Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
502 Cards in this Set
- Front
- Back
|
How long does it take for acute inflammation to occur after an injury?
|
1-2 mins
Happens the same way every time. |
|
|
What are the 3 major components of acute inflammation?
|
1) Vascular size changes--increased blood flow
2) Structural changes--make room for plasma proteins and leukocytes 3) Immigration of neutrophils (PMNs) |
|
|
Which type of cell is first to arrive at the site of injury?
|
PMNs
|
|
|
Acute inflammation generates 4 things
|
1) RUBOR--redness
2) CALOR--heat 3) DOLOR--pain 4) TUMOR--swelling |
|
|
Are WBCs present in acute inflammation?
|
Yes
|
|
|
What are the ocular manifestations of acute inflammation in uveitis?
|
1) RUBOR = injected conj
2) CALOR = can't be measured in eye 3) DOLOR = CB and iris spasm 4) TUMOR = flares |
|
|
What are the 4 possible outcomes of acute inflammation?
|
1) Complete resolution
2) Scarring or fibrosis (fr injury itself, not fr inflammation process) 3) Abscess formation (pus) 4) Progression to chronic inflammation |
|
|
Does chronic inflammation occur the same way every time?
|
No. Chronic inflammations are not all identical!
|
|
|
How long does chronic inflammation last?
|
Weeks to years
|
|
|
Which cells are involved in chronic inflammation?
|
Mononuclear cells: macrophages, lymphocytes, plasma cells (produce antibodies)
|
|
|
Chronic inflammation is characterized by...
|
1) Infiltration of mononuclear cells
2) Tissue destruction--secondary to inflammation (ex: RA) 3) Repair involving neovascularization and fibrosis |
|
|
What causes chronic inflammation?
|
-Persistent infxns (ex. H pylori)
-Prolonged exposure to toxic agents (asbestos) -Autoimmune dz (RA) |
|
|
Are granulomatous inflammation acute or chronic?
|
Chronic--it takes a long time for cells to get this large.
|
|
|
Mutton Fat KP's is seen in which dz?
|
Syphilis
Sarcoid TB |
|
|
Granulomatous inflammation is characterized by which type of cells?
|
Large macrophages w/ squamous cell-like appearance
|
|
|
TB and leprosy are examples of which type of granulomatous inflammation?
|
Bacterial
|
|
|
Histoplasmosis and blastomycosis are examples of which type of granulomatous inflammation?
|
Fungal
|
|
|
Suture and vascular grafts are examples of which type of granulomatous inflammation?
|
Foreign body
|
|
|
What are the most common etiologies of bilateral, anterior, chronic uveitis?
|
TB and sarcoidosis
|
|
|
In the PPD (TB skin test), what is considered positive in a healthy person w/ a normal immune system?
|
15mm or more
|
|
|
In the PPD (TB skin test), what is considered positive in a health-care worker or someone in contact w/ a person w/ active TB?
|
10 mm
|
|
|
In the PPD (TB skin test), what is considered positive in an immunocompromised (HIV or bone marrow suppression) person?
|
5 mm
|
|
|
Which local factors prolong wound healing?
|
-Local infxn
-Decreased blood supply -Inability to form clots |
|
|
Which systemic factors prolong wound healing?
|
-DM
-Immunocompromised (HIV, cancer) -Decreased peripheral blood flow -Systemic infxn -Malnutrition -Increased glucocorticoid production (fr stress) |
|
|
What is another name for type 1 hypersensitivity?
|
Anaphylactic
|
|
|
What is the inflammatory process for type 1 hypersensitivity?
|
Primary exposure: Allergen activates B-lymphocyte => IgE antibodies produced => binds to mast cells and basophils
Second exposure: allergen crosslinks w/ IgE => degranulation of mast cells or basophils |
|
|
What are the common causes of anaphylaxis?
|
Peanuts, shellfish, drugs (penicillins), snake venom, etc
|
|
|
How long does it take for the initial response to occur? Late phase reponse?
|
Initial response: 5-30 mins
Resolves in 30-60 mins Late phase: 4-6 hrs later |
|
|
Which phase result in tissue damage?
|
Late phase response
|
|
|
What is released fr mast cells and basophils?
|
Histamine
|
|
|
How does type 1 response occur?
|
FIRST and FAST!
|
|
|
What is type 2 hypersensitivity?
|
Cytotoxic
Involves foreign cells |
|
|
Which immune response antibodies are involved in type 2?
|
IgM and IgG
|
|
|
Rh disease is an example of which type of hypersensitivity?
|
Type 2
Maternal IgG crosses placenta and attacks fetal erythrocyte antigens |
|
|
What's another example of type 2 hypersensitivity?
|
Goodpasture's syndrome
Rheumatic fever |
|
|
In type 3 (immune-complex-mediated) hypersensitivity, the body is attack what?
|
Its own cells.
Antigen-antibody complexes activate compliment response => triggers attack on neutrophils => release lysosomal enzymes |
|
|
What are some example of type 3 hypersensitivity?
|
Immune complex glomerulonephritis
Systemic lupus erthematosus RA |
|
|
Which type of lymphocyte is involved in type 4 delayed/cell-mediated hypersensitivity?
|
T-lymphocytes
|
|
|
What do T-lymphocytes release upon exposure to antigens?
|
Leukokinin => macrophage activation
|
|
|
What are some examples of type 4 delayed hypersensitivity?
|
PPD skin test
Contact dermatitis Corneal transplant rejection |
|
|
Phylectenulosis is a type 4 delayed hypersensitivity rxn to what?
|
Staph infxn secondary to blepharitis
|
|
|
If you see phylectenules in immunocompromised pts, which dz should you worry about?
|
TB
|
|
|
SLE, RA, JRA, Sjogren's, Gout, Sarcoidosis, Ankylosing Spondylitis and Reiter's are all examples of what?
|
Autoimmune disorders
|
|
|
What is the the pt profile for SLE?
|
Female
Age 20-30 Butterfly rash Arthritis--joint pain in 90% |
|
|
SLE is which type of hypersensitivity?
|
Type 3 (body attacking its own cells)
|
|
|
Which organs are usually affected in SLE?
|
skin, kidneys, joint, heart
|
|
|
What are the common symptoms of SLE?
|
-Butterfly rash (malar rash)
-Discoid lupus -Arthritis -Photosensitivity -Neuro disorders (seizures) -Immuno disorders -Hemolytic anemia |
|
|
SLE pts will produce positive _____ antibodies and 90% will have ____
|
Anti-DNA
Joint pain |
|
|
SLE can lead to the following ocular manifestations:
|
-Disc edema
-Papilledema |
|
|
What is the pt profile for RA?
|
Female
Age 40-50 Dry eyes Symmetric arthritis Sx worse in AM |
|
|
Which type of joints does RA affect?
|
Small joints (hands, wrists, feet)
|
|
|
Do RA symptoms worsen or improve w/ movement?
|
Improve
|
|
|
What is the #1 cause of bilateral uveitis in a child?
|
JRA
|
|
|
What is the pt profile for JRA?
|
Female
Young (child) Chronic bilateral non-granulomatous anterior uveitis |
|
|
JRA pts often present w/ low grade fever? Iritis?
|
Yes.
|
|
|
What is the ocular manifestation of JRA?
|
1. Chronic bilateral non-granulomatous anterior uveitis
2. Iritis |
|
|
What is the triad associated w/ Sjogren's Syndrome?
|
Dry mouth
Dry eyes Arthritis |
|
|
What is the pt profile for Sjogren's Syndrome?
|
Female
Age 40-60 Lipstick sign |
|
|
What is the underlying cause of gout?
|
Formation of monosodium urate crystals in joints
|
|
|
What causes the formation of monosodium urate crystals?
|
Increased uric acid levels.
