Systemic Disease Flashcards
1
Q
defense response that eliminates the products of cellular injuries (necrotic cells and debris), plays a role in the healing of injured cells by diluting or destroying the agent responsible for injury
A
inflammation
2
Q
acute inflammation
A
an immediate response to injury that occurs 1-2 minutes post-injury, deterministic (happens the same way every time)
generates redness, heat, pain, swelling, and has presence of WBCs
3
Q
3 major components of acute inflammation
A
- vascular size changes (dilation) to facilitate increased blood flow
- structural changes in the microvasculature (increased permeability) to facilitate the arrival of plasma proteins and leukocytes from the circulation
- immigration of neutrophils (PMNs) from circulation to the site of injury
4
Q
outcomes of acute inflammation
A
complete resolution, scarring, fibrosis, abscess formation, and/or progressing to chronic inflammation
5
Q
chronic inflammation
A
prolonged inflammation lasting from weeks to years. active inflammation, tissue injury, and healing all progress at the same rate
6
Q
chronic inflammation is characterized by:
A
- infiltration with mononuclear cells (macrophages, lymphocytes, and plasma cells)
- tissue destruction
- repair involving new vessel proliferation (neovascularization) and fibrosis
7
Q
chronic inflammations will arise in the following situations:
A
persistent infections, prolonged exposure to potentially toxic agents, and autoimmune diseases
8
Q
major differences between chronic and acute inflammation
A
acute begins 1-2 minutes post-injury, chronic lasts weeks to years
acute involves PMNs and chronic involves macrophages, lymphocytes and plasma cells
acute happens the same way every time, chronic inflammation is not all the same, some types are granulomatous some are not
9
Q
granulomatous inflammation
A
a type of chronic inflammation that is marked by large, activated macrophages with a squamous cell-like appearance
10
Q
examples of granulomatous inflammatory diseases
A
bacterial - tuberculosis, leprosy (hansen), syphilis
fungal - histoplasmosis, blastomycosis
foreign body - suture, vascular graft
unknown - sarcoidosis
11
Q
local factors that prolong wound healing
A
local infections, decreased blood supply, or the inability to form clots
12
Q
systemic factors that prolong wound healing
A
immunocompromised states including diabetes, decreased peripheral blood flow, systemic infection, malnutrition, and increased glucocorticoid production (stress)
13
Q
reversible cell injury
A
marked by a decrease in blood supply to a cell and a corresponding decrease in oxygen supply (hypoxia) will cause an increase in lactic acid concentration (decrease in tissue pH) and a decrease in ATP production (causes an accumulation of intracellular sodium and then cellular edema)
it is reversible when oxygen is restored to the cell and normal ATP, aerobic respiration, and sodium-potassium pump function is restored
14
Q
irreversible cell injury
A
persistent ischemia and insufficient ATP results in sodium accumulation which causes edema in the cell disrupting the membrane and causing crucial components needed for ATP production to leak out (irreversible tissue necrosis)
15
Q
irreversible tissue necrosis
A
progressive loss of membrane phospholipids, cytoskeletal abnormalities, toxic oxygen radicals which damage the cell membrane and other cell components, lipid breakdown products that accumulate in ischemic cells and result in phospholipid degradation
16
Q
two processes occur with necrosis
A
- enzymatic digestion of the cell
- denaturation of proteins
17
Q
four types of necrosis
A
coagulative, liquefactive, caseous, fat necrosis
18
Q
apoptosis
A
well-organized self-destruction of cells (programmed cell death), critical in fine-tuning the developing retina!
19
Q
coagulative necrosis
A
the structural boundary of a coagulated cell, tissue, or vessel is maintained, but integral structural proteins are denatured. occurs for example following a myocardial infarction
20
Q
liquefactive necrosis
A
a cell with a well-defined boundary remains but consists of dull, gray-white remains. seen in fungal infections in the lungs
21
Q
caseous necrosis
A
central necrotic tissue appears white and cheesy, example in tuberculosis infections
22
Q
fat necrosis
A
death to adipose tissue, small white lesions are formed
23
Q
Types of hypersensitivities
A
Type I - anaphylactic (first and fast)
Type II - cytotoxic
Type III - immune complex-mediated
Type IV - delayed or cell-mediated
24
Q
Anaphylactic (Type I) hypersensitivity reaction
A
an allergen activates a B-lymphocyte and IgE antibodies are produced and bind to the surface of mast cells and basophils. A second exposure to the allergen causes cross-linking of IgE, allowing calcium to enter and resulting in degranulation of the cell. Histamine is the primary mediator released from the mast cells and basophils.
The initial response is 5-30 minutes and resolved in 30-60 minutes. Late phase response can be 4-6hours later
25
What clinical effects does the release of histamine cause
benign itching, redness, rhinitis, wheezing due to bronchocontriction, hypotension due to exntensive vasodilation, tachycardia, nausea/vomiting, abdominal pain, diarrhea, headache, syncope, or seizures, life-threatening anaphylactic shock
26
Cytotoxic (Type II) hypersensitivity reaction
facilitated by antibodies against antigens absorbed on cell surfaces. IgM and IgG antibodies bind an antigen or enemy cell which leads to its destruction.
