ALL BsS

What 5 things contribute to the characteristics of pulse?

(VP DRS) V- Viscosity of the blood P- Peripjeral resistance D- Distensibility of aorta and large arteries R- Rate of cardiac emptying S- SV- amount of blood ejected

Describe the systemic manifestations that indicate the presence of chronic inflammation

(WALU) W- weight loss A-Anemia L-Low grade fever U- usually normal peripheral WBC count

Coma: oParesthesia:

A deep state of unconsciousness, neither awake nor aware g. Paresthesia is an abnormal dermal sensation (e.g., a tingling, pricking, chilling, burning, or numb sensation on the skin) with no apparent physical cause.

Define exudate

Inflammatory extravascular fluid containing increased protein, cellular debris and having a specific gravity of >1.020 Increased vascular permeability is what's allowing protein into interstitial space

Define: geographic tongue strawberry tongue- glossitis-

Inflammatory process causing superficial denuded circles, exposing the tips of papillae / erythema, bumps covering entire surface hairy tongue

Cervical cancer

Pathway: Pelvic + para-aortic lymph Hematogenous spread Site of metastasis: Uterus, vagina, pelvic cavity, bladder, rectum Lungs, liver, bone

Excretion

Physiologic ∆s w/ age: ________: Half-life increased for drugs primarily eliminated by the kidneys. Because: decreased blood flow to kidneys and decreased GFR.

Describe the lifecycle and migration of Neutrophils

Short-lived cells in blood: half-life of 6-7 hrs in Connective tissue: 1-4 days (die by apoptosis) reach full maturity in the bone marrow process can accelerate during infection

decubitus ulcer

Signs and symptoms Skin over bony areas may appear reddened, non-blanchable, bruised, and tender. Area of skin may feel cooler or warmer than surrounding skin. Common areas of for ulcers are: tailbone, along spine, shoulders, heels, backs of arms and legs.

What are the 5 layers of the Epidermis? ("Come Lets Go find Some Bars")

Stratum Corneum S. Luciderm S. Granulosom S. Spinosum S. Basale

7 characteristics of a Heart murmur

T- timing/duration R- radiation R- respiratory phase I- intensity P- pitch L- location

Describe the function of Agranulocytes- Lymphocytes T, B, NKC, Plasma cells

T-cells: -cell mediated immunity -B cella activation B-cells: -humoral immune system -pre cursors to Ab producing plasma cells NKC: - kill certains virus-infected cells -some tumor cells PC: -short lived produce Abs

o Breast biopsy o Mammography: for any palpable mass found during PE o MRI: for suspicion of metastatic lesions o US: for lesions felt only by the patient

Dx w/u of breast carcinoma?

o Tinel= + (tap) for tingling/shock pain o Phalen= + (flexion) for pain/paresthesia o Carpal compression for numbness/tingling

Dx w/u of carpal tunnel syndrome

o Plain XRs (see spinal alignment disk space narrowing, osteoarthritis ∆s_ o MRI: (morphology of herniation.)

Dx w/u of lumbar disk herniation?

o McMurray test o XR: normal o MRI: best to Dx

Dx w/u of meniscal tears

Dx: Biopsy & direct immunofluorescence Lab: autoantibodies (IgG) on IF or ELISA

Dx workup and labs for pemphigus vulgaris

often done clinically but biopsy may help to r/o psoriasis if suspected; histopathology will reveal hyperkeratosis

Dx workup for lichen simplex

often made clinically using information about patient's potential exposure and living conditions

Dx/labs for flea bite

hemi- (i.e. hemiplegia)

half (one side)

malleolus

hammerlike protuberance (either side of ankle)

Define torticollis-

aka Wry neck. Shortening or excessive contraction of the sternocleidomastoid muscle

-ectomy

excision of

cystectomy

excision of the bladder

Define effusion

excess fluid in interstitial areas and body cavities because of exudates or transudates

polyuria

excessive amount of urine

-orrhagia

excessive bleeding

Diaphragmatic excursion

expected: distance between 2 points 3-5 cm Abnormal: -smaller/limited could be result of pulmonary pathologic process abdominal issues superficialpain

antalgic:

gait that minimizes weight-bearing on a lower limb or joint and indicates a higher probability of MSK pain

cholecyst/o

gallbladder

-otripsy

crushing

Define pulsus bigeminus

group of 2 heartbeats followed by a long pause 2nd pause is weaker than first due to irregular rhythm (Hypertrophic obstructive cardiomyopathy)

Epstein-Barr virus (EBV):

mechanism: _____ infects B cells in oropharynx and epithelial cells and establishes latency in resting memory B and epithelial cells.

Pseudofolliculitis Barbae

medical term for razor bumps

Describe bronchovesicular sounds

medium pitched sound mostly over 1st and 2nd ICS anteriorly between scapulae

melanosomes..

melanin is produced by melanocytes and packaged as

temporal lobe

memory, understanding, language

When using the otoscope, what are 3 things you should see?

minimal cerumen (should be odorless) uniformly pimk color hairs in outer 3rd of canal

-ostomy

new permanent opening (ie, colostomy)

Medial epicondylitis of the elbow

o "Golfer's elbow," is seen after repetitive use of the flexor and pronator muscles of the wrist and hand (as occurs when playing golf, using a screwdriver, or hitting an overhand tennis stroke). o Pain is insidious at the medial elbow and worsens with resisted forearm pronation and wrist flexion. o Patients may complain of a weak grasp. Tenderness to palpation occurs just distal and anterior to the medial epicondyle.

Neoplasia -

o "new growth", abnormal mass of cells which grows more or less progressively at the expense of the host and is caused (at least in part) by genetic abnormalities of the involved cells

pro- (i.e. prognosis)

preceding, coming

What is the rebound tenderness (Blumberg sign)?

press firmly into abdomen + test= suggests peritoneal inflammation

lateral

side

-ectasis or ectasia

stretching (dilating)

anatomy

the study of the structure of the body

postnatal

the time and events after birth

Describe Peripheral or Secondary lymphoid organs

the tissues in which adaptive immune response are initiated and the lymphatic vessels that connect them to other tissues in the bloodstream. MALT: mucosa-associated lymphoid tissue GALT: gut BALT: bronchus Lymph nodes

Murmur- Respiratory Phase

variations associated w/ venous return INC on inspiration or DEC on expiration

hydro- (i.e. hydrate)

water

intra- (i.e. intramuscular)

within

tendon lacerations of the hand

Etiology: flexor digitorum sublimis (FDS) and flexor digitorum profundus (FDP) that are susceptible to rupture or laceration through trauma, RA, other inflammatory conditions CP: -Swelling and tenderness along palmar surface of affected finger(s) -Partial tendon tears will present with very painful active finger flexion -Loss of sensation may occur if nearby nerves are damaged

Calcaneal fracture

Etiology: high energy axial loading driving the talus downward CP: significant heel pain, swelling, deformity, and blistering of skin occur during the first 36 hours as a result of severe damage to the surrounding. Can't bear weight

Bennett metacarpal fractures

Etiology: intra-articular fracture of 1st metacarpal w/ associated subluxation or dislocation @CMC joint. The ulnar portion of the metacarpal usually remains in place ("constant fragment"). The distal portion usually subluxes radially and dorsally from the pull of the Ab.PL and the Add.Pol CP: o severe pain @ fracture site. Swelling. limited or no ability to move thumb., Misshapen or deformed look to thumb. Numbness or coldness in thumb

radial head fracture

Etiology: typical cause is a FOOSH w/ a pronated forearm or with the elbow in slight flexion. Or a direct blow to the lateral elbow CP: -elbow pain, swelling, and pain when moving forearm -tenderness over radial head, just distal to lateral epicondyle - "Fat pad" sign may be only XR evidence

Achilles tendon rupture

Etiology: MOI is usually mechanical overload from an eccentric contraction of the gastrocsoleus muscle complex. Occurs as a sudden, forceful dorsiflexion of the foot while gastroc is contracted. Tear is usually @ the site of poorest blood supply. Most common sports: basketball, racket sports, soccer.

PCL injury of the knee

Etiology: The _____ is the strongest ligament in the knee. ____ injuries represent significant trauma and are highly associated with multi-ligament injuries and knee dislocations. Common with anterior tibial trauma, such as dashboard injury during MVA

lumbar disk herniation

Etiology: Due to bending or heavy lifting while back id flexed causing herniation or extrusion of disks into spinal cord area -L5-S1 disk 90% of time. CP: Pain with back flexion or prolonged sitting. Radicular pain into the leg due to compression of neural structures. Lower extremity numbness and weakness.

Neck pain

Etiology: degenerative joint diseases -whiplash from trauma -poor posture -cervical radiculopathy -could be RA, fibromyalgia, osteomyelitis, fractures, lateral sclerosis. Presentation: pain that may be exacerbated with movements, may radiate to head, chest, arm.

Anterior posterior dislocation of the shoulder

Etiology: 95% of dislocation in the anterior direction. _______: ABDucted, externally rotated _______: ADDuction, INTernal rotation Presentation: Obvious deformity with the humeral head dislocated anteriorly. The patient holds the shoulder and arm in an abducted/externally or adducted/internally rotated position. Acute pain and deformity that are improved w/ manual relocation of the shoulder Patients with posterior dislocations complain of difficulty pushing open a door.

keratoacathoma

Etiology: Common, rapidly growing epithelial tumor and can cause tissue damage. HPV, UVR & chemical carcinogens may be causative. Affects 2:1 over females. Clinical presentation: Dome shaped nodule with central hyperkeratotic plug. Firm, but not hard. Skin-colored, slightly red, brown. Removal of keratotic plaques results in crater.

Mallet finger

Etiology: In ball sports, the ball can strike and forcefully flex an extended fingertip, causing the extensor tendon to snap or an avulsion fracture of the tendinous attachment at the distal phalangeal base

Meniscal tears

Etiology: Injury to these shock absorbers occurs acutely (young people), repeated microtrauma such as squatting or twisting (older patients). Commonly seen in arthritic knees.

Dysplastic nevi

Etiology: Most common in Caucasian patients. Family history of this or melanomas. Typically arise later in childhood and develop over many years. Clinical presentation: Larger, vary in color, asymmetric outline, irregular borders. Fried egg appearance.

Paget disease

Etiology: a manifestation of intraepidermal carcinoma or underlying GI cancer, but can occur independently as well. Usually present on the breast, axillary and anogenital areas. Signs/symptoms:resembles chronic eczema, can occur on the nipple/breast unilaterally or bilaterally, may ooze. PE: Appear red/pink in light skin persons and hyperpigmented in dark skinned persons. Scaly plaque with insidious onset, often is pruritic.

erythema multiforme

Etiology: most commonly HSV, mycobacteria (minor) or secondary to medications ("major" most often) S/s: pruritic and/or painful (particularly mouth lesions); appear over several days; prior occurrences PE: erythematous iris-shaped(target) papular and vesiculobullous lesions typically involving the extremities (especially the palms and soles) and the mucous membranes; systemic sxs with major/severe cases

Hyperuricemia / Tumor Lysis Syndrome

Eval: Characterized by electrolyte and metabolic derangements which occur after rapid breakdown of proliferating malignant cells. Electrolyte abnormalities include hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia. Clinical findings: vomiting diarrhea, cramping, lethargy, seizures, cardiac arrhythmias, and shock Ddx: sepsis

dermatofibroma

Exhibit fibroblastic differentiation, classified as "Fibrohistioctytic" Benign (non-cancerous) lesions, which tend to have hyperplastic epidermis and hyperpigmented, flattened rete described at "dirty feet." Can feel firm (like a stone under skin) can be black, red, brown or flesh colored. Exerting lateral pressure on the lesion. The skin overlying a this will frequently dimple.

cobalt blue light is for?

Fluorescein dye is injected into vein of patient, provider can observe movement of fluid within the vessels. The dye will appear yellow/green. Abnormalities will be able to been noted from observation, such as hemorrhaging, corneal ulcerations or abrasions

· miliaria crystallina (subcorneal): discrete, clear fluid-filled vesicles, see picture at left · miliaria rubra (deep epidermis): pink papules · miliaria profunda (dermis): non-follicular skin-colored papules on back after multiple bouts of miliaria rubra · miliaria pustulosa: turbid vesicopustules or pustules

Four types of miliaria, depending on depth of sweat gland obstruction:

Define nociceptive pain: types?

Free nerve endings, or nociceptors, in the PNS transmit pain impulses from the site of injury to the thalamus and cerebral cortext. There are two specialized nerve fibers: One nerve fiber transmits sharp, well-localized pain quickly the other transmits dull, burning, diffuse, and chronic pain slowly.

f/u every 3-4 months for the first 2-3 years, then 1-2s yearly after that.

Frequency and nature of follow-up differs depending on type of cancer and treatment, the patient, and potential problems. Generally:___?

Stage 4: decubitus Ulcers.

Full thickness skin loss with extensive necrosis of or damage to muscle, bone, or supporting structures stage?

Describe the parasite-Flagellate infections

GTL G- Giardia Lambia T- Trichomonas vaginalis L- Leishmania spp T- Trypanosoma brucii spp

Describe the flagellate examples

GTTL G- Giardia lamblia T- Trichomonas vaginalis T- trypanosome brucii L- Leishmania spp

Describe the auscultatory gap-simple answer

Gap of ~10-15 mm Hg where Korotkoff sounds can be heard, disappear and reappear below systolic BP reading.

HPV 6, 11, 16, 18

Gardasil (quadrivalent) protects against?

Tympany percussion sounds might be heard where?

Gastric bubble

Describe the function of granulocytes- Mast Cells

Generated from the bone marrow Secretes inflammatory mediators (histamine, chemotactic factors for eosinophils and neutrophils) play a central role in inflammation wound healing, angiogenesis, immune tolerance, defense against pathogens and BBB function

Murmur- Intensity

Grade I- Barely audible II- Quiet but audible III- Moderately loud IV- Loud with thrill V- Very Loud, thrill easily palpable VI- Very loud, thrill palpable and visible can hear w/o stethoscope

Describe a murmur

Heard because of abnormal turbulent blood flow during systole/diastole -causes disruptions in blood flow in/out -CCB: stenotic/damaged valve

Describe pathologic splitting of the S2 sound

Hearing two distinct sounds during expiration is abnormal. Types: -Fixed -Paradoxical

Get-Up and Go Test

Helpful in assessing fall risk / gait impairments --> tests a person's ability to get up from a chair, walk 3 meters, return, and sit down. Inability to complete task <15 seconds considered abnormal. Longer times associated with greater risk of functional impairments --> patient should be further evaluated.

Loop Diuretic

High Efficacy: Cause diuresis by inhibiting Na+/K+/2Cl- cotransporter in the ascending limb of the loop of Henle.

o ionized calcium o PTH, PTH related protein o 25-hydroxy vitamin D levels o ECG (shows shortened QT intervals)

Labs for Hypercalcemia

2 or more elevations above 25% from baseline of uric acid, potassium, phosphorus, and calcium 2 days before or 7 days after cytotoxic treatment indicates TLS

Labs for Hyperuricemia / Tumor Lysis Syndrome

Imaging: o CT with contrast o MRI o venography

Labs for Superior Vena Cava Syndrome

Describe helminths

Large multi-cellular -CANNOT multiple in humans -visibile to eye - types: Nematodes Platyhelminths (flat worms) -trematodes (Flukes) -Cestodes (tapeworms)

alopecia areata

Localized hair loss in round or oval areas with no apparent inflammation of the skin, with solitary or multiple areas of hair loss Nonscarring; hair follicle intact; hair can regrow

Define neuropathic pain:

Long-term pain associated with damage or dysfunction of the CNS or PNS (i.e. amputation)

Mitochondrial disorders (MMK)

M-MELAS M-MERRF K- Kearn-Sayers

· Scalp: shampoos with selenium sulfide(Selsun Blue), zinc pyrithione (Head&Shoulders), and/or tar (Neutrogena T Gel) (can rotate between all 3) · Ketoconazole shampoo can be used on scalp, face, chest · Low potency steroids · Elidel

Mgmt/complications for seborrheic dermatitis

o Most young active pts will require autograph (patellar/hamstring) o Recovery takes >6 months. o Hinged knee brace, refer to orth o DO NOT immobile knee; difficult to regain ROM o Nonoperative tx for oldies: PT/brace

Mngmt for ACL injury of the knee

o Shoulder reduction (relocation) asap (Stimson least/quite) o Sling immobilization for 2-4 weeks along w/ pendulum exercises o Recurrent dislocation should be managed with PT o Refer to surgery if @ risk for 2nd dislocation (young ppl) or if in certain jobs to avoid recurrent dislocation whilst at work (police officer)

Mngmt for Anterior/posterior dislocation of the shoulder

o Nonsurgical management is treatment of choice. o Sling, analgesics, and no overhead activity. o Indications for operative management: open fractures, fractures that compromise the airway or neurovascular structures, the presence of significant displacement and/or tenting of the skin, floating shoulder.

Mngmt for Clavicle fracture

o SL o Heal in 1-2 wks, or after accustomed to activity

Mngmt for Medial tibial stress syndrome (shin splints)?

o SL (pts usually recover in 12-18 months) o Activity modification, NSAIDs, ice. stretching program followed by strengthening exercises

Mngmt for Medial/lateral epicondylitis

PT focused on hip and quadricep strengthening.

Mngmt for Patellar tendinopathy?

o Sx relief: ice, Anti-inflammatory meds o if hypo mobility: PT o some research in exercising therapy

Mngmt for Patellofemoral pain syndrome?

o Ice, NSAIDs, stretching, and/or PT o night splints, and corticosteroid injections.

Mngmt for Plantar Fasciitis?

Partial tear: PT Full tears: surgery. o Also refer when partial tears are greater than 50% and present with significant pain.

Mngmt for Rotator Cuff Tendinopathy/Tear

o NSAIDs • Thumb spica Splint o Corticosteroid (most sx resolve after 1x)

Mngmt for for De Quervain tenosynovitis?

o Aspiration (may recur) o Surgical exploration best long term

Mngmt for ganglion cyst?

o Corticosteroid injection + percunateous aponeurotomy o Rapidly growing nodule: Intranodular triamcinolone &/or collagenase -Surgery: open fasciectomy, partial fasciectomy, or percutaneous needle aponeurotomy indicated in severe cases

Mngmt of Dupuytren contracture?

o Majority R non-surgical w/ protected weight bearing and PT. o Grade I/II: as tolerated. o Grade II: hinged knee brace 4 stability, early PT to keep ROM/MS o Grade III: require long leg brace, 6-8 wks to heal o chronic MCL tear/ or acute + other ligaments= surgery

Mngmt of MCL/LCL injuries?

o Splint in slight hyperextension for 6-8 weeks o Any flexion of the DIP joint will disrupt healing. o Per lecture: surgery if finger remains displaced.

Mngmt of Mallet finger

o Tx is by protection in a short leg cast, walking boot, or a heavy stiff-soled shoe. o Avoidance of high-impact activities, Use orthotics, RICE, start new activity slowly, may require casting or surgical intervention.

Mngmt of Stress fracture of the foot

1st line: conservative approach with o Pt education o Activity modification and o PT If no response in 3 mo. = ortho referral

Mngmt of Subacromial impingement syndrome (rotator cuff impingement)?

o Conservative: -activity mod -NSAIDS -splinting in neutral position for 3 months -methylprednisone injection o Surgery if >3 months

Mngmt of carpal tunnel syndrome

Acute: bed rest 48 hours o moderate activities, oNSAIDs, o PT w/Mckenzie method, o prednisone o Microdiskectomy Refer if: cauda equina, worsening neuro Sx, loss of motor function

Mngmt of lumbar disk herniation?

o Conservative treatment in older patients with degenerative tears (analgesics, PT.) o Acute tears are best treated with arthroscopic repair and debridement.

Mngmt of meniscal tears

o 50% resolve w/in 1 wk, 90% w/in 6 weeks Nonpharmacologic: o PT education of recovery o Activity modification Pharmacologic: o NSAIDs, muscle relaxants. Surgery if severe

Mngmt of of Low back pain?

o Partial tear: nonsurgical. Thumb should be immobilized in splint for 4 weeks. PT can help pt regain function. o Complete rupture: refer to ortho

Mngmt of of UCL injury of the thumb ("Gamekeeper's thumb)

Describe agranulocytes (mononuclear cells)

Monocytes Macrophages Lymphocytes

Normal physical findings in the examination of the ear-otoscopic findings of canals:

No lesions No discharge No foreign bodies Cerumen should have no odor

Describe lipedema

No pitting foot spread due to fatty deposition in legs NOT TRUE EDEMA

Describe Lymphedema

No pitting thick skin swollen foot due to lymphatic obstruction

Areflexia: o Hyperreflexia: oHypoflexia:

No reflexes Overactive or overresponsive reflexes to stimuli Muscles that are less responsive to stimuli

Stage 1: decubitus Ulcers.

Non-blanchable erythema of intact skin stage?

Describe hypotonic alteration Bc of? Can lead to?

Occurs when osmolality of the ECF is less than normal Because of excess H2O or hyponatremia Cellular edema With hyponatremia, plasma volume decreases (hypovolemia). With excess water, the ECF is elevated causing symptoms of hypervolemia.

Describe hypertonic alteration

Occurs when the osmolality of the ECF is HIGHER than normal Water moves out BC of water loss or hypernatremia hypernatremia: Decreased water

perioral dermatitis

Often occurs in patients with rosacea Can also occur around the eyes and nose "perioroficial" Most common in females, especially around hormonal changes Beware of steroid addition

CN: 1 2 3

Olfactory optic oculomotor

How to perform a breast exam? (6/6)

Only palpate the nipple if there's a reason/concern can have PT do it

Dull percussion sounds might be heard where?

Over liver

Describe the PCT

PRIMARY WORKHORSE -only spot where microvilli are -F to reabsorb ½-2/3 of H2O, solutes, glucose, and small proteins

Describe the parasite- Sporozoan infections

PTC P- Plasmodium spp T- Toxoplasma gondii C- Cryptosporidium spp

Define acute pain: Sustained by?

Pain of short duration that has a sudden onset in association with injury, surgery, or an acute illness episode. sustained by inflammation.

Define nociceptive pain: somatic and visceral

Pain that arises from nociceptors in the structures of the body wall (i.e. skin, muscles, tendons, joints, bones, and connective tissue) Pain that arises from nociceptors in internal organs enclosed within a cavity or the tissues supporting these organs

Signs and symptoms of breast disease: nipple discharge colors

Pale clearish white= milk Green= Infection or cyst blood = trouble (intraductal papilloma)

Bronchophony

"brachial sounds" spoken words are louder than normal on auscultation

Bacterial toxogenicity

-Endo/exotoxins see other

Describe Hypoxia and additional facts

-most common cause of cellular injury -ischemia is the most common cause

MC mortality Cancer in women

1. Lung 2. Breast 3. Colon/rectum

o Pe, Hx o XR may shout small avulsion fracture

Dx w/u of Mallet finger

o The posterior drawer test, sag sign, o XR necessary to r/o fracture but will not visualize PCL. o MRI is diagnostic.

Dx w/u of PCL injury of the knee?

PCL injury of the knee

Dx w/u: o Tibial sag + actively slide foot= what?

ECOG Grade 5:

Eastern Cooperative Oncology Group: Dead

flexor tenosynovitis (trigger finger)

Etiology: -caused by a disparity in size between the flexor tendors and the surrounding reticular pulley system (A1 over MCP joint) - Flexor tendon catches when it attempts to slide through the stenotic sheath -may be a result of repetitive use due to pulley thickening

tibial stress fracture

Etiology: Most _____ fractures in athletes are secondary to running. MCI 2 sites: 1: Between the middle & distal 1/3 of the tibia along the posteromedial border most often associated with running. 2: along the middle third of the anterior cortex most commonly associated with activities involving a great deal of jumping (eg, dancing, basketball, gymnastics).

Stress fracture of the foot

Etiology: Occur most often in the 2nd & 3rd metatarsals in the foot, which are thinner (and often longer) that the adjacent first metatarsal.

ACL injury of the knee

Etiology: ________ tears are common with sporting injuries, resulting from valgus (twisting) blows to the knee, or pivoting, jumping, deceleration or hyperextension (stop)

Plantar Fasciitis

Etiology: believed to be caused by repetitive microtrauma and biomechanical overuse.. Heel spurs, fat-pad atrophy. Overuse CP: o CC is typically sharp and stabbing heel pain that's most severe in the morning or standing after rest. Pain usually improved w/ ambulation, but may worsen after activity/end of the day. PE: localized tenderness upon palpation of the medial calcanea tubercle. Pain w/ 1st steps in arch or near heel

scaphoid fracture

Etiology: caused by FOOSH or forceful hyperextension & radial deviation of wrist CP: -swelling or paresthesias of hand, painful wrist -snuffbox tenderness -pain with radial deviation -pain with axial compression of thumb

onychocryptosis (ingrown toenail)

Etiology: causes: improper nail care, hygiene, genetic predisposition, and chronic trauma.

popliteal (Baker) cyst

Etiology: excessive joint fluid due to synovitis or trauma that can effuse posteriorly through the intra-articular space CP: posterior knee pain, intra-articular swelling of the knee, calf pain, cl

-malacia

softening

lamina

thin, flat part of vertebra

thorac/o

thorax (chest)

pharyng/o

throat

· frozen section:

tissue removed, frozen in cryostat machine, cut with a microtome & stained with various dyes · · examined under microscope · · If the tissue is determined to be cancerous, the mass can be removed right then

oscopic biopsy:

tissue samples are taken out through the endoscope

incision

to cut into

excise

to cut out

excision

to remove or take out

describe autoregulation

· ∆s in afferent arteriolar pressure and resistance happen at the same time · Renal blood flow & GFR relatively constant -WHY?: · To prevent wide fluctuations in systemic arterial pressure from being transmitted to the glomerular capillaries · May also protect against damage from hypertension -HOW? · Myogenic mechanism · Tubuloglomerular feedback · Unknown mechanism

Describe Plasma (intravascular fluid)

¼ of ECF. Typically high in: Na, Bcarbonatei, Cl, Al

self-neglect / neglect

Presentation: malnutrition, dehydration, poor hygiene, inadequate or inappropriate clothes, and/or decubitus ulcers or bedsores, look for sudden deteriorations of health or absence of needed assistive devices (e.g. hearing aids) Assessment: assess social history (e.g. support system), physical exam to look for signs

systemic isoretinoin or glucocoriticosteroids

Tx for Acne conglobata

Electrocautery or liquid nitro

Tx for Sebaceous hyperplasia

Excision

Tx for keratoacathoma

When palpating, TO DETERMINE Vibration , use what?

Ulnar surfaces of hand and fingers

Palliative Performance Scale:

Used to determine if a patient is eligible for hospice and median survival in days.

Steady state ion content?

Uses energy to maintain a constant state of ion levels (maintain homeostasis)

Hepadnaviruses

Very unusual Enveloped ds DNA viruses Hepadnaviridae family Replicate genome using RNA intermediate produced by reverse transcriptase (no animal cells produce this) Released by exocytosis Infects hepatocytes (liver cells)

How to perform a breast exam? (5/6)

W/ pt supine (hand as if "fainting"), use 3 fingers in circular motion to palpate light, medium, and deep all breast tissue

USPSTF recc. for Breast

Women aged 40-49 years old → o decision for mammography is an individual one, usually for women with a parent, sibling, or child with breast cancer *Note that this recommendation is of Grade C Women aged 50-74 years old → o mammography, w/ or w/o clinical breast examination, every 1-2 years *Note that this recommendation is of Grade B

sebaceous hyperplasia

You observe numerous skin-colored or yellowish, umbilicated (i.e. have a central dell) papules on forehead and central face. Sebaceous gland (i.e. oil gland) enlargement

What is Systolic pressure?

]maximum pressure on the artery during LV contraction

Adverse drug reactions

___ _____ ____ are the most common form of iatrogenic illness or therapy adverse reactions

Stereotactic radiosurgery:

____ _____ : Multiple radiation beams converge on target tumor, delivering high dose radiation to the tumor, but little to surrounding tissues.

Ionizing radiation

____ _____ is used to kill cells by causing DNA strands to break and cross-link.

EBV and HHV8

____ and _____ are the two herpes viruses associated with cancer, primarily in immunocompromised hosts such as HIV/AIDS and transplant recipients

Cervarix (bivalent):

____ covers HPV 16, 18

tissue tumor markers -

____: substances found in the tumor itself ‣ Ex: alpha-fetoprotein in germ cell tumors, estrogen/progesterone receptors in breast cancer, EGFR in non-small cell lung cancer

N ● NX ● N0 ● N1-N3

_____ category describes whether or not the cancer has reached nearby lymph nodes. ____: Regional lymph nodes cannot be evaluated ____: No regional lymph node involvement (no cancer found in the lymph nodes) ____: Involvement of regional lymph nodes (number and/or extent of spread)

Solid tumors cervical & testicular

_____ mostly metastasize to the lungs, liver, brain, and bones

circulating tumor markers -

_____: substances produced by both benign and malignant cells that either are present in or on tumor cells that are found in blood, spinal fluid or urine ‣ includes hormones, enzymes, genes, antigens, antibodies Ex: calcitonin for medullary thyroid cancer, CA-125 for ovarian cancer, beta-2-microglobulin for myeloma, leukemia, lymphoma

tumor suppressor genes oncogenes

______ are known as "breaks" while _____ is known as the "accelerator/gas"

Frailty

______ is defined as a geriatric syndrome characterized by weakness, weight loss and low activity. It is associated with poor health outcomes. Its foundation is borne from biologic vulnerability to stressors and decreased physiologic reserves leading to a limited capability of maintaining homeostasis.

Staging of breast carcinoma

______: the extent of cancer in the body Different modalities used for staging: surgery, PE, imaging, lab tests The American Joint Committee on Cancer and the International Union Against Cancer have a joint TNM (tumor, regional lymph nodes, distant metastases) staging system for breast cancer. Click below to see the table, it's 3 pages

Geriatrics

_______ - the branch of health care concerned with the care of the aged, including physiological, pathological, psychological, economic, and sociological problems. As life expectancy in society as a whole increases, geriatrics takes on ever greater importance in health care

Quadrivalent HPV vaccine (Gardasil)

_______ protects against genital warts caused by HPV 6, 11, 16, 18. o Recommended for females and males aged 9 to 26.

Mortality:

____________ rate is a measure of the frequency of occurrence of death in a defined population during a specified interval

19. Describe the etiology, clinical presentation, diagnostic work up, laboratory findings, patient education, management and complications of the following scaling disorders:

a. Psoriasis b.pityriasis rosea c.seborrheic dermatitis d.lichen planus

Define pathogenicty

ability of a pathogen to produce disease

Define pulsus alternans

alteration of strong and weak arterial pulse due to alternate strong and weak ventricular contraction due to LV systolic dysfunction

MoA of all corticosteroids EXCEPT triamcinolone

anti-inflammatory, antipruritic, vasoconstrictive agent Depress formation, release, and activity of endogenous chemical mediators of inflammation through the induction of phospholipase A2 inhibitory proteins (lipocortins) and sequential inhibition of the release of arachidonic acid.

-opathy

any disease of

trichopathy

any hair disease

sutures

articulations in the cranial bones; immovable joints

Describe peripheral vision/ visual fields procedure

assess by confrontation test provider and pt face eachother both cover same eyes wiggle fingers from 4 directions assess significant difference

What's iliopsoas muscle test (Psoas sign)

assessment of appendicitis + test= pt will have pain when lying supine and asked to raise their lef against provider who's pushing downward on thigh, preventing them from raising leg RLQ pain= possible peritoneal irritation of psoas muscle

oblique

at an angle

As part of the neurologic examination, Tuning forks are used in screening tests for what two things?

auditory function and vibratory sensation

ab- (ie, abnormal)

away from

aBduction aDduction

b. - lateral movement of a limb away from the median place of the body lateral movement of a limb towards the median plane of the body

bronch/o

bronchus

Describe the anatomy of the Internal eye and how many layers?

composed of three separate layers. The outer wall is composed of the sclera posteriorly and the cornea anteriorly. The middle layer (uvea) consists of the choroid posteriorly and the ciliary body and iris anteriorly. The inner layer of nerve fibers is the retina.

fascia

connective tissue sheath; covers, supports, and separates muscles; holds muscle fibers

1. Hemodialysis:

constant flow of blood alongside a semipermeable membrane w/ cleaning solution →unwanted components removed, needed components added back. Vascular access (fistula) required. Tx occurs 3x/week and each session lasts 3-5h

arterial insufficiency

deficiency or occlusion of blood flow through an artery

encephalo

entire brain

interphalangeal joints

fingers and toes

When palpating the the auricles, the consistency the should be?

firm, mobile, and without nodules. If folded forward, it should readily recoil to its usual position.

Invasive carcinoma

first step of metastatic process via BV and lymph

pod/o

foot

foramen

holes in the bone for large vessels and nerves to pass through

diaphysis:

long shaft of a bone (contains medullary cavity)

· Topical Tacrolimus or systemic cyclosporine

mgmt/complications with lichen planus

· Myopathy

o Neuromuscular disorder in which the primary sx is muscle weakness due to dysfunction of muscle fibers

· Polyneuropathy

o Neuropathy of several peripheral nerves simultaneously

Done after staging of cancer

o Once the TNM designations have been determined, an overall stage is assigned, stage I, II, III, or IV. o Clinical staging utilizes physical examination, laboratory and imaging tests as well as results from biopsies; o Pathologic staging relies on the results from surgery.

GFR

o Single best marker of kidney function

Normal physical findings in the examination of the Mouth- uvula and hard palate:

o Whitish hard palate should be dome shaped with transverse rugae o Hard palate may have bony protuberance at the midline (torus palatinus) o When patient says "ah" and tongue is depressed the soft palate should rise symmetrically with the uvula remaining in the midline

Metastatic carcinoma -

o spread to other organs/ sites

What is Conductive hearing loss

obstruction from ear wax, thickening of the tympanic membrane/chronic infections defect from sounds being conducted to cochlea

unilateral

one side

-algia or dynia

pain

dys- (i.e. dysuria)

painful or difficult

o Neuroleptics: Haloperidol o Chlorpromazine o Olanzapine

palliative management of · terminal delerium

Describe how to examine the nails-(2nd part) ("AT")

palpate nails for: Adherence to nail bed Thickness

pancreat/o

pancreas

cerebro

part of brain

-oscopy

procedure using a scope

Lateral bending → Inversion →

process of turning towards one side turning inward

Internal rotation → External rotation →

process of turning towards the center of the body process of turning away from the center of the body

Define lactation -

production of milk by the mammary glands

Define frontal bossing-

prominent forehead protrusion. Associated with prematurity, thalassemia, Pagets disease

Conversion of prothrombin to thrombin

prothrombinase complex (prothrombin and activated factors X and V) activates prothrombin into thrombin

Physical finding with arterial pulse waveform showing alternating strong and weak beats. Possible left ventricular failure.

pulsus alternans:

Define chronic pain: Sustained by?

Pain that lasts several months or longer that sometimes experiences episodic exacerbations sustained by a pathophysiologic process (i.e. joint disease, chronic inflammation, headache, or cancer)

Hemiplegia: oParaplegia:

Paralysis on one side of the body Paralysis of lower half of body

Breast cancer

Pathway: Axillary, transpectoral, internal mammary lymph Site of metastasis: Bones, lung, brain, liver

Testicular

Pathway: Lymph to periaortic --> Subclavian veins --> R ventricle Site of metastasis: Lungs, liver, brain

Colon cancer

Pathway: Mesenteric lymphatics, Portal venous system, IVC, R ventricle, Pulm artery Site of metastasis: Liver Lungs

Prostate cancer

Pathway: Regional lymph and veins --> Batson plexus of presacral veins Site of metastasis: Bones (esp lumbar spine) liver

Lung cancer

Pathway: o Left Ventricle o Pulmonary Vein Site of metastasis: Multi-organ, including brain

hidradentitis suppurativa

Patient will present as → a 27-year-old obese, African American female with tender inflammatory nodules and abscesses in her axillae and anogenital area. The lesions have waxed and waned over the past few years but have become more painful and bothersome in the past month. Some of the larger lesions are foul smelling and are draining a purulent material.

rosecea

Patient will present as → a 46-year-old white woman presents with facial flushing that she notes is worse when she has her morning coffee and when she is stressed at work. Physical examination reveals the presence of localized facial erythema, telangiectasias as well as several scattered papules and pustules on her cheeks.

Absorption

Physiologic ∆s w/ age: ______: Bioavailability of most drugs is unaltered. Because: gastric acid production is decreased, but so it GI motility. So- while our powers of digestion may wane, we have more time to do our digesting.

Metabolism

Physiologic ∆s w/ age: ______: Drugs that are greatly affected by first pass metabolism have increased bioavailability and increased half-life. Because: First pass metabolism is decreased.

Distribution

Physiologic ∆s w/ age: ______: Serum concentration of drugs that are hydrophilic or distribute to lean muscle is increased. Lipophilic drugs will be cleared from the body more slowly. Because: lean muscle, total body water, and serum albumin decrease. Body fat increases,

Protein Binding

Physiologic ∆s w/ age: _______: Drugs that bind with protein will be increased in serum because albumin levels are decreased.

Milia

Pinpoint to 2-mm papules representing benign, superficial epidermal inclusion cysts. tiny epidermoid cysts sometimes can develop within or adjacent to a suture line following cutaneous surgery. Found under the skin. Common in newborns- tiny white bumps that appear across the baby's nose, chin or cheeks. Disappear within a few weeks or months.

Describe the examination of the thyroid gland via anterior approach

Place the tips of the index and long finger on trachea above the sternal notch and just inferior to the cricoid cartilage(felt beneath the thyroid cartilage, AKA the adam's apple). Have patient swallow. Normally, the isthmus of the thyroid gland will be felt rising and falling(note any abnormalities). Then tuck the index and long finger of your right hand posteriorly to the patient's left sternocleidomastoid(SCM) muscle and push it anteriorly(relative to the patient). While holding that position, palpate in front of the SCM on the same side while the patient swallows; note any abnormalities. Repeat on the opposite side.

Describe how to perform indirect percussion

Place your nondominant hand on the surface of the body with the fingers slightly spread. Place the distal phalanx of the middle finger firmly on the body surface with the other fingers slightly elevated off the surface. Snap the wrist of your other hand downward, and with the tip of the middle finger, sharply tap the interphalangeal joint of the finger that is on the body surface You may tap just distal to the interphalangeal joint if you choose, but decide on one and be consistent because the sound varies from one to the other.