Uric acid found in red meat and beer. |
|
|
Which joint is most commonly affected in gout?
|
MTP of big toe (podagra)
|
|
|
What is the pt profile for gout?
|
Men
Sudden onset of red hot joints |
|
|
Which ocular dz can occur secondary to gout?
|
Band keratopathy
|
|
|
What is the pt profile for Celiac Sprue?
|
Female
Northern European descent |
|
|
What is Celiac Sprue?
|
Intolerance to wheat or gliadin (protein in gluten) => fat in stools
|
|
|
What is the pt profile for sarcoidosis?
|
Black female
Noncaseating granulomas |
|
|
Sarcoidosis is characterized by...
|
1) Non-caseating granulomas
2) Increased levels of serum ACE |
|
|
25% of sarcoidosis pts will have ocular manifestations. 75% of those will have ___
|
Anterior granulomatous uveitis
|
|
|
Sarcoidosis is associated w/the following systemic and ocular dz
|
1) Restrictive lung disease
2) Bell's palsy 3) Presenting sign of dacryoadenitis |
|
|
Can chest x-ray be used to dx sarcoidosis?
|
Yes.
|
|
|
Which posterior segment findings are common w/ sarcoidosis?
|
1) Vitritis
2) Vasculitis (candle wax droppings) 3) Optic nerve dz |
|
|
What is the pt profile for ankylosing spondylitis
|
Males
Age 10-30 Positive HLA B27 gene |
|
|
Ankylosing spondylitis is characterized by
|
Bamboo spine
Sacroiliitis (inflammation of sacroilliac) Uveitis Aortic regurgitation |
|
|
Ankylosing spondylitis is a chronic inflammation of which joints?
|
Spine
Large joints |
|
|
When you suspect a uveitis pt has ankylosing spondylitis, which diagnostic test should you order?
|
Lower back x-ray
HLA B27 |
|
|
HLA B27 is positive in which dz?
|
CRAP
C = Crow's dz R = Reiter's (reactive arthritis) A = Ankylosing spondylitis P = Psoriatic arthritis |
|
|
Reiter's syndrome is known as
|
Reactive Arthritis
|
|
|
What is the classic triad for Reiter's/reactive arthritis?
|
Can't see, can't pee, can't dance w/ me
Can't see = conjunctivitis/ant. uveitis Can't pee = urethritis Can't dance = arthritis |
|
|
What is the pt profile for reactive arthritis/Reiter's?
|
Males
Positive HLA B27 (chlamydial infxn starts this) |
|
|
Is osteoarthritis an autoimmune disorder?
|
No. It is a breakdown of cartilage
|
|
|
Osteoarthritis affects what type of joint?
|
Large joints
Knees, hips |
|
|
Osteoarthritis is characterized by
|
Asymmetrical pain
Worsens throughout day w/ increased acitivity |
|
|
Treatment for osteoarthritis includes
|
NSAIDs
Joint replacement |
|
|
What is the pt profile for osteoporosis?
|
Old ladies
|
|
|
What is the mechanism for osteoporosis?
|
Demineralization of bone
Pts asymptomatic but prone to fractures and decreased height |
|
|
What are the risk factors associated w/ osteoporosis?
|
Age
Decreased estrogen Tobacco use Steroid use |
|
|
Which ones are commonly affect in osteoporosis?
|
Spine
Hip Pelvis |
|
|
What is the most important screening test for osteoporosis?
|
Bone density test (DEXA)
Should be done at age 50 |
|
|
What is the pt profile for fibromyalgia?
|
Female
Age 20-50 Chronic pain w/ multiple trigger points |
|
|
Fibromyalgia is typically associated with?
|
Giant cell arteritis
|
|
|
How will fibromyalgia show up on lab work and clinical exam?
|
Lab work = normal
Clinical exam = normal |
|
|
What is the treatment for fibromyalgia?
|
Exercise and antidepressants
|
|
|
Which immunoglobulin is affected in diseases of immunodeficiency?
|
IgA
|
|
|
T/F: IgA is involved in mucosal defenses.
|
True
|
|
|
Most ppl w/ IgA deficiency show no sx but may suffer from...
|
1) Recurrent respiratory tract infxn
2) Keratinization of cornea 3) Weight loss 4) Diarrhea |
|
|
Do ppl die fr AIDS?
|
No. Die fr opportunistic infxns.
|
|
|
Which 5 grps are most at risk for AIDS in the US?
|
Homosexual/bisexual males
IV drug users Recipient of blood transfusions Heterosexual in sexual contact w/ other high risk grps |
|
|
HIV can only be acquire through which routes?
|
1) Sexual contact
2) Parenteral (no by mouth) inoculation--IV drug use, blood transfusions 3) Fr mother to newborn |
|
|
AIDS is characterized by severe loss of which cell type?
|
CD4 T-cells
|
|
|
What is the turning point for HIV --> AIDS?
|
CD4 count of <200
|
|
|
What is the screening test for HIV dx?
|
ELISA
Western Blot to confirm ELISA Both tests together have 99.9% specificity |
|
|
What is the most common ocular infxn and leading cause of blindness in AIDS pts?
|
Cytomegalovirus (CMV) retinitis
|
|
|
Pts at CD4 count of less than ____ is at risk for CMV retinitis.
