Systemic Flashcards
What happens with acute inflammation
- vasodilation 2. structural changes 3. PMNs
What happens with chronic inflammation
Macrophages, lymphocytes, plasma cells, Tissue destruction, repair.
Granulomatous inflammation
Marked by a large amount of macrophages.
What affects wound healing
decrease blood flow, other infections,
What happens with cell death?
Lack of oxygen and increased anerobic respiration results in increase cellular Na. If this prolongs necrosis will occur.
Necrosis
The death or one or more cells as a result of irreversible damage.
Coagulative necrosis
Occurs with heart attack. The structure is maintained but inside is sad
Liquefactive necrosis
Lungs with fungus.
Caseous Necrosis
TB.
Hypersensitive Reactions
ACID
Type I hypersensitivity
analphyactic. IgE mediates and bind to mast cell for degranulation. Ca binds the next time for increased response. Initial is 5-30 and late 4-6 hours.
Type 2 hypersensitivity
Cell mediated. Occurs with IgG and IgM. Attacks a foreign body but also hurts the own cell.
Type 3 hypersentivity
Immune complex mediated. Antigen/AB complexes. Occurs with lupus. No foreign part.
Type 4 hypersentivity
Delayed. T lymphocytes encounter an antigen and release luekokini leading to macrophage activation.
Systemic Lupis Erythromatosis
SLE. W>M. 30s. Mallar rash. Type 3. Can have dry eye, disc edema, papilledema, etc. ANA+
Rheumatoid Arthritis
W>Ms. 50’s. Synovial shift in morning so pain is worse. Dry eye=aqeuous deficient. ANA and RF+
Scleromalacia perforans
common with RA. Necrotizing scleritis without inflammation.
JIA
W>M. chronic bilateral non-granulomatous anterior uvieits. Can have a low grade fever. ANA+
Sjogren’s Syndrome
Dry mouth, eye, and arthritis. No arthritis in primary.
Sarcoidosis
Middle aged african American women. non-caveating granulomous and increased ACE. Order a lung X-ray if suspect.
SE with Sarcoidosis (The big 6)
- Anterior granulomatous uveitis 2. bells palsy 3. vitritis (cotton balls) 4. vasculitis (candle wax) 5. ON disease 6. Dacroadentitis
Ankylosing spondylitis
M>F. Young. Has a bamboo spin, sacroiliitis, uveitis, and aortic regurgitation. HLAB27 and X ray should be ordered.
Reactive arthritis
M>F. Urethra, uveitis, joint pain. HLA B27.
Psoriatic Arthritis
Sores in synovial fluid so join pain. HLA B27
Which disease are HLA B27 postiive
CRAP. Chrns, reactive arthritis, Ankylosing, psoriatic.
Which are ANA positive
RA, SLE, JIA,
Giant Cell arteritis
AAION. Superior temporal can affect SPCAs. Have scalp and jaw tenderness. Test to order include ESR, CRP, CBC/WBC, and temporal artery biopsy. Has skip lesions.
Granulomatosis with polyangiitis
(weaner’s granulomatosis). Vasculitis including the kidney, lungs, and upper respiratory tract. Can cause granulomatous sclerouveitis.
Scleroderma
tightening of the skin. Can cause dry eye and shrinkage of areas of the skin and conj.
Gout
Uric acid in the MTP (podogra). Painful. Men.
Band keratopathy
Calcium in bowman’s
Congenital immunodeficinty disease
IgA. Born with less. Can have keratinization of cornea, weight loss, diarrhea, and reccurnt upper respiratory tract infections.
AIDS
Caused by HIV an RNA virus that does reverse transcriptase to make DNA.
What CD4 count means you have aids
200 or less
Tests to run for Aids
ELISA and Western blot
Most common infection with AIDs
Cytomegalovirus retinitis, pneumonia, toxo, TB, kaposiosacroma.
Seborrheic Keratosis
Benign. Elevated stuck on appearance.
Keratocanthoma
Isolated dome shaped nodules. Remission over months.
