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IPAP > Pathology: Block 3 > Flashcards

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

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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

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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

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4
Q

What types of microbes can cause urethritis?

A

Bacteria
Atypicals
Chemical

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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

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6
Q

What is epididymitis a complication from?

A

Untreated urethritis or prostatitis

Usually Chlamydia in younger men, Uropathogen in older men

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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

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8
Q

Define Orchitis

A

Epididymo-Orchitis

Inflammation of testes, often from progression from epididymitis that can lead to sterility

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9
Q

What microbes can cause prostatitis?

A

Same as UTI- E Coli or Proteus Mirabilis

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10
Q

What are the clinical features of prostatitis?

A

Pain during urination
Urgency/frequency
Low fever

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11
Q

What is the difference between DRE findings in a prostatitis PT?

A

Acute: tender and enlarged
Chronic: soft and boggy

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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

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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

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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

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15
Q

What separates a hydrocele from an incarcerated inguinal hernia

A

Lack of inguinal canal involvement

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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

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17
Q

What are the treatment methods for a hydrocele?

A

NSAIDs
Support/elevate
Find and treat underlying cause
Surgical drainage if persistent

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18
Q

Define Vericocele

A

Abnormal dilation of testicular veins in sperm cord that can resemble a “bag of worms”

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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

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20
Q

Where do the L and R testes drain blood into?

A

L: L renal vein
R: inferior/vena cava

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21
Q

What are the clincial features of varicoceles?

A

A-Sx
Dull discomfort w/ prolonged standing/exertion
Bag-of-worm in anterior scrotum

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22
Q

How are varicocele’s treated?

A

None if A-Sx

Surgical if painful or cause of infertility

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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

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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

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25
Q

What is the difference in presentation of BPH and prostate cancer?

A

Cancer begins in prostate periphreals w/ late development of urinary Sx

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26
Q

How does BPH present in clinic?

A

Inc freq/urgency at night

Dec strength of flow

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27
Q

How is BPh seen with imaging?

A

Post void residual US will be inc w/ BPH (norm= 50mL)

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28
Q

When/who is penile cancer more likely to be seen in?

A

Uncircumcised >40y/o in non-US countries from poor hygiene or exposure to HPV

Tx w/ surgery and radiation

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29
Q

When/who is testicular cancer most common in?

A

25-45y/o w/ Seminoma being the most common type that rapidly grows and spreads

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30
Q

How are testicular cancers tested and treated?

A

US
Chest x-ray
Serum tumor markers- HCG, AFP, LDH

Urology referral ASAP for orchiectomy

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31
Q

Cancer on the scrotal wall tend to metastesize to ?

Cancer on the testes tend to metastesize to ?

A

Inguinal nodes

Para-aortic nodes

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32
Q

What is the most common type of cancer in males?

A

Prostate cancer w/ testosterone as the primary stimulant of cancer growth

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33
Q

What are the clinical features of prostate cancer?

A 
ASx like BPH
DRE to detect nodule
Trans-Rectal US
PSA +4ng
Alkaline phosphatase- indicates metastases to bone/spine
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34
Q

How is prostate cancer treated?

A

Dec testosterone w/ anti-androgen meds, estrogen
orchiectomy
Surgery
Chemo/rad

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35
Q

Define Vulvovaginitis

A

Vaginitis

Inc in PTs w/ ABX, pregnancy, DM or immunodeficiency

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36
Q

What are the common infectious agents of vaginitis?

A

Albicans- most common especially post-ABX
Gardnerella- overgrowth from dec lactobacillus/inc pH
STDs- Cl, Gnr, Syph, HS/PV

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37
Q

How are bacterial vaginitis samples identified for diagnosis?

S/Sx of Ablicans and Garderella infections

A

Clue cells on wet prep

Albicans- itch, discharge, dryness
Gardnerella- bacterial vaginitis, burning, fishy, Clue cells

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38
Q

Define PID

A

Ascending lower genital infection of the uterine cavity, once cervicitis- infection is assumed to be in uterus or higher

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39
Q

PID is associated with what STDs?

A

Chlamydia
Gonorrhoeae
Small risk post-IUD inplantation

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40
Q

PID affects what structures and which one is especially vulnerable to PID?

A

Cervicitis, Endometritis, Salpingitis (cervicitis= assumption infection is superiorly located too)

Fallopian tubes-develop tubo-ovarian abscess

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41
Q

How does PID present in clinic?

A

Abd pain, fever, nausea, discharge/bleeding
Cervical motion tenderness- hallmark finding
Peritonitis- late finding

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42
Q

How is PID treated?

A

High dose, broad spectrum w/ short in patient admission

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43
Q

Define Menorrhea

Define Amenorrhea

A

Menstrual flow

No menstrual flow

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44
Q

Define Menorrhagia

Define Metrorrhagia

A

Profuse and heavy

Irregularly timed

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45
Q

Define Metrohenorrhagia

Define Dysmenorrhea

A

Irregular heavy

Painful menses

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46
Q

Dysfunctional uterine bleeding is excessive/irregular bleeding related to hormonal disturbances from what two main causes?

A

Failure of ovulation and luteal phase

Contraception induced (start or stop phase)

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47
Q

Define Leiomyomas

A

Fibroids

Benign tumor that appears during reproductive years and more common in AfAm

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48
Q

How do large or multiple fibroids present and how are they treated?

A

Endometrial bleeding and dysmenorrhea
Compression causes urinary Sx and constipation

Myomectomy or hystorectomy

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49
Q

Define Leiomyosarcoma

A

Rare cancer forming directly from myometrium, not from leiomyoma, and frequently recur after removal

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50
Q

Define Endometriosis

A

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

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51
Q

How does endometriosis present?