Pts w/ CD4 count of less than ___ is at high risk for CMV retinitis. |
Less than 200 = at risk
Less than 50 = high risk |
|
|
Which drug is used to tx CMV retinitis?
|
Gancyclovir
|
|
|
Which opportunistic infxns are commonly found in HIV pts?
|
1) Pneumocystic pneumonia
2) Parasitic infxn (Toxoplasmosis, Histoplasmosis) 3) Bacterial infxn (TB, esp in young person) 4) Viral infxn (CMV, HSV) 5) Progressive multifocal leukoencephalopathy (AIDS induced multiple sclerosis) |
|
|
If you see TB in a young person, you should think...
|
HIV
|
|
|
Herpes virus HHV-8 causes what on the eyelids?
|
Kaposi's sarcoma
Malignant! |
|
|
What is meningoencephalitis?
|
AIDS dementia
|
|
|
In progressive multifocal leukoencephalopathy (PML), 45% of pts present w/ what kind of VF?
|
Homonymous hemianopsia
|
|
|
What is an example of reversible cell injury?
|
Temporary ischemia
|
|
|
Lack of O2 will cause...
|
1) Increase in glycolysis and anaerobic respiration => increased lactic acid and decreased pH (b/c have more H+)
2) Decrease ATP production => Na+ accumulates in cells => cellular edema |
|
|
What is an example of irreversible cell injury?
|
Heart attack or stroke
|
|
|
What is cell necrosis?
|
Cell death
|
|
|
What are the two processes associated w/ necrosis?
|
1) Enzymatic digestion of cell
2) Denaturation of proteins |
|
|
What are the 4 types of necrosis?
|
1) Coagulative necrosis
2) Liquefactive necrosis 3) Caseous necrosis 4) Fat necrosis |
|
|
What is coagulative necrosis?
|
-Follows myocardial infarction
-Structure is maintained but proteins are denatured |
|
|
What is liquefactive necrosis?
|
-Seen w/ fungal infxn and often in lungs.
-Cell w/ well defined boundary but inside has dull, gray-white remains. |
|
|
What is caseous necrosis?
|
-Seen in TB infxns
-Central tissue = white and cheesy |
|
|
What is far necrosis?
|
-Death of adipose (fat) tissue.
-Small white lesions |
|
|
What is Down's Syndrome?
|
Chromosomal disorder
Extra 21st chromosome |
|
|
What's the most important risk factor for Down's Syndrome?
|
Maternal age
50+ = high risk |
|
|
What are the systemic findings for Down's Syndrome?
|
Mental retardation
Flat facial profile Congenital heart dz Early onset Alzheimer's |
|
|
What are the ocular manifestations of Down's Syndrome?
|
Congenital cataracts
Glc Strab Prominent epicanthal folds Pts at risk for keratoconus |
|
|
What is Edward's Syndrome?
|
Extra 18 chromosome
|
|
|
What are the systemic and ocular manifestations of Edward's Syndrome?
|
Severe mental retardation
Rocker bottom feet Low set ears Congenital heart dz Microphthalmos |
|
|
Which is more severe/fatal? Down's or Edward's syndrome?
|
Edward's syndrome!
Death w/in 1 yr |
|
|
What is microphthalmos?
|
Small, malformed globe
|
|
|
What is Klinefelter's Syndrome?
|
XXY
Calvin Klein--male w/ female characteristics |
|
|
What are the characteristics of Klinefelter's Syndrome?
|
-Testicular atrophy
-Long extremities -Gynecomastia (enlarged breasts in males) -Female hair distribution -Hypogonadism (little sex hormone production) |
|
|
What is Turner's Syndrome?
|
Xo (missing an X)
Tina Turner |
|
|
What is the most common cause of primary amenorrhea (no menstrual periods)?
|
Turner's syndrome
|
|
|
What are the characteristics of Turner's syndrome?
|
-Short stature
-Dysgenesis (multiple reproductive organs) -Webbing of neck -Coarctation of aorta (aorta narrows) |
|
|
What are the ocular manifestations of Turner's syndrome?
|
Strabismus
Amblyopia Reduced accommodation CI |
|
|
Do autosomal dominant disorders occur equally in both male and female?
|
Yes
|
|
|
When do automsomal dominant conditions typically present?
|
After puberty
|
|
|
Examples of AD conditions
|
1) Neurofibromatosis
2) Marfan's syndrome 3) Huntington's Chorea 4) Familial Adenomatous Polyposis (FAP) |
|
|
If you have facial palsy + loss of hearing, where is the lesion located?
|
Auditory canal
|
|
|
What is neurofibromatosis?
|
Tumor forming nerve cells
|
|
|
What is the classic triad for neurofibromatosis?
|
1) Cafe au lait spots
2) Neurofibromas--S shaped ptosis 3) Lisch nodules on iris |
|
|
What is Marfan's syndrome?
|
Connective tissue disorder: think gumby b/c long extremities
|
|
|
What are the systemic manifestations of Marfan's?
|
Cardiovascular:
-Aortic incompetence -Dissecting aortic aneurysm -FLoppy mitral valves |
|
|
What are the ocular manifestations of Marfan's?
|
Lens subluxation--up and out
RD |
|
|
What is the lens subluxation pattern for homocysturnia?
|
Down and in
|
|
|
What is Huntington's Chorea?
|
Gradual onset and progression of involuntary muscle movement and dementia
|
|
|
Which chromosome does Huntington's Chorea affect?
|
Chromosome 4
|
|
|
What is the age of clinical onset of Hungtington's Chorea?
What is the survival rate? |
Onset: 30-50 yrs
Survival rate: 15-20 yrs |
|
|
What is Familial Adenomatous Polyposis (FAP)?
|
Deletion on chromosome 5 => polyps on colon post puberty
|
|
|
100% of FAP pts get what dz?
|
Colon cancer
|
|
|
What is Gardner's Syndrome?
What is it associated w/? |
Multifocal CHRPE in fundus (tear drop shaped w/ more pigment on one side)
Associated w/ FAP |
|
|
What do the following dz have in common?
Sickle cell anemia Cystic fibrosis PKU (Phenylketonuria) |
All autosomal recessive
|
|
|
What is the most common form of sickle cell anemia?
|
V/G => Valine substituted for glutamic acid
|
|
|
Which form of sickle cell anemia has the more severe ocular manifestations?
|
SC
|
|
|
What type of retinal neovascularization occurs w/ sickle cell anemia?
|
SEA FAN retinopathy
|
|
|
What is the most lethal genetic disorder among caucasians?
|
Cystic fibrosis
|
|
|
What is cystic fibrosis?
|
Mutation to chloride channel
|
|
|
What diagnostic test can be used to dx cystic fibrosis?
|
Chloride sweat test
|
|
|
What are characteristics of cystic fibrosis?
|
1) Recurrent pulmonary infxn
2) Pancreatic insufficiency |
|
|
PKU is caused by?
|
Mutations in enzyme phenylalanine hydroxylase (converts phenylalanine to tyrosine)
|
|
|
If not treated, PKU results in what neurological problem?
|
Mental retardation
|
|
|
Fragile X syndrome
Duchenne's muscular dystrophy Becker's muscular dystrophy are all ___ dz. |
X linked
|
|
|
What are the symptoms of Fragile X syndrome?
|
Mental retardation
Enlarged testicles Long face and jaw Large ears Autism |
|
|
What is Duchenne's muscular dystrophy?
|
Deletion of gene encoding dystrophin
|
|
|
Duchenne's muscular dystrophy is characterized by
|
Muscle weakness and breakdown
Starts fr pelvic girdle and progresses superiorly |
|
|
What is Becker's muscular dystrophy?
|
Similar to Duchenne's but not as severe
|
|
|
What causes osteogenesis imperfecta (brittle bone dz)?
