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Systemic dz Flashcards

1
Q

What occurs during acute inflammation

A

1-2 mins post injury

  • PMNs arrives to site of injury
  • vasodilation (incr blood flow)
  • incr permeability (for plasma proteins and leukocytes

RUBOR, CALOR, TUMOR, DOLOR (redness, pain, swelling, heat)

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2
Q

Chronic inflammation

A

weeks to years

  • inflammation lasting weeks to years
  • infiltration of mononuclear cells (macrophages, lymphocytes, and plasma cells)
  • tissue destruction
  • neo and fibrosis
  • occurs in persistent infections (helicobacter pylori), prolonged exposure to toxins (asbestos), autoimmune dz (RA)
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3
Q

What can cause granulomatous inflammation?

A

sarcoid, TB, syphilis, leprosy, histoplasmosis, suture/vascular graft

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4
Q

What are some examples of local and systemic factors that could effect wound healing

A

local = decreased blood supply, inability to form clots, local infection

systemic = diabetes, decreased peripheral blood flow, infection, malnutrition, increased glucocorticoid production, immunocompromised pts, systemic infection

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5
Q

What are 4 types of hypersensitivity reaction?

A

ACID

Type 1: Anaphylaxis

Type 2: Cytotoxic

Type 3: Immune complex

Type 4: Delayed

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6
Q

Describe Type 1 hypersensitivity

A

Anaphylaxis

Allergen activates B-lymphocytes & IgE antibodies which bind to mast cells and basophils
- calcium enters the cell & degranulates
- FIRST AND FAST reaction

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7
Q

Describe type 2 hypersensitivity cytotoxic

A

IgG & IgM abs bind to antigen causing cell destruction

Ex. Rh dz, rheumatic fever

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8
Q

Describe type 3 hypersensitivity - immune complex mediated

A

Ag/Ab complex activates complement response
- triggers attack on neutrophils and release lysosomal enzyme

Ex. SLE and serum sickness

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9
Q

Describe type 4 hypersensitivity

A

Delayed or cell-mediated type IV

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10
Q

SLE

A

F
- discoid lupus
- photosensitivity
- renal disorder
- neurological disorder
- immunological disorders

(+) ANA

joint pain, dry eye, peripheral keratitis (infiltrates), photophobia, neuro-ophthalmic complications (edema, papilledema)
- skin, kidney, heart, joints

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11
Q

RA

A

F, 40-50yo

(+) RF

  • systemic, destruction of articular cartilage
  • worse in the AM
  • pain in hands, wrist, feet, small joints

Ocular SE
- K sicca, scleromalacia perforans, PUK, PK, choroiditis, retinal vasculitis, episcleral nodules, RD, ME, papilledema

NECROTIZING SCLERITIS WITHOUT INFLAMMATION

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12
Q

JIA

A

<6 yo
(-)RF (+) ANA

  • 6 yo with (+) ANA will more likely have ocular manifestations
  • most common uveitis in children
  • asymptomatic, bilateral, nongran ant uveitis
  • low grade fever
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13
Q

Sjogrens

A

F, 40-60yo

2 types:
primary = dry eye + dry mouth
secondary = dry eye + dry mouth + RA

  • Associates with SLE, polyarteritis nodosa, wegeners granulomatosis
  • 5% develop malignant B cell lymphoma (higher risk with primary sjogrens)
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14
Q

Sarcoidosis

A

Idiopathic, AA, F
(+) ACE, chest X-ray

asymptomatic, breathing difficulty, dry cough

dry eye, chronic dacryoadenitis, chronic bilat ant gran uveitis, CN7 palsy , vasculitis (candle wax dripping), vitritis (cotton ball opacities)

optic nerve (unilateral disc edema or papilledema) = WORST OUTCOME

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15
Q

Ankylosing spondylitis

A

Bamboo spine, sacroilitis causing lower back pain & IMPROVES w/ exercise & NSAID

(+) HLAB27, sacroiliac x-ray

  • nongran ant uveitis
  • aortic regurgitation
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16
Q

What is (+) HLAB27 associated with?

A

UCRAP

ulcerative colits
crohns disease
reactive arthritis
ankylosing spondylitis
psoriatic arthritis

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17
Q

Reactive arthritis

A

can’t see, can’t pee, can’t climb a tree

Young male
Fever

conjunctivitis, ureithritis, arthritis
(+) HLAB27

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18
Q

Psoriatic arthritis

A

asymmetric, peripheral small joint pain

TX: UVB light & methotrexate
(+) HLAB27

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19
Q

Which autoimmune disease causes (+) ANA

A

JIA
Sjogrens
Lupus

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20
Q

Most common cause of episcleritis?

A

idiopathic

others: RA, lupus, UCRAP

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21
Q

Which dz is also known as the ‘great mimic’

A

syphilis

can cause nongran and gran uveitis

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22
Q

Which autoimmune dz causes nongran uveitis

A

JIA
UCRAP
syphilis great mimic

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23
Q

Which autoimmune dz cause gran

A

sarcoid
TB
syphilis great mimic

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24
Q

which autoimmune dz can cause optic dz?

A

sarcoid
lupus
syphilis great mimic

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25
Q

GCA, temporal arteritis

A

> 55 yo
- affects medium sized/large vessels
- STAT ESR, STAT CBC differential (increase in platelets & WBC), STAT CRP, temporal biopsy

jaw claudication, anorexia, neck pain, scalp tenderness, temporal HAs & fever
- 50% may develop polymyalgia rheumatica (fatigue and morning stiffness of hips and shoulders)

AION 2’ GCA due to occlusion of spcas (may not be present (24-48 hrs after onset)
- IMMEDIATELY tx with steroids and aspirin (81mg), send to ER for possible stroke

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26
Q

Abnormal GCA blood work results

A

ESR:
men: > age/2
women: > age+10/2

CRP: >2.45 mg/dL

Elevated CBC platelets:
> 400,000 cells/uL

** 90% will have elevated ESR >50. An elevated ESR and CRP is 97% specific for GCA **

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27
Q

Granulomatosis w/ polyangitis (Wegner’s granulomatosis)

A
  • systemic vasculitis involving upper respiratory tract, lungs, kidneys
  • granulomatous scleroueveitis, retroorbital mass lesion w/ proptosis, episcleritis, conjunctivitis, scleritis, ciliary vessel vasculitis
  • peripheral sclerokeratitis that may lead to corneal ulceration
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28
Q

Scleroderma

A

multisystem disorder causing inflammation and vascular changes of skin and internal organs
- dry eye, shrinkage of skin and conj

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29
Q

Goute

A
  • monosodium urate crystal in joints
  • mainly in MTP of big toe (aka podagra)
  • Band keratopathy (bowmans layer, calcium)
  • Men
  • red hot joints
  • tx w/ allopurinol = inhibits xanthin oxidase (enzyme for uric acid production)
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30
Q

Deficiency of immunoglobulin A

A

most common of the primary immunodeficiency dz
Iga is most prominent Immnoglobulin external excretions, including tear film
- mucosal defense
- asymptomatic, respiratory tract infections, keratinization of the cornea, weight loss, diarrhea

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31
Q

AIDS

A
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32
Q

Allergic contact dermatitis

A
  • type 4 hypersensitivity
  • delayed 24-72 hours
  • cosmetics: makeup, shampoo, soaps, hairspray, fingernail, polish, perfume, jewelry, poison ivy, cls solution
  • medications: amnioglycosides (tobragent 30), trifluridine (antiviral), cycloplegics (tropicamide, phenyl), glaucoma meds (timolol, alphagan, trusopt, preservatives (thimerosal, BAK)

ocular signs of contact dermatitis:
acute periorbital swelling
conjunctival chemosis, redness, itching, and tearing

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33
Q

Impetigo

A

gram (+)
infection with colored crusted lesions
very common in children

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34
Q

HSV

A

2 types:
- HSV1 = most common, above teh belt, most associated with ocular manifestations
- obtain from primary infection as a child
- virus hides in the trigeminal ganglion
- reactivation can be triggered by stress, sun exposure, hormonal changes, fever, trauma, immuno-suppression

  • HSV2 = below the belt, sexually transmitted, herpetic keratitis in neonates

Primary exposure = bleph w/ focal vesicular lesions on the eyelids and periorbital skin
Recurrent infections = dendritic keratitis, marginal or geographic ulcers, neurotrophic keratopathy, interstitial keratitis, necrotizing stromal keratitis, disciform endotheliitis, acute anterior unilat nongranulomatous uveitis with trabeculitis, acute retinal necrosis

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35
Q

HZV

A
  • initially presents as chickenpox
  • lays dormant in nerve roots
  • > 50, consider medical eval if they are <40 to determine if they are immunocompromised
  • bleph w/ vesicles on eyelid, acute follicular conjunctivitis, episcleritis, pseudodendritic keratitis, acute anterior unilateral non-granulomatous uveitis with trabeculitis, acute retinal necrosis, optic neuritis, EOM palsies, proptosis

Hutchinson’s sign = vesicular rash on tip of the nose indicating V1 involvement which increases risk of other ocular involvement

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36
Q

Behcet’s Disease

A
  • recurrent oral aphthous uclers
  • genital ulcers, eye lesions, skin lesions
  • asian and middle eastern young adults
  • acute recurrent hypopyon (classic for behcet’s), iritis, ant uveitis, retinal vasculitis, vitritis, 2’ cataracts, glc, and neo lesions
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37
Q