How is it treated?

A

Sx become prominent during reproductive years
Dysmenorrhea and Pelvic pain
Urinary/Bowel Sx associated w/ menses

Tx: regulation w/ OCPs

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52
Q

Define PCOS

A

Enlarged ovaries bilaterally that is a complex hormonal disturbance and not an anatomic abnormality

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53
Q

What are the pathophysiologic occurrences that happen during PCOS?

A 
High LH, low FSH
Multiple cystic follicles but anovolulatory- infertile
Oligomenorrhea
Excessive androgen= hirsutism
Insulin dysfunction= obesity
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54
Q

Due to the rapid onset of ruptured ectopic pregnancies, what must be checked on all female PTs w/ CCO abd pain?

A

HcG

US to ID ectopic pregnancy

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55
Q

What are the weight and time frames for the criteria of abortion?

A

500g or 20wks gestation

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56
Q

What are the 4 types of abortions?

A

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

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57
Q

Define Toxemia of Pregnancy

A

Preeclampsia and Eclampsia

Abnormal function of placenta or abnormal materno-placental interactions

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58
Q

Pre-Eclampsia is a Triad of Sxs at what point of pregnancy?

A

Especially 1st pregnancy
34th week
HTN, Edema, Porteinuria

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59
Q

What are the S/Sx of eclampsia

A

Rare
Pre-Eclampsia Sxs
Seizures
Comas

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60
Q

How is Pre/Eclampsia treated/cured?

A

Delivery

Mg sulfate IV may prevent seizures but delays delivery

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61
Q

What is the majority of the cause of the 3% of GI cancers in women >60y/o

A

HPV- 90% are SCC and often with co-existing vaginal or cervical cancer

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62
Q

How does Vulvar Carcinoma appear?

A

Warty, leukoplakia white patches that need biopsy to confirm Dx

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63
Q

What are the primary risk factors that predispose cervical carcinoma?

A 
HPV is 1*
Early age of intercourse
Multiple partners
STDs- HSV or Syphilis
Smokers
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64
Q

What screening method has reduced incidences of cervical carcinomas?

A

Papanicolaou- ID of early dysplasia (Cervical Intraepithelial Neoplasia)

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65
Q

If female PT has suspicious PAP results, what is the next step?

A

Colposcopy w/ biopsy

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66
Q

How are early cervical carcinoma lesions treated?

A

Cryotherapy or Loop Electrosurgical Excision Procedure

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67
Q

What is the most common of the GYN cancers?

A

Endometrial Carcinomas- primarily post-menopausal women and strong associated w/ estrogen exposure

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68
Q

What are the risk factors of endometrial carcinoma?

What is not a risk factor that is odd from other cancers?

A

Estrogen supplements/producing tumor
No pregnancy
Early menarche/late menopause
Obesity, DM, HTN

Smoking

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69
Q

How does endometrial carcinomas present?

How is it treated?

A

Abnormal uterine bleeding
Post-menopause vaginal bleeding is cancer until proven otherwise

Treated w/ hysterectomy, radiation/chemo

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70
Q

What is the second most common GYN cancer?

A

Ovarian cancer BUT #1 most deadly

Most are surface epithelial tumors

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71
Q

What are the risk factors of Ovarian Cancer

What are two protective factors?

A

+ FamHx
Nulliparous
High fat diet
Anovulation

Multiparous, oral contraceptives

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72
Q

What are the 3 types of tissue in breasts?

What do they respond to?

A

Lactiferous, Fatty, CT

Hormones

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73
Q

What happens to breast tissue during menopause?

A

Lactiferous tissue replaced with fatty tissue and atrophy of ductal structures

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74
Q

Define Amastia

A

Congenital absence of breast

Complete lack of tissue, nipple or areola

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75
Q

Define Polythelia

A

Supernumerary nipples w/out breast tissues/glands that can occur anywhere along milk line but often misidentified as mole/birthmark

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76
Q

Define Polymastia

A

More than 2 breasts
Supernumerary- anywhere along milk line
Accessory- tissue w/out nipple in axilla, often confused as breast cancer metastasis

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77
Q

Who are acute mastitis almost exclusively seen in?

A

Lactating women

From incomplete emptying of milk from duct with skin Staph/Strep

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78
Q

How does acute mastitis present?

How is it treated

A

Erythema and edema
Pain/tender

Continue/inc breast feeding
ABX
Warm compress
Post feeding cleaning

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79
Q

Who is chronic mastitis seen in?

A

Older non-lactating women w/ unknown etiology

Biopsy to r/o cancer

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80
Q

Define Gynecomastia

A

Male breast enlargement
Infants- from maternal estrogen
Teens/young male- puberty
Older- obesity, cirrhosis, estrogen secreting tumor, Klinefelter’s Syndrome

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81
Q

What medications can cause gynecomastia?

A

Cimetidine- long term PUD

Anabolic steroids- converted to estrogen during metabolic breakdown

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82
Q

Define Fibrocystic Change

A

Fibrotic and cystic changes from tissue due to over response to hormones and aging, Sx improve post menopause

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83
Q

What are the clinical features of Fibrocystic Changes

A

Pain and Nodularity lumps
Sx vary w/ cycle
US/Mammogram reveal cysts and calcifications

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84
Q

How are Fibrocytic Changes treated?

A

Support
Dec caffeine
OCPs may stabilize cycle variability
Fine needle aspiration/excision of cysts

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85
Q

What is the most common benign tumor of female breasts?