Ex. Rh disease when maternal IgG antibodies cross the placenta and attack fetal erythrocyte antigens
27
Immune complex-mediated (Type III) hypersensitivity
mediated by antigen-antibody (Ag/Ab) complexes either in the systemic circulation or those formed at the location of antigen deposition. Ag/Ab complexes activate the complement response, triggering an attack on neutrophils, and lysosomal enzymes release.
ex. Lupus, serum sickness, etc.
28
Delayed/Cell-mediated (Type IV) hypersensitivity
sensitized T-Lymphocytes encounter an antigen and release leukokinin leading to macrophage activation
ex. TB skin test, contact dermatitis, and corneal transplant rejection
29
Systemic Lupus Erythematosus (SLE)
autoimmune disease, F\>M 10:1, ANA+
butterfly rash, discoid lupus, photosensitivity, arthritis/joint pain (90%), renal disorders, neuro disorders (seizures), immune disorders, hemolytic anemia.
30
Ocular findings associated with SLE/Lupus
Dry eye, recurrent episcleritis, peripheral keratitis (infiltrates), photophobia, disc edema and papilledema
31
Rheumatoid Arthritis (RA)
systemic inflammatory disease causing symmetric arthrititis in multiple locations that leads to destruction of articular cartilage, in hands, wrists, feet, and small joints, worse in the morning. F\>M, RF+, 25% have ocular manifestations.
32
Ocular findings associated with Rheumatoid Arthritis
```
keratoconjunctivitis sicca (15-25%), scleromalacia perforans, peripheral corneal ulceration, peripheral keratitis
less common: choroiditis, retinal vasculitis, episcleral nodules, RDs, mac edema, papilledema
```
33
Juvenile Idiopathic Arthritis (JIA/JRA)
F\>M, affects multiple joints, RF(-) but can be ANA(+), most common cause of uveitis in children (80% of peds uveitis),
Pts \<6yo and ANA(+) are at higher risk for ocular manifestations
34
Ocular manifestations of JIA/JRA
Asymptomatic, chronic, bilateral, non-granulomatous, anterior uveitis, also often with a low-grade fever
JIA is the cause for about 80% of pediatric uveitis cases
35
Primary Sjogren's syndrome
aqueous deficient dry eye with a dry mouth, evidence of reduced salivary secretion, a positive focus score on a minor salivary gland biopsy, and the presence of autoantibodies (ex. SS-A, SS-B, ANA, RF)
36
Secondary Sjogren's syndrome
primary Sjogren's syndrome AND an autoimmune connective tissue disease (most often RA, SLE, polyarteritis nodosa, Wegener's granulomatous) with the triad: **dry eyes, dry mouth, and an autoimmune disease**
37
Association between Sjogren's syndrome and lymphoma
approx. 5% of Sjogren's pts develop a malignant B cell lymphoma. 20% of deaths of Sjogrens pts are related to lymphoma. Primary Sjogrens risk for lymphoma is higher (8.7) compared to secondary Sjogrens (4.5). The risk of malignant B cell lymphoma increases from 2.9% at 5 years to 4.8% at 10 years. Mean time to develop lymphoma in Sjogrens pts is 7 years.
38
Sarcoidosis
idiopathic, often affecting African-American females, characterized by non-caseating granulomas and increased levels of serum angiotensin-converting enzyme (ACE) in most cases, also 90% of pts have lung involvement (chest x-ray indicated)
39
Ocular manifestations of Sarcoidosis
present in 25% of sarcoid pts. 19% of sarcoid pts will have chronic, bilateral, anterior granulomatous uveitis (makeup 75% of ocular manifestations), chronic dacryoadenitis, dry eye disease, CNVII palsy, posterior seg findings such as vasculitis (candle wax drippings), diffuse vitritis (cotton ball opacities), and 1-5% of pts will develop optic nerve disease
40
Ankylosing spondylitis
chronic inflammatory disease of the spine and large joints, 10-30yo M\>F, 90% are HLA-B27(+)
bamboo spine, sacroiliitis lower back pain that improves with exercise and responds well to NSAIDs, acute unilateral/alternating NGAU, aortic regurgitation
41
most common known cause of acute unilateral (or alternating) anterior non-granulomatous uveitis
ankylosing spondylitis, especially with complaints of lower back pain, order a sacroiliac x-ray
after that suspect reactive arthritis and IBD
42
Reactive arthritis (Reiter's syndrome)
triad: urethritis, conjunctivitis and/or anterior uveitis, arthritis
M\>F, typically HLA-B27(+) in 85-95%
43
Psoriatic arthritis
asymmetric, peripheral, small joint pain with accompanying psoriatic lesions found on the knees, elbows, and scalp. 7% of pts will develop anterior uveitis, HLA-B27(+)
tx: UV-B light and methotrexate
44
HLA-B27 (+) conditions that may cause ocular manifestations
Ulcerative Colitis, Crohn's disease, Reactive arthritis, Ankylosing spondylitis, Psoriatic arthritis
45
Temporal Arteritis (Giant Cell Arteritis)