Malignant melanoma

A
  • common cancer in young women
  • depth invasion is the number one prognostic factor
  • risk factor = age, skin, color, fam hx, and repeated irritation and sun exposure
  • ABCDE = asymmetry, border irregularity, color differences, diameter, enlarging
    found on stratum basal

superficial spreading melanoma is the most common variant of melanoma - rapid growth, classically found on non-exposed skin

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38
Q

Basal cell carcinoma

A
  • malignancy of the basal cell layer of the epidermis
  • early pearly
  • telangiectasia
  • progression to lead to rodent ulcer
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39
Q

Squamous cell carcinoma

A
  • malignancy of the stratum spinosum
  • nonhealing ulcer that appears as an erythrematous plaque
  • can arise from precancerous lesion called actinic keratosis
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40
Q

Sturge-Weber syndrome

A
  • rare congenital vascular disorder characterized by a facial capillary malformation known as port wine stain
  • seizures, focal neurologic deficits, mental retardation
  • unilat glc (due to incr episceral venous pressure)
  • vascular malformation of conj, episclera, choroid and retina
  • iris heterochromia
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41
Q

Tuberous sclerosis

A
  • multisystem genetic dz that causes benign tumors to grow in the brain and other organs
  • hypopigmented macules (ash-leaf spots), shagreen patches (leather thick skin that is dimpled like an orange peel, usually found on the lower back or neck), angiofibroma, and a distinctive brown fibrous plaque on the forehead
  • retinal lesions such as astrocytic hamartomas or phakomas (grey/yellow lesion), these can calcify and be seen on a CT scan
  • punched out areas of chorioretinal depigmentation in midperiphery of retina
  • coloboma
  • angiofibroma of the eyelid
    -papilledema
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42
Q

AD

A

abnormal dominant gene
- 75% of children will have condition

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43
Q

AR

A

2 abnormal recessive gene
- 50% of children will have condition

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44
Q

X-linked disorders

A

defective recessive gene on the Xchromosome
- half of sons will have condition
- half of daughters will have condition

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45
Q

Down syndrome

A
  • common chromosomal disorder
  • extra 21st chromosome

mental retardation, flat facial profile, prominent epicanthal folds, congenital cat, glc, strab, asimian crease on palms, congenital heart dz, early onset of alzheimer’s

  • down syndrome pts are at increase risk for develpment of keratoconus (TDOME)
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46
Q

Klinefelter’s syndrome

A

” calvin klein is a guy”

  • most common cause of primary hpogonadism
  • extra X chromsome (XXY)
  • testicular atrophy, long extermities, gynecomastia, female hair distribution, hypogonadism
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47
Q

Turner’s syndrome ***

A

Tina turner is a girl (XO)

  • absent x chromosome
  • keratoconus, strab, amblyopia, reduced accommodation, and convergence insufficiency
  • affects 1 in 3000 females and is characterized by short stature, dysgenesis, webbing of neck, coarctation of the aorta
  • most common cause of primary emnorrhea (no menstrual periods)
  • will affect binocular system = strabismus and amblyopia
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48
Q

Autosomal dominant

A

occur equally in males and females
- usually occur after puberty

Ex. von hippel lindau dz, NF1 type 1 (von recklinghausen’s dz), Marfan syndrome, Huntington’s Chorea, Familial Adenomatous Polyposis (FAP)

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49
Q

Von Hippel Lindau dz

A
  • AD
  • manifested by a host of benign and malignant tumors
  • retinal angiomas that can hemorrhage if left untreated, leading to Rd, glc, and loss of vision
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50
Q

Neurofibromatosis type 1 (Von Recklinghausen’s dz)

A
  • tumor-forming nerve cells
  • cafe au lait spots, neurofibromas, lisch nodules on the iris
  • optic nerve glioma
  • congenital glc
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51
Q

Marfan’s syndrome

A
  • CT disorder characterized by skeletal anomalies (very tall w/ long extremities, subluxating joints, long finger and toes)
  • cardiovascular SE aortic incompetence, dissecting aneurysm, floppy mitral valves (cant play basketball)
  • subluxation of cyrstallin lens (sup temp), glaucoma, RD
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52
Q

Huntington’s Chorea

A
  • AD located on chromosome 4
  • gradual onset and progression of chorea (involuntary muscle mvmts) and dementia
  • clinical onset 30-50yo with 15-20 year survival
  • abnormal eye mvmts will occur and include a delay in pursuits, voluntary saccades, and refixation
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53
Q

Familial Adenomatous Polyposis (FAP)

A

Deletion on chromosome 5
- results in hundreds of polyps on the colon post puberty
- 100% of pts get colon cancer
- Gardner syndrome is a variant of FAP characterized by multiple atypical CHRPES ( 4 or more, often tear drop shaped with a hypopigmented border on one end

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54
Q

Autosomal recessive

A

usually seen in 1 generation
- 25% of offspring from 2 carrier paretns are affected
- dz often more severe compared to AD dz

ex. sickle cell, PKU, tay sachs

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55
Q

Sickle cell anemia

A
  • painful
  • RBC causing blockages within arteriole vessels; this ultimately results in organ failure
  • caused by a single base pair mutation in the beta globin gene where valine is substituted for glutamic acid
  • 1 in 400 aa are affected
  • sickle cells can occlude retinal arterioles leading to ischemia and subsequent retinal neo (proliferative retinopathy) = “sea fan retinopathy”
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56
Q

What causes proliferative retinopathy?

A

DR VOS

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57
Q

PKU (Phenylketonuria)

A
  • caused by mutation in the enzyme phenylalanin hydroxylase - this is used in AA conversion of phenylalanine to tyrosine
  • if not treated, it will result in mental retardation
  • All newborns are tested for PKU
  • if pt is a positive carrier then diet low in phenylalanine is initiated
  • phenylalanine is found in milk products, aspartame, meat, chicken
  • occur in 1/10,000 people
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58
Q

Tay-Sachs dz

A
  • genetic disorder that most commonly affects eastern european Jews
  • progressive destruction of the nervous system
  • cherry red spot in retina
  • atrophy of ON
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59
Q

X-linked genetic disorders

A
  • Fabry’s dz
  • Duchenne Muscular Dystrophy
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60
Q

Fabry’s dz

A
  • caused by abnormal lipid deposit in blood vessel walls
  • deficiency of enzyme alpha galactosidase A allows lipids to build up to harmful levels in the eyes, kidneys, ANS, and cardiovascular system
  • affects adolescent boys and is characterized by excruciating pains in extremities and abdomen
  • areas of telangiectasias on the umbilicus, groin, elbows, knees

ocular findings: whorl shaped keratopathy

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61
Q

X-linked disorder

A

duchenne muscular dystrophy

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61
Q

duchenne muscular dystrophy

A
  • deletion within the gene encoding dystrophin
  • 1/30,000 male infants are afflicted w/ sx appearing by age 5
  • muscle weakness that begins in the pelvic girdle and progresses superiorly (walk and get tired)
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61
Q

Osteogenesis imperfecta

A
  • caused by host of genetic defects giving rise to abnormal collagen synthesis
  • characterized by multiple fractures occurring iwht minimal trauma
  • ocular findings = blue sclera, keratoconus, megalocornea
    TDOME
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62
Q

Mitochondrial disorders

A

Lebers hereditary optic neuropathy

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63
Q

Lebers hereditary optic neuropathy

A
  • mitochondrial disorders
  • rare recessive disorder that results in bilateral asymmetric primary optic atrophy
  • 85% males
  • avg onset is late teens or early 20s
  • Early = optic disc hyperemia telangiectatic vessels
    late = progressive optic disc pallor with loss of central vision (BCVA 20/200 to CF)

“my mother leber lost my eyes”

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64
Q

What’s the most common type of anemia?

A

Iron deficiency

  • in adults results from GI blood loss (peptic ulcer dz, colon cancer)
  • occur with malabsorption or increased need with decreased intake (ex. childhood or pregnancy)
  • impairs cellular function causing brittle hair, nail spooning, and pica (eat dirt/ice)
  • tx with oral iron
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65
Q

Anemias

A

decreased hemoglobin

Iron deficiency
Aplastic anemia

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66
Q

Aplastic anemia

A

Pancytopenia is characterized by severe anemia, neutropenia, thrombocytopenia

causes include
- infection
- radiation
- drugs: chloramphenicol, acetazolamide, trimethoprim, methotrexate, pyrimethamine

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67
Q

Which drugs cause aplastic anemia?

A

drugs: chloramphenicol, acetazolamide/methazolamide, trimethoprim, methotrexate, pyrimethamine,

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68
Q

What happens with RBC with chronic kidney dz?

A

decreased amt of erythropoietin (EPO), a hormone that normally stimulates RBC production in the bone marrow

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69
Q

How does sickle cell cause proliferative retinopathy

A

due to crescent or sickle-shaped cells occluding retinal vessels (think DRVOS)

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70
Q

Vitamin B12 Deficiency

A

inadequate intake or malabsorption of vitamin B12, often caused by pernicious anemia

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71
Q

Pernicious anemia

A

autoantibodies directed against parietal cells of the stomach, causing decreased production of intrinsic factor B12

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72
Q

Folic acid deficiency

A

Dietary deficiency common in alcoholics
- may be drug-induced (chemotherapy, methotrexate), or malabsorption sx
- deficiency in pregnancy causing risk of neural tube defects (spina bifida)

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73
Q

What stimulates production of RBC?