Describe serum

Plasma differs from SERUM in that SERUM is plasma that has been allowed to clot in the laboratory in order to remove fibrinogen and other clotting factors that may interfere with some diagnostic tests

Define presbyopia

"aging vision" the lens of they eye looses ability to focus associated with age and is progressive

Define autophagy

"eating one self" occurs when cells are starved/ nutrient deprived

Define the descriptor "facies" and discuss how it is used in the general assessment

"expression or appearance of the face and features of the head and neck that, when considered together is characteristics of a clinical condition or syndrome"

KUB Kidney, Ureter, Bladder X ray

"gas, mass, bones, stones" indications: o Follow visible stone disease/assessing stone burden. o Assesses stent position o Disadv: Low specificity and sensitivityElevated radiation exposure o Quantifying degree of ureteral obstruction

Oncogene -

"good" genes that influence orderly cell growth BUT too many copies or mutations make these "bad" genes o Cause cancer when ACTIVATED o Most blood cancers and soft tissue carcinomas begin with activation of this

Chiggers

"harvest mites" that usually reside on leaves or grass in humid places that pierce skin and release digestive enzymes

Define myopia

"nearsidedness" visual image is focused IN FRONT of the retina, rather than on it occurs when physical strength of the eye is greater than the optical length Can see near objects clear, but far objects blurred

port wine stain-

"nevus flammeus"- reddish-purple nevus of the face or neck, usually not elevated. Caused by abnormal function of tiny blood vessels, may deepen with age.

Auspitz sign

"positive" sign when scratching/curette-ing of a scaly lesion reveals punctate bleeding points within the lesion. (Pinpoint bleeding with removal of plaque) Suggests psoriasis (non-specific sign) (vs. wart for ex.)

Define autophagy

"self-eating" it's an intracellular degradation system that basically recycles substances and releases them into the cytosol

caudal

"tail" or base of spine (similar to inferior)

Whispered pectoriloquy?

"voice of the chest" whispered words have an increased intensity and pitch

Egophony is?

"voice of the goat" if present, may be a condtion that consolidates lung tissues/fibrosis

anemia

"without blood" - Low Red Blood Count

Para

# of pregancies reaching viable gestational age

What are 4 characteristics of the pulse?

("ARRR") Amplitude Rate Rhythm Regularity

Identify the 4 major pathways by which malignant neoplasms spread throughout the body

("BALL") B- Blood-borne Transport A- Angiogenesis L- Lymphatic Invasion L- Lymphagiogensis

What are the 3 vascular flow changes that occur in acute inflammation?

("ChIC") Ch- ∆s in vascular flow and caliber that lead to an increase in blood flow I- Increased vascular permeability (vascular leakage) C- Cellular events that lead to the EMIGRATION of leukocytes to the site of injury

What are the 4 causes of edema?

("DiiL") D- decreased cap/plasma oncotic pressure I- increased capillary hydrostatic pressure I- increased capillary permeability L- lymphatic obstruction

3 factors affecting RR?

("EAE") Emotions Activity Exercise

Describe the systemic manifestations that indicate the presence of acute inflammation

("FCC") F- fever over >100.4 Acute onset and rapidly rising C- ∆s in WBC count -Neutrophil leukocytosis with a left shit C-∆s in plasma protein levels and other "acute-phase" reactions -Alpha1 antitrypsin, C-reactive protein

Clinical Signs and symptoms of acute inflammation

("FRT CD") F- fuctio Laesa: loss of function R- Rubor: redness T- Tumor: swelling (not necessarily a mass tho) C-Calor: heat D- Dolor: pain

Describe malignant neoplasm

("FUC U MAN") F- failed apoptosis U- unencapsulated C- cells look different (decreased differentiation) U- unrestrained growth w/ invasion of adjacent tissues M- metastases A- anaplasia present N- nomen: ends in "carcinoma" or "sarcoma"

What are 3 general mechanisms of cellular injury?

("HRC") H-hypoxia R- Reactive O2 Species/ free rad C- chemical injury

Reversible vs Irreversible cell injury

("LADS, CSM") Reversible: L- Loss of ATP A- Autophagy of lysosomes D- Detachment of ribosomes S- Swelling Irreversible: C- Ca2+ moves into cell S- Severe vacuolization of mitochondria M-Mitochondrial membrane damage

Characteristics of a benign neoplasm?

("MR CONNS") M- May be encapsulated R- Remain local C- Cells look normal (highly differentiated) O- "-oma" N- No anaplasia N- Not capable of causing death S- Slow growth

5 Factors affecting pulse?

("PHADE") Pain Heart health Activity level Drugs Emotions

Chronic inflammation may occur after AI or may begin insidiously during AI under what 3 conditions?

("PIP") P-Persistent infections I- Immune reactions (autoimmune conditions) P- Prolonged exposure to toxic agents

BP is dependent on what 3 factors?

("PSH") peripheral vascular resistance Heart rate stroke vol

3 key features of chronic inflammation?

("TIA") Key features are histologically different from acute inflammation Tissue destruction largely induced by the inflammatory cells Infiltration with mononuclear cells which include macrophages, lymphocytes, and plasma cells Attempts at healing by connective tissue replacement of damaged tissue via angiogenesis and fibrosis

Autoeczematization

(AKA "Id response," "autosensitization dermatitis") -- acute, generalized skin reaction to a variety of stimuli (pre-existing/ new dermatitis, skin infection, etc.). Often presents with erythematous/papular pruritic rash, Reaction patterns ranging from generalized, erythematous, morbilliform, and urticarial eruption (after blunt trauma) to a generalized, petechial, papulovesicular dermatitis (after the acute irritation of chronic stasis dermatitis). May indicate infection with fungi, bacteria, viruses, or parasites. Classic presentation commonly seen in patients with venous-stasis disease

What cells are involved during chronic inflammation?

(ELMM) Eosinophils Lymphocytes Macrophages Mast cells

Leukotrienes vs. prostaglandins

(Lipooxygenases) potent chemotactic agent involved in intense vasoconstriction, bronchospasm, and vascular permeability (Cyclooxygenases) involved in pathogenesis of pain and fever

Explain the roles sodium play in fluid balance within the body

(MR PANC) M- membran transport R-regulates osmotic forces P-Primary ECF Cation A- acid-base balance N- neuromuscular irritability C-cellular chemical reactions

Erythropoiesis process quick

(PB PORE) Pro Baseo Poly Ortho Retic Erythrocyte

What organs are present in LUQ?

(PB SSS LLL) P- part of D/T colon B- Body of pancreas S- Stomach S- Spleen S- Splenetic flexure of colon L- Left kidney upper pole L- Left adrenal gland L- Left lobe liver

What organs are present in RUQ?

(PHS GRR HD) P- Part of A/ D colon H- Head of pancreas S- stomach pylorus G- Gallbladder R- R liver R-R kidney upper pole R- R Adrenal gland H- Heaptic flexure of colon D- Duodenum

Explain the roles Cl- play in fluid balance within the body

(PPL) P- Primary ANION in ECF P- provides electroneutrality L- levels vary inversely w/ HCO3

What organs are in the LLQ?

(PULLLLS) P- Part of descending colon U- uterus (if enlarged otherwise its midline) L- L ovary/ FT L- L spermaticord L- L ureter L- L kidney (lower pole) S- sigmoid colon

What organs are in the RLQ?

(RAPRRR) R- Right kidney (lower pole) A- appendix/ cecum P- part of ascending colon R- R ovary/ FT R- R spermatic cord R- R ureter

Describe the PMI?

Point of Maximal Impullse -usually generated by the apex may be produced by: -enlarged RV -dilated aorta -pul Ar or LV wall motion abnormality

USPSTF recc. for Lung

- Adults aged 55-80 years old who have: o a 30 pack-year smoking history and currently smoke OR o quit within the past 15 years → annual screening for ____ cancer with low-dose CT - Screening should be discontinued once a person has: o not smoked for 15 years OR o develops a health problem that substantially limits life expectancy OR o the ability or willingness to have curative lung surgery *Note that these recommendations are of Grade B

shave biopsy

- Indications → superficial benign and malignant tumors e.g. seborrheic keratoses, warts, dome-shaped nevi, and nonmelanoma malignancies - Procedures → lesion is elevated and infiltrated with lidocaine, then a blade is smoothly drawn through the base of the lesion for detachment - Patient Education → not useful for most inflammatory skin diseases, produces excellent cosmetic results

USPSTF recc. for Cervical cancer

- Women aged 21-29 years old screening for ______ cancer every 3 years with cervical cytology alone - Women aged 30-65 years old o screening every 3 years w/ cervical cytology alone AND o every 5 years with high-risk human papillomavirus (hrHPV) testing alone, OR o every 5 years with hrHPV in combination with cervical cytology (co-testing) *Note that these recommendations are of Grade A

Ascending- Dorsal column

- brings information in from the periphery, vibration, fine touch, conscious proprioception; we are testing the dorsal column when we perform neuro tests in the office; enters dorsal spinal cord and travels up spinal column ipsilaterally (on the same side as sensation) until it travels up to the medulla and then crosses over

MOI: chemical/toxic injuries

- cell membrane is usually damaged by interaction, highly variable intracellular process depending on chemical/toxin. Ex/s Rx/street drugs, CO, lead, mercury, CCl4 from dry cleaning.

Define edema/dependent edema Collects where for ambulatory? Non-ambulatory?

- diffuse swelling from increased intracellular fluid. Often collects in lower (dependent) areas legs in ambulatory pts, sacrum in nonambulatory

Lotions

- easier to apply and allow for uniform coating of the affected area, and are often the favorite preparation in treating children. - they are more drying than ointments, and preparations with alcohol tend to sting eczematized or abraded skin. - they are suitable for application to large surface areas due to their ability to spread easily.

Hyperuricemia

- high uric acid concentration in the blood (Men >6 mg/dl, women > 7mg/dl)

Define spoon nails

- nails lose concavity, in extreme central part of the nail is depressed, lateral is elevated (spoon shape is transverse)

MOI: reactive oxygen species

- normal product of oxygen metabolism that can increase and overwhelm antioxidant systems, causing cell damage

sebaceous gland

- secrete sebum, which is a lipid-rich substance that acts as a lubricant and moisturizer for skin and hair.

ointments

- semisolid preparations that spread easily. They are petrolatum-based vehicles, capable of providing occlusion, hydration, and lubrication. Drug potency often is increased by an ointment vehicle due to its ability to enhance permeability.

Multi-infarct Dementia (VaD)

-After stroke/ vascular Dz -Sudden onset after stroke/ stepwise fashion - memory impairments less severe <AD -Depression may be more sever >AD Behavioral/ psych ∆s o Impaired recall, but better recognition

Describe: Capillary Hydrostatic Pressure (AKA Blood pressure) Interstitial Oncotic Pressure

-CHP: outward movement of H2O from Cap to IS IOP: osmotically attracts H2O from CAP to IS

decubitis ulcers

-Caused by pressure, shearing forces, friction, and moisture, these are commonly seen in patients who are bed bound or immobile. -Decrease in capillary flow → to ischemia, capillary thrombosis and occlusion of lymphatic vessels → edema and eventually cell death

Describe Autocrine signaling

-Cell secretes a hormone or chemical messenger that binds to its own receptors X: immune response, cancer cell

SOFT TISSUE-Neck-artery/vein

-Common carotid artery and internal jugular vein are deep and run parallel to the sternocleidomastoid -External jugular vein crosses the surface of the sternocleidomastoid diagonally

Pick's Disease (FTD)

-Early neurodegenerative Dz affecting young adults w/ mean age of 50 -Gradual onset -Early ∆s in PBS (personality, behavioral, social) -NO MEMORY OR VISUOSPATIAL IMPAIRMENTS -Excessive eating, OCD, new talents, AGGRESSIVE -Speech impairments oNormal MMSE early on oFrontal system affected 1st (verbal fluency, abstraction, executive F)

SOFT TISSUE-Head

-Facial landmarks include: Palpebral Fissures - the area between the open eyelids Nasolabial folds - the lines on either sides of the mouth that extend from the edge of the nose to the outer corners of the mouth -Facial muscles are innervated by cranial nerve V and VII -Temporal artery is the major artery of the face Passes anterior to ear, over temporal muscle, and onto forehead

AD

-Genetics, but unknown cause -Slow onset - ∆s in visuospatial, language, and learning/recalling - little/no insight into deficits -irritable/behavioral ∆s

Adnexal structures of the skin

-Hairs (for sensation, heat loss prevention, and protection) -Arrector pili (smooth muscle that pulls hairs straight) -Nails (protection) -Sebaceous glands (secrete sebum oil) -Sweat glands (apocrine or eccrine)

Topical phototoxic dermatitis

-Inadvertent contact with or therapeutic application of a photosensitizer, followed by UVA irradiation. -Most common topical photoxic agents are Rose Bengal used for ophthalmologic examination. -Others include lime, lemon celery, or parsley; perfumes and cosmetics (oil of bergamot) -Most common route of contact is either therapeutic or occupational exposure. -Clinical presentation is like acute irritant contact dermatitis

Describe bacteria w/o cell wall

-Instead of rigid cell wall, they have a trilaminar unit membrane, a simple cell membrane - NO peptidoglycan layer - They don't stain with gram stain. X: Mycoplasma genitalium, Mycoplasma pneumoniae

Describe Hormonal signaling

-Involved specialized endocrine cells that secrete hormones - Then uses bloodstream to send signals far away to other cells X: TSH

Describe granulomatous inflammation and when do they occur?

-Is a specific type of chronic inflammation and is associated with TB, syphilis and sarcoidosis. -If macrophages are unable to control the tissue damage/infection, the body attempts to wall off the infected area creating a granuloma.

Describe Jugular Venous Distention

-Is observed seated -Blood flow from the head to the heart is measured by central venous pressure - It reflects the activity of the R side of the heart -JVD occurs when there's an INC CVP - The level you see the pulse bulge gives an indication of RA pressure

How do you measure JVP?

-Lay at 30-45* -observe JV pulsations -measure from sternal angle to the top of the visible oscillations over internal jugular vein a JVP of >3-4 cm indicative of INC CVP -Document by # of CMs above sternal angle OR "CVP by JVP= X"

Describe Paracrine signaling

-Local action to influence nearby cells -quickly absorbed, destroyed, or immobilized X: livercell

What are common causes of granuloma formation?

-May form if neutrophils and macrophages are unable to destroy a microorganism's during AI response -X: TB, syphilis and sarcoidosis, infections by bacteria, fungi, and parasites

What is the: -Anterior triangle -Posterior triangle

-Medial border of sternocleidomastoid, mandible, and the midline -Trapezius, sternocleidomastoid, and the clavicle

SOFT TISSUE-Head-Salivary glands:

-Parotid glands: located anterior to the ear and above the mandible -Submandibular glands: located medial to the mandible at the angle of the jaw -Sublingual glands: located anteriorly in the floor of the mouth

Describe arachidonic acid metabolites

-Powerful mediators of endothelial injury and tissue damage -from 2 major classes of enzymes: 1: Cyclooxygenases (PROSTAGLANDINS and thromboxjnes) 2: Lipooxygenases (LEUKOTRIENES and lipoxins)

Describe Huntington disease

-Result of trinucleotide repeat -AD disorder ->40 repeats in CAG -Sx: progressive dementia and increasingly uncontrollable limb movement. Not usually seen until 40

What gets through?

-Small things · Water, ions (na, K, Cl, Mg, Ca, PO4...) · Small solutes (Glucose, AAs, creatinine, urea -Bigger) · Small proteins · Large proteins: No · Cells: no

SOFT TISSUE-Neck-2 muslces

-Sternocleidomastoid extends from the sternum and medial third of the clavicle to the mastoid process -Trapezius extends from the scapula, lateral third of the clavicle, to the vertebrae to the occipital prominence

Describe what IL-1 and TNF are both involved in

-Systemic acute phase reactions

Describe the medulla

-T cells -Epithelial reticular cell stroma -Hassall's corpuscles Concentric, flattened epithelial reticular cells May calcifyFunction - uncertain but may secrete factors (interleukins 4 and 7) needed for thymic function

What organs/systems are usually affected by mitochondrial disorders?

-Tend to be multi-system disorders Body systems with high E demand: -Brain, eye, heart, muscle Eye ex: Kearn-sayers Muslce/nervous: MERRF, MELAS

viral culture

-Viruses are inoculated onto a this culture with growing cells. They will not grow on nonliving media.

Bacteria ability to evade the host immune system (antigenic switching)

-bacteria can change their surface Ags to go undetected by host immune system phase variation: genetically reversible ability to turn off and turn on the expression of genes for coding for surface Ags Antigenic variation -modification of the gene for an expressed surface Ag by genetic recombination w/ one of many variable unexpressed DNA sequences

Endocytosis Functions

-cellular uptake of nutrients -regulates quantities of proteins in PM - controls signaling output of receptors -Used by pathogens to sneak in

Describe osmolarity

-concentration of solute molecules per volume of solution (aka total concentration of all solutes) Low osmolarity: soln w/ fewer solutes/ L High Os: soln w/ more solutes/L Tonicity: used to compare osmolarity of a cell to osmolarity of the ECF around cell

CJD

-d/t prions - Rapid progressive dementia - Myoclonus -Muscular coordination problems - Personality ∆s -Impaired vision -exaggerated startle response -Seizures/coma

What is Sensorineural hearing loss?

-due to damage/disease of the 8th cranial nerve i.e rock concert, loud noises as well as aging.

Describe bacteria transmissibility

-enter into the human host via respirator, Gi, urogenital tract, or skin injury -bacteria must then overcome host immune defense like phagocytosis, acidity o stomach and urogenital tract, lytic enzymes in saliva, stomach

Kidney anatomy: medulla

-forms the inner part -has regions called pyramids -lobe is the structural unit of the kidney and each is composed of pyramids

Describe vascular constriction in homeostasis

-induced by thromboxane A2 (released from activated platelets) - it's a brief and intense contraction of BLS to reduce blood loss during injury

Describe the buffering system

-it's a solution that can minimize ∆s to pH -it's immediate and different than compensation -can absorb excess H+ or OH- to minimize ∆s -only NON-VOLATILE acids most important: -bicarbonate- carbonic -hemoglobin

gels

-made from water-soluble bases - After applying, the alcohol evaporates leaving a concentrated dose behind - Popular due to clarity of use and ease of application and removal. - Suitable for facial or hairy areas. - Lack protective or emollient properties. - Tend to be drying or cause stinging.

Describe Neurotransmitter signaling

-released by neurons to communicate with the cells they innervate - released at junctions called chemical synapses - NTs diffuse across synaptic cleft

Describe discontinuous sound- fine crackles

-soft high pitched and very brief -x: roll a strand of hair berween fingers near ear, or rub thumb/index

Describe the importance of hydrogen ion and pH

-the higher the H+--more acidic--lower pH -the lower the H+--more basic--higher pH Normal: 7.35-7.45

Describe pulse amplitude

0 (absent) through 4+ (strongest), where 2+ is normal

What are the 6 phases of the cardiac cycle?

1. Atrial systole (aka diastole) 2. AS ends AD begins 3. Ventricular systole 1st 4. VS 2nd 5 V diastole early 6. VD late

Describe the electrical conduction of the pericardium

1. Begins @ the SA nose (loc on RA) 2. Atria contract 3. signal travels to & is delayed at the AV node (loc on atrial septum) 4. passes through Bundle of His 5. R and L Bundle Branches 6. through Puerkinje fibers (loc in ventricular myocardium) 7. ventricular contraction begins @ the apex and goes toward base of the heart

2 characteristics of viruses

1. genome consisting of RNA or DNA NOT BOTH 2. protein-containing structure (capsid) designed to protect gnome

MC mortality cancer in men

1. lung 2. prostate 3. Colon/rectum

2 gen functions of lymphoid system

1. neutralize or inactivates foreign molecules 2. destroys microorganisms, infected cells, cells of transplanted organs or cancer cells

I- Inducing angiogenesis E- evading growth suppressors A- Avoiding immune destruction T- Tumor promoting inflammation G- Genomic instability R- Resisting cell death I- Invasion & metastasis I- immortality D- Deregulating cellular energies S- Sustaining proliferative signaling

10 biologic features of neoplastic cells?

For vibratory sensation, the greatest sensitivity to vibration occurs when the fork is vibrating between ___ and ____

100 and 400 Hz.

Review after

14. Describe the appropriate history and physical examination for the patient with orthopedic trauma.

Tanner's stage 1

1: Infantile/prepube -areola not pigmented -only papilla elevated

What are the 2 ways pyrogens are released in the body?

1: an exogenous pyrogen from a pathogen 2: an endogenous pyrogen released when a phagocyte destroys an invader

W- wear and tear/ rate of living I- immunologic

2 systematic theories on aging?

circulating tumor markers and tissue tumor markers

2 types of tumor markers?

D- Dyplastic Nevi A-Actinic Keratosis K- Keratoacanthoma

3 Pre-malignant lesions

Estrogen receptor Progesterone receptor EGFR gene mutation

3 Tissue receptor tumor markers

F- Free radical R- Replicative & telomere senescence M- Mitochondrial damage

3 cellular theories on aging?

E- Epigenetics and genetic control S- Somatic mutation E- Error catastrophe

3 molecular theories of aging?

BRCA 1 and 2 Philadelphia chromosome

3 onco gene tumor markers

Slit / streak is for?

3-D view of the eye. Side view of cornea and lays inward from that. (i.e pt had something flew into their eye- acute visit) Examination of the anterior eye and determination of the elevation of lesions on the retina

Mini-mental State Examination

30-point tool to test orientation, immediate recall, delayed recall, concentration/calculation, language, visuospatial domains--> test for dementia. Most widely-used screening test of cognition. Useful if to detect cognitive decline if repeated every 6-12 months *Note: MMSE is copyrighted. Forms must be purchased **Also note: test is culturally and language-biased.Scores should be adjusted for age/ education ***And this: administered verbally, patients are asked to write and draw --> hearing, visual, or other physical impairments may make the scoring less valid

spinal nerves -

31 pairs that innervate specific areas, with some overlap, divided into dermatomes

A fingertip unit is the amount that can be squeezed from the fingertip to the first crease of the finger. One fingertip unit is = to approximately 0.5 g. For example, one hand-size area of skin requires 0.5 fingertip units or .25 g of steroid cream. The amount dispensed and applied needs to be considered closely since too little steroid can lead to a poor response and too much can lead to unwanted side effects.

32.Explain the concept of the fingertip unit method for calculating the quantity of a topical preparation needed to treat a particular body part. Note: you do not need to memorize the number of fingertip units for each body part nor the corresponding weight of ointment required for application

-Occlusion increases hydration and the absorption of topical steroids -Use saran wrap to hold perspiration against skin hydrating the stratum corneum, increasing topical medication penetration 10-100X -Only leave in place for 2 hours (longer would increase the potential of infection and side effects) -Do not use in intertriginous areas because they act as occlusive dressings themselves.

34. Discuss the procedures and clinical usefulness of steroid potentiation by occlusion

Adverse Effects: "Skin atrophy, telangiectasia, hypertrichosis, acneiform eruptions, and striae, as well as increased intraocular pressure (exacerbation of glaucoma) when used around the eyes." Steroids are often used in patterns called "cycling." This involves taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again. ... At the beginning of a cycle, the person starts with low doses of the drugs being stacked and then slowly increases the doses

35. Discuss adverse effects associated with the use of topical steroids as well as the concept of steroid treatment cycling.

i.benzoyl peroxide (Benzac AC) iii.topical antibiotics - clindamycin (Cleocin T), erythromycin, metronidazole (Metrogel) ii.retinioids - tretinoin (Retin-A), adapalene (Differin) iv.keratolytics - salicylic acid

4 acne topical therapies

H- hormones O- Oncogenes A- Antigens T- Tumor tissue markers

4 categories of tumor markers?

o Drug-drug interactions o OTC drugs o Polypharmacy o Elder-inappropriate medications

4 causes of iatrogenic events in the geriatric pt?

Concentration of Leukocytes

5-10k mm^3 <1% of buffy coat

S- Slower inductive reasoning/ problem solving D- Diminished sptial orientation D- Decline in perceptual speed D- Decreaed numerical ability L- Losses in verbal memory F- FEW ∆s in verbal ability

6 cognitive ∆s associated w/ aging?

PE/DVT Spinal cord compression SVC syndrome Hypercalcemia Hyperuricemia/ tumor lysis syndrome Febrile neutropenia

6 oncologic emergencies?

C- Cheyene-Stokes breathing R- Respiration w/ mandibular movement A- Apnea period P- Pulselessness on radial artery D- Dec. urine output P- Peripheral cyanosis D- Death rattle

7 signs a person is within days or hours of dying

Normal physical findings in the examination of the Nose-sinuses

: o Expect no tenderness upon palpation of the frontal and maxillary sinus areas

Describe the nail plate

: aka finger nail- composed of keratinized epithelial cells, sits on the highly vascular nail bed which lies on periosteum

3. Renal transplantation

: pts w/ ESRD that are otherwise healthy enough are suitable, however average wait is 2-6 yrs. 2/3 allografts are from deceased donors, and survival rates are slightly lower (1 yr 89% and 5 yr 66%). Factors that determine survival include ABO and HLA typing, immunologic response of host, immunosuppressive regimen used, age and race, length of time on dialysis, comorbidities.

Describe the epidermis

:the outermost portion of the skin. Top layer is the stratum corneum, which is the chief mechanical barrier protecting the body against environmental exposures

Describe BMI for: Under nutrition Appropriate weight for height Overweight Obesity

<18.5 18.5 - 24.9 25-29.9 30 or greater

Describe macrocyte

>9 microns Due to low folic/B-12

deep vein thrombosis

A blood clot in a deep vein, most often an extremity check for Homan's sign (pain on dorsiflexion= +test) Findings: o EMERGENCY o Pain and swelling in ankle, calf or thigh, o Associated w/ immobilization, bedrest o May progress to PE

Describe Plaques? size? Examples?

A circumsized, elevated, superficial, solid lesion >.5 cm eczema, lichen planus, psoriasis, tinea

Describe macules. size? Larger? Examples?

A circumsized, flat, discoloration that may be brown, blue, red, or hypopigmented Up to .5 cm >.5= Patch moles, freckles, tattoos

Describe Cheyenne-Stokes respirations Associated with?

A cylce of Increased then decreased respirations, then periods of apnea, then repeats Brain damage, drug induced resp compromise

Superior Vena Cava Syndrome

A group of signs and symptoms that occur when there is an obstruction of this major vessel. Evaluation facial plethora (red face), venous distention - neck/superficial chest vein distention, upper extremity edema, dyspnea, orthopnea, and presyncope. Ddx - UE DVT, lymph obstruction, Eosinophilic fasciitis

Solar lentigo (lentigines)

A localized proliferation of melanocytes due to chronic exposure to sunlight, usually presents after 40 y/o (or in children with xeroderma pigmentosum), most commonly in Caucasians; correlated with skin phototypes I-III and duration and intensity of solar exposure; "sun spots, liver spots, age spots, wisdom spots" freckles

Describe Jugular Venous Pressure

A means of estimating RA pressure (via internal JV) -Venous pressure will rise during right hearted failure and is unable to successfully empty -Is measured -semi recumbent position

Describe a Bruit

A murmur outside of the heart If present, it can be felt as a Thrill CCB: vascular disease

Polymorphous Light Eruption most common photodermatosis

A pruritic, erythematous, symmetrically distributed, eruption of variable interindividual morphology (in most cases papular) on sun-exposed skin areas, within hours to days of exposure, with full resolution in several days.

Define fluid balance

A steady state process in the body regulated by the osmotic equilibrium between the extracellular fluid and the intracellular fluid.

Describe the physiological splitting of S2 during inspiration

A2 and P2 are separated by <30 ms and are thus are heard as a single heart sound (S2)

Afferent v Efferent

A= brings blood in E= blood out (normally smaller)

Major phases in viral growth

AP USM A-attachement: to target P- penetration: virus enters (endocytosis, direct fusion) U- uncoating: virion disassembly, expression replication S- synthetic period: RNA/DNA genome replication M- maturation/ release RNA: in cytoplsm DNA: nucleus -naked: complete -enveloped: must budd

acne vulgaris

Abnormal keratinization of pore, androgen sensitivity Starts as microcomedones Comedones (open and closed) Superficial inflammatory lesions (erythematous papules and pustules) Deep inflammatory lesions (cysts/nodules)

What is hypopnea?

Abnormal, shallow respiration's

Dec gastric acidity/motility o NE: bioavailability of most drugs unaltered

Absorption changes?

Describe plasma protein composition

Albumins= 57% Globulins= 38% Fibrinogen= 4% Prothrombin= 1%

What is stroke volume

Amount of blood pumped through LV in one pump

4. VS 2nd

As ventricular pressure rises and exceeds pressure in the arteries (pulmonic/aorta) semilunar valves (Pul Ar) open and blood is ejected

What's the appropriate exam technique to examine external ear? (1st part) ("AIP")

Ask about the use of hearing assistance devices Inspect auricle and mastoid area Palpate auricle: -tragus -helix -lobule

Tinetti Balance and Gait Assessment

Assess a patient's fall risk. Observe as patient rises from chair (without using arms), walks 10 feet, turns around, walks back, returns to seated position. Should take <16 seconds. Difficulty with task indicates increased fall risk / need for further workup.

BUN

Assess kidney and liver function. An increase in ___ indicates decrease in GFR. Can assess for AKI, CKD, dehydration/fluid overload.

K

Assess kidney function, drug side effects, dietary intake. Can indicate AKI, CKD, hyperaldosteronism, hypomagnesemia, Cushing's

Glucose

Assess pancreas and insulin production. Helpful in diagnosing DM, Cushing's

What is diastole

Atrial contraction AV valves open (Tri Mi) ventricular filling Semilunar valves closed (Pul Aor)

What is systole?

Atrial filling/ relaxing AV valves closed ventricular contraction Semilunar valves open

SPT VI Black

Based on Fitzpatrick Skin classification, what is the classification of a skin do not burn, become darker

SPT I Pale white

Based on Fitzpatrick Skin classification, what is the classification of a skin that burns easily, do not tan?

SPT II White

Based on Fitzpatrick Skin classification, what is the classification of a skin that burns easily, tan with difficulty?

SPT V brown

Based on Fitzpatrick Skin classification, what is the classification of a skin usually do not burn, tan easily

How are viruses classified?

C NES C-capsid (icosahedral, helical, complex) N- nucleus acid (DNA v RNA) E- envelope (naked vs enveloped) S- size (diameter of helical capsid viruses, # of capsomeres)

Describe AI outcome: complete resolution (CDR NR)

C- cessation of leukocyte infiltration D- death by apoptosis of neutrophils R- return of normal vascular permeability N- Neutralization and/or spontaneous decay of chemical mediators R- removal of edema/necrotic debris

Describe the S2 sound

C- closure of the Semilunar (Pul Ar) L- Loudest @ R and L 2nd ICS S- Should not hear when feeling pulse E- end of systole H- Has 2 sounds: -A2: aortic valve closure -P2: pulmonic valve closure

X-linked disorders (CHOD)

C- colorblindness H- Hemophilia (A&B) O- ocular albinism D- Duchenne muscular dystrophy

What are possible outcomes of Acute inflammation? ("CPRs")

C- complete resolution P- Progression to chronic inflammation R- Repair S- supparation/Abscess formation

What are the 4 forces that determine if fluid moves out of the capillaries into insterstial space?

C-Capillary Hydrostatic Pressure (AKA Blood pressure) I- Interstitial Oncotic Pressure C- Capillary (plasma) Oncotic Pressure I- Interstitial hydrostatic pressure

overflow incontinence

CB: Anatomic obstruction by prostate, stricture, cystocele A contractile bladder associated with diabetes mellitus or spinal cord injury Neurogenic (detrusor-sphincter dyssynergy), associated with multiple sclerosis and other suprasacral spinal cord lesions

Urge

CB: Detrusor overactivity, isolated or associated with one or more of the following: Local genitourinary condition such as tumors, stones, diverticula, or outflow obstruction Central nervous system disorders such as stroke, dementia, parkinsonism, spinal cord injury

Stress

CB: Weakness of pelvic floor musculature and urethral hypermobility Bladder outlet or urethral sphincter weakness

5. Dietary management:

CKD pts should be evaluated by renal nutritionist; pt specific recommendations concerning protein (0.6-0.8 g/kg/day), salt (<2g/day), water (<2L/day), potassium (<50-60 mEq/day = 2g/day) and phosphorus (800-1000 mg/day) restriction

Describe the S1 sound

CLBC Caused by closure of the AV valves (Tri Mi) Loudest @ the apex beginning of systole Corresponds w/ pulse

Describe: Capillary Oncotic P Interstitial Hydrostatic P

COP: Osmotically attracts H2O from the interstitial to capillary IHP: Inward movement of H2o from interstitial to capillary

tibial stress fracture

CP: Pt commonly describes pain occurring in the region of the fracture with activity (eg, running or jumping) and resolving with rest. The pain eventually progresses and lasts longer after the activity until the patient is symptomatic at rest. Physical examination often reveals localized pain to palpation. Sometimes persistent thickening, secondary to periosteal reaction, can be appreciated by palpation along the tibia.

PCL injury of the knee

CP: + "sag" sign posteriorly. Difficulty with ambulation, although chronic ____ injuries can ambulate without gross instability. Knee may freely dislocate.

Morton neuroma

CP: -Affects 3rd interspace but can be in other interspaces. -Enlargement of the 3rd common digital branch of the medial plantar nerve (lateral plantar nerve → deep transverse metatarsal ligament in 3rd interspace.) -Benign growth from the fibrous coverings of the medial plantar nerve. -Many etiologies have been proposed (trauma, ischemia, overpronation,etc)

Low back pain

CP: -nerve impingement when pain is "leg dominant" -decreased ROM, asymmetries, weakness, sensation -tenderness

carpal tunnel syndrome

CP: -pain, burning, numbness tingling on palmar surfaces of thumb, index, long fingers, radial half of the ring finger (median nerve distribution)-aching radiates proximally -exacerbated by activity, initially worse at night -late weakness/atrophy of thenar eminence

MCL/LCL injuries of the knee

CP: Because these ligaments are extra-articular, the patient may not have an effusion. Main finding is pain along the course of the ligament. They may have limited ROM due to pain, especially in first two weeks post injury.

flexor tenosynovitis (trigger finger)

CP: characterized by local tenderness over the proximal tendon pulley at the MCP joint, with pain referred to the PIP joint and a snapping when the finger/thumb goes through an active range of motion. Usually a history of repetitive strain is involved

Subacromial impingement syndrome

CP: classically presents with one or more of the following: o pain with overhead activities o nocturnal pain with sleeping on the shoulder o or pain on internal rotation (eg, putting on a jacket or bra). -Can have scapular winging

ganglion cyst

CP: o Dorsal wrist: small cysts barely palpable but very painful; large cysts are soft and mildly symptomatic o Palmar wrist: swelling adjacent to radial artery o Flexor sheath: firm pea-like lesion on palmar flexor sheath, may be mistaken for bone spur

Describe phagocytosis and the steps ( OEF D)

Cell eating • Steps o Opsonisation (target recog and adherence) o Engulfment and formation of phagosomes o Fusions with lysosomal granules w/in phagocyte o Destruction of trarget

HPV 16/18

Cervarix (bivalent) protects against?

EGFR Gene Mutation Epidermal Growth Factor Receptor

Clin. Utility: -Aid in determining tx and prognosis Asso. cancer: -Non-small cell lung

AFP Alpha fetoprotein

Clin. Utility: -Aid in dx liver cancer and monitor response to tx -Assess stage, prognosis & response to germ cell tumor tx Asso. cancer: - Liver -Germ cell tumors

Human Calcitonin

Clin. Utility: -Aid in dx, monitor response to tx and identify recurrence Asso. cancer: -Medullary thyroid

Bence Jones Proteins

Clin. Utility: -Aid in dx, monitor response to tx and identify recurrence Asso. cancer: -Multiple myeloma -Waldenström macroglobulinemia

CA-125

Clin. Utility: -Aid in dx, monitor response to tx and identify recurrence Asso. cancer: -Ovarian

PSA Prostate-specific antigen

Clin. Utility: -Aid in dx, monitor response to tx and identify recurrence Asso. cancer: -Prostate

Beta-HCG Beta-human chorionic gonadotropin

Clin. Utility: -Assess stage, prognosis & response to tx Asso. cancer: -Choriocarcinoma -Germ cell tumors

Philadelphia Chromosome BCR-ABL Fusion Gene

Clin. Utility: -Confirm dx, predict response to targeted therapy, monitor disease status Asso. cancer: -Chronic myeloid leukemia -Acute lymphoblastic leukemia -Acute myelogenous leukemia

Estrogen Receptor Progesterone receptor

Clin. Utility: -Determine whether tx with hormone therapy and some targeted therapies is appropriate Asso. cancer: -Breast cancer

BRCA1 BRCA2

Clin. Utility: -Determine whether tx with specific targeted therapy is appropriate Asso. cancer: -Breast -Ovarian

Describe Decreased Cap/plasma oncotic pressure

Common causes: • liver failure and DEC plasma proteins • caused by losses or diminished production of plasma albumin • decreased oncotic attraction of fluid within capillary causes fluid to move into interstitial space edema

Sebaceous hyperplasia

Common in elderly. Occurs in immunocompromised and transplant recipients. Sebaceous gland enlargement.

Biological aging:

Decline and deterioration of functional properties at the cellular, tissue and organ level. Breakdown in maintenance of specific molecular structures and pathways, a loss of homoeostasis and failure of homeodynamics.

Define atrophy

Decrease in cellular size- due to loss of subcellular organelles/substances. Can be a normal process, or also due to pathological atrophy.

pulsus paradoxos:

Decrease in pulse amplitude during inspiration. Possible premature contractions, COPD/restrictive airway disease, pericardial effusion/pericarditis.

pulse deficit:

Difference in count between heartbeats and peripheral pulse (central vs peripheral pulses). This occurs when the heart is contracting, the pulse is not reaching the periphery. This can occur with atrial fibrillation, very early diastolic ventricular ectopic beats and come patient with a pacemaker.

Anagen phase - rapid growth Catagen phase - apoptosis-driven regression Telogen phase - resting period A - anagen; B - catagen; C - telogen

Different phases of hair growth

Maternal vs. Paternal imprinting?

Differential expression based on whether it came from mom or dad Maternal imprinting: -Maternal-inherited allele is silent -Paternal-inherited allele is active -smaller growth Paternal imprinting: (Opposite) -Paternal-inherited allele is silent -Maternal-inherited allele is active -larger growth

Describe the 3 passive transport types

Diffusion: -non-polar shit -small polar shit Facilitated Diff: -vis transport proteins (protein channel and carrier protein) Osmosis -movement of H20 through semi permeable membrane

Dx: o Hook test: absence of tendon= + for distal rupture o Plain XR (rule out concurrent injury) o MRI to DX Tx: Proximal- usually non-surgical. Activity mod., NSAIDs, PT Distal: o Splint in flexion & supination o Almost always need surgery

Dx w/u and mngmt of Bicipital Rupture?

