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