|
Genetic defects that results in abnormal collagen synthesis
|
|
|
What are the ocular findings of osteogenesis imperfecta?
|
1) Blue sclera
2) Keratoconus 3) Megalocornea |
|
|
Robin's egg blue sclera is associated w/ which two dz?
|
1) Osteogenesis imperfecta
2) Pseudoxanthoma elasticum |
|
|
What is the pt profile for Leber's Hereditary Optic Neuropathy?
|
Men
Ages 20-30 |
|
|
How does Leber's Hereditary ON transmit?
|
Recessive disorder
Maternal inheritance My mother leber lost my eyes. |
|
|
What is the ocular manifestation of Leber's?
|
Progressive central vision loss
|
|
|
What is the most common type of anemia?
|
Iron deficiency anemia
|
|
|
What are the causes of iron deficiency anemia?
|
1) GI blood loss (ulcer, colon cancer)
2) Malabsorption 3) Increased need w/ decreased intake (pregnancy) |
|
|
What are symptoms of iron deficiency?
|
Brittle hair
Nail spooning PICA (eating dirt) |
|
|
What is aplastic anemia?
|
Pancytopenia (decreased RBC, WBC and platelets) w/ severe anemia, neutropenia (low WBC) and thrombocytopenia (low platelets)
|
|
|
What can cause aplastic anemia?
|
1) Viruses
2) Radiation 3) Drugs (chloramphenicol, acetazolamide--oral CAI, trimetholquine, chemotherapy drugs) |
|
|
T/F: Sickle cell anemia can cause proliferative retinopathy due to crescent shaped cells occluding retinal vessels.
|
True
|
|
|
Vitamin B12 deficiency can cause what type of anemia?
|
Pernicious anemia: autoantibodies against parietal cells in stomach => decreased production of intrinsic factors
|
|
|
What are the causes of folic acid deficiency?
|
Alcoholism
Drug induced (chemo, methotrexate) |
|
|
What is the significance of folic acid deficiency in pregnancy?
|
Increased risk of neural tube defects (spina bifida)
|
|
|
What is the pt profile for multiple myeloma?
|
40+ yrs old
African descent |
|
|
What is the life expectancy for multiple myeloma?
|
3 yrs due to kidney failure
|
|
|
What is indicative of multiple myeloma and kidney failure?
|
Bence Jones Proteins in urine
|
|
|
What is multiple myeloma?
|
Malignant clone of plasma cells in bone marrow
|
|
|
In neoplastic disorders of WBCs, what is the cause of death?
|
1) Loss of normal cells
2) Poor organ fxn b/c of malignant cells |
|
|
What are the two types of lymphomas?
|
1) Hodgkin's Lymphoma
2) Non-Hodgkin's Lymphoma |
|
|
Which type of lymphoma is more common?
|
Non-Hodgkin's (60%)
|
|
|
What are the two peak age grps for Hodgkin's Lymphoma?
|
15-30
>50 |
|
|
What are the symptoms of Hodgkin's Lymphoma?
|
Enlarged lymph nodes
Fever Night sweats--drenching Itching General malaise |
|
|
Reed-Sternberg cells is a type of which lymphoma?
|
Hodgkin's Lymphoma
aka: owl-eyes nucleus |
|
|
50% of Hodgkin's Lymphoma is associated w/ which dz?
|
Epstein Barr Virus (mononucleosis)
|
|
|
What are the symptoms of Non-Hodgkin's Lymphoma?
|
Enlarged lymph nodes
GI tumors |
|
|
Which test is typically done on Non-Hodgkin's? Why?
|
Bone marrow biopsy
To determine if T or B cell type |
|
|
What is the predominant cell type in Acute Leukemia?
|
Blast cells (immature marrow cells)
|
|
|
Who is at risk for Acute Leukemia?
|
All ages
|
|
|
What are the two major types of Acute Leukemia?
Which one has better prognosis? |
1) Acute Myeloblastic Leukemia (AML)
2) Acute Lymphoblastic Leukemia (ALL) *ALL kids survive = better prognosis |
|
|
AML affect which age group?
|
Infants
Middle aged or older |
|
|
AML is characterized by excessive ____
|
Myeloblasts
|
|
|
What is seen w/in leukemia cells in AML?
|
Auer Rods
|
|
|
ALL affect which age group?
|
2-10 yrs
*All KIDS survive |
|
|
ALL is characterized by excessive ___
|
Lymphoblasts
|
|
|
What is Roth Spot?
Roth spots are characteristics of which systemic dz? |
Retinal hemorrhage w/ white spot in middle.
Characteristic of leukemia and endocarditis. Think: Endocarditis = heart = red Leukemia = WBC = white |
|
|
What are the two types of chronic leukemia?
|
1) Chronic Myelocystic Leukemia (CML)
2) Chronic Lymphocytic Leukemia (CLL) |
|
|
90% of CML cases have ____
|
Philadelphia chromosome
|
|
|
Which type of chronic leukemia have better survival rate?
|
CLL (5-10 yrs)
CML (3 yrs) |
|
|
CML is characterized by decreased WBC and increase ____
|
granulocytes
|
|
|
CLL is characterized by decreased WBC and increased ___
|
lymphocytes
|
|
|
What is leukopenia?
|
Decreased WBC
|
|
|
What is leukocytosis?
|
Increased in WBC
Post surgery, infxn, illness, pregnancy |
|
|
What is neutrophilia?
|
Increase in neutrophils
Due to stress, exercise, bacterial infxn |
|
|
What is thrombocytosis?
|
Increased platelets
Due to inflammation, kidney dz, spleen removal |
|
|
What its pancytopenia?
|
Decreased WBC, RBC and platelet
|
|
|
What is thrombocytopenia?
|
Decreased platelets
Due to infxn, liver failure, bone marrow dz |
|
|
Which of the following is NOT benign?
1) Adenomas 2) Cystadenomas 3) Carcinomas 4) Sarcomas |
3) Carcinomas
4) Sarcomas |
|
|
What type of visual field loss does pituitary adenomas create?
|
Bitemporal VF defect
Also gives ON palor |
|
|
Where are adenomas found?
|
Glands
|
|
|
Where are cystadenomas found?
|
Fat and ovary
|
|
|
What are the two types of cystadenomas?
|
1) Papillomas--epithelial, finger-like projections
2) Polyps--mucosa to lumen of hollow organ |
|
|
Carcinomas arise from _____ cells.
|
Epithelial
Better prognosis b/c more superficial |
|
|
Sarcomas arise fr ____ tissues.
|
Mesenchymal (connective)
|
|
|
What is the most common primary orbital malignancy?
|
Rhabdomyosarcoma--connective tissue cancer that causes bone destruction
|
|
|
What do pts w/ Rhabdomyosarcoma complain of?
|
1) Exophthalmos--eye displaced forward
2) Diplopia--due to muscles |
|
|
What is dysplasia?
|
Abnormal epithelial cell growth b/c of disruption to cell maturation.
|
|
|
Which is the earliest form of pre-cancerous lesion?