systemic vasculitis that affects the medium to large vessels, including the temporal artery. \>55yo, with symptoms of jaw claudication, jabbing neck pain, anorexia, scalp tenderness, temporal headaches, and fever. 50% of pts may also develop polymyalgia rheumatica (fatigue and morning stiffness in the hips and shoulders), also may lead to AION
46
Testing for GCA
STAT - ESR, CRP, CBC w/differential and platelets
Temporal artery biopsy considered gold standard
47
Abnormal bloodwork (GCA results)
elevated ESR: \>age/2 (men); \>(age+10)/2 (women)
elevated CRP: \>2.45mg/dL
elevated platelets: \>400,000 cells/uL
90% of GCA pts will have an ESR \>50. An elevated ESR and CRP is 97% specific for GCA
48
How does GCA cause AION
AION can happen secondary to GCA because of an occlusion of the SPCAs from the ophthalmic artery
ischemic optic neuropathy findings may not be present for the first 24-48hrs after the onset of blindness
49
tx if GCA is suspected
therapy with prednisone should be initiated immediately, also low aspirin (81mg) to reduce the chance of visual loss or stroke
50
Granulomatosis with polyangiitis (Wegener's Granulomatosis)
systemic vasculitis involving the upper respiratory tract, lungs, and kidneys, 65% have ocular manifestations
51
Ocular manifestations of Granulomatosis with polyangiitis (Wegener's)
granulomatous sclerouveitis, retro-orbital mass lesion with proptosis, conjunctivitis, episcleritis, scleritis, and ciliary vessel vasculitis.
Peripheral sclerokeratitis may also occur and lead to corneal ulceration
52
Scleroderma
a multisystem disorder causing inflammation and vascular changes of the skin and internal organs. Ocular effects include dry eye and shrinkage of areas of the skin including the conjunctiva
53
Gout
caused by the formation of monosodium urate crystals in joints in response to increased uric acid levels, M\>F
band keratopathy can occur secondary to gout
54
Podagra
gout occurring in the metatarsophalangeal (MTP) joint of the big toe (most frequent)
55
Deficiency of Immunoglobulin A
most common inherited immunodeficiency disease, a decrease of IgA in serum and secretions (normally found in tear film), may be asymptomatic or may suffer from recurrent respiratory tract infections, keratinization of the cornea, weight loss, and diarrhea
56
symptoms of AIDS
prolonged duration of fever, lymphadenopathy, sore throat, rash, myalgia/arthralgia, headache, and mucocutaneous ulcers
57
what CD4 count means the patient has progressed from HIV to AIDS?
200
58
What is the most common cause of blindness in AIDS and what CD4 count represents the highest risk for it?
CMV retinitis, lower than 200 CD4 count is at risk but lower than 50 is high risk
59
AIDS testing
ELISA for screening HIV, Western blot for confirmation. Together have a 99% specificity rate
60
Common opportunistic infections and neoplasms found in HIV pts
- pneumocystic pneumonia (*pneumocystis jiroveci*)
- toxoplasmosis, with papilledema and CN palsies due to meningoencephalitis
- bacterial infections: pneumonia, meningitis, TB
- viral infections: CMV, HSV, Kaposi's sarcoma (caused by HHV-8)
61
Seborrheic Keratosis
benign crusty, plaque-like, tan lesions, classic elevated “stuck on” look, M\>F, \>30yo
62
Keratoacanthoma
benign isolated dome-shaped nodules usually on the face and can mimic squamous cell carcinoma, has spontaneous remission (few months)
63
Papillomas
common, slow-growing squamous epithelial tumours, may be caused by HPV, finger-like/cauliflower-like appearance - elevated and multilobulated with a central vascular core
64
Xanthelasma
yellow, elevated, plaque-like lesions that are typically bilateral, symmetric, and located within the medial portion of the eyelids. Associated with high cholesterol, F\>M, recurrences common
65
Molluscum Contagiosum
chronic, infectious skin condition caused by DNA pox virus. single or multiple dome-shaped waxy umbilicated nodules on the eyelid or eyelid margin. Nodules can open and result in follicular conjunctivitis. If multiple consider HIV presence
66
Rosacea
syndrome of unknown etiology that affects sebaceous glands. ocular rosacea findings due to inflammation of the meibomian sebaceous glands and the sebaceous glands of Zeis
67
Signs and symptoms of ocular rosacea
inspissated meibomian glands, blepharitis, hordeola, chalazia, dry eye disease, phlyctenules, staph marginal keratitis, SPK, corneal neovascularization
68
Contact Dermatitis
delayed (24-48hr) type 4 hypersensitivity, often caused by cosmetics or medications, and can sometimes lead to periorbital swelling or conjunctival symptoms (chemosis, redness, itching, tearing)
69
Common medications that can cause contact dermatitis
aminoglycosides, trifluridine, cycloplegics/mydriatics, glaucoma medications, preservatives (BAK, thimerosal), contact lens solutions
70
Impetigo
gram (+) infection with honey coloured crusted lesions, common in children
71
Which simplex virus is the more common cause of herpetic keratitis in neonates (75%)?