Papillomas
Viral slow growing epithelial tumors that may be caused by HPV. Look like skin tags. HPV can cause cervical cancer.
Xanthelasma
Yellow plaque lesions in lid. Associated with high cholesterol.
Molluscum contagiosum
Common in kids. Spread by DNA pox virus. Dome shaped waxy nodules. If multiple think HIV.
Acne Rosacea
telengectasia and rhinopehyma. Can have hordeolum, chalzia, phlyctenulues, keratitis, and dry eye.
Allergic contact dermatitis
Type 4.
Impetigo
Grame + infection. Honey colored crusted lesion. Very common in kids.
HSV 1
Above the belt. More likely ocular
HSV 2
STD. Can have ocular manifestations with birth. Herpetic keratitis in neonates. Dendritic keratitis can also occur.
Herpes zoster virus
Chicken pox and shingels. Will have keratitis with pseudo dendrite.
Behcet’s disease
Middle east. Must have 2 of the following (skin lesions, mouth lesions, genital lesions, ocular lesions). Have acute recurrent hypopyon.
Superficial spreading melanoma
The most common variant of melanoma. It has rapid growth and is found on non-exposed skin
Basal cell carcinom
Most common. Telengectasia. Can have a rodent ulcer
Squamous cell carcinoma.
No telengectasia. More likely to metastasize. Arises for actinic keratosis.
Sturge Weber syndrome
Capillary malformation. Can cause glaucoma due to increase episcleral venous pressure. Can also cause iris heterochromia. Have port wine stain.
Tuberous sclerosis
Astrocytic hamartomas. Grows tumors in the brain and other organs. Have hypo pigmented macule, shagreen patches, angiofibromas, and brown plaque on the forehead.
Down syndrome
Trisomy 21. Prominent epicanthal folds, congenital cataracts, strabismus, glaucoma, keratoconus.
Klonefelter’s syndrome
XXY.
Turner’s syndrome
XO. Keratinous. BV issues (CI, strabismus, amblyopia, reduced accommodation)
Von hippie Lindau Disease
AD. Benign and malignant tumors. Retinal angiomas can rupture.
Neurofibromatosis Type 1
AD. Von recklinghauson’s disease. Tangle of tissue. Optic nerve glioma, litchi nodules, cafe au last spots.
Marfan’s syndrome
AD. Connective tissue disorder. Long stature. Keratinous. Sublimation of lens up. Aortic problems. Floppy valves.
Huntington’s chorea
AD. Bad movement and eye movemens
Familial adenomatous polyposis
AD. Gardner’s is a variant that will have CHRPE lesions (4 or more). Refer for testing as 100% with FAP will get colon cancer.
Sickle Cell
AR. glutamic acid on beta goblin to valine. Sickling of cell. African american. Sea fan retinopathy. Can get jaundice. Decrease hemoglobin, MCV normal, increased reticulocyte.
Tay Sach’s
AR. Cherry red spot. Atrophy of ON with increased glycolipids.
The only AR conditions we talked about
Sickle cell, Tay sach’s, PKU.
The only AD conditions we talked about
Huntingtons, Von hippie, Neurofibromatosis, FAP, Marfans.
The only X linked conditions we talked about
Fabry’s and Duchenne musclular dystrophy.
Leber’s Hereditäre Optic Neuropathy
Mitochondrial. Cause central vision loss. My mother leber lost my eyes.
What tests to order for anemia
CBC-Hgb and MCV
Anemias with MCV low
All low HGB. Low MCV with iron deficient anemia and aplastic anemia.
Iron deficiency anemia
Most common. Pica.
Aplastic Anemia
Attack all cells in the bone marrow (pancytopenia). Acetazolamdie and chloramphenicol can cause
Issues with normal MCV
Sickle cell and chronic kidney disease (cannot release as much erythropotein)
Anemias with increased MCV
Folate acid anemia, and Vitamin B12 deficiency.
Vitamin B12 Deficiency
Cobalamin. Often caused by pernicious anemia.