1) Dysplasia 2) Low grade dysplasia 3) High grade dysplasia 4) Invasive carcinoma |
Low grade dysplasia
|
|
|
In which stage does the growth penetrate epithelial basement membrane?
1) Dysplasia 2) Low grade dysplasia 3) High grade dysplasia 4) Invasive carcinoma |
4) Invasive carcinoma
|
|
|
What does the TNM staging stand for?
|
T = tumor size
N = nodal involvement M = metastasis |
|
|
Which form of skin cancer results fr metaplasia?
|
Squamous cell carcinoma
|
|
|
What is the difference b/n metaplasia and neoplasia?
|
Metaplasia = existing cells changing into diff type
Neoplasia = abnormal/disorganized new growth |
|
|
T/F: All neoplasia are malignant.
|
False. Neoplasia can be benign or malignant.
|
|
|
Melanocytic nevi are (benign/malignant).
|
Benign
|
|
|
What is an example of macule?
|
Moles and freckles
Flat, <1cm |
|
|
What is an example of papule?
|
Wart
Elevated, <1cm |
|
|
What is an example of patch?
|
Cafe au lait spots
Flat, irregular, >1cm |
|
|
What is an example of a plaque?
|
Psoriasis
Elevated, firm, >1cm |
|
|
What is an example of a nodule?
|
Elevated, firm, 1-2 cm
|
|
|
What is a teratoma?
|
Encapsulated tumor w/ hair, teeth and bone
|
|
|
Malignant melanoma
|
"Means to kill you"
Most common cancer of young women |
|
|
What are the risk factors of malignant melanoma?
|
Age
Skin color Family hx Repeated irritation & sun exposure |
|
|
You see a lesion that has a shiny, firm pearly nodule w/ superficial telangiectasia. What do you suspect?
|
Basal cell carcinoma
|
|
|
Which layer is affected in basal cell carcinoma?
|
Epidermis--basal cell layer
|
|
|
Can basal cell carcinoma become ulcerated?
|
Yes
|
|
|
What is the tx of basal cell carcinoma?
|
5-FU or biopsy
|
|
|
You see a non healing ulcer that appears as erythematous plaque. What do you suspect?
|
Squamous cell carcinoma
|
|
|
Which layer is affected in squamous cell carcinoma?
|
Epidermis--stratum spinosum
|
|
|
SCC can arise fr what type of pre-cancerous lesion?
|
Actinic keratosis (stuck on skin)
|
|
|
What is the medical term for dandruff? What is it caused by?
|
Seborrheic dermatitis
Caused by fungus or yeast infxn |
|
|
What test can be used to confirm Tinea Corporis (Ring Worm)?
|
KOH test
|
|
|
Where do you typically find lesions in psoriasis?
|
Scaling on knees, elbows, scalp
|
|
|
Impetigo is a gram (+/-) lesion that is characterized by ____ and is common in (kids/adults).
|
Gram +
Yellow crusting (cornflakes) Kids |
|
|
Clubbing of nails is an indicator of...
|
Lack of O2 in periphery
Common in respiratory and cardiovascular dz |
|
|
Which two tests are used to distinguish b/n sensory hearing loss and neural hearing loss?
|
Weber Test
Rinne Test |
|
|
Otitis media is caused by which type of bacterial infection?
|
Strep Pneumoniae
H Influenza |
|
|
What is the most common tx for otitis media?
|
Amoxicillin
|
|
|
True vertigo is always associated w/ which of the following symptoms?
1) HA 2) Nystagmus 3) Syncope |
2) Nystagmus
|
|
|
Which condition is known to cause vertigo + hearing loss + tinnitus?
|
Meniere's Dz
|
|
|
80% of salivary gland tumors will involve this gland.
|
Parotid gland
|
|
|
Majority of salivary gland tumors are (benign/malignant).
|
50-60% benign
|
|
|
How can you distinguish TMJ fr Giant cell arteritis?
|
TMJ
-Any age -Non-specific HA -Jaw pain GCA -75+ yr old -Temporal HA -Pain when comb hair -Jaw claudication (ischemia) after prolonged chewing |
|
|
How long do Transient Ischemic Attacks (TIAs) last?
|
<24 hrs
Usu. < 15 mins |
|
|
What is the most likely cause of TIA?
|
Embolism--foreign body in blood vessel
|
|
|
Which type of TIA causes ipsilateral visual symptoms (amaurosis fugax) + aphasia (diff speaking) + contralateral motor loss?
|
Carotid artery TIA
|
|
|
Which type of TIA causes transient bilateral vision loss, diplopia, vertigo?
|
Vertebrobasilar TIAs
|
|
|
What is the treatment for TIA?
|
Aspirin + antiplatelet agent
|
|
|
What is the Hollenhorst plaque?
|
Embolism found in retinal vasculature
Most common origin = carotid artery Need to refer pt for TIA work up asap |
|
|
What are the risk factors for stroke?
|
-HTN
-DM -Hyperlipidemia -Valve dz -Tobacco abuse -Age -Family hx |
|
|
Early dx of stroke via...
|
Auscultation of subclavian and carotid arteries for bruit
CT scans for size and location |
|
|
Which type of stroke is more common? Ischemic or Hemorrhagic?
|
Ischemic
|
|
|
What is the most common cause of ischemic stroke?
|
Cholesterol plaque
|
|
|
If a stroke pt has
1) Ipsilateral blindness 2) Contralateral hemiparesis 3) Aphasia (difficulty w/ words/speaking) Where would you suspect the stroke to be? |
Internal carotid
|
|
|
Stroke in the middle cerebral region presents w/ the following symptoms:
|
1) Homonymous hemianopsia or quadrantanopsia
2) Hemiplegia (ipsi total paralysis) 3) Hemisensory loss 4) Broca's (broken speech) 5) Wernicke's (wordy speech) |
|
|
Stroke in the anterior cerebral region presents w/ the following sx:
|
1) Hemiparesis
2) Sensory loss--legs > arms 3) Tactile anomia--can't name objects by touch |
|
|
Which type of ischemic stroke gives
1) Amnesia 2) Ocular paralysis 3) Homonymous hemianopsia |
Posterior cerebral
|
|
|
Which branch of the posterior cerebral artery serves as the major supply for the visual cortex and LGN?
|
Calcarine branch
|
|
|
Pt presents w/
1) Sudden severe HA (worst HA of their life) 2) CN III palsy 3) Nuchal rigidity (neck stiffness) dx? |
Subarachnoid hemorrhages
|
|
|
What is the most common cause of subarachnoid hemorrhages?
|
Rupture of intracranial aneurysm
|
|
|
Where does intracranial aneurysms usu occur?
|
Circle of Willis
|
|
|
What is epilepsy?
|
Recurrent seizures
|
|
|
What is Status Epilepticus?
|
Prolonged seizure lasting >5mins
|
|
|
Which type of HA often wake pts up in the middle of the night and lasts for less than 1 hr?
