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450 Cards in this Set
- Front
- Back
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What is micropenis and what are the causes?
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Smaller than average penis.
- could potentially be a girl (genetic testing) - Kallman's syndrome - a hypopituitary - Congenital Adrenal Hyperplasia |
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What is congenital adrenal hyperplasia?
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A benign tumor on the adrenal gland of a baby (or on the mother in utero) where the adrenal gland makes extra androgens making a baby girl look like a boy. The tumor must be removed to avoid the baby developing Addison's Disease.
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What is hypospadius?
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The opening for the urethra appears on the underside of the penis. It is mostly cosmetic, but could affect fertility.
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What is epispadius?
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The opening for the urethra appears on the topside of the penis. It is mostly cosmetic, but could affect fertility.
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What is priapism?
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An erection that won't return to it's normal flaccid state within 4 hours without stimulation. Can cause dysfunction after.
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What causes priapism?
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Sickle cell disease
medications (like Viagra) spinal cord injury |
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How do you treat priapism?
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Venipuncture.
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What is erectile dysfunction?
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When a man can't get an erection.
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What are the causes of erectile dysfunction?
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Priapism
Atherosclerosis Nerve trouble Medications Psychological issues Prostate surgery |
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What does it mean for a patient, who has taken Viagra, to see blue?
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That he should never take it again. It could potentially be permanent or cause him to go blind.
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What are the treatments for erectile dysfunction?
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1. Sexual counseling - a man can still have an orgasm and he can still make his partner happy.
2. Physical treatments for an erection such as pumps, pills, rods, cock rings and injectionable meds. |
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What is phimosis?
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When the foreskin is inflamed or scarred and is too tight. Can effect erection or urination if bad enough.
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What causes phimosis?
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Infection
poor hygiene idiopathic |
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What is paraphimosis?
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An inflammation of the retracted foreskin of the penis.
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How do you treat phimosis or paraphimosis?
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Treat the infection.
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What is this drawing displaying?
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phimosis
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What is this drawing displaying?
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Paraphimosis
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Can you fracture a penis?
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Yes, an erection or partial erection is needed and then an injury is caused often by a difficult or experimental sexual position.
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How do you treat a fractured penis?
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Pain relief
anti inflammatories should heal |
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What causes penile cancer and how is it treated?
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The HPV virus can cause penile cancer.
It is treated with surgery. |
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What is Cryptorchidism?
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Undescended testes. It is common among baby boys and treatable by a simple surgical correction.
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What is hydrocele?
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Accumulation of fluid in the scrotum.
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What are the causes of hydrocele?
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For a little boy, it may be the inguinal canal is too open.
For an adult, it could be infection, radiation treatment or trauma. |
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What is varicocele?
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A varicose vein in the spermatic cord. It can be seen as bumps on the scrotum. It can increase the temperature of the testicle, risking infertility.
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What is an inguinal hernia?
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A protrusion of abdominal-cavity contents through the inguinal canal. More common in men. The bulge may be fluid or intestines.
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What is the treatment for an inguinal hernia?
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Surgery, or watch and wait. Could potentially strangulate the bowel.
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How can one tell if a bulge is an inguinal hernia?
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Hold it down. Have the patient put pressure on it. If it does not come back right away, it is a hernia. If it comes back immediately, it could be a hydrocele.
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What is torsion of the testicle?
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A twisted testicle or cord. It is compressing the blood vessels. Causes a risk of ischemia. It is emergent and extremely painful.
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What causes torsion of the testicle?
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An injury or partly descended testicle.
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What is epididymitis or orchiditis?
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Infected testes causes by infection or STI.
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What are the symptoms of epididymitis?
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- Hydrocele
- pain - fever - dyspareunia |
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What is dyspareunia?
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Pain with sexual intercourse or orgasm.
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What is the treatment for epididymitis?
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Treatment of the infection - antibiotics. If not treated, may cause infertility.
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Describe testicular cancer.
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- Often seen in late childhood
- diagnosed by a lump on the testicle - may possibly develop gynecomastia (man boobs) - early, it responds well to surgery |
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What is prostatitis?
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An inflammation or infection of the prostate.
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What are the symptoms of bacterial prostatitis?
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- have urethritis at the same time
- WBCs in the urine - pain on ejaculation |
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Why does prostatitis sometimes not respond well to antibiotics?
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Because of the basic pH of the prostate.
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What are the symptoms of non-bacterial prostatitis?
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- pain with orgasm
- frequent urges to pee during the night |
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What is Benign Prostatic hyperplasia?
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An overgrowth of the prostate. It is not cancerous. If it grows in, it can block the urethra.
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What are the symptoms of Benign Prostatic hyperplasia?
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- a weaker stream of urine
- retained urine - increased risk of UTI |
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What is the treatment for Benign Prostatic hyperplasia?
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A small incision to cut back the prostate.
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Describe prostate cancer.
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- 40% are genetic and 40% are idiopathic
- something else seems to be going on besides genetics - most get it when they're older and it progresses slowly - for a smaller group, it grows quickly and kills - common in European and African American heritage - starts microscopic, then you can feel it in rectal exams - stage IV goes metastic |
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What are the treatments for prostate cancer?
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- watch and wait
- when treated, 50% will lose sexual function - some lose bowel or bladder function, possibly 30% - test the blood level of the prostate |
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What is pelvic inflammatory disease?
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An infection of the uterus, and often, the oviducts.
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What causes pelvic inflammatory disease?
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- usually sexually transmitted (not always)
- can be caused by anything that introduces bacteria |
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What are the symptoms of pelvic inflammatory disease?
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- pelvic pain
- dyspareunia - dysmenorrhea - adnexal pain (oviduct or umbilical pain) - discharge - fever |
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What risks does pelvic inflammatory disease cause?
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- risk of infertility
- scarring in the uterus can cause miscarriage - peritonitis |
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What is this that we're looking at?
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An intestinal hernia.
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What are we looking at here?
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An inguinal hernia.
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What is vulvovaginitis?
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An inflammation or infection of both. Yeast infections and herpes are both.
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What is Bartholin's cyst?
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When the vestibular gland is infected. It's a fluid filled sac that's created when the Bartholin's gland is blocked.
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What is treatment for a Bartholin's cyst?
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A sitz bath (epsom salt), opens the duct and brings down the swelling.
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Describe cervical cancer.
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- caused by HPV
- #1 worldwide cancer killer of women - a cell sample, called a pap smear, helps to observe the cells and hopefully treat before it becomes cancer - if it becomes cancer, it spreads to the underneath of the peritoneum, blocking the ureters and blood supply and metastasizes late. |
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What is the precancerous stage called of cervical cells and how do we treat it?
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cervical intraepithelia neoplasia. If it's a small amount, we may watch it. If it's a lot, we can remove it by liquid nitrogen and freezing off the cells. If it's truly significant, a cone shaped piece of tissue will be removed from the cervix, a procedure called "cold cone biopsy".
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What is endometriosis?
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When endometrial tissue is found in places other than the uterus, such as on the ovaries, in the oviducts or lining of the pelvis, as well as other places.
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Why is endometriosis painful?
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Endometrial tissue builds up and sloughs off cyclically like it does in the uterus, but only the uterus is made for that. Other organs will build up scar tissue and cause pain and bleed.
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What are the symptoms of endometriosis?
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- inflammation
- scar tissue - pain - adhesions |
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What are the etiology theories of endometriosis?
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- that menstruation happened backwards and out the oviducts
- that the tissue ends up in the lymphatic system and travels elsewhere - that during fetal development, the tissue developed in places it wasn't supposed to |
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What is the treatment for endometriosis?
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- find out the pain scale of the menstrual cramps
- laparoscopic surgery to find the endometrial tissue and remove it (although it may grow back) - block the hormones to block the cycle (the pill) - meds that prevent the release of luteinizing hormone and FSH - remove the ovaries (menopause is the only final treatment) |
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What are the lesions called that is caused by endometrial tissue and why?
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They are called "chocolate lesions' because the blood that collects in them is dark brown or black and resembles melting chocolate.
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What is amenorrhea and what may cause it?
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No menstrual cycle. If there hasn't been one yet, it could potentially be Turner's Syndrome or low body weight.
If there has been a cycle, it could be the female athlete triad or hormone issues. |
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What makes up the female athlete triad?
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- underweight
- overexercising - not eating healthy can cause amenorrhea |
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What hormonal issues can cause amenorrhea?