Folic acid deficiency
Occurs in pregnancy and alcoholism. Worry about neural tube defects with pregnancy.
Multiple Myeloma
Cancer of plasma cells. Affects kidney. Increased Ca in blood.
Hodgkins lymphoma
40% lymphoma. Reed-sterner cells. Associated with EBV.
Non-hodgkin’s lymhoma
60%.
Acute Lymphoblastic leukemia
Better prognosis. Increase lymphoblasts
Acute Myeoblastic Leukemia.
Poor prognosis. Increased myeblasts. Auer rods in blood cells.
Chronic Lymphocytic Luekemia
Better prognosis.
Chronic Myeocytic Leukemia
Worse prognosis. Associated with philidelphia chromosome.
Leukopenia
Decreased number of WBC
Lukocytosis
Increase in the abolsute number of WBC
Neutrophilia
Increase in the absolute number of neutrophils.
Thrombocytosis
Increased platelets count
Pancytopenia
Decrease in number of red and white blood cells and plateletes
Thrombocytopenia
Decrease in platelets.
Non-inflammatory causes of edema
Protein poor transudate. Increased organ pressure, reduced plasma osmotic pressure, lymphatic obstruction, sodium retention,
Inflammatory causes of edema
Protein rich exudate. Acute and chronic inflammation and angiogenesis.
Purpura
Greater than 3mm hemorrhage associated with trauma, vascular disease, or low platelet count
Ecchymoses
Greater than 1-2 cm and include subcutaneous hematoma or bruises
Virchow’s triad of thrombus
Stasis, injury, alteration in the constitutes in the blood (Prot C or S or things like birth control)
Types of Embolus
FATBAT. Fat=fracture. Air. Thrombus, bacterial, Amniotic fluid, tumor.
Where does an embolus formed in the vein system go?
The lungs
Where does an embolus formed in the arterial system go?
The brain
Shock
Decreased blood perfusion from a reduction in cardiac output or circulating blood volume.
Cariogenic shock
Occurs when heart stops.
Hypovolemic shock
Occurs when you loos a large amount of fluid or blood
Septic
Vasodilation causes pooling of blood with infection
Atherosclerosis
cholesterol plaques build up. Endothelial cell injury can lead to further atherosclerosis. Macrophages try to fix the damage to the endothelium and can cause a blockage of the vessel.
Amaurosis Fugax
Ipsilateral vision loss in one eye due to carotid arty disease.
Roth Spots
Leukemia and endocarditis.
Left sided heart failure
Most common cause is ischemic cardiomyopathy from Coranary artery disease. Fluid backs up in the lungs.
Right sided heart fialure
Most commonly caused by left sided heart failure. Now blood poos in abdomen and legs.
Rheumatic Fever
Type II hypersensitivity. Strep causes. The disease can alter the shape of the heart valves.
Bacterial Endocarditis
Bacterial in the inner lining of the heart (especially the lungs) Get roth spots.
Heart palpitation
Premature ventricular complexes most common. Most are benign
Transient Ischemic Attacks
Less than 24 hours. Most common cause is an embolism. There are two types of TIA
Carotid artery TIA
Contralateral arm/hand weakness or sensory loss and face and legs symptoms. Patients can also have amaurosis fugax (ipsilateral visual symptoms)
Vertebrobasilar TIA
Diplopia, ataxia, vertigo, dysarthria, and either unilateral or bilateral vision loss.
Hollenhurst plaque
Embolism found in retinal vasculature. These patients have TIAs and should be referred asap.
Stroke
Sudden onset of neurological deficits. Like TIA but lasts longer.
Macular sparing homonymous hemianopsia
Most common. Can affect middle cerebral or posterior cerebral but not both.
Ischemic Stroke
Most common. Occurs from occlusion with an embolus or other.
Hemorrhagic stroke
Occur from a hemorrhage that stops oxygen from reaching its destination.
Subarachnoid hemorrhages
Worst headache that they have. Can have a pupil involving CN III lesion.