HSV-2 during passage through birth canal
72
What are the chances of having a recurring HSV corneal epithelial infection?
25% chance of having a recurrence and risk increases to 40-45% after a second episode
73
HZV ophthalmicus findings:
blepharitis with vesicles on the eyelid margin, acute follicular conjunctivitis on the affected side, episcleritis, **pseudodendritic keratitis**, acute unilateral NGAU with trabeculitis, ARN, optic neuritis, EOM palsies, proptosis possible
74
Hutchinson's sign
a vesicular rash on the tip of the nose indicating involvement of V1 which increases the risk of ocular involvement of HZV
75
Behçets disease
inflammatory disease with recurrent oral aphtous ulcers, with 2 of the following for dx: genital ulcers, eye lesions, or skin lesions. Asian and middle eastern young adults
76
Behçets disease ocular findings
acute recurrent HYPOPYON, iritis, posterior and anterior uveitis, retinal vasculitis, vitritis, secondary cataracts, glaucoma, and neovascular lesions
77
Malignant melanoma
most common cancer of young women, ABCDE, depth of invasion is #1 prognostic factor
78
ABCDE characteristics for suspicious skin lesions (malignant melanoma)
asymmetry, border irregularity, colour differences, large diameter, enlarging
79
superficial spreading melanoma
most common variant of melanoma (70%) of cases, rapid growth and often on non-exposed skin such as upper back
80
basal cell carcinoma
malignancy of basal cell layer, appears as shiny, firm, pearly nodule with superficial telangiectasia, progression to central ulceration (rodent ulcer)
tx: 5-FU or sx
81
squamous cell carcinoma
malignancy of the stratum spinosum layer, non-healing ulcer often appearing as an erythematous plaque, can arise from actinic keratosis
82
Sturge-Weber syndrome
rare congenital vascular disorder, port wine stain, may have seizures, focal neurological deficits, unilateral glaucoma, vascular malformations in eye, iris heterochromia
83
unilateral glaucoma in Sturge-Weber syndrome is due to
increase in episcleral venous pressure
84
Tuberous sclerosis
AD genetic disease, benign tumours grow in the brain and other organs. 90% have skin lesions - hypopigmented macules (ash-leaf spots), shagreen patches (orange peel), angiofibromas, brown fibrous plaques on forehead
85
ocular findings in Tuberous sclerosis
retinal astrocytic hamartomas, punched out lesions of chorioretinal depigmentation in midperiphery, coloboma, angiofibromas of eyelid, papilledema (related to hydrocephalus)
86
Downs syndrome
most common chromosomal disorder, extra 21st chromosome, mental delay, flat facial profile, prominent epicanthal folds, congenital cataracts, glaucoma, strabismus, congenital heart disease, early onset of Alzheimers, increased risk for keratoconus
87
Klinefelters syndrome
XXY, male primary hypogonadism, testicular atrophy, long extremities, gynecomastia, female hair distribution, no ocular associations
88
Turner syndrome
X0, absent second X, 25% have ocular associations - keratoconus, strabismus, amblyopia, reduced accommodation, and convergence insufficiency
systemic - short stature, dysgensis, webbing of neck, amenorrhea, coarctation of aorta (narrowing)
89
Von Hippel Lindau disease
AD inherited disease, retinal capillary angiomas that can hemorrhage if untreated, leads to SRD, glaucoma, and loss of vision. Hemiangiomas can happen in CNS also, assoc w/ renal cell carcinoma and pheochromocytoma (increased catecholamines)
90
NF type 1 (Von Recklinghausen's disease)
tumour-forming nerve cells - **neurofibromas, cafe au lait spots, Lisch nodules** on iris, optic nerve gliomas, congenital glaucoma
91
Marfan's syndrome
CT disorder, subluxation of lens, glaucoma, RDs, CV - aortic incompetence, dissecting aortic aneurysm, floppy mitral valves
92
Huntington Chorea
AD disorder involving chromosome 4, chorea (involuntary muscle movements) and dementia, abnormal eye movements - delay in pursuits, voluntary saccades, and refixation
93
Familial Adenomatous Polyposis
deletion on chromosome 5 results in hundreds of polyps on the colon post-puberty, 100% of pts develop colon cancer, associated with Gardners syndrome which has CHRPEs
94
Gardner Syndrome
variant of FAP characterized by multifocal atypical CHRPEs (4+) with tear drop shape and hypopigmented border on one end
95
Sickle Cell Anemia
AR, painful crises due to sickle shape RBCs, 8% of African-Americans are carriers, single base pair mutation in beta globin gene (valine subs glutamic acid), can lead to ischemia and proliferative retinopathy (sea fan shape)
96
Phenylketonuria (PKU)
AR, phenylalanine hydroxylase mutations, can cause mental delay, diet with low phenylalanine (avoiding milk, aspartame, meat and chicken)
97
Tay-Sachs disease
AR genetic disorder, Ashkenazi Jewish descent, progressive destruction of the nervous system, ocular - cherry-red spot in retina, atrophy of optic nerve
98
Fabry disease
X-linked, abnormal lipid deposits in blood vessel walls, deficiency of alpha galactosidase A, pain in extremities and abdomen, areas of telangiectasia on umbilicus, groin, elbows, knees are dx, ocular - light coloured whorl shape corneal opacities
99
Duchenne muscular dystrophy
X-linked, deletion within gene coding dystrophin, muscle weakness that begins in pelvic girdle and progresses superiorly
100
Osteogenesis imperfecta (Brittle bone disease)
multifactorial genetic defects causing abnormal collagen synthesis, fractures happen with minimal trauma, ocular - blue sclera, keratoconus, megalocornea
