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70 Cards in this Set

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bronchopneumonia
agents: (HPS) Hemophilus, pseudomonas (in cystic fibrosis abfter 6 month of age), staphylococcus (acquired by contamination from skin microbes-->form abscess-->cavitary lesions
rales +/- rhonchi on auscultation due to inflammation
confined to alveoli contiguous to bronchi
X-ray: peribronchial infiltrate
Lobar pneumoina
entire lobe
dullnes on percussion
decreased sounds on auscultaion due to consolidation (xray)
agents:
#1 Pneumococcus: strep pneumonia: casues caugh, fever, rigors
Process: congestion (lobar filled wiht bacteria and mucin)-->red hepatization (lobe filled with RBC)-->Gray hepatization (lobe filled wiht fibrin)--.resolution
#2: Klebsiella pneumonia: prolonged onset of progresseive dyspnea, cough, fever, CURRANT JELLY SEPUTUM (coagulation of necrotic tissue)
Atypical pneumonia
patchy pneumonia bilaterally
Rales on auscul
pulmo infiltrates bila on xray
agents:
Viruses: children: RSV, adenovirus, influenza
adults: Influenza A and B

Mycoplama pneumonia ( Eaton agent): most common lung patho in ages 5-35: cause bullos myringitis (bullae in tympanic memb), pharyngitis, bhronchitis, pneumonia. casues "walking pneumonia" that evolves on weeks to productive cough for mucupurulent sputum.
legionnaire's dis
unilat patchy or lobar infiltrate on Xray
rales
High fever+PNEUMONIA+DIARRHEA+cough

agent: legionella pneumophila
strep pneumonia
#1 cause of pneumonia overall
Aspiration pneumonia
#1: Gastric acid: cause pink frothy sputum, SOB, cyanoisi, Etc, due to aspiration of vomit during inebriation or drug OD
#2; anaerobic Bacteria (from gingivae): purulent foul smelling sputum due to aspiration of gigival organism in saliva secondary to decreased consciousness, decreased pharyngeal controll (MS, ALS)

#3: mechanical obstruction: drowning or aspiration of objexts
Hamartoma
benign
overgrowth of native tissue to the site
adenoma
benign tumor of glandular structure
leiomyoma
benign tumor of smooth muscle
carcinoid
specialized serotonis-histamine producing benign or malignant tumore usually arising from the GI.
if metast to liver develop carcinoid syndrome: flushing (clavicles upward (pathognomic)), diarrhea, bronchospasm, Rt heart valve lesion, hypotension
Dx: 24 hr urinary 5-HIAA

can also develop in lung to cause same symps but usually develop in GI
carcinoma
malignant tumor of epithelial origin
1st symp: new onset cough or change in existing cough
adenocarcinoma
assoc. wiht preexisting lung scar from TB, pneumonia, trauma etc.