A

parietal cells

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74
Q

Multiple Myeloma

A
  • proliferation of malignant clone of plasma cells in the bone marrow
  • this results in extensive skeletal bone destruction, unexplained anemia, hypercalcemia, acute renal failure
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75
Q

Leukemia and lymphoma

A

malignant proliferation dz involving leukocytes
- early cell growth and maturation are inhibited, causing malignant clones of these cells to accumulate
- death results b/c of substantial loss of normal cells and poor organ function owing to the increase of malignant cells

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76
Q

Lymphoma (Lymph tumor)

A

Proliferation of malignant lymphoid cells in solid tissues (lymph nodes, spleen, GI tract)
- localized initially but may subsequently spread

  1. Hodgkin’s lymphoma
  2. Non-Hodgkin’s lymphoma
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77
Q

Hodgkins lymphoma

A

2 peak age groups: 15-30 and then >50
- commonly presents w/ large lymph nodes, fever, night sweats, itching
- Characterized by reed-sternberg cells
Prognosis is good if its dx early
- 50% of cases associated with EBV

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78
Q

Non-Hodgkins lymphoma

A

Enlarged lymph nodes and GI tumors w/ abdominal pain
- Heterogeneous group of malignancies with variable prognoses depending on the type
- Bone marrow biopsy is performed to determine T or B cells

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79
Q

Key difference between Hodgkin and nonhodgkins lymphoma

A

Hodgkin =
- ages 15-30 and >50
- reedsternberg cells
- associated with EBV
- better prognosis

Nonhodgkins =
- occur at any age
- T cell or B cell lymphoma
- more common

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80
Q

Acute Leukemia

A
  • affects all ages but usually occurs in younger pts
  • predominate cell type is blast cells >30% of marrow are cells are blast (immature cells)
  • Acute Myeloblastic Leukemia (AML) = occur in infants/middle age or or older, excessive myeloblast, auer rods
  • Acute lymphoblastic Leukemia (ALL) = peak 2-10 yo, excessive lymphoblast, better prognosis
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81
Q

Acute Myeloblastic Leukemia (AML)

A
  • occurs in infants and middle-aged or older
  • characterized by a normal WBC count with excessive myeloblasts
  • Auer Rods may be seen with leukemic cells in the blood
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82
Q

Acute Lymphoblastic Leukemia (ALL)

A
  • peak age 2-10 years
  • Normal WBC with excessive lymphoblasts
  • better prognosis, 75% of children remain dz free >5 years with tx
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83
Q

What does a roth spot indicate?

A

leukemia and endocarditis

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84
Q

Chronic Leukemia

A
  • usually affects older adults
  • predominant cells are mature cells of the bone marrow
  • pts often asymptomatic but may have anemia

Chronic myelocytic Leukemia (CML) = 25-60yo onset, 3 year survival rate, 50-30K WBC count w/ increased grunolyctes in all states of maturation, philadelphia chromosome

Chronic lymphocytic leukemia (CLL) = >50yo onset, 5 year survival rate, 20-200K WBC count w/ mature small lymphocyte, more common in male

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85
Q

Chronic myelocytic Leukemia (CML)

A
  • Age of onset 25-60 yo
  • poor prognosis, only 3 year survival rate
  • WBC count of 50-30K w/ increased granulocytes in all states of maturation
  • 90% cases have Philadelphia chromosome
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86
Q

Chronic lymphocytic leukemia (CLL)

A
  • onset > 50 yo
  • Male:Female 2:1
  • 20-200K WBC count with predominance of mature small lymphoctyes
  • 5-10 year survival rate
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87
Q

Leukopenia

A

decr WBC due to bone marrow injury, bone marrow inactivation, drugs, or chemical supression

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88
Q

Leukocytosis

A

increase WBC count due to infections, illness, stress, pregnancy

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89
Q

Neutrophilia

A

increase number of neutrophils
- results from stress, exercise, pain, fear, photologic infections (typically bacteria)

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90
Q

Thrombocytosis

A
  • Elevated platelet count
  • include inflammation, kidney dz, or spleen removal
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91
Q

Pancytopenia

A

Decr WBC and RBC and platelets

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92
Q

Thrombocytopenia

A

Decr platelets
- caused by infection, liver failure, bone marrow disorders

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93
Q

Edema

A
  • increased interstitial fluid that can be inflammatory (protein-rich) or non-inflammatory (protein-poor transudate)
  • recognized by swelling of legs due to subcutaneous edema or shortness of breath due to pulmonary edema
  • tx with diuretics and leg compression
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94
Q

What are some non-inflammatory vs inflammatory causes of edema?

A

Non-inflammatory
- Increased organ pressure: CHF, liver cirrhosis, venous obstruction or compression
- Reduced plasma osmotic pressure: protein-losing glomerulo-pathologies, malnutrition
- Lymphatic obstruction: post-surgical or neoplastic
- Sodium retention: excessive salt intake w/ renal insufficiency

Inflammatory
- Acute and chronic inflammation
- Angiogenesis

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95
Q

Diabetic macular edema

A

caused by microaneurysms and dilation of capillary walls
- pericytes, endothelial foot plates that surround vessels, are damaged, allowing leakage of blood and fluid = edema

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96
Q

Hemorrhage

petechiae
purpura
ecchymoses
Hemothorax/Hemopericardium/Hemoperitoneum

A

leakage of blood due to vessel injury that may be uncontained or enclosed within a tissue
- aka hematomas (within a tissue)

petechiae = 1-2 mm heme on skin
purpura = >3mm heme (trauma, local vascular inflammation, low platelet counts)
ecchymoses = greater than 1-2cm (include subcutaneous hematomas or bruises)
Hemothorax/Hemopericardium/Hemoperitoneum = large accumulation of blood in body cavities

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97
Q

Thrombosis

A
  • Blood clot in vein, occlusion of vessels after a relatively minor injury
  • can form anywhere in the circulatory system, may be arterial or venous and may be non-occlusive
  • most common location of thrombus formation is deep venous system in legs
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98
Q

Virchow’s triad

A

cause of venous thromboembolism

  1. alteration of blood flow (stasis)
  2. Vascular endothelial injury
  3. Alterations in constituents of blood through inherited or acquired hypercoagulable state (drugs, oral contraceptives, smoking)
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99
Q

Acquired causes of hypercoagulable states

A

oral contraceptives, smoking, vasculitits (temporal arterities), malignancies, immobilization/pregnancy

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100
Q

Inherited hypercoagulable states

A

Factor V Leiden mutation, prothrombin gene mutation, protein C and S deficiency, and antithrombin III deficiency

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101
Q

Venous Thrombosis

A

occur in superificial or deep leg veins
- deep leg veins (typically above the knee) are more likely to embolized heart or lungs

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102
Q

Arterial Thrombosis

A

atherosclerosis, myocardial infarction
- they usually travel (embolize) to brain, kidney, spleen

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103
Q

CRVO and BRVO

A
  • associated with HTN and diabetes
  • conditions that most commonly result from thrombus formation
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104
Q

What is the difference between thrombus vs embolus

A

thrombus = clot remains where it was formed

Embolus = clot that has dislodged from where it was formed

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105
Q

Embolism

A
  • any solid/liquid/gas mass carried by blood to a distance site from its point of origin

FAT BAT

Fat emboli = long bone fractures and liposuction
Air emoblism = result from gas bubbles after chest wall injury or obstetric procedure
Thrombus = number one cause of emboli ***
Bacteria/Tumor = can cause tissue destruction and muscle pain
Amniotic fluid emboli = can lead to DIC esp postpartum

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106
Q

Shock

A
  • decr blood perfusion resulting form a reduction of either cardiac output or circulating blood volume

CHAS

Cardiogenic = heart not pumping blood
Hypovolemic = heme and fluid loss from vomiting, diarrhea, burns, trauma
Septic = overwhelming microbial infections or TSS gram + septicemia
Anaphylactic = Histamine release

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107
Q

Aneurysms

A
  • abnormal dilation of vessels
  • true embolism = enclosed by complete arterial wall
  • most common aneurysms occur in abdominal aorta, iliac, and other large arteries

-False aneurysms = can form with parts of arterial wall missing
- death from rupture, pressure on adjacent structures, occlusion of proximal vessels, or emoblism from mural thrombosis
- Pupil-involving CN 3 palsies
- Associated with Marfans
- abdominal aortic aneurysms are found in men older than 50
- risk of rupture increases with max diameter of aneurysms bulge

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108
Q

Atherosclerosis

A
  • slowly progressing dz of the arteries marked by elevated fibrosis and fatty intimal plaques
  • formed by fat deposits, smooth muscle and cell proliferation, and synthesis of the extracellular matrix
  • elastic arteries, descending thoracic artery, ICA, coronary arteries, abdominal aorta
  • SOB and chest pain
  • may begin in childhood and appears in middle age
  • tx = statin meds
  • arcus senilis
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109
Q

What can cause atherosclerosis

A

Endothelial cell injuries

  • monocyte and leukocytes circulating bloodstream to the injured vessel endothelium –> transform into macrophages –> attract lipids
  • accumulation of macrophages and adhesion of platelets in the injured area causes a massive plaque or clot to form = myocardial infarction
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110
Q

Risk factors for atherosclerosis

A

> 50 yo, family hx, HTN, smoking, hypercholesterolemia, and diabetes

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111
Q

Lab results of atherocholesterol

A

Increased LDL, decr HDL, incr total cholesterol

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112
Q

What are the normal cholesterol values of the following?