Dx: Yergason test to determine instability of the long head of the biceps in its groove. Tx: o corticosteroid injection into tendon sheath o activity mod, PT, NSAIDs o If conservative fails: corticosteroid injection into Subacromial

Dx w/u and mngmt of Bicipital Tendonitis?

o Finkelstein's test

Dx w/u for De Quervain tenosynovitis?

o PE. Hx o MRI Gold standard

Dx w/u for Medial tibial stress syndrome (shin splints)?

o Hx and PE

Dx w/u for Medial/lateral epicondylitis

o Pain w/ resisted knee extension o XR: AP, PA weight bearing with 45°flexion, lateral, and merchant

Dx w/u for Patellar tendinopathy?

-Test active flexion, and flexion against resistance. -FDP tear will not allow flexion at DIP -FDS tear will not allow flexion at PIP

Dx w/u for tendon lacerations of the hand?

o after 4-6 wks of sx--> plain XR o tripple phase bone scan: dx after 2-3Ds o MRI: best o a distinction between a compression versus tension-sided injury must be made

Dx w/u for tibial stress fracture?

(supine, apply varus stress, if lax ⟶LCL). (supine, apply valgus stress, if lax ⟶MCL)

Dx w/u interpretation for MCL/LCL injuries: Varus stress test? Valgus stress test?

o + Thompson test o PE to Dx

Dx w/u of Achilles tendon rupture?

o External rotation stress test reproduces MOI. o XRs: should be obtained, mortise view may lack normal overlap between tibia and fibula. o MRI is better at diagnosis

Dx w/u of Ankle sprain (eversion/ high)?

o valgus and varus stress tests using grade 1-3 o Imaging avulsion type injuries o LCL injuries should have MRI to determine involvement. Grade I: pain but no instability-- sprain Grade II: instability at 30 degrees of knee flexion--> partial tear Grade III: marked instability, not much pain--> full rupture

Dx w/u of MCL/LCL injuries of the knee?

o Observation of pt o Palpation bone/soft shit o ROM o Spurling test- extends, side-bends, partial rotate to side being tested followed by axial load: pain= + for nerve root irritation o Lhermitte sign: forward flexion causing parathesia= + for cervical radiulopathy o UE DTRs o MRI 4 soft o CT definitive for bone

Dx w/u of Neck pain?

o "stork test" to reproduce pain o "scotty dog" XRs: AP, lateral, & R/L oblique of lumbar spine = fracture through the collar

Dx w/u of Spondylolysis?

o XR normal at first. o MRI and technetium bone scans are best tests

Dx w/u of Stress fracture of the foot

o Neer & Hawkins impingement elects pain o Definitive D/x is radiography: -AP scapula, -AP acromioclavicular joint, -lateral scapula -lateral axilla views.

Dx w/u of Subacromial impingement syndrome (rotator cuff impingement)?

o Gld Std: compare laxity at the joint to THAt at the contralateral side. o If laxity is seen only at 30 degree of the MCP joint flexion, partial tear is suggested. o When there is laxity at both 30 degree flexion and full extension, a complete rupture is likely. o Radiograph to rule out other pathology.

Dx w/u of UCL injury of the thumb ("Gamekeeper's thumb)

ECOG Grade 3:

Eastern Cooperative Oncology Group: Capable of only limited self-care, confined to bed or chair >50% of waking hours

ECOG Grade 2:

Eastern Cooperative Oncology Group: Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about >50% of waking hours

ECOG Grade 4:

Eastern Cooperative Oncology Group: Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair

ECOG Grade 0:

Eastern Cooperative Oncology Group: Fully active, able to carry on all predisease performance without restriction

ECOG Grade 1:

Eastern Cooperative Oncology Group: Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework, office work

What's Grey Turner sign

Ecchymosis in flanks oIndicates hemoperitoneum or pancreatisis

Describe the procedure for obtaining the auscultatory gap,

Ensure cuff is snug and palpate the brachial or radial pulse while inflating the cuff. Inflate to 20-30 mm Hg above the point when the pulse is not palpable. Slowly deflate the cuff and note the point when you again feel the pulse. Fully deflate the cuff. Wait 30 sec. Place bell of stethoscope @ antecubital fossa. Inflate the cuff until it is 20-30 mm Hg above the palpable systolic pressure. Deflate the cuff slowly, listening for the Korotkoff sounds. Note mmHg when sounds start and stop.

AST

Enzyme found in liver and heart Detects liver damage and assesses hepatic cellular integrity

ALT

Enzyme found in liver and kidneys Detects liver damage and assesses hepatic cellular integrity

ALP

Enzyme in liver and bone Assess biliary tract, can indicate liver or bone disease

Equilibrium

Equilibrium: o Rate of formation of products= rate of formation of reactances o No energy required to maintain o No free energy will enter or leave o No different than surroundings

Polymorphous Light Eruption

Erythematous pruritic papules or plaques sometimes with vesicles extending over sun-exposed areas (usually neck, arms, legs) - face is usually spared. Pruritic rash over sun-exposed areas several days after sun exposure

Define exdudation

Escape of fluid, proteins and blood cells from the vascular system into the interstitial tissue or body cavities Cells are spaced further apart

carpal tunnel syndrome

Essentials: o Pain, burning, and tingling in the distribution of the median nerve. o Initially, most bothersome during sleep. o Late weakness or atrophy of the thenar eminence. o Can be caused by repetitive wrist activities. o Commonly seen during pregnancy and in patients with diabetes mellitus or rheumatoid arthritis.

adhesive capsulitis (frozen shoulder)

Essentials: o Very painful shoulder triggered by minimal or no trauma. o Pain out of proportion to clinical findings during the inflammatory phase. o Stiffness during the "freezing" phase and resolution during the "thawing" phase.

Rotator Cuff Tendinopathy/Tear

Essentials: A common cause of shoulder impingement syndrome after age 40. Difficulty lifting the arm with limited active range of motion. Weakness with resisted strength testing suggests full-thickness tears. Tears can occur following trauma or can be more degenerative.

Plantar Fasciitis

Essentials: o Heel pain worse in the morning with initial weight bearing or after a period of rest. o Heel pain precipitated by a recent increase in activity. o Localized tenderness at the medial calcaneal tubercle. o Pain with passive dorsiflexion of the great toe.

Morton neuroma

Essentials: o Shooting pain, numbness, and/or tingling in the interspace between the third and fourth metatarsal heads. o Cramping, burning, and feeling of walking on a stone or marble. o Pain and paresthesias that may radiate to the toes. o Symptoms exacerbated by shoe gear with a narrow toe box or high heels. o Classic Mulder click elicited in the interspace.

Subacromial impingement syndrome (rotator cuff impingement)

Essentials: o Shoulder pain with overhead motion. o Night pain with sleeping on shoulder. o Numbness and pain radiation below the elbow are usually due to cervical spine disease.

Vitiligo

Etiology Autoimmune - Melanocytes are destroyed by cytotoxic lymphocytes. Signs and symptoms Patient may notice a pale patch which gradually turns completely white. White hair/prematurely gray hair. it may appear at site of physical trauma (koebner phenomenon) or after illness or emotional stress. PE Findings 5 mm to 5 cm, "chalk" or pale white (depigmented), sharply marginated, symmetric macules and patches. Often found around openings (eyes, mouth, nose) and on digits, genitals, low back, elbows and knees.

Founier's gangrene

Etiology Caused by a mix of multiple, aerobic and anaerobic microbial organisms. May be caused by organisms associated with the urogenital tract, ano-rectum or cutaneous source. Commonly the patient is immunosuppressed. Clinical Presentation: Severe pain that generally starts on the anterior abdominal wall and migrates into the gluteal muscles, scrotum, and penis. Tense edema outside the involved skin, blisters/bullae, crepitus, and subcutaneous gas. Acute scrotal swelling. Systemic findings: fever, tachycardia, and hypotension.

Stasis Dermatitis

Etiology Develops on the lower extremities secondary to venous incompetence and chronic edema Signs and symptoms Mild erythema and scaling associated with pruritus. Initial site of involvement is typically the medial aspect of the ankle over a distended vein PE Findings Erythematous, scaly and oozing patches over the lower leg. Several stasis ulcers can also be found. **When it becomes inflamed with crusting and exudate, it is easily confused with cellulitis. Symmetrical and bilateral involvement is most common

Albinism (oculocutaneous)

Etiology Genetic. Mutations in the tyrosinase gene are responsible for deficient tyrosinase activity in the melanocytes. A decrease in the production of melanin only (melanopenic hypomelanosis) Present at birth. Signs/ symptoms/PE Findings White skin, white eyelashes, eyebrows, and scalp hair. Irises appear translucent. Heme pigment gives face a pinkish hue. Squinting resulting from photophobia and nystagmus. Diagnosed at birth.

Post-inflammatory hyperpigmentation (PIH)

Etiology It may follow a drug eruption, acne, atopic dermatitis, contact dermatitis, or lichen planus, or any type of trauma to the skin, it is especially seen in skin phototypes IV,V, and VI. Signs and symptoms Darkened skin

Melasma

Etiology May be associated with pregnancy, sun exposure, contraceptive hormones, or idiopathic. More common in women. Caused by an increase in the production of melanin (melanotic hypermelanosis) Signs and symptoms An acquired light or dark brown hyperpigmentation that occurs in sun exposed areas, most often the face. PE Findings Well demarcated Macular hyperpigmentation most sharply defined in the malar and frontal areas of the face, usually uniform but also blotchy. "Patchy light to dark brown hyperpigmentation"

Acanthosis nigricans

Etiology Related to heredity, obesity, endocrine disorders(particularly diabetes), drug administration and malignancy. It is thought that excess growth factor stimulation in the skin leads to proliferation of keratinocytes and fibroblasts. Can be a marker of insulin resistance & T2DM. Signs and symptoms Patients complain of darkened/"dirty" skin on neck or in body folds.

ganglion cyst

Etiology/CP: • Most common soft tissue tumor of the hand • Typically 15‐40 years‐old • Cyst arising from joint capsule or tenosynovial sheath • Synovial fluid can be pushed into cyst but "one‐way valve" prevents backflow • 60‐70% Dorsal (Volar more common in women) • 50% spontaneously resolve

Dupuytren contracture

Etiology: - unknown cause, but has genetic predisposition -characterized by hyperplasia of the palmar fascia and related structures, with nodule formation and contracture of the palmar fascia. CP: -nodular or cord-like thickening of one or both hands (4th and 5th digits most common) -tightness, inability to extend fingers, tenderness (though generally not overly painful)

De Quervain tenosynovitis

Etiology: -atraumatic inflammation of abductor pollicis longus & extensor pollicis brevis tendons - Often caused by repetitive activity CP: - Pts may complain of difficulty gripping items and often rub the area over the radial styloid. -Pain is located on the radial side of the wrist and thumb and occasionally radiates proximally or distally. - There is tenderness to palpation just distal to the radial styloid.

carpal tunnel syndrome

Etiology: -compression of median nerve between carpal ligament and other structures in the carpal tunnel

olecranon bursitis

Etiology: -excessive frictional forces, overuse, trauma, RA, gout, infection CP: -tense, edematous, painful area overlying elbow extensor surface -pain with ROM minimal until tight elbow flexion

Clostridial myonecrosis (aka gas gangrene)

Etiology: A predisposing factor for the development of this condition is usually present in the form of trauma or injection drugs. Caused by several types of aerobic bacteria. Clinical presentation: Sudden onset with rapidly increasing pain in affected area. Hypotension, and tachycardia. Fever will be present but not in proportion to the severity of infection. Wound becomes swollen, and the surrounding skin pale. Foul smelling brown, blood tinged serous discharge.

Patellofemoral pain syndrome

Etiology: Caused by overuse of knee. AKA anterior knee pain, chondromalacia, or "runner's knee" o Lateral deviation/tilting of patella in relation to femoral groove CP: Anterior knee pain often described as around and/or behind the patella and pain with bending movements (kneeling, squatting, climbing stairs) and less commonly in full extension. Pain is localized under kneecap but can refer posteriorly. May present as insidious onset of diffuse aching.

Patellar tendinopathy

Etiology: Caused by/from overuse/overloading the patella tendon. AKA "jumper's knee." Pain usually results from recurrent overload of the knee during running, jumping or lunging. CP: presents with the insidious onset of well-localized anterior knee pain, focused at the inferior pole of the patella. Pain is often exacerbated by activities such as jumping, lunging, ascending/descending stairs, and kneeling. Onset of pain typically begins after exertion but can progress over time to encompass the entire activity.

Boxer metacarpal fracture

Etiology: Fracture of the 5th metacarpal. Shaft and neck fractures usually display apex of dorsal angulation due to interosseous muscle pull as a result of punching CP: Depressed knuckle. Swelling. Inability to move finger. Shortened finger.

Rotator Cuff Tendinopathy/Tear

Etiology: Hx of repetitive overhead activity. Prolonged repetitive activity involving overhead motion. FOOSH/pulling shoulder injuries. CP: Weakness or pain with overhead movement. Night pain is also common.

adhesive capsulitis (frozen shoulder)

Etiology: Idiopathic. Commonly in patients 40 to 65 years old. It is more commonly seen in women than men, especially in perimenopausal women or in patients with endocrine disorders, such as diabetes mellitus or thyroid disease. There is higher incidence following breast cancer care (such as mastectomy).

greater trochanteric bursitis

Etiology: Inflammation can be either the result of direct trauma or of insidious onset. CP: Patient will complain of lateral hip pain with tenderness to palpation at superiolateral aspect of lower leg at the hip Pain over lateral aspect of hip. Sx worsened with pressure on lateral hip such as rolling on side at night.

Tuft fracture

Etiology: The MC injury to the very tip of the distal phalanx resulting from a crush injury, typically seen when the child catches their hand in a door that doesn't require fixation and can be treated conservatively

Anterior, posterior hip dislocation

Etiology: ____dislocation is rare and is caused by forced abduction like when someone lands on their feet from a high fall ____ dislocation can occur in a MVA when the flexed knee strikes the dashboard

Colle fracture-distal radius fractures

Etiology: a FOOSH injury that leads to dorsal (upward) displacement of the distal radius fragment. MC type CP: Pt presents w/ pain, swelling, and tenderness @ distal forearm and on examination w/ "dinner fork" deformity (dorsal displacement of the distal fragment and solar angulation of the distal intact radius w/ radial shortening)

Smith fracture-distal radius fractures

Etiology: a FOOSH injury that leads to palmar (downward) displacement of the distal radius fragment CP: Pain, swelling, and tenderness @ distal forearm

Subacromial impingement syndrome (rotator cuff impingement)

Etiology: o Causes can be related to muscle strength imbalances, poor scapula control, rotator cuff tears, subacromial bursitis, and bone spurs. o Describes a collection of diagnoses that cause mechanical inflammation in the subacromial space.

Hallux Valgus (Bunion)

Etiology: o Idiopathic, shoes, hereditary. Deformity @ the big toe joint w/ abduction and valgus rotation of the great toe + medially prominent 1st metatarsal head. o Form when there's a disruption of the balance of forces on the tendons that cross the big toe joint

carpal tunnel syndrome

Etiology: o Painful Entrapment neuropathy disorder caused by compression of median nerve between carpal ligament & other structures w/in tunnel. o Caused by repetitive movement/wrist activities o Commonly seen in pregos/ diabetes/RA

Hip fractures

Etiology: typically occur after a fall. Risk is increased for people who have osteoporosis, are female, over 5'8", and over the age of 50. High velocity needed in younger pts CP: patient usually complains of groin pain. Shortening of the affected leg, with abduction and external rotation, is common but may not be obvious in cases of nondisplaced fractures.

Ankle sprain (inversion)

Etiology: Most common sport injury seen in outpatient clinic. Usually report "turning the ankle" during a fall, or after landing the foot on an irregular surface (a hole, opponent's foot). Most common MOI is inversion and plantar flexion (injures anterior talofibular ligament) rather than the calcaneofibular ligament.

Spondylolysis

Etiology: One of the most common causes of back pain in active young children and adolescents -"stress fracture" in pars interarticularis of posterior neural arch of vertebrae -repetitive hyperextension of lumbar spine -rarely at L5 level, commonly bilateral

Medial tibial stress syndrome (shin splints)

Etiology: Seen in runners. Thought to be either a periostitis. The pull of the tibia's posterior muscle from its origin on the tibia and posterior tibial tendinitis are also possible causes. Risks include flat feet, rigid arches and worn-out footwear.

MCL injuries of the knee LCL

Etiology: _____ is the most commonly injured ligament in the knee. Usually injured with valgus stress to a partially flexed knee. Can also occur with a blow to lateral leg. The _____ is also commonly injured with ACL tears. The _____ is much less commonly injured, but can occur with medial blow to knee.

ANKLE SPRAIN (EVERSION or "HIGH")

Etiology: a syndesmotic injury involves the anterior tibiofibular ligament and anterolateral aspect of ankle, superior to the anterior talofibular ligament. MOI: foot being turned out, externally rotated and everted.

Spinal stenosis

Etiology: common in older pts, OA in the lumbar spine can cause narrowing of the spinal canal. Disk herniation. Presentation: pain that worsens with extension relieved by sitting-single or bilateral leg pain worse with walking -limited extension of lumbar spine with pain radiating down legs.

Actinic keratosis

Etiology: Primarily from high sun exposure; outdoor workers, golfers, sports etc. Takes months to years to develop. Clinical presentation: Discrete, dry, gritty, rough or adherent scaly lesions on sun exposed areas. They have a sandpaper like consistency. < 1 cm in size typically. May or may not be painful. can progress to squamous cell carcinoma

Ulnar collateral ligament injury of the thumb (gamekeeper's thumb)

Etiology: Typically occurs secondary to a FOOSH with an abducted thumb receiving a valgus force (like when holding a ski pole).

Bowen disease (carcinoma in situ skin)

Etiology: UV Radiation Originates in keratinocyte S/Sx: Small, well demarcated raised pink-red scaly plaque. May resemble psoriasis / actinic keratosis.

squamous cell carcinoma

Etiology: Usually occurs on sun exposed areas, may arise from an actinic keratosis. Can occur on genitals. Lesions on face and genitals have higher rates of mets. More common in light-skinned people but also some have a genetic predisposition. Signs/symptoms: appear as a sharply demarcated nonhealing ulcer or warty nodule, often plaque, macule or papule shaped and scaly/crusty. PE: above, commonly occur on face/ears/neck

necrotizing fasciitis

Etiology: Usually polymicrobial, historically beta-hemolytic GAS. Soft-tissue infections also caused by P. aeruginosa and Clostridium species. Portal of entry - minor trauma, laceration, needle puncture, surgical incision S/s: Local redness, edema, warmth, pain in the involved site 36-72h after onset. Involved tissue may be numb with progression PE: rapid progression of infection with extensive death of soft tissues and overlying skin = Involved soft tissue becomes dusky blue in color; vesicles or bullae appear. Infection spreads rapidly along fascial planes. Extensive, cutaneous soft-tissue necrosis develops. Necrosis manifests as a black eschar with surrounding irregular border of erythema. Fever and other constitutional symptoms are prominent as the inflammatory process extends rapidly over the next few days

Stevens-Johnson syndrome/Toxic Epidermal Necrolysis

Etiology: acute life-threatening mucocutaneous reactions characterized by extensive necrosis and detachment of the epidermis and mucosal surfaces. These two are variants of the same disease that different only in BSA. Idiopathic or drug induced (SATTANN) S/s: 8 weeks after drug exposure; fever, HA, rhinitis, myalgias; flaccid blisters that slough to form tender erythematous erosions. PE: Initially symmetric & distributed on face, upper trunk, prox extremities - "atypical targets" erythematous irreg shaped dusky red to purpuric macules. Dark center may evolve into flaccid blisters which spread with pressure and break easily.

malignant melanoma*

Etiology: the most malignant skin cancer, arises from melanocytes in the dermal-epidermal junction. Caused by a combination of genetics and sun damage. Genes involved are thought to be BRAF (which is also a breast cancer gene, MC1R and CDK genes. But it's mostly sun damage, so wear sunscreen. Signs/symptoms: ABCDEs, tender lesions, bleeding, changing or evolving mole is an ominous sign PE: Be aware it can occur in them mouth, genitals, and under nails (not limited to sun exposed areas)

Spinal Cord Compression

Evaluation Back pain is generally the first symptom, motor deficits including weakness and paralysis, sensory deficits recognized on PE, autonomic dysfunctionand loss of sphincter tone may present late in progression of the disease Presentation/differential -most common in metastatic lung, breast, or prostate cancer -50% of pts w/ osseous metastases develop SC compression Ddx - mechanical back pain, disc herniation, cauda equina

Iatrogenic

Events that are the result of any activity by clinicians that has an unintended negative impact on the individual and not consistent with patient's goals

Natural Selection

Evolutionary theory on aging?

Describe ROS and free radical induced cell injury

Ex. by excess ROS- "oxidative stress" O2: excess ROS overwhelms the cell's antioxidant system and damages the CM FR: injures chemical bond formation with proteins, lipids, and carbohydrates—key molecules in membranes and nucleic acids.

Phototoxicity

Exaggerated sunburn reaction o erythema, edema, vesicles, and bullae o burning, stinging o Frequently resolves w/ hyperpigmentation

Drug/chemical induced photosensitivity

Exaggerated sunburn reaction in all sun-exposed areas: erythema, edema, vesicles, and bullae; burning, stinging; frequently resolves with hyperpigmentation. pt will present with Stinging, burning rather than itching sensation

Describe a Scales

Excess dead epidermal cells that are produced by abnormal keratinization and shedding

Describe the LoH

F: concentrating or diluting fluid thin Descending: water permeable, ion impermeable Thin/thick ascending: water impermeable, ion permeable

Describe the function of Agranulocytes- Monocyte and macrophage

F: in innate and adaptive immunity -microbe phagocytosis -wound/tissue/bone healing -debris removal -largest cell -migrate to inflammation site and become macrophages

Describe the spleen's white pulp

F: lymphoid tissue/ immune function peri-arteriolar lymphoid sheaths (PALS): made up of mostly T cells follicles: scattered along sides of PALS].made up of mostly B cells

How to calculate *C from *F?

F= (1.8)C+32

Describe the function of Agranulocytes- Lymphocytes types?

F= immune system Types: T-cells B-cells NKC Plasma Cells

CN 7 8 9

Facial Acoustic Glossopharyngeal

Describe Systemic "acute phase" reactions

Fever, loss of appetite release of neutrophils into bloodstream and corticoroids -hemodynamic effects of septic shock

Clot lysis

Firbrinolytic system degrades the fibrin of the clot while macrophages consume the expended platelets -tissue plasminogen activator (tPA) -and urokinase pal activator (uPA) activate plasminogen -plasminogen binds to fibrin and degrades tPA: VIP 4 endothelial cells uPA: VIP in extravascular or tissue compartments

HPV 6, 11, 16, 18, 31, 33, 45, 52, 58

Gardasil 9 (nonavalent) protects against?

Describe flexible thin walled cells: spirochetes

Gram-negative spiral shaped Very small and slender Require darkfield microscope Ex. Borrelia burgdorferi (lyme dz), Treponema pallidum (syphilis)

When palpating the patient's hair, what should you expect to find

Hair should be smooth and symmetrically distributed and have no splitting or cracked ends. Fine, silky hair may be associated with hyperthyroidism or may be familial.

Describe acid fast bacteria

Have high mycolic acid content in cell wall that requires a special Kinyoun counterstain that is blue/green. X: Mycobacterium tuberculosis, Mycobacterium leprae (leprosy)

Describe AI outcome: Repair

Healing by connective tissue replacement (fibrosis) and scarring Occurs after substantial tissue destruction or when inflammatory response takes place in tisues that don't regenerate

Describe the Rinne test

Helps distinguish whether the pt hears better by air or bone conduction Place the base of the vibrating tuning fork on the mastoid bone and ask the pt to tell you when sound is no longer heard, time this number in seconds Quickly move the fork from the mastoid to about 1 to 2 cm from the auditory canal, ask the pt to tell you when they can no longer hear the fork, time this number in seconds Compare the times, air conduction should be heard 2x as long as bone conduction

Describe precursor cell

High mitotic activity, not self-renewing, first cells morphologically identifiable for a specific lineage. They have committed to becoming one particular cell.

High: 16, 18, 31-68 Low: 6, 11

High risk HPV strains? Low risk?

Tzank smear

If you see "[m]ultinucleated epithelial giant cells" they probably have HSV or VZV. Differentiation requires a culture, immunofluorescence microscopy, or genetic tests.

Describe Reticulocyte

Immature RBC they're bigger BC RBC shrink when they mature

Describe the Cortex

Immature T cells - thymocytes No B cells - no follicles Macrophages to phagocytose developing T cells that fail their exams

Describe blood thymus barrier

Impermeable epithelium vessel walls - complete tight junctions and thickened basement membrane -Macrophage in perivascular space -Epithelial reticular cells

susceptible carrier leads to cancer

In regard to tumor suppressor genes, the 1st mutation leads to becoming a ___ ____ whereas a 2nd mutation ____ ____ ____

When would you not hear an S3 gallop?

In someone w/ significant mitral stenosis. BC it prevents rapid filling of ventricles

infliximab (Remicade)

Indicated for severe psoriasis and moderate-to-severe psoriatic arthritis, TNF inhibitor, shown to be highly effective in randomized trials, may increase likelihood of subsequent serious infection

atopic dermatitis presentation

Infants: eczematous plaques appear on cheeks, forehead, scalp, extensor surfaces Kids: lichenified, eczematous plaques in flexural areas of neck, elbows, wrists, ankles Adults: lichenification in anticubital/popliteal areas, involvement of hands, wrist, ankles, feet, face -Pityriasis alba may present as area of mild hypopigmentation on the face and cheeks-ITCHY Ill-defined, scaly, red plaques

acne conglobata

Inflammation of sebaceous glands/hair follicles leading to inflammation drainage. Occurs on trunk and buttocks more than face. Severe cystic acne of trunk/buttocks. Coalescing nodules, cysts, abscesses and ulceration

Cipro, Norflo (quinolone) 250 mg BID 5-7 days (doubled w/ pyelonephritis)

Inhibits DNA synthesis (Bactericidal) N/V/D, dizziness

Ampicillin, Augmentin (penicillin) 250 to 500 mg QID

Inhibits cell wall synthesis (Bactericidal) Diarrhea, rash w/mono

Cephalexin (1st gen cephalosporin) 250-1000 mg QID 7-14 days

Inhibits cell wall synthesis (Bactericidal) Seizures

TMP-SMX (sulfa) 800 mg BID 10-14 days

Inhibits folic acid synthesis (Bacteriostatic) N/V/D, rashes, possible nephrotoxicity

Cells of adaptive and innate immunity

Innate: Granulocytes: BEN Monocytes: MD (dendritic) Adaptive: "TBD"

When using the otoscope, insert speculum approx. ___?

Insert ½ inch into EAC, avoid inner bony ⅔ MUST go inside the canal

How to perform a breast exam? (2/6)

Inspect Areolae and nipples for: same things also nipple eversion/inversion

How to perform a breast exam? (1/5) ("LESS CRCSV")

Inspect both breasts for: L-lesions E-edema S-size S-symmetry C-contour R-retraction/dimpling C- color/texture S- supernumary nipples V-venous pattern

Describe how to examine the skin 1st part ("MUNCH-V")

Inspect epidermis including intertrigenous areas, sun/non-sun exposed skin for: M-moist/dry U- Uniform appearance N- Nevia Striae C-color H- hygiene V- vascularity

Describe how to examine the nails-(1st part) ("A-DICCS")

Inspect finger and toe nails for: A-Assess for spoons, clubs, grooves, or pitting D-Discoloration I-Integrity C-Configuration C-Cleanliness S-Symmetry

Describe how to examine hair (2 parts) ("CQD")

Inspect hair for: Color Quantity Distribution Palpate the hair for: Texture and resilience

Describe how to examine the skin 2nd part

Inspect mucous membranes, scelera, conjunctiva, buccal mucous mbns, tongue, lips for: Color Hydration Lesions

A penlight and tongue blade are used to inspect what in the mouth?

Inspect tongue gingival mucosa (gum line) buccal mucosa (cheeks) salivary gland outlets (Parotid ducts= Stensen ducts, Submandibular ducts= Wharton ducts)

Describe the basic exam techniques (IPPA)

Inspection Palpation Percushion Auscultation **perform from head to toe and 360 degree

Auscultation is what?

It involves listening for sounds produced by the body.

What is percussion and what are sound waves?

It involves striking one object against another to produce vibration and subsequent sound waves Sound waves are heard as percussion tones (called resonance) that arise from vibrations 4 to 6 cm deep in the body tissue.

Describe the clinical usefulness of assessing this measurement.

It is used to eliminate guessing and is done by checking the "palpable" systolic pressure (done by inflating cuff to 30 mmHg above point when pulse disappeared)

Describe Indirect or mediate percussion?

It's a technique in which the finger of one hand acts as the hammer (plexor) and a finger of the other hand acts as the striking surface.

o D-dimer o arterial blood gas (alkalosis) o chest xray to R/O other causes o CT o pulmonary angiography o ECG -heparin, 6 months warfarin after -thrombolytics

Labs & Management for PE/DVT

Lab: -2: MRI of entire spine (Gold standard) Tx: -1st line: -corticosteroids (dexamethasone) -3: emergent surgical decompression followed by radiation

Labs & Tx for Spinal Cord Compression

blood cultures, urine cx, chest xray

Labs for Febrile Neutropenia

What are the Gram + Rods

Lysteria monocytogeines

Describe laboratory diagnosis of Chronic inflammation ("MISS SB")

M- Microbiologic cultures I-Immunologic studies S-Serologic studies for Abs S- Serum autoantibody levels for autoimmune dz S- Skin test for TB B- Biopsy of lesions (may provide clues to etiology)

6 F of the lymphatic system

MAPP MP M- movent of lymph fluid/ drainage of interstate space A- absorption of fat and fat soluble substances in gut P- phagocytosis P- production of lymphocytes and Ab M- manufacture of blood when BM is stressed F- fluid conservation

crotamiton (Eurax) (10%) - topical

MOA: Scabicidal (Specific MOA unknown) ant-puretic effects linked to histamine and serotonin. Indication/Contraindication: pruritis and scabies infection. Contraindicated by hypersensitivity. Adverse events: dermatitis, skin irritation. Drug interactions: no known significant interactions. Patient education: Don't apply to open wounds or weeping membranes. Avoid eyes and mucous membranes. Wash bed and linens. Report severe infections.

lindane (shampoo, lotion preparation)

MOA: Similar to others. CNS stimulant to pests. Causes convuLsions and death. Indications / contraindications: Shampoo - lice infestation, lotion - scabies. Contraindicated by hypersensitivity or seizure disorder. BLACK BOX WARNING - neurotoxicity for infants and elderly. Adverse effects: Common - pruritus, dizziness, anxiety. Serious - Myelosuppresion, seizure. Drug interactions: PREGNANCY CATEGORY C, DO NOT USE IF BREASTFEEDING. Patient education: The shampoo should be applied to dry hair after washing once. Patient should use a fine comb to brush out lice/larva. Patient should wash bedding and linens. The patient should report dizziness and anxiety.

ivermectin (Stromectol) - (0.5%) - topical

MOA: hiiiperpolarizes nerve cells, causing paralysis and death. Indication/contraindications: pediculosis capitis, rosacea, onchocerca infection, intestinal strongyloidiasis. Contraindicated by hypersensitivity and pregnancy Adverse events: Common - pruritis, dizziness. Serious - Mazzotti reactions, seizure. Drug interactions: Warfarin - Increased INR Patient education: do not apply to mucous membranes or open wounds. Shower after 48 hours of applications. Wash bedding and linens. Report severe infections.

Describe the procedure for the correct and appropriate usage and function of the ophthalmoscope

Magnification power (+/-20 to +/- 140) Optic disc should be visible at 3-5cm (1.5-2in) from patient at 10-15* angle from midline If not, rotate lens dial SLOWLY with index finger

What's MELAS

Mitochondrial Encephalopathy, Lactic acidosis, and Stroke-like episodes

o MICE mnemonic. Modified activities ⟶Ice ⟶Compression ⟶Elevation. o Followed by protected weight bearing with brace if needed. Early motion is essential.

Mngmnt for Ankle sprain (inversion)

o Type I-III typically treated non-surgically. o Brief period of sling immobilization for comfort, followed by early initiation of ROM exercises. o NSAIDs can be used for early pain control. o Type IV-VI should be referred urgently to ortho surgeon.

Mngmt for Acromioclavicular joint sprain/separation

o Distinguish Compression vs. mid anterior cortex ("dreaded black line") tension-sided Compression: Fractures along the posteromedial border--> -easy management w/ conservative o Mid anterior cortex: occurs @ tension side of tibial cortex - very hard to manage, but w/ conservative - if not respond/ needed asap--> surgery

Mngmt for for tibial stress fracture?

o Mild/mod: conservative tx -soaking toe, topical Abx, cotton wisps under nail edge o Severe: matricectomy using phenol/ NaOH

Mngmt for onychocryptosis (ingrown toenail)?

Type I: Nonoperative, posterior splint/sling + early movement. Type II-IV: Orthopedic referral

Mngmt for radial head fracture?

o Operative or conservative oEither way, immobilize it in slight plantar flexion + non-weight bearing+ EAI

Mngmt of Achilles tendon rupture?

o Do NOT recommend early motion like an inversion sprain o These should be casted or in a walking boot for 4-6 weeks. o Then, protected weight bearing with crutches. o PT is crucial.

Mngmt of Ankle sprain (eversion/ high)?

o Depends on severity and etiology. o short term: stretching, strengthening, postural exercises in PT -chiropractic manipulation -NSAIDs o Chronic (>30 Ds): - tricyclic antidepressants or SSRIs for sleep...

Mngmt of Neck pain?

o Acute isolated tear: nonoperative. - Knee brace w/ knee extension + crutches + PT o Complete tear (gd. 3)/ ACL involved/ unstable lateral knee: may need: surgery

Mngmt of PCL injury of the knee?

o Antilordotic bracing to reduce pain o Rehab for strengthening and stretching hamstrings o Activity modification and gradual return to play, Surgery if severe.

Mngmt of Spondylolysis?

epidermal inclusive cyst (sebaceous cysts)

Mobile dermal nodule, often with an overlying punctum. Most common cutaneous cysts arise from hair follicles, not oil glands. It contains degenerating keratinocytes - rancid smell if opened. EICs become severely inflamed if contents enter dermis - often mistaken for infection.

Trichomonas vaginalis

Most common protozoal urogenital tract infection -sexually transmitted to lower genital tract -in urethra, often produces no Sx

Describe autosomal recessive disorders ("CTSM" )

Most metabolic diseases Cystic Fibrosis Tay-Sachs Disease S- Sickle cell Disease

phototherapy -UVB

Option for moderate-to-severe plaque psoriasis that is not fully responsive to topicals, narrowband UVB is more effective than broadband UVB, usually takes 15-20 treatments to achieve clearance

What's considered a fever for adults at 6 AM and 4PM? For kids?

Oral >98.9 (37.2) @ 6 AM Oral >99.9 (37.7) @ 4 PM rectal > 100.4 (38*)

totally bed bound

PPS level: 10-30% Ambulation?

Mainly sit/lie Mainly in bed

PPS level: 50% 40% Ambulation?

Reduced

PPS level: 60-70% Ambulation?

Full

PPS level: 80-100% Ambulation?

Xerosis (Dry Skin)

Present in the winter or other cold environments, especially in combination with low humidity; may be attributed to inadequate filaggrin production or altered lipid profile; predisposing factors include atopic dermatitis, ichthyosis, increasing age; exacerbated by excessive washing

Febrile Neutropenia

Presentation/differential o neutropenia = neutrophil count <1800/mcL; severe is <500 o Lower the count, the more prone to infection Evaluation -look for signs of infection - common causes are septicemia, cellulitis, pneumonia abscess, perianal area, central venous catheter erythema or discharge

Ankle sprain (eversion/ high)

Presentation: Severe or prolonged pain over the anterior ankle at the anterior tibiofibular ligament, worse with weight bearing. Often more painful than typical sprain. Some mild swelling, patient may or may not have effusion. Limited ROM in all directions.

lumbar disk herniation

Presentation: -localized low back pain that worsens with activity -"sciatica" pain radiating down posterior leg below knee -pain worsens with back flexion -numbness, weakness exp. With plantar flexion.

Medial tibial stress syndrome (shin splints)

Presentation: Pain associated with activity in the beginning of training after a relatively inactive period. Pain is usually located along anterior compartment of the shin. Pain may be sharp and razor like, or dull ache and throbbing over the distal one-third of the posteromedial tibia. Can be during and after exercise. Can be aggravated by touching the spot. o Pain reproduced w/ dorsiflexion/plantar flexion/standing toe raises

Acromioclavicular joint sprain/separation

Presentation: o Pain and deformity over top of shoulder. o Pain usually occurs after a fall onto the lateral shoulder with patient's arm at the side.

Stress fracture of the foot

Presentation: Incipient mid dorsal foot pain of varying intensity at rest is then accentuated by walking. Swelling and point tenderness are likely to be present. Tenderness to touch at the site of the fracture. Possible bruising.

Ankle sprain (inversion)

Presentation: Localized pain and swelling over lateral aspect of the ankle, difficulty weight bearing, limping. Ankle may feel unstable. May be swelling, bruising over lateral aspect of the ankle. Point of maximal tenderness should be inferior aspect below lateral aspect of ankle if it is consistent with ATF. Swelling may limit ROM.

Meniscal tears

Presentation: Patient may have antalgic gait, and difficulty squatting. May complain of catching, locking, clicking. Commonly associated with joint line pain and effusion. Patients typically have area of maximal tenderness. Swelling within first 24 hours.

ACL injury of the knee

Presentation: Patient will typically fall down after injury, usually with an audible pop where the knee buckles. Patient will have acute swelling w/ activity, difficulty weight bearing and complaints of instability. After resolution of swelling, patients will walk with a "stiff knee" gait, or quadriceps avoidance.

Acromioclavicular joint sprain/separation

Presentation: o Pain that localizes on top of the shoulder. May be notable asymmetry compared to unaffected side. Pain is worse with overhead or crossbody shoulder motions. Limited ROM and weakness on exam.