|
Cluster
|
|
|
What is the pt profile for cluster HA?
|
Men 30-50 yrs
Smokers and alcohol drinkers |
|
|
Which type of HA can cause transient or permanent ipsi Horner's syndrome (post ganglionic)?
|
Cluster
|
|
|
Which type of HA presents w/ band-like distribution?
|
Tension
|
|
|
Are females more likely to get tension HA than males?
|
Yes
|
|
|
Which type of HA has
1) Trigger factor 2) Lasts 4-72 hrs 3) Worsen w/ physical activity 4) Affects women ages 20-30 |
Migraine
|
|
|
55+ yr old pt presents w/ scalp tenderness, jagging neck pain, and jaw claudication. What do you suspect?
|
Temporal arteritis HA
|
|
|
Temporal arteritis HA pts also develop a condition characterized by fatigue and morning stiffness. What is the condition?
|
Polymyalgia Rheumatica (PMR)
|
|
|
What is the gold standard for dx-ing temporal arteritis?
|
Biopsy
|
|
|
Which two tests, when positive, are highly diagnostic of temporal arteritis?
|
ESR
C-reactive protein |
|
|
Your pt complains of a non-specific HA that has been getting worse w/ time, esp in the morning. Pt also reports nausea, vomiting and visual changes. Dx?
|
Brain tumor
|
|
|
Meningitis is often preceded by this infxn.
|
Upper respiratory tract infxn
|
|
|
What is the classic triad of meningitis?
|
Fever
HA Neck stiffness (nuchal rigidity) |
|
|
What is the triad of Horner's Syndrome?
|
Ptosis
Anhydrosis (lack of sweating) Miosis |
|
|
Horner's syndrome is associated w/ which type of HA?
|
Cluster
|
|
|
Horner's syndrome is associated w. which type of tumor?
|
Pancoast tumor (apex of lungs)
Affects preganglionic sympathetic fibers |
|
|
Sympathetic fibers = MOOCH
(can't get to eye => need a ride) |
1) Internal carotid artery = EMERGENCY
-New onset -Neck pain 2) CN III to Muller's muscle -Ptosis 3) CN V to dilator muscle -Miosis |
|
|
Bell's palsy is a deficit of (upper/lower) motor neuron in CN VII and affects (half/quarter) face.
|
Lower motor neuron
Half of face |
|
|
Bell's palsy is significant b/c it affects the cornea and results in ___
|
Exposure keratopathy and corneal dryness
|
|
|
Do pts typically recover fr Bell's Palsy? How long does it take?
|
Yes.
W/in 1 yr |
|
|
What is the most common primary malignant brain tumor?
|
Glioblastoma Multiforme
|
|
|
What is the prognosis for glioblastoma multiforme?
|
Poor
1 yr life expectancy |
|
|
What is the most common brain tumor in adults? What is it fr?
|
Lung and breast
Metastasis |
|
|
What is the most common benign brain tumor?
|
Meningioma
Found in middle age women |
|
|
Schwannoma usu affect which CN?
|
8th
Gradual onset of progressive proptosis Common in young to middle age adults |
|
|
Pituitary adenoma is caused by?
And causes... |
Prolactin-secreting tumor
1) Bitemporal hemianopsia VF defect 2) ON pallor |
|
|
What is the pt profile for MS?
|
Female
Age 20-40 Caucasian Genetic component |
|
|
Is prognosis better for young onset or older onset?
|
Young onset
|
|
|
What are the sx of MS?
|
1) Retrobulbar optic neuritis
2) Pain on eye movement 3) APD 4) INO (nystagmus but eyes can converge) |
|
|
To be dx w/ MS, what do you need?
|
2 CNS lesions
2 + occasions Involvement of white matter |
|
|
What is Uhthoff's phenomenon? Which dz is it associated w/?
|
Decreased acuity w/ increased body temp
MS |
|
|
What do you use to test for Adie's Tonic Pupil?
|
0.125 Pilocarpine
Cilly ladies get adies. |
|
|
Which two diseases have ascending muscle weakness?
|
Duchenne's Muscular Dystrophy
Guillain-Barre Syndrome |
|
|
Guillain-Barre Syndrome causes the following ocular sx:
|
1) Adies tonic pupil
2) Diplopia |
|
|
Which receptors are affected in myasthenia gravis?
|
ACh receptors--auto antibodies bind to receptor and block ACh fr binding
|
|
|
Myasthenia gravis is prominent in which gender and age grp?
|
Old men
Young women "Hugh Heffner disease" |
|
|
Sx of MG are worse at the (beginning/end) of day.
|
End
|
|
|
Which class of drug is contraindicated in MG pts?
|
Beta blockers --> cause fatigue and make MG worse
|
|
|
What are the sx of MG?
|
1) Weakness of EOMs --> diplopia and ptosis
2) Respiratory weakness 3) Jaw muscle weakness |
|
|
Which ophthalmic dz is an example of disorders caused by ganglion cell destruction (gangliosidoses)?
|
Tay-Sachs dz
|
|
|
What is characteristic of Tay-Sachs dz?
|
1) Cherry red spot at macula
2) Seizures 3) Blindness 4) Loss of motor skills |
|
|
Cherry red spot at the macula is characteristic of which dz?
|
Tay-Sachs dz
CRAO |
|
|
What is the pt profile for Alzheimer's?
|
Women
Head injury Down Syndrome Epilepsy |
|
|
In which stage of Alzheimer's are pts unable to recognize themselves and family members?
|
Severe stage
|
|
|
In which stage of Alzheimer's do pts forget words, are apathetic and tend to repeat words during conversation?
|
Early stage
|
|
|
In which stage of Alzheimer's do pt's personal grooming habits deteriorate and hallucinations occur?
|
Moderate stage
|
|
|
What causes Parkinson's dz?
|
Low dopamine
Side note: High dopamine = Schizo |
|
|
What does Parkinson's dz cause?
|
TRAP
T= tremor at rest R= rigidity A= akinesia (slow to initiate movement, often 1st sign) P= postural instability |
|
|
Parkinson's dz is a degeneration of neuron in which part of the brain?
|
Substantia nigra
|
|
|
Which drugs are used to tx Parkinson's dz?
|
Levodopa
Bromocriptine Carbidopa Sinemet |
|
|
If an elderly pt is on Coumadin and has a minor head injury, which type of hematoma are you most concerned about?
|
Subdural
|
|
|
Symptoms to watch w/ any head trauma includes:
|
1) Pupil size (blown pupil = uncal herniation, increased pressure stretches brainstem)
2) Nausea/vomiting 3) Loss of consciousness |
|
|
What are the 4 non-inflammatory (protein poor) causes of edema?
|
1) Increased organ pressure
2) Reduced plasma osmotic pressure 3) Lymphatic obstruction 4) Sodium retention |
|
|
Diabetic macular edema is caused by...
|
1) Microaneurysms
2) Dilation of capillary walls Both allow leakage of blood and fluid |
|
|
What are the two inflammatory (protein rich) causes of edema?