A

Fibroadenoma- post puberty but young from over response to inc estrogen

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86
Q

What are the clinical features of Fibroadenoma

A

Mobile nodule that varies w/ cycle and during pregnancy

Painless- separates this from fibrocystic changes

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87
Q

How are Fibroadenoma treated?

A

Eval w/ US and mammography

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88
Q

Typically lumps are ? size before they can be palpated

A

2-2.5cm

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89
Q

S/Sx of breast cancer

A 
Lumps
Painless
Nipple discharge- worry w/ spontaneous and unilateral
Peau d'Orange
Retraction
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90
Q

Bloody or serous nipple discharge is associated with ?

A

Ductal Carcinoma

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91
Q

Define Galactorrhea

A

Bilateral milky discharge no associated w/ cancer from high prolactin levels from pituitary adenoma

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92
Q

Breast cancer risks increase with ? exposure

A

Estrogen- inc risk with early menarche, nulliparity or late menopause
Post-menopause inc risk

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93
Q

What are half or more of breast cancers located?

A

Upper lateral quadrant

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94
Q

Hyperpituitarism is AKA ?

A

Pituitary adenoma- common pathology that secrete functional hormones

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95
Q

Define Lactotropic Adenoma

A

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

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96
Q

How is lactotropic adenoma treated

A

Bromocriptime

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97
Q

Define Somatotropic Adenoma

A

Growth hormone
Pre-puberty= gigantism
Post-puberty= acromegaly

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98
Q

Define Corticotropic adenoma

A

ACTH

Cushing’s from over stimulation of adrenal cortex

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99
Q

What are the causes of Hypopituitarism

A

Congenital- empty sella syndrome; dwarf; hypogonadism
Tumor- dec circulation and destruction of pituitary
Circulatory distrubance- Sheehan Syndrome- post partum ischemia
Trauma- basal skull injury

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100
Q

How does hypopituitarism present in clinic?

A

Weak
Cold intolerant
Poor appetite/weight loss
HOTN

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101
Q

Hypopituitarism and Hyperpituitarism have the same Sx with what exceptions that HYPO has?

A

Cold intolerant
HOTN
Men- impotence/libido loss
Women- amenorrhea

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102
Q

Diabetes Ins. can be caused what three things?

A 
Damage to:
Hypothalamus
Pituitary stalk
Tumors of post. pituitary
Causes: intercranial tumor, infection of meninges, intracranial hemorrhage, basilar skull fx
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103
Q

What is the normal regulation of ADH with high/low serum NA

A

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

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104
Q

What are the clinical features of DI?

A

Polyuria: 5-6L/day of hypotonic urine w/ no change on water restriction
Polydipsia
NO POLYPHAGIA

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105
Q

What causes Thyrotoxicosis

A

Excess production of T3/T4 from:
Graves
Idiopathic nodular hyperplasia
Tumor- thyroid adenoma

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106
Q

What are the clinical features of Hyperthyroidism?

A 
Slowly appearing Sxs EXCEPT during thyroid storm w/ Graves Dz
Restless/nervousness
Tremors
Excess sweating
Heat intolerant
HIGH T3/4, Low TSH
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107
Q

How is Hyperthyroidism treated?

A

RI 131 ablation

Surgery

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108
Q

Who is more likely to have Graves Dz?

How is it characterized?

A

10x in women

Thyrtoxicosis
Exophthalmos
Dermopathy- pretibial myxedema (dough like skin)

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109
Q

What are the 3 types of hypothyroidism?

A

Thyroiditis- Hashimoto
Thyroidectomy
Iodine deficiency

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110
Q

Thyroiditis is most common ? and associated with ?

A

Hypothyroidism in US

Associated w/ other auto immune dz like Sjogren’s Syndrome

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111
Q

Iodine deficiency is rare in Western culture but is associated with ?

A

Goiters

Cretinism for deficiency during pregnancy

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112
Q

What are the clinical features of hypothyroidism?

A

Slowing of all metabolic processes
Slow, sleepy, weight gain
Low T3/4, HIGH TSH

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113
Q

How is hypothyroidism treated?

A

Synthetic Thyroid supplements for remainder of life

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114
Q

What is the pathophysiology behind a nodular goiter?

A

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

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115
Q

What are the thyroid hormone levels with a nodular goiter?

How is it treated?

A

Normal/Low T3/4
High TSH

Subtotal thyroidectomy

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116
Q

Thyroid neoplasms are more common in ? and primarily associated with ?

A

Females

Neck irradiation

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117
Q

Define Follicular Adenoma

A

Benign tumor presenting as solitary nodule but can’t be differentiated from normal tissue on R123 scan so Dx req’d by biopsy

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118
Q

Define Papillary Thyroid Carcinoma

A

80% of malignant thyroid nodules

Hormonally inactive tumor and seen as a “cold” nodule

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119
Q

Define Follicular Thyroid Carcinoma

A

15% malignant in female over 40, most are inactive “cold” nodules
Hormonal active ‘hot” nodule seen on radioactive scans

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120
Q

What are the majority of hyperparathyroidisms from?

A

Inc PTH secretion from benign parathyroid adenoma, usually just one of four
2* cause from end-stage renal failure

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121
Q

Excessive PTH stimulates what type of bone cell?

A

Osteoclast activity with Ca reabsorption

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122
Q

What are the clinical features of hyperparathyroidism?

A

ASx
Pathological Fx
Multiple kidney stones
High Ca, Low PO4

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123
Q

How is hyperparathyroidism treated?

A

Surgical excision of primary tumor

Kidney transplant if renal failure, causes PTH glands regress to normal

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124
Q

What is hypoparathyroidism usually caused by?