101
Leber hereditary optic neuropathy
mitochondrial disorder (maternal inheritance) bilateral asymmetric primary optic atrophy, 85% M\>F, may spontaneously improve in 35% of cases. ocular - optic disc hyperemia and telangiectatic vessels, later on progressive optic disc pallor with resulting loss of central vision (BCVA 20/200 to CF)
102
Iron deficiency anemia
most common type of anemia - more than 50%, can be caused by GI blood loss (peptic ulcer disease, colon cancer, etc.), malabsorption, impairs cellular functions and can cause brittle hair, nails, pica
103
aplastic anemia
pancytopenia characterized by severe anemia, neutropenia, and thrombocytopenia, can be caused by infectious agents (viruses), radiation, drugs (chloramphenicol, acetazolamide, trimethoprim, methotrexate, and pyrimethamine)
104
anemia of chronic kidney disease
chronically damaged kidneys synthesize inadequate amounts of erythropoietin (EPO), which normally stimulates RBC production in the bone marrow
105
Vitamin B12 deficiency
malabsorption of B12 can be caused by pernicious anemia (autoantibodies directed against the parietal cells of the stomach causing decreased production of intrinsic factor)
106
Folic acid deficiency
dietary cause, common in alcoholics, can also be drug-induced (chemotherapy, methotrexate), deficiency during pregnancy increases the risk of neural tube defects (spina bifida)
107
Multiple myeloma
neoplastic disorder of plasma cells, extensive skeletal bone destruction, unexplained anemia, hypercalcemia, and acute renal failure
108
Hodgkin's lymphoma
40% of lymphomas, 15-30yo or \>50yo, enlarged lymph nodes, fever, night sweats, itching, characterized by Reed-Sternberg cells (owl eye nucleus), good prognosis with early dx, 50% of cases assoc w/ EBV
109
Non-Hodgkins lymphoma
60% of lymphomas, enlarged lymph nodes and GI tumours (abdominal pain), variable prognoses, bone marrow bx to determine T or B cell types
110
Acute Myeloblastic Leukemia
occurs in infants or middle aged + , normal WBC count with excessive myeloblasts, **Auer Rods** may be seen within leukemic cells in blood
111
Acute Lymphoblastic Leukemia
2-10yo, normal WBC count with excessive lymphoblasts, with tx 75% of children remain disease free \>5yrs
112
Chronic Myelocytic Leukemia
25-60yo, poor prognosis, WBC count of 50,000 to 300,000 with increased granulocytes, 90% of cases have **Philadelphia chromosome**
113
Chronic Lymphocytic Leukemia
\>50yo, M\>F 2:1, WBC count of 20,000-200,000 with predominance of mature small lymphocytes, 5-10yr survival rate
114
Leukopenia
decrease in number of WBCs, due to bone marrow injury/inactivation, drugs, or chemical suppression
115
Leukocytosis
increase in the absolute number of WBCs, can occur after surgery, infections, illness, stress, or pregnancy
116
Neutrophilia
increase in absolute number of neutrophils, typically from stressm exercise, pain, fear, or infections (bacterial)
117
Thrombocytosis
elevated platelet count, caused by inflammation, kidney disease, or spleen removal
118
Pancytopenia
decrease in the number of RBCs, WBCs, and platelets
119
Thrombocytopenia
decrease in platelets, caused by infection, liver failure, and bone marrow disorders
120
non-inflammatory causes of systemic edema
increased organ pressure (CHF, liver failure, venous obstruction), reduced plasma osmotic pressure, lymphatic obstruction, sodium retention
121
inflammatory causes of systemic edema
acute and chronic inflammation, angiogenesis
122
hemorrhage types
hematoma is when a hemorrhage is within a tissue, petechiae (1-2mm), purpura (\>3mm), ecchymoses (\>1-2cm), hemothorax/hemopericardium/hemoperitoneum (large accumulations of blood in body cavities)
123
thrombus
results from inappropriate activation of blood clotting in an uninjured vein (or minor injury) anywhere in the circulatory system
124
most common site for thrombus formation
in the deep venous system in the legs
125
Virchow's triad for venous thromboembolism
venous thromboembolism is a result of:
1. alterations in blood flow
2. vascular endothelial injury
3. alterations in the constituents of the blood through an inherited (mutations) or acquired (meds, smoking, vasculitis) hypercoagulable state
126
six types of emboli
1. fat emboli - assoc w/long bone fractures and liposuction
2. air embolism - result from gas bubbles after a chest wall injury or from an obstetric procedure
3. thrombus - main cause of emboli, 95% of emboli from DVT go to pulmonary system
4. bacteria and tumour - can cause tissue destruction and muscle pain
5. amniotic fluid emboli - can lead to DIC, especially postpartum
127
shock
decreased blood perfusion resulting from a reduction of either cardiac output or circulating blood volume, four types: cardiogenic, hypovolemic, septic, and anaphylactic
128
cardiogenic shock
can be caused by myocardial infarction, ventricular rupture, arrhythmias, and pulmonary embolisms. heart fails to pump due to cardiac cell damage, extrinsic pressure, or outflow obstruction
129
hypovolemic shock
can be caused by hemorrhages and fluid loss from vomiting, diarrhea, burns, or trauma
130
septic shock
can be caused by overwhelming microbial infections or toxic-shock gram-positive septicemia, involves peripheral vasodilation leading to pooling of blood
131
anaphylactic shock
involving histamine, can cause hypotension, tachycardia, wheezing, sneezing, stridor, bronchospasm, nausea, vomiting, diarrhea, urticaria, itching, headache, syncope, seizure, etc.