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- the body producing too much prolactin
- the body not producing enough estrogen (often related to body weight) - too many stress hormones - pregnancy - lack of thyroid hormones |
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What is oligomenorrhea and what causes it?
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Not enough periods. Can be caused by
- hormone issues - body weight - stress - pregnancy |
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What is polymenorrhea and what causes it?
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Too many menstrual cycles. Often caused by thyroid levels out of whack.
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What is menorrhagia and what causes it?
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Excess menstrual flow. Often caused by
- thyroid issues - menopause - clotting trouble (platelets or proteins) |
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What causes normal dysmenorrhea?
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Lactic acid from the contracting uterus and prostaglandins that are made to cause the contractions.
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What do prostaglandins do during the menstrual cycle?
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Cause contractions in the uterus and often enter the intestines and cause diarrhea.
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What causes abnormal dysmenorrhea?
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- endometriosis
- infection - miscarriage - tumor |
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What is a leiomyoma?
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A smooth muscle growth, a fibroid in or on the uterus.
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Describe leiomyomas.
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- common
- usually benign - they respond to estrogen - idiopathic - about 25% of women will get them - more common in African-American women |
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What are the symptoms of leiomyomas?
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- can cause pressure and pain in the uterus
- can cause the uterus to become enlarged - can cause bleeding - can cause miscarriage - can become cancerous |
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How do you treat a leiomyoma?
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Removal
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What is endometrial cancer?
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Cancer of the lining of the uterus.
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What kind of population gets endometrial cancer?
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- white, jewish, urban women
- women who are peri or post menopausal - women on Temoxifen, a treatment used in breast and ovarian cancers. |
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What is the symptom of endometrial cancer and what is the treatment?
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Bleeding after menopause or between cycles. Treatment can be endometrial ablation, a procedure where the endometrial lining is destroyed by extreme temperatures - hot or cold.
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What are the three kinds of female "support failure"?
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- prolapse
- systocele - rectocele |
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What is a prolapse?
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When the uterus falls into the vagina. The cervix may actually fall outside the vagina.
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What is the treatment for a prolapse?
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- Surgery to put it back in place
- hysterectomy - a pessery to hold it in place temporarily (looks like a diaphragm) |
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What is a cystocele and what can cause it?
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When the bladder bulges into the vagina. A childbirth injury may cause this.
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What is a rectocele and what may cause it?
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When the rectum is bulging into the vagina. A childbirth injury may cause this.
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What are ovarian cysts?
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Follicles that failed to ovulate. Some may grow and rupture. If it ruptures, it's excruciating and will need narcotic pain meds.
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What is polycystic ovarian disease syndrome?
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A hormone imbalance that causes multiple un-ovulated ovarian cysts.
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What causes polycystic ovarian disease syndrome?
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A hormone imbalance caused by the hypothalamus and the pituitary glands.
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What are the symptoms of polycystic ovarian disease syndrome?
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- obesity (because of insulin resistance)
- high risk of type II diabetes - high androgens (possibly causing acne & facial hair) - fertility issues - oligomenorrhea |
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What is the treatment for polycystic ovarian disease syndrome?
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- oral contraceptive
- ovulation suppression meds |
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Describe ovarian cancer.
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- 80% of ovarian tumors are benign
- in a younger woman, it's more likely to be benign - in an older woman, it's more likely to be malignant - if malignant, it has a high association with breast cancer - metastasizes quickly |
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What are the risks associated with ovarian cancer?
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- genetics
- smoking - using talcum powder in the genital region |
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What are the symptoms of ovarian cancer?
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- At first there are not many signs or symptoms
- ascites - digestive pain |
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What is the treatment for ovarian cancer?
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- meds that block hormones
- surgery - chemo - radiation |
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What are the gestational disorders?
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- Pre-eclampsia (AKA Toxemia)
- Hyperemesis Gravidarum - Gestational diabetes - Spontaneous abortion (misscarriage) - Ectopic pregnancy |
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What is pre-eclampsia?
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Gestational induced hypertension. Also known as Toxemia.
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Describe Pre-eclampsia.
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- common in pregnancy, in particularly, first pregnancy
- typically, it appears in last trimester - higher risk with already having kidney or heart disease - higher risk with multiples (twins, triplets) - cause is immunological |
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What are the symptoms of pre-eclampsia?
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- increased BP
- edema (particularly the ankles) - protein in the urine - possible kidney shutdown - possible liver failure - risk of seizures (which can kill) - risk of DIC |
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What does DIC stand for and what is the condition?
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Disseminated Intravascular Coagulation. Is when the body overreacts to an infection, inflammation or cancer and clots throughout the body using up all the platelets. Then in the place of an injury, even minor, there is risk of serious bleeding.
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What is the treatment for pre-eclampsia?
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- magnesium sulphate
- bed rest - induce early or deliver by c-section - causes an increased risk of heart disease for the rest of the mom's life |
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What is hyperemesis gravidarum?
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- extreme morning sickness
- not very common - is idiopathic |
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What are the risks associated with hyperemesis gravidarum?
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- hypovolemia
- alkalosis - malnutrition - circulatory shock |
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What causes gestational diabetes?
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The placenta makes chorionic somatomammotropin, which goes to the mom's body, decreasing insulin sensitivity. Usually, the mom's body increases insulin production to counter-balance. If not, gestational diabetes takes place.
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Who are at risk for gestational diabetes?
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- overweight women
- women with type II diabetes in the family |
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Why is gestation diabetes dangerous?
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- Often happens around 6 months, when the baby starts to put on weight and the baby could become too big.
- after birth, the baby's sugar will crash and can cause a risk for seizures. - this will also increase the baby's risk for type II diabetes after birth - Mom's high blood sugar can damage her system with atherosclerosis, retina damage, nerve damage, and also put her at risk for type II diabetes. |
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What is macrosomia?
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Abnormally large baby at birth.
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What is spontaneous abortion and what causes it?
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Miscarriage. 10 - 15% of births are miscarried
- about 60% have chromosomal problem. - infection - trauma - endocrine imbalances - poor implantation - fibroids |
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What are the symptoms of spontaneous abortion?
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- cramping
- bleeding |
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What is the treatment for a spontaneous abortion?
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- D & C (Dilation and curettage)
- watch or excessive bleeding |
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What is ectopic pregnancy?
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A pregnancy outside the uterus, typically in a fallopian tube, but not always.
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What are the causes for ectopic pregnancy?
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Partial blockage of an oviduct by scar tissue or endometriosis.
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What are the symptoms of an ectopic pregnancy?
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- pregnancy symptoms
- intense umbilical pain about 1 1/2 months after the last menstrual cycle - positive pregnancy test |
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What is the treatment for an ectopic pregnancy?
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Take the oviduct out with the pregnancy.
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What kind of lesion is this, what is it called and how do you know?
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This is endometriosis, a chocolate lesion because it looks like melted chocolate.
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What are we looking at?
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An ovary with polycystic ovarian disease.
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What is this a picture of?
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A normal placenta.
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What is this a picture of?
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A leiomyoma, also called a fibroid.
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What is mastitis?
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An inflammation of the breast. In the ducts, producing a red, painful area. A fever typically accompanies it. Usually related to breast feeding or lactation. If not, could be breast cancer.
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What is a breast abscess?
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Is not lactational, it is a localized infection. Is tender red and may be hard to the touch. Breast cancer can look like an abscess.
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What is mammary duct ectasia?
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Dilation of a milk duct.
- It is seen in older women (aged in their 50's or higher) - there is typically a high number of B-cells and antibodies - there are no signs of inflammation - there is a nodule and dishcarge |
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What is a fibrocystic change?
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A non-cancerous, fluid filled cyst in the breast. An overgrowth of the epithelia that causes scarring.
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Describe fibrocystic change of the breast.
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- common
- 25% of women have a mild form, 30% have it - they increase in size right before the menstrual cycle - caffeine makes it worse - they are estrogen sensitive - starts to show up at puberty, but more when full developed - Menopause makes it go away - doesn't increase risk for breast cancer, but makes it difficult to monitor for it. |
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What is Fibroadenoma?
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A benign tumor of the breast.
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What is adenocarcinoma?
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An epithelial cancer. Most common form is the ductal of the breast, which is responsive to estrogen. The less common kind is the glandular, which is more responsive to progesterone.
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What are the risks associated with adenocarcinoma?