. financial exploitation

Presentation: Ambiguity of financial status Inability to pay bills, buy food or medications Sudden changes in legal documents (eg, will, power of attorney, or health care agent) Excessive concern regarding expenses necessary for patient's care by the possible abuser Assessment: patient may be living well below their means, there may be discomfort/evasiveness when discussing finances, ambiguity of the patient's finances, unexplained inability to pay bills, unexplained sudden changes to legal documents

Abandonment

Presentation: An example of this is when family (or a care facility) abandons the senior in an emergency room. Assessment:

Ulnar collateral ligament injury of the thumb (gamekeeper's thumb)

Presentation: Pain at medial aspect of the MCP joint of the thumb. Pt has history of specific event of valgus-directed force on abducted thumb. Pain, swelling, and occasionally ecchymosis over the ulnar aspect of the MCP.

Achilles tendon rupture

Presentation: Sudden pain in the calf after attempting a pushing off movement, often with an audible pop. Immediate weakness is noted.

sexual abuse

Presentation: bruises or bleeding around the genitals or chest, unexplained STIs or genital infections, torn, stained or bloody clothing especially underwear, and new injuries Assessment: patient's report, physical exam, observe for inappropriate relationships between patients and their caregivers

Clavicle fracture

Presentation: pain involving the affected shoulder, arm adducted and internal rotated to avoid motion. Possible swelling, discoloration, and deformity at fracture site. Displaced fractures may cause tenting of skin.

physical abuse

Presentation: pattern of bruising or burns, broken bones, sprains, dislocations, internal injuries, open wounds, cuts, untreated injuries Assessment: patient's report is essential; also physical exam to look for any signs

Define inflammation ("A DIA")

Process by which the body responds to local injury by: A- Attempting to contain and isolate injury D- Destroy invading microorganisms U- Inactivate taxis A- Achieve repair

Describe Anabolism? 4 examples?

Process of building larger molecules using smaller ones + ATP CONSUMES E R- Requires energy A- amino acid biosynthesis G- Glycogen storage G- Gluconeogenesis

Define transudation

Process of fluid leaving vascular space due to high hydrostatic pressure No ∆ in cell spacing

Red-free filter is for?

Produces a green beam for examination of the optic disc for: pallor minute vessel changes recognition of retinal hemorrhages, with blood appearing black

Describe development of leukocytes

Production: -both produced in BM - both develop from CFU-L stem cells (common ly. progenitor) Maturation -B cell= bone marro -T cells= thymus

Describe chronic inflammation and what 3 things occur at the same time?

Prolonged process: (weeks to months) Occur at same time: -active inflammation -tissue destruction -attempted healing

Describe plasma composition

Proteins= 7% water= 91% other solutes= 2%

Specific gravity

Provides an assessment of the capacity of the renal tubules to concentrate or dilute urine. Results depend on hydration + kidney function

Acute inflammation is characterized by? ("REE")

R- Relatively short duration (minds, hours, days) E- Exudation of fluid and plasma proteins (edema) E- Emigration of WBC, particularly neutrophils ( AKA granulocytes) to the site of inflammation

Describe autosomal recessive patterns? ("RUB HM")

R- reccurrnce risks for a carrier couple is 25% U- Unaffected parent B- both genes affected by pathogenic variants H-horizontal pattern with one generation affected M- More common in specific ethnic groups and consanguinity

How to perform a breast exam? (3/6)

Re-inspect PT in the following positions: Arms up over head Hands on hips/ or pushed together Seated and leaning over Recumant ***perform last

Water retention is regulated by what and how`

Regulated through thirst perception and ADH secretion ADH Causes" -INC H2O reabsorption (distal convoluted tubules of kidney) -Sec. when plasma vol DEC or [plasma] INC -osmolality receptors sense INC [plasma] and vol depletion

Standard Precautions include what five things? ('"SHRPS")

Safe injection practices Hand hygiene Respiratory hygiene/cough etiquette PPE: use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated exposure Safe handling of potentially contaminated equipment or surfaces in the patient environment.

Describe formation of the blood clot

Secondary hemostasis -involved TFs, activated platelets, clotting system/ coagulation cascade firbrin Process: complex cade in which fibrin is ultimately produced that acts like glue to hold and reinforce platelet plug

Sebaceous hyperplasia

Small bumps 1-3 mm. Can be flesh colored or yellow. Telangiectasia and central umbillification. Can be confused with BCC ut are soft on palpation and can express small amounts of sebum

Small aperture is for?

Small pupils, always started with this aperture

When palpating the patient's thyroid gland, what what's a normal finding?

Small, smooth, symmetrical, and free of bumps Right lobe can be as much as 25% larger Rise w/ ease upon swallowing It may be palpated from in front or behind the patient, but facing the patient facilitates the correlation of inspection with palpation findings.

Skin tag

Soft, skin colored growth that hangs from the surface of the skin on a thin piece of tissue called a stalk. Cannot turn into skin cancer.

Somatic vs Germline/ Gonandal mosaicism

Somatic - somatic cells affected-->expresses disease -Germline NOT affected -CAN'T pass it on Germline/ Gonandal -somatic cells NOT affected--> no expression. -Germline IS affected. -CAN pass it on

Describe the S3 sound

Sometimes heard during the first stage of diastole: ventricular filling sound may be heard if volume of blood being transferred is large Can be normally heard in: -Children, <40 year adults, and in 3rd term of pregnancy Best heard with bell

Describe an Click sound?

Sound produced when valves are thickened, roughened, stenosed or diseased o Ejection click -Semilunar valve o Mid-late nonejection systolic click -Mitral prolapse o Pulmonary ejection: best heard on expiration in 2nd L ICS o Aortic click: less sharp, less involved with S1 may be heard 2nd R ICS

Milia

Special lesion, Minute epidermoid cysts lined with epidermis and filled with keratin, thought to result from pilosebaceous or eccrine sweat duct plugging

Purpura

Special lesion, Reddish-purple lesions resulting from extravasation of red blood cells from cutaneous vessels into skin or mucous membranes, non-blanching

Blaschko Lines

Special lesion, Single or multiple lines of normal skin cell development that are invisible under normal conditions; however, they become apparent when some diseases of the skin or mucosa manifest, look like swirls or wave-like shapes and occurs in a wide variety of congenital and acquired skin conditions

Receptive aphasia (Wernickes Aphasia): o Expressive Aphasia (Brocas Aphasia): i. Vertigo:

Speech disorder that causes fluent, often rapid, and effortless nonsensical speech with good inflection and articulation. Words are often malformed or invented. Speech disorder that causes non-fluent; slow, laborious speech with few words. Inflection and articulation are impaired, but words are meaningful with nouns, verbs, and adjectives. A sudden internal or external spinning sensation, often triggered by moving your head too quickly.

Large aperture is for?

Standard for dilated pupil and gen. exam

true

T/F: bivalent, quadrivalent, or 9‐valent HPV vaccine for females aged 11 to 12 for the prevention of cervical, vaginal, anal and vulvar cancer, and genital warts

false quadrivalent or 9‐valent HPV vaccine in males aged 11 or 12 years

T/F: bivalent, quadrivalent, or 9‐valent HPV vaccine for males aged 11 or 12 years

False hormone-negative, tripple negative, or HER2-postive are more likely to have a complete response to neoadjuvant tx

T/F: Pts w/ hormone receptor-positive are more likely to have a pathologic complete response to neoadjuvant chemotherapy than those w/ hormone-negative, tripple negative, or HER2-postive

False - not necessarily o the key to cellular transformation is to acquire deregulated balance of proliferation and death or apoptosis.

T/F: cancer proliferates faster than their normal counterparts

Corticosteroids

TOPICAL ONLY, first-line treatment, can be used as monotherapy or with other topicals, UV light, and/or systemic agents. (see * and ** below), avoid use on face, groin, axilla and breasts, generally fewer local adverse effects than vitamin D analogs

What's the appropriate exam technique to examine external ear? (2nd part) ("TP")

Test hearing bilaterally -whisper test while occluding opposite ear Perform otoscopy -finger strut -inspect ear canal, TM, bony landmarks -ID findginds

What's shifting dullness?

Tests for ascites (increase fluid in the peritoneal cavity) + test= will have pateitn dullness border shift midline

What's Murphy sign

Tests for cholecystitis (inflamed gallbladder) + test= patient abruptly stops inhalation or gallbladder is tender to palpation

lipoma

Texture is your clue. It feel like what they are, collections of fat under the skin. Most common benign mesenchymal neoplasms in adults Composed of mature white adipocytes. Painless, slow growing mass of subcutaneous tissues of the trunk, neck, or extremities.

Normal thyroid gland findings (from class obj)

The Thyroid should be small, smooth, and free of any bumps. Symmetrical. Right lobe can be as much as 25% larger than the left. Glands should rise with ease upon swallowing. Should not be painful to the touch.

Describe tonicity

The ability of an extracellular solution to make water move into or out of a cell by osmosis

Define Virulence

The degree of pathogenicity as indicated by the case fatality rates and or the ability of the organism to invade host tissues

○ Tumor location, size and level of tumor invasion (T) ○ Absence or presence and extent of nodal metastasis (N) ○ Absence or presence of systemic metastasis (M)

The elements used for staging: o T o N o M

Describe the auscultatory procedures

The environment should be quiet Place the stethoscope on the naked skin (clothing obscures the sound) Listen not only for the presence of sound but also its characteristics. The sounds are often subtle or transitory, and you must listen intently to hear the nuances. Closing your eyes may prevent distraction and help you focus on the sound. Auscultation should be carried out last

Describe the anatomy of the eye-External

The eye is made up of the external eye and internal eye. External structures include: the eyelid, conjunctiva, lacrimal gland, eye muscles, and the bony orbit. There are four rectus and two oblique muscles attached to each eye.

Prognosis:

The likely outcome or course of a disease; the chance of recovery or recurrence

Define osmosis

The movement of water through a selectively permeable membrane into an area of higher solute concentration

Lateral epicondylitis of the elbow

The patient describes pain with the arm and wrist extended. For example, common complaints include pain while shaking hands, lifting objects, using a computer mouse, or hitting a backhand in tennis

Coagulation Inflammatory Migratory/proliferative Remodeling

The phases of wound healing

Angelman's Syndrome can happen how?

The same situation as PWS, but when the mom's is missing

Define and describe epigenetics. Types? ("DR H")

The study of heritable ∆s in gene expression or phenotype caused by mechanisms BESIDES ∆s in DNA sequences • Epi modifications can cause people with the same genes (twins) to have different diease profiles • 3 major types: DNA Methylation RNA Based Modification Histone modification

What does density have to do with percussion tone?

The tone of the percussion note is dependent upon the density of the medium The more dense the medium, the quieter the percussion tone.

o Decorticate (A): oDecerebrate (B):

The upper arms are held tightly to the sides of the body. Elbows, writs, and fingers are flexed, and the feet are plantar flexed The arms are fully extended with forearms pronated. The wrists andfingers are flex, the jaw is clenched

Melanosomes

The variation in the degree of skin color is due to variations in

2. Type II

There are 4 types of heterogeneity: _____- heterogeneity among the cells of the primary tumor

1. Type I

There are 4 types of heterogeneity: _____- the heterogeneity of tumors that occur among different patients

3. Type III

There are 4 types of heterogeneity: ______- heterogeneity of metastatic lesions

4. Type IV

There are 4 types of heterogeneity: _______-heterogeneity among the cells of each metastasis that develops as they grow

Describe gram positive bacteria

They have an inner cytoplasmic mbn thick outer peptidoglycan. They stain purple because the crystal violet is trapped. Cocci X: staphylococcus aureus, streptococcus pyogenes Rods X: Bacillus cereus, Clostridium difficile, Listeria mono

Thymic education

This is the process by which T cells "learn" to distinguish between 'self' and non-self antigens. only 2-3% pass test

Physical blocking sun screen

Titanium dioxide; zinc oxide Unlikely to cause allergy or irritant contact dermatitis Nano-particle size developed so less "white" on the skin. speculation about nano-sized titanium dioxide infiltrating through the skin to affect systemically Not seen with zinc oxide. Studies limited.

Cure:

To heal or restore health; a treatment to restore health o The medical community considers many cancers "______" when doctors cannot detect cancer 5 years after diagnosis. But recurrence after 5 years is still possible

SL o topical clobetasol o +/- minoxidil & triamcinolone

Treatment for Alopecia Areata

Hydroquinone 3% solution o azelaic acid 20% cream o tretinoin

Treatment for Melasma

Spirochete and acid fast rod Gram + blunt-end rod

Treponema pallidum Mycobacterium tuberculae Clostridium botulinum

What are 4 non-mendelian inheritance? (TIMM")

Trinucleotide repeats ( fragile X, Huntington D) Imprinting (PWS) Multfactoral Mitochondrial (MELAS)

CN 4 5 6

Trochlear Trigeminal Abducens

What's the order of the cardiac valves?

Try Pulling Mi Arm

What are Korokoff Sounds?

Turbulence of blood flow in the artery.

Mild: topical Abx and Benzoyl peroxide gel Topical retinoids Moderate: Add PO Abx (minocycline) Use isoretinoin to prevent scar Severe: Add systemic isoretinoin or glucocoriticosteroids can be used

Tx for Acne Vulgaris

Liq. N o 5-fflourouracil topical o liquimod o Lasers

Tx for Actinic keratosis

Monitoring versus surgical excision with narrow margins.

Tx for Dysplastic nevi

-assume infection and treat empirically: o FQ or o 3rd/4th gen cephalosporin: Cefepime

Tx for Febrile Neutropenia

1st: No formal Tx but, Top. Clindamycin +/- Tetra/doxy/augment

Tx for Hidradenitis Suppurativa

o Rehydration and volume replenishment o glucocorticoids o bisphosphonates for long term tx o Calcitonin for immediate treatment

Tx for Hypercalcemia

o aggressive hydration to increase urine output o Hemodialysis o allopurinol to block uric acid production o Rasburicase degrades uric acid into allantoin

Tx for Hyperuricemia / Tumor Lysis Syndrome

o Stop shaving or laser it o top. Retinoids, eflornithine

Tx for Pseudofolliculitis Barbae

-manage airway -restore flow of SVC (stent) -final tx would be addressing the underlying malignancy

Tx for Superior Vena Cava Syndrome

Surgical excision/ drainage

Tx for epidermal inclusive cyst (sebaceous cysts)

PT with focus on IT band and hip stretch. Ice & NSAIDs for pain. Steroid injections can be considered.

Tx for greater trochanteric bursitis?

o Nondisplaced or minimally (<1mm) displaced: -Thumb spica cast Displaced: -Surgery: open reduction and fixation

Tx for scaphoid fracture?

Sunburn

UVA/B radiation-induced skin inflammation and activity in the epidermis and dermis involving cytokines, neuropeptides, nitrous oxide, prostaglandins, ROS, and altered protein expression; increased blood flow in superficial and deep vascular plexus causes redness, temp increase

Define transudate

Ultrafiltrate of plasma containing DEC protein and specific gravity <1.012 resulting from hydrostatic pressure imbalance across vascular endothelium Fluid is pushed through capillaries due to high pressure within capillary

Alopecia areata

Unknown · Association with other autoimmune diseases (addison's disease) · 10-20% of persons have a familial history · Follicular damage occurs in anagen followed by rapid transformation to catagen and telogen. Then do a dystrophic anagen status. · Age of onset: young adults, <25 y/o, children are affected more frequently. Can occur at any age

GA-body development - Tanner stage-

Used to denote level of puberty for both females and males in five stages ranging from preadolescent to adult.

Using the Insufflator- ear

Used to evaluate the mobility of the tympanic membrane to identify if fluid in the middle ear. Only perform if suspect an infection Speculum must form an airtight seal. Gently squeezes the bulb. The ™ will move towards middle ear and then back. No movement will be seen if perforated or tubes present. Use a Valsalva technique if seal is poor.

What are the Gram- RODS

VERY Vibrio cholerae E. coli Rickettsia rickets Yersinia pestis

CN 10 11 12

Vagus Spinal accessory Hypoglossal

Discuss vellus hair and lanugo.

Vellus Hair: short fine, hair that mostly covers the body. Lanugo: first hair to be produced by the fetal hair follicles.

Describe Vesicle and Bullae? size? Examples?

Vesicle- circumscribed collection of free fluid up to .5 cm Bullae- circumscribed collection of free fluid >.5 cm *blister like chicken pox, herpes

Describe: Blood-borne Transport Angiogenesis

Via hematogenous, malignant cancer cells crossing blood vessel walls and entering circulation where they can be transported elsewhere in the body tumor BV formation

EBV Epstein-Barr Virus

Virus that Causes: 1. Hogdkins Lymphoma 2. Burkitt's lymphoma 3. Nasopharyngeal carcinoma 4. Immune deficiency _____lymphoma - HIV-associated non-Hodgkin's lymphoma - Post-transplant lymphoproliferative disorder

HHV-8

Virus that Causes: 1. Kaposi Sarcoma 2. Primary effusion lymphoma 3. Castelman's Disease

HTLV-1 Human T-lymphotropic virus (retrovirus). "Tax" and "Rex"

Virus that Causes: 1. T-cell lymphoma + leukemias 2. Non-hodgkin lymphoma

Epstein-Barr virus (EBV):

Virus that can result in these malignancies: o cancers of the nasopharynx (mainly nasopharyngeal carcinoma) o Hodgkin disease o non-Hodgkin lymphoma o Burkitt's lymphoma, post-transplant lymphoma, T & NK cell lymphoma o HIV-ass. non-Hodgkin's lymphoma o PTLD

Bilirubin

Waste byproduct of RBC breakdown in liver High levels can lead to jaundice. Monitor to screen for liver disease, biliary tract integrity, hemolytic anemia.

Thiazide Diuretics

Weak diuretic (acts on DCT) by inhibiting Na - Cl cotransporter. Increased Na & water excretion thereby decreases ECFV. Promotes Ca++ reabsorption.

Describe how a child can have Prader-Willi Syndrome and what are the symptoms? ("SHSHM")

When kids are missing gene activity that normally comes from dad dad's copy is missing (paternal imprinting, mutation, deletion) OR When there are 2 copies form mom (uniparental disomy PWS) Signs: S-Short, Obese H- Hypotonia S-Small hands/feet H-hypogonadism M-Mild-mod retardation

What's Rovsing sign

When the LLQ is palpated, pt feels pain in the RLQ Could indicate peritoneal irritation/appendicitis

Describe a pathological S4 Gallop sound?

When the ventricle is stiff and non-compliant, the pressure wave gradient generated as the atria contract generates this sound -Usually it's pathologic due to increased resistance to ventricular filling following atrical contraction

How to perform a breast exam? (4/6)

With PT seated, Palpate both breasts' -4 quadrants -nipples and areolae -chest wall sweep -lymph nodes:

Single treatment;

____ ______used as an alternative to surgery for treatment of intracranial lesions.

Gardasil-9

_____ coverage includes HPV types 6, 11, 16, 18, 31, 33, 45, 52, 58 causing up to 90% of cervical cancers o Also been proven to protect against anal cancer and anal intraepithelial neoplasia caused by these strains.

Home care

_____: Caregiver is often a family member, partner, friend, or neighbor, but may be hired privately or through an agency. More for help with IADLs like grocery shopping, cooking, etc. Often must pay for services out-of-pocket, but if ADLs are severely impaired may qualify for Medicaid to pay.

Lifespan

______ is the # of yrs that one person lives; you only have one lifespan. Only get one!

Tumor heterogeneity The driver genes include those that provide a selective growth advantage in the face of therapy and those that provide a growth advantage during tumor evolution prior to treatment.

______- cellular populations from different sections of the same tumor vary in many ways including growth rate, immunogenicity, ability to metastasize, and drug response. This results from genetic, epigenetic, and microenvironmental influences that cancer cells undergo during cancer progression.

Young old

______: 65-74 years

Middle old

______: 75-84 years

Aging

______: Growing older. Most authorities confine the term to the maturation and physiological changes in organ systems that occur after the 30th year of life (Oh boy, count me in!) Any physiological, cellular, or biochemical change that occurs over time rather than from injury or disease.

Medical oncology

_______ is the use of pharmacologic agents to kill cancer cells. This spans a wide range of types of drugs and types of cancers that are susceptible in various ways; utilizing MOA's that work for specific types. This is the systemic administration of chemotherapeutic drugs to treat cancer cells. Most of these drugs also affect "normal cells" as well.

Old old

_______: 85 years +

Disease

_______: A condition marked by subjective complaints, a specific history, clinical signs and symptoms, and laboratory or radiographic findings. Disease is usually objective and tangible or measurable.

Adult day care

_______: provide care to people who are disabled and/or confused or have memory loss. They socialize, eat nutritious meals, and sometimes exercise and receive health services, then return home at night. Allows caregivers time off if the person can't be left alone. Some long-term care insurance will cover, but usually paid for out-of-pocket.

PE: DVT:

_______: tachypnea, tachycardia, dyspnea, chest pain on inspiration, hemoptysis, syncope, pleuritic chest pain, cough, fever _______: leg pain, swelling, tenderness, Ddx ____: MI, pneumonia, pericarditis, pleurisy Ddx ____: bakers cyst, muscle strain, cellulitis

Gerontology

________ - the scientific study of the processes and effects of aging and of age-related diseases on humans

Iatrogenesis

________: State of ill health or an adverse event that is caused by, or is the result of, a well intended health care intervention. Most commonly, it is an adverse drug event or reaction

Debulking

_________ (surgical reduction of tumor burden) is the process in which as much as the tumor is excised but not entirely due to limitations such as when invasion of cancer tissue into vital anatomy or mass of tumor limits complete excision. One example is in palliative care in order to relieve luminal obstruction or pain from tumor growth.

Excision

_________ is the complete removal of a cancer; _______ is able to be performed before metastases occurs and when the tumor can be eliminated fully by excision.

Surgical Oncology

_________: Often the definitive treatment of cancers that do not spread beyond the limits of surgical excision. Also indicated for relief of symptoms, such as those caused by tumor mass obstruction or obstructive pain. types: debunking and excision

Age-associated disease

_________: Pertaining to conditions that vary with different stages of development or years of life. Susceptibility of a given disease that increases/ higher prevalence in the older population; thought to be associated w/ chronic proinflammatory state (CA, DM, CVD, osteoarthritis, Alzheimer's, Parkinson's)

Home health care

_________: home health agency coordinates skilled nurses, home health aides, and/or therapists who provide in-home services such as assessments, treatment, training for the person or their caregiver. Goal is to allow person to remain at home or return home sooner after hospitalization. May also be used in the setting of an adult foster home, residential care, or assisted living facility. Requires physician referral.

Established Incontinence

__________: addressed after "transient" causes have been uncovered and managed properly. Risk factors for "established" incontinence include older age, female sex, increased BMI, and limited physical activity.

Causes of hyperuricemia- 2 mechanisms Over producers Under excretor

______________ - Individuals who OVERPRODUCE uric acid ® overly metabolizing purines - >800 mg uric acid in 24 hrs ________________ - Individuals who DO NOT EXCRETE uric acid efficiently ® build up in kidney and intestines

M ● M0 ● M1

_____category tells whether there are distant metastases (spread of cancer to other parts of the body) ____: No distant metastasis (cancer has not spread to other parts of the body) ____: Distant metastasis (cancer has spread to distant parts of the body)

P53

_____is a driver mutation. Gene _____ causes an autosomal dominant disorder called Li-Fraumeni syndrome (LFS).

T: extent of tumor TX T0 Tis T1-T4

____category describes the original (primary) tumor. o ___: Primary tumor cannot be evaluated o____: No evidence of primary tumor o____: early cancer that has not spread to neighboring tissue o____: Size and/or extent of the primary tumor

Define degeneration

a breakdown in cell structure that leads to someone loss of F not cell death BC it may be reversible

Define effector

a cell/tissue/organ that acts in response to a stimulus cells that act in response to injury

Describe Pustules? size? Examples?

a circumscribed collection of leukocytes and free fluid varies in size white heads, folliculitis, impentigo,

Describe Atrophy

a depression in the skin resulting from thinning of the epidermis or dermis

Describe an Erosion Will there be scaring when it heals?

a focal loss of epidermis don't penetrate below dermoepidermal junction and therefore heal without scarring

Describe a thrill?

a palpable murmur that feels like vibration/purring signifies turbulent blood flow Associated w/: -an audible murmur (grade 4/6) -congenital abnormalities (VSD) -Valvular abnormalities Best felt w/ ulnar surface of bP

melanin

a pigmented polymer that absorbs UV light

olecranon

a process on the ulnar bone (elbow)

Describe an antigen:

a toxin or foreign substance which induces an immune response. They are molecules recognized by lymphocytes

26. Describe the etiology, clinical presentation, diagnostic work-up, and initial management of the following inflammatory and infectious disorders of fascia and muscle:

a.Fourniers gangrene b.clostridial myonecrosis (aka gas gangrene) c.necrotizing fasciitis

17. Describe the etiology, signs and symptoms, physical exam findings, diagnostic work up, laboratory findings, patient education, management and complications of the following life-threatening dermatoses:

a.drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DRESS) b.erythema multiforme c.Stevens-Johnson syndrome d.toxic epidermal necrolysis

18. Describe the etiology, clinical presentation, diagnostic work up, laboratory findings, prevention, patient education, management and complications of the following sebaceous and sweat gland disorders:

a.hidradentitis suppurativa b.rosacea c.perioral dermatitis d.acne vulgaris e.acne conglobata f.epidermal inclusion cysts (previously sebaceous cysts) g.sebaceous hyperplasia

20. Describe the etiology, clinical presentation, diagnostic work up, patient education, management and complications of the following benign lesions

a.keloids b.dermatofibroma cseborrheic keratosis d.skin tags (acrochordons) e.pyogenic granuloma f.cherry angioma g.milia H.lipoma

27. Describe and discuss the following dermatologic diagnostic and therapeutic procedures including their indications and patient education:

a.shave b.punch c.excisional d.incisional e.Mohs surgery f.electrodesiccation g.cryotherapy

24. Describe the etiology, genetic contribution*, clinical presentation, diagnostic work up, laboratory findings, patient education, management and complications of the following pigmentation disorders:

a.vitiligo b.melasma c.[oculocutaneous] albinism* d.post-inflammatory hyperpigmentation e.acanthosis nigricans

Auscultation should be carried out last, except with ____ examination

abdominal examination Listen before you touch

Dysplasia

abnormal development or growth of cells, tissues, or organs

paresthesia:

abnormal or unpleasant sensation resulting from injury to 1+ nerves · patients will describe a numb, tingling, prickly, stinging or burning sensation

Define anoxia

absence of O2 caused by an obstruction (clot)

apnea

absence of breathing

Define edema

accumulation of fluid within the interstitial spaces May be localized or generalized

Describe aggregation

activated platelets release granules which stimulate further platelet activation and inhale the hemostatic process -clotting cascade (turns fibrinogen--> fibrin)

Describe pulse rate/rhythm

adult normal is 60-100, down to 50 for athletes and those on beta blockers. Rhythm can be irregularly irregular or regulary irregular.

Acanthamoeba castellani

affects CNS ingestion of trophozoite found in lakes and water, they invade via the nasal cavity and directly invade the brain causing necrotic lesions Sx:term-107 headaches, fever, nausea

anti- (i.e. antibiotic)

against

contra- (i.e. contraindicated)

against or not

sinuses

air spaces in cranium that lighten the skull and serve as voice resonating chambers

Describe caseous necrosis

aka "cheesy" combo of coagulative and liquefactive necrosis waste not fully digested by hydrolyses. Tissue's soft, granular and cheesy like often due to TB/ fungus infection

Describe fat necrosis

aka "fat saponification" (breast tissue caused by cellular enzymes and lipase breaking down triglycerides into free FA they then combine with Ca, Mg, and Na--> soap Tissue appears chalky and white occurs in breast, pancreas, ab structures caused by damage to tissue (X car accident)

Describe discontinuous sound- rales

aka crackles excess secretion in small airways

Describe the eponychium and paronychium

aka cuticle- pushes up and over the lower part of the nail body the soft tissue surrounding the nail border

Cerebrum-

alert and oriented, graphesthesia, stereognosis tests

Murmur- Location

anatomical landmarks area of greatest intensity, usually area

Describe gibbus deformity

anterior colapse of 1 or more vertebrae causing kyphosis

spondylolisthesis

anterior slipping of one vertebra on the vertebra below o Occurs when the vertebrae shift forward due to instability from the pars fracture

When palpating the ears, palpate the ____and _____ area for tenderness, swelling, and nodules.

auricles and mastoid

Describe apical pulse -

auscultated on L 5th intercostal space (2 inches below nipple), 'point of maximal impulse'

bullous pemphigoid

autoimmune disease IgG autoantibodies target proteins in skin, resulting in blister formationusually in the elderly. Interaction between autoantibody & BP antigen in hemidesmosomes followed by complement and mast cells activation (-) Nikoslky

Successful aging:

avoidance of disease and disability, the maintenance of high physical and cognitive function, and sustained engagement in social and productive activities.

degloving:

avulsion type injury where the skin is pulled back, just like it sounds; secondary to trauma

aneurysm

ballooning of a weakened portion of an arterial wall

pre- (i.e. prenatal)

before

ante- (i.e. anteflexion)

before, forward

frontal lobe

behavioral control, thinking planning

low-pitched sounds are heard best using the _______ side of the stethoscope examples

bell murmurs and bruits over arteries

inferior (sub) (infra)

below

flexion

bending

Radial deviation → Ulnar deviation →

bending of the wrist towards the thumb bending of the wrist towards the pinky

inter- (i.e. intercostal)

between

Define rhinitis/rhinorrhea -

bilateral mucoid or purulent discharge

Define mydiases

bilateral pupillry dilation usually >6mm in diamet

Define miosis

billateral pupillary constriction usually <2 mm in diameter

Define hematochezia? hematemesis? melena?

bleeding from upper GI producing red stool emesis of blood passing dark digested blood through the anus

Flea bites

bloodsucking ectoparasites with saliva that produces papular urticaria in sensitized individuals, pupae can lie dormant for months

cyano-

blue

Define astigmatism

blurred vision caused bby misshapen cornea or lens

oste/o

bone

bilateral

both sides

encaphal/o

brain

mast/o

breast

Define mastalgia -

breast pain

-pnea (pneumo-)

breathing, air, lungs

Describe afferent lymphatic vessels:

bring lymph, potential pathogens/antigens to get screened by lymphocytes in the lymph node. Enters the peripheral/cortical portion of lymph nodes.

Physical findings in the eye that may indicate the presence of- thyroid disease

bulging eyes aka exophthalmos, periorbital edema, tremors in closed eyelids, lid lag (sclera is exposed above iris when patient looks down)

Define proptosis/exopthalmos

bulging og the eye anteriorly out of orbit

Reticular layer

bulk of dermal tissue, large collagen fibrils organized into bundles w/ surrounding elastic fibers

How does primary active transport function? X?

by creating a net positive charge outside the cell that's used to power processes X: Na/K pump

How does secondary active transport function? X?

by using energy from other processes like primary active transport to move shit against concentration gradients x: glucose transport

Describe multipotent stem cell

can develop into more than one cell type, more limited than pluripotent.

Human herpesvirus type 8:

can result in the following malignancies: o Kaposi sarcoma (present in 100% of all Kaposi's tumors) o Pleural-effusion lymphomas o Castleman's disease

chondr/o

cartilage

intervertebral disks

cartilaginous material between vertebrae

Etiology

cause of disease

Oxygen-derived free radicals do what

cause the destruction of CMs and cell structure

incision:

caused by a clean, sharp-edge object like a knife, razor

Cutaneous mycoses-epic

caused by dermatophytes Epi -distinguished according natural habitats: Anthroprophilic- on human skin Zoophillic- on animal skin Geophilic- in soil Trans via infected skin scales

cerebr/o

cerebrum

cervic/o

cervix

Describe Eosinophils

characteristic of immune reactions mediated by IgE and parasitic infections

Cutaneous mycoses- clinical sig

characterized by itching, scaling skin patches Common: onychomycosis- T. unguium athlete's foot- T. pedis scalp ringworm- T. corporis jock itch- T. cruris

steth/o

chest

atopic dermatitis

chronic inflammatory skin dz, wide range of severity, affects 20% of kids, 3% adults. Thought to be caused by genetics (60-80%), skin barrier dysfunction, impaired immune response, &/or environment (food cause is uncommon).

synovial fluid

clear joint fluid that acts as a lubricant

limbic system

collection of structures with no firm consensus of what it includes; long-term memory, olfaction, behavior, motivation, emotion

col/o

colon

chromo-

color

Mini-Cognitive Assessment Instrument

combo of Clock Draw Test (CDT) + 3-Item Recall Quick, easy, and essentially rules out dementia if both components normal (~80% sensitivity) More useful in poorly-educated or non-English speakers, who may perform poorly on MMSE.

Describe dry gangrene

commonly result of coagulative necrosis skin dries, shrinks (wrinkles) and color ∆s from dark brown to black

secondary infection of excoriations; potential provocation of asthma

complications from bedbugs

corneal damage, fluid and electrolyte problems, nutrition problems, secondary infection (bacteremia, sepsis). Acute life-threatening reactions characterized by extensive necrosis and detachment of the epidermis and mucosal surfaces

complications with Stevens-Johnson syndrome/Toxic Epidermal Necrolysis

severe cases may involve the mucous membranes of the airway and lead to interference in breathing/eating. Corneal involvement may lead to ulcerations and possible blindness (VERY rare)

complications with erythema multiforme

-osis, iasis

condition of

subluxation:

condition where articular surface of joint has been displaced but there's still some contact between the articular surfaces (partial dislocation)

Define strabismus

condition where eyes are misaligned, both eye don't focus on an object at the same time but can focus with either eye

Define constipation? dysphagia? globus?

condition which bowel movement are infrequent or incomplete difficulty swallowing the sensation of having a lump in the throat

Describe hypsopdias? Epispadias?

congenital defect. Urethral meatus located on ventral side of glans penis congenital condition where urethra opens on top of penis

temporomandibular joint TMJ

connecting point of lower jawbone and temporal bone

tetany

constant muscle contraction

Slow infections and carrier-states viral pathogenesis

continuous low level of viral productions which translate to a prolonged incubation period followed by progressive disease true pathogen is carried by a healthy individual and passed to other individuals where it results in disease

When palpating the skin, how it feels should range from___ to ____

cool to warm to the touch

kerat/o

cornea of eye

Describe sputum

coughing up and spitting out mucus produced in the respiratory tract when lugs are diseased acute- infection chronic- significant anatomic ∆ tumor, bronchiecrasis

hemoptysis

coughing up blood

theca

covering or sheath of a tendon

crani/o

cranium (skull)

Physical findings in the eye that may indicate the presence of-Hypercholesteremia

creamy white appearance of retinal vessels aka Lipemia Retinalis

Kinin System and 4 F

creates a vasoactive peptides fro plasma proteins (PIC B) F: P-Pain I-INC VP C-Contraction of smooth muscle B-BV dilation Bradykinn effects similar to histamine

Kussmaul respirations Associated with?

deep, labored, rapid breathing A type of hyperpnea. Associated with metabolic acidosis

Abnormal/ pathologic split of S2- Paradoxical split

delay in A2 closure -separate during exp -sound close together on inspiration CX: left bundle branch block

Describe intracellular parasites

depend on the host cell for energy (ATP & NAD+) - grow in cytoplasmic vacuoles - round to ovoid organisms which have an envelope resembling gram negative bacteria Ex: Chlamydia pneumoniae

Murmur- Pitch

depends on pressure and rate of blood flow H, M ,L

fossa (ae)

depressions or hollows

asteatotic dermatitis (eczema craquele)

dermatitis superimposed on xerosis; common in elderly during winter months; often results from hot baths or drying soaps. pt will present with dry, fissured pruritic skin with fine scales often in pretibial area of legs but may also be on arms or trunk

-olysis, -olytic, -olyzed

destruction, to separate out

-trophy

development

Describe progenitor cell:

develops into myeloid and lymphoid cells. See chart what each can develop into.