in peripheral lung

in non smokers also
squamous cell carcinmona
smoking
parneoplastic syndrome: PTH like peptide-->hypercalcemia
centrall lung
Large cell carcinoma
smoking
periphery of lung
small cell carci (oat cell carci)
smoking
worst px
centrally
parneoplastic: ADH-->fluid overload-->pulmo and systemic edema
paraneo: ACTH: cause cushings syndrome
may cause Eatern Lambert syndrom: antibody to presynaptic Ca channels on neurons of NMJ-->proximal muscle weakness (hip and shoulder)
nephritic syndrome
acute onset inflmamatory process-->decrease filtering
S&S:
HEMATURIA
RBC CASTS (pathognomonic)
hypertension, edema,
increased BUN, CREATININE-->represent azotemia (accumulation of nitrogenous compounds in blood)
neprotic syndrome
change in glomerular permeability-->loss of protein greater than 3.5g/day
S&S:
severe proteinuria
frothy urine
hypoalbuminemia
hyperlipidemia
edema (secondary to decreased oncotic pressure)
Rapidly progressive (crescentic) glomerulonephritis (RPGN)
severe glomerular injury, severe acute form of nephritic syndrome
cresents (prolif. of epitheium of bowmans capsule that surrounds glomerulus)
type 1 RPGN: antibody mediated cytotoxicity: causes: idiopathic, goodpastures
Type 2: (immune complex dis) casues: idiopathic, SLE, Henoch schonlein, post infectious
Type III: (pseudo-immune-->+ANCA dix) casues: idiopathic wegners, microsopic polyangitis, advanced terminal polyartertitis nodosa
Minimal change dis/ lipid nephrosis/foot process dis
Nephrotic
most common nephrotic synd in children
idiopathic
some have recent Hx of URI
Bx; loss of foot processes
Membranous glomerulonephritis
nephrotic
30-50 age
most common adult nephrotic
usually idiopathic but can be asso. wiht colon or lung cancer, chronic inf, heavy metal exposure, drugs
microscopic hematuria
RENAL VEIN THROMBOSIS IS COMMON
BX: thick BM, subepithelial deposits of IgG and C3 complement in a spike and dome
ESRD in few years
focal segmental glomerulosclerosis
nephrotic
less than 3
usually idiopathic, chronic ureteral reflux or heroin abuse, HIV
hematuria, HTN, renal insuffi
Bx: sclerosis or glomerulus in a focal and segmental pattern-->progress to diffuse-->renal failure
very similar pathology to minimal change
membranoproliferative glomerulonephritis (messangiocapillary GN)
5-30, females>males
immune complex deposition in glomerulus, closely assoc. wiht RECENT UPPER RESP INFX, HEPATITIS C, other autoimmune idss
start as nephritic but become nephrotic
BX: messangial prolferation, BM thickining and splittting, subendothelial deposits of IgG and C3 show as "TRAM TRACKING"
LABS: decreased complement levels
ESRD in 10 years
acute proliferative glomerulonephritis (acute post strep glomerulonephritis)
nephritic
3-14 age, risk declines wiht age
3-4 weeks after GABHS infx
labs: (+) ASO TITER and decreased C3 complement
BX; mesangial proliferation, subepithelial deposits of IgG and C3 in granular "LUMPY BUMPY" pattern
Antiglomerular Basement memb (goodpasture's dis)
nephritic
11-39
strong prediliction for males
antiglomerular BM antibodies-->activate complemnt-->sever inflammation
Hemoptysis: because same BM in lungs
progress to RPGN
Bx: mesangial proliferation, "LINEAR" deposition of IgG adn C3 on BM, Cresecent in RPGN
ESRD in months to years
IgA nephropathy
nephritic
most common overall primary glomerular dis.
11-29
strong predilection for males
IGA immune complex depostion
usually follows VIRAL upper resp infx, non-specific viral syndrome, GI syndrome
BX: focal and segment glomerular mesangial prolif, igA immune complex deposits
Labs: increased serum IgA
usually benigh
Diabetic glomerulosclerosis (kimmelstiel wilson syndrome)
nephritic + nephrotic
any age about 20 years after onset of diabetes
most common secondary glomerular dis
microalbuminuria is early finding
Bx: small kidneys, diffuse glomerulosclerosis of BM-->nodules of mesangial prolif (kimmelsteil wilson nodules)
Acute tubular necrosis
death of cells that line the renal tubules
pre-renal acute renal failure is the the #1 cause of ATN: little blood is delivered to renal and too little fluid reaches the tubules
MUDDY BROWN CASTS: pathognomonic
also caused by toxins: Free HgB (from massive hemolysis), myoglobin (from rhabdomyolysis), ethylene glycol, aminoglyosides, Amphothericin B, Cisplatin, contrast media
if treated early: full recovery in 7-21 days
Pre-renal acute renal failure
due to hypoperfusion of kidneay with inadequate blood delivry to glomerulus
casues: hypotension, dehydration, hemorrhage, severe CHF, shock
oliguria
Labs: High BUN and CREATININE, with a BUN:CREATININE ratio of >20:1 (kidney retains urea in attempts to conserve volume)
Tx: IV fluids
renal (intrinsic) actue renal failure
due to damage to the kidney tissue and its tubules
casues:
Acute tubular injury: from drugs, metals, contrat, prolonged pre-renal ARF (# 1 cause of renal ARF)
Acute glomerulonephritis
Acute tubulointerstitial nephritis: inflammation of tubules or renal parenchyma secondary to allergic rxn ( usually to drugs), or to infx.