132
arcus senilis
peripheral corneal opacity, a sign that the patient has or had high cholesterol, does not affect vision
133
normal cholesterol values
aim for total cholesterol \<200, HDL \>40, LDL \<130 (\<100 for diabetes or heart disease), triglycerides \<150
134
immediate treatment for myocardial infarction
325mg of aspirin
135
CPR standards
rate of 100 compressions per minute, compress chest at least 5cm, 30 compressions to 2 ventilations
136
left-sided heart failure
when the left side fails, blood backs up into the lungs (pulmonary edema) causing shortness of breath. most common cause if ischemic cardiomyopathy resulting from CAD/MIs
137
right-sided heart failure
inability to pump blood into the lungs, causing back up of blood in the abdomen (ascites) and legs (lower extremity edema), causes shortness of breath, edema, and chest discomfort. most common cause of right CHF is left CHF, also pulmonary hypertension, COPD, and MIs
138
diagnostic findings of CHF
elevated BNP, cardiomegaly on chest x-ray, changes on ECG
139
rheumatic fever
5-15yo, untreated pharyngeal infections with group A beta hemolytic streptococci (S. pyogenes) can alter the shape of the mitral valve requiring valve replacement later in life
fever, elevated ESR, red-hot joints, endocarditis
140
bacterial endocarditis
bacteria infecting the inner lining of the heart, especially valves, present with fevers, and ECG shows “vegetations” on valves or abscesses within heart tissue. Can see Roth spots in the retina
141
most common cause of heart palpitations
premature ventricular complexes (PVCs), benign, irregular heart beats
142
TIAs
transient ischemic attack, neurologic deficits usually less than 15mins due to inadequate perfusion
143
Carotid artery TIA
with contralateral hand/arm weakness or sensory loss and face and leg symptoms, can have ipsilateral visual symptoms (amaurosis fugax) or aphasia
144
Vertebrobasilar TIA
can result in diplopia, ataxia, vertigo, dysarthria, and uni- or bilateral vision loss
145
macular sparing homonymous hemianopsia
most commonly from a stroke in the occipital lobe that has affected either the MCA or PCA but not both
146
macula only homonymous hemianopsia
most commonly occurs from a tumour that has compressed both blood supplies to the macular cortex. almost never occurs from a stroke because occlusion would have to occur in both blood supplies simultaneously
147
ischemic vs hemorrhagic stroke
ischemic is 80% of all strokes, results from an occlusion of an artery leading to the brain (often embolism of an atherosclerotic plaque) and hemorrhagic stroke is due to acucmulation of blood in the brain due to bleeding (often subarachnoid hemorrhage)
148
subarachnoid hemorrhage
sudden severe headache, pupil-involving CN3 palsy, nuchal rigidity, 30% will have change in consciousness, besides trauma most common cause is rupture of intracranial aneurysm (CN3 causing aneurysms often occur in junction bw posterior communicating and interal carotid arteries)
149
Status Epilepticus
prolonged seizure lasting longer than 5 minutes
150
cluster headaches
M\>F, 30-50yo, orbital or temporal, usually unilateral, common in smokers and alcohol users, 1-2 attacks per day lasting \<1hr, present with red eyes and/or nasal stuffiness and can cause a transient or permanent ipsilateral Horner's syndrome
151
tension headaches
F\>M, worse with stress, band-like distribution with varying intensities
152
brain tumour headaches
interrupt sleep, worse in the morning, all ages, often with more symptoms or neurological deficits, assoc w/ nausea, vomiting, visual changes and steadily increase in severity with time
153
meningitis
triad: fever, headache, neck stiffness (meningismus)
may also have nausea, vomiting, sweats, weekness, myalgias, papilledema, photophobia, ⅓ of pts will have seizures
154
glioblastoma multiforme
most common primary malignant brain tumour, found in the cerebal hemispheres and can cross the corpus callosum, \<1yr life expectancy
155
most common primary malignant brain tumour
glioblastoma multiforme
156
most common benign brain tumour
meningioma (although can become malignant)
157
schwannoma
tumour of Schwann cells, can cause gradual onset of painless, progressive proptosis, often in CN8 (acoustic schwannoma), rare
158
pituitary adenoma
can be functional (hormone-secreting, prolactin) or non-functional, can cause a bitemporal hemianopsia or junctional scotoma visual field defect
159
most common presenting symptom of MS
optic neuritis (25%)
160
ocular findings of MS
optic neuritis (25%), pain on eye movement (90%), APD, internuclear ophthalmoplegia, and diplopia
161
diagnosis of MS
requires 2 separate CNS lesions on 2+ occassions, must include involvement of white matter
162