A

Accidental removal/damage during thyroid surgery causing dec PTH secretion which allow ostoblasts to inc Ca deposits in bone

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125
Q

What are the clinical features of hypoparathyroidism?

A

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

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126
Q

What will the lab results be for a PT with hypoparathyroidism?

A

Low Ca
High PO4

Ca/Vit D supplements
Synthetic PTH supplementation

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127
Q

What causes Cushing’s Syndrome (Hypercorticolism)

A

Pituitary adenoma- excess ACTH= Cushing’s Dz
Adrenocortical tumor- excess corticosteroids= Cushings Synd.
Exogneous glucocorticoids- prolonged steroid tx of autoimmune disorder

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128
Q

What are the clinical features of Cushing’s Syndrome?

A 
Central, truncal obesity
Moon face and Buffalo Hump
Facial redness
Cutaneous striae
Dec muscle mass
Facial hair and acne
Thin scalp hair
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129
Q

How is hypercortisolism treated?

A

Excision
Medical suppression of endocrine stimulation
If caused by exogenous steroids- gradual taper and cessation

130
Q

What was the primary cause of Addison’s before modern ABX were used?

Lav results will show what high/low abnormalities?

A

TB

Low- Na Cl
High- K

131
Q

When do Addison’s Sx aren’t visible/notable until how much damage has occured?

A

90% of adrenal cortex is destroyed

132
Q

What are the clinical features of Addison’s Dz

A 
Slow insidious onset w/ progressive weakening/fatigue
Weight loss
Fatigue
Bronzing Pigmentation
HOTN and syncope
133
Q

What will the lab results for Addison’s Dz show?

A

ACTH administration should trigger corticosteroid release while Addison’s Dz will have diminished/no response

134
Q

How is Addison’s treated?

A

Life long corticosteroid supplementation

135
Q

What is Pheochromocytoma linked with?

A

Family association w/ Multiple Endocrine Neoplasia (MEN)

Tumor secreting catecholamines (Epi/NorEpi)

136
Q

What are the clinical features of Pheochromocytoma?

A

Sx Triad: HA, Diaphoresis, and Tachycardia
Paroxysmal HTN
BUT: many PTs don’t present with Sx Triad

137
Q

What are the lab results of Pheo?

A

Inc Epi/NorEpi
24hr Vanillylmandelic Acid Test
(break down metabolite of Epi/NorEpi)

138
Q

How is Pheo treated?

A

Surgical resection

Only time HTN can be treated is with surgery

139
Q

Define Neuroblastoma

A

Malignancy of neonate/peds under 5 from undifferentiated adrenal medulla cells that gow and metastasize rapidly

140
Q

What are the clinical features of Neuroblastoma?

What’s the test and Tx?

A

Large abd tumor
VMA urine test elevated
Tx w/ surgery, chemo/rad

141
Q

What is the most common site for tumors to be in the human body?

A

Skin

142
Q

Define Macule

Define Patch

A

Flat lesion <2cm “Freckle”

Similar to macule but larger than >2cm

143
Q

Define Papule

Define Nodule

A

Elevated skin induration <1cm

Larger than papule, 1-5cm

144
Q

Define Tumor

Define Vesicle

A

Nodule >5cm of SCC

Fluid filled elevation <1cm

145
Q

Define Bullae

Define Pustule

A

Vesicle >1cm “Burns”

Vesicle filled w/ pus “Impetigo”

146
Q

Define Ulcer

Define Crust

A

Epidermal defect “chancre”

Skin covered w/ dried blood/plasma “healing”

147
Q

Define Excoriation

Define Fissure

A

Superficial skin defect from scratching

Sharp edged defect into deeper layers “Athletes foot”

148
Q

Define Wheal

Define Scales

A

Elevated itchy/transient lesion w/ erythema “bite”

Flakes removed w/ scraping “Seborrheic Dermatitis”

149
Q

Define Nevus

A

Most common congenial anomaly of normal skin elements arranged in abnormal manners- flat macules/slightly raised papules

150
Q

Define Melanotic Nevi

A

Common brown birthmarks and moles

151
Q

Define Port-Wine Stain

A

Nevus Flammeus- clustered capillary venules imparting deep red color usually on face/neck/torso

152
Q

Define Strawberry Hemangiomas

A

Vascular malformation of entire capillary causing raised papule w/ intense red color on face/neck/torso

153
Q

Characteristics of 1st degree burns

A

Mild erythema/edema (sunburn) of epidermis that heals quickly

154
Q

Characteristics of 2nd degree burn

A

Partial burn sparing dermis and forming bulla resulting in thinner new skin

155
Q

Characteristics of 3rd degree burns

A

Full through Epi/dermis and into muscles/fat causing scars from healing process

156
Q

What kind of 3rd degree burn can heal w/out intervention?

A

Welder’s burn

157
Q

Difference between Trench Foot and Frostbite?

A

Trench- wet but not freezing, necrosis with blisters and ulcers

158
Q

What issue can arise from electrical burns?

A

Deep thrombus
Compartment syndrome
Arrythmias
Rhabdo

159
Q

What causes ionizing radiation

A

Occupational exposure

Medicine- CT, Xray, Radiation

160
Q

What kind of dermal appearance does lightning strikes make?

A

Lichtenberg marking

161
Q

What acute viral Dzs are common in kids?

A

Measles
Chicken pox
Post viral rash- exanthems

162
Q

Common warts come from what virus?

A

Verruca Vulgaris from HPV

Hands/feet warts are different than HPV

163
Q

What are the 3 major types of skin infections?