Where do aneurysm with CN III palsies occur
Circle of Willis. Typically at posterior communicating and ICA.
Who does anterior cerebral supply?
Frontal lobe
Who does middle cerebral supply
fontal lobe, temporal and parental, and occipital
Who does posterior cerebral supply?
Temporal and occipital.
Syncope
Decreased blood to the brain
Cluster Headaches
M>W. Worse in morning. Associated with corners. Orbital or temporal. Usually unilateral.
Tension headaches
Band like distribution. More common in females.
Migraine Headaches
W>M. Lasts a long time. Prodrome. Better after menopause.
Meningitis Triad and ocular
Stiff neck, Head ache, fever. papilledema.
Glioblastoma Multiforme
The most common primary malignant brain tumor.
Meningioma
Being brain tumor.
Schwannoma
Can cause gradual onset of proptosis.
Pituitary adenoma
Bitemporal hemianopsia as well as prolactin which causes milk production
Multiple Sclerosis
F>M around age 40. Diagnosis requires two separate central nervous system lesions on two separate occasions. Most common sign is ON. Can also have pain on eye movement, APD, INO, and diplopia.
Uthoff’s phenomena
Decreased VA with hot
INO
Caused by damage to MLF. The eye with the nystagmus means there is contralateral damage to the MLF.
Guillain-Barre Syndrome
Just like MS but in the periphery. Can have Addies tonic pupil and papilledema.
Myasthenia Gravis
Associated with thymic tumor, RA, and lupus. Bodies binding to acetylcholine receptors. Ptosis and diplopia with symptoms worse at the end of the day.
Alzheimer’s disease
Age, Amyloid, Aricept, acetylchinerasterase inhibitor.
Parkinson Disease
Too little dopamine. TRAP. Tremor, rigidity, akinesia, postural instability.
Why do we monitor pupils with head trauma
Epidural hematoma can cause brain to go through foramen magnum but will damage pupils first.
Epidural hematoma
blood above the skull after closed head trauma
Subdural hematoma
Blood between dura and arachnoid. Can have a blown tumor
Horner’s Syndrome
Does not always have anhydrous. Pan cost affects preganglionic fibers
Bells palsy
Diagnosed by exclusion.
Type I diabets
Do not release insulin like they should. Due to beta cell destruction. Worry about diabetic ketoacidosis (start using other things for energy).
Type II Diabets
Resistance to insulin. No DKA.
Normal A1C
Less than 7
Normal fasting plasma glucose
Less than 126
Diabets INsupidus
Lack of ADH. ADH pulls water out so reduced ADH=more water loss. Think diabetes but will have normal glucose.
What has the greater genetic association?
Type II.
Hypothyroidism
Have increased TSH with decreased T4 and T3.
Hashimotis Thyroiditis
ANA +. Autoimmune mediated condition that attacks the thyroid gland.
Hyperthryoidism
Have decreased TSH with increased T4 and T3.
Hyperparathyroidism
Increased calcium in the blood form the bones. Causes band keratopathy, renal stones, bone pain. etc.
Hypoparathyroidism
Most commonly seen after a thyroidectomy. Will have decreased calcium in the bones. Can have cataracts and uveitis and difficulty with muscle contraction.
Addison’s Disease
ANA+. Autoimmune atrophy of the adrenal glands. Decreased corticosteroid.
Cushing’s Syndrome
Hypercortisolism. Effect of excess steroids on the body. Have a central obesity, a moon face, and a buffalo hump.
Pheochromocytoma
Tumor secreting excessive amount of norepinephrine and epinephrine. Can be on adrenal glands or anywhere on the SNS chain. Causes increased BP, heart palpitations, pain, pallor, perish, papilledema.
Acute Renal Failure
Cause with heart attack or shock.
Chronic renal failure
Caused by HTN or DM
Tests for the Renal failure. What would they look like with kidney failure
GFR-low. Creatine-1 is normal. Would be high. BUN=increased in disease.
Nephrotic syndrome
Greater than 3.5 grams protein in the urine.