Total cholesterol
LDL
HDL
triglycerides

A

Total cholesterol: <200
LDL: <130
HDL: >40
triglycerides: <150

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113
Q

Coronary Artery Dz

A

atherosclerosis within the coronary arteries
- asx, chest pain (angina), and dyspnea
- if not treated, pt may suffer with MI - tx with 325 mg aspirin immediately

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114
Q

Carotid artery dz

A

atherosclerosis of the carotid arteries

  • 25% of strokes are due to build up of plaque causing stenosis of the carotid arteries
  • present with sensory loss, dizziness, amaurosis fugax, or complete loss of vision in the ipsilateral eye, high pitched bruit over the artery
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115
Q

HTN

A
  • most common primary dx in America
  • leads to increased heart attack, heart failure, stroke, kidney dz
  • 140/90
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116
Q

AHA Blood pressure categories

A
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117
Q

Risk factors for HTN

A

increase w/ age, fam hx, race, obesity, diabetes, smoking, excessive sodium intake
- AA has the highest probability of HTN
- Asians has the lowest risk

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118
Q

Hypertensive retinopathy

A

Characterized by narrowing of retinal arterioles
- acute or advanced HTN = retinal vasculature may be injured enough to cause occlusion or leakage
- changes seen on NFL = soft exudates and CWS, extravascular edema (hard exudates), intraretinal heme, retinal arterial macroaneurysms
- HTN choroidopathy is often found in young pts with acute HTN = elschnig spots and siegrist streaks

Severe HTN
- optic neuropathy, flame heme, venous congestion, and macular exudates
- papilledema found in stage 4 HTN retinopathy

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119
Q

Congestive Heart Failure

A
  • heart inability to fill with blood (diastolic heart failure)
  • inability to pump sufficient amts of blood through the body (systolic heart failure)
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120
Q

Left-sided heart failure

A
  • blood backs up into lungs (pulmonary edema)
  • common cause is ischemic cardiomyopahty resulting from CAD (MI)
  • primary sx SOB (dyspnea on exercise)
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121
Q

Right-sided heart failure

A
  • inability to pump blood into lungs causing blood to back up in the abdomen (ascites) and legs (lower extremity edema)
  • sx = edema, chest discomfort, SOB
  • most common cause is left-sided CHF; other causes = pulmonary HTN, COPD, right-sided MI
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122
Q

Heart attack is more common on the right or left side of the heart?

A

left

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123
Q

Risk factors of CHF

A

coronary heart dz, smoking, HTN, obesity, diabetes, valvular heart dz

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124
Q

Diagnostic findings of CHF and Tx?

A

BNP (Brain natriuretic peptide), cardiomegaly on chest x-ray, changes on echocardiogram

Tx = b-blockers, ACE inhibitors, diuretics

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125
Q

Rheumatic fever

A
  • affects 5-15yo
  • results from untreated pharyngeal infection with group A beta hemolytic streptococci (strep pyogenes
  • this can alter shape of the heart valves (80% mitral valves is attacked), often requiring replacement later in life
  • s/s = fever, elevated ESR, red-hot joints, endocarditis
126
Q

Bacterial endocarditits

A

Bacteria may affect lining of the heart, esp the valves

  • risk factors = prosthetic heart valves, IV drug use, age
  • pt presents with fevers, sx from arterial emboli, or heart failure, depending on the severity of valvular damage
  • echocardiogram will show “vegetations” (mixture of bacteria and thrombus) on heart valves or abscess within the heart tissue
127
Q

What does a roth spot indicate

A

endocarditis or leukemia

128
Q

Heart palpitations

A
  • atypical rhythm
  • most are benign, irregular heartbeats, with the most common being premature ventricular complexes (PVCs)
  • increase w/ dehydration, stress, decr sleep, exercise, or pregnancy
129
Q

Transient Ischemic Attacks

A
  • Temporary neurological deficits due to inadequate perfusion (always less than 24 hrs, usually less than 15 mins)
  • most likely caused by an embolism

2 types of TIA
- carotid artery TIA
- vertebrobasilar TIA

130
Q

Carotid artery TIA

A

w/ contralateral hand/arm weakness or ensory loss and face and leg sx
- pt can also have ipsilateral, amaurosis fugax, aphasia

131
Q

Vertebrobasilar TIAs

A

diplopia, ataxia, vertigo, dysarthria, and either unilateral or bilateral visual loss

132
Q

Hollenhorst plaque

A

embolism found in the retina vasculature, often have TIAs and should be referred immediately

133
Q

Stroke

A

sudden onset of neurological deficits reflecting arteries involved and brain structures they supply

Risk factors: HTN (#1), DM, hyperlipidemia, tobacco use, age, family hx

Auscultation of subclavian and carotid arteries for a bruit can be a clue to early dx
- CT scans used to determine size and location of stroke

134
Q

Macular sparing homonymous hemianopsia

A
  • most commonly from a stroke in the occipital lobe that has affected either middle or posterior cerebral artery, NOT BOTH
135
Q

Macula only homonymous hemianopsia

A

usually caused by a tumor compressing both PCA and MCA

never from a stroke

136
Q

What are the 2 types of stroke?

A

Ischemic stroke
Hemorrhagic stroke

137
Q

Ischemic stroke

A

80% of strokes due to occlusion of artery leading to the brain
- embolism of an atherosclerotic plaque is the most common cause
- tx = stop smoking, meds for HTN, hyperlipidemia, diabetes

138
Q

Hemorrhagic stroke

A

accumulation of blood within the brain due to bleeding from brain tissue, trauma, and/or vascular malfomrations
- most common type of hemorrhagic stroke is subarachnoid heme

139
Q

Subarachnoid heme

A
  • sudden severe HAS, pupil involving CN 3 palsy, nuchal rigidity
  • 30% pt will have change in consciousness
  • head trauma, rupture of an intracranial aneurysm (most common cause)
  • occur btw PCA and ICA
140
Q

Circle of Willis

A

meeting loop for the basilar artery, ICA, and ACA and PCA = small arteries bridging the basilar and internal carotid

  • forms beneath the brain and allows for a system of redundancy for the flow of blood to intracranial tissue
141
Q

Draw the circle of willis

142
Q

What does the anterior cerebral supply?

A

frontal lobe

143
Q

What does the Middle cerebral artery innervate?

A

frontal lobe, lateral surfaces of temporal and parietal lobe, occipital lobe

last and largets branch of ICA

144
Q

What does the posterior cerebral artery supply?

A

temporal and occipital lobe

stroke involving this vessel can cause contralateral hemiplegia, hemianopsia, color blindness, verbal dyslexia, and opposite VF defect

145
Q

Seizures

A

Single events may be caused by fever, HAs, stress, illness, or neurological defects
-s/s = cognitive dysfunction, nuchal rigidity, staring episodes, complete shaking of all ligaments
- tx = antiepileptics (phenytoin, phenobarbital, carbamazepineine, valproic acid). Absence of seizures are treated with Klonopin

146
Q

Epilepsy

A

recurrent seizures

147
Q

Status epilepticus

A

prolonged seizure

148
Q

Syncope

A
  • abrupt transient loss of consciousness lasting a few seconds to a few minutes due to decreased blood flow to the brain
  • Prompt recovery to full consciousness follows syncopal episode
  • Causes = cardiac abnormalities (heart rhythm disturbances or valve disorders), vascular problems (postural hypotension or vasovagal episodes), or neurological disorders
149
Q

5 main types of Headaches

A

Cluster HAs
Tension HAs
Migrain HAs
Temporal Arteritis HAs
Brain tumors

150
Q

Cluster HAs

A
  • men 30-50 yo
  • maybe orbital or temporal in location, usually unilateral
  • often occur in smokers and alcohol drinkers
  • often wake pts up at night or early morning
  • 1-2 attacks per day, each lasting less than 1 hr
  • Often present with red eyes and/or nasal stuffiness and can cause a transient or permanent ipsilateral Horner’s syndrome
151
Q

Tension Has

A
  • occur in all ages, F
  • worse with stress and may precede a migraine HA
  • present like band-like distribution
152
Q

Migraine HAs

A
  • Women 20-30, rarely after 50yo
  • started by certain triggers
  • may present with or without auras, nausea, or photosensitivity
  • migraines last anywhere from 4-72 hours and aggravated by physical activity
153
Q

Brain tumors

A
  • can cause HAs
  • all ages/sexes
  • associated with nausea, vomiting, visual changes, and steadily incr severity with time
  • Brain tumor-causing HAs tend to be worse in the morning
  • a child with a brain tumor is likely to have 1 or more other physical sx and 1 or more neurological deficits
  • less than 1% of pts with brain tumors have HAs as their only sx
154
Q

Meningitis

A
  • Inflammation of the meninges caused by various infectious agents such as viruses, bacterial, tb, fungi, or chemical agents
  • common and extremely hard to tx
  • preceded by upper respiratory tract infection
  • s/s = classic triad fever, HA, neck stiffness (meningism), nausea, vomiting, sweats, weakness, myalgias, papilledema, photophobia, 1/3 of pts will have seizures
155
Q

Primary brain tumors clinical presentations

A

seizures, dementia, focal lesions

**brain tumors can be primary or metastatic*

156
Q

What’s the most common primary malignant brain tumor

A

Glioblastoma Multiforme
- found in cerebral hemispheres and can cross the corpus callosum
- prognosis is grave, with less than one year life expectancy

157
Q

common primary tumor sites

A

lung and breast

158
Q

Most common benign brain tumor

A

Meningioma

  • these arise from arachnoid cells and extend to the brain
  • can be malignant
  • middle aged women
159
Q

Schwannoma

A

Tumor of schwann cells
- can cause gradual onset of painless, progressive, proptosis
- localized to the 8th nerve (aka acoustic schwannoma)
- Rare. most common in young to middle-aged adults

160
Q

Pituitary Adenoma

causes what kind of VF defect?