A

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
Q

What causes a “Honey Crusted” lesion

A

Impetigo- Staph or Strep

Highly contagious found in kids on mouth/nose

165
Q

Define Folliculitis

A

Infection in hair follicles by Staph A causing furuncles and carbuncles

166
Q

Define Furuncle

A

Boil

Pustule involving single hair and surrounding tissue w/ pointed appearance

167
Q

Define Carbuncle

A

Enlarged furuncle involving multiple hair shafts and tissue in head or neck
Male > Female

168
Q

Thrush usually also presents with what secondary agent?

A

Intertrigo- dermatitis at body folds

169
Q

Dermatophytes AKA ?

A

Tinea that live in the dead outer layer of keratin skin/hair/nails causing itching and scratching

170
Q

Characteristics of “classic” ringworm

A

Semicircular shape w/ erythematous edge and central clearing

171
Q 
What are the names of tinea on:
Body
Groin
Foot
Scalp
Hand
Nail
A 
Corporis
Cruris
Pedis
Capitis
Manum
Unguium
172
Q

Characteristics of Eczema

A

Inflammatory skin disease w/ non-specific lesions of localized edema, papules and vesicles usually w/ itching

173
Q

What are the two major forms of eczema?

A

Exogenous: environmental/contact dermatitis

Endongenous: immune basis like Atopic dermatitis on face, elbows and knees and associated w/ nasal/respiratory allergies

174
Q

Define Seborrheic dermatitis

How is it managed?

A

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
Q

Characteristics of psoriasis

A

T lymphocyte mediated autoimmune disorder involving keratinocytes
Symmetrical patches of plaques coveed by silvery scale and generally non-pruitic

176
Q

Where is Psoriasis usually seen?

A

Extensor surfaces- elbows and knees but also scalp and nails

177
Q

What are the 4 warning signs of cancer

A

Persistent non-healing
Friable
Irregular shape/margins
Atrophic/keratotic margins

178
Q

What are the ABCDEs of skin neoplasms

A 
Asymmetry
Borders
Color
Diameter
Evolving
179
Q

What are the four types of Epithelial Tumors

A

Seborrheic Keratosis- stuck on appearance
Actinic Keratosis- scaly surface
BCC- rolled up w/ pearl color
SCC- recurrent bleed/crust

180
Q

Characteristics of Seborrheic Keratosis

A

Benign easily removed tumor that’s brown and flat

Treated w/ cryotherapy

181
Q

Characteristics of Actinic Keratosis

A

Pre-cancer from sun exposure and may precede SCCs

182
Q

What appearance does Actinic Keratosis have and how is it treated?

A

Red macules w/ rough/scaly surface

Treated w/ cryotherapy and Antineoplastic solution to desquamate large areas (5-Fluorouracil)

183
Q

Characteristics of BCCs

How are they treated

A

Common malignant skin tumors in sun exposed areas that’s elevated w/ central depression

Rarely metastases, excision/cautery destruction

184
Q

Characteristics of SCC and how are they treated?

A

Invasive tumor on sun exposed areas

Full depth excision

185
Q

What are the 3 types of benign pigmented tumors

A

Ephelis- freckle that is hyperreactive to UV light
Lentigo- unresponsive to UV light
Melanotic nevus- over abundance of melanocytes

186
Q

Define Malignant melanoma

A

Half originate from freckles/pre-existing nevi

Half originate from existing skin

187
Q

What are the 3 types of malignant melanomas

A

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
Q

Define Achondroplasia

A

Dwarfism

Impaired endochondral ossification in long bones

189
Q

How does Achondroplasis present clinically and get sub-divided into two categories??

A

Body habitus out of proportion
Shortened legs/arms with small face- endochondral ossification
Trunk and upper cranium develop normal= intermembraneous ossification

190
Q

Osteogenesis inperfecta is a defect in production of ?

A

Type 1 Collagen

191
Q

Define Osteomyelitis

A

Bone infection from Staph A

192
Q

How does Osteomyelitis present in adults and kids?

A

Adults- complicated open Fx

Kids: Bacteremia seeding of metaphysis

193
Q

Who is the “classic PT” of osteoporosis

A

Caucasian woman w/ slender/small frame

194
Q

What are the risk factors for osteoporosis

A

Age/Gender- elder women
Dec estrogen post-menopause
Dec mobility
Poor diet/malabsorption

195
Q

What are the clinical features of osteoporosis?

What imaging modality is used to see this dz?

A

Femoral neck Fx
Wedge Fx- Kyphosis/Dowager Hump

DEXA scan

196
Q

What meds can be given for osteoporosis

A

Alendronate
Ibandronate
Zoledronic acid

197
Q

What are the S/Sx of osteoporosis

A 
Bone pain/tenderness
Fx w/ little/no trauma
Loss of height
Neck/lower back pain
Stooped posture
198
Q

Define Osteomalacia

A

Rickets

Softening of bones from inadequate Ca mineralization, Vit D and/or PO4

199
Q

What are the clinical features of Osteomalacia

A

Bow legs
Breast bone projection
Scoliosis

200
Q

How is osteomalacia treated?

A

Vit D
Ca
PO4
Braces on bones

201
Q

Define Paget’s Dz

A

Osteitis Deformans
M/W over 40 esp w/ British/European ancestry
Irregular bone restructuring leading to thickened/deformed bones

202
Q

What are the clinical features of Pagets Dz?

A

Affects skull, prox femur and axial skeleton often w/ bowlegs
X-rays show lytic lesions from excessive remodel (honeycome/cottonwool appearance)

203
Q

How are Paget’s and Osteoporosis similar and different?

