear, olecranon, and patella
221
What test is conducted to dx gout?
How is it treated?
Aspiration for negative birefringent crystals
NSAIDs- indomethacin
222
What type of bone tumor is more common?
Secondary- metastases from breast, prostate, lung, kidney or thyroid dz
223
What are the 3 types of benign bone tumors?
Osteoma- tumors of bone cells
Chondroma- tumors of cartilage
Nonossifying Fibroma- tumor of fibroblasts
224
How are benign bone tumors further evaluated and considered for surgical excision?
CT/MRI
Monitor x 6-12mon w/ repeat images
Excised if pain producing
225
Define Ewing's Sarcoma
10-20y/o M>F in long bones that spreads to soft tissues w/ Sunburst/Onion Skin appearance on x-rays
226
Define Osteosarcoma
Most common primary bone cancer
Tumor on long bone involving metaphysis near knees
Hematogenously spreads to lungs
227
Define Chondrosarcoma
Neoplastic cartilage cells in 35-60y/o
| Cartilage tumor in axial skeleton of pelvis/vertebrae and adjacent long bones
228
What is different about Condrosarcoma's treatment than the other bone/joint neoplasms?
Non-reactive to chemotherapy
229
What age/gender does Myasthenia Gravis effect?
20-35 women
| 50-60 men
230
How does Myasthenia Gravis present?
Weakness worse at end of day
| Ptosis and bland facial expression
231
What lab tests can be conducted for Myasthenia Gravis?
Ach Abs or,
| Ach challenge test- muscle weakness SHOULD improve
232
How is Myasthenia Gravis treated?
AChE inhibitor- Aricept
233
What is the most common muscular dystrophy?
Duchenne's
| Males w/ genetic X-linked defect of dystrophin protein
234
What are the clinical features of Duchenne's?
Affects pelvic girdle and lower extremities
| Uses arms to lift torso by climbing legs (Gower's Sign)
235
What tests are ran to dx Duchennes?
Elevated serum CK- non specific and elevated in all dystrophies
Reqs genetics testing
236
How is Duchenne's managed?
Corticosteroids- Prednisone
237
What is the most common childhood muscle weakness disorder?
Cerebral palsy- motor neuron dz of brain/spinal cord causing Floppy Child Syndrome and delayed milestone achievements (rolling/clapping @ 6mon)
238
What are the two acquired muscle myopathies?
Diabetic- chronic hypoperfusion and peripheral nerve dysfunction
Cancer- paraneoplastic syndrome of tumor
239
What is the pathologic chain of rhabdo?
```
Damage/death
More edema
Vascular compression
Ischemia
Damage
```
240
What will labs show in PTs with rhabdo?
How is it treated?
Inc K
Inc CK-MM
Tx w/ large volume of IV
241
What are the 5 Ps of compartment syndrome?
```
Pain- out of proportion to exam
Parasthesia
Pallor
Paralysis- late
Pulselessness- late
```
242
What is normal intracompartmental pressure?
When is fasciotomy indicated?
ICP normally 30-40mm below diastolic
When DBP-ICP is less than 30
243
Define Liposarcoma
Malignant fatty tumor that's a rapid grower and non-mobile
Usually over adult thigh, arm, abd wall
244
Scalp lacs can bleed significantly and may be an expanding ?
Hematoma
245
What are the 3 types of skull fractures?
Linear
Depressed
Basilar- temporal region
246
What are the S/Sx of a basilar skull Fx
Raccoon eyes
Battle's sign
Hyemotympanum
Halo sigh
247
What classically causes an epidural hematoma?
Middle meningeal artery torn by temporal bone fragments causing blood between skull and dura that shows Sxs in minutes to Hrs
248
What are the clinical features of epidural hematomas?
LOC
Lucid interval and feels ok
Min-Hrs later: cerebral compression causes Sx- HA, N/V, confusion, vision changes
249
Characteristics of subdural hematoma
Blood between dura and arachnoid from veins being torn during opposing brain and dura movements
250
Typically, what causes subdural hematomas?
Blunt trauma hitting the heat (elderly falls)
| Repeated small trauma (boxing, football) can have same effect as one large trauma
251
How does subdural hematoma present clinically?
Days/wks later w/ worsening HA to lateralizing signs
Unilateral dilated pupil
Unilateral weakness
Decorticate/decerebrate
252
Characteristics of subarachnoid hemorrhage
Bleeding between arachnoid membrane and pia matter from brain trauma or vascular abnormalities (occult bleeds)
253
What are the clinical features of Berry Aneurysm/AVMs?
Thunderclap HA
Hemiparesis
Hemiplegia
Rapdi adv to coma/seizure
254
Key term differences between Epideral, subdural and subarachnoid bleeds
Epi: blood outside of dura, concave shape
Sub-D: blood under dura, crescent shape
Sub-A: blood in brain w/ compressed ventricles
255
How does increased ICP cause death?