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- genetics
- smoking - the amount of estrogen exposed to - obesity (adipose tissue makes estrogen) - geography (dietary, environmental) - fire retardant chemicals added to furniture & building materials |
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How is adenocarcinoma treated?
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A test for estrogen receptors is performed to determine which drugs will be used to fight the cancer
- estrogen blocking - hormonal menopause - tamoxifen Sugery, chemo, radiation & sentinel node biopsy |
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What are the symptoms of adenocarcinoma?
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- a lump which shows up in mammography
- skin retraction - nipple retracts or has discharge - skin changes of the breast (looks like psoriasis or has inflammation - looks like infection) |
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What is a sentinel node biopsy?
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A sentinel node is the first lymph node that a tumor drains into. It is removed and analyzed in a lab. If the lymph node is cancer free, then others don't need to be removed and the cancer has not spread.
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Who has gynecomastia?
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- can be seen in babies who are breastfeeding
- sometimes can be seen on teen boys - is a sign of liver failure - shows up in obese men - also can be seen in men on steroids |
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What is gynecomastia?
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Female breasts on a male.
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What is an endocrine disorder?
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An excess or lack of proper hormones of the secretary hormones.
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What is hyper pituitary?
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An excess of all or a few of the anterior pituitary hormones.
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What happens in an adult with an excess of growth hormone from the anterior pituitary?
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- Acromegaly in an adult
- pituitary giant for a child - would just grow big |
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What are the symptoms of acromegaly?
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- excess of insulin like growth factor
- enlargement of hands and feet - enlargement of the jaw - brow becomes more permanent - tongue gets larger - heart gets larger (cardiomegaly), causing a risk of cardiac death |
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What is a prolactinoma?
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An anterior pituitary tumor that produces prolactin.
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Describe a prolactinoma.
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- benign
- very common - causes high levels of lactation or - hypogonad |
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What is hypogonad?
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A condition caused by a prolactinoma in the anterior pituitary which causes a decrease in fertility, amenorrhea or oligomenorrhea and a decrease in libido.
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What happens with an excess ACTH from the anterior pituitary?
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It will trigger adrenal steroid production and can cause Cushing's Disease with an excess of cortisone, possibly aldosterone and an excess of sex steroids.
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What happens if the anterior pituitary creates too much thyroid stimulating hormone (TSH)?
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A hyperthryoid.
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What happens if the pituitary creates too many gonadotropins?
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An increase in the follicle stimulating hormone and luteinizing hormone will cause premature puberty in a child. This happens naturally in men and women of menopausal age.
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What is Sheehan's Syndrome and what can cause it?
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A hypopituitary condition where ALL the hormones are low or gone. This can be caused by
- post shock (shows up months later after the stored hormones are gone) - diabetes mellitus (artery damage has caused no blood flow to the pituitary) - a particularly difficult child birth, where she went into shock can cause a woman to develop Sheehan's syndrome. |
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What happens when there is too little growth hormone from the anterior pituitary?
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A child will become a pituitary dwarf, where they will be proportional, but brain will be undersized.
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What is hypogonadism?
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When there is too little luteinizing hormone and too little follicle stimulating hormone from the anterior pituitary. If the condition is congenital, it is called Kallman's and the child never goes through puberty.
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What can cause hypogonadism post puberty and what are the symptoms?
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It can be caused by medical treatment. The symptoms are
- decrease in pubic/ axillary hair - decrease in libido - decreased muscle mass in men/ SC fat in women - amenorrhea or oligomenorrhea in women |
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What happens when the anterior pituitary does not produce enough Thyroid stimulating hormone (TSH)?
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The person will become hypothyroid.
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What happens with a lack of ACTH from the anterior pituitary(adenocorticotropic hormone)?
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The patient will develop Addison's Disease.
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What happens if the posterior pituitary does not produce enough anti-diuretic hormone?
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The patient will develop diabetes insipidus, a disorder which results in extreme polyurea and hypernatremia.
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What happens if the posterior pituitary produces too much anti-diuretic hormone?
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It is usually cancer related (lungs & intestines). Causes hyponatremia and the patient to retain water.
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What happens when the thyroid produces too many of the thyroid hormones thyroxine and triiodothyrone?
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Thyrotoxicosis.
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What are the causes of thyrotoxicosis?
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- an excess of TSH
- Grave's disease and and possibly a goiter - hormone producing benign adenomas - 'thyroid storm' where the patient needs to go to the emergency room |
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What are the symptoms of thyrotoxicosis?
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- weight loss
- tremor - changes in reflexes – faster and stronger - may be irritable (emotionally labile) - trouble with heat - diarrhea - hair change - skin change – pores get smaller - eye changes – exphthalmos (more prominent fat pad behind eyes builds doesn’t go down ) - tachycardia |
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What are the causes of hypothyroid?
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- low thyroid stimulating hormone (TSH)
- Hashimoto's autoimmune disorder - congenital (baby born without a thyroid) - lack of iodine |
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What are the symptoms of hypothyroid?
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- decrease in metabolism
- trouble tolerating cold - lack of energy - a child will slow down growth or stop growing - decreased reflexes - myxedema (swelling of anterior shins and feet) - hair changes (wirey) - skin changes (more coarse - lose lateral eyebrows) - impaired memory - menorrhagia |
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What is the treatment for a hypothyroid?
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- hormone replacement - synthroid
- remove the tumor (if there is one) |
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What is hypoparathyroid and what causes it?
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A lack of parathyroid, causing hypocalcemia. It is Iatrogenic.
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What does iatrogenic mean?
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Caused by the treatment of a physician. An example is when the thyroid is overactive and removed, the parathyroid is often removed with it, causing hypoparathyroidism, causing hypocalcemia.
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What is hyperparathyroidism?
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When the parathyroid is over active. Typically it is an ectopic situation and cancer. Causes hypercalcemia and risks of bone fractures.
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What is Cushing's?
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A disease caused by an excess of ACTH, which is caused by medication or an adenoma, which causes an excess of cortisol.
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What is a thyroid storm?
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When a patient has untreated or undertreated hyperthyroid and their BP, heart rate and temperature are far too high. The patient goes to the ER, not quite sure what's wrong with them.
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What happens with Cushing's Disease?
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The excess cortisol causes a decrease in WBC count and action. The excess cortisol also causes an increase in blood sugar.
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Why does excess cortisol cause an increase in blood sugar?
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Because both glycogenolysis and gluconeogenesis are both happening at the same time.
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What are the symptoms of Cushing's?
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- thinner skin, producsing stretch marks
- muscle loss - increase in yellow fat in the face, stomach & back of neck - decrease in immunity - can also lose bone minerals |
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What is hyperaldosteronism?
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Too much aldosterone is produced by the adrenal glands. Water and sodium are retained.
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What are the symptoms of hyperaldosteronism?
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- lose potassium
- increase in BP |
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What is exophthalmos?
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Bulging of the eye due to hyperthyroidism.
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What is most likely wrong with this lady and how do you know?
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Cushing's because of the fat pad on her back called a "buffalo hump".
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What symptom do we see and what condition does she have?
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Exophthalmos (protruding of the eyes). Hyperthyroidism.
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What symptom is displayed here and what does it show a problem with?
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A goiter. She has an issue with her thyroid.
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What is Paget's Disease of the breast?
|
Breast cancer that appears on surface of the skin like eczema and is itchy.
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What does this guy have and what caused it?
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Acromegaly. A hyper pituitary.
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What symptom is shown by this statue?
|
Gynecomastia.
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Regarding the adrenal gland cortex, what are the 4 things we learned about that can go wrong?
|
1. Cushing's
2. Hyperaldosteronism 3. Congenital Adrenal Hyperplasia 4. Addison's Disease |
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What are the symptoms of Congenital Adrenal Hyperplasia?
|
- premature puberty in kids, but not fertility - they will stop growing
- virilization in females (she'll grow hair - hirsutism) - voice changes - broader shoulders - muscle mass - gynecomastia in men (man boobs) |
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What is Addison's Disease?
|
When the adrenal glands do not produce sufficient steroid hormones. Typically, autoimmune. As the adrenal gland cells die, the stored hormones are still being released, so symptoms arise when the adrenal gland is approximately 90% gone.
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What are the symptoms of Addison's Disease?
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The person may be slim but be okay until a crisis hits, either physical or emotional and may go into circulatory and possibly hypoglycemic shock.