A

Similar- treatment

Different- Paget’s has high vascularity around bone deformities causing increased bleeding risk during ortho surgery

204
Q

What are the 4 steps of bone healing

A

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
Q

What factors promote Fx healing

A

Immobilization
Alignment
Blood supply
Diet

206
Q

What action can delay early fracture healing processes?

A

Motion between fragments

207
Q

What is the most common joint disease?

A

Osteoarthritis- DJDz

208
Q

Dejenerative joint disease involves what types of joints?

A

Weight bearing- knees, hips, vertebrae

Finers

209
Q

What two processes can accelerate joint surface cartilage wearing away?

A

Injury

Mechanical stress

210
Q

What type of ortho changes can PTs with osteoarthritis present with?

A

Soft/thin cartilage
Exposed subchondral bone
Narrow joint spaces
Osteophytes

211
Q

PTs with osteoarthritis may present with what curious presentation?

A

Gross x-ray deformities w/ only minor Sx

212
Q

How does osteoarthritis present clinically?

A 
Initial stiffness/pain
Cool to touch
Crepitus
Bouchard nodes- proximal
Heberden nodes- distal
213
Q

How is osteoarthritis treated?

A

Remaining active

NSAIDs

214
Q

Difference between RA and Osteoarthritis?

A

RA spares weight bearing axial skeleton

215
Q

Clinical features of RA

A

Symmetrical joint inflammation
Ulnar deviation
Finger Z deformity
Rarely elbow and ankle involvement

216
Q

RA can present with what four extra-articular manifestations?

A

Anemia
Pericarditis
Episcleritis
Skin lesions

217
Q

How is RA treated?

A

Lab test for rheumatoid factor may show but is not specific so-
NSAIDS
DMARDs

218
Q

What diseases/issues can lead to uric acid accumulating

A

Obese
ETOH
Renal Dz
Diuretics

219
Q

How does gout present clinically?

A

Podagra- swelling/redness of great toe
Systemic fever
Leukocytosis
Malaise

220
Q

Gout PTs may have what derm S/Sx

A

Tophi on ear, olecranon, and patella

221
Q

What test is conducted to dx gout?

How is it treated?

A

Aspiration for negative birefringent crystals

NSAIDs- indomethacin

222
Q

What type of bone tumor is more common?

A

Secondary- metastases from breast, prostate, lung, kidney or thyroid dz

223
Q

What are the 3 types of benign bone tumors?

A

Osteoma- tumors of bone cells
Chondroma- tumors of cartilage
Nonossifying Fibroma- tumor of fibroblasts

224
Q

How are benign bone tumors further evaluated and considered for surgical excision?

A

CT/MRI
Monitor x 6-12mon w/ repeat images
Excised if pain producing

225
Q

Define Ewing’s Sarcoma

A

10-20y/o M>F in long bones that spreads to soft tissues w/ Sunburst/Onion Skin appearance on x-rays

226
Q

Define Osteosarcoma

A

Most common primary bone cancer
Tumor on long bone involving metaphysis near knees
Hematogenously spreads to lungs

227
Q

Define Chondrosarcoma

A

Neoplastic cartilage cells in 35-60y/o

Cartilage tumor in axial skeleton of pelvis/vertebrae and adjacent long bones

228
Q

What is different about Condrosarcoma’s treatment than the other bone/joint neoplasms?

A

Non-reactive to chemotherapy

229
Q

What age/gender does Myasthenia Gravis effect?

A

20-35 women

50-60 men

230
Q

How does Myasthenia Gravis present?

A

Weakness worse at end of day

Ptosis and bland facial expression

231
Q

What lab tests can be conducted for Myasthenia Gravis?

A

Ach Abs or,

Ach challenge test- muscle weakness SHOULD improve

232
Q

How is Myasthenia Gravis treated?

A

AChE inhibitor- Aricept

233
Q

What is the most common muscular dystrophy?

A

Duchenne’s

Males w/ genetic X-linked defect of dystrophin protein

234
Q

What are the clinical features of Duchenne’s?

A

Affects pelvic girdle and lower extremities

Uses arms to lift torso by climbing legs (Gower’s Sign)

235
Q

What tests are ran to dx Duchennes?

A

Elevated serum CK- non specific and elevated in all dystrophies
Reqs genetics testing

236
Q

How is Duchenne’s managed?

A

Corticosteroids- Prednisone

237
Q

What is the most common childhood muscle weakness disorder?

A

Cerebral palsy- motor neuron dz of brain/spinal cord causing Floppy Child Syndrome and delayed milestone achievements (rolling/clapping @ 6mon)

238
Q

What are the two acquired muscle myopathies?

A

Diabetic- chronic hypoperfusion and peripheral nerve dysfunction

Cancer- paraneoplastic syndrome of tumor

239
Q

What is the pathologic chain of rhabdo?

A 
Damage/death
More edema
Vascular compression
Ischemia
Damage
240
Q

What will labs show in PTs with rhabdo?

How is it treated?

A

Inc K
Inc CK-MM

Tx w/ large volume of IV

241
Q

What are the 5 Ps of compartment syndrome?

A 
Pain- out of proportion to exam
Parasthesia
Pallor
Paralysis- late
Pulselessness- late
242
Q

What is normal intracompartmental pressure?

When is fasciotomy indicated?

A

ICP normally 30-40mm below diastolic

When DBP-ICP is less than 30

243
Q

Define Liposarcoma

A

Malignant fatty tumor that’s a rapid grower and non-mobile

Usually over adult thigh, arm, abd wall

244
Q

Scalp lacs can bleed significantly and may be an expanding ?

A

Hematoma

245
Q

What are the 3 types of skull fractures?