Brain herniates into foramen magnum compressing autonomic centers causing coma and apnea
256
What are the S/Sx of inc ICP?
Pupil dilation- anisocoria
Papilledema
Posturing- decro (flex), decere (extend)
Cushings Triad: respiratory change (Cheyne-Stokes/Agonal), widening pulse press, bradycardia
257
What is the 3rd most common cause of death in US?
CVAs
Ischemic- majority, blood flow to brain decreased from thrombus(slower onset)/embolism (rapid onset and cerebral dysfxn)
Hemorrhagic- HTN or ruptured aneurysm/AVM
258
What are the clinical features of CVAs?
Weakness/paralysis- opposite side of stroke
Aphasia
Visual deficits- toward side of stroke
259
Imgaing modality for ruling in/out CVAs?
CT
Fibrinolytics
Transport to stroke center
260
Difference of treatment options for ischemic and hemorrhagic strokes?
No fibrinolytics to hemorrhagic strokes
261
What causes viral meningitis?
Virus spreads from URI, ear or hematogenously
Adults- influenza
Kids: adenovirus, measles, rubella
262
What causes bacterial meningitis?
Adults: Strep Pneumo
Kids/young adults: Neisseria
Neonates: GBS
263
What are the clinical features of meningitis?
Fever
HA
Nuchal rigidity/meningismus
Brudzinkis Sign- forced neck flexion causes flexion of hips/knees
Kernig's SIgn- prone PT w/ hip flex at 90*, extension triggers pain/spasm of hamstring
264
All suspected meningitis SCF specimens have what test ran in the lab?
Culture
Viral= clear, lymphocytes, normal/high protein, NORMAL glucose
Bacteria: cloudy, neutrophils, high protein, low glucose
265
How does rabies present?
Weeks/months later
Flu-like
Agitation
Delirium
266
Who is more likely to have MS?
Women w/ North/Western European ancestry
| 15x higher if 1* relative w/ MS
267
What are the clinical features of MS?
Exacerbation/remission periods
Sensory Sx: loss of touch w/ tingling, blurred vision
Motor Sxs: Weakness, unsteady, incontinence
268
How is MS suspected and Dx confirmed?
2 nerve related Sxs in two or more episodes separated by 1mon or more
Confirmed w/ MRI
269
MS destroys what specific neural cells?
Oligodendroglial cells around fibers
270
Alzeihmer's is atrophy of cortex w/ ?
90% of PTs have what mutated gene?
Neuritic/senile plaques
| NuerofibrillaryAPOE4 tangles
271
What meds are used to slow Alzeihmers?
AChE inhibitor- Aricept
| Memantine
272
Parkinson's Dz is the degernation of ? system
Extrapyramidal motor systems from loss of pigmented neurons due to Lewy's Bodies
273
What are the 4 features of Parkinson's?
Pill rolling
Slow shuffling
Cogwheel
Mask like face
274
Huntington's Dz is atrophy of ?
Caudate necleus and motor cortex from autosomal dominant genes
275
Key Sx of Huntington's Dz?
How does the brain look different on scans?
Choreiform movement
Wide sulci
Large ventricles
276
What is the key feature of ALS?
Hand muscle fasciculations
| Degeneration of anterior horns/spine
277
What are the age onsets of the neuro disorders?
```
MS 25-40
ALS 35+
Huntingtons 40+
Parkinsons 60+
Alzeihmers 70+
```
278
Slide 32
Neuro
279
Define Myopia, Hyperopia, Astigmatism, and Presbyopia
M; nearsighted
H: far sighted
A: uneven refraction, total blurry
P: farsightedness of age from loss of lens elasticity
280
What appearance does classic pink eye have?
Inflammed vessels stand out against sclera's white background
281
What are the types of conjunctivitis?
Viral: most common, adenovirus, preceded by URI
Allerigic- eitchy eyelids and more edematous
Bacterial: copious mucopurulent discharge from trauma/poor contact hygiene
282
Characteristics of keratitis
Infection of cornea w/ ulcerative process that's usually an extension of conjunctivitis
283
What causes keratitis?
In US= HSV cold sore or zoster on CN5, ophthalmic branch, unilatral redness, photophobia, dendritic pattern
Out of US: Chlamydia trachomatis- major cause of blindness, contagious from contact or flies
284
Define Hordeolum
Stye, Staph A infection of eye lash follicle w/ small pustule at lash line
285
# Define Chalazion
Define Blepharitis
Blocked meibomian gland, not ABX treatment
Red/swollen eyelid and eyelash follicle
286
Characteristics of cataracts
Most common cause of vision loss in US but also one of the most treatable eye disorders
287
What are the types of cataracts?
Senile: most common, wear and tear on lens 60% +70y/o
Secondary: from trauma/burns/inflammation and higher risk of development in diabetics BUT NOT A CAUSE
288
Characteristics of Open and Closed angle glaucoma
Open: impaired reabsorption, slow inc of IOP
Close- sudden flow impedence, rapid inc of IOP causing painful red eye and blurred vision
Can be caused/triggered by mydriatics
289
How is glaucoma treated?