-ography

diagnostic procedure

high-pitched sounds are heard best using the _______ side of the stethoscope examples are?

diaphragm heart, lung and abdominal

Varicocele

dilated varicose internal spermatic veins findings: scrotal mass, may often inc in size w/ valsalva

Describe direct central vision assessment

distance assessed with the Snellen chart @ 20 ft nearsight with Rosenbaum @ 14" recorded as fraction

When palpating, the ulnar surface of the hand and fingers is best for what?

distinguishing vibration bc most sensitive

Delirium: o Dementia: oDepression:

disturbance in mental abilities that results in confused thinking and reduced awareness of the environment a group of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities is a mood disorder that causes a persistent feeling of sadness and loss of interest

Define pulsus bisferiens

double pulse per cardiac cycle is appreciated sign of aortic regurgitation

Define Otorrhea -

drainage from the ear; cerumen drainage is normal, but any blood or CSF could indicate serious head trauma

Define ptosis

drooping of the upper eyelid

Signs and symptoms of breast disease: Mass

duration, skin changes, texture?

family history of atopy, xerosis, elevated serum IgE, repeated skin infections.

dx workup for atopic dermatitis

ot/o

ear

myring/o

eardrum

tympan/o

eardrum

What's Cullen sign?

ecchymosis (bruising) around umbilical area Could be indicative of hemoperitoneum (blood in peritoneum), ectopic pregnancy, pancreatitis

hinge joint

elbows, knees, fingers

Nodule x?

elevated firm deeper in the dermis erythema nodosum, lipoma

Mass X?

elevated solid deeper in dermis >2cm neoplasm, benign tumor

Cyst X?

elevated, cirumscribed, liquid or semisold in dermis or subcutaneous sebaceous cyst, cystic acne

Describe pluripotent stem cell

embroyoic stem cell is considered this, can make any cell in the body.

epiphysis:

end part of a long bone

"Facies" most commonly occurs in what kind've patients?

endocrine conditions but can include congenital and infectious among others;

Bacterial adherence to host cells

enhances virulence by preventing bacteria from being removed by mucus or organ fluid flow= bacteria can form microlonies Ways: -pili -fimbriae -cell surface adhesions molecules - hydrophobic cell wall

Define gynecomastia -

enlargement of "pubescent male breasts" (usually benign)

Define lymphadenopathy

enlargement of the lymph nodes Localized: suggests regional infection or disease Generalized: suggests a systemic inflammatory, infectious, or malignant process

Define goiter-

enlargement of the thyroid gland, commonly found with thyroiditis

DNA viruses

enter the host cell's nucleus and are replicated and assembled there

nephro

entire kidney

reno

entire kidney

What's a normal CVP upon JVD assessment?

equal/less than 9cm of H2O

When palpating, the dorsal surface of the hands is best for?

estimating temperature.

seborrheic dermatitis

etiology: · Hereditary diathesis, but Malassezia furfur may play pathogenic role signs/sx: · Gradual onset of itchy, scaly scalp · May be itchy PE: · Orange-red or gray-white skin, often with "greasy" or white dry scaling macules, papules · Scalp = dandruff · Will be more scattered and discrete on the face (can be behind ears, nasolabial folds, eyebrows, glabella, bears mid sternum & intertriginous areas too)

Lichen planus

etiology: · Mostly idiopathic · Cell-mediated immunity plays major role tho · . Per patrick's lecture: autoimmune, medication rxn signs/sx: · Main sx: Pruritus (itching) · Violaceous (purple), flat topped, polygonal papules · Wickham striae · Worse with trauma (Koebnerizes) PE: · Flexural aspects of arms, legs - can become generalized; can be on genitals · In mouth, milk-white reticulated papules; may becomes erosive & ulcerate · May have scarring alopecia & destructive nail changes as well

Psoriasis

etiology: · Polygenic trait · 28x normal production of epidermis cells · T cell-driven disease - CD8+ T cells signs/sx: · Chronic, recurring papules and plaques PE: · Erythematous plaques with silver scale in elbows, knees, scalp, lower back, buttocks, palms/soles, or inverse psoriasis in underarms & groin

Pityriasis rosea

etiology: · Reactivation of human herpesvirus-7 and HHV-6 is the most probably cause signs/sx: · One primary "herald patch" lesions is the first to start on trunk · 1-2 weeks later generalized rash (can look very similar to guttate psoriasis) · May be itchy PE: · Herald patch: salmon-red plaque with scale that is attached at periphery and loose toward the center of the lesion · Rest of rash is in dull pink or tawny, oval, scattered, in a "christmas tree" pattern on the back · Follows the lines of cleavage, confused to trunk and proximal aspects of the arms & legs · Rarely on face

basal cell carcinoma

etiology: UV Radiation P53 gene mutation Originates in basal keratinocyte S/SX: Waxy or pearly papule or nodule w/central scab or erosion. Edge with rolled border. Present in sun-exposed areas (common on nose, forehead, periocular area), w/wo central depression

cholecystectomy

excision of the gallbladder

hemorrhoidectomy

excision of the hemorrhoids

oophorectomy

exicision of the ovary

A/P diameter

expected: diameter should be < 1/2 lateral diameter abnormal: Increased a/p diameter (barrel chest)

Define supernumerary nipple/s -

extra nips along embroyonic "milk line"

Hyperextension

extreme or abnormal extension of a joint, f usually the result of trauma, increased muscle tone, joint adhesions, or congenital formation

ophthalm/o

eye

Describe peyronie disease

fibrous band in corpus cavernosum scar tissue interferes w/ erection Could possibly from trauma,inflammation, or inherited

Pemphigus vulgaris

flaccid serous filled vesicles and bullae on skin (easily erupted) randomly scattered and discrete. Erosions bleed easily. Scalp erosions may crust. Occurs on mucosa, scalp, face, chest, axillae, groin, umbilicus. Bedridden pts occurs on back.

lamina (ae)

flattened part of the vertebral arch ( thinnest part of vertebrae)

aponeurosis

flattened tendon; resembles a membrane that attaches muscle to bones or tissue

-orrhea

flow or discharge

Describe hydrocele?

fluid accumulation in scrotum from defect in tunica vaginalis findings: swelling around testicle is soft, fluctuant, ovoid, and non-tender

31. Discuss the following types of topical preparations used in the treatment of dermatologic conditions:

foams creams lotions gels ointments

post- (i.e. postpartum)

following, after

When Inspecting and palpating the gingivae and buccal mucosa, what 3 things should you look for?

for color, lesions, and tenderness

Describe the S4 sound

forceful atrial ejection into distended ventricle -Atrial contraction required to make sound normal: heard in a well-conditioned athlete usually abnormal though

Describe paraphimosis

foreskin is retracted and can't moved back over glans

Dx anaerobic bacteria

foul-smelling discharge, gas, necrotic tissue, abscess formation, the unique morphology of certain anaerobes on Gram's Stain, and failure to obtain growth on aerobic culture despite the presence of organisms on Gram-stained direct smear.

Cryotherapy

freezing with liquid nitrogen - Indications → small superficial nonmalignant lesions e.g. genital warts, actinic keratoses, thin seborrheic keratoses, lentigines, molluscum contagiosum - Procedures → administered with a direct spray or contact probe with an autoclavable tip - Patient Education → scarring is minimal with superficial freezing, cosmetic results are equal to or better than those obtained with electrodessication and curettage

dis- (i.e. disease)

from

Mitochondrial inheritance

from Female to all kids males can't transmit

carcinoma in situ

full thickness dysplasia of epithelium no spread or growth under basement not malignant

Stage 3: decubitus Ulcers.

full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through underlying fascia stage?

Single-stranded RNA viruses

genetic material either directly translated in host cell by their ribosomes or replicated by proceeding through dbl stranded intermediates IOT avoid cellular response

When palpating the patient's thyroid gland, it requires a ___ touch. Why?

gentle Nodules and asymmetry will be more difficult to detect while pressing too hard.

Define Induction

giving rise to something neighboring cells/tissues

Define oncogene

good= proto-onco gene bad= causes uncontrolled cell growth-> cancer

Define pallor/ rubor / cyanosis

gradation of loss of skin tone, turning white/grey/blue

spinal cord -

grey matter=cell bodies, white matter=myelinated axons; sensory innervation enters via dorsal side, ventral side controls motor movements

pulsus bigeminus:

groups of two heartbeats close together followed by a longer pause. Basically a normal pulse followed by a PVC. Second pulse (PVC) is weaker than the first. Caused by irregular rhythm.

-plasia

growth (cell)

physis:

growth plate

Describe the hair follicle / shaft

hair consists of a root and a shaft, which sit in a follicle at the base of the follicle the papilla contains capillaries that supply nourishment for growth Melanocytes in the follicle synthesize pigment giving hair its color Adults have both vellus (short, fine, soft and nonpigmented) and terminal hair (coarser, longer, thinker and usually pigmented) The same of the hair follicle directly related to the shape of the hair (straight vs. curly)

Define torus palatinus-

hard palate with a bony protuberance at the midline - benign finding - more common in women

cephalo

head

cephalic

head (similar to superior)

While some sounds can be heard "grossly," which is..., others require augmentation with a?

heard with only the ears stethoscope

Describe abnormal splitting of the S2 sound

hearing during EXPIRATION is abnormal common: paradoxical split fixed split

cardi/o

heart

GA-body development- body habitus

height / weight / proportionality Overweight vs Anorexic appearing? BMI help indicate if proportionate but be cautious with people with overdeveloped muscles as they may have a high BMI.

-cele

hernia, swelling

singultus? reflux? gastroparesis? eructation? borborygmi?

hiccups! backwards flow (often in the context of indigestion) delayed/slowed gastric emptying burping stomach rumbling

Describe Bronchial sounds

high pitched, hard to hear over manubrium if heard at ll

Describe tracheal sounds

high pitched, harsh heard over trachea and neck

hyper- (i.e. hypertension)

high; too much

ball and socket joint

hip and shoulder joints

transverse (trans-)

horizontal body plane, divides body into top and bottom sections; across or through

low-cobalt diet (?); emollients to preserve skin barrier; avoidance of potential allergens/irritants

how to prevent Pompholyx Dyshidrotic eczema

topical corticosteroids (except for on face)

how to treat Irritant contact dermatitis

1. topical corticosteroids (mid-high potency); o topical calcineurin inhibitors: tacrolimus o Emollients o oral antihistamines o phototherapy w// cyclosporine may be useful for recalcitrant cases

how to treat Nummular (discoid) Eczema

do not require tx but topical corticosteroids and oral antihistamine helpful for pruritus; eradication from pt's living space

how to treat bedbugs

Oral antihistamines to stop itching, topical corticosteroids

how to treat papular urticaria

drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DRESS)

idiosyncratic adverse drug reaction, occurs within 1-12 weeks of starting new medication or increase in dose; commonly anticonvulsants and sulfonamides,abx, NSAIDs, anti-HIV, anti-TB

ile/o

ileum (small intestine)

Band Neutrophil

immature neutrophil (normally takes 14 days to mature) process expedited in infection serves as a QRF

Describe the function of leukocytes

immune and inflammatory responses

Hyperplasia

increase in tissue/organ BC of increase in NUMBER of cells

Describe Albumin

increases osmotic pressure carrier protein helps liquid from leaking out of BV

Tactile fremitus increase?

increases when lung density increases caused by consolidation of lung tissue

oral contraceptives I looked up "Estrostep"

indications: Acne vulgaris in females with androgen excess or acne flares with menses contraindications: women at high risk of arterial or venous thrombotic diseases. Hypersensitivity adverse effects: increased sex hormone binding globulin, edema, HA, abdominal pain, Mastalgia, increased blood sugar patient education: This drug works best when used with calcium/vitamin D and weight-bearing workouts like walking or PT (physical therapy).

benzoyl peroxide (Benzac AC)

indications: Acne vulgaris, acne rosacea contraindications: hypersensitivity adverse effects: 1-10%: contact dermatitis, desquamation, erythema, skin irritation, stinging of skin, xeroderma patient education: May take up to 8 weeks to see effect of medication.

keratolytics - salicylic acid

indications: Acne, Dermatitis, hyperkeratotic skin disorders contraindications: hypersensitivity, some interactions with specific brands of SA adverse effects: CNS, confusion, dizziness, HA, localized burning & irritation. Desquamation, exfoliation of skin, tinnitus, and hyperventilation patient education:

topical antibiotics - clindamycin (Cleocin T), erythromycin, metronidazole (Metrogel)

indications: Acne, bacterial vaginosis contraindications: hypersensitivity adverse effects: (topical) xeroderma, oily skin, erythema, burning sensation of skin, exfoliation of skin, pruritus patient education: Often used with benzoyl peroxide

isotretinoin (Accutane, Claravis)

indications: Acne, severe nodulocystic acne vulgaris Resistant to treatment contraindications: Pregnancy - teratogenicity; hypersensitivity adverse effects: Mucus membrane dryness, cheilitis, dry eyes, blepharoconjunctivitis, epistaxis, xerosis patient education: it can lead to depression

Lowest potency hydrocortisone

indications: Anal/genital itching Inflammatory/pruritic corticosteroid-responsive dermatoses Hemorrhoids contraindications: Hypersensitivity Limited use only in geriatric ptts

oral antibiotics - tetracycline, erythromycin, minocycline

indications: Severe acne contraindications: Hypersensitivity adverse effects: Exfoliative dermatitis, nail discoloration, pruritus, skin photosensitivity. Fungal infection, super infection patient education:

diascopy

indications:A discolored lesion. clinical usefulness:Determining if a lesion is blanchable or not. collection procedures: Press a microscope slide or magnifying glass over the lesion. Observe. interpretation: If the discoloration goes away with pressure it is blanchable. Hemorrhagic lesions are nonblanching. Blood filled lesions without bleeding blanch.

Cryptosporidium spp

infected feces water asymptomatic-mild diarrhea/ab pain immune- severe diarrhea

Define paronychia

infection of the lateral nail fold (often purulent)

Subcutaneous mycoses and epi and CS

infections on dermis, subcutaneous, and bone trans: traumatic/ puncture wounds NO HUMAN-HUMAN CS: most commonly confined to tropics X: mycetoma sporotrichosis, chromomycosis,

-itis

inflammation of

Define Lymphadenitis? Lymphangitis?

inflammation of LN(s) inflammation of lymphatic vessel red streaking

In order: 1. Topical retinoids: tretinoin 2. Benzoyl Peroxide 3. Use of topical antibiotics such as erythromycin or clindamycin.

initial therapy for an adolescent with mild comedonal acne

Describe adhesions

initiated by loss of endothelia cells -this releases collagen and vWF -vWF and fibrinogen deposit to site -platelets adhere to site

avulsion:

injuries in which a body structure is forcibly detached from its normal point of insertion- a type of amputation; also 'degloving' is used as a synonym

What's stridor?

inspiratory wheeze partial trachea/larynx obstruction seen commonly in forein body aspiration, croup

-ograph

instrument (or machine) that records

-otome

instrument for cutting thin section

-oscope

instrument for looking into

-ometer

instrument that measures or counts

Subcutis/Panniculus (AKA hypodermis)

insulates; reserve energy supply; cushions and protects skin; allows for mobility over underlying structures; mostly adipose tissue; actively growing hair follicles, apocrine and eccrine sweat glands live here; blood vessels and nerves

Palpation of the orbit is one of the simplest methods for what?

intraocular pressure assessment

Define inversion/eversion of the nipple -

inverted nipples are tucked inward, most are everted

Define nystagmus

involuntary, repetitive eye movement

Describe the fibrous organization

involved: fibrin mesh -fibrin strings connecting the platelets will contract and shorten -leads to closure of the wound -increase strength in clot

Formation of the platelet plug

involved: vWF, fibrinogen, and platelets involves the adhesion, activation, aggregation of platelets into a plug that serves as a barrier against blood flow -exposure to extracellular matriculates, vWF (from sub endothelial collagen), and fibrinogen will activate platelets to form platelet plug

irid/o

iris (eye)

laceration

irregular tear-like wounds caused by blunt trauma

Life expectancy at age x

is defined as the average # of yrs remaining to be lived by a member of a survivorship group who is exactly age x from a specific starting point., using the age-specific mortality experience of the current population. Your life expectancy changes as you grow older and face different risks.

Discuss the reason for obtaining blood pressure measurements in both arms

is important both for accurate BP detection and for cardiovascular risk stratification. It should be taken from both arms at least one time for a new patient. Normal variant between arms is 5-10 mm Hg with Right arm tending to be higher.

2. Peritoneal dialysis:

is the "dialyzer"; dialysate instilled into peritoneal cavity via indwelling catheter. Can be done continuous ambulatory (CAPD) 4-6x per day or continuous cyclic (CCPD) done every night. Allows for patient autonomy but removes large amounts of albumin. Peritonitis is a common complication.

Describe plasma

it's PRE-CLOT liquid extracellular component after centrifuge before clotting if it clots than it becomes serum Major proteins: in 2 classes: albumin and globulin

Describe the clotting cascade

it's a series of reactions divided into 3 pathways -intrinsic -extrinisc -common

What is GA? Name some things it includes?

it's the initial assesment made by a provider during an encounter includes: facia expression affect body habitus stature apperance of illness speech alterations, clothing gender stage of life comfort or distress odor

pruritus

itching

jejun/o

jejunum (small intestine)

nephr/o

kidney

ren/o

kidney

A second tier of precautions, Transmission-Based Precautions, are designed to supplement Standard Precautions in the care of patients who are?

known or suspected to be infected by epidemiologically important pathogens that are spread by airborne or droplet transmission or by contact with dry skin or contaminated surfaces.

Stupor: o Lethargy:

lack of critical mental function and a level of consciousness wherein an affected person is almost entirely unresponsive and only responds to stimuli such as pain. Can also respond to some verbal stimuli (think alcohol intoxication) A state of weariness that involves diminished energy, mental capacity, and motivation.

MOI: hypoxia

lack of sufficient oxygen causes decreased ATP production in mitochondria, failure of NaK pumps, and a cascade of cellular disaster

Define amastia / polymastia -

lack of/accessory breast(s)

acetabulum

large socket for head of femur (hip)

laryng/o

larynx (voice box)

meniscus

lateral and medial knee cartilage

Describe efferent lymphatic vessels:

less efferent vessels than afferent-important because this slows down the rate of filtration, allows time for immune cells to screen the lymph. Efferent vessels are found in lymph nodes, spleen, and thymus

lichen simplex

lichenified scaly plaque with excoriations often on scalp, extensor surfaces, anogenital regions, leathery

bio- (i.e. bioethics)

life

Pectus carinatum

like Tad

-oid

like, similar to

Leishmania spp

live in macrophages transmitted by bite of sandfly c-> oriental sore espunida

hepa, hepat/o

liver

You can also use your fist for percussion. Fist percussion is most commonly used to elicit tenderness arising from the?

liver, gallbladder, or kidneys

hypo- (i.e. hypotension)

low; not enough; under

sigmoid/o

lower portion of colon

Describe Hypotonic

lower solute than a cell Water moves into a cell

pneum/o

lungs

decubitus

lying down

recumbent

lying down

Describe Waldeyer's ring

made of 3 LNs Pharyngeal, Palatine, and Lingual. Together they form a circle at the entrance of gut and airway.

Describe coagulative necrosis

mainly occurs in kidney, heart, & adrenal glands caused by: denaturation of protein albumin -∆s it from gelatinous to transparent firm commonly caused by: hypoxia (2* ischemia) chemical injury

When palpating the tongue, any ulcer, nodule, or thickened white patch on the lateral or ventral surface of the tongue may be suggestive of?

malignancy

Describe Lymphoid tissue

many organs that play a role in production/maturation of lymphocytes loc: -Thymus -BM -LN -Spleen -GALT (gut-ass. LT) -MALT (Mucossa-ass.LT) 1* organs: thymus, BM 2* organs: the rest

poly- (i.e. polyuria)

many, much

Presentation: Most common types of melanomas seen in these individuals are acral lentiginous melanomas. These occur as dark, irregularly shaped lesions in non sun-exposed areas like on the palms, soles and nails. Causes for difference in presentation: Darker skinned individuals have larger and more dispersed melanosomes, confers more photoprotection and reduces the risk of skin cancers.

melanoma in dark skin individuals

Presentation: Greater affects lightly skinned individuals (skin phototypes I & II). Mostly seen in sun exposed areas: sun, neck, trunk Causes for difference in presentation: melanosomes are smaller and grouped within a membrane --> less photoprotection against UV rays

melanoma in white skin individuals

The common pathway

merges both pathways as factor X is used to create thrombin from prothrombin. -factor X is activated (either way) it activates prothrombin -converts it to thrombin using factor V thrombin cleaves fibrinogen--> fibrin--> clot

Hydroquinone can be used (not effective in all cases of PIH)

mgmt Post-inflammatory hyperpigmentation (PIH)

Excision. Procedure depends on location/severity: Cryotherapy Electrodissection / curretage

mgmt for Bowen disease

Penicillin Some recommend adding clindamycin

mgmt for Clostridial myonecrosis (aka gas gangrene)

Aggressive fluid resuscitation, early surgical debridement and broad spectrum antibiotic therapy.

mgmt for Fournier's gangrene

Symptomatic management. Treat associated disorder. Topical keratolytic and systemic retinoids my improv but overall not effective

mgmt for acanthosis nigricans

o cryotherapy o 5-flurocouracil (Efudex) chemotherapy cream o imiquimod, ingenolmebutat gel, topical retinoids, diclofenac gel, facial peels for larger surface areas.

mgmt for actinic keratosis

No treatment available. Patients should see ophthalmologist and a dermatologist regularly

mgmt for albinism

Procedure depends on location/severity: Excision or Mohs

mgmt for basal cell carcinoma

Ulcer care: cleansing, debridement, dressings, address moisture and treat infection. Position patient to avoid pressure over existing ulcers and bony prominences. Pain management, nutritional management and surgery can also be implemented.

mgmt for decubitus ulcer

Surgical treatment only if they are changing (growth, color, bleeding) or become spontaneously painful. Do not go away on their own. Nodules remain for life.

mgmt for dermatofibroma

1st line: Corticosteroid injections (intralesional Triamcinolone): for earlobe keloids, locations of mid-sternal region. Given every 2-3 weeks at least 4 times PRIOR to surgery. 2nd line: intralesional 5-fluorocuracil, silicone gel sheets, pressure therapy, cryotherapy.

mgmt for keloids

immediate excision, there is adjuvant chemo and immunotherapy for metastatic

mgmt for malignant melanoma

surgery, radiation, or chemotherapy. Lymph node dissection if spread.

mgmt for paget disease

Surgical/excision-laser therapy Topical and systemic beta-adrenergic receptor antagonists- Timolol and propranolol

mgmt for pyogenic granuloma

No treatment needed (benign) Cosmetic management: cryotherapy, curettage or laster therapy liquid nitrogen

mgmt for seborrheic keratosis

excision, Mohs micrograph surgery, cryotherapy, topical chemotherapy

mgmt for squamous cell carcinoma

Leg elevation, compression stockings, emollients, mid potency topical glucocorticoids and avoidance of irritants. Wet compresses may aid in healing erosions or ulcers if present.

mgmt for stasis dermatitis

Sunscreen, cosmetic coverup, topical steroids, tacrolimus, topical/systemic photochemotherapy, regimentation PUVA therapy, narrow band UVB.

mgmt for vitiligo

· exfoliative cytology:

microscopic exam of cells shed from the surface · · Ex) Cervix, lung sputum, urine

Describe protozoa

microscopic, singe celled -can multiply in humans -classified on movement and site of infection -X: FACS F-flagellates A- ameba C-Ciliates S- Sporozoa 2 stages: dormant immotile stage: permits survival Motile actively feeding

medial

middle

When palpating the patient's trachea, look for?

midline position

pemphigus vulgaris

more prevalent in Jewish population. Autoimmune disorder, where antibodies attack desmosomes causing loss of cell-to-cell adhesion in the epidermis (acantholysis). usually starts in oral mucosa, it may take months for skin lesions to manifest. NO pruritic. Burning and painful erosions - oral erosions may prevent adequate food intake. Epistaxis, hoarseness, and dysphagia. Weakness, malaise, weight loss

Signs and symptoms of breast disease: Retraction -

more than just an inversion, tissue is pulled further in or to the side

Giardia lamblia

most common Dx parasitic intestinal disease in US -ingested from drinking contaminated water s: foul smelling watery diarrhea

Describe fibrinoid necrosis

most commonly seen in rheumatic heart disease Ab fighting infection cross-react w/ glycoproteins in heart, joints, and others--> autoimmune causes lesions in heart called Aschoff bodies

stomat/o

mouth

Define chemotaxis

movement of leukocytes towards injury site because of a chemoattractant can be exogenous (bacterial products) or endogenous (leukotrienes/ cytokines)

my/o

muscle

ad- (ie, adduction)

near, toward

proximal

nearest to center

metaphysis:

neck, between diaphysis and epiphysis

neur/o

nerve

radiculopathy:

nerve root damage characterized by: · lower motor neuron s/sx such as hyporeflexia, atrophy, weakness · sensory disturbances like numbness/tingling sensations (paresthesia), burning sensations (dysesthesia), & shooting (radicular) pain

Papillary layer

no more than 2X thickness of epidermis, separated from reticular by plexus of blood vessels

keratolytics salicylic acid

no specific FDA indication, limited evidence for use of this monotherapy in treating psoriasis, may enhance the efficacy of topical corticosteroids when used in conjunction

Does breast cancer usually have pain?

no. it's usually painless only about 10% of cases reported pain

Hearing the physiologic splitting of the S2 is?

normal on inspiration Abnormal on expiration -can be normal bc A2 and P2 are separated by <30 ms -usually heard as one sound though

Define emmetropia

normal vision condition when parallel rays are focuses exactly on the retina and vision is perfect

Tumor suppressor gene

normal: -repair DNA errors -initiatte apoptosis -slow cell division bad: -causes cancer when turned off

rhin/o

nose

hypo- (i.e. hypodermic)

not enough, low or under

Nummular (discoid) Eczema

not really known, more common in adulthood, some retrospective correlation with HCV infection, xerosis, environmental allergen exposure

Pompholyx Dyshidrotic eczema

not really known, occurs spring and fall mostly, may be brought on by stress. pt will present acute explosive outbreak of vesicles and bullae on palms and soles resembling "tapioca" that may be painful or pruritic

What is Resting pulse

number of heart beats per minute while at complete rest (taken while patient is resting- seated or in supine position in a comfortable environment)

parasthesia

numbness and tingling in extremities

Describe glomerular filtration

o 1ststep in making urine that Separates plasma from blood cells o How? 3 layers -Endothelial layer · Large pores where solutes, plasma proteins, and fluid can pass through. Not blood -Basement · Fused to endothelial layer · Prevent plasma proteins from leaving -Epithelium · Podocytes attached to basement membrane by foot processes · Filtration slits act as a final filtration barrier before fluid enters glomerular space

PT education on risk factors for cancer

o 30% of all cancers in US linked to tobacco (80% of lung cancer cases occur in smokers) o skin cancer MC type. Use SPF 30. reapply every 2hr o PT: 150 min of mod. 75 min of intense o BMI <25

2* metastatic malignancy risk Quality of life

o 60% of pre- and peri-pubescent females treated with radiation for Hodgkin's disease developed breast cancer. o @ least 1/3rd of the >14million survivors in the US face physical, mental, social, job, or financial problems related to their cancer

remission:

o A decrease in or disappearance of signs and symptoms of cancer. o In complete ______, all signs and symptoms of cancer have disappeared, although cancer still may be in the body and could recur

Paraneoplastic syndrome -

o A group of symptoms that may develop when substances released by some cancer cells disrupt the normal function of surrounding cells and tissue. These are often due to tumor marker behaviors: example: prostate tumors secrete prostate specific antigen into the blood which causes other effects.

· rectocele

o A hernial protrusion of part of the rectum through the posterior vaginal wall

· Sprain

o A joint injury in which some of the fibers of a supporting ligament are ruptured by the continuity of the ligament remain intact

· Subluxation

o A partial dislocation

Describe Humoral immunity

o Abs circulates in blood and binds to Ags on infectious agents -Ab binding kills in 3 ways: · Blocks Ag activity · Marks Ag for phagocytosis · Activates the complement system which directly kill some bacteria and activates immune system

Cell volume maintenance

o An increased solute gradient inside the cell will increase cell volume o Water will follow where the highest concentration of solutes are o An increase in extracellular solute concentration will pull water outside the cell to maintain the concentration gradient o Results in decreased cell vol

Sarcoma (malignant)-

o Arising from connective tissues, like bone, soft tissue, muscle (i.e., rhabdomyo_____ is a malignant cancer of skeletal muscles; rhabdomyoma when benign)

Adenocarcinoma (malignant) Adenoma (benign)-

o Arising from ductal/glandular structures (i.e., mammary ______ from breast glandular tissue)

Define normal flora

o Assemblage of microbes constituting a microbial community and occupying a specific habitat o Protective o Varies widely by body site and impacted somewhat by age, sex, diet nutrition, early developmental changes, puberty etc.

Locally Advanced Disease of breast carcinoma

o Axillary adenopathy, Skin findings—erythema, thickening, dimpling

creatinine - serum and urine

o Better than BUN o Rises later than BUN o Minimally affected by hepatic function o suggests chronicity of Dz o Inversly related to GFR o As GFR decreases by 1/2, this doubles

ARB

o Block AT1 receptors (blunting Aldosterone) overall helps sodium and water excretion. o 1st line for CKD (similar mechanism to ACE above).

ACE i

o By blocking _____, less Aldosterone makes it back to the Kidney to stimulate Na and water reabsorption. o Renal protective (1st line for patients with CKD). less Ang. II to constrict efferent arteriole helps decrease glomerular capillary pressure preserving endothelium.

Lymphoma-

o Cancer arising from lymphatic tissue

Carcinoma:

o Cancer arising in epithelial tissue 1. Adeno (glandular) breast, colon, prostate 2. Basal Cell (basal layer of epidermis) 3. Squamous cell (SCC) head and neck, cervix 4.Transitional cell - urothelium, bladder, ureter, kidney

Leukemia-

o Cancer of blood-forming cells

Late effects of cancer tx

o Cardiac issues o Metabolic syndromes o Secondary malignancy o Osteoporosis, insufficiency fractures

· Dislocation

o Complete separation of the contact between 2 bones in a joint

· Neuropathy

o Damage to a nerve that causes weakness, numbness and pain

Benign neoplasms

o Differentiated cells o Slower growth rate o Encapsulated o No metastasis o Non-invasive o Can cause harm: impact the function of the organ of origin o Name typically ends in -oma

Dysplasia -

o Disordered proliferation/growth with loss of cellular uniformity and architecture

Describe how Erythropoiesis is controleld

o During hypoxia, stimulation of receptors on the kidney/liver to release glycoprotein erythropoietin As levels rise, an increase in proliferation and differentiation of proerythbloasts occurs in bone marrow

BUN

o End product of protein metabolism and digestion o Rough measurement of kidney function o Less useful than GFR

Describe estimation of glomerular filtration rate

o GFR is a measure of kidney function o Estimated by serum creatinine limitations: -production of creatinine differs among/within people over time

Describe presence of hematuria and/or proteinuria

o Glomerulonephritis -Inflammation of glomeruli-->sudden onset of hematuria and proteinuria o Diabetic kidneys-->protein in urine

24 hour spot urine

o Goldstandard test but too $$$$

BUN : Creatinine ratio

o Helpful in determining cause of renal impairment o >20:1= pre renal, early post azotemia o <10:1= intrinsic renal, late postrenal

Describe continuous sound- WHEEZES

o High pitched, musical, hissing o Suggests narrowed smaller airways o X: asthma, COPD, bronchitis

Steady state

o Homeostasis o Balance requires energy to maintain o Multiple variables with multiple outcomes o Has higher level of energy than its surroundings

Abdominal CT

o Indications: Further investigation of masses found on ultrasoundor IVP. o Use: Non-contrast can detect hemorrhage or stones.contrast for neoplasms, cysts, renal vessels and ureters and masses. NOT GOOD for screening prostate cx, but can stage it.

Intravenous pyelogram (IVP)

o Indications: eval for urinary tract using contrast: Kidneys, ureters and bladderCTs and ultrasound more common now o Use: Medullary sponge kidney, papillary necrosis

Describe an Rub sound?

o Inflammation of the pericardial sac cuases a roughening of the parietal and visceral surfaces, which produces a rubbing machine-like sound\ o Used to diagnose pericarditis

Describe tubular reabsorption and secretion

o Initiated in thick ALoH -Na and Cl are removed · out of tubular lumenàmedullary interstitium -H2O is retained · BC thick ALoH is impermeable to H2O, H2O cannot follow the NaCl transportàhow it's retained -Fluid becomes more and more dilute as it enters distal tubule -The longer the loopsàthe greater H2O absorptionàgreater [piss]

Creatinine clearance

o Insensitive indicator of early renal insufficiency o Dec as GFR decreases

Phosphorus

o Inverse relationship with Ca2+ Vital for energy production, acid/base buffer, muscle/nerve function, bone maintenance Assess kidney disease, PTH or calcium disorders

Normal physical findings in the examination of the Mouth- lips:

o Lip symmetry is expected o No lesions should interrupt the vermillion border between the lips and facial skin o Lip surface should be smooth and free of lesions

Metastatic Disease of breast carcinoma

o Most common sites—bone (pain), liver, lungs

Normal physical findings in the examination of the Nose- nasal cavity:

o Nasal mucosa should be free of masses, abnormal discharge, lesions, glisten and appear deep pink o Nasal septum should be aligned, non-perforated, with often a film of clear discharge o Turbinates should be firm and same color as surrounding area

Describe a bruit, indicate the significance of its presence and discuss the common locations to assess for bruits.

o Normal arteries are patent silent o Abnormal arteries have turbulent blood flow and will create a sound o May be associated with a pulsatile mass and be indicative of an enlarged aorta signaling a potential aneurysm Auscultate w/ bell at these Locations: o Carotid (have pt hold breath while seated) o Abdominal aorta (the rest in supine) o Iliac o femoral o renal

Describe lymphatic obstruction

o Occurs when lymphatic channels are blocked because of infection or tumor o Proteins and fluids aren't reabsorbed and accumulate in the interstitial space o Causes lymphedema o Can occur in arm/leg after surgical removal of axillary or femoral lymph nodes during treatment for cancer

· Fracture

o Partial or complete break in the continuity of the structure of bone

Long term effects of of cancer tx

o Peripheral Neuropathy o Fatigue o Anxiety/ Depression/ PTSD o Cognitive dysfunction o Other (pain, dental problems, dysphagia, lymphedema, bowel/bladder ∆, sexual dysfunction, premature menopause, sleep disturbance, financial toxicity)

"no-man's-land" of the hand:

o Portion of the hand occupied by muscle tendons of flexor digitorum superficialis muscle & flexor digitorum profundus · called this nick name because injury to this area historically resulted in poor healing outcome · area from distal metacarpals to intermediate phalanges

What are central lymphoid organs

o Primary/Central lymphoid tissues are sites of antigen-independent lymphocyte generation and differentiation into mature naïve cells: o bone marrow for B cells; bone marrow and the thymus for T cells

Normal physical findings in the examination of the Mouth- buccal mucosa, teeth, and gums:

o Proper tooth occlusion o Upper molars should fit into the groove on the lower molars and premolars and canines interlock fully o Mucous membranes should be pinkish red, smooth, and moist o Stenson duct should not be swollen o Gingivae should be coral pink in white patients and more hyperpigmented in other races with a slightly dotted pink appearance and be free of induration, thickening, masses without tenderness o Gum surface beneath dentures should have no inflammation, swelling or bleeding

Normal physical findings in the examination of the Mouth-tongue:

o Protruded tongue should be maintained at the midline o No atrophy or fasciculations should be present o Tongue should appear dull red, moist, glistening with a smooth yet roughened surface with papillae and small fissures anteriorly and a smooth, slightly uneven surface (rugae) with thinner mucous posteriorly o Ventral surface should be pink, smooth, with large veins between frenulum and fimbriated folds o Free of nodules, ulcerations or areas of indurations

Risk factors for Breast carcinoma

o Race - white o Age: older o FHx: breast CA in parent, sibling, or child (especially bilateral or premenopausal) o Genetics: BRCA1, BRCA2, or other mutations o PHx: endometrial CA, proliferative forms of fibrocystic dz, CA in other breast o Menstrual hx: early menarche (under age 12); late menopause (after age 50) o Reproductive hx: Nulliparous or late first pregnancy Lifestyle (from lecture): Alcohol consumption, obesity, tobacco

Normal physical findings in the examination of the Throat-tonsils:

o Same pink color as the pharynx o Usually able to fix tonsillar pillars o Should not be red, hypertrophied, or covered with exudate

Normal physical findings in the examination of the Nose- external nose:

o Skin should be smooth w/o swelling and conform to the color of the face o Columella should be directly midline (width should not exceed the diameter of the naris) o Nares oval and symmetrically positioned o No discharge o Nasal structures should feel firm and stable to palpitation o Nasal breathing should be noiseless o No tenderness

Normal physical findings in the examination of the Throat- pharynx:

o Smooth, glistening, pink mucosa with some small, iirregular spots of lymphatic tissue and small blood vessels o Expect bilateral gag reflex response

Classic Mammography Findings of breast carcinoma

o Spiculated, soft tissue mass with clustered microcalcifications

· Strain

o Stretched/ torn muscle/tendon

Describe cellular immunity

o T cells differentiate during immune response into several different subtypes that react directly w/ Ag on their surface Develop into: · Helper T-cells (CD4) "CD4 is here 4 u" o Help T cells kill and B cells develop in to plasma cels · Cytotoxic T cells (CD8) "CD8 terminates" o Attack & kill targets directly

fractional excretion of sodium (FENa)

o Tests reabsorptive function of kidney using Cr, Na+, and spot urine

· parity

o The # of completed pregnancies (viable or not) o > 24 weeks

1. If pt can't bear weight for 4 steps, check for: 2. Tenderness @ posterior edge of the medial/ lateral malleolus and 3. tenderness over the navicular (medial midfoot) or @ base of the 5th metatarsal if any--> get XR

o The Ottawa Ankle Rules IOT Dx w/u pt for Ankle sprain (inversion)

β blockers

o They may inhibit JG cells from releasing Renin (amongst B1B2 adrenergic antagonist duties). o By blocking RAAS upfront, the effects of Angiotensin II and Aldosterone are blunted. Efferent Arteriole Constriction Na reabsorption

Anion Gap

o To evaluate metabolic acidosis o > 12= acidodis o <10 alkalosis

Normal physical findings in the examination of the ear- otoscopic findings of tympanic membrane

o Translucent, pearly gray color o Visible landmarks should be present (umbo, handle of malleus, cone of light) o No perforations o Should be slightly conical

Neoadjuvant:

o Treatment given as a first step to shrink a tumor before the main treatment, which is usually surgery, is given. Examples of this therapy include chemotherapy, radiation therapy, and hormone therapy. It is a type of induction therapy. o Done BEFORE primary (induction) treatment

Malignant neoplasms

o Undifferentiated cells o High growth rate o Unencapsulated o Capable of metastasis o Invasive o Primary tumor and metastasized disease can cause harm o Name typically ends in -carcinoma or -sarcoma

· Urethrocele

o Urethral prolapse into the vagina due to weakening of surrounding tissues

PCL injury of the knee

o Usually follows an anterior trauma to the tibia, such as a dashboard injury during a motor vehicle accident. o The knee may freely dislocate and reduce. o 1/3 of multi-ligament injuries involving the ____ have neurovascular injuries. o Hyperextension

Epstein-Barr virus (EBV):

o Virus that affects B cells and causes lymphoproliferation and infected cell expression of LMP1 (latency associated integral membrane protein)

principles by which viral infection leads to malignant transformation

o Viruses enters a host cell & begin to make proteins that interfere with normal cell functions, enabling cell to grow in an uncontrolled manner & avoid apoptosis. o Infected cells are usually recognized/eliminated by immune system. If infected cells are not destroyed, persistent infection results. o As persistently infected cells grow, they may develop mutations that promote even more cell growth, leading to formation of a high-grade lesion & ultimately a tumor.