- lose the ability to increase BP - weight loss - darker pigment at folds of skin - blue lines in the mouth |
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What is the treatment for Addison's Disease?
|
- Cortisone (should carry injectable in case of emergency)
- aldosterone - should wear a medical alert bracelet |
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What is pheochromocytoma?
|
A benign adrenal medulla tumor.
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What are the symptoms of pheochromocytoma?
|
- excess epinephrine
- fast heart rate - diaphoresis - anxiety |
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What is the treatment for pheochromocytoma?
|
- epinephrine blocking drugs
- then surgery |
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What is Diabetes Mellitus?
|
An endocrine metabolic disorder where a person has chronically high blood sugar.
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What are the types of Diabetes?
|
Type I and Type II
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Describe type I Diabetes.
|
Somewhat genetic, autoimmune, beta cells are attacked to the point where the body can no longer make insulin. The body is insulin dependent. The cells can't take in the sugar in the blood and are starving. The body burns lipids and can develop ketoacidosis. The body also burns proteins.
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What are the symptoms of type I diabetes?
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- polyuria
- polydipsias - lose muscle mass |
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What does type I diabetes put someone at risk for?
|
With the high blood sugar and lipids going into the blood, put someone at risk for
- small artery damage - retina damage - kidney damage - stroke - gangrene |
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What is the treatment for type I diabetes?
|
Insulin with a regular schedule for meals.
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Describe type II diabetes.
|
Non-insulin dependent, insulin resistant, cells have a low or no response to insulin. Very high rates among African and Native Americans. 90% correspondence among people with it in the family. Metabolic syndrome puts one at risk for type II diabetes.
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What is the metabolic syndrome?
|
A set of risk factors that occur together putting one at risk for type II diabetes.
- high cholesterol - high blood pressure - apple shape obesity (excess visceral fat) - high fasting glucose level |
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What are the symptoms of type II diabetes?
|
Hyperglycemia puts one at risk for
- glucosuria - small artery damage - blurry vision - dark skin lesions - increased skin infections (especially yeast) - hyperosmolar coma |
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What is a hyperosmolar coma?
|
A coma brought on by high blood sugar and a severe lack of water in the blood.
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What is the treatment for type II diabetes?
|
- insulin encouraging medications
- diet changes - weight loss - exercise - in some cases, gastric bypass surgery can help to cure it |
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What is primary and secondary diabetes?
|
Primary is type I and type II, Secondary is diabetes brought on by a condition or disease.
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Give examples of secondary diabetes.
|
1. Adrenal cushings – increased cortisone
2. stress – increased blood sugar, cortisone & epinephrine 3. Gestational Diabetes |
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What are the signs that a person has increased intracranial pressure?
|
- "racoon eyes" - two black eyes
- bleeding or clear fluid from the ears or nose - "battle sign" - bruise behind the ear - projectile vomiting - stupor - being 'out of it', less than conscious - papilladema - 'tenting' of the retina inside the eye |
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What are the causes of intracranial pressure?
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- a brain bleed
- swelling of the brain - if cerebral spinal fluid can't get out - tumors - infections |
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What is the treatment for intracranial pressure?
|
- take a piece of skull to relieve pressure
- high oxygen (carotid arteries will crimp down sending less blood to the brain) - shunt for spinal fluid |
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What happens to the brain in an injury?
|
Herniations - 4 kinds
1. Cingulate 2. Uncal 3. Central 4. Tonsilar |
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What are the additional symptoms of a cingulate herniation (in addition to the symptoms of the intracranial pressure)?
|
- increased pressure
- hemiparesis (partial paralysis on the side of the injury) - hemi-sensation loss (starts in the legs and works upwards on the side of the injury) |
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In a cingulate herniation, which way is the brain moving?
|
If there is a hematoma on the right side, the brain moves to the left to make room for it.
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What are the additional symptoms of an uncal herniation (in addition to the symptoms of the intracranial pressure)?
|
- brain swells towards the middle and squishes the thalamus, changing the consciousness level
- blown pupil on that side - hemiparesis, starting with the face and arm and working it's way down |
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What is a "blown pupil"?
|
When the eye slowly dilates, becomes oval and becomes unresponsive.
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What are the additional symptoms of a central herniation (in addition to the symptoms of the intracranial pressure)?
|
- when the brain swells on both sides to the middle
- patient will have a change in consciousness - blown pupils on both sides - when stimulated, may respond with decorticate, or decerebrate posturing |
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What is decorticate posturing?
|
During a brain herniation, when unconscious and stimulated, the arms and toes curl in.
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What is decerebrate posturing?
|
During a brain herniation, when unconscious and stimulated, the arms twist out and toes point.
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What is another name for central herniation?
|
Transtentorial.
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What are the additional symptoms of a tonsilar herniation (in addition to the symptoms of the intracranial pressure)?
|
- major brain swelling to the point where it tries to go through the foramen magnum
- rapid change in pupils to a pinpoint - vital signs are unstable to crashing - breathing irregular - paralyzed - if at crash sight, this patient is least likely able to save |
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|
What is cerebrovascular disease?
|
A group of brain dysfunctions related to disease of the blood vessels supplying the brain, including global ischemia and cerebral infarct.
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What is global ischemia?
|
A lack of oxygen to the whole brain, typically after shock.
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What are the two outcomes from global ischemia?
|
- if it's short enough, the person may come out and be confused and hopefully recover.
- if it's not temporary, it will be too long and the ischemic damage will cause liquefactive necrosis. |
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|
What is a cerebral infarct and how many kinds are there?
|
It is a stroke and the kinds are;
1. transient ischemic attack “mini strokes” 2. cerebrovascular accident “stroke” 3. Cerebral aneurysm |
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Describe transient ischemic attack, or mini strokes.
|
- can cause damage (even permanent)
- person can still have damage that’s apparent and increase risk of Alzheimer’s - increase risk of bigger stroke later |
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|
Describe a cerebrovascular accident, or stroke.
|
There is a large amount of affected tissue in the brain . It may or may not be permanent, depends on recovery.
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|
What are the most common causes for strokes or mini-strokes?
|
- atherosclerosis
- ischemic - clot or vasospasm (thrown clot or plaque rupture) - a bleed (5-10% are hemorrhagic strokes - can't treat this with a clot buster or it's made worse) |
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|
What is the symptom of a stroke, or ministroke, in a child?
|
It might be seen as an 'absence seizure', or a petit mal seizure. If the child does not have epilepsy, they should be seen by a doctor.
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What are the symptoms of a stroke, or ministroke, in an adult?
|
- sudden loss of hearing
- sudden loss of vision - hemiparesis or pain on one side of the body - confusion - loss of ability to talk - loss of balance - sudden personality change - headache - hiccups - nerve palsy (Bell's palsy) |
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What is the treatment for a cerebrovascular accident type of stoke?
|
- scans to determine if it is ischemic or hemorrhagic
- if hemorrhagic, may go in and cauterize or give just give supportive care - if ischemic, may treat like a heart attack with blood thinners, vasodilators, and may go in through an artery and pull out the clot |
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What is the treatment for a mini stroke?
|
- baby aspirin
- Coumadin - treat the atherosclerosis |
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|
What is meningitis?
|
A central nervous system infection. Can either be viral or bacterial.
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|
Which meningitis is more serious and why?
|
Bacterial because it often goes into the bloodstream and becomes septic.
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What causes meningitis?
|
- anything that can introduce bacteria
- spinal tap - artery tap - skull fracture - some are contagious |
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|
What are the symptoms of meningitis?
|
- fever
- headache - stiff neck - can go into encephalitis (brain infection) - can turn into a palsy - nerves inflamed |
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|
What is the treatment for meningitis?
|
- take a lumbar spinal tap looking for bacteria, virus, protein or blood cells
- antibacterials or antivirals - support care - 20% morbidity, 20% mortality (usually bacterial has these #s) |
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|
How can they tell by the glucose level if meningitis is bacterial or not?
|
If there is a drop in glucose in the CSF, then it's bacterial.
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|
What are the chronic diseases that we went over in this class?
|
- Seizure disorder (epilepsy)
- Parkinson's Disease - Alzheimer's - Multiple Sclerosis |
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|
Describe seizure disorder.
|
- diagnosed as kids before age 20
- temporary dysfunction of the impulses - abnormal motor function - abnormal sensory input - change in consciousness - followed by somewhat non responsive stupor (not quite unconscious) - abnormal sensation |
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|
What are the causes of seizure disorder?