A

Linear
Depressed
Basilar- temporal region

246
Q

What are the S/Sx of a basilar skull Fx

A

Raccoon eyes
Battle’s sign
Hyemotympanum
Halo sigh

247
Q

What classically causes an epidural hematoma?

A

Middle meningeal artery torn by temporal bone fragments causing blood between skull and dura that shows Sxs in minutes to Hrs

248
Q

What are the clinical features of epidural hematomas?

A

LOC
Lucid interval and feels ok
Min-Hrs later: cerebral compression causes Sx- HA, N/V, confusion, vision changes

249
Q

Characteristics of subdural hematoma

A

Blood between dura and arachnoid from veins being torn during opposing brain and dura movements

250
Q

Typically, what causes subdural hematomas?

A

Blunt trauma hitting the heat (elderly falls)

Repeated small trauma (boxing, football) can have same effect as one large trauma

251
Q

How does subdural hematoma present clinically?

A

Days/wks later w/ worsening HA to lateralizing signs
Unilateral dilated pupil
Unilateral weakness
Decorticate/decerebrate

252
Q

Characteristics of subarachnoid hemorrhage

A

Bleeding between arachnoid membrane and pia matter from brain trauma or vascular abnormalities (occult bleeds)

253
Q

What are the clinical features of Berry Aneurysm/AVMs?

A

Thunderclap HA
Hemiparesis
Hemiplegia
Rapdi adv to coma/seizure

254
Q

Key term differences between Epideral, subdural and subarachnoid bleeds

A

Epi: blood outside of dura, concave shape
Sub-D: blood under dura, crescent shape
Sub-A: blood in brain w/ compressed ventricles

255
Q

How does increased ICP cause death?

A

Brain herniates into foramen magnum compressing autonomic centers causing coma and apnea

256
Q

What are the S/Sx of inc ICP?

A

Pupil dilation- anisocoria
Papilledema
Posturing- decro (flex), decere (extend)

Cushings Triad: respiratory change (Cheyne-Stokes/Agonal), widening pulse press, bradycardia

257
Q

What is the 3rd most common cause of death in US?

A

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
Q

What are the clinical features of CVAs?

A

Weakness/paralysis- opposite side of stroke
Aphasia
Visual deficits- toward side of stroke

259
Q

Imgaing modality for ruling in/out CVAs?

A

CT
Fibrinolytics
Transport to stroke center

260
Q

Difference of treatment options for ischemic and hemorrhagic strokes?

A

No fibrinolytics to hemorrhagic strokes

261
Q

What causes viral meningitis?

A

Virus spreads from URI, ear or hematogenously
Adults- influenza
Kids: adenovirus, measles, rubella

262
Q

What causes bacterial meningitis?

A

Adults: Strep Pneumo
Kids/young adults: Neisseria
Neonates: GBS

263
Q

What are the clinical features of meningitis?

A

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
Q

All suspected meningitis SCF specimens have what test ran in the lab?

A

Culture
Viral= clear, lymphocytes, normal/high protein, NORMAL glucose
Bacteria: cloudy, neutrophils, high protein, low glucose

265
Q

How does rabies present?

A

Weeks/months later
Flu-like
Agitation
Delirium

266
Q

Who is more likely to have MS?

A

Women w/ North/Western European ancestry

15x higher if 1* relative w/ MS

267
Q

What are the clinical features of MS?

A

Exacerbation/remission periods
Sensory Sx: loss of touch w/ tingling, blurred vision
Motor Sxs: Weakness, unsteady, incontinence

268
Q

How is MS suspected and Dx confirmed?

A

2 nerve related Sxs in two or more episodes separated by 1mon or more
Confirmed w/ MRI

269
Q

MS destroys what specific neural cells?

A

Oligodendroglial cells around fibers

270
Q

Alzeihmer’s is atrophy of cortex w/ ?

90% of PTs have what mutated gene?

A

Neuritic/senile plaques

NuerofibrillaryAPOE4 tangles

271
Q

What meds are used to slow Alzeihmers?

A

AChE inhibitor- Aricept

Memantine

272
Q

Parkinson’s Dz is the degernation of ? system

A

Extrapyramidal motor systems from loss of pigmented neurons due to Lewy’s Bodies

273
Q

What are the 4 features of Parkinson’s?

A

Pill rolling
Slow shuffling
Cogwheel
Mask like face

274
Q

Huntington’s Dz is atrophy of ?

A

Caudate necleus and motor cortex from autosomal dominant genes

275
Q

Key Sx of Huntington’s Dz?

How does the brain look different on scans?

A

Choreiform movement

Wide sulci
Large ventricles

276
Q

What is the key feature of ALS?

A

Hand muscle fasciculations

Degeneration of anterior horns/spine

277
Q

What are the age onsets of the neuro disorders?

A 
MS 25-40
ALS 35+
Huntingtons 40+
Parkinsons 60+
Alzeihmers 70+
278
Q

Slide 32

A

Neuro

279
Q

Define Myopia, Hyperopia, Astigmatism, and Presbyopia

A

M; nearsighted
H: far sighted
A: uneven refraction, total blurry
P: farsightedness of age from loss of lens elasticity

280
Q

What appearance does classic pink eye have?

A

Inflammed vessels stand out against sclera’s white background

281
Q

What are the types of conjunctivitis?

A

Viral: most common, adenovirus, preceded by URI
Allerigic- eitchy eyelids and more edematous
Bacterial: copious mucopurulent discharge from trauma/poor contact hygiene

282
Q

Characteristics of keratitis

A

Infection of cornea w/ ulcerative process that’s usually an extension of conjunctivitis

283
Q

What causes keratitis?