Uhthoff's phenomenon
decreased acuity or worsening of other neuro symptoms after an increase in body temperature
163
internuclear ophthalmoplegia
lesion in MLF that results in loss of ipsilateral adduction and contralateral nystagmus
164
Guillain-Barre Syndrome (GBS)
inflammation and demyelination of peripheral nerves, symmetric ascending muscle weakness that starts in distal lower extremities
165
ocular findings of GBS
Adie's tonic pupil, diplopia (CN palsies), facial diplegia, papilledema (caused by elevated protein in the CSF)
166
myasthenia gravis
autoantibodies directed against acetylcholine receptors. can be assoc w/ thymoma, rheumatoid arthritis, and lupus
167
ocular findings of myasthenia gravis
ptosis and diplopia due to EOM weakness, symptoms worsen at end of day
168
Alzheimer's disease
deposits/plaques of beta amyloid and neurofibrillary tangles, most common form of dementia
169
Parkinsons disease
deficiency of dopamine in the striatum due to degeneration of neurons in the substantia nigra
resting tremor, rigidity, akinesia, and postural instability
170
epidural hematoma
blood collects between skull and dura, often from middle meningeal artery being affected in closed head trauma. initial loss of consciousness, period of lucidity, and then another loss of consciousness
171
subdural hematoma
venous blood collects between the dura and the arachnoid space, symptoms vary, often headache or altered mental state. can be seen in minor head injury in elderly pts especially if on Coumadin
172
symptoms to watch for with any head trauma
changes in pupillary size (a blown pupil may signal an impending uncal herniation), nausea or vomiting, loss of consciousness
173
diabetes insipidus
extreme thirst and polyuria resulting from lack of ADH or a deficiency in renal response to ADH
tx - increased fluids, intranasal desmopressin (ADH analog), indomethacin, or HCTZ for the nephrogenic causes
174
hypothyroidism
increased TSH and decreased Free T4 and T3, symptoms include cold intolerance, hypoactivity, weight gain, fatigue, lethargy, decreased appetite, constipation, myxedema, dry cool skin, coarse hair, etc.
175
Hashimoto's thyroiditis
autoimmune-mediated condition that attacks the thyroid gland, most common cause of hypothyroidism in iodine-sufficient areas of the world, F\>M 10:1
176
hyperthyroidism
85% caused by Graves disease, excessive production of T3 and T4 hormones, F\>M 8:1, heart palpitations, weight loss, heat intolerance, and/or hair loss. Elevated T4 and decreased TSH
177
Graves disease
autoimmune condition caused by TSH autoantibodies resulting in constant thyroid stimulation and excessive production of T3 and T4 hormones. Proptosis and upper lid retraction are the main ocular signs. SLK is assoc but less common
178
hyperparathyroidism
marked by hypercalcemia, caused by an oversecretion of parathyroid hormone, symptoms include bone pain, fractures, renal stones, constipation, mental changes, fatigue. Pts can present with band keratopathy (excessive calcium deposits within the superficial cornea)
179
hypoparathyroidism
decreased serum calcium, seen following a thyroidectomy, symptoms include tetany, muscle cramps, irritability, carpopedal spasms, convulsions, and mental changes, ocular signs can be cataracts, uveitis, and blurry vision
180
Addison's disease
chronic adrenocortical deficiency that is the result of autoimmune atrophy of the adrenal glands, symptoms include weakness, fatigue, anorexia, weight loss, nausea, vomiting, diarrhea, abdominal pain, muscle and joint pains, amenorrhea
181
Cushings syndrome (hypercortisolism)
effects of excessive corticosteroids, includes central obesity, moon face, buffalo hump, also can have osteoporosis, hypertension, poor wound healing, hyperglycemia, and elevated serum cortisol levels
182
pheochromocytoma
rare condition caused by a tumour (located on one or both adrenal glands or anywhere along the sympathetic nervous chain) secreting excessive amounts of norepinephrine and epinephrine. symptoms include elevated BP, papilledema, severe headache, perspiration, heart palpitations, and anxiety
183
Acute renal failure
abrupt decline in renal function, decrease in GFR and increase in creatinine and BUN
184
chronic renal failure
kidneys fail to make urine and excrete nitrogenous wastes, main causes of chronic renal failure are diabetes and hypertension
185
Glomerular disease
inflammation of the glomerulus of the kidney, can be nephritic or nephrotic
186
glomerular disease - nephritic syndrome
assoc w hypertension, edema, and active urine sediment with hematuria, blood casts, and proteinuria
187
glomerular disease - nephrotic syndrome
assoc w greater than 3.5 grams of protein in the urine, accompanied by hypoalbuminemia, hyperlipidemia, and edema