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- biochemical difference (can be fixed)
- brain tumor - electrolyte imbalance - medications |
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|
What are the kinds of seizures that can take place?
|
- partial seizures – motor or sensory
- complete seizures – which are both - complex seizures – affect consciousness - simple seizure – which don’t affect consciousness - grand mal AKA 'tonic - clonic' (tonic – stiff and may have tremor and chlonic – convulsing) |
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What is a unique symptom that a person with a seizure disorder may experience?
|
A prodrome, an 'aura' that may give them a clue that they may have a seizure.
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|
What are the triggers than can cause someone to have a seizure?
|
- electrolytes
- heat - stobing lights - stress |
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What kind of brain herniation is #1?
|
Cingulate.
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What kind of hernia is #2?
|
Uncal Herniation.
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What kind of brain herniation is #3?
|
Central Herniation.
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|
What kind of brain herniation is #4?
|
Tonsilar Herniation. The brain tries to go down the foramen magnum.
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|
Describe Parkinson's Disease.
|
A progressive disorder of the brain that leads to shaking (tremors) and difficulty with walking, movement, and coordination. Damage deep in the brain in the basal ganglia. There is a decrease in dopamine and a gradual loss in the structures that make dopamine.
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|
What causes Parkinson's Disease?
|
- idiopathic
- after encephalitis - drug toxicities - traumatic brain injury (football players) |
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|
What are the early symptoms of Parkinson's Disease?
|
- decrease in risk taking
- loss of facial expression - tiredness - loss in flexibility - bradykinesia (can be overcome by emergencies or dancing - will move normally in those situations) |
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|
What are the later symptoms of Parkinson's Disease?
|
- immobility and / or tremor (tremor on relaxation, when doing something you’re fine until you relax ) - lean forward when walking
- problems with digestive motility – decreased movement - decreased appetite and increased constipation - orthostatic hypotension - progresses to depression and dementia |
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|
What is the treatment of Parkinson's Disease?
|
- increasing Dopamine
- can try to block the signals that cause rigidity for a while, but cannot stop it from progressing - can only treat the symptoms |
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|
Describe Alzheimer's Disease.
|
- Chronic
- progressive - degenerative - slow change in higher functions - change in mood and behavior - brain shrinks over time |
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|
What are the risks associated with Alzheimer's Disease?
|
- age
- down syndrome (on the 21st chromosome) - head injury increases risk - mini-strokes increase risk |
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|
What are the symptoms of Alzheimer's?
|
- increase in proteins built up in the brain
- trouble thinking things through - loss of higher mental functioning - personality changes - memory loss - progression varies to ultimately lose functions such as swallowing and coughing (which can ultimately kill them) |
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|
Describe Multiple Sclerosis.
|
Autoimmune condition where there is more than one attack by T-cells on some area of the brain or spinal cord (myelin sheath).
- more in women - typical onset in the 30's - more in Northern European Heritage - family tendency but not genetic - higher association living further away from the equator (low vitamin D) - still considered one of the major causes of disability in the US |
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|
What are the symptoms of multiple sclerosis?
|
- first symptom is usually associated with the eye (blurry or double vision)
- trouble with reflexes - trouble standing - balance trouble (inner ear or cerebellum issues) - fatigue |
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|
How is multiple sclerosis diagnosed?
|
- It usually takes a while to diagnose
- A spinal tap is performed and looking for inflammation - an MRI is performed looking for lesions |
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|
Describe the cycle of multiple sclerosis.
|
- Multiple sclerosis is relapsing and remitting
- a relapse can be triggered by stress, heat or infection - will have an episode and then go into remission |
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|
How is Multiple Sclerosis treated?
|
- first an attempt is made to stop the attack to prevent damage using corticosteroids
- then an attempt to prevent a future attack is made using immune suppressing drugs |
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|
What are the spinal cord related pathologies that we studied?
|
- Guillain–Barré syndrome
- Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's) - Spinal Cord injury |
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|
Describe Guillain–Barré syndrome.
|
- occurs post infection or, rarely, post vaccine
- it is a demyelination of the skeletal motor nerves (an inflammatory process) - starts at the feet and works it's way down in weeks (patient falls then can't stand up) - patient ends up on ventilation - usually reverses itself |
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|
What is the treatment for Guillain–Barré syndrome?
|
- try to slow the progression
- plasmapheresis to decrease the number of antibodies in the blood |
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|
Describe Amyotrophic lateral sclerosis.
|
- involves the muscles and upper brain stem
- it is a demyelination of the upper and lower motor neurons (the ones from the brain to spinal cord and the ones from the spinal cord to the muscle) - idiopathic - patients have too much glutamate - there is an association with exposure to blue-green algae - is musculoskeletal |
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|
What are the symptoms of ALS?
|
- wasting of small muscles
- trouble talking or swallowing - twitching of a group of muscles within a bigger muscle - uncontrolled fasciculation |
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|
What is fasciculation?
|
involuntary contractions or twitchings of groups of muscle fibers
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|
What is the treatment for ALS?
|
- supportive and psychological (will eventually be trapped in a body that can't move or communicate)
- technology (to aid in moving and communicating) |
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|
What is an early sign of ALS?
|
The finger drop test. Holding hands out and one finger can't stay up.
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|
How do we treat spinal cord injuries?
|
- immediately treat the swelling to avoid ischemia in the spinal cord (ice, cortisone)
- if swelling is treated immediately, it's possible to avoid full paralysis maybe with partial paralysis instead |
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|
How does a spinal cord injury present itself?
|
Very often there is spinal cord shock initially. Even if full functioning can be regained, it's not initially known because full paralysis takes place in spinal cord shock. The full extent of the damage won't be clear for a few days.
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|
What can happen with spinal cord injuries.
|
Dysreflexia, where reflexes have abnormal responses, such as high blood pressure in response to a full bladder.
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|
How do we treat spinal cord injuries after spinal cord shock?
|
- rehab
- Supportive care, considering the whole person - Psychological care, sexual function, etc. |
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|
What is a weird fact about spinal cord patients?
|
That quadraplegics can function sexually but paraplegics can't.
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|
What are the congenital CNS issues we went over in class?
|
- hydrocephalus
- neural tube defects - cerebral palsy |
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|
Describe hydrocephalus.
|
- when the cerebrospinal fluid is trapped in the skull
- there is pressure on the brain - a shunt is placed to drain the fluid |
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|
Name the neural tube defects we went over.
|
- Spina Bifida - defects of the spinal cord and / or vertebrae. It varies and involves rehab
- anencephaly - no brain or brain stem |
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|
What are the causes for neural tube defects?
|
- poor nutrition, specifically, lack of folic acid
- high body temperature from an infection |
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|
Describe cerebral palsy.
|
- an injury to the CNS system, before, at or after birth (up to one year)
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|
What kind of injury can cause cerebral injury?
|
- infection
- head injury - lack of oxygen (compressed umbilical) - blood sugar crash after birth (from gestation diabetes) - a jaundiced baby not treated for hemolytic anemia of the newborn |
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|
What are the symptoms of cerebral palsy?
|
- excess muscle tone (uncontrolled spastic movements)
- uncontrolled with LOW muscle tone - loss of coordination from the cerebellum (ataxia) - other problems like seizures or learning challenges - dyskinesia - no progessive |
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|
What is the treatment for cerebral palsy?
|
- braces
- botox injections - supportive care |
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|
What kind of post injury problems did we go over?
|
- complex regional pain syndrome
- peripheral neuropathy |
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|
Describe complex regional pain syndrome.
|
- an abnormal response by the immune system to an injury in a limb
- acute or after an ongoing chronic injury - excess response by the sympathetic NS - the amount of pain is in excess to what the patient should feel |
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|
What are the symptoms of complex regional pain syndrome?
|
- limb is warm to the touch
- red, swollen - over time, skin and hair changes over the area - contractures - muscle atrophy from not being used (too painful to use) - bone loss and gangrene over time |
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|
How is complex regional pain syndrome treated?
|
- diagnose it (which can be difficult)
- block pain (intrathecal drug pumps to send pain meds directly to the area) - give immunoglobulins (IgGs) - rehab - electrical stimulation |
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|
Describe peripheral neuropathy.
|
- damage to peripheral nerves, often goes with peripheral vascular disease
- causes besides PVD are - outlet syndromes - diabetes - trauma - same causes as PVD - to treat, treat the cause |
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|
What are the skeletal disorders we went over in class?
|
A. fractures
B. achondroplasia C. osteogenesis imperfecta D. rickets (osteomalasia for adults) E. osteoporosis F. osteopetrosis G. Osteitis Deformans or Paget's H. Osteoarthritis I. Lyme Disease J. Cancers |
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|
What are the complications for fractured bones?
|
- broken skin – infection, blood loss
- fat embolus - damage the growth plate – epiphyseal (can effect limb length ) - damage blood supply , causing osteonecrosis |
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|
What is a fat embolus?
|
When yellow marrow from the bone can end up in the blood vessel and cause a pulmonary embolus.