A

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
Q

Define Hordeolum

A

Stye, Staph A infection of eye lash follicle w/ small pustule at lash line

285
Q

Define Chalazion

Define Blepharitis

A

Blocked meibomian gland, not ABX treatment

Red/swollen eyelid and eyelash follicle

286
Q

Characteristics of cataracts

A

Most common cause of vision loss in US but also one of the most treatable eye disorders

287
Q

What are the types of cataracts?

A

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
Q

Characteristics of Open and Closed angle glaucoma

A

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
Q

How is glaucoma treated?

A

Stat opto referral to reduce IOP
Reduce humor production w/ BB or A-Agonist
Pilocarpine to constrict pupil for angle closure crisis

290
Q

Characteristics of ARMD

A

Loss of central vision from Drusen Bodies
Dry- less aggressive
Wet- rapid progression

291
Q

What 3 things can be seen in hypertensive retinopathy?

A

Reactive narrowing of retinal arterioles: copper/silver wiring
Retinal hemorrhages: dot and flame hemorrhages
Retinal edema/exudates: cottonwool spots

292
Q

What will be seen on exam in diabetic retinopathy

A

Cottonwool spots

Neovascularization

293
Q

Define Retinoblastoma

A

Eye malignancy in kids that causes white pupil or white reflex
Eye enucleation needed otherwise is lethal

294
Q

What is the eye tumor of adults?

A

Malignant melanoma- tumor from pigmented cells in uveal tract causing dark spots on iris/conjuctiva
Tx w/ eye enucleation

295
Q

When is allergic otitis externa seen?

A

Kids w/ atopic dermatitis or adults w/ chronic eczema

Itching, erythema dn flaking

296
Q

When is bacterial otitis externa seen

A

Swimmers ear in kids from Staph A or Pseudomonas
D/c, tender w/ motion
Tx w/ ABX, steroids or acidifying drops

297
Q

When is fungal otitis externa seen?

A

Hot climate and aquatic sports
Sx like bacteria w/out discharge and hyphae is seen in canal
Tx w/ antifunglas or acidifying drops

298
Q

What is simply referred to as “ear infections”?

A

Otitis media
Acute= extension of viral URI
Sx: red/bulging TM that may spontaneously perf and drain

299
Q

How is chornic/recurrent otitis media treated?

A

Repeat infections or failed ABX Tx
ENT referral
Myringotomy- PE tubes

300
Q

What can cause perforated TMs?

A

Mechanical
Acoustic
Barotrauma
Infection

301
Q

Define Cholesteatoma

A

Benign but erosive tumor that’s a common compliation of chronic otitis media

White passes seen in middle ear w/ inspection

302
Q

Define Labrynthitis

A

Benign Positional Vertigo
Debris in labyrinth from virus or trauma
PT feels dizzy, like on roller coaster

303
Q

Define Meniere’s Dz

A

Fluid imbalance between inner ear compartments

Sx Triad: Vertigo, Hearing loss, Tinnitus

304
Q

How will the Weber and Rhinne result in PTs w/ Meniere’s Dz?

A

Weber to affected ear

Rhinne AC>BC

305
Q

What are the 3 types of hearing loss

A

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
Q

What ototoxic meds can cause sensory hearing loss?

A

Gentamicin
Vancomycin
Antimalarials

307
Q

What decible noise can cause damage?

A

> 85 can release free radicals the irreversible damage hair cells

308
Q

Mammogram can catch growths at what size?

A

.5cm

309
Q

Physiological steaps behind Cholesteatoma

A

Canal epithelium grows inward to TM perforation
Neg pressure pulls squamous cells in and forms cyst
Cyst contents/size damages ossicles and mastoid

310
Q

How are Cholesteatoma and Meniere’s Dz similar

A

Chol: Drainage, vertigo, hearing loss
MD: tinnitus, hearing loss (sensory), vertigo

311
Q

Define Presbycusis

A

Hearing loss of old age

312
Q

What 4 areas do AVMs tend t form?

A

Frontal
Parietal
Temporal
Cerebellum

313
Q

Where do most Berry Aneurysms form?

A

40%- Anterior communicating artery
34%- Middle cerebral artery
20%- Posterior communicating artery
4%- Basalar/posterior cerebral artery junction

314
Q

What are the CT image shapes of brain bleeds?

A

Epidural: concave
Subdural: crescent
Subarachnoid: compressed ventricles

315
Q

Condensed info on MS

A

25-40
Auto immune that demyelinates nerves
Blurred vision, sensory loss and muscle weakness

316
Q

Condensed info on Alzeihmers

A

70+
Amyloid plaques and neurofibril tangles
Dementia/memory loss

317
Q

Condensed info on Parkinson’s

A

60+
Decreased dopamine neurons in nigra/extrapyrimidal motor disorder
Pill roll/cog wheel/mask

318
Q

Condensed info on Huntington’s

A

40+
Atrophy of caudate nucleus/cerebral cortex
Gyrating movement
Dementia/behavior change

319
Q

Condensed info on ALS

A

35+
Anterior horn/medulla/cerebral cortex
Fasciculations and muscle wasting but intellect is spared

320
Q

Characteristics of Ewing’s

A

10-20y/o M>F
Long bones w/ sunburst/onion skin
Malignant and spreads through blood, 100% fatal w/out treatment

321
Q

Characteristics of Osteosarcoma

A

10-25y/o
Most common 1* bone cancer
Invasive spread and blood metastases to lungs

322
Q

Characteristics of Chondrosarcoma

A

35-60y/o
Cartilage tumor in axial skeleton
Tumor NOT chemo sensitive

IPAP (212 decks)

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