Define immunocompetent cell

o a mature T/B cell able to recognize a particular Ag and trigger an immune response

Describe fixed splitting of the S2 sound

o a wide splitting of the A2 and P2 that DOES NOT VARY w/ respiration o X: -Atrial septal defect and RV failure

Oblique - Decubitus - Supine - Prone -

o between lateral and AP (or PA) o lying horizontal o lying on the back o lying face down

· cyanotic cervix

o bluish color indicates increased vascularity, which may be a sign of pregnancy.

cystourethroscopy

o camera up your urethra and go look into the bladder. o Indication: evaluation of lower urinary tract o Adverse effects: pain, infection

· ectropion

o cervical ectropion occurs when eversion of the endocervix exposed columnar epithelium o common in adolescents, pregnant pts, and those taking estrogen-containing contraceptives o not an abnormality, but BC it's hard to differentiate between cervical carcinoma, more tests need to be performed

descending spinal tracts - Corticospinal -

o conveys impulses to muscle groups, muscle tone, posture, precise motor movements

osteoblasts:

o create bone o form center of ossification o create solid bone

Describe paradoxic splitting of the S2 sound

o delay in closure of the A2 valve resulting in a paradoxical motion A2 and P w/ respiration o the components separate during expiration and sound closer together (as one sound)

· uterine prolapse

o descent or herniation of the uterus into or beyond the vagina

Neoplasm -

o divided into benign and malignant types based on pathologic criteria and judgement of potential clinical behavior

AP - PA - Lateral -

o from front-to-back o from back-to-front o from the side

Carcinoma in situ -

o full thickness dysplasia of epithelium but without spread

Describe a nephron and F

o functional unit of the kidney o it's a tubular structure w/ subunits that include the renal corpuscle, PCT, LOH, DCT, and collecting duct all contribute to formation of urine

· nulliparous · nulliparity

o has not carried a pregnancy to 24 weeks previously o never having completed a pregnancy >20 weeks

· multiparous

o having borne more than 1 child

· cystocele

o hernial protrusion of the urinary bladder through the anterior wall of the vagina, sometimes even exiting the introitus

Hypertrophy -

o increase in size of a tissue or organ due to increase in size of component cells

descending spinal tracts -Corticobulbar -

o innervates motor function of CN

Describe a glomerulus

o is a tuft of capillaries that form filtrate o Filters excess fluid and waste products out of the blood and into the urine collecting tubules o Using 3 layers

· multigravida

o is or has been pregnant for at least a second time o counts as single births

Anaplasia -

o lack of differentiation- hallmark of CA

osteocytes

o living bone cells o maintain bone matrix & act as mechanoreceptors o communicate with and influence action of osteoblast & osteoclasts

Describe continuous sound- rhonchus / rhonchi:

o low pitched, snoring honking sounds caused by the rattling of secretions in the large airways o Found in: -transient airway plugging (bronchitis, cystic fibrosis, bronchiectasis

postvoid residual

o measure urine left in bladder after someone attempts to empty it all the way (Ultrasound) o Indication:incontinence, obstruction

Tumor suppressor genes -

o normal genes that slow cell division by repairing DNA errors or initiating apoptosis o If impaired, cell division can progress uncontrolled o Most carcinomas begin with loss of tumor suppressor gene o Cause cancer when INACTIVATED

Describe an Snap sound?

o occurs early in diastole caused by thickene valve leaflets opening the more severe the thickening, the earlier it occurs

Describe ejection sounds?

o opening of semilunar (aortic/pulmonic) valves is usually silent o abnormal dilation/ calcification of the aortic/pulmonic valves can cause early systolic ejection as they open during systole

Describe the function of granulocytes- Eosinophils

o parasites and allergic reactions o Help regulate vascular mediators released from mast cells

· cervical stenosis

o passage through cervix (from vagina to main body of uterus) is narrowed or completely closed

· gravida

o pregnant

· friable cervix

o red patchy areas, granular areas, and white patches that could indicate cervicitis, infection, or carcinoma

Metaplasia -

o replacement of one cell type with another type in the same tissue

Double-stranded RNA Viruses

o replicates in cytoplasm o dsRNA must replicate its genome replicated to (+) ssRNA, which can be used in transcription o RNA w/in icosahedral capsid o RNA polymerase

"classic characteristics" CP for breast carcinoma

o single lesion, hard, immobile, irregular border

Erect - Cephalic - Caudal - Axial -

o standing o towards the head o towards the feet o along the axis of an anatomic structure

Define immune response

o the body's ability to recognize and respond to foregin particles and infections o Has a memory fuction with B cells

Invasive carcinoma -

o tissue boundaries (including basement membrane) have been breached

· gravidity

o total # of pregnancies

· entropion

o uterine columnar epithelial tissue is not exposed. Normal.

HPV Human Papilloma Virus 16 and 18

o virus that affects mucoepithelial cells via DNA circular genome malignancies: 1. Cervical Cancer 2. Anal Cancer 3. head/neck (tonsils, tongue, larynx)

Lewie Body Dementia

oAbnormal buildup of proteins oInsidious onset and progressive oCore feats: Parkinsonism, fluctuation in cognition impairments, vivid visual impairments o Classicaly has a fluctuating day-day quzlity o Memory/language impairments less severe <AD

puncture:

object puncturing the skin, like a splinter, nail

Describe obligate aerobes facultative anaerobes obligate anaerobes

obligate aerobes an organism that requires O2 to live/grow e.g Pseudomonas facultative anaerobes an organism that CAN live/grow in the presence or absence of O2 e.g E. coli obligate anaerobes an organism which CANNOT live/grow in the presence of O2 Clostridium

Intrinsic pathway

occurs when negatively charged molecule (i.e bacteria) contact causes a cascade of factors that produce factor X. -within blood -damaged surface Factor XII is activated, which then activates factor XI, which activated factor IX, which along with factor VIII activates factor X in the common pathway

Describe wet gangrene

occurs when neutrophils invade in liquefactive necrosis occurs in internal organs causes them to be cold, swollen and black with a foul odor and pus

Toxoplasma gondii

oocyst from infected cat poop raw/undercooked causes brain lesions, baby blindness, hydrocephaly, lymphadenopathy

Describe eccrine glands

open directly onto the surface of the skin and help regulate body temperature through sweat secretion. These glands are distributed throughout the body except at the lip margins, eardrums, nail beds, inner surface of the prepuce and glans penis. **note that eccrine glands begin to function after the first month of life

cirrh-

orange yellow

Passive/facilitated transport is driven by what?

osmosis, hydrostatic pressure, and diffusion

peripheral

outer edges

Kidney anatomy: cortex

outer layer contains all of the glomeruli most of PCT and parts of DCT

Normal flora on the skin, mouth/ URT

outer: Staph. epidermis and Staph aureus Deep: Proprionibacterium acne Nose: S. aureus, S. epidermis, Candida, diptheroids Nasopharynx: Strep. pneumonia Mouth: Streps Teeth/gums: Streptococcus mutans

oophor/o

ovary

Percussion over air is? Over fluid is? Over solid areas?

over air is loud over fluid less loud over solid areas soft.

o benzodiazepines o oldies: antipsychotics o young: antihistamine + opioid if dyspnea o address spiritual needs

palliative management of anxiety & agitation

o Address food choices, snacks sups o megestrol o Dronabinol, mota o Corticosteroids o Cyproheptadine o Antidepressants o Androgens: oxandrolone

palliative management of diminished appetite

o Senna o Osmotic laxatives: Lactulose, sorbitol, PEG products o Magnesium citrate... o Methylnaltrexone

palliative management of · constipation

o Counseling, exercise o SSRIs: fluoxetine o Tricyclics; noritriptyline o SNRIs: venlafaxine o Bupropion, mirtazapine

palliative management of · depression

o Motility inhibitors: loperamide, diphenoxylate, tincture of opium, octreotide

palliative management of · diarrhea

o Opioids: morphine o Benzos: lorazepam o Bronchospasm: albuterol, iprtropium o CHF: furosemide

palliative management of · dyspnea/air hunger

o Chlorpromazine o Baclofen o Benzodiazepines (lorazepam, diazepam) o Metoclopramide o Gabapentin

palliative management of · hiccoughs

o Haloperidol o Chlorpromazine o Metoclopramide o Synthetic cannabinoids

palliative management of · nausea/vomiting

o H1 antihistamines: diphenhydramine/hydroxizine o H2 antihistamines: ranitidine o moisturizers/ topical agents

palliative management of · pruritis

Neuropathic pain: o gabapentin and pregabalin o SSNRIs: duloxetine & venlafaxine Somatic pain: -Opioids (morphine, hydromorphone, oxycodone, oxymorphone, methadone, hydrocodone, fentanyl, meperidine / codeine)

palliative management of· pain - somatic and neuropathic

-plegia

paralysis

Cushing syndrome:

paraneoplastic syndromes: Cancer: Lung (small cell, bronchial carcinoid, adenocarcinoma, squamous), thymus, pancreatic islet, medullary thyroid carcinoma, pheochromocytoma

Hypercalcemia:

paraneoplastic syndromes: MOA: overproduction of parathyroid related peptide (PTrP) that mimic parathyroid hormone action in the kidneys, bones, and intestines resulting in _________. CP: AMS, weakness, lethargy; muscle twitching, cardiac arrhythmias; constipation, dehydration, polyuria.

Hyponatremia/SIADH (syndrome of inappropriate antidiuretic hormone secretion):

paraneoplastic syndromes: Cancer/ MOA: excess vasopressin (an antidiuretic hormone) imbalance that results in impaired water excretion Small Cell Lung Carcinoma intracranial neoplasms CP: Presentation: ataxia, fall, HA, confusion, nausea, fatigue, lethargy, coma, death.

Hypercalcemia:

paraneoplastic syndromes: Cancer: Squamous cell (head and neck, lung, skin), breast, genitourinary, gastrointestinal

Carcinoid syndrome:

paraneoplastic syndromes: Cancer: Associated with intestinal neuroendocrine tumors of GI tract or lungs

Cushing syndrome:

paraneoplastic syndromes: MOA: cortisol excess from ectopic production of ACTH or ACTH-like molecules CP: muscle weakness, hyperglycemia, hypokalemia, hypertension, central obesity

Carcinoid syndrome:

paraneoplastic syndromes: MOA: produce serotonin degradation products that lead to.. CP: flushing, diarrhea, and breathing difficulty, cardiac valvular lesions.

Lambert-Eaton myasthenic syndrome:

paraneoplastic syndromes: o disrupted communication between nerves and muscles. o is an immune-mediated, myasthenia-like syndrome with weakness usually affecting the limbs and sparing ocular and bulbar muscles.

abrasion:

partial thickness wound caused by damage to skin, can range from epidermisà dermis

Acute superficial thrombophlebitis

partial/complete occlusion of a vein due to a thrombus secondary to inflammation scaring of vessel wall -presents as tender, swollen erythematous area

- Education on proper use of medications. - Lesions take 4-6 weeks to improve (3-4 months for chest and back lesion improvement). - Avoid topical exposure to oils, cocoa butter, and greases in cosmetics. - Scaring can occur with or without manipulation of lesions. - Anxiety and depression are common in patients with excoriated acne. - Low glycemic diet has been associated with improvement and lower incidence of acne.

patient education regarding the time course of therapeutic response and need for long-term adherence to treatment regimens for comedonal acne

bed bug

patient present with papular urticaria; bites tend to occur in lines or clusters often in hotels and shelters but increasingly common in bedding and furniture of residential homes

flea bite

patient presents with papular urticaria; non-follicular groups of 3 lesions,

PE findings of hair loss pattern in male

pattern/extent of hair loss varies from bitemporal recession, to frontal and/or vertex thinning, to loss of all hair except that along the occipital and temporal margins ("Hippocratic wreath"). Onset: any time after puberty, as early as the second decade; often fully expressed in 40s. Paradoxically, men with extensive pattern hair loss may have excess growth of secondary sexual hair (ie.axillae, pubic area, chest, and beard)

pyel/o

pelvis of kidney

pyelo

pelvis of kidney

Define diplopia

perception of 2 images and may be monocular (optic problem) or binocular (alignment problem)

parietal lobe

perception, making sense, arithmetic, spelling

How does imprinting affect the phenotype?

phenotype is dependent upon which parent transmits the deleted chromosome

Intracellular and renal buffering system

phosphates ammonia+ phosphate

Epidermis (outer layer)

physical barrier, makes new skin cells, gives skin its color. -28 day cycle -Layers: Stratum corneum, granulosum, spinosum and basalis -Contains Keratinocytes (hold water in), melanocytes, Langerhans Cells

Normal aging:

physical, emotional and social changes that occur as a result of biologic aging; expected and not necessarily detrimental (i.e. gray hair). A decline in physiologic function not usually related to a disease.

-oplasty

plastic surgery on

Describe activation

platelet shape ∆s activation of arachidonic pathway

Describe formed elements

platelets= <1% Leukocytes= <1% RBC= >99%

descending spinal tracts -

prefix is always cortico- because it starts in the cortex Motor

What is Diastolic pressure?

pressure exerted by blood consistently between each contraction

Standard Precautions are designed to?

prevent the transmission of HIV, hepatitis B, and other blood-borne pathogens based on the principle that all blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes may contain transmissible infectious agents.

Moisturize skin, avoid itching and excessive washing, cover up when going out in cold weather

prevention and pt education on xerosis

treat the whole home including pets with quick-kill insecticide

prevention of flea bite

Nodule

primary lesion, > 0.5 cm palpable, solid, round, or ellipsoidal lesion that is usually found in the dermal or subcutaneous tissue - Depth of involvement and/or substantive palpability differentiates a nodule from a large papule or plaque

plaque

primary lesion, > 0.5 cm solid plateau-like elevation above the skin surface that occupies a relatively large surface area in comparison with its height above the skin, usually well-defined

Wheal

primary lesion, evanescent swelling of the skin w/ surrounding erythematous flare, papule to plaque, may have central zone of pallor

macule

primary lesion, flat, even w/ surrounding skin surface level, different color from surrounding skin, hyper- to hypo- to de-pigmented, <0.5cm diameter (patch is the same, just >0.5cm diameter)

Bulla

primary lesion, fluid-filled cavity or elevation arising from cleavage of layers of epidermis (intraepidermal) or dermal-epidermal interface (subepidermal); >0.5cm diameter; clear, serous, hemorrhagic, or pus-filled contents

Vesicle

primary lesion, luid-filled cavity or elevation arising from cleavage of layers of epidermis (intraepidermal) or dermal-epidermal interface (subepidermal); <0.5cm diameter; clear, serous, hemorrhagic, or pus-filled contents

Papule

primary lesion, solid, elevated, significant portion projects above plane of surrounding skin, <0.5cm diameter

Describe the collecting duct

principle cells -reabsorb water and Na intercalated cells -secrete H -reabsorb K

arthroplasty:

procedure done to reshape, reconstruct, or replace a diseased/damaged joint · performed to alleviate pain, permit normal function, or correct a developmental/accidental/hereditary joint defect

Electrodessication and Curettage (ED&C)

procedure used in the removal of superficial lesions. The lesion is scraped with a curette and then electrodesiccated to help control the bleeding and destroy any cancer cells that remain - Patient Education → wound may be left exposed to the air or may be covered with a bandage or light dressing, daily washing with soap and water is encouraged, may be covered bandage or gauze if desired

-ometry, -imetry

procedure using the measuring or counting instrument

Describe Leukocyte extravasion? Steps? ("MR ATM")

process by which neutrophils migrate out of blood and into tissues 1. Migration 2. Rolling 3. Adhesion to BV wall 4. Transmission across endothelium 5. Migration through interstitial tissue towards chemotactic stimulus

Describe catabolism? 5 examples? (McGOO)

process of breaking large molecules into smaller ones resulting in smaller molecules +ATP M- MAKES energy c- citric acid cycle G- Glycolysis O- Oxidative decarboxylation O- Oxidative phosphorylation

basal ganglia -

processing station, if reaching for something the pre-motor cortex plans movements → basal ganglia allow extension and inhibits flexion

bullous pemphigoid

prodromal urticarial, papular lesions and evolves in weeks to months into bullae. No constitutional sxs unless severe & widespread pruritic erythematous papular and/or urticarial lesions with large tense bullae grouped in arciform and serpiginous patterns. Bullae erupt less easily than pemphigus, then form into crusts. Localized to axillae; medial aspects of thighs, groins, and abdomen; flexor aspects of forearms; lower legs (often first manifestation), mucous membranes (less severe)

prominences, processes, tuberosities

projections

Describe Isotonic alteration

proportional ∆s in the amount of electrolytes and water no shrinking/swelling occurs

Entamoeba histolytica

protozoa- amoeba invades intestines (colon liver) transmission: ingestion oocysts patho: ingesting oocysts from contaminated food and water -feed on intestinal bacteria - invades epithelium, inducing ulceration in the colon Sx: mild diarrhea to dysentery w/ blood/ mucous in stooh

· Mgmt depends on age, type of psoriasis, site & extent of involvement, previous treatment, associated medical disorders · Options include: Corticosteroids: mid‐high potency for most areas, low potency for face and intertriginous areas (triamcinolone) topical steroids, hydrocolloid dressing, topical anthralin, Vitamin D analogue creams, combined with phototherapy

psoriasis mgmt/complications

Miliarial heat rash

pt presents with Burning, itching, superficial aggregated small vesicles, papules, or pustules on covered areas of the skin (usually the trunk)

Xerosis (dry skin)

pt presents with Itching, a dry appearance, and less commonly chapping and cracking of the stratum corneum. Dryness of the skin, particularly lower extremities as well as hands, forearms, cheeks, lips, and trunk

Allergic contact dermatitis

pt presents with itchiness that extends beyond area of direct contact with allergen; pruritic vesicular crusted lesions often developing 48-72 hrs after contact

Irritant contact dermatitis

pt presents with itchiness that occurs only in area of direct contact with irritant; erythematous and scaly rash developing within 24 hrs of contact

papular urticaria

pt presents with symmetrically distributed, pruritic 3-10mm papules (NOT necessarily confined to areas of bites), dx made clinically (though often missed because the initial bite may have gone unnoticed)

Nummular (discoid) Eczema

pt presents with well-demarcated coin-shaped plaques that may become vesicular or annular, often on upper extremities and backs of hands, VERY pruritic

Solar lentigo (lentigines)

pt will present with no symptoms usually, occasional itching and may bleed when caught on clothing; if scratched, removed tissue may look waxy. Circumscribed 1-3 cm, but up to 5 cm variegated mix of non-uniform brown macule; round, oval, with slightly irregular border; often scattered; exclusively over sun exposed areas

What is Tachycardia:

pulse of >100 bpm (note: 90-99 bpm called "elevated pulse"). Usually a normal reflex response to changes in physiologic, pharmacologic, or pathophysiologic stimuli as mediated by the sympathetic nervous system (ex. exercise, emotional upset, fever, respiratory compromise, etc.). In healthy response, tachycardia resolves when conditions return to baseline.

Opportunisitc mycoses and types

rarely affect healthy mostly immunocompromised X: PMS CC Pneumocytis jiroveci Mucorymycosis Spergillosis Cryptococcosis Candidiasis

-ogram

recording or "picture" produced by an "-ography" procedure

proct/o

rectum, anus

· surgical biopsy:

removal of a piece of tissue that can provide info regarding histology & grade · · Excisional: complete removal, usually with a margin of normal tissue · · Incisional: removal of a portion of a lesion

incisional biopsy

removal of part of the lesion - Indications → acceptable in select clinical circumstances such as facial or acral location, low clinical suspicion or uncertainty of diagnosis, or very large lesion - Procedures 1. Skin tension lines can be revealed by compressing the skin 2. A diamond-shaped or elliptical excision is outline with its long axis parallel to the wrinkle lines 3. A cut is made through the entire dermis down to the subcutaneous fat - Patient Education → instruct on proper wound care

Excisional biopsy

removal of the entire lesion - Indications → deep inflammatory diseases (e.g. erythema nodosum), malignant melanoma - Procedures 1. Draw an ellipse around the lesion to be excised, including a 2 to 5 mm margin of normal skin around the lesion - Patient Education → instruct on proper wound care

osteoclasts

remove bone (aka resorption) o large multi-nucleated bone cells derived from hematopoietic stem cells in bone marrow o remodel bone & reabsorb bone o full of lysosomes & hydrolytic enzymes o major role in mineral homeostasis

6. Medication management:

renally cleared drugs should be adjusted for GFR (insulin decreased; avoid laxatives, antacids, magnesium containing meds, phosphorus containing meds, morphine, NSAIDs, IV contrast). Diuretics, opioids and palliative care can help sx at end-of-life.

Define regeneration

replacement of lost cells and tissues no scar can occur in stable tissues

Describe: Diaphragmatic abdominal thoracic respiration

respiration via diaphragm **allows for deep breaths breathing with abs relies on intercostal's **provides shallower breaths

Describe liquefactive necrosis

results from breakdown from their own hyrolases causing tissue to become soft, liquefied, and form cysts commonly caused by ischemia during injury or bacteria (due to neutrophil releasing hydrolyses from fighting infection)

contact dermatitis

results from direct skin contact to chemicals or allergens Irritant: universal irritants like soap, detergent Allergic: poison ivy, neomycin, nickel, rubber, essential oils, adhesive tape

General examples of cellular injury related to Free radicals

results in increased degradation and decreased activity LDP: Lipid peroxidation (damage cell membrane) DNA fragmentation Protein cross-linking

Spermatocele

retention cyst of a tubule of the rete testis or the head of the epididyis finding: scrotal mass, heaviness/fullness in testicle

phleborrhexis

rupture of a vein

sacr/o

sacrum

Describe Isotonic:

same concentration No net movement of water

Epidermal Atrophy

secondary lesion that is manifested by a thinning of the epidermis, which becomes transparent, revealing the papillary and subpapillary vessels, similar to loss of skin texture and cigarette paper-like wrinkling

Dermal Atrophy

secondary lesion that is the loss of connective tissue of the dermis and depression of the lesion

Ulceration

secondary lesion, A defect in which the epidermis and the upper dermis have been destroyed, always occurs within pathologically altered tissue, always heals with scar formation

Fissure

secondary lesion, A linear loss of continuity of the skin's surface or mucosa that results in excessive tension or decreased elasticity of the involved tissue - Frequently occurs on the palms and soles where the thick stratum corneum is least expandable

Erosion

secondary lesion, Defect of the epidermis and does not involve the dermis, sharply defined, red, oozes, but heals without a scar

Crust

secondary lesion, Hardened deposits that result when serum, blood, or purulent exudate dries on the surface of the skin

Scar

secondary lesion, Proliferation of fibrous tissue that replaces previously normal collagen after a wound or ulceration breaches the reticular dermis, have a deeper pink to red color before becoming hypo- or hyper-pigmented

Atrophy

secondary lesion, Refers to a diminution of some or all layers of the skin

Excoriation

secondary lesion, Surface excavations of epidermis that result from scratching

Keloid

secondary lesion, Well-circumscribed pink to purple or hyperpigmented firm nodules or plaques

Describe gummatous necrosis

seen in late stages of syphilis these are destructive skin, bone, & soft tissue lesions appear firm, rubber-like, and swollen

Orothopnea

severe dyspnea in which breathing is very difficult in any position other than sitting erect or standing

grooves

shallow linear depressions in bone (or tooth)

What's dyspnea? Orthopnea? PND?

shortness of breath shortness of breath while laying down Paroxysmal Nocturnal Dyspnea sudden onset of shortness of breath during sleep

What's platypnia?

shortness of breath relieved when laying down worsens with sitting/standing

Describe the function of granulocytes- Basophils

similar to mast cells in allergic responses secretes inflammatory mediators (histamine, chemotactic factors 4 Eosin/Neut) involved with allergic reactions

Murmur- Radiation

site farthest from location of greatest intensity at which sound is still heard sound usually transmitted in direction of blood flow

fungal culture

skin scrapings, nails, scalp, hair, or under nail debris. Places these scrapings into a dermatophyte medium or sterile container. If it is this type of organism,__________ growth may occur -Take a long time to get back

axial

skull, thorax (ribs and sternum), vertebral column

Trypanosoma brucii sppp

sleeping sickness from tsetse fly bit bite around neck so will see @ posterior nodes 1st

brady- (i.e. bradycardia)

slow

Define Montgomery tubercles -

small bumps (sebaceous glands) on areola (arrows indicate Montgomery tubercles)

bursa

small sacs that cushion joints between tendons and bones

When palpating the patient's hyoid bone, thyroid, and cricoid cartilages, they should be?

smooth and nontender and should move under your finger when the patient swallows.

Describe vesicular sounds

soft-relatively low-pitched over most of lungs

Define hyper-osmotic

solution has a higher concentration of particles Cell volume would shrivel BC H2O will move out of cell & into solution (BC solution has a higher [ ])

Define Hypo-osmotic

solution has a lower concentration of particles Cell volume would balloon BC water will enter cell (BC solution has LOWER [ ])

Describe Hypertonic:

solution with a higher solute concentration than a cell water moves out of a cell

Describe discontinuous sound- course crackles

somewhat louder, lower in pitch, and last longer than fine -x: sound like opening Velcro fastener

Cyst

special lesion, Encapsulated cavity or sac lined with an epithelium that contains fluid or semisolid material, has a spherical or oval shape resulting from the tendency of the contents to spread equally in all directions, tends to be resilient on palpation

Telangiectasia

special lesion, Persistent dilatations of small capillaries in the superficial dermis that are visible as fine, bright, non-pulsatile red lines or net-like patterns on the skin

Lichenification

special lesion, Reactive thickening of the epidermis from repeated rubbing, resulting in accentuated skin lines,

Petechiae

special lesion, Small, pinpoint purpuric lesions

Burrow

special lesion, Wavy, threadlike tunnel through the outer portion of the epidermis excavated by a parasite

Comedone - Open Comedo = blackhead - Closed Comedo = whitehead

special lesion, is the loss of connective tissue of the dermis and depression of the lesion

Describe the apocrine glands

specialized, found only in the axillae, nipples, areolae, anogenital area, eyelids, and external ears. They secrete oily fluid containing protein, carbs, and other shizz **note that apocrine gland function does not begin until puberty.

Cimex lectularius Cimex hempitera

species of bedbugs

Define koilonychias

spoon nails

upright

standing

vertebral column

starting at the neck: cervical vertebrae (7), thoracic or dorsal (12), lumbar (5), sacral (5,fused), coccyx or tailbone (4)

gastr/o

stomach

ureterolith

stone in the ureter

Define homestasis and 3 parts

stopping blood loss in response to vascular injury Primary homeostasis: -platelet plug creation secondary hom: -coagulation -blood clot Clot organization and wound healing

ligament

strong fibrous tissue that connects bone to bone

Describe the hypodermis This layer provides what?

subcutaneous layer that consists of loose connective tissues filled with adipose. This layer generates heat and provides insulation, shock absorption and reserve of calories

For breast exam, what lymph node groups do you palpate?

supraclavicle, infraclavicle, lateral axillary, central, subscapular, pectoral

anastomosis

surgical joining of two ducts, vessels, or bowel segments to allow flow from one to another

-orrhaphy

surgical repair of

Describe a Heave/Lift

sustained palpable movements of localized areas of the precordium due to increased intensity of systolic contraction of one or more cardiac chamber -may indicate increased cardiac output or left ventricular hypertrophy

Whats' diaphoresis? Syncope? Claudication?

sweating temporary LOC pain in extremities bc of muscle ischemia

Lymphedema

swelling results from obstruction of LV or LN non-pitting

The four signs of inflammation are

swelling, pain, heat, redness

You can check the _____ blood pressure by palpating?

systolic

What is pulse pressure

systolic BP minus diastolic BP

Murmur- timing

systolic vs. diastolic if heard during: systolic, may be Tri Mi diastolic may be Pul Arm

Describe: Tachypnea bradypnea hyperventilation...resperations

tachypnea is respirations greater than 20. Bradypnea is respiration under 12. Hyperventilation is respirations greater than 20 and deep with arterial CO2 levels decreasing.

de- (i.e. dehydrate)

take away, remove

What's the heel jar (Markle ) test?

tap heel + test= abdominal pain associated with peritoneal irritation or appendicitis

dent/o

teeth

Describe Tactile fremitus

tells you about the underlying lung tissue and density

ten/o, tend/o, tendin/o

tendon

Ascending- Spinocerebellar -

terminates in the cerebellum and is unconscious proprioception

Ascending- Spinothoracic

terminates in the sensory cortex coarse touch, pressure, temp, pain; enters spinal cord dorsally and then immediately crosses over to the other side of the spinal cord and into the opposite side of the brain

orchi/o

testicle

orchid/o

testicle

What's fluid wave

tests for ascites + test= fluid wave impulse felt

What's obturator muscle test (Obturator sign)?

tests for irritation of obturator muscle can be irritated w/ ruptured appendix or pelvis abscess + test= RLQ pain= possible obturator muscle irritation which could mean ruptured appendicitis or pelvic abscess

Infectious dose and lethal dose

the # of organisms required to cause infections the # of organisms required to cause death

Hormonal function of kidney w/ vitamin D

the 2nd hydroxylation of inactive vitamin D occurs in kidney stimulated by parathyroid hormone produced calcitriol (active vitamin D) -calcitriol is needed for absorption of Ca and PO4 in Small intestine

Pronation → Plantar flexion → Dorsiflexion →

the act of lying face down (your hands are PRONE when you are dribbling a basketball like a PRO) extension of the foot so that the forepart is depressed with respect to the position of the ankle (when you PLANT your foot on the gas pedal, you are PLANTar flexing) movement of a part at a joint to bend the part towards the posterior aspect of the body

appendicular

the appendages that hang from the axial skeleton; upper and lower extremities (includes shoulder and pelvic girdle)

Describe Paradoxically breathing

the chest contracts during inhalation and relax during exhalation. Opposite of normal respiration.

Define Pulse Deficit

the difference between a radial and apex of the heart pulse sign that the HB are not reaching the peripheral artery and are too weak to be palpated

Salter-Harris Type I

the fracture involves only the physis

Salter-Harris Type V

the fracture involves only the physis but there is compression of the physis- high risk of the physis fusing as the fracture heals

Salter-Harris Type III

the fracture involves the physis and epiphysis

Salter-Harris Type II

the fracture involves the physis and metaphysis and is the most common

Salter-Harris Type IV

the fracture involves the physis, epiphysis, and metaphysis

Describe chemical cell injury

the interaction between the toxic substance and CM causes damage -it interferes with the transmembrane protein transporter function and causes cell swelling

Renal pelvis and renal intersitium

the major calyces join to form the renal pelvis that connects w/ the proximal end of the ureter the tissue that surrounds the LoH in medulla that assists w/ H2O reabsorption Where EPO is produced

Define presbycusis-

the most common type of sensorineural hearing loss caused by the natural aging of the auditory system. AC > BC

Describe imprinting

the process of gene silencing depending on which one received from which parent • Depending on the gene (either from mom or dad) one is silenced one is active • When the egg and sperm form, they're reset and some are always silenced in the egg and some always in the sperm

Define degradation

the result of enzymatic process the ∆ from a more complex form to a less complex 1

R- Replicative & telomere senescence

theory pt 2: • Senescent cells produce a variety of cytokines, chemokines, and proteases (AKA "SASP" senescence-associated secretory phenotype) that are major drivers of age-related inflammation

Error -Catastrophe

theory: • Aging is the result of the accumulation of errors in cellular molecules that are essential for cellular function and reproduction • The accumulation of these errors eventually reaches a catastrophic level that is incompatible with cellular survival --> cell death --> organ death --> death-death

I- immunologic

theory: • As we age, T-cells ↓ and B-cells overproduce antibodies = age-related auto-immunopathies and gammopathies = increased background levels of inflammation o "inflamm-aging" (increased CRP, ESR, IL-6, TNFα) • older people are generally considered immunocompromised and have reduced infection responses (fever, leukocytosis) w/ increased mortality

W- wear and tear/ rate of living

theory: • As we age, small traumas to the body build up → point mutations increase in number, and the efficiencies of the enzymes encoded by our genes decrease • "_______" refers to one of the oldest theories of aging that we all have a finite amount of time on our clock, and there are ways of using up the time faster

M- Mitochondrial damage

theory: • As we age, the # of mitochondria in cells ↓ and mitochondrial size↑ (megamitochondria) = mitochondrial function is disrupted o ATP production ↓ = lack sufficient energy for important cellular functions o superoxide radicals and peroxide production ↑ → oxidative injury to mitochondria → vicious cycle repeats • associated w/ sarcopenia, frailty, cognitive impairment of aging

Senescence R- Replicative & telomere senescence

theory: • _______ = response of normal cells to arrest proliferation when telomeres are at maximum shortness, DNA is damaged, oncogenes expressed, super-mitotic signals, telomere-independent pathways (cytoskeletal, IFN, IGF, MAP kinase, oxidative stress) o cells irreversibly arrest proliferation, have altered function, sometimes resistant to apoptosis (induced and maintained by cyclin-dependent kinase inhibitors p16 & p21) o senescent cells accumulate w/ age, may contribute to normal aging and frailty

Somatic Mutation

theory: • accumulation of mutations in the genetic material of somatic cells as a function of time --> decrease in cellular function --> decrease in organ function --> organ function decreases below a critical level --> death

Natural Selection

theory: • evolution is driven by early reproductive success, with little selective pressure for late-life reproduction or post-reproductive survival → aging is caused by late degeneration that evolution had no reason to select against

Epigenetics and genetic control

theory: • expression of many genes & proteins changes w/ age o dysregulation of gene expression o decrease in programmed response to such changes • epigenetic changes w/ age lead to an accumulation of DNA methylation and histone acetylation gene silencing decreased miRNA expression decreased protein production

F- Free radical

theory: • oxygen free radicals are generated by mitochondria when they produce ATP from oxygen→ oxidants set off chain reactions → damage to biological molecules • the body has natural antioxidant mechanisms to control free radicals o these ↓ w/ age = ↑ oxidative stress → damage accumulates → biological chaos ensues

melanosomes.

these organelles are picked up by keratinocytes and moved to an area above the keratinocytes' nuclei acting as a protective shield from UV light.

Describe an immunoglobulin

they are a group of glycoprotein antibodies produced and secreted by plasma cells :(IgG, IgE, IgD, IgM, IgA). - IgG is the most abundant in circulation throughout the body. -IgM is the largest and produced during the initial response to an antigen. -IgE is in low concentration. Initial response is IgM. Later response is IgG. -antibody: counteracts a specific antigen by recognizing it and binding to it.

Descrbibe Peyers patches

they are confluent lymphoid follicles in the ileum of the small intestine. It monitors the entrance to the intestine for pathogens.

subtyping is clinical usefulness

they're critical for understanding and tracking outbreaks organisms forming a type w/in a larger group X: E. coli 0157 is a subtype of E. coli

What are secondary lesions? What are the 4 listed ("SAFE")

they're primary lesions transformed Scales- epi Atrophy-epi or dermis Fissure-linear loss Epi and derm Erosion-epi no scaring

Remodeling

this phase of wound healing is characterized by Scar formation and revision, ECM degradation, further contraction and tensile strength, the main cells involved myofibroblasts where they have phenotypically changed from fibroblasts

Inflammatory phase

this phase of wound healing is characterized by cell recruitment, chemotaxis, and wound debridement, the main cells involved are neutrophils, monocytes, macrophages where they are slowed down by selectins which are expressed on the endothelial cells of blood vessels and binds to integrins (diapedesis), after which we have hemidesomosome break-down leading to keritinocyte migration

Migratory/proliferative phase

this phase of wound healing is characterized by epidermal resurfacing, fibroplasia, angiogenesis, ECM deposition, contraction. the main cells involved are keratinocytes, fibroblasts, endothelial cells. Cross-talk between MMPs, integrins, cells, cytokines leading to cell migration, ECM production

Coagulation phase

this phase of wound healing is characterized by fibrin plug formation, release of growth factors, cytokines, hypoxia, the main cells involved is platelets where they aggregate and release fibrinogen fragments and other pro-inflammatory mediators

Describe a pathologic S3 Gallop sound?

thought to be the sound the ventricle makes when it is forced to dilate beyond its normal range due to volume overload in the atria -CCB: heart failure, DEC Ven compliance -X: mitral regurgitation

Conversion of fibrinogen to fibrin

thrombin is an active enzyme that converts fibrinogen into fibrin

Femoral hernia

through femoral ring, cancal, and fossa ovalis below inguinal canal, more common in females

thyr/o

thyroid gland

When performing a percussion, use the ___ and not the ____ of the plexor finger (short fingernails are a necessity).

tip pad

Hormonal function of kidney w/ vitamin ERP

tissue hypoxia id detected by the glomerulus -peritubular fibroblasts in kidneys produce/release ERP · This stimulates BM to INC rate of RBC production

lingua

tongue

hyper- (i.e. hypertension)

too much, high

Vit D analogs such as: calcipotriene (Calcitrene topical) calcitriol (Vectical topical)

topical, first-line "alternative" treatment, may be used in conjunction with a corticosteroid, may cause skin irritation

posterior (dorsal)

toward the back, or in back of

anterior (ventral)

toward the front, or in front of

trache/o

trachea

When palpating the patient's trachea, an unequal space indicates?

trachial midline displacement and may be associated with a mass or pathologic condition in the chest.