Stat opto referral to reduce IOP
Reduce humor production w/ BB or A-Agonist
Pilocarpine to constrict pupil for angle closure crisis
290
Characteristics of ARMD
Loss of central vision from Drusen Bodies
Dry- less aggressive
Wet- rapid progression
291
What 3 things can be seen in hypertensive retinopathy?
Reactive narrowing of retinal arterioles: copper/silver wiring
Retinal hemorrhages: dot and flame hemorrhages
Retinal edema/exudates: cottonwool spots
292
What will be seen on exam in diabetic retinopathy
Cottonwool spots
| Neovascularization
293
Define Retinoblastoma
Eye malignancy in kids that causes white pupil or white reflex
Eye enucleation needed otherwise is lethal
294
What is the eye tumor of adults?
Malignant melanoma- tumor from pigmented cells in uveal tract causing dark spots on iris/conjuctiva
Tx w/ eye enucleation
295
When is allergic otitis externa seen?
Kids w/ atopic dermatitis or adults w/ chronic eczema
| Itching, erythema dn flaking
296
When is bacterial otitis externa seen
Swimmers ear in kids from Staph A or Pseudomonas
D/c, tender w/ motion
Tx w/ ABX, steroids or acidifying drops
297
When is fungal otitis externa seen?
Hot climate and aquatic sports
Sx like bacteria w/out discharge and hyphae is seen in canal
Tx w/ antifunglas or acidifying drops
298
What is simply referred to as "ear infections"?
Otitis media
Acute= extension of viral URI
Sx: red/bulging TM that may spontaneously perf and drain
299
How is chornic/recurrent otitis media treated?
Repeat infections or failed ABX Tx
ENT referral
Myringotomy- PE tubes
300
What can cause perforated TMs?
Mechanical
Acoustic
Barotrauma
Infection
301
Define Cholesteatoma
Benign but erosive tumor that's a common compliation of chronic otitis media
White passes seen in middle ear w/ inspection
302
Define Labrynthitis
Benign Positional Vertigo
Debris in labyrinth from virus or trauma
PT feels dizzy, like on roller coaster
303
Define Meniere's Dz
Fluid imbalance between inner ear compartments
| Sx Triad: Vertigo, Hearing loss, Tinnitus
304
How will the Weber and Rhinne result in PTs w/ Meniere's Dz?
Weber to affected ear
| Rhinne AC>BC
305
What are the 3 types of hearing loss
Conductive: loss of AC, external/middle ear problem
Sensory: cochlear damage, inner ear receiver damage from trauma or presbycusis
neural: auditory nerve/brain damage from MS, stroke or tumor
306
What ototoxic meds can cause sensory hearing loss?
Gentamicin
Vancomycin
Antimalarials
307
What decible noise can cause damage?
>85 can release free radicals the irreversible damage hair cells
308
Mammogram can catch growths at what size?
.5cm
309
Physiological steaps behind Cholesteatoma
Canal epithelium grows inward to TM perforation
Neg pressure pulls squamous cells in and forms cyst
Cyst contents/size damages ossicles and mastoid
310
How are Cholesteatoma and Meniere's Dz similar
Chol: Drainage, vertigo, hearing loss
MD: tinnitus, hearing loss (sensory), vertigo
311
Define Presbycusis
Hearing loss of old age
312
What 4 areas do AVMs tend t form?
Frontal
Parietal
Temporal
Cerebellum
313
Where do most Berry Aneurysms form?
40%- Anterior communicating artery
34%- Middle cerebral artery
20%- Posterior communicating artery
4%- Basalar/posterior cerebral artery junction
314
What are the CT image shapes of brain bleeds?
Epidural: concave
Subdural: crescent
Subarachnoid: compressed ventricles
315
Condensed info on MS
25-40
Auto immune that demyelinates nerves
Blurred vision, sensory loss and muscle weakness
316
Condensed info on Alzeihmers
70+
Amyloid plaques and neurofibril tangles
Dementia/memory loss
317
Condensed info on Parkinson's
60+
Decreased dopamine neurons in nigra/extrapyrimidal motor disorder
Pill roll/cog wheel/mask
318
Condensed info on Huntington's
40+
Atrophy of caudate nucleus/cerebral cortex
Gyrating movement
Dementia/behavior change
319
Condensed info on ALS
35+
Anterior horn/medulla/cerebral cortex
Fasciculations and muscle wasting but intellect is spared
320
Characteristics of Ewing's
10-20y/o M>F
Long bones w/ sunburst/onion skin
Malignant and spreads through blood, 100% fatal w/out treatment
321
Characteristics of Osteosarcoma
10-25y/o
Most common 1* bone cancer
Invasive spread and blood metastases to lungs
322
Characteristics of Chondrosarcoma
35-60y/o
Cartilage tumor in axial skeleton
Tumor NOT chemo sensitive