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|
|
Describe achondroplasia.
|
- genetic form of dwarfism
- the long bones are affected - central part of the face is also affected - no affect on intelligence - is autosomal dominant (1 gene, you have it, 2 genes would kill you) |
|
|
What is osteogenesis imperfecta?
|
- an autosomal group of conditions
- not as much protein and cartilage in the bone as needed - it is a brittle bone disease |
|
|
What are the symptoms of osteogenesis imperfecta?
|
- lack of collagen
- sclera of the eye has a blue tinge (because it's thin) - brittle bones |
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|
Describe the more and less severe forms of osteogenesis imperfecta.
|
- In the more severe form, the baby dies in the birth canal because all of his bones break during delivery
- In the less severe form, DSS is investigating all the broken bones, which may lead to genetic testing to diagnose. |
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|
How do we treat osteogenesis imperfecta?
|
- supportive care - there is no cure
- treatment is aimed at strengthening the bone to avoid fractures |
|
|
What is Rickets?
|
- in children, bending of the long bones
- can see the legs bow out as an older child - is called osteomalacia in adults |
|
|
What is osteomalacia?
|
An adult form of rickets, a softening of the bones caused by lack of vitamin D, lack of calcium or a malabsorption issue. Kidney failure or liver failure patients may get it due to the inability to make vitamin D.
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|
How are Rickets and osteomalacia treated?
|
supplemental vitamin D
|
|
|
What is osteoporosis?
|
A decrease in bone mass, increased fracture risk.
|
|
|
What causes osteoporosis?
|
- a decrease in estrogen/ testosterone
- genetics - certain meds - cortisone steroids, thyroid meds |
|
|
What can reduce the risk of osteoporosis?
|
- the more bone mass as an adult before loss begins, reduces risk
- more dairy and vitamin D reduces risk - avoiding soda because the phosphoric acid in soda binds to the calcium in the blood and is excreted. |
|
|
What is the treatment for osteoporosis?
|
- estrogen at menopause for ladies
- testosterone for men later in life (these both increase cancer risk of breast and prostate) |
|
What does this person have and how do you know?
|
Type II diabetes mellitus. This dark skin lesion is called acanthosis, common in people with hyperglycemia.
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|
What is this a picture of?
|
Diabetic retinopathy.
|
|
What does this person have and how do you know?
|
ALS. This picture demonstrates the finger drop test.
|
|
What is this a picture of and what condition does this person have?
|
This is a cross section of the spinal cord. The faded areas are missing myelin stain showing that this person has ALS.
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|
What is this a picture of?
|
An Alzheimer's neurofibrillary tangle.
|
|
What is this a picture of?
|
An Alzheimer's plaque.
|
|
What is this person's health issue? What is this particular hematoma called?
|
A head injury. A Battle's sign.
|
|
What does this little girl have?
|
Cerebral palsy.
|
|
What is wrong with this little boy and how do you know?
|
He has intracranial pressure because he is displaying decerebrate posturing - hands curled in and toes pointed.
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|
What is going on with this person in this photo and how do you know?
|
Intracranial pressure because he is displaying decorticate posturing - arm is curled in despite lack of consciousness.
|
|
What is wrong with this person's left eye? What most likely has happened to him?
|
His left eyes is displaying a "blown pupil". He most likely has a head injury.
|
|
What is this a slide of?
|
Evidence of a stroke.
|
|
What is this a picture of?
|
A hematoma causing a cingulate herniation.
|
|
What is this a picture of? What is wrong with the right side?
|
This is a picture of a brain and on the right side displaying atrophy of Huntington's disease.
|
|
What is this a picture of and what most likely is going on?
|
This is a papilledema - "tenting of the retina" - intracranial pressure.
|
|
What's wrong with this little girl and how do you know?
|
Meningitis. She has a stiff neck.
|
|
What is this a slide of?
|
Brain tissue with multiple sclerosis. The far left is normal tissue, the middle is inflamed and the right side shows demyelinated.
|
|
|
What is osteopetrosis?
|
A rare, hereditary, autosomal recessive disorder where bone fills in the marrow cavity. There is a decrease in osteoclast activity. Affects children.
|
|
|
What are the symptoms of osteopetrosis?
|
- anemia
- infections - compression of the nerves - fractures (not sure of any treatment) |
|
|
Describe Osteitis Deformans, or Paget's Disease.
|
- An inflammatory disease occurring in people more in their later years, over 50.
- More common in men - idiopathic - 40% may be inherited - bones soften and reform, demineralizing, then remineralizing looking different. |
|
|
What are the symptoms of osteitis deformans or Pagets?
|
- possible facial deformities
- can paralyze the ribcage - can compress the nerves - the areas of flare are obvious |
|
|
What is the treatment for osteitis deformans or Pagets?
|
Calcintonin.
|
|
|
What is osteoarthritis?
|
- A degenerative bone disorder caused by wear and tear, age or injury.
- There is decreased bone cartilage in the joints, a loss of the anti-friction qualities of the cartilage. |
|
|
What are the symptoms of osteoarthritis?
|
- pain with use
- stiffness in the morning (of the joints ;-) - inflammation - bone spurs - crepitus |
|
|
What is crepitus?
|
Grinding sensation in the joint during use.
|
|
|
What is the treatment for osteoarthritis?
|
- anti inflammatories
- NSAIDS - pain meds - artificial joints (joint replacement) |
|
|
What is Lyme Disease?
|
- A spirochete infection carried by the deer tick.
- More common in the US, Northeast and Michigan - Can progress to chronic. |
|
|
What are the symptoms of Lyme Disease?
|
- initially, a rash resembling a bull's eye and flu-like symptoms
- secondary symptoms include; - joint pain - arthritis like symptoms for about 60% of patients - some may have heart of neurological symptoms - |
|
|
What is the treatment for Lyme Disease?
|
Antibiotics. If treatment is not started early, destructive arthritis and neurological issues and inflammatory conditions will take place.
|
|
|
What cancers affect the skeletal system or bone?
|
- Chandroma - a cartilage tumor that is benign
- Sarcomas of the bone - always malignant - Metastases - of other cancers - leukemias of the marrow cavity |
|
|
What are the pathologies that affect the muscular system that we went over?
|
1. Compartment Syndrome
2. Muscular Dystrophies 3. Myesthenia Gravis 4. Fibromyalgia |
|
|
Describe compartment syndrome.
|
- post trauma
- localized bleed in the limbs - within the trapped space of the connective tissue compartment - doesn't expand |
|
|
What are the symptoms of compartment syndrome?
|
- inflammation
- pressure increasing in the area and no place to get out - extreme pain - ischemia - decreased pulse - neuro symptoms (because of trapped nerves) |
|
|
What do we worry about with compartment syndrome?
|
- even though it can regrow, we worry about the loss of the nerve in that area if it goes 2-4 hours of complete blockage
- if it goes 6 -8 hours, can lose the muscle as well and is permanent - may have to cut open the area to relieve the pressure |
|
|
Describe muscular dystrophies.
|
- genetic
- most common is Duschenne's, which is X-linked recessive (so more common in boys) - is progressive damage and loss of muscle - some adult onset - some teen onset |
|
|
What is the treatment for muscular dystrophy?
|
- supportive
- steroid treatment - main cause of death is respiratory and cardiomyopathy - carriers have an increased risk of developing a cardiomyopathy |
|
|
Describe Myesthenia Gravis.
|
- autoimmune
- serious (muscle gets skinny) - onset around 20-30 years - more common in women - second group – 40s - 50s – equal in gender - attacks the receptor for acetylcholine in the skeletal muscle - weakening and fatigue - crisis if stressed - classic sign is a weakness of one of the eyelids (ptosis) - starts with facial muscles |
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|
What is the treatment for myesthenia gravis?
|
- block acetylcholinesterase which destroys acetylcholine
- anti immune drugs (cortisone) - remove the thymus gland |
|
|
Describe fibromyalgia.
|
- muscle pain
- poor sleep - a lot of pain in the morning - have trigger points (can find a knot in the muscle) |
|
|
What is the treament for fibromyalgia?
|
- anti depressant meds sometimes work (muscle relaxers)
- treat symptoms - pain blockers - sleep aides |
|
|
What are hemangiomas?
|
Excess of blood vessel growth. There are 2 kinds;
- Strawberry - Port |
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|
Describe a strawberry hemangioma.
|
A bumpy textured lesion that typically goes away by the age of 5. If it affect vision or the urinary system, then it must be treated.