Acute vascular nephrophahy: vasculits, malignant HTN, TTP, atheroembolism
infiltrative dis: sarcoidosis, amyloidosis, etc.
LABS: Hi BUN, CREATININE, BUN:CREATININE RATIO OF >10:1, elevated K, Na, Mg, Cl, and decreased Ca
Tx: treate the cause
post renal ARF
obstruction of outflow from the urine
causes: BPH, Bladder stone, urolithiasis of ureters, renal collecting system injury from trauma
oliguria/anuria
increase K levels as it worsens
Calcium stones
usually percipitated by dehydration
most common type of kidney dis
primary treatment: hydration
thiazides reabsorb Ca from renal tubule decreasing stones
MG-NH4-phosphate stone
triple stone/staghorn calculus/struvite stone
casued by urea-splitting organism: proteus and staphylococcus saprphyticus
tx: ABX to eradicate the pathogens
Uric acid stone:
uric acid crystal serve as core on which Ca oxalate can deposit
causes: increase consumption pf purines, gout, leukemia, tumor lysis syndrome, high cell turnover
cystine stone
due to cystinuria (AR disorder)
impaired tubular reabsorption of cysteine, ornithine, arginine, lysine (COAL: black stone), cystine crystalizes to form a stone, OAL pass in urine
candidiasis
casued by candida spp.
yeast infx
DOC: miconazole
symps: pruritis, erythema, satellite lesions, curd-like white or adherent white discharge
due to overgrowth of yeast natural to the area (opportunistic infx)
ph:< 4.5
color: bright white
odor: bready
microscopic: germ tubes, pseudohyphae
Trichomonas(STD)
thrichomonas vaginalis
DOC: metronidazole
symps: extreme pruritis, frothy green discharge
ph: <4.5
color: yellow green
odor: putrid
micro: darting trichomonads
Bacterial vaginosis
overgrowth of normal flora gardnerella and mobiluncus due to disruption of flora by douching, feminie products
DOC: metronidazole
profuce grey white discharge wiht or without prutits
+ whiff test
ph: <4.5
color: grey white
odor: fishy
micro: clue cells
Gonorrhea
neisseria gonorrheaa
DOC: ceftriaxone + doxy (for chlamydia)
thich purulent discharge
if left untreated in female: ascends to casue PID, salpingitis-->may cause infetility, ectopic pregancy
trichomoniasis
often carried asymptomatically in the rectum
trichomonas vaginalis
extreme pruritis because very motile
DOC: metronidaxole
non-gonococcal urethritis
infectiour urethritis in male due to anything but gonorrha
usually due to chlamydia trachomais
DOC: doxy +ceftriaxone
lymphogranuloma venereum
primalily in tropics
hits lymph nodes wiht granulomas-->develop granuloma in inguinal nodes-->eruption/ulcers on surface
Chlamydia tracho.