188
post streptococcal glomerulonephritis
renal infection caused by group A beta hemolytic streptococci (S pyogenes), occurs 7-21 days after respiratory or skin infections, 5-15yo, sudden onset hematuria, edema, HTN, RBC casts in the urine
189
pyelonephritis
bacterial infection of the kidneys, symtpoms include dysuria, frequency, urgency, fever, chills, flank pain, costovertebral angle tenderness, and nausea/vomiting
190
renal cell carcinoma
triad: flank pain, hematuria, and abdominal renal mass, dx with abdominal ultrasound
191
most common bacterial STD in the US
chlamydia
192
chlamydial serotypes D-K
cause adult inclusion conjunctivitis, with chronic follicles and papillae in the inferior palpebral conj and fornices, minimal mucopurulent discharge, punctate keratitis, superior pannus, peripheral SEIs, and PAL
193
chlamydial serotypes A-C
cause trachoma conjunctivitis, with follicular and papillary conjunctivitis with mild superior pannus, Arlt lines, and Herbert pits. progressive scarring can lead to cicatricial entropion, trichiasis, and corneal ulceration
194
gonorrhea - ocular infection
severe, hyperacute, purulent discharge
195
HSV diagnosis confirmed by
multinucleated giant cells on a Wright-Giemsa stain
196
three phases of syphilis
primary - chancre (painless ulcer in the genital region)
secondary - lesions involving the eye, kidney, mucous membranes, skin, CNS, or liver
tertiary - nervous system and ophthalmic lesions including Argyll Robertson pupil
197
ocular manifestations of syphilis
interstitial keratitis, retinitis, retinal vasculitis, salt and pepper fundus, flame hemes, uveitis, CN and optic neuropathies, acute multifocal chorioretinitis and vitritis (panuveitis)
198
syphilis testing
nontreponemal - RPR, VDRL
treponemal - FTA-ABS, TPPA, MHA-TP
199
benign prostatic hypertrophy
increased urinary frequency, urgency, nocturia
tx - Terazosin or surgery
200
2nd most common cause of cancer death in males
prostate cancer
201
elevated PSA
elevated prostate specific antigen may indicate prostate cancer
202
most common cancers in women in the US
breast, lung, and colon cancer
203
most common cancers in men in the US
prostate, lung, and colon cancer
204
congenital heart disease - right to left shunt
oxygen deficit is immediately problematic, ex. Tetralogy of Fallot
205
congenital heart disease - left to right shunt
includes ventral septal defect, atrial septal defect, and patent ductus arteriosus
206
ocular signs of fetal alcohol syndrome
shortened palpebral fissures, microphthalmia, strabismus, epicanthus, telecanthus, blepharoptosis, optic nerve hypoplasia, and retinal vessel tortuosity
207
rubella
transferred from mother to fetus, causes microphthalmia, glaucoma, cataracts, and heart defects
208
infant cataracts
suspicious for rubella or galactosemia
209
duodenal ulcer
burning or hunger-like pain, primarily in the epigastric area, pain may occur or worsen when the stomach is empty and is worse in the middle of the night when acid secretion is the greatest
210
gastric ulcer
the main symptom is pain soon after eating
211
Barrett's esophagus
normal lining of esophagus is replaced by metaplastic columnar cells, can lead to esophageal adenocarcinoma, which requires surgery
212
Crohn's disease
infectious etiology, any portion of GI tract but rectal sparing, skip lesions, transmural inflammation, cobblestone mucosa, bowel wall thickening, ulcers, fistulas, assoc w NGAU
213
Ulcerative colitis
autoimmune, continuous lesions in colon and rectum, mucosal inflammation, friable pseudopolyps, crypt abscesses, ulcers, assoc w NGAU
214
Wilson's disease
copper accumulation, concentrates in the liver, brain, cornea (Kayser-Fleischer ring) other manifestations are sunflower cataracts, cirrhosis of liver, basal ganglia degeneration, and dementia
215
AST and ALT enzymes
enzymes contained within liver cells that are released into the blood in increased concentrations in cases of hepatitis
216
cholecystitis
inflammation of the gall bladder lining secondary to obstructive cholesterol stones, sludge, or infection. most common in overweight young adult women, pain in upper right abdomen, and positive murphy's sign
217
hepatitis
viral inflammatory condition of liverparenchyma that leads to necrosis, type A and E are transmitted vie fecal oral route, B and C through blood/body fluids, D carried only with B, vaccines only are available for A and B
218
temporomandibular disorder (TMJ)
commonly a result of acute and chronic inflammation secondary to arthritis, trauma, dislocations, developmental anomalies, and other factors. Headaches, facial pain and jaw pain
219
ocular associations of obstructive sleep apnea
floppy eyelid syndrome, NTG, and NAION