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|
|
Describe a port hemangioma.
|
- flat
- permanent - also called nevus flammeus, or stork bite - can treat with laser treatments, but may leave a scar - green stick makeup will help to hide it as they get older |
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|
What is a mongolian spot?
|
An area with more melanin than others.
- often lumbar sacral - usually disappears by age 5 - needs to be checked to be sure it's not spina bifida - benign - typically in kids with darker skin |
|
|
What are the pediatric skin infections we went over in class?
|
- Measles
- Rubella - Varicella |
|
|
Describe measles.
|
– viral infection
- macules (flat sharp edged spot - bright pink or red ) around face arms and torso - fever about 100º - sensitive to light - risk of encephalitis (brain damage ) - risk of congenital problems for fetus if mom has measles |
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|
Describe Rubella.
|
- German measles
- punctate (point like) red macules - fever – less than 100ºF - viral - face neck possibly chest - lymphadenitis (swollen painful, around the neck ) - significant risk of congenital damage if pregnant woman gets rubella |
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Describe Varicella.
|
- also called chicken pox
- viral - highly contagious - start with a prodrome – then get a macule which becomes a papule – raised, rounded and red - papule becomes a vesicle which are filled with clear liquid , which then becomes a pustule which becomes crusty and then resolves - pruritis!! - once the rash appears you’re contagious but feel fine - if you get it and have decreased immunity as an adult , there's a high chance of getting pneumonia too |
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|
Describe shingles.
|
- caused by herpes zoster (same virus as chicken pox)
- virus lives in a spinal nerve - comes with decreased immunity - pain in that dermatome - papule, blisters with virus in them - if you touch it, WASH YOUR HANDS!! |
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What is the treatment for shingles?
|
- anti virals
- pain control - hope it doesn’t involve the eye – patient may go blind |
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What does this physician have?
|
Bell's palsy.
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|
What could be wrong with this hand?
|
Media nerve palsy (the thenar muscle looks like it's not working - muscle at the base of the thumb).
|
|
What does this person have?
|
hypoglossal nerve palsy.
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What was this person bit by and what does it carry?
|
A deer tick that carries Lyme Disease.
|
|
What does this show? How do you know? What are the white arrows pointing to?
|
Osteoarthritis because there's very little space where there should be cartilage. The arrows are pointing to bone spurs.
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|
What does this poor boy have?
|
Osteogenesis Imperfecta.
|
|
What does this child have?
|
Osteomalacia
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What condition is seen here and how do you know?
|
Osteopetrosis because there is no marrow space
|
|
What is the condition seen here?
|
Osteoporosis
|
|
What condition is seen here?
|
Osteitis deformans, or Pagets
|
|
What does this poor little girl have?
|
Rickets
|
|
What did this person recently suffer from?
|
Compartment syndrome.
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|
What does this lady have?
|
Myesthenia Gravis
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|
Describe Verruca.
|
warts
- condyloma - is contagious - papilloma viruses (benign papule – neoplasm) - skin colored (same as epidermis it’s in) - no pain or itch - pain if it’s on sole of the foot (plantar warts grow in) |
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|
What is the treatment for Verruca?
|
- genital – freeze them
- on hand of child – duct tape will irritate it and the immune system will kick in and kill it - kill with liquid nitrogen |
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Describe Molluscum contagiosum.
|
- contagious
- viral - papule “pearly” – light colored - indent in the top and can express from it curd-like stuff which is dead cells and virus (contagious) to themselves and others - itchy - in kids a lot - wrestlers, sex partners, etc. |
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What is the treatment of Molluscum contagiosum?
|
Freeze with liquid nitrogen
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|
Describe impetigo.
|
- stratum corneum
- bacterial - a superficial infection will affect the epidermis to the stratum corneum - staph or strep - flat macule – becomes a vesicle with clear fluid, then honey colored crust (serum & bacteria ) - very contagious - localized |
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What is the treatment for impetigo?
|
Antibiotics and hygiene (contagious)
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|
Describe Tinea.
|
A fungus of the stratum corneum.
- pedis (athlete’s foot ) - corporis – ring worm - anualis – on hand - barbarae – around follicles of the beard & fingernails - peri-ungal infections – hard to treat |
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What does tinea look like on the hands and feet?
|
looks dry, itchy and white
|
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|
What does tinea look like on areas without a stratum lucidum?
|
red, raised, bumpy papules
|
|
|
What is the treatment for tinea?
|
Anti-fungal
|
|
|
What is cellulitis?
|
A bacterial infection of the dermis.
|
|
|
What are the symptoms of cellulitis?
|
- systemic symptoms
- can trace to break in skin - fever - edema - is epidermis involved in the infection?? - if yes, skin color change – red - if no, skin color will not change – will be painful - may be the only sign – swelling –draw around it - crepitus (maybe) – twinge sensation (spreading of ) - warm |
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|
What is Erysipelas?
|
bacterial infection of the full epidermis
|
|
|
What are the symptoms of erysipelas?
|
- red
- fever - spreading - painful - need to treat quickly |
|
|
What is the treatment for erysipelas?
|
- antibiotics, but need to be monitored to be sure treatment works
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|
|
Describe necrotizing fasciitis?
|
The dying of subcutaneous layer of the skin.
- bacterial - used to be called “gas gangrene” - happens where there is loose CT, adipose & areolar CT (a lot of space ) - fast spreading - high chance of going septic - Can develop DIC (disseminated intravascular coagulation) |
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|
What are the symptoms of necrotizing fasciitis?
|
- can start with papule, then pustule, then bullae (bubble in epidermis)
- many times, no superficial skin symptoms - very high levels of pain compared to skin appearance - if on a limb, it may be increased in size, but no edema superficially - may have bulla - may have discharge from bulla - may have lymphadenitis - crepitus (infection kind – not arthritis) - fever - skin may be discolored or not |
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|
What is the treatment for necrotizing fasciitis?
|
- open up and drain infection (surgery)
- IV antibiotics - sometimes amputation |
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|
Describe acne vulgaris.
|
- start with bump, becomes a pustule then recedes or gets popped
- don’t pop ones on the bridge of nose!! Meningitis - hurt - unattractive - can leave scars if bad enough |
|
|
What is the treatment for acne vulgaris?
|
- clean skin
- hydrogen peroxide - acutane (thalidomide) – does it end up in semen? - antibiotics (tetracycline) |
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|
Describe rosacea.
|
- happens in mid-adulthood
- blood vessels on the nose and cheeks are enlarged giving the face a flushed appearance - bumpy - flares with alcohol |
|
|
What is the treatment for rosacea?
|
long term low dose tetracycline
|
|
|
What is dermatitis and how many kinds are there?
|
- allergic, inflammatory, redness, swelling, itchy epidermis. 4 kinds;
1. contact dermatitis 2. eczema 3. Atopic dermatitis 4. seborrheic dermatitis |
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|
Describe contact dermatitis.
|
- in physical contact with an allergen
- can usually trace it back to allergen - nickle is a common allergy - small red papules - can progress to eczema or hives |
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|
Describe eczema.
|
- allergic
- more severe than contact dermatitis - edema in vesicles - very itchy & oozy - plaque if bad enough (raised flat top surface) |
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|
What is the treatment for eczema?
|
- find the allergen and avoid
- anti inflammatory steroid creams or ointments |
|
|
Describe atopic dermatitis.
|
- typically idiopathic
- in families with allergies - can be a medicine allergy |
|
|
Describe Seborrheic dermatitis.
|
- related to skin oil
- theory is person is allergic to yeast living in the skin oil (face & scalp) - scalp - oily spots on face |
|
|
Describe psoriasis.
|
- inflammatory
- salmon colored plaques - raised with silver scales (dry skin on top of the plaque) - common locations are extensor surfaces – elbows - common in family history with allergies |
|
|
What is the treatment for psoriasis?
|
- standard psoriasis (anti inflammatory & cortisone ) - systemic (systemic meds)
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|
|
Describe Lichen Planus
|
- inflammatory
- systemic - can be greyish depending on skin tone - 4 Ps (purple , pruritic , polygonal , plaques ) - have a fine silver scale - if oil it, will show fine purple lines underneath - itchy - raised - can be in mouth |
|
|
What causes Lichen Planus?
|
- medicine allergy
- graft vs. host disease |
|
|
What is the treatment for Lichen Planus?
|
- remove trigger
- cortisone ointment |
|
|
Describe erythema nodosum.
|
- subcutaneous to dermis
- red - swollen - warm - tender to painful (like a bruise) - color varies depending on time of day - more pale or purple early in day - flares or red later in day - nodule - inflammatory |
|
|
What are the causes of erythema nodosum?
|
- TB
- rheumatic heart disease - sarcoidosis - medicine allergy - granuloma diseases |
|
|
What is the treatment for erythema nodosum?
|
- remove trigger (change meds?)