DOC: doxy
granuloma inguinale
Klebsiella granulomatis (calymmatobacterium granulomatis or donovania granulomatis)
bacterium in macrophage: donovan body
hits the groin then blocks the inguinal are-->granulomas develp on the genitals-->blocks lymphatic drainage from genital region
DOC: tetracycline
chancroid
primarily tropics
hemophilus ducreyi
micro: school of fish (bacteria mover together like fish)
soft PAINFUL CHANCRE
DOC: ceftriaxone
syphilis
treponema pallidum
DOC: PEN G
3 stages:
1st stage: PAINLESS HARD CHANCRE (appears 2-10 weeks after infx)
2nd stage: maculopapular red rash on palms, condylama on geitals
3rd stage: gummas (granulomas in skin (painless) in bone (painful), tabes dorsalis, phychosis, dementia, leutic aneurysm, aortitis, arotic regurgitation
condyloma acuminatum
genital warts
painless
BX: koilocytes (marker for HPV, epithelial cells wiht perinuclear clearing)
usually type 6 and 11
types 16,18: oncogenic
viral proteins E6, E7 inteerfere wiht p53, RB tumor suppresson genes
tx; cryotherapy
Genital herpes
HSV1 (oral), HSV 2 (genital)
exquisitely painful fluid filled vesicles that erupt in a group on a erythematous base
recur during physical or emotional stress
live virus become latent in sensory ganglion cells (trigeminal ganglion (oral herpes), lumbar and sacral ganglion(genital herps)
+ TZank test: multinucleated giant cells
DOC: acyclovir
chlamydial cervicitis
chlamydia trachomatis
if untreated-->ascend to cause PID in females
DOC: Doxy
Germ cell tumors
from cells that would normally become sperm
seminoma
germ cell tumor
painless enlargement of testes
peak 35
#1 most common germ cell tumor
always malignant
very radiosensitive
+/- elevated hCG
Embryonal
germ cell tumor
painful with early metasteses
peak <35
#2 most common germ cell tumor
ELEVATED HCG
POOR PX
choriocarcinoma
rare peak in teens-20s
always malignagn
very high hcg
yolk sac
germ cell tumo
infantile type
peak in infany
always malignant
ELEVATED SERUM ALPHA FETOPROTEIN
TERATOMA
2 or mor germ layers
usually malignant: comprised of immature neoplastic cells
non germ cell tumors
from nonspermatozoan cells
2 types: stromal sex cord tumors, non stromal sex cord tumors
leydig cell tumor
stromal sex cord tumor
usually benign
+ intracytoplasmic reinke crystals
precociuos puberty if occurs before puberty
gynecomastia: if after puberty
sertoli cell tumor
stromal sex tumor
benign
asymp
lymphoma
non stromal sex tumor
in elderly and AIDS
surface epithelium ovarian tumors
in females>20 years
1: serous
2: mucinous
3: endometriod
4; clear cell
5: brenner
serous
cystadenoma/cystadenocarcinoma
cystic
lined wiht fallopian tube epithelium (ciliated adn secrete a watery secretion)
half of all ovarian cancers, and bilateral
mucinous
cystadenoma/cystadenocarcinoma
cytic
lined wiht columnar cells that make mucus
may cause: pseudomyxoma peritonei
endometioid
glandular tissue resembling endometrial tissue, usually malignant
solid tumor
clear cell
solid tumor
large epith cells with large clear cytoplasm
can occur wiht endometriosis, endometriod carcinoma or ovary
usually malignagnt
brenner/celioblastoma
solid tumor
transitional epi
germ cell tumor of ovary
#1 type in women <20
1: teratoma
2: dysgerminoma
3: endodermal sinus tumor
4: choriocarcinoma
teratoma
2 or more germ layers
either mature (90%) or immature (20%)
dermoid cyst: mature teratoma: cyst lined by skin wiht hair follicles+/- nails, sebaceous glands, bones, teeth, GI, neurologicla resp, thrroid tissue
2: stroma ovarii: only one 1 type of layer, can cause hyperthyroidism
stromal sex cord tumors
3 types:
1: granulos-theca cell tumor
2: sertoli-leydig cell tumor
3: fibroma
granulosa-theca cell
secrete large amt of estrogen
+ call-exner bodies (follicle filled wiht eosinophilic material)
assoct: wiht casueing secondary endomettial hyperplasia, or endometrial ca
sertoli-leydig cell (androblastoma)
make large amt to testosterone
cause virilization of females (clitoromegaly, hirsutism, deep voice-irreversible)
fibroma
benign
casue meigg's syndrome-->ascites, pleural effusion+ovarian tumor
solid tumor of spindle shaped fibroblasts
Krukenbery tumor
metas tumor to tumor, characterized by bilater replacement of ovaries wiht mucin-producing SIGNET-RING CELLS
primary source is oftern STOMACK TUMOR