Vocal fremitus/ vocal resonance

transmitted voice sounds egophony whispered pectoriloquy

1st: minoxidil 2nd dinasteride

treatment and complications for hair loss

oral antihistamines, topical steroids

treatment for Polymorphous Light Eruption

topical corticosteroids under occlusive dressings; topical tacrolimus; severe cases: oral prednisone

treatment for Pompholyx Dyshidrotic eczema

phlebotomy w/ iron supplement and/or hydroxychloroquine Stopping all triggering medications, stopping alcohol consumption, every 2-4 weeks and very low-dose antimalarials in order to get rid of porphyrins; deferasirox (an iron chelator)

treatment for Porphyria cutanea tarda

withdrawal of offending drug(s) and supportive care; burn unit; consult with dermatologist

treatment for Stevens-Johnson syndrome/Toxic Epidermal Necrolysis

drying compresses and high potency topical corticosteroids; PO prednisone if severe

treatment for allergic contact dermatitis

medium-potency topical corticosteroids or liberally-applied emollients mometasone (Elocon) / triamcinolone (kenalog)

treatment for asteatotic dermatitis (eczema craquele)

triamcinolone or hydrocortisone cream, tacrolimus ointment (ok for thin skin), oral prednisone if severe

treatment for atopic dermatitis

1st Top roids: clobetasol + sys. Roids: prednisone+ antihistamines 2nd Lance blisters

treatment for bullous pemphigoid

scrubbing with soap; topical corticosteroids & oral antihistamines/calamine lotion

treatment for chiggers

stop (or sub) all suspect medications and discontinue non-essential medications; consult with dermatology; if not severe use topical steroids and systemic antihistamines; if severe, start systemic steroids

treatment for drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DRESS)

Definitive treatment is complete surgical excision

treatment for epidermal inclusive cyst (sebaceous cysts)

prevention with valacyclovir or famciclovir; oral steroids

treatment for erythema multiforme

corticosteroid creams, topical abx if infection suspected

treatment for flea bite

o 1Ln: Topical CTCSTRDS + NSAnti-PruriticAgents (menthol, phenol, pramoxine) o 2Ln: intralesional steroids +/- topical tacrolimus AND monteklaust AND fexodenadine/ SSRIs

treatment for lichen simplex

It can be easily extracted without scarring

treatment for milia

Keep cool, light clothing, triamcinolone acetonide 0.1% in lotion, or mid-potency corticosteroid in lotion

treatment for miliaria

Requires early and complete surgical debridement of necrotic tissue in combination with high-dose antimicrobial agents

treatment for necrotizing fasciitis

1st: prednisone then add immunosuppressive (Rituximab, azathioprine)

treatment for pemphigus vulgaris

Adults: Metro/ clinda/ erythro gel /azelaic acid cream/ Na sulfacetamide Kids: erythro/azithro

treatment for perioral dermatitis

Avoid triggers Local: Metronidazole/ ivermectin/ clinda Systemic: PO tetracyclines: minocycline/doxy

treatment for rosecea

Benign= none or Q-switch laser or Liquid nitrogen (be careful in regards to hypopigmentation) tretinoin 0.1% cream, or tazarotene 0.1% used over 10 months, bleaching creams, offer a full skin exam to be sure that there are no melanoma as well because these are a form of sun damage and patient has likely been in sun

treatment for solar lentigo

Mild-moderate: supportive care, NSAIDs for pain Moderate-Severe: fluid replacement, parenteral analgesia (From someone with a history of sunburns, best treatment is aloe vera, with or without some sort of "Caine", depending on severity -Tom)

treatment for sunburn

Cool wet dressings, aspirin, systemic corticosteroids or azathioprine if severe

treatment for topical phototoxic dermatitis

-oma

tumor (new growth), neoplasm, space-occupying lesion

What's a Bruit?

turbulent blood flow through a vessel

Eversion → Supination →

turning outward the act of lying flat upon the back (your hands are SUPINE when you are holding a bowl of SOUP)

arthrodesis:

tx for severe arthritis where overlying articular cartilage is removed & the two opposing bones are allowed to fuse/heal together (fusion of 2 bones) · after successful arthrodesis, no motion is possible through the joint and the source of pain is removed

Define middle ear effusion -

tympanic membrane will bulge with no mobility, dullness in color

Chemical blocking sun screen physical blocking sun screen

types of sun screen

MOI: Free radicals

uncharged atoms floating around with unpaired e-, forming problematic bonds

cryptorchidism

undescended testicles uncommon but can happen in prematures can INC fertility issues/ testicular cancer

Define aniscoria

unilateral, unequal size of pupils

keratolytics coal tar

used for mild psoriasis (<5% BSA, not occurring on genitals, hands, feet, or face), this is reformulated as topical liquor carbonis distillate (LCD), this is indicated for localized psoriasis, apparently they smell bad (according to Patrick), stains the bathtub "golden" and clothing, can be used in conjunction with topical steroids

4. Erythropoietin:

used to treat anemia of CKD if other causes excluded (don't start tx until Hgb <9 and titrate to Hgb 10-11). Replete iron stores w/ supplement prior to administration of ESA. HTN is common complication.

hyster/o

uterus

metr/o

uterus

colp/o

vagina

Describe Nitric Oxide

vasodilation

phleb/o

vein

ven/o

vein

What is diastole?

ventricles at maximal relaxation

3. Ventricular systole 1st

ventricular contraction pushes AV valves closed doesn't create enough pressure to open semi lunar valves

spondyl/o

vertebra

coronal

vertical body plane, divides body into front and back sections (anterior and posterior) standing

sagittal

vertical body plane, through trunk of body; if exactly through middle , it is midsaggital, and divides the body into equal right and left sides.

vas/o

vessel

Describe: Lymphatic Invasion Lymphagiogensis

via the lymph system. Lymphadenopathy is common The malignancy creates new vessels to supply nutrients and allowing for further growth

Describe acute and persistent viral pathogenisis

viral infection followed by clearing by immune system viral infections in which the host cell may be altered antigenic ally but isn't killed/ disrupted in ability to multiply

occipital lobe

vision

Define hyperopia

visual image is focused BEHIND the retina rather than directly on it May be caused by the eyeball being too small or focusing power being weak Can see far objects clearly, near objects blurry

Describe water distribution in the body

water makes up about 60% of TBW TBW= about 42L water balance regulated by ADH

-paresis

weakness (less than paralysis)

Allergic type will have a positive patch test; gram stain or culture to r/o infection or impetigo

what are the Dx/lab workup for allergic contact dermatitis

Protein Channel VS. Carrier Protein

when open, forms an open pore across the lipid bilayer that allows ions (mainly K+)and selective polar organic molecules to diffuse across Solute binds causing a conformational change and solutes translocates across membrane

Describe pulse deficit

when peripheral pulse rate is not the same as apical (concern : arrhythmia)

What is situs inversus?

when the heart and stomach are placed to the right and the liver to the left

What is dextrocardia?

when the heart is positioned to the right, either rotated or displaced, or as a mirror image

What is systole?

when the ventricles are at maximal contraction

The palmar surface should be used when?

whenever discriminatory touch is needed for determining position, texture, size, consistency, masses, fluid, and crepitus

Hair

which adnexal structures of the skin evolutionarily- insulation and protection, now- profound role in social interactions

Apocrine sweat glands

which adnexal structures of the skin function is more obscure, but likely includes pheromone production

Eccrine sweat glands

which adnexal structures of the skin regulation of body temp in response to thermal stress by releasing sweat; resorption of Na+/ Cl-

sebaceous glands

which adnexal structures of the skin secretion of sebum hypothetically to keep skin and hair supple, prevent water loss, may provide mechanism of vitamin E transit; mild antibacterial action (innate immune function)

leuko-

white

milia-

white, pinhead-sized, keratin-filled cyst

Ludwig

who classified hair loss in women

Hamilton

who classified hair loss pattern in male

Abnormal/ pathologic split of S2- Fixed split

wide splitting of A2/P2 that DOES NOT vary w/ respiration CX: atrial septal defect, RV failure

Describe Mast Cells

widely distributed connective tissue cells derived from stem cells contain mediators like histamine

Describe Gram negative bacteria

will stain pink have 3 cell wall layers - inner cytoplasmic membrane -thin pepdidoglycan -outer lipopolysaccharides (LPS) Rod X: E coli, klebsiella, bordetella pertusis Cocci X: Neisseria gonorrhoeae, Moraxella catarrhalis

xanth/o-

yellow

· cervical motion tenderness

§ pelvic inflammatory process like pelvic inflammatory disease § ruptured tubal pregnancy § ovarian cyst § tubal (ectopic) pregnancy § salpingitis

Development of a blood clot

§ prothrombinase --> prothrombin --> thrombin-->converts fibrinogen to fibrin § fibrin polymerizes into a fibrin clot

Impede Bone Healing

· Medical Conditions · Medications · Advanced Age · Poor Blood Supply · Platelet Dysfunction · Infection · Large Hematoma · Extensive soft tissue damage

Promote Bone Healing

· Weight bearing bones · Young Age · Good blood supply · Bone graft

Describe interstitial fluid

¾ of ECF. Same composition as plasma. Only difference is that this fluid is found on the outside of capillaries

psoriasis

• A common (2‐3% of population), life‐long, genetic, autoimmune skin disease • Characterized by well‐demarcated areas of thick, red, scaly skin • From the Greek "psoros" meaning "rough, scabby" • Term first used (along with "lepra") by Hippocrates (460‐377 B.C.) in Corpus Hippocraticum

Describe increased capillary permeability

• Common causes: - Inflammation • Excess amounts of liquid escape from the plasma to the interstitial space --> edema • Often very severe bc of loss of proteins from vascular space DEC CAP oncotic P and INC interstitial ONC P

Describe varisocsities

• Dilated, tortuous alterations in the saphenous veins and tributaries • Dull, aching pain and heaviness • Hereditary and exacerbated by pregnancy and obesity

Describe the process of fluid movement between plasma and interstitial fluid

• Entirely occurs as a result in chages in hydrostatic pressure and osmotic forces at the arterial and venous ends of capillaries • 4 forces determine if fluid moves out of the capillaries into insterstial space ("IS"), or if fluid moves from the IS back into the capillary

Describe the concept of heterozygote advantage and give an example of a disorder in which this concept is applicable.

• Having two different copies of the same gene= heterozygote aka a "carrier" • Being a carrier of the two different copies of alleles may give an advantage for some diseases by lessening the effects of it • Because they're less likely to be affected by the disease, they're more likely to pass it down Sickle Cell anemia

Describe heterozygote advantage and Sickle Cell anemia

• Homozygous recessive people, have sickle cell anemia and its effects • Heterozygote recessive people, carry the sickle cell trait, but don't have the effects as bad if at all • The recessive allele carries a resistance to malaria • Homozygous dominat people, don't have sickle cell but also don't have the resistance

common myths about aging

• Older adults are alienated from members of their family • Increasing age brings about a decline in sexual desire and interest. Older adults are not physically capable of engaging in sexual intercourse • Older adults are very isolated from their communities. Social contacts decrease with age • Older women focus mainly on keeping their families together • Older women suffer from poor physical health

Pemphigus vulgaris

• Onset in 50s• Mortality near 100% pre‐steroid era • Current mortality 10%, therapy related• Increased incidence in Jewish population • Usually starts in mouth • Skin shows flaccid blisters or erosions • Chronic disease‐long term therapy typical

Describe osmosis

• Passive movement of wter across a semipermeable membrane from lower to hight solute concentration • Occurs until equilibrium is reached • Driven by osmotic pressure differences (which is influenced by plasma mbm thickness, size of molc, and their soluability

Describe passive transport

• Passive transport occurs when water and small electrically uncharged molecules move easily through pores in the plasma membrane's lipid bilayer. • It occurs naturally through any semipermeable barrier. • Driven by diffusion osmosis, hydrostatic pressure, and

Describe cytokines

• function as chemical signals between cells to provide positive and negative regulation of the immune response • Important in Nat. Immunity through 2 inflammatory types: IL-1 and TNF

Describe Phagocytosis

• larger molecular substances are engulfed by the PM and enter the cell so that they can be isolated and destroyed by lysosomal enzymes • req metabolic energy and often involve binding of the substance with plasma mbn

Describe Micropinocytosis

• taking up of specific macromolecules by invagination of the cell membrane, which is pinched off, forming a small vesicle in the cytoplasm • it then fuses with a lysosome and lysosomal enzymes digest them for cell use

Describe Macropinocytosis

• when large droplets of fluid are trapped underneath the ruffles of the cell membrane • important for Ag presentation by specialized Ag presenting cells

Describe tumor necrosis factor

•Alpha- cachectin from macrophages F: IL-1 like INC synthesis of inflammatory liver proteins Beta- lymphotoxin from Tc cells F: kill some cells Increase phagocytosis by macrophages/ neutrophils

Describe mosaicism and how it occurs

•Is when someone has cells with different #s or arrangements of chromosomes •Occurs bc of early mitotic failure of chromosomes or sister chromatids to divide right called nondisjunction onccuring in one embryonic cell but not others

Describe fragile X syndrome

•Result of trinucleotide repeat -200 or more repeated "CGG" DNA sequences -When it gets 2 big, the gene is hypermethalated -Males more affected than females -Sx: substantial cognitive impairment (2nd most common cause of geneti retards)

CP for breast carcinoma

● Less frequent breast sxs 1. Breast pain 2. Nipple discharge 3. Erosion, retraction, enlargement, or itching of the nipple 4. Redness, generalized hardness, enlargement, or shrinking of breast

CP for breast carcinoma

● Rarely axillary mass/swelling on initial presentation ● Systemic metastasis sxs (rare on initial presentation) 1. Back pain 2. Jaundice Weight loss

Fluid intelligence

● abilities not based on experiences or education ● reasoning and problem solving in novel situations ● declines with age, beginning in late 50s/early 60s and rapidly declining thereafter ● ex: memories, ability to think and react quickly, mental flexibility or multitasking, learning new information

Crystallized intelligence

● knowledge or experience accumulate over time ● Over-learned, well-practiced, familiar skills, ability and knowledge ● Typically remains stable with age, showing gains into the 60s and stability through 70s ● Ex: education, reading ability, wisdom

Define alopecia

- hair loss

o ROM, flexibility, neurovascular status o Imaging: XR

Dx w/u of Hallux Valgus (Bunion)?

o Acute: -PE/Hx Dx -imaging rarely used bc majority of pts better after 4-6 wks o If in risk category: -kids, pts >50 w/ new onset, trauma, or pts w/ failed conservative tx--> imaging done

Dx w/u of Low back pain?

Anterior, posterior hip dislocation

CP: o hip is abducted, externally rotated, and knee is flexed where femoral head can dislocate medially toward the obturator foramen or lat towards pubis o hip is adducted, internally rotate, and knee is flexed w/ shortened leg

red flag symptoms of low back pain.

Cancer related symptoms: Unexplained weight loss Failure to improve with treatment Pain longer than 6 weeks Pain at night or rest History of malignancy and age of over 50 should also be considered.

Cell solute gradients

Concentration gradient drives the solutes to move from an area of higher concentration to an area of low concentration

Concentration of RBCs in blood of the adult male and female:

Concentration: ~5 billion per milliliter of blood Males: 4.5 to 5.9 X 10^6 cells/microliter Females: 4.0 to 5.2 X 10^6 cells/microliter

Common bacteria infections

Cutaneous mycoses Subcutaneous my Systemic

Dx: Xr Tx: o ulnar gutter cast/splint o MCP flexed @ 60-90 4-6 wks

Dx w/u and Tx of Boxer metacarpal fracture

AP and later XR reduction

Dx w/u and Tx of anterior/poster hip dislocation

o AP/ L XR o Internal rotation o MRI/CT for additional injuries o Surgery w/in 24 hours Femoral neck fx: hemiarthroplasty/ THR Peritrochanteric: ORIF

Dx w/u and mngmt for Hip fractures?

o PE/ XR/ US Tx: o Conservative +/- intraarticular corticosteroid injection

Dx w/u and mngmt for popliteal (Baker) cyst?

-Aspirate fluids and test for WBC, Crystals, Culture, Glucose, Gram stain -US may be useful in some cases, also used to guide direct injections Mngmt: -Rest, NSAIDs -Local glucocorticoid injections -Abx may be warranted if signs of systemic infection present

Dx w/u and mngmt of olecranon bursitis?

Dx: XR TX: o Ice, elevation, immobilization w/ thumb spica splint o Refer to ortho

Dx w/u and tx of Bennett metacarpal fractures?

o The Lachman and anterior drawer tests o Plain radiographs usually negative (help rule out fracture doe) o MRI 2 Dx

Dx w/u for ACL injury of the knee

o Plain XR: Zanca view is the most accurate. o Cross-arm adduction test

Dx w/u for Acromioclavicular joint sprain/separation

o anterior drawer and subtalar tilt tests o The Ottawa Ankle Rules to check need for radiographs

Dx w/u for Ankle sprain (inversion)?

o XR: AP/Ax-L scapular-- Hill-sachs lesions o MRI: 4 soft tissue/ RC o CT: to ID bone loss

Dx w/u for Anterior/posterior dislocation of the shoulder

Describe the phases of hair growth ("ACT")

Anagen phase: active growth 3-4 years Catagen phase: follicular regression 2-3 weeks Telogen phase: resting period 3 months

Plasmodium

Anopheles bite blood--> liver Asexually causes: anemia, malaria

What is "blunt" percussion? It's AKA as? Purpose?

Another type of percussion AKA Direct Percussion To elicit pain, not identify sounds

What are the helminthic infections

ATEST A- Ascaria lumbricoides T- Taenia solium E- Enterobius vermicularis S- Schistosoma spp T- Trichinella spiralis

Describe erythrocytes

Anucleate and lack many organelles Carry O2, remove Co2 Hb synthesis stops Life: about 120 days

HBV & HCV Hepatitis B and C

Causes: 1. Hepatocellular carcinoma

o AP/L Oblique/radiocapitellar view XR

Dx w/u for radial head fracture?

Hospital insurance

Medicare Part A covers?

lobe

lobe, as of lung

What is normal capillary refill time?

<2 sec

Describe Microcyte

<6 micron due to low Fe

BP=?

= Cardiac output x resistance

Describe hematopoiesis

=creation of blood triggered by Erythropoietin 0-3 months: tolk sac 3-9: liver spleen 5-birth: occurs in BM for adults

What are the percussion notes of the abdomen and their expected loc?

(RTHD) R- Resonance T- Tympanic H- hyperresonance D- dullness

Chronic Arterial Insufficiency

"I CPR GUD" I- intermitten pain- resting pain C- cool P- pallor on elevation R- rubar on dependency G- gangrene may form U- ulder, on toe D- dec or absent pulse

Nikolsky sign

"Positive" = epidermis dislodged from the dermis by shearing, lateral pressure (with a finger), resulting in an erosion Important diagnostic sign in acantholytic or blistering disorders such as pemphigus or the staphylococcal scalded skin (SSS) syndrome or other blistering or epidermonecrotic disorders, such as toxic epidermal necrolysis (TEN).

chronic venous insufficiency

"VISA B" V- varicosities I- induration S- stasis pigmentation A- ankle ulcerations B-Brawn ankle edem

Crush:

(closed) caused by great/extreme amount of force applied over a long period of time

What is: Hyperopic Myopic

(farsighted) eye require "plus" black number (clockwise) (nearsighted) eye requires "minus" red numbers (counterclockwise)

bite:

(of a person or animal) use the teeth to cut into YOU

Define nail pitting

- "ice pick" holes into the nail (often psoriasis)

Define peau 'd orange

- "orange skin" appearance of edematous breast bc of loss of lymph

Describe blood composition

- 8% of TBW -plasma= 55% of it -formed elements= 45% of it

Define onycholysis

- nail separates from nail bed (trauma, fungus, psoriasis)

Describe Endocytosis (Part of Bulk Transport)

- Cellular internalizing process where a section of PM enfolds shit from outside cell, invaginate, & separates from PM - Forms vesicle inside the cell

Describe ICHP- venous obstruction

- Common causes: - vasoconstriction -Causes hydrostatic pressure to increase behind the obstruction, pushing fluid from cap into interstitial spaces

Drugs that predispose for hyperuricemia and acute gouty arthritis

- Diuretics (thiazides) - Low dose aspirin - Niacin - Cylosporin

hemangioma / "stork bites"

- Dull red benign lesion (collection of blood vessels usually on face or neck, grows rapidly then regresses),

Describe Neurohormonal signaling

- Hormones are released into the blood by the neurosecretory neurons - Neurosecretoy neurons release blood-borne chemical messengers to other cells X: angiotensin II

Mohs surgery

- Indications - Extensive recurrent skin cancers that have not responded to aggressive conventional surgical techniques or radiation - procedure -> Thin layers of tissue are removed and analyzed until clear margins are obtained - Patient Education → preserves maximum amounts of normal tissue around the cancer, provides great reliability in determining adequate margins of excision, but is time-consuming and often requires hours or days to perform

punch biopsy

- Indications → most superficial inflammatory and bullous diseases, benign and malignant tumors (except malignant melanoma) o Provides a sample of full thickness - Procedures → Local anesthesia is induced around and under, but not directly into the lesion - Tissue is immediately transferred to a preservative and bleeding is controlled with gauze pressure or Monsel's solution - Patient Education → biopsies of the face with a 2-mm minimizes scarring and results in a wound that has smooth, round edges, and heals with a slightly depressed scar

What are the 4 normal breath sounds?

T- Tracheal B- bronchial B- Bronchialvesicular V- vesicular

Define anaplasia

- Loss of differentiation, display variation in size and shape, nuclear abnormalities and frequent mitotic activity. **Invariably malignant**

USPSTF recc. for Prostate

- Men aged 55-69 years old àthe decision to undergo periodic prostate-specific antigen (PSA) based screening should be an individual one - Screening offers a small potential benefit of reducing the chance of death from prostate cancer, but many will experience potential harms of screening, including false positive results that require additional testing, possible prostate biopsy, overdiagnosis, overtreatment, and treatment complications such as incontinence and erectile dysfunction - Clinicians should not screen men who do not express a preference for screening *Note that these recommendations are of Grade C

USPSTF recc. for Testicular

- Recommends against screening for testicular cancer in adolescent or adult men *Note that this recommendation is of Grade D

USPSTF recc. for Colon

- Screening for _____ cancer starting at age 50 --> 75 years *Note that this recommendation is of Grade A - Adults aged 76-85 years → decision is an individual one, taking into account the pt's overall health and prior screening history *Note that this recommendation is of Grade C

Pathophys of uric acid

- Uric acid is formed during breakdown of purine nucleotides - Forms insoluble crystals in fluid at concentrations >6.8 mg/dL ® forms insoluble crystals called monosodium urate (MSU) in connective tissues® crystals cause severe, painful, inflammation - Macrophages congregate for inflammasomes that activate interleukins and chemokines - Overtime this causes joint damag

creams

- Water-in-oil: less than 25% water. 2-phase system. - Less greasy, spread easily on skin, and provide a protective film of oil that remains in the skin as an emollient. - Slow evaporation of water phase provides a cooling effect

What is pulsus paradoxus

- abnormal sign, pulse amplitude decreases greatly with inspiration (>10mmHg) and vice versa with expiration.

Define striae

- long thin parallel, slightly recessed nonpigmented/hyperpigmented stripes (stretch marks)

MOI: Ischemic

- reduced blood supply (one cause of hypoxia). -arteriosch

Define Beau lines

- transverse deep grooves, should disappear as nails grow out

foams

- triphasic liquids composed of oil, organic solvents and water, which are kept under pressure in aluminum cans. - Highly effective in delivering greater amount of drug at an increased rate compared to similar vehicles of transport. - Leaves minimal residue after applying

Define leukonychia

- white spots, laterally distributed, sign of minor trauma or manipulation

Define penetrance

-AD -either you have it or you don't -proportion of ppl w/ pathogenic variant who show ANY clinical Sx -probability of a gene/ genetic trait being expressed -2 types

Describe Variant Expression

-AD -severity of Sx -There's a range of signs and Sx -All affected ppl have some finding of the disease -may be mild or sever

Describe the rating scale for pulse assessment

0= no palpable pulse 1= diminished 2= normal 3= full/ increased 4= bounding

Demographics for Breast carcinoma

1 in 8 American women Most common CA in women (along with skin CA) Highest rates in Western Europe and North America 1.7 million women diagnosed worldwide Second to lung CA as cause of death Highest rates of death are in black women in USA

Describe the edema assessment scale

1+= >2 mm, rapid refill 2+= 2-4 mm, 10-15 sec refill 3+= 4-6 mm, >1 min refill 4+= 6-8mm, 2-5 min refill

2 function of the thymus

1- development of T cells 2- thymus education: pass or die

Describe erythropoiesis process

1- hemocytoblasts--> proerythroblasts 2- diff into erythroblasts 3- immature RBC begin synthesizing/ storing Hb 4- diff into reticulocyte and eject organelles/ nucleus 5- mature into erythrocyte and enter circulation

1. Inflammation 2. Repair 3. Remodeling

1. · 1‐3 days 2. · 3‐?? Days · Soft and hard callus formation 3. · Removal and replacement of bone

MC Cancer in women

1. Breast 2. Lung and bronchus 3. Colon and Rectum

Penetrance types

1. Complete: all ppl with pathogenic variant have SOME Sx 2. Reduced: some ppl with pathogenic variant have NO Sx

How does hypomethylation and hypermethylation increase caner risk?

1. hypo: it INC the rate of transcription in tumor cells which led to an increased oncogene activity 2. hyper: this DEC the rate of transcription and their ability to inhibit tumor formation

3 red flags for hereditary cancer

1. Hypomethylation of tumor cells 2. Hypermethylation of tummor suppressor genes 3. Family history

Describe hyperthemia and hypothemia

104 95

MC Cancer in men

1. Prostate 2. Lung and bronchus 3. Colon and Rectum

What are the semilunar valves and what do they do?

1. Pulmonic valve -separates the RV from pulmonic artery 2. Aortic valve -separates LV and aorta during systole (ventricular contraction), these open and blood flows through their vesselT

What are the atrioventricular valves & what do they do?

1. Tricuspid -separate the RA from RV 2. Mitral ("bicuspid") -separates the LA from LV during diastole (atrial contraction), these valves open and blood flows into ventricles

Beta-HCG Human calcitonin

2 hormones tumor markers

Describe Iso-osmotic?

2 solutions w/ the same contraction No ∆ in cell volume

P- PSA A- AFP C- CA-125 B- Bence Jones Proteins C- CEA

5 Antigen tumor markers

P- Paget disease M- malignant melanoma S- SCC B-BCC B- Bowen disease

5 Malignant lesions

· hypercalcemia · Cushing syndrome · Lambert-Eaton myasthenic syndrome · carcinoid syndrome · hyponatremia/SIADH

5 paraneoplastic syndromes:

What happens at DCT?

5-10% of NaCl reabsorption

Describe formed elements- leukocyte concentration

5-10k Leukocytes/ mm blood Neutrophils 60-70% Lymphocytes 20-25% Monocytes 3-8% Eosinophils 2% - 4% Basophils 0.5-1%

Describe Wheals? size? Examples?

A firm edematous plaque resulting from infiltration on the dermis with fluid are transient and may only last a few hours varying sizes hives, mastocytosis

Describe a Fissure

A linear loss of epidermis and dermis with sharply defined nearly vertical walls examples: chapping hands, Ecema (fingertip)

methotrexate (MTX, Trexall)

A systemic (or sub-Q), non-biologic medication, use for moderate-to-severe plaque psoriasis that is not fully responsive to topicals or phototherapy, indicated for erythrodermic psoriasis, first-line treatment for pustular psoriasis

cyclosporine (Sandimmune)

A systemic, non-biologic medication, use for moderate-to-severe plaque psoriasis that is not fully responsive to topicals or phototherapy, may be slightly more effective than methotrexate

Describe vasoactive amines - histamine / serotonin

Amines found in basophils, platelets, and mast cells release histamine and serotonin causing vasodilation and INC VP

Describe the parasite- Amoeba infections

AE A- Acanthomoeba castellani E- Entamoeba hystolitica

Describe venous insufficiency / obstruction

Acute Chronic DVT

P53 tumor suppressor gene

Activation of _____ induces: · cell cycle arrest · apoptosis · senescence (stoppage of cell proliferation) · DNA repair · Some aspects of regulation of cellular metabolism.

Describe the function of granulocytes-Neutrophils

Active phagocytes of bacteria and other small particles. Hallmark of inflammation-1st ones

transient incontinence

Acute incontinence refers to those situations when the incontinence is of sudden onset, usually related to an acute illness or an iatrogenic problem, and subsides once the illness or medication problem has been resolved

Ca

Assess kidney, PTH and thyroid function, vitD deficiency, malignancy and immobilization. Useful for hyper/hypoparathyroidism and CKD. Must calculate corrected _____ using albumin

presenting appearance - acutely ill vs. chronically ill-

Acutely ill may present with healthy hair and skin. Chronically ill may present with unhealthy dry hair/skin and a malnourished look suggesting illness has been present for a longer period of time.

Adjuvant:

Additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. This therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy.

Chemotherapy: HER2 Targeted therapy: o Trastuzumab Endocrine therapy: o Tamoxifen o Aromatase inhibitors o Biphosphonates For older women: decisions relating to use of systemic therapy should take into account patient's comorbidities and physiological age rather than chronological age

Adjuvant Therapy options for breast carcinoma

o Self-renewal o Multipotent

Adult/cancer stem cells have two essential characteristics: o____ = some fraction of the cell divisions creates new stem cells o_____ = have the ability to differentiate into multiple different cell types

Cl-

Assess pH balance and hydration status

Carbon Dioxide/Bicarbonate

Assess pH, renal failure, metabolic disorders.

6. VD late

All chambers are relaxed Ventricles fill passively

Describe Globulin

Alpha and Beta: non-immune globing (carrier/lipo proteins, clotting factors) Gamma: immunoglobins (Antibodies) Fibrinogen and prothrombin: clot formation

pulsus bisferiens:

Also known as a biphasic pulse, occurs in patients with significant aortic valve regurgitation. A double pulse is felt due to backflow of blood in early diástole. The first pulse felt is normal systole, while the second is actually early diástole due to the regurgitation of blood.

Nitrofurantoin 100 mg BID x 5-7 days

Alters bacterial RNA, inhibiting DNA/RNA/cell wall synthesis (Bactericidal) GI upset, hemolytic anemia, nephrotoxicity

Retrovirus

An RNA virus that reproduces by transcribing its RNA into DNA and then inserting the DNA into a cellular chromosome

What is a Papules? size? Larger? Examples?

An elevated solid lesion up to .5 >.5 cm = plaque Milia, sebaceous hyerplasia, nevi, warts, dermatofibroma, seborrheic keratoses

Drug/chemical induced photosensitivity

An exogenous photosensitizing medication administered orally (most commonly NSAIDs, quinolones, tetracyclines, amiodarone, and phenothiazines) causes unexpected sunburn or dermatitis during UV exposure; occurs 2-48 hours after sun exposure

ACL injury of the knee

An injury involving an audible pop when the knee buckles. Acute swelling immediately (or within 2 hours). Instability occurs with lateral movement activities and going down stairs.

Na

Assess volume status and osmolality. Can indicate dehydration/fluid overload, polyuria, hyperglycemia

Catagen

Apoptosis-driven phase between telogen and anagen phase. About 1% of hairs in this phase.

Tanner's stage 4

Areola and papilla enlarge -secondary mound projects

dislocation:

Articular bones of joint have been displaced and have no contact points with each other

5 V diastole early

As ventricles relax, pressure in ventricles drops blood flows back against cusps of semilunar valves and forces them closed Blood flows into relaxed atria

Katz Index of Independence in Activities of Daily Living

Assesses ability to perform ADLs (bathing, dressing, toileting, transferring, urinary/fecal continence, feeding). Deficits in independence in ADLs can signal need for more in-depth evaluation of socio-environmental circumstances.

What's Ballottement?

Assessment for presence, size, and mass of organs

Describe the assessment of turgor.

Assessment of skin elasticity can be helpful to detect certain conditions. Gently pinch a small section of skin on the forearm or sternal area between the thumb and forefinger and then release the skin ( Fig. 9.11 ). The skin should move easily when pinched and return to place immediately when released. Poor skin turgor can indicate severe dehydration. The skin is very slow to return to normal and "tents" up. This may occur with excessive vomiting, diarrhea, or dehydration for another cause. Skin that is firm or cannot be pinched may suggest an underlying connective tissue disease such as scleroderma.

bacteria

Bacteria are larger, easily grown in the lab, and can be seen with regular microscopes. Generally they can be treated successfully with antibiotics however, many bacteria are now becoming resistant to antibiotics.

Describe spore-forming bacteria

Bacteria that produce spores in response to harsh environment Ex. Clostridium difficile, Bacillus anthracis

Functions of the skin

Barrier - protection from infection and loss of water, UV light immunologic, Temp regulation - insulation (several layers), regulation (sweat eccrine glands) Nerve sensation - Interface with external and internal environment injury repair - scar

SPT IV Light brown/olive

Based on Fitzpatrick Skin classification, what is the classification of a skin Hardly burn, tan easily?

SPT III white

Based on Fitzpatrick Skin classification, what is the classification of a skin May burn initially but tan easily?

seborrheic keratosis

Benign skin tumor. Most common in fair skinned ELDERLY with prolonged sun-exposure Typically appear as sharply marginated, pigmented lesions, can rise all body surfaces no palms or hands Small papule/plaque velvety warty lesions with "greasy/stuck on appearance" Varied possible colors ex. Flesh-colored, grey, brown and black.

pyogenic granuloma

Benign vascular lesion; - most common in pregnant women - Exuberant overgrowth of granulation tissue. - Commonly occur in the mouth and on the hands, but can occur anywhere - Granuloma gravidarum - Shave excision (with curettage), laser, cryosurgery (+/‐)

Phototoxicity systemic causes

Benoxaprofen, chlorpromazine, tetra, FQs

histamine vs. serotonin

Both Cause vasodilation and INC vascular permeability Histamine response to physical injury such as trauma, heat or cold, or immune reactions, Serotonin: activates T-cells, attracts neutrophils cytokine secretion

Woods lamp

Black-light used to help detect bacterial or fungal skin infection. Help define the true edges of a pigmented lesion for biopsy interpretation: Helps diagnose TINEA CAPITIS (fluoresce blue-green), vitiligo (well defined borders, no pigmentation), melasma/Erythrasma shows up coral-red pink

When Inspecting during a basic exam, what are some things to keep in mind?

Body features, symmetry & contour Shape, size, color Moisture vs. dryness intact vs. disrupted pulsations/ movement

Tanner's stage 2

Breast bud stage -first pube changes -areola diameter enlarges -breast/papilla elevate

Tanner's stage 3

Breast/areola enlarge more -continuous and round contour

Describe lymphocytes

involved in Ab & cell-mediated immune Rxns as either B or T cells

arthr/o

joint

which favors what?

CHP and IOP -from capillary to interstitial -favor filtration COP and IHP -from interstitial to capillary -oppose filtration

onychocryptosis (ingrown toenail)

CP: Mild: Pain with pressure, nail fold swelling, edema, and erythema. Moderate: can present with seropurulent discharge and ulceration of the nail bed. Severe: chronic inflammation and formation of granulation tissue with associated nail fold hypertrophy. Dx w/u: check for infection

adhesive capsulitis (frozen shoulder)

CP: Very painful and/or limited shoulder ROM. o Restricted active and passive ROM o most notably internal rotation as the first motion to be affected. o 3 phases to this

Bunion

CP: When sx present, pt frequently report a dull achy pain, swelling, and redness at the site. Exacerbated with walking and narrow shoe gear but relieved with rest.

Physical findings in the eye that may indicate the presence of-Diabetes

Cataract Formation - Soft exudates (also called cotton-wool spots) are caused by infraction of the nerve layer. Described as yellow areas caused by infarction of nerve layer of the retina. Initially, patients are asympotomatic. It is folloed by blurred vision, distortion, or visual acuity loss in more advanced stages. On ophthalmoscopic examination, appears as blood vessels with balloon-like sacs. Blots of hemorrhages on the retina itself. Tiny yellow patches of hard exudates.- decreased corneal sensation, failure to respond to direct light but retaining constriction during accommodation.

red flag symptoms of low back pain.

Cauda Equina Syndrome is an emergency. Presents with: Urinary retention or incontinence Saddle Anesthesia Decreased anal sphincter tone or fecal incontinence Bilateral lower extremity weakness and progressive neurological deficits

Describe ICHP- Na/H2O retention

Causes volume overload, increased venous pressure, and edema Common causes: •Right congestive heart failure, renal failure, cirrhosis

High-risk HPV genotypes 6, 11 16, 18

Cervical infection with the HPV is associated with a high percentage of all cervical dysplasias and cancers. - Types __ and ___tend to cause genital warts and mild dysplasia and rarely progress to cervical cancer; - type___ causes 50% of cancer -Type___ causes 20% of cancer

Define metaplasia

Change of one adult cell type to another in response to external stimuli, reversible process (ie replacement of columnar with squamous epithelium in bronchi of cigarette smokers)

Rosacea

Chronic acneiform condition of facial pilosebaceous units with increased reactivity of capillaries to heat. Often, long history of easy flushing Usually develops after age 30 Can be very sensitive and dry Triggers: wind/sun, spicy food, hot beverages, alcohol, exercise, stress, vasoactive drugs

hidradentitis suppurativa

Chronic follicular occlusive disease manifested as recurrent inflammatory nodules, abscesses, sinus tracts, and complex scar formation. Lesions are tender, malodorous, often with exudative drainage. Common in intertriginous skin regions: axillae, groin, perianal, perineal, inframammary skin Most common in women, ages 20-30 years, and African American Disease is recurrent and progressive HS is not a primary skin infection. Often misdiagnosed as bacterial folliculitis Causes significant emotional distress

CEA Carcinoembryonic Antigen

Clin. Utility: - Monitor response to tx and identify recurrence Asso. cancer: -Colorectal -others

Lateral epicondylytis of the elbow

Clinical Presentation: o "Tennis elbow" because it is seen in activities that involve repetitive wrist extension (such as a backhand stroke in tennis). o Pain over the lateral elbow that may radiate down the forearm. Tenderness to palpation over the origin of the extensor carpi radialis brevis tendon, which is anterior and distal to the lateral epicondyle. o Pain is aggravated with wrist extension or forearm supination.

clot retraction

Clot must be destroyed IOT prevent thrombolytic events -reduces size of and breaking down the clot over days - edges injury are slowly brought together IOT repair -depends on the release of multiple CFs from the end of coagulation cascade (XIIIa crosslinks) -these cause fibrin mesh to contract and condense

Phototoxicity topical causes

Coal tar Anthraquinone-based dye Psoralens cause this type of reaction

Describe AI outcome: Suppuration/Abscess formation

Collection of walled off infection area containing purulent material/pus Occurs with pyogenic organisms

pattern hair loss (androgenic alopecia)

Combined effects of androgen on genetically predisposed hair follicles. Genetics: (1) autosomal dominant and/or polygenic (2) inherited from either or both parents. Age of onset: Men—may begin any time after puberty, as early as the second decade; often fully expressed in 40s. Women—40% occurs in the 6th decade.

Murmur- Pattern

Crescendo- Increasing intensity caused by increased blood velocity. Decrescendo- Decreasing intensity caused by decreased blood velocity. Square or plateau- Constant intensity

What 5 things drive epigenetic mechanisms? ("DEAD D")

D- development (utero & childhood) E- environmental chemicals A- aging D- diet D- drugs/pharmaceuticals

Describe the 3 major types of epigenetic modifications?

D: -Attachment of a methyl group to a cytosine base -causes a gene to become transcriptionally inactive or silent R: Gene expression can be regulated by ∆s in mRNAs and other non-coding RNAs H: -Histones are proteins that DNA winds around -This can be modified based on how tight or loose the histones are around DNA

Documentation for abnormal breast mass: ("DP CLS MSND")

Delineation Pain Consistency Loc Size Mobility Shape Nodes Discharge

mental or psychological symptoms reported by patients at the end of life

Depression - hopelessness, anxiety or irritability · Confusion · Delirium · Agitation[1]

Describe the 2 categories of lung sounds for adventitious breath sounds

Discontinuous: intermittent/brief/ non muscial -Fine crackles -Course crackles -Rales Continuous -wheezes -rhonchus/rhonchi

5-year disease free survival rate:

Disease-free survival rate=the percentage of people in complete remission after finishing treatment

o Dec in TBW/ lean body mass/ plasma albumin o INC in adipose o NE: - INC in [serum] of hydrophilic drugs and drugs to lean body mass -DEC protein binding= INC in free drug - Delay in clearance of lipophilic drugs

Distribution changes?

Describe memory cells

Do not secrete antibodies but circulate in the blood and reside in tissues for months to years, ready to respond to antigen -INC speed and vigor of subsequent responses (vaccinations work by inducing memory cell production)

When palpating, TO DETERMINE Temperature, use what ?

Dorsal surface of hand

Variant Expression with Down s., Marfan S., Neurofibromatosis Type i

Down: heart, Gi defects, ID Marfan: aneurysm, ectopia lentos, tall NeuroF: optic glioma, neurofibromas

Alignment, gait, and stance assessment. Patellar grind test will be positive.

Dx w/u for Patellofemoral pain syndrome?

o Clinical Dx o Imaging rare

Dx w/u for Plantar Fasciitis?

o Supraspinatus: Empty can test, Hawkin-kennedy, Neer test o Infraspinatus/ TMinor: External rotation test o Subscapularis: Internal rotation test o Complete tear: Drop arm, Internal/External rotation lag test o Imaging: AP/ Ax/ Supraspinatus outlet, AP ACJ

Dx w/u for Rotator Cuff Tendinopathy/Tear

Assess ROM - patient should have full strength & ROM but the extremes of motion will bring on pain symptoms. Imaging to r/o other pathology.