- treat cause - may need steroids to get bumps to go down - if bad enough can cause lymphedema (ace bandages) |
|
|
Describe urticaria.
|
– hives
- temporary moving eczemas - evanescent - rapidly disappearing (and reforming) - very allergic - show up as contact allergy or systemic allergy as in medications - vesicles - papules - release serum |
|
|
What is the treatment for utricaria?
|
- hydrate
- remove cause - Benadryl |
|
|
Describe pemphigus vulgaris.
|
- common
- bulla disorder - bubbles in epidermis - autoimmune attack on skin cells junctions (dermasomes) - similar to blistering and peeling from sunburn |
|
|
What is the treatment for pemphigus vulgaris?
|
- worried about water loss – may have to treat like burn patient
|
|
|
Describe erythema multiform.
|
- serious epidermis & mucosal allergic reaction - edema
- red macules - vesicles - could get bullae - hives - edema in mucosa - concerned about breathing and urinating - worry about water loss, pain & infection risk |
|
|
What is the treatment for erythema multiform?
|
- serious cases in hospital
- benadryl - cortisone |
|
|
Describe vitiligo.
|
- de-pigmented areas of skin
- autoimmune attack on melanosites - hereditary qualities - darker skin will show more - no treatment – only cosmetic |
|
What condition is this?
|
Acne vulgaris.
|
|
What condition do we see here?
|
Contact dermatitis.
|
|
What condition is this a picture of?
|
Bullae
|
|
What condition is this?
|
Cellulitis
|
|
What condition is this?
|
Erythema multiforme
|
|
What condition is this?
|
eczema
|
|
What condition does this woman have?
|
Erysipela
|
|
What condition do we see here?
|
erythema nodosum
|
|
What condition does this woman have?
|
Hemangioma - port wine stain
|
|
What is this called?
|
A strawberry hemangioma
|
|
What does this guy have?
|
chicken pox
|
|
What condition are we looking at?
|
Herpes simplex vesicles and one scale.
|
|
What is this a picture of?
|
shingles
|
|
What does this woman have on her face and what concerns do we have?
|
Shingles. Worry about her eye. She could go blind
|
|
What's on this child's face?
|
Impetigo
|
|
What is this a picture of?
|
Lichen planus with oil applied
|
|
What condition is this?
|
Lichen planus without oil on it
|
|
What is in this person's mouth?
|
Lichen planus
|
|
What does this guy have?
|
molluscum contagiosum
|
|
What does this person have?
|
Atopic dermatitis
|
|
|
Describe scabies.
|
- a mite lays eggs in the stratum corneum, which then hatch and migrate and poop on their way to folds in the skin
- spots of inflamed tissue and papules in the pathway of the bug are obvious |
|
|
How does one pick up scabies?
|
- could be from working in the mud
- sleeping on sheets that haven’t been washed in a while - is contagious |
|
|
What is the treatment for scabies?
|
anti-mite ointment
|
|
What skin condition is this?
|
Scabies
|
|
What is this a magnified view of?
|
A scabies trail
|
|
|
What is seborrheic keratosis?
|
- inflamed reaction to yeast in skin oil (skin neoplasm)
- skin oil is filling skin cells with keratinocytes - looks like skin colored coins - melanin colored (a little darker than skin and on sun exposed areas) - benign |
|
|
What is the treatment for seborrheic keratosis?
|
Can remove it, but if it's age related, it's better left alone
|
|
What is this a picture of?
|
Seborrheic keratosis
|
|
|
What is nevus?
|
- A skin neoplasm called a mole
- most are benign - there are malignant types |
|
|
What are the malignant types of moles or nevus?
|
- basal cell
- squamous cell - melanoma |
|
|
Describe basal cell carcinoma.
|
- it affects the deepest epidermis
- is somewhat dangerous - can have it removed and it usually doesn't come back |
|
|
Describe squamous cell carcinoma.
|
- is a superficial epidermis cancer to mid-epidermis
- is almost always treatable and removable - is usually on sun exposed areas |
|
|
Describe melanoma
|
- affects the melanocytes
- is very aggressive, but can get patient-tailored treatment |
|
|
How can you tell if a mole is malignant or not?
|
If the color is even, that's good - if not, then bad
If the border is even, that good - if uneven, that's bad If the surface is even, that's good - if uneven then bad If not itchy, that's good - if itchy, then bad If it's the same as always, that's good, if it changes, bad If it's a wound that's not healing, then it's bad |
|
What is this skin condition?
|
Larva migrans
|
|
What is this skin condition?
|
Basal cell carcinoma
|
|
What is this skin condition? There are a couple of different things it could be.
|
A dysplastic nevus, but it looks similar to melanoma. It should be looked at by a doctor.
|
|
What is going on with this guy's ear? He can't seem to get it to heal.
|
It is a malignant mole.
|
|
What is this a picture of?
|
A melanoma
|
|
What does this lady have on her cheek?
|
She has a malignant melanoma
|
|
What is on this guy's lip?
|
A squamous cell carcinoma
|
|
What is this a picture of?
|
A basal cell carcinoma.
|
|
What is this a picture of?
|
A round benign nevus. Evenly colored, evenly shaped and evenly textured.
|
|
What do they toe nails tell you?
|
That this person is getting over a serious illness because there is a line that shows healthy growth behind it.
|
|
What skin condition is shown here?
|
Psoriasis
|
|
What is this a slide of?
|
A scabies mite in the outer layer of the epidermis.
|
|
What does this poor little baby have?
|
A benign mole, but could potentially have a brain tumor underneath.
|
|
What is this skin condition?
|
Scabies
|
|
What are the names of these marks?
|
pustules
|
|
What skin condition is this and what's another name for it?
|
Urticaria or hives.
|
|
What skin condition is this and what's another name for it?
|
Tinea corporis, or ring worm
|
|
What's wrong with these fingernails?
|
tinea barbarae
|
|
What's wrong this person and what's another name for it?
|
Tinea pedis, or athlete's foot.
|
|
What is this skin condition and what's another name for it?
|
Verrucae, or warts.
|
|
What is this a mark of? Who might get this?
|
Acanthosis. A diabetic.
|
|
What does this handsome man have? (If you don't recognize him, he has a normal size head and trunk but his arms and legs are short).
|
Achondroplasia. His name is Peter Dinklage and he was in the movie "Elf".
|
|
|
Of the skin diseases, what's caused by a virus?
|
- measles
- rubella - varicella (chicken pox) - shingles (varicella) - molluscum contagiosum - verrucae (warts) |
|
|
Of the skin diseases, what's particularly dangerous to pregnant women?
|
- measles
- rubella - varicella |
|
|
Of the skin diseases, what's caused by bacteria?
|
- Necrotizing Fasciitis
- Impetigo - Cellulitis - Erysipelas (NICE) |
|
|
Of the skin diseases, what involves pruritis?
|
- Varicella
- Eczema - Lichen planus - Dermatitis - Shingles – herpes zoster - Scabies - Psoriasis |
|
|
Of the skin diseases, which ones are allergic/ inflammatory?
|
- Contact dermatitis
- Atopic dermatitis - Seborrheic dermatitis - Eczema (CASE) |
|
|
Of the skin diseases, which ones are contagious?
|
- Measles
- Rubella - Varicella - Shingles - Molluscum Contagiosum - Impetigo |