A
  • functional (hormone secreting) or non-functional
  • Prolactin secreting tumor is the most common functional pituitary adenoma
  • can cause bitemporal hemianopsia or junctional scotoma VF defect
161
Q

Multiple sclerosis

A
  • recurrent inflammation of the CNS that results in demyelination
  • F 20-40yo
  • Caucasians living in northern latitudes and genetics
  • Systemic sx include weakness, numbness, tremor, lack of coordination, vertigo, bowel and bladder dysfunction, fatigue
  • sx may last weeks to months
162
Q

Ocular findings for MS

A
  • optic neuritis = most common presenting sx
  • pain on eye mvmt, APD, INO, and diplopia
163
Q

MRI for MS

A

dx requires 2 separate central CNS lesions (separated in space) on 2 or more occasions (separated in time)
- these lesion must include involvement of white matter

164
Q

MS pt with optic neuritis will classically present with..

A

sudden, non-progressive onset of monocular vision loss
- Uhtoff’s phenomenon

165
Q

Internuclear ophthalmoplegia (INO)**

A

lesion in the MLF that results in loss of ipsilateral adduction and contralateral nystagmus

166
Q

Guillain-Barre Syndrome (GBS)

A

characterized by inflammation and demyelination of peripheral nerves and motor fibers of the ventral roots
- classically present with symmetric ascending muscle weakness that begins in the distal lower extremities

167
Q

Ocular findings for GBS

A

Adies tonic pupil, diplopia (multiple CN palsies), facial diplegia
- elevated protein and cerebrospinal fluid can cause papilledema
- ptosis

168
Q

Myasthenia Gravis

A
  • characterized by autoantibodies against ach receptors in the NMJ
  • affects all ages but more common in younger women and older men
  • associated with thymic tumor (thymoma), RA, lupus
  • s/s = respiratory weakness, and weakness of jaw muscles, ptosis, dipolopia, sx worse at the end of the day
169
Q

Alzheimer’s Dz

A
  • pt develops deposit plaques of protein called beta amyloid and disorganized masses of protein fibers within the brain cells (neurofibrillary tangles)
  • most common form of dementia, >65 yo
  • More prevalent in women, people with head injuries, down syndrome, prolonged exposure to chemicals, lower educational levels, and epilepsy
  • No cure but Aricept help slow progression
170
Q

Vascular dementia

A
  • have damaged area of brain tissue 2’ to reduced cerebral blood flow
  • due to vessels having clots or fatty deposits (cerebral microinfarcts)
  • most prevalent who are at risk for strokes, esp with longstanding HBP and diabetes
  • it can occur together with alzheimer’s dz
171
Q

Parkinson’s Dz

A
  • deficiency of dopamine in the striatum due to degeneration of neurons in the substantia nigra
  • classic sx: tremor, rigidity, akinesia, and postural instability (TRAP). Slowness of mvmt. Slowness of mvmt is often the first sign, along with cogwheel rigidity and pill rolling tremor
  • Tx: levodopa, bromocriptine , Carbidopa, Sinemet
172
Q

Epidural Hematoma

A
  • after closed head trauma (fall/blow to head), blood collects between the skull and dura
  • middle meningeal artery is often affected due to laceration of temporal region of skull
  • injury has 3 phases: loss of consciousness, lucidity, another loss of consciousness
173
Q

Subdural Hematoma

A

Venous blood collects btw dura and arachnoid space
- pt may be asymptomatic depending on severity of causative trauma
- Elderly = commonly seen w/ minor head injury esp on Coumadin
- Sx vary, though altered mental state and HAs are common

174
Q

Symptoms to watch with any head trauma

A
  • changes in pupillary size (blown pupil may signal impending uncal herniation)
  • Nausea or vomiting
  • Loss of consciousness
175
Q

Horner’s syndrome

A
  • lesion in the sympathetic pathway from the hypothalamus to the eye
  • classified as preganglionic central, preganglionic, postganglionic
176
Q

Where are the following located & what can cause damages to each?:

Preganglionic central lesion
Postganglionic lesion
Postganglionic lesin

A

Preganglionic central lesion: btw hypothalamus and ciliospinal center of Budge- Waller (C8-T2)
- CVA, demyelinating dz, cluster HAs, tumor, neck trauma

Postganglionic lesion: between ciliospinal center of budge Waller and superior cervical ganglion
- pancoast tumor, thyroid mass, neck trauma, hx of thyroid or neck sx

Postganglionic lesion: btw superior cervical ganglion and iris dilator muscle
- carotid artery dissection, interal carotid aneurysm, cavernous sinus fistula, canvernous sinus syndrome, head trauma, cluster HAs)

177
Q

Classic triad for horner’s

A

ptosis, miosis, ipsilateral anhydrosis (no sweating or flushing on the affected side)
- pt w/ carotid artery dissection may also present with neck and shoulder pain

178
Q

Anhydrosis is most prominent with lesion located where?

A

preganglionic central or preganglionic lesion

  • while postganglionic lesion will only result in anhydrosis of the ipsilateral forehead, as most sweat fibers diverge away from the sympathetic fiber near the superior cervical ganglion
179
Q

Congenital horner’s

A
  • less than 5% of cases
  • due to birth trauma causing brachial plexus injury, thoracic or cervical neuroblastomas (life-threatening tumors)
  • heterochromia
180
Q

Bell’s Palsy

A
  • Idiopathic condition (rule out CN 7 palsy)
  • sudden deficit of lower motor neuron in CN 7 causing facial muscle paralysis on the ENTIRE side of face
  • ectropion resulting in exposure keratopathy
  • Tx = patching/closing eyelid, oral steroids/antiviral, 71% will have complete recovery within one year without tx
181
Q

Type 1 DM (Juvenile DM)

A
  • younger pts
  • most common sx polyuria, polydipsia, weight loss
  • 90% immune mediate and +HLA
  • beta cell destruction = lack of insulin
  • Tx = insulin injection, close monitoring of glucose and diet
  • Complications = Diabetic ketoacidosis, microangiopathy (retinopathy, nephropathy, neuropathy, cataracts and glc
182
Q

Type 2 DM

A
  • increased insulin resistance or abnormal B-cell secretions of insulin
  • most pts over age 40
  • obesity
  • most pt asymptomatic at the time of dx
  • Tx = diet monitoring, exercise, oral glycemic agents, occasionally insulin
183
Q

Hgb A1C Norm
fasting plasma glucose norm

A
  • reflects state of glycemia over the last 90-120 days
  • <7%
  • > 126 or higher is abnormal
184
Q

Is ketoacidosis more common in type 1 or 2 DM?
Which one has more of a genetic predisposition?

A
  1. type 1= eye exam 5 years after dx
  2. type 2 = needs eye exam ASAP
185
Q

Diabetes Insipidus

A
  • extreme thirst and polyuria form lack of ADH or deficiency in renal response to ADH
  • Tx = increase fluid intake, intranasal desmopressin (ADH analog), indomethacin, or HCTZ for nephrogenic cause
186
Q

Hypothyroidism

A

Caused by abnormality that hinders the appropriate production of thyroid hormones
- sx: cold intolerance, hypoactivity, weight gain, fatigue, lethargy, decr appetite, constipation, weakness, myxedema, dry cool skin, and coarse hair
- Lab value: increase TSH, decr T3 and T4
- Hashimoto’s Thyroiditis

187
Q

Hashimoto’s Thyroiditis

A
  • auto-immune mediated condition that attacks the thyroid gland
  • most common cause of hypothyroidism in iodine-sufficient areas of the world
  • common in ages 45-65 and F
188
Q

Hyperthyroidism

A
  • caused by Graves dz, autoimmune condition caused by TSH autoantibodies
  • constant thyroid stimulation of T3 and T4 hormones
  • middle age pts 4-5th decade, F
  • heart palpitations, weight loss, heat intolerance, hair loss
  • increased T4, decr TSH
189
Q

Ocular signs of Grave’s ophthalmopathy

A
  • proptosis, UL retraction
  • less common = SLK, bilateral, inflammatory rx
190
Q

Hyperparathyroidism

A
  • causes by hypercalcemia, oversecretion from parathyroid hormone
  • sx = bone pain, pathologic fractures, renal stones, constipation, mental changes, and fatigue
  • band keratopathy
  • tx = parathyroidectomy
191
Q

Hypoparathyroidism

A
  • most common after thyroidectomy
  • tetany, muscle cramps, irritability, carpopedal spasms, convulsions, mental retardation
  • most prominent evidence is decr serum calcium
  • ocular findings = cataracts, uveitis, blurry vision
192
Q

Addison’s dz

A
  • ADD steroids (need steroids vs cushings dz has too much steroids in the body)
  • chronic adrenocortical deficiency that is the result of autoimmune atrophy of the adrenal glands
  • sx = weakness, fatigue, anorexia, weight loss, nausea, vomiting, diarrhea, ab pain, muscle and join pains, and amenorrhea
  • tx = replacement therapy with combo of glucocorticoids and mineralocorticoids
193
Q

Cushing’s syndrome (Hypercortisolism)

A
  • effects of excessive corticosteroids on the body
  • the result of chronic, prescribed steroid meds
  • central obesity, moon face, buffalo hump
  • may have osteoporosis, poor wound healing, hyperglycemia, elevated serum cortisol levels
194
Q