Post streptococcal glomerulonephritis
Renal infections caused by streptococci. Occurs after street infections.
Renal Cell Carcinoma
Flank pain, hamatouria, abdominal renal mass.
Chalmydia
The most common bacterial STD. Chronic. Treat with Azithromycin and doxycycline.
Gonorrhea
Hyper acute. Purulent discharge. Often with Chlamydia. Treat with cefrtiaxone (gonorrhea), doxycycline (in case also has chlamydia)
Syphilis
STD caused by treponema palladium. Primary phase is a chancre. Secondary is eye lesions, kidney, CNS, etc. Third phase is CNS-Argyll Robertson pupil
Syphilis Ocular Manifestations
Interstitial Keratitis, salt and pepper funds, uveitis.
Lab tests to see if currently have Syphills
VDRL, RPR, EIA
Lab tests to see if every had syphillis
FTA-ABS, TPPA, MHA-TP.
Benign Prostatic Hypertrophy
Prostate grows and makes it difficult to urinate.
Prolactin vs. oxytocin
Prolactin=milk production. Oxytocin=milk ejection.
Most common cancers in women
breast, lungs, colon
Most common cancers in men
prostate, lungs colon
Most likely cancers to cause death in women
Lung, breast, colon
Most likely cancers to cause death in men
Lung, prostate, colon.
What causes neural tube defects during pregnancy
Folic acid deficiency
Cerebral Palsy
Non progressive varied infections, toxins and congenital malformations in infants.
Rubella
Mothers transfer this to the features. Microphthalmia, glaucoma, cataracts.
What do you think with infant cataract
Rubella or galactosemia.
Peptic Ulcer Disease
Helicobacter pylori, NSAIDS, etc.
Barrett’s Esophagus
From squamous to columnar. Occurs from continuous acid damage to esophagus.
IBD
Chron’s and ulcerative collinitis
Chron’s Disease
Infectious. Fat old crone skipping down a cobblestone road. Rectal sparing. Skip lesions.
Ulcerative colitis
More common uvieits. Colon–>rectum.
Wilson’s disease
hepatolenticular degeneration. Collection of copper. Has a kayser fleshier ring and sunflower cataract.
Which types of hepatitis have a vaccine
A and B.
Which is the only DNA hepatitis virus
B
Which are transmitted by fluid
B,C,D
Which are transmitted fecal oral
A and E
Hepatitis A
Vaccine. Fecal oral
Hepatitis B
Vaccine. Fluid. DNA.
Hepatitis C
No vaccine. Fluid.
Hepatitis D
No vaccine. Carries with hepatitis B
Hepatitis E
Fecal oral. no vaccine.
Tests for hepatitis
AST and ALT.
Cholecystitis
inflammation of the gall bladder. Most common in overweight females of child breaking age.
Pancreatitis labs
amylase and lipase
Pancreatitis cause
Alcohol and gall stones.
Meniere’s disease
vertigo, hearing loss, tinnitus.
Temporomandicular disorder (TMJ)
Headaches, facial pain, and jaw pain. It is a join issue.
COPD
Emphysema and Chronic bronchitis.
Emphysema
Pink puffers. More air spaces.
Blue bloaters
Mucus. Stops oxygen exchange. Blue bloaters.
Asthma affects
Acute reversible bronchoconstirction and chronic inflammation in the air ways
Tuberculosis Ocular manifestations
Bilateral granulomatous uveitis, CME, keratitis, phlyctenules.
Normal TB results
15 mm in everyone. 10 mm in healthcare. 5 mm in immunocompromised or living with TB
Carcinoma
Malignant tumor of epithelial cells
Sarcoma
Malignant tumor or CT
Metaplasia
Mature form one mature cell to another mature cell
Neoplasia
New growth
Dysplasia
Disorganized growth.
Wernicke-Korsakaoff
No vitamin B1 (thiamine). Toxic optic neuropathy. Korsakoff is not reversible.
What causes schizophrenia
Increased levels of dopamine