|
1) Acute and chronic inflammation
2) Angiogenesis |
|
|
1-2 mm hemorrhages in skin are called
|
Petechiae
|
|
|
What are purpura?
|
>3mm hemorrhages
Associated w/ trauma, local vascular inflammation and low platelet count |
|
|
Ecchymoses are hemorrhages that are >___ in size.
|
>1-2 cm
Bruises |
|
|
What are the risk factors for thrombosis?
|
Thrombosis = stationary blood clots
1) Oral contraceptive 2) Smoking 3) Vasculitis (ie temporal arteritis) 4) Conditions of stasis blood flow (ie immobilization, pregnancy, heart failure) |
|
|
Are thrombosis arterial or venous?
|
Both
Anywhere in circulation |
|
|
Thrombosis of lamina cribosa causes which ocular dz?
|
CRVO
|
|
|
What puts women over 35 yrs old at risk for deep venous thrombosis?
|
Combination of smoking + Oral contraceptive use
|
|
|
Which type of venous thrombosis are more likely to embolize in the hear or lungs?
|
Deep leg veins (above knee)
|
|
|
What is the difference b/n thrombus and embolus?
|
Thrombus = stationary clot
Embolus = clot that has dislodged and moved away fr where it was formed |
|
|
Which two systemic dz lead to increased risk of CRVO and BRVO due to thrombus formation?
|
HTN
DM |
|
|
Where do arterial thrombus usually travel to?
|
Brain
Kidneys Spleen |
|
|
What are the 6 different types of emboli?
|
1) Fat--bone fractures & liposuction
2) Air--chest wall injury 3) Thrombus = most common! esp DVT 4) Bacterial 5) Tumor 6) Amniotic fluid--postpartum |
|
|
What is cardiogenic shock?
|
Heart fails to pump due to cardiac cell damage or outflow obstruction
Caused by myocardial infarction, ruptures, pulmonary embolism |
|
|
What is hypovolemic shock?
|
HypoVolemic = hemorrhage and fluid loss fr vomiting, diarrhea
|
|
|
What is the most likely cause of CN III palsies that involves the pupil?
|
Aneurysm
|
|
|
What the risk factors for Atherosclerosis?
|
1) Smoking
2) Hypercholesteremia 3) DM 4) HTN 5) Age >50 6) Family hx |
|
|
What are signs of high cholesterol on the cornea, esp if seen in younger pts?
|
Arcus Senilus (doesn't affect vision)
|
|
|
What are the normal cholesterol values?
|
Total cholesterol <200
HDL (good) >40 LDL (bad) <100 Triglycerides <150 |
|
|
What should be given immediately if a pt experiences a heart attack?
|
325 mg Aspirin
|
|
|
What is the basic of CPR?
|
ABC
Airway, breath, compression Cycle of 30 compressions and 2 breaths |
|
|
HTN is when blood pressure reaches what point?
|
140/90
|
|
|
90% of HTN is _____, meaning there's no clear cause.
|
essential
|
|
|
Which race has the highest risk for HTN? Lowest?
|
High: African American
Low: Asian |
|
|
In hypertensive retinopathy, when you see hemorrhages, CWS and hard exudates?
|
Stage 3
|
|
|
In stage 4 of HTN retinopathy, what do you typically see?
|
ON swelling
|
|
|
In HTN retinopathy, what is the pattern of hard exudates?
|
Star (at the macula)
|
|
|
Who is generally affected by Rheumatic fever?
|
Children (5-15)
Post strep pyogenes infxn |
|
|
What is the significance of rheumatic fever?
|
Damage to heart (esp mitral) valve
|
|
|
What are the effects of left sided congestive heart failure?
|
Blood backs up in lungs => pulmonary edema
Left Lungs |
|
|
What are the effects of right-sided congestive heart failure?
|
Blood backs up in abdomen and legs
|
|
|
What is the most common cause of left sided CHF?
|
Ischemic Cardiomyopathy (fr coronary artery dz)
|
|
|
What is the most common cause of right sided CHF?
|
Left sided CHF
|
|
|
What are the risk factors for bacterial endocarditis?
|
1) Prosthetic heart valve
2) IV drug use 3) Age |
|
|
IV drug use can cause what type of occlusion in young pts?
|
CRAO
|
|
|
Which ocular manifestation can be seen w/ endocarditis and leukemia?
|
Roth spots (red w/ white center)
|
|
|
In mitral valve regurgitation, where does blood backflow into?
|
Blood normally flow fr atrium --> ventricle
Backflows to atrium when ventricle contracts |
|
|
Aortic regurgitation is often seen in which systemic dz?
|
Endocarditis
Aortic dz Ankylosing spondylitis |
|
|
Renal failure causes abrupt decrease in renal fxn and ____
|
Glomerular filtration rate (GFR)
|
|
|
Which two lab test can measure kidney fxn?
|
Creatinine
Blood urea nitrogen (BUN) Want both to be low |
|
|
What is the normal creatinine level?
|
1.0
|
|
|
Chronic renal failure is seen in which types of pts?
|
DM
HTN |
|
|
What is the difference b/n nephritic and nephrotic syndromes?
|
NePHROtic = >3.5 g protein in urine
|
|
|
What are the signs and sx of Benign Prostatic Hypertrophy?
|
-Increased urinary frequency
-Having to go at night -Weak stream |
|
|
Which drug, used to tx Benign Prostatic Hypertrophy, causes floppy iris syndrome?
|
Flomax
Class: -alpha sympatholytic agents -ends in -osin -relaxes prostate muscles |
|
|
What is the #1 cause of cancer death in men?
|
Lung cancer
|
|
|
What is the #2 cause of cancer death in men?
|
Prostate cancer
|
|
|
Which test is used to dx prostate cancer?
|
PSA (prostate specific antigen)
|
|
|
Chlamydia is called ____ in the eye.
|
inclusion conjunctivitis
|
|
|
What is the most common bacterial STD in the US?
|
Chlamydia
|
|
|
What is the most common viral STD in the US?
|
HPV
|
|
|
What is the tx for chlamydia?
|
Azithromycin (1gram, 1x)
Doxycycline Tx pt and partner |
|
|
What is the incubation period for gonorrhea?
|
3-5days following infection
|
|
|
Gonorrhea is usually (symptomatic/asymptomatic)
|
asymptomatic
|
|
|
What type of discharge is found in ocular infxn in pts w/ gonorrhea?
|
Copious hyperacute purulent discharge
|
|
|
What is the tx for gonorrhea?
|
1) Azithromycin (1g 1x)
2) Ceftriaxone (125mg IM) + Doxy (100mg PO BID x7days) |
|
|
Where do you find type 1 Herpes simplex virus?
|
Above the belt
|
|
|
Which lab test is used to diagnose HSV?
|
Wright-Gram stain (+) for multinucleated giant cells
|
|
|
Which type (1 or 2) of HSV can be found in the eye?
|
Both
|
|
|
What is the management for HSV?