Dx w/u for greater trochanteric bursitis?

-AP/L XR may not show - PA/O w/ ulnar deviation may be req. to see

Dx w/u for scaphoid fracture?

What are the 4 characteristics of sound? ("D-QIP")

Duration Quality Intensity Pitch

ABCDE rule: Asymmetry Border Irregularity Color variegation Diameter > 6mm Evolution Wood's lamp to visualize borders Sentinal node biopsy for prognostic purposes

Dx W/u for malignant melanoma

Wood lamp examination. Skin biopsy, will show absence of melanocytes. Electron microscopy- will show absence of melanocytes and of melanosomes in keratinocytes

Dx W/u for vitiligo

Dx: XR: 3 views: AP, Lat, & axial shows sclerotic band Tx: A posterior leg splint/ bulky Jones splint o Crutches & non-weight-bearing status instructions. o Refer to ortho

Dx w/ and mgnmt for Calcaneal fracture

Dx o PE, neuro o MRI or CT scan Tx: o flexion based PT o Facet coriticosteroid injections, o Surgery: spinal decompression

Dx w/u and Mngmt of Spinal stenosis?

Dx: o XR: AP/Ax/L to r/o other o Clinical Dx Tx: o NSAIDs and PT o +/- corticosteroid injections and prednisone o Not responding >6 mo or worsening ROM > 3 mo= surgery o Pt education is CRITICAL

Dx w/u and Tx for adhesive capsulitis (frozen shoulder)?

Dx: XR: AP/L Tx: o Impacted or minimally displaced fctr: PCP managed. Volar/Sugar-tong splint o Brace vs. cast o Frctrs that require reduction are often unstable and require internal fixation

Dx w/u and Tx of Colle and Smith fracture?

o AP XR o CT can better see medial or lateral 1/3

Dx w/u for Clavicle fracture

Bicipital Tendonitis

Eitology: Inflammation of the biceps tendon from impingement in its subacromial position. May result from subluxation of the biceps tendon out of its groove in the proximal humerus. CP: Pain localized to anterior proximal humerus & shoulder joint o resisted supination of the forearm worsens pain

Bicipital Rupture 1: Proximal rupture 2: Distal rupture:

Eitology: MOI usually a forceful mvmt of the arm and is more common in older athletes or following direct trauma. CP: 2 types: 1: CB Older adults w/ rotator cuff disease. "Popeye" muscle distally. Some shoulder weakness. Often w/ pain, swelling, and ecchymosis @ elbow. 2: CB forced extension of elbow. "Popeye" muscle proximally. Weakness w/ flexion & supination. Variable pain

o DEC renal blood flow/GFR NE: o INC T 1/2 of drugs w/ predominant renal elimination

Elimination changes?

Compare ∆s in hematopoietic tissue types during embryonic and fetal stages, birth and adulthood

Embryonic--hematopoiesis occurs in the vessels of the yolk sac Fetal--occurs in the liver sinusoids 5th month of gestations: starts in BM Birth: BM Adult: RBM made at the ends of bones n shit

Hyperresonance percussion sounds might be heard where?

Emphysematous lungs

2 intestinal amoeba

Entamoeba histolytica Acanthamoeba castellani

Low back pain

Eti: Exact cause is often difficult to diagnose; often multifactorial. There are usually degenerative changes in the lumbar spine involving the disks, facet joints, and vertebral endplates (Modic changes). o Red flags: history of major trauma, minor trauma in patients > 50 years, persistent fever, history of cancer, metabolic disorder, major muscle weakness, bladder or bowel dysfunction, saddle anesthesia, decreased sphincter tone, and unrelenting night pain.

phalangeal fractures

Etiology -Distal phalanx most common hand fx -Usually a result of crush injury (and thus is commonly an open fx)

hirsutism

Excessive hair growth in women

Melanin

Exposure to UV light stimulates the production of _________ within melanosomes, producing a "tan."

Normal flora Eye and bladder

Eye: primarily S. epidermis then S. aureus, S. pneumonia, corynebacteria sterile in young people, common in elderly/diabetic UTI= E. coli most common cause

X linked characteristics (FUN DR)

F- females typically unaffected/ more mildly than males U- usually many more males>females N- no male to male D- daughters of affected men are all carriers R- recurrence is 25% 4 female carrier= affected son

Describe interleukin-1 (F PEG)

F-Fever inducing (exogenous pyrogen) P-Proinflammatory cytokine E- enhances innate/adaptive immunity G-growth factor

o In the first 2 years, pts should be examined every 6 months, then every year afterwards.

F/U plan for breast cancer?

Describe the spleen's red pulp

F: main filtration Sinusoids and cords rich in macrophages that engulf -damaged and old blood cells -foreign particles

Which percussion sound is the softest?

Flatness

What are the 5 tones produced by percussion? ("FRT HD")

Flatness Resonance Tympany Hyperresonance Dullness

Anagen

Growth phase; determines the ultimate length of hair at a site. It has rapidly proliferating epithelial cells and is exquisitely sensitive to drugs, growth factors, hormones, stress, and immunologic and physical injury. Destruction of epithelial stem cells = permanent hair loss. Hairs have pigmented malleable proximal ends. 85 to 99% of hairs will be in this phase.

Resonance percussion sounds might be heard where?

Healthy lung tissue

Describe the Weber test

Helps assess unilateral hearing loss Tuning fork is used to compare hearing by bone conduction with that by air conduction Place the base of the vibrating tuning fork on the midline of the pt's head and ask whether the sound is heard equally in both ears or is better in one If the sound is lateralized, have the pt identify which ear the sound is better To test for reliability, repeat the procedure while occluding one ear, it should be heard best in the occluded ear

presenting appearance -affect

How the patients expressed emotions is observed by another.

What are the Most classic conditions associated with a particular face features?

Hypothyroid facies Hyperthyroid facies Cushinoid facies "Moon facies" Leonine facies Depressed facies

Describe 4 F of platelets

ICIA I- initiate P-P interactions--> plug formation to stop bleeding C- contribute to regulation of blood flow into a damaged site by induction of vasoconstriction (vasospasm) I- initiate the repair process including clot retraction/dissolution (fibrinolysis) A-acitvate the coagulation (clotting) cascade to stabilize PPP (TXA2)

The Karnofsky Performance Scale Higher Lower, Karnofsky

Index allows patients to be classified as to their functional impairment. o This can be used to compare effectiveness of different therapies and to assess the prognosis in individual patients. o A _____ score means a patient is able to carry out daily activities. o The _____ the _______ score, the worse the survival for most serious illnesses.

Describe BMI

Index for relating a person's body weight to height

Stress

Incontinence: Involuntary loss of urine (usually small amounts) with increases in intra-abdominal pressure (eg, cough, laugh, exercise)

Urge

Incontinence: Leakage of urine (variable but often larger volumes) because of inability to delay voiding after sensation of bladder fullness is perceived

"overflow incontinence" Incontinence associated with incomplete bladder emptying

Incontinence: Symptoms are variable and nonspecific Classic "overflow" incontinence involves leakage of urine (usually small amounts) resulting from mechanical forces on an overdistended bladder with little or no sensation of urinary urgency

Define hyperplasia

Increase in NUMBER of cells caused by an increased rate of cellular division (result in increase in size of tissue or organ as a whole)

Describe barrel chest

Increased A/P diameter ribs more horizontal spine kyphotic trachea may be posteriorly displaced sternal angle more prominent

Spasticity: oFlaccidity:

Increased muscle tone Decreased muscle tone

What is hyperpnea?

Increased rate and depth of breathing regardless of PT's subjective perception

lithotripsy

Indication: renal calculi Adverse effect: infection, bleeding,

Abdominal-pelvic/renal US

Indications: -pelvic/renal USRenal trauma o Use: Thickness, size and echogenicity of kidney, obstructions/masses, residual urine, evaluation of percutaneous procedure outcome, hydronephrosis

Low Potency -Fluocinolone, Triaminoclone (Aristocort A) Intermediate Potency - mometasone (Elocon), triamcinolone (Kenalog)

Indications: Inflammatory/pruritic corticosteroid-responsive dermatoses contraindications: Hypersensitivity Do not use in infants < 3 mos Use care in geriatric pts

High Potency - fluocinolone, halcinonide (Halog), triamcinolone (Kenalog) Highest Potency - betamethasone (Diprolene), clobetasol (Temovate), halobetasol (Ultravate)

Indications: Moderate to severe inflammatory/pruritic corticosreroid-responsive dermatoses contraindications: Hypersensitivity Do not use in infants < 3 mos Use care in geriatric pts

Koebner phenomenon

Induction of psoriatic lesions due to injury or irritation of normal skin. Often appears as linear scratch marks Poorly understood, but common phenomenon in psoriasis. Trauma-induced lesion, commonly seen in psoriasis

Describe Tanner's stage ("IBBAM")

Infantile Breast Bud

Describe plasma-other solutes

Ions, gases, waste products, nutrients, regulating substances

Pectus excavatum

Like Preston

PE findings of hair loss pattern in female

Look for signs of virilization (acne, excess facial or body hair, male-pattern or escutcheon), but most are endocrinologically normal. Lose scalp hair according to male pattern, but hair loss starts centrally instead and far less pronounced & more diffuse in women. Onset: 40% occurs in the sixth decade.

Factors affecting body temp?

MIIBE M-metabolic processes I-Infectious I-ingestion of exogenous shit B-body heat loss E-Environmental shit

permethrin (Elimite) (1%) - topical

MOA: Direct action against the parasite. It delays membrane repolorization thereby affecting parasite nervous system, paralyzing the pest. Kills live pests for 5 days after treatment but does not kill unhatched eggs. Indication/ Contra: FDA indicated for headlice and scabies. Contraindicated by hypersensitivity. adverse events: pruritis, rash, stinging. Drug Interactions: no known significant interactions. Patient Education: Don't apply to open wounds or wheeping membranes. Avoid eyes and mucous membranes. May exacerbate pruritis, erythema, edema. Wash off 10 minutes after application.

Urine osmolality

o Used to differentiate renal from non-renal o >500= azotemia o <400= AKI

Describe B cells

Made and mature in BM F: make specific Abs Loc: inside LN, spleen Ag: bacterial/viral Life: short

Describe T cells

Made in BM, mature in thymus Types: -Helper T cells-CD4 -Killer T cells- CD8 -Memory T cells Loc: outside lymph nodes, spleen, gut, respiratory Ag: protists/fungi Life: long

Dermis

Major structural element (pliability, elasticity, tensile strength); thermal regulation; binds water; receptors for sensory stimuli; site of vascular, lymphatic, nerve networks; contains many resident cells (fibroblasts, macrophages, mast cells, circulating cells of immune system Has 2 layers. From superficial to deep: Papillary, Reticular

Consanguinity affects individuals in what way?

Makes them more susceptible to autosomal recessive disorders Their risk for these disease are double that of normal people With each decreasing degree of relationship, this proportion is reduced by one half

Describe AD disorders ("MnM MR H")

Marfan syndrome neurofibromatoses Many câncer predisposition syndromes (HBOC, HNPCC, FAP) Most hereditary cardiomyopathies Rare early AD Huntington disease

cephalohematoma-

Mass of clotted blood between skull and periosteum of a newborn (due to birthing trauma),

Tanner's stage 5

Mature breasts **don't fully mature until eggo preggo

Chemical blocking sun screen

May be allergen or irritant No consensus on estrogen effects Risk for systemic absorption, no consensus on risk, but have been seen in urine after many days to date, benefits appear to outweigh risks

Total Protein

Measures albumin and globulin in blood. Assess nutritional status, liver and renal disease, dehydration status, multiple myeloma

Morbidity:

Measures of __________ frequency characterize the number of persons in a population who become ill (incidence) or are ill at a given time (prevalence)

Meniscal tears

Mechanism of Injury is typically a pivoting motion with the foot planted. Swelling is likely to occur and pain can be palpated along the joint line. Patient may describe a clicking or locking sensation in the knee.

Federal and individual State governments Usually no fees to patients (some states charge small fees for some services)

Medicaid is funded by?

Medical Insurance (optional)

Medicare Part B covers?

Medicare advantage (optional w/ A AND B)

Medicare Part C covers?

Rx drugs (optional w/ A OR B)

Medicare Part D covers?

Federal government (general revenue, payroll taxes, social security taxes, etc.) Patients pay deductibles and small monthly premiums.

Medicare is funded by?

o DEC 1st pass metabolism o Minor s in phase 1 metabolism o No ∆s in phase 2 metabolism NE: o INC bioavailability of drugs w/ extensive 1st pass metab o INC T1/2 of drugs that are metabolized in phase 1

Metabolism changes?

2 dangerous properties of malignant neoplasms that distinguish them from benign neoplasms

Metastasis- "most important and deadliest characteristic" Invasion implies that tissue boundaries, such as epithelial basement membrane, have been breached. maybe: Anaplasia Rapidly-growing with hemorrhage and necrosis Locally invasive Poorly differentiated Large

Hamilton Depression Scale

Most widely used interview scale to measure depression in inpatient populations. Takes 20-30 minutes to administer. Scores of 0-7 are considered normal, and scores greater than or equal to 20 indicate moderately severe depression contains a relatively large number of somatic symptoms and relatively few cognitive or affective symptoms

· Self-limited, 8-10 weeks · Symptomatic: oral antihistamines and/or topical antipruritic lotions, topical steroids, phototherapy, short course of oral steroids

Mgmt/complications for pityriasis rosea

Describe the dermis What 4 things does it contain?

Middle layer that supports and separates the epidermis from adipose tissue Contains: Blood and Lymph vessles, hair follicles, sweat glands Interdigitating papillae secure the epidermis to the dermis

Describe what Macrophages do?

Monocytes in blood Macrophages in tissue Central feat of CI bc of al the shit they produce: -enzymes, plasminogen activator, acid hydrolyses, lipase, plasma proteins, complement components, coagulation factors, cytokines, NO2

X-linked recessive

More in males than females Can skip If dad affected, all girls will be affected

What are the granulocytes

NEB Neutrophils Eosinophils Basophils Mast cells

Describe salt distribution in body

Na= 90% of ECF cations NA regulation by aldosterone Aldosterone iNC read

Physical findings in the eye that may indicate the presence of- Hypertension

Narrowing of vessels, increased vascular tortuosity, copper wiring (diffuse red-brown reflex), arteriovenous nicking, and retinal hemorrhages

Retinoids

Natural compounds and synthetic derivatives of retinol that have Vitamin A like activity Affects regulation of cell proliferation and normal epithelial differentiation Used in the treatment of inflammatory skin diseases, skin malignancies, hyperproliferative disorders and photoaging

Magnesium

Needed for energy production, muscle and nerve function, bone maintenance. o 2nd MC intracellular cation Assess for kidney disease

What are the Gram - DIPLOCOCCI

Neisseria gonorrhoeae

o Chemotherapy: o HER2+ BC: trastuzumab and pertuzumab o Hormone receptor + (HER2 -) - generally only reserved for post-menopausal women who cannot tolerate chemotherapy o Triple-negative breast cancer - chemotherapy

Neoadjuvant Therapy options for breast carcinoma

Porphyria cutanea tarda

Non-inflammatory blisters on sun-exposed sites; as blisters heal the skin takes on an atrophic appearance. pt will present with Painless blistering and fragility of the dorsal surfaces of the hands, facial hypertrichosis (on cheeks and temples especially) and hyperpigmentation

Distinct Presentation: both BCC and SCC their presentation in darker skinned individuals follows the same as in light skinned individuals with the exception of the lesions looking less pink. Causes for difference in presentation: same as melanoma.

Non-melanoma skin cancers (NMSCs) in dark skin individuals

Presentation: just like in melanoma, it greater affects lightly skinned individuals (skin phototypes I & II). Causes for difference in presentation: same as for melanoma

Non-melanoma skin cancers (NMSCs) in white skin individuals

The Karnofsky Performance Scale

Normal: 80-100 • Unable to work: 50-70 •Unable to care or self: 0-40

What are the 8 cervical lymph nodes:

Occipital Postauricular Pre auricular Tonsilar Submandibuluar Submental Anterior chain Posterior chain

Anaerobic infections

Occur naturally, but most common= flora in the body -cause infection due to injury/trauma -affect the: abdomen, pelvic, respiratory tract, skin and bones Can cause: -appendicitis, periodonitis, -abscess -sinusitis -pneumonia -Lemierre's syndrome higher risk if: -low blood supply -open wounds -weak immune -diabetes,

Describe hypotonic alteration

Occurs when ECF Na [ ] is less than normal water moves into cell hyponaturemia: excess water

Describe AI outcome: Progression to chronic inflammation

Occurs when acute inflammation cannot be resolved, or may have features of chronicity from the outset Acute inflammation and chronic inflammation can coexist

Geriatric Depression Scale (GDS)

Older patients often have fewer mood complaints, and more somatic complaints, making traditional depression screens (ex: PHQ-9) less effective for screening elders. --> GDS considers these differences Specialized depression screen tool designed for elders. Shortened, 15-item scale available. Widely used, available in many languages (¡Qué maravilloso!)

How is light and deep palpation performed

One hand up to 1 cm deep two hands up to 4 cm

Describe antigen presentation cell

Only dendritic cells: macrophages, B cells, Use MHC II to present Ag to T cell activating it -then, any cell can present that Ag via MHC I

A transporter allows what?

Only those ions that fit the unique biding site on the protein

Miliaria (heat rash)

Ostia of sweat glands are plugged, causing sweat duct to rupture and producing stinging and irritation; common in hot, moist climates, rare forms associated with fever and heat prostration; bedridden febrile patients are susceptible

Flatness percussion sounds might be heard where?

Over muscle

Describe laboratory diagnosis of acute inflammation ("PB WED")

P-Presence of acute inflammatory cells: -Neutrophils- bacterial -Lymphocytes- viral B-Biopsy and examination of tissue W-Will see a Left shift of systemic neutrophils E-Examination of exudate (characteristic high proteins levels and specific gravity) D-Diagnostic tests: Culture, gram stain, Ab levels, complement levels

When palpating, TO DETERMINE Position, texture, size, consistency, fluid, crepitus, form of a mass, or structure, use what ?

Palmar surface of the fingers and finger pads

Describe how to examine the skin 3rd part

Palpate epidermis and mucous membranes for: Moisture Elasticty Temp Turgor Texture Lesions

How should you palpate the nose?

Palpate the bridge and soft tissues of the nose. Note any displacement of bone and cartilage, tenderness, or masses. Place one finger on each side of the nasal arch and gently palpate, moving the fingers from the nasal bridge to the tip.

Define palpation

Palpation involves the use of the hands and fingers to gather information through the sense of touch. Certain parts of your hands and fingers are better than others for specific types of palpation

Telogen

Period of relative quiescence, prior to shedding. Club hairs with depigmented rounded proximal ends. 1 to 15% of hairs in this phase.

What is Blood pressure?

Peripheral measure of cardiovascular function Force of blood exerted against the walls of the arteries as blood flows through them

29. Describe the mechanism of action, indications, contraindications, adverse effects, drug interactions, and patient education for the following drugs commonly used to treat scabies and lice:

Permethrin (Elimite) Crotamiton (Eurax) Ivermectin (Stromectol) Lindane (shampoo, lotion preparation)

Porphyria cutanea tarda

Photosensitivity due to a deranged metabolism of porphyrins; cases are sporadic or hereditary; associated with taking certain drugs (e.g. estrogens), alcohol liver disease, hemochromatosis, or hep C

Describe chronic venous insufficiency edema

Pitting pigmented ulcer Advanced due to chronic obstruction or valvular incompetence of the deep veins

Describe orthostatic edema

Pitting swollen foot due to prolonged sitting/ standing

How should you palpate the patient's trachea and what should you compare?

Place a thumb along each side of the trachea in the lower portion of the neck ( Fig. 11.25 ). Compare the space between the trachea and the sternocleidomastoid muscle on each side.

Define Gonadal Mosaicism

Presence of >1 cell line in the gonads, NOT the rest of body Mutation occurred in a precursor sperm/egg and IS passed on

Hypercalcemia

Presentation/differential -most common in solid tumor cancers (ex: breast and lung) Evaluation -Muscle weakness, hyporeflexia, anorexia, constipation, dehydration, cramping -fatigue -nausea -polyuria -AMS -cardiac dysrhythmias -tremors "bones, stones, moans and groans"

Spondylolysis

Presentation: Insidious onset of low back pain that worsens w/ activity and lumbar extension - neurologic symptoms rare -exam can be from normal to severe pain.

o Selective Estrogen Receptor Modulators (SERMs): tamoxifen and raloxifene o Aromatase inhibitors (AIs): exemastane and anastrozole o Early detection

Preventative measures for Breast carcinoma?

Pustule

Primary lesion, circumscribed, raised cavity in epidermis or infundibulum containing pus; vary in size; may coalesce to form "lakes" of pus

Indirect hernia

Protrusion thorugh the deep inguinal ring lateral to the inferior epigastric vessels comes down whole canal

What's McBurney sign

Pt has rebound tenderness and sharp pain during palpation of McBurnery's point Right side, 1/3 distance from belly B and iliac Pain w/ palpation= appendicitis or other peritoneal inflammation

Mallet finger

Pt presents w/ inability to actively extend the fingertip while maintaining normal passive ROM and the DIP joint remains passively flexed. Pt reports the injury occurring after a sudden axial blow to the extended fingertip where the DIP was forcibly flexed against an actively extended finger. On radiography, there may be a small bony avulsion fragment on the dorsum at the distal phalanx.

Chiggers

Pt presents with red papule with white hard center area occurring up to 1-2 days after bite; often in warm sweaty areas, ankles; highly pruritic but painless

Mallet finger

Pts present with swelling, tenderness over the distal phalanx, and an inability to actively extend the DIP joint.

2 main lymphatic drainage?

R subclavian vein: drains R side of head, chest, and arm Thoracic duct: everywhere else

Pregnancy Category X Exposure in 1st 3 weeks of pregnancy results in CNS, cardiac, thymus and craniofacial abnormalities Informed consent required to prescribe Wholesalers, prescribers, pharmacists and patients (male and female) all need to be registered with iPLEDGE Negative pregnancy test must be documented with each Rx - prescriber has the responsibility of pregnancy counseling

RETINOIDS FOR ACNE Teratogenicity well established - facts dont use while pregnant

Syphilis RPR/VRDL

RPR (rapid plasma reagin) standard choice for diagnosis in clinic, easier to do than VDRL. VDRL (venereal disease research laboratory) is standard for CSF, more reliable for CSF than RPR. confirm with FTA-ABS

Effferent and GFR

Raise GFR Constrict INC V/P in Glo Lower GFR Dilate DEC V/P in Glo

Afferent w/ GFR

Raise GFR: Dilate INC volume/ pressure in glomerulus Hormone: prostaglandin Lower GFR constrict DEC vol/ P in glomerulus

Skin color

Ratio of black/brown eumelanin vs. red/yellow pheomelanin and how it is spread within a cell is what determines the

What is the most accurate temperature? Normal temp in general?

Rectal ABOUT 97.3-99.5

Describe Myeloid tissue

Red/active BM Primarily found in flat bones of pelvis, vertebrae, cranium/mandible, sternum, ribs, and extreme prox portions of humerus/ femur -makes RBC, WBC, and platelets Yellow/Inactive -Makes fat cells, cartilage, and bones

Describe how temperature is controlled

Regulated by the hypothalamus It raises temperature above the set point when exposed to pyrogens.

Normal physical findings in the examination of the ear-auricle:

Same color as skin and be free of cysts or other lesions, deformities or nodules. No openings, skin tags, or discharge in preauricular area. Auricle should be positioned at or above this line (align with lateral aspct of eyelid)

Polymorphous Light Eruption

Resistance to UV-induced immune suppression w/ subsequent delayed hypersensitivity to UV-induced Ags

Define neuropathic pain: central and peripheral

Results from injuries in the CNS Results from injuries in the PNS

C- CNS neoplasms H- Heavy metals A- Alcoholism N- normal hydrocephalus T- Thyroid disease S- subdural hematoma H- Hypercalcemia D- Depression B- B12 deficiency D- Drug affects

Reversible causes of dementia?

Describe autosomal dominant patterns? ("SR PA V")

S- single pathogenic variant R-Recurrence risk 50% for an affected individual P-Phenotypes more variable than AR conditions A- Affected parent usually V-Vertical pattern with multiple generations affected

What are the Gram + cocci

S. aureus Strepo pneumonia

drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DRESS)

S/s:fever, malaise, and facial edema with lymphadenopathy or an exfoliative dermatitis (face, trunk, extremities commonly involved) PE: skin eruption (macular exanthem, erythematous centrofacial swelling) with systemic sxs (fever etc.) and internal organ involvement (liver, kidney, heart)

What are normal heart sounds?

S1 and S2 S3: in children, adults under 40, and 3rd tri of pregnancy S4: well-conditioned athletes

1. Atrial systole (aka diastole)

SA node fires off atrial contraction forces a small amount of additional blood through Atrioventricular valves (Tri Mi) into relaxed ventricles 2. AS ends AD begins

5 characteristics of the spleen

SF SAL S- Site of fetal hematopoiesis F- filters blood to remove damaged, worn out cells S- serves as blood resevoir A- activates immune response to substances/ microbes in blood L- largest secondary lymphatic organ

cardiac output=?

SV x HR

Stage 2: decubitus Ulcers.

Stage w/ partial thickness skin loss involving epidermis, dermis or both ?

Describe the examination of the thyroid gland via posterior approach

Same process except instead of palpating with your index and long finger, you palpate with both thumbs. keep your thumbs in front of the neck to avoid encircling the patient's throat in a choking position

telogen effluvium

Scalp disorder characterized by the thinning or shedding of hair resulting from the early entry of hair in the telogen phase (the resting phase of the hair follicle) Alopecia is preceded by a psychologically or physically stressful event 6-16 weeks prior to the onset of hair loss. Growing hairs convert rapidly to resting hairs.

Keloids

Scars of overgrowth of dense fibrous tissue which develop as a result of cutaneous injury (grows BEYOND the site of original skin injury): Hereditary tendency is more common in patients with skin of color, African Americans

Pain on palpation on the eye is consistent with what 3 things? ("SOC")

Scleritis, Orbital cellulitis Cavernous sinus thrombosis.

Albumin

Serum protein produced in liver used to generate osmotic pressure, and transport substances in blood. Screen and stage liver and renal disease. Assess liver function. Decreased levels indicate liver disease. low levels also seen in malnourishment

Lab work up for Pattern Hair Loss to rule out other issues

Serum testosterone, DHEAS, iron, total iron binding capacity, thyroid labs, vitamin D, CBC will identify most other causes in hair thinning in women

* systemic steroids should never be used to treat flares of psoriasis (CMDT 2019) **the use of topical corticosteroids is based on the grading of the psoriasis. For example, treating mild psoriasis (affecting <5% of BSA) should include a lower potency [class V or VI] steroid, as compared with treating a moderate-to-severe psoriasis (affecting >5% of BSA) which should include a higher potency steroid [class I].

Setroid facts

Describe the appropriate setting to perform a breast exam

Setting: Performed when a patient presents with specific breast concern, as a follow-up to abnormal exam, or as part of overall heath visit.

Describe common normal variations in the physical exam findings of the hair, skin and nails due to age.

Skin will have different colors depending on sun exposure vs. non-sun Moisture versus dryness of skin. Turgor and mobility show skin's resilience. Elderly pts may have coallegen loss=> reduced turgor Hair coloring

When using the otoscope to inspect tympanic membrane, how should it look? ("STL")

Slightly conical Translucent and pearly gray Landmarks should be visible: -umbo, handle of malleus, light reflex no perforations

Mitochondrial DNA? Passed by? Males?

Small amount of DNA, no introns or DNA repair, heteroplasty (some normal some aren't) Passed from females to all her kids (not all will express it) Males can't pass it on

stated age vs. apparent age

Stated age- actual age Apparent age- perceived age based upon appearance (subjective) Important to state if stated age and apparent ages do not match.

30.Describe the use of "non-drug" modalities to treat acute and chronic dermatitis.

Study with group

caput succedaneum-

Subcutaneous edema due to prolonged pressure from the dilated cervix during delivery or vacuum suction in newborns. Reabsorbs within 1-3 days

hypoxemia

Subnormal oxygenated arterial blood

Clostridial myonecrosis (aka gas gangrene)

Sudden onset of pain and edema in an area of wound contamination Prostration and systemic toxicity Brown to blood-tinged watery exudate, with skin discoloration of surrounding area. Gas in the tissue by palpation or radiograph Gram-positive rods in culture or smear of exudate

"water resist"-good for 20 minutes in water "very water resistant"- good for 80 min, though without toweling off No such thing as "waterproof"

Sun protection fact

K sparing diuretics

Synthetic steroids that antagonize aldosterone receptors. Inhibit epithelial Na transporter at the late DCT / CD. Reduces K loss in urine.

5-year survival rate:

The percentage of people who will be alive 5 years after diagnosis, does not include those who die from other diseases

radiation oncology

The underlying principle of____ ______ is the destruction of malignant tissues while minimizing damage to normal tissues.

o Pt ed o Orthotics, splinting, surgery

Tx of Hallux Valgus (Bunion)?

Emollients

Tx of Xerosis

o Long-acting steroid injection into the flexor sheath

Tx of flexor tenosynovitis (trigger finger)?

Which percussion sound is the loudest?

Tympany

Mongolian spots-

Typically seen in babies with darker skin. Flat, gray-blue, benign, irregular borders, and usually disappear.

EBV

Virus that infects - Infects B cells in the oropharynx and epithelial cells - Establishes latency in resting memory B cells, epithelial cells

viruses

Viruses are so small that they can only be seen with an electron microscope, cannot be grown on artificial media, and are not successfully treated by antibiotics.

Normal physical findings in the examination of the ear- hearing tests: Weber Rinne Whisper

Weber test: Should be able to hear ringing of tuning fork equally in both ears. With one ear occluded should be able to hear best in that ear Rinne test: Air conducted sound (with fork away from ear) should be heard twice as long as bone conducted sound (with fork on mastoid bone) Whisper test: Should be able to hear whispered voice bilaterally

o to screen o diagnose o follow cancer progression o monitor for resistance

What are the 4 ways that tumor markers are used?

28. Describe the following diagnostic/treatment techniques, their indications, clinical usefulness, collection procedures and interpretation:

a. KOH preparation b. Gram stain c. diascopy d. Wood light examination e. viral culture f. bacterial (wound) culture g. fungal culture h. herpes serology i. Tzank smear j. skin biopsy k.RPR/VDRL

36. Describe the general clinical use of the following treatments for psoriasis:

a.Vitamin D analogues - calcipotriene (Calcitrene topical), calcitriol (Vectical topical) b.corticosteroids c.keratolytics - coal tar, salicylic acid d.phototherapy -UVB e.methotrexate (MTX, Trexall) f.cyclosporine (Sandimmune) g.infliximab (Remicade)

22. Describe the etiology, genetic contribution*, clinical presentation, diagnostic workup, laboratory findings, prevention, patient education, management and complications of the following malignant lesions:

a.basal cell carcinoma b.Bowen disease c.malignant melanoma* d.Paget disease e.squamous cell carcinoma

16. Describe the etiology, clinical presentation, diagnostic work up, laboratory findings, patient education, management and complications of the following blistering disorders:

a.bullous pemphigoid b.pemphigus vulgaris

i.oral antibiotics - tetracycline, erythromycin, minocycline ii.isotretinoin (Accutane, Claravis) iii.oral contraceptives

acne systemic therapy

superior (supra)

above

melanocytes

all humans have the same number of _____ in their skin

Define dysplasia (aka atypical hyperplasia)

alteration in adult cell causing disorderly proliferation change in the size, shape, and organization of cells, may be reversible.

X-linked dominant

an abnormal allele is dominant and occurs on the X chromosome Every gen affected Won't skip

Define hypertrophy

an increase in the SIZE of cells caused by increased work demands or hormonal stimulation (Results in increase in size of tissue or organ)

Cell injury due to chemical/toxic substance

cell injury occurs when the chemical substance interacts with the CM causing INC permeability

Bacterial invasion of host cells and tissues

bacteria that can enter host cells or penetrate mucosal surface enable the bacteria to spread from initial infection site -aided by bacteria enzymes collagenase and hyaluronidase (degrade extracellular matrix components) -many use :invasions: that interact w/ host cell receptors to start signaling cascades that induce phagocytosis for bacterial uptake - invasion causes inflammation (pyogenic or granulomatous)

Normal flora GI tract and Rectum Genetalia

bactericides, E. coli, candida Internal: lactobacillus species, Candida (minor)

Cerebellum

balance, coordination, muscle tone. Romberg, shin scrape, gait,

melano-

black

cyst/o

bladder

hemo- (i.e. hematemesis)

blood

CVA tenderness test/

costovertebral angle test blunt percussion IOT illicit pain

Define pulsus paradoxus

dec in pulse amplitude during inspiration Due to possible premature contractions, COPD, restrictive airway disease, pericardial effusion, pericarditis

Tactile fremitus decrease?

decreased when lung tissue is replaced by fluid/air airway obstruction

Flexion → Extension →

decreases in the angle between the bones in the joint movement that brings the members of a limb into or toward a straight position

25. Describe the etiology, clinical presentation, diagnostic work up, laboratory findings, prevention, patient education, management and complications of the following circulatory disorders:

decubitus ulcers stasis dermatitis

Systemic mycoses epi and CS

deep within the body occur where fungal is in soil epi: entry via inhalation of spores-> lungs-> any organ CS: germinate in lungs may lead to meningitis healthy- self limiting immune: may death X: coccidiodomycosis histoplasmosis paracoccidiodomycosis blastomycocis

salping/o

fallopian tube

distal

farthest from center

tachy- (i.e. tachycardia)

fast

lip- (i.e. lipoma)

fat

tendon

fibrous tissue attaching muscle to bone

When Inspecting and palpating the lips, what 3 things should you look for?

for symmetry, color, and edema

polio

gray

papular urticaria

hypersensitivity to insect bite (fleas, ticks, mosquitoes, bed bugs), most frequent in children

General examples of cellular injury related to reactive O2 species

hypertension, hyperlipidemia, diabetes mellitus, ischemic heart disease, CHF sleep apnea, endothelial injury--> atherosclerosis

-otomy

incision into (ie, tracheotomy)

retinoids - tretinoin (Retin-A), adapalene (Differin)

indications: Acne vulgaris, acne rosacea contraindications: hypersensitivity, Pregnancy adverse effects: Burning sensation, skin irritation, erythema, dermatitis, local skin. Vitamin A toxicity patient education: A lentil-sized amount is sufficient to cover the entire face. Washing face 20 min after application helps to minimize irritation. Acne might flare in first 4 weeks of treatment

Brainstem

information relay, homeostasis, respiration, motor/sensory innervation (CN III-XII)

Direct hernia

inguinal hernia protruding through hesselbach triangle medial to inferior epigastric vessels

Chronic and latent viral pathogenesis

initial infection and immune system regulated it, but it never truly clears the virus ONLY FOR HERPES have acute primary infection, immune clears it up, but virus never goes away

Preload vs Afterload

initial stretching of the cardiac myocytes (muscle cells) prior to contraction. Afterload is the force or load against which the heart has to contract to eject the blood

eupnea

normal breathing

Define galactorrhea -

production of milk unrelated to nursing

What is Bradycardia:

pulse of <60 bpm (note: <60 can be normal in fit individuals or those taking beta blockers). Bradycardia can be caused by intrinsic factors (ex. anatomical or physiological conditions) or extrinsic factors (ex. medications such as beta blockers).

-ocentesis

puncture (tapping)

re- (i.e. rehudrate)

put back

erythro-

red

Hair follicles

remarkably productive organs undergoing constant tissue remodeling

needle biopsy:

removal of tissue of internal tumor, often performed with direct vision or guided with US or CT

cost/o

rib

What is nasal polyps?

rounded, elongated mass projecting into the nasal cavity from boggy mucosa

Scale

secondary lesion, Flat plate or flake arising from the outermost layer of the stratum corneum

derm/o

skin

Cherry angioma (aka senile angiomas)

skin disorder that afflicts elderly subjects resulting from the proliferation of blood vessels that tend to increase in size and number with age and may bleed with minor trauma. Small circular or oval red papules

What are primary lesions and what are the 9?

skin lesions as it first appears Macules Papules Plaques Wheals Vesicle and Bullae Pustules cyst nodules mass

cranio

skull only

-opexy

surgical fixation

dia- (i.e. diarrhea)

through (as in running through)

ureter/o

ureter

urethr/o

urethra

miturition

urination

Discuss approach to treating inflammation

use of NSAIDS, corticosteroids RICE (rest, ice, compression, elevation) removing the inflammatory agent.

Assessment of the Hepatojugular reflux

use your hand to apply firm pressure for 10 seconds to the abdomen in the midepigastric region and instruct the patient to breathe regularly. Observe the neck for an elevation of at least 3 to 4 cm in JVP that lasts beyond a few seconds. The JVP equilibrates to its true level after removal of the abdominal hand pressure.

calcipotriene (Calcitrene topical)

used for plaque or scalp psoriasis, may be used in conjunction with betamethasone for patients with mild-to-severe plaque psoriasis

calcitriol (Vectical topical)

used for plaque-type psoriasis (ointment)

a-, an-, ar- (ie, anemic)

without or not

gyne

woman

carp/o

wrist

common myths about aging

• Increasing age brings about greater psychological distress • Older adults are less satisfied with their lives than younger adults • All cognitive domains demonstrate decline with age • As individuals reach old age, they become preoccupied with memories of their childhood and youth

Is percussion used in cardia exams?

• Limited value in estimating size or loc of heart • Not usually performed

Describe how to assess for edema

• Using the 1+ to 4+ scale • Check using 2 fingers • Begin distally and move centrally • Press firmly over a bony prominence • Compare "like" areas • Record where edema ends using surface topographic references • In a bedbound pt, check sacrum

Describe the Compliment System

• consists of 20 component proteins found in plasma that function in innate and adaptive immunity against microbes Activated by "complement cascade" affect a variety of phenomena in AI: -vascular permeability, vasodilation, leukocyte adhesion, chemotaxis, activation, phagocyte -C3 an C5 most important inflammatory mediators

Describe ECF

⅓ of total body water. Broken down into: T- transcellular (saliva etc.) I- Interstitial fluid (fluid surrounding cells) L- intravascular fluid (plasma) L- Lymph

Describe ICF

⅔ of total body water. Rich in K, Ca, Mg, protein