Pheochromocytoma

A
  • rare condition caused by tumor secreting excessive amts of NE and epinephrine
  • can be located on one or both adrenal glands or anywhere along sympathetic nervous chain
  • any age but most common 40-60 yo
  • sx = elevated BP, papilledema, severe HA, perspiration, heart palpitations, anxiety, sense of impeding doom
  • tx = remove tumor
  • should be suspected in pts with HTN accompanied by HA (pain), palpitations, pallor, perspiration
195
Q

Lab test for acute renal failure

A

Decr GFR
Incr BUN and creatinine

196
Q

Chronic renal failure

A

kidneys failure to make urine and excrete nitrogenous waste

  • main causes are diabetes (most common) and HTN
197
Q

Glomerular dz

A

Inflammation of the glomerulus of the kidney
- there are 2 types:
Nephritic syndrome: assoc w/ HTN, edema, active urine sediment with hematuria, blood casts and protein uria
Nephrotic syndrome: associated with greater than 3.5 grams of protein in the urine. It is accompanied by hypoalbuminemia, hyperlipidemia, and edema

198
Q

Post streptococcal Glomerulonephritis

A
  • renal infection caused by strep pyogenes
  • occurs 7-12 days after a respiratory infection or skin infection
  • most common in ages 5-15 years
  • sx = abrupt onset of hematuria, edema, HTN, and RBC casts in the urine
199
Q

Pyelonephritis

A
  • very sick pts, pain when tapping kidneys
  • bacterial infection of the kidneys
  • sx = dysuria, frequency, urgency, fever, chills, flank pain, costovertebral angle tenderness, nausea/vomiting
200
Q

Renal cell carcinoma

A
  • asymptomatic
  • if sx are present, triad = flank pain, hematuria, and abdominal renal mass
  • the first diagnostic test is an abdominal ultrasound
201
Q

Sexually transmitted dz

A

Chlamydia
Gonorrhea
HSV
Syphilis

202
Q

Most common bacterial sexually transmitted dz in the US

203
Q

syphilis

A
  • Most common bacterial sexually transmitted dz in the US
  • cause cervicitis in women and urethritis and/or epididymitis in men
  • Serotypes A-C, D-K
  • Tx azithromycin or doxycycline
204
Q

Serotypes D-K

A

chlamydia
- AIC
- characterized by chronic follicles and papillae in the inf palpebral conj and fornices
- minimal mucopurulent discharge
- punctate keratitis, superior, pannus, peripheral SEIs and PAL

205
Q

Serotypes A-C

A
  • trachoma conjunctivitis (chlamydia)
  • characterized by follicular and papillary conjunctivitis with mild superior pannus, arlt lines, herbert pits
  • Progressive scarring, superior tarsal conjunctiva may result in cicatricial entropion, with resulting trichiasis and corneal ulceration
206
Q

Gonorrhea

A
  • sexually transmitted dz caused by direct contact with Neisseria gonorrhoeae
  • signs and symptoms range from no sx, to vaginal discharge, pelvic pan, urethritis, and dysuria or urinary frequency
  • males are asymptomatic or burning upon urination
  • severe, hyperacute, purulent discharge
  • Tx: single dose ceftriaxone 250 mg IM plus Doxycycline 100 mg p.o. BID x 7 days (given together to cover for chlamydia)
207
Q

HSV

A
  • Type 1 and II (Both can be found in the eye)
  • Dx confirmed by multinucleated giant cells on a Wright-Giemsa stain
  • Type 1 = mucosal lesion on the lips
  • Type 2 = sexually transmitted dz and is found on the mucosa of male and female sex organs
  • tingling, irritation, itching
  • Tx = acyclovir or famciclovir (no cure but taken prophylactically)
208
Q

Syphilis

A
  • sexually transmitted dz caused by spirochete Treponema pallidum
  • 3 phases: primary, secondary, tertiary
  • primary = chancre (painless ulcer in genital region)
  • secondary = lesion can involve eye, kidney, mucous membranes, skin, or CNS, or liver
  • tertiary = leads to CNS and ophthalmic lesions including argyll Robertson pupil
209
Q

What are some ocular manifestations of syphilis?

A
  • Interstitial keratitis, retinitis, retinal vasculitis
  • Salt and pepper fundus and flame-shaped retinal heme
  • Uveitis
  • CN and optic neuropathies
  • Acute multifocal chorioretinitis and vitritis
210
Q

Why is syphilis also called “the great mimic”

A

b/c of its variable presentation

211
Q

What would lab tests for active syphilis look like?

A

+ FTA-ABS, + RPR and VDRL
- positive 4-6 weeks after initial infection

212
Q

What would lab tests for latent syphilis look like?

A

(+)FTA-ABS, (-)RPR and VDRL
- indicates pt had syphilis infection earlier in life and has now been tx, or has an earl syphilis infection (less than 6 weeks
- (+)FTA-ABS if the pt has EVER had syphilis

213
Q

Tests for syphilis

A

FTA-ABS, RPR, VDRL
- CDC recommends EIA or MFI as screening test (less false positives)
- most tests screen for Syphilis IgG antibodies = if this is negative no other testing is needed, the pt does not have syphilis
- If syphilis IgG is positive = RPR is performed

214
Q

(+) syphilis IgG and (+) RPR

A

pt has untreated syphilis

215
Q

(+) syphilis IgG, (-) RPR

A

FTA-ABS or TPPA is performed
- if this is negative then it was likely a false positive test
- if positive then pt has possible active syphilis and early syphilis infection (<6 weeks), or pt was previously tx for syphilis and no longer has active infection

216
Q

Benign Prostatic Hypertrophy (BPH)

A

Enlarged prostate
- Tx w/ alpha 1 blocker, -prosin/Terazosin, sx
- risk factor = male w/ fam hx, >50yo,
- signs and sx include increased urinary frequency, urgency, nocturia, a weak stream, hesitancy and dribbling

217
Q

Prostate cancer

A
  • 2nd most common cause of cancer death in males
  • incidence increase w/ age
  • Risk facts = >50yo, fam hx, AA
  • elevated PSA (prostate specific antigen)
218
Q

Pregnancy

A
  • s/s: amenorrhea, nausea, vomiting, breast tenderness, weight gain
  • lab test = incr human chorionic gonadotropin hormone (Beta HCG) levels
  • divided into 3 trimesters: 0-12 weeks, 13-26 weeks, and 27-40 weeks
  • common test during pregnancy: down syndrome (15-18 weeks), STD testing, ultrasounds (18-22 weeks), diabetic screening (26-28 weeks), Rhogam injection for Rh negative women (28 weeks), and group B strep test (36 weeks)
219
Q

Pregnancy complications

A
  • spontaneous abortion (miscarriage) - occurs less than 20 weeks
  • Still birth - death to fetus after 20 weeks of pregnancy
  • Ectopic pregnancy = pregnancy within the fallopian tube or anywhere outside the uterus ( sx pelvic pain, fever, mass inside fallopian tube on ultrasound, increase HCG levels
  • Pre-eclampsia = triad of HBP (greather than 140mmHg), protein in urine, selling in the lower extremities. Best tx is to deliver the baby
    – eclampsia occurs when the above sx are present and the pt has seizures
    – both conditions can cause adverse effects in pregnancy, including still birth and maternal death, if not tx properly
220
Q

Breastfeeding

A

oxytocin = milk ejection (posterior pituitary)
prolactin = milk production (anterior pituitary)
- benefits - mother/child bonding and transfer of immunoglobulins

221
Q

Cervical cancer

A
  • common but treatable in women
  • begins as cervical dysphasia and progresses over time to malignancy
  • risk factor = early sex and multiple sex partners, hx of HPV
  • abnormal pap smear
  • tx = sx, radical hysterectomy, chemo
222
Q

Breast cancer

A

2 main types:
- Ductal carcinoma = starts in tubes (ducts) that move milk from breast to nipple
- Lobular carcinoma = starts in parts of breast called lobules that produce milk

  • estrogen causes breast cancer tumor to grow
  • estrogen receptor-positive cancer or ER positive cancer
  • risk factors = age, fam hx, defects in BRCA1 and BRCA2 genes
223
Q

Most common cancer in women in the US in order

A

breast> lung> colon

224
Q

Most common causes of cancer death in women in order

A

lung > breast > colon cancer

225
Q

Most common cancers in men in order

A

prostate > lung > colon cancer

226
Q

Most common causes of cancer death in men in order

A

lung > prostate > colon cancer

227
Q

What causes spina bifida?

A

folic acid deficiency

228
Q

What is spina bifida characterized by?

A

defective closure of the posterior vertebral arches with intact meninges and spinal cord
- spina bifida oculta = milder, no sx
- Severe cases = lower body dysfunction, bowel/bladder/leg abnormalities
- decreased learning capacity and enlarged ventricles are common
- spina bifida can be sig reduced w/ folic acid supplement

229
Q

Anencephaly

A

most severe (100%) fatal neural tube defect disorder
- orbital bones are normal but absence of brain and cranial bone tissue

230
Q

Congenital heart disease: Right to left shunt

A

“blue babies”
- oxygen deficit

231
Q

Congenital heart dz: Left to right

A

“blue kids”
- less severe compared to blue babies
- out of breath

232
Q

Number one cause of congenital malformation?

A

fetal alcohol syndrome

233
Q

Ocular signs of fetal alcohol syndrome

A

shortened palpebral fissure, microphthalmos, strabismus, epicanthus, telecanthus, blepharoptosis, ON hypoplasia, retinal vessel tortuosity

234
Q

Cerebral palsy

A
  • Not enough CO2 for the body
  • non-progressive varied infections, toxins, and congenital malformations in infants
  • s/s: mental slowness or retardation, impaired function of voluntary muscles, seizures, and speech and sensory defects, hyperactive reflexes are also common
235
Q

Rubella

A
  • mother transfers this to fetus
  • microphthalmia, glc, cataracts
  • screened for in early pregnancy
236
Q

Microphthalmia

A
  • small malformed globe
  • w/o any other ocular defects = pure microphthalmos or nanophthalmos
237
Q

Syphilis

A

mucous and membrane lesions on the fetus
- if left untreated, baby can evelop interstitial keratitis and CNS disorders
- screened early in pregnancy

238
Q

Toxoplasmosis

A
  • acquired by the fetus, can result in stillbirth
  • most will develop brain or eye problems including retinochoroiditis
239
Q

Infant cataracts should raise suspicion for?

A

rubella or galactosemia

240
Q

What is screened during pregnancy?

A

Toxo
rubella
syphilis

241
Q

Gastroesophageal Reflux Disease (GERD)

A

mvmt of gastric juices into the esophagus due to gastroesophageal junction incompetence
- cause heartburn
- risk factors = alcohol, hiatal hernias, obesity, pregnancy, scleroderma, smoking

242
Q

Peptic ulcer dz

A
  • caused by NSAID, heliobacter pylori, food intolerance, smoking
  • tx: H2 blockers, proton pump inhibitors, combination therapy (H2 blocker or PPI plus 2 antibiotics) for H pylori
  • Dx w/ endoscopy and barium swallow studies
243
Q

What are the 2 main ulcer locations for peptic ulcer dz?

A

Duodenal ulcer = sx include burning, hunger-like pain, primarily epigastric area, pain my occur or worsen on an empty stomach or worse in the middle of the night when acid secretion is the greatest

Gastric ulcer = main sx is pain soon after eating

244
Q

Barrett’s Esophagus

A
  • Normal esophageal lining replaced by metaplastic columnar cells; occurs as a result of squamous changing to columnar cells
  • Dx via upper endoscopy w/ biopsy to confirm cell change
  • can lead to esophageal carcinoma (requires sx)
  • tx includes long-term proton pump inhibitors
245
Q

Inflammatory Bowel Disease (IBD)

A

2 main ones are
- inflammatory bowel dz
- crohns dz

246
Q

Chron’s dz

A

think of a fat old cron skipping down a cobblestone road
- infectious
- occur at any portion of the GI tract, usually the ileum, small intestine, and colon
- Rectal sparing
- SKIP lesions
- Transmural inflammation, cobbleston mucosa, creeping fat, bowel wall thickening, ulcers and fistulas
- Strictures, fistulas, perianal dz, malabsorption and nutritial depletion
- nongranulomatous uveitis

247
Q

Ulcerative colitis

A
  • autoimmune
  • colon, continuous lesion, rectal involvement
  • mucosal inflammation, friable pseudopolyps, crypt abscesses, and ulcers
  • severe stenosis, toxic megacolon, colorectal, carcinoma
  • non-granulomatous uveitis

HIGHER PREVALENCE compared to crohns

248
Q

Colon cancer

A
  • third leading cancer in both males and females
  • causes = low-fiber, high-fat diet, exposure to toxins
  • Risk factors = age, fam hx of. colon or breast cancer,
  • need colonoscopy
  • Tx = surgical removal, chemotherapy, radiation
249
Q

Wilson’s dz

A
  • failure of copper to enter circulation in the form of ceruloplasmin leading to copper accumulation
  • affects brain, liver, cornea (Kayser-Fleischer Ring)
  • sunflower cataract, cirrhosis of liver, basal ganglia degeneration, and dementia
250
Q

What’s used to tx Wilson’s dz?

A

Penicillamine (Cuprimine)
- chelating agent (binds to copper)
- ocular SE = ocular myastenia (diplopia, ptosis), ocular pemphigoid, optic neuritis

251
Q

Alcohol hepatitis

A
  • swollen, necrotic liver cells due to alcohol consumption
  • Mallory bodies (hyaline), fatty changes, and sclerosis around the central vein are also present, with an increase in AST and ALT liver enzymes
252
Q

AST and ALT

A

liver enzymes released into the blood in increased concentrations in cases of hepatitis

253
Q

Hepatitis

A
  • Viral inflammatory conditions of the liver parenchyma that leads to necrosis includes type A-E
  • ” bowels w/ vowels”
  • A = spread via fecal-oral route
  • B = spread via blood, IV drugs, sex
  • C = spreads like B, chronic hepatitis in 80% of hep C infections
  • D = carried only with hep B as a superinfection. increasing morbidity and morality
  • E = spread via fecal- oral route
254
Q

Which hepatitis vaccinations are available?

A

A (2 shots) and B (3 shots)

255
Q

Which hepatitis infection spread via fecal oral route

A

A and E

Vowels with the bowels

256
Q

Cirrhosis

A

presence of fibrosis with creation of excessive extracellular matrix
- normal blood flow through the liver is hindered and nutrient and metabolite exchange are thus reduced
- most common causes are alcohol, viral hepatitis (drugs, toxins, CHF, biliary obstruction, autoimmune complexes)
- complications = portal hypertension
- GI heme and liver failure may result in death

257
Q

Jaundice

A
  • normal liver cells conjugate bilirubin and excrete it into bile (will eventually be excreted as urine)
  • Conjugated bilirubin is converted by bacteria to urobilinogen (can also be formed directly by heme metabolism)
  • jaundice occurs when pathway is either obstructed in the liver or bilirubin is hemolyzed in blood or cannot be excreted in urine
  • build-up of bilirubin in blood can cause yellowing of skin and conj (common in cirrhosis, hemolytic disorders, or obstructive gall bladder)
258
Q

Cholecystitis

A

” angry gall bladder”

  • inflammation of the gallbladder 2’ to obstructive cholesterol stones, sludge or infection
  • most common in females who are overweight or of childbearing age
  • pain in upper right quad, esp after meals
  • (+) Murphy’s sign
259
Q

Acute Pancreatitis

A
  • most common cause is alcohol abuse or gallstones (others = trauma, drugs, infection, hyperlipidemia, infection, tumor)
  • pain around umbilicus w/ possible radiation to the back
  • lab shows incr amylase and lipase
260
Q

Chronic Pancreatitis

A
  • the most common cause is chronic alcohol abuse
  • hx of recurrent acute pancreatitis
  • Periodic or continuous periumbilical pain radiates through the back
  • weight loss, steatorrhea (fatty stools), diabetes
261
Q

Hearing loss

What’s the most common cause of hearing loss?
Testing?

A
  • loss of conduction is the most common form of hearing loss due to cerumen impaction or trauma (others include sensory loss or neural deficits)
  • Sensory hearing = due to deterioration of cochlea
  • Neural loss = damage to CN 8
  • Tests = Weber test and Rinne test to determine the culprit
262
Q

Otitis media

A
  • pain in ear from bacterial infection
  • Strep. pneumonia and H. influenza
  • Tx amoxicillin or other gram + agents
  • Very common in infants/children
263
Q

Vertigo

A
  • dz of the vestibular ear system causing dizziness and nystagmus
  • True vertigo = ALWAYS associated w/ nystagmus
264
Q

Dz associated with vertigo?

A

Meniere’s dz = vertigo, hearing loss, tinnitus
Tx: cut tobacco, salt, antihistamines

265
Q

Sinusitis

A
  • Inflammation of the paranasal sinuses due to viral/bacterial/fungal infection
  • may have anterior/posterior mucopurulent drainage, nasal obstruction, facial pain, pressure, fullness, decr sense of smell
266
Q

What ocular problems can result from sinusitis?

A

Orbital cellulitis - most often ethmoid sinusitis

267
Q

Allergic rhinitis

A
  • runny nose, sneezing, conj hyperemia, water eyes
  • Tx = histamine receptor blockers, nasal spray, eye drops (patanol)
268
Q

Pharyngitis

A
  • enlarged cervical nodes, sore throat, fever
  • caused by viral or bacterial agents
  • Group A strep infections need to be tx with penicillin or gram + agents
269
Q

Acute bacterial sialadenitis

A
  • commonly located in the parotid or submandibular gland
  • swelling and pain of gland
  • S. aureus
  • Tx with antibiotics, IV nafcillin often used
270
Q

Salivary gland tumors

A
  • 80% involves parotid gland, 50% will be benign
  • asymptomatic mass in the gland and can extend deep into the facial nerve areas
  • MRI and CT scans used for dx
  • Tx = remove tumor
271
Q

Temporalmandibular Disorder (TMJ)

A
  • acute and chronic inflammation 2’ to arthritis, trauma, dislocations, developmental anomalies, and other factors
  • HAs, jaw pain, facial pain
272
Q

Obstructive sleep apnea

A
  • breathing disorder during sleep
  • inadequate muscle ton of the tongue and/or airway dilator muscle results in obstruction of the upper airway stopping the pt from breathing during sleep
  • s/s = disruptive snoring, daytime sleepiness, obesity (BMI >30), large neck circumference (>42 cm in men)
  • assoc. w/ HTN, fatal and nonfatal cardiovascular events (acute MI, atrial fibrillation), stroke, epilepsy, and diabetes
273
Q

Ocular association w/ sleep apnea

A
  • FES
  • NTG
  • NAION
274
Q

Chronic obstructive Pulmonary Disease (COPD)

A
  • obstruction of air flow to be trapped in the lungs
  • LEADING CAUSE is SMOKING
  • 2 categories
    1. Emphysema (pink puffers)
    2. Chronic Bronchitis (Blue bloaters)
275
Q

Emphysema (COPD)

A
  • pink puffers
  • enlargement of air spaces and decr in recoiling b/c of destruction of alveolar walls
  • sx = shortness of breath (dyspnea), decr breath sounds, tachycardia
276
Q

Chronic Bronchitis (COPD)

A
  • Blue bloaters
  • productive cough for 3 consecutive months in 2 or more years due to hypertrophy or mucous secreting glands in the bronchioles
  • common sx include cyanosis of fingers and those and wheezing/crackling of lungs
277
Q

What medications should we avoid in pts with COPD or any other underlying lung dz ?

A

B-blockers

278
Q

Asthma

A
  • 2 primary components
    1. Acute reversible bronchoconstriction (triggered by infection, allergens, stress)
    sx - coughing, wheezing, dyspnea, tachycardia
  • Tx w/ bronchodilators - abuterol, isoproterenol and metaproterenol
  1. Chronic inflammation of airways
    - tx w/ inhaler or steroids
279
Q

Pneumoconiosis

A
  • restrictive lung, lungs cannot expand
  • caused by occupation inhalation of dust
  • AKA coal worker’s pneumoconiosis, asbestosis, Silicosis, and Berylliosis
  • SOB, decr lung volume and compliance
  • chest x-ray will show diffuse infiltrates w/ ground glass appearance
280
Q

Tuberculosis

A
  • caused by airborne droplets of mycobacterium TB
  • fever, cough, night sweats
  • chest x-ray
  • always a (+) TB test if exposed
281
Q

What does a Latent TB lab look like?

A

(+) test but negative chest x-ray

282
Q

What does an active TB lab look like?

A

(+) test and (+) chest x-ray

283
Q

What medications are used to tx TB? meds used for Latent TB vs Active TB?

A

“RIPE cheese”

Rifampin
Isoniazid (use in isolation in latent TB
Pyrazinamide (NOT ON TEST)
Ethambutol

284
Q

Ocular findings for TB?

A

Phlyctenules, Episcleritis, Scleritis, Keratitis, Bilateral chronic granulomatous uveitis, CME, Unilateral optic disc edema or papilledema, conjunctival granulomas

285
Q

What are the 2 most common causes of chronic, bilateral, anterior granulomatous uveitis?

A

TB and sarcoid

286
Q

Norms for TB test

A
  • <15mm
  • <10mm (for healthcare workers)
  • > 15mm (immunocompromised: HIV or bone marrow suppression)

>15mm is abnormal

287
Q

Interferon-gamma release assays (IGRAs)

A
  • TB test measures pts immune reactivity to M. tuberculosis antigens by measuring the amt of interferon-gamma
    produced by WBC in response to these antigens
  • CDC recommends using IGRA in place of TB skin test for TB testing during pregnancy, screening healthcare workers, contact investigations, pt undergoing eval for TB infection, pt who received BCG (vaccination or cancer therapy), pt who are unlikely to return for TB test readings
288
Q

QFT-GIT

A
  • TB test interpreted as follows based on Nil response, TB response, and Mitogen response

(+) = most likely has TB
(-) = not likely to have TB

  • does NOT differentiate btw active and latent TB infections, must include chest x-rays and sputum analysis to determine if pt has active or latent TB
289
Q

Which TB test is recommended in children less than 5 years of age?

A

TB skin test

290
Q

Bacterial Pneumonia

A
  • infection of lungs caused by bacteria or virus
  • most common cause is strep pneumonia (pneumococcus)
  • productive cough, SOB, fever
  • less common form is “walking pneumonia”
291
Q

“walking pneumonia” is caused by which agent?

A

Mycoplasma pneumoniae

292
Q

Influenza

A
  • Acute respiratory illness caused by influenza A or B
  • sx include fever, cough, rhinitis, HA, myalgias
293
Q

Most common cancer deaths in men and women

A

Lung cancer

294
Q

Lung cancer

A
  • most common cause of death in men and women
  • Adenocarcinoma most common lung cancer
  • Cigarette smoking leading cause, 2nd hand smoke and can also lead to lung cancer
  • maybe asymptomatic or may present with cough, hemoptysis, SOB, weight loss
  • bone pain from metastasis
295
Q

tumor of the apex of the lung is called?

A

Pancoast tumor - can cause horner’s

296
Q

Neoplasia

A
  • irritate normal cells which mutate and give rise to new cells
  • suppressor genes are often inactivated in pre-malignant cells
  • oncogenes facilitate and encourage cancer mutation and growth
  • can be benign or malignant
  • Melanocytic nevi are most common benign neoplasms
297
Q

Classifications of Neoplasms

A
  1. Behavior - benign, borderline, malignant
  2. Degree of differentiation - well or poorly differentiated
  3. Embryologic origins - epithelial (adenocarcinoma, squamous cell carcinoma), lymphoproliferative (leukemia, lymphoma), mesenchymal (sarcoma)
  4. Gross appearance - well-circumscribed or infiltrative
298
Q

Benign tumors

A
  • slow-growing and well-circumscribed
  • Ex. Adenomas, cystadenomas, papillomas, polyps
299
Q

Malignant tumors

A
  • often aggressive w/ invasion of adjacent tissues and have metastatic potential
  • metastatic = shifts from origin to another site in the body
  • carcinomas = arise from epithelial cells
  • sarcomas = arise from mesenchymal (CT) tissue
300
Q

Most common primary orbital malignancy

A

Rhabdomyosarcoma (CT cancer that causes bone destruction)

301
Q

Dysplasia

A
  • abnormal growth of epithelial cells caused by a disruption in cell maturation
  • Low-grade dysplasia = earliest form of pre-cancerous lesion
  • High grade dysplasia = synonymous with carcinoma in situ (CIN) transformation into cancer is high but tx is still effective
  • Invasive carcinoma (cancer) = final step in this process - growth penetrates the epithelial basement membrane to invade tissue
302
Q

Metaplasia

A
  • change from one mature cell type to another as an adaptive response from chronic irritation or a pathogen or carcinogen
  • tx aims to reverse cell damage
  • If left alone, dysplasia and cancer can result
  • Squamous cell carcinoma, the 2nd most common form of skin cancer, results from metaplasia
303
Q

Oncogenes

A
  • protein-encoding genes that has the potential to cause cancer
  • Multiple oncogenes, such as the “Ras” oncogenes, have been found to play a role in specific cancers
304
Q

Tumor supressor genes

A
  • repress cell cyle and/or promote apoptosis
  • prevent DNA dmg and regulate cellular activities
  • Loss of tumor suppressor genes, such as BRCA gene in breast cancer, can lead to cancer
305
Q

Anorexia Nervosa

A
  • a distorted view of body img and overwhelming fear of being fat
  • decr body weight (less than 85% of ideal body weight)
  • absence of 3 consecutive menstrual cycles
  • F>M
306
Q

Bulimia Nervosa

A
  • binge eating 2 times a week for 3 months
  • compensate binge eating by vomiting, over-exercising, using laxatives
307
Q

Kwashiorkor

A
  • protein malnutrition resulting in skin lesions, anemia, edema, liver malfunctions
  • very swollen belly on a malnourished appearing pt
308
Q

Marasmus

A
  • protein-calorie malnutrition resulting in tissue wasting
  • wasting and weight loss in affected individuals
309
Q

Alcoholism

A
  • addiction to alcohol
  • withdrawal tremor, tachycardia, HTN, nausea, seizures, delirium tremens, and hallucinations
  • Alcoholics are more prone to gallstones, alcohol hepatitis, and cirrhosis of the liver
  • Alcoholic cirrhosis = long-term alcohol abuse causing micronodular cirrhosis; presenting sx include jaundice, hypoalbuminemia, coagulation factor deficiencies, portal HTN
  • Wernicke-Korsakoff syndrome = thiamine B1 deficiency
  • toxic optic neuropathy that leads to bilateral temporal optic nerve pallor
310
Q

Major depression

A
  • caused by inappropriate transmitter involvement, metabolic abnormalities, or psychological factors. Strong genetic predisposition
  • sx: feeling of worthlessness, guilt, anxiety, fatigue, insomnia and withdrawal from social situations
  • tx = antidepressants, counseling, and electroconvulsive therapy
311
Q

Anxiety

A
  • sx of apprehension, worry, irritability, difficulty concentrating
  • Physical complaints include insomnia, tachycardia, HTN, nausea, diarrhea
  • Tx = benzodiazepines, antidepressant, counseling
312
Q

Schizophrenia

A
  • incr levels of dopamine in mesolimbic region
  • characterized by massive disruption of behavior, mood, thinking for at least 6 months
  • Tx antipsychotics

Positive = delusions, thought disorders, inappropriate affect, incr motor fxn
Negative = lack of speech and though, loss of emotional response, no effect, social isolation

313
Q

Bipolar disorder

A
  • characterized by episodes of severe depression alternating w/ periods of mania
  • tx same with severe depression and may include hospitalization
  • Manic episodes characterized by elevated mood, decr need for sleep, flighty thought, dec reasoning skills, incr activity, aggressive behavior
  • Mania is often followed by periods of severe depression
314
Q

Suicide

A
  • common cause of death in US
  • serious depression, alcohol and substance abuse, stressful life events
  • highest risk are middle-aged white and elderly men, though women and teens report more suicide attempts
  • Tx = hospitalizations, depression meds, counseling

KMK (18 decks)

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