Can HSV be cured? |
Acyclovir
Famciclovir No cure |
|
|
Which lab test is used to confirm pregnancy?
|
Beta HCG--human chorionic gonadotropin hormone level
|
|
|
Spontaneous abortion occur less than ____ weeks.
|
20
|
|
|
Death of fetus after 20 weeks is called ____.
|
still birth
|
|
|
What is the triad for pre-eclampsia?
|
1) BP > 140
2) Protein in urine 3) Swelling in lower extremeties |
|
|
What distinguishes pre-eclampsia fr eclampsia?
|
Eclampsia also has seizures.
|
|
|
What is the role of oxytocin in breast feeding?
|
Milk ejection
|
|
|
What is the role of prolactin in breast feeding?
|
Milk production
P before O...production before ejection |
|
|
Most common cancers in women.
Most common cancer death in women. |
Common: breast > lung > colon
Death: lung > breast > colon |
|
|
Most common cancers in men.
Most common cancer death in men. |
Common: prostate > lung > colon
Death: lung > prostate > colon |
|
|
Pt is diagnosed w/ anorexia after absence of how many consecutive menstrual cycles?
|
3
|
|
|
Pt is dx w/ bulimia after how many episodes of binge eating?
|
2x/wk for 3 months
|
|
|
Swollen belly in a malnourished pt is a sign of which dz?
|
Kwashiorkor
|
|
|
What are the presenting sx of alcoholic cirrhosis?
|
1) jaundice
2) hypoalbuminemia 3) portal HTN 4) coagulation factor deficiency |
|
|
Wernicke-Korsakoff syndrome in alcoholics is associated w/ _____ deficiency.
|
Vit B1 (thiamine)
|
|
|
Vit B1 deficiency leads to what type of ocular signs?
|
Bitemporal ON pallor
|
|
|
What is delirium tremens? What is used to tx it?
|
Life threatening withdrawal sx
2-5 days after last drink Tx w/ benzodiazepines |
|
|
During pregnancy, what type of supplements can be used to decrease incidents of neural tube defects?
|
Folic acid
|
|
|
Which type of neural tube defect is more severe?
|
Anencephaly
|
|
|
What is spinal bifida?
|
-Neural tube defect
-Posterior vertebral arches don't close all the way -Spinal cord and meninges are intact |
|
|
What is the significance of right to left shunt?
|
Blue (cyanotic) babies b/c deoxygenated blood gets shuttled back and forth
|
|
|
What is the significance of left to right shunt?
|
Blue (cyanotic) KIDS
|
|
|
What is the #1 cause of congenital malformation?
|
Fetal alcohol syndrome
|
|
|
Which 2 dz cause salt and pepper retinopathy in the eye?
|
Rubella
Syphilis |
|
|
What are the defects in Rubella?
|
Cataracts
Microophthalmia Glaucoma Salt & pepper retinopathy Heart defects |
|
|
What are the defects of syphilis?
|
Interstitial keratitis
CNS disorder |
|
|
"head light in fog" is used to describe which dz?
|
Toxoplasmosis
|
|
|
In toxoplasmosis, what condition does "head light in fog" refer to?
|
Cells in vitreous.
This distinguishes toxo fr histoplasmosis (which does not have cells in vitreous) |
|
|
If you see cataracts in an infant, what should you suspect?
|
Rubella or galactosemia
|
|
|
What are the underlying causes of peptic ulcer dz?
|
1) H pylori bacteria
2) Chronic NSAID use (Cox blocker => no prostaglandins => no stomach protection) 3) Food intolerance 4) Hiatal hernias |
|
|
What are the tx for peptic ulcer dz?
|
1) H2 blockers
2) Proton pump inhibitors 3) Combo therapy: 1 or 2 + antibiotics |
|
|
What is Barrett's esophagus?
|
Squamous cells in normal lining replaced by metaplastic columnar cells
|
|
|
What is the tx for Barrett's esophagus?
|
Proton pump inhibitors
|
|
|
What is the difference in etiology b/n Crohn's Dz and Ulcerative Colitis?
|
CD = infectious
UC = autoimmune |
|
|
What is the difference in location b/n Crohn's dz and Ulcerative Colitis?
|
CD = rectal sparing, SKIP lesions
UC = rectal involvement |
|
|
(Crohn's/Ulcerative Colitis) has cobblestone mucosa, creeping fat, and fistulas.
|
Crohn's
Think: Fat old Crohn skipping down a cobblestone road. |
|
|
(Crohn's/Ulcerative colitis) has friable pseudopolyps and crypt abscesses.
|
UC
|
|
|
Which inflammatory bowel dz has higher incidence of uveitis?
|
Ulcerative colitis
|
|
|
What is diverticulum?
|
Pocketing off the colon
Acquired |
|
|
Irritable bowel syndrome affects (males/females) more.
|
Females
|
|
|
Appendicitis results in pain where?
|
Right side, lower quadrant
Acute pain |
|
|
What is the primary screening method for colon cancer?
|
Colonscopy
Should be done at age 50 and 10 yrs later is normal |
|
|
Which element is involved in Wilson's dz?
|
Copper
|
|
|
Copper accumulates in which areas in Wilson's dz?
|
Liver
Brain Cornea: Kayser-Fleischer ring (greenish brown ring in peripheral cornea) Sunflower cataract |
|
|
Which chelating agent is used to bind copper and tx Wilson's dz?
|
Penicillamine (Cuprimine)
|
|
|
What are the ADEs of Penicillamine?
|
-Chelating agent used to tx Wilson's dz
3 ocular effects 1) Myasthenia (diplopia and ptosis) 2) Pemphigoid 3) Optic neuritis |
|
|
Which liver enzymes are increased in alcoholic hepatitis?
|
AST and ALT
These enzymes are released in hepatitis regardless of etiology |
|
|
Which OTC medication should be avoided in pts w/ liver dz and alcohol consumption?
|
Liver dz =/= tylenoL
|
|
|
Does hepatitis have an inflammatory component?
|
Yes.
|
|
|
Which types of Hepatitis spread via the bowels?
|
Hep A and Hep E
vowels + bowels (fecal oral route) |
|
|
Vaccinations are available for which type of hepatitis?
|
A and B
|
|
|
Is Hep C chronic or acute?
|
Hep C = Chronic
|
|
|
What happens to the liver in cirrhosis?
|
Enlarges --> develop nodules --> shrinks
|
|
|
What are the most frequent causes of liver cirrhosis?
|
Alcohol and viral hepatitis
|
|
|
Jaundice is caused by build up of which liver cells?
|
Urobilinogen and bilirubin
|
|
|
Jaundice is commonly seen in which systemic dz?
|
Cirrhosis
Hemolytic disorders Obstructive disorders (gallbladder) |
|
|
Liver cancer is associated w/ which dz?
|
Hep B and C
Wilson's dz Alcoholic cirrhosis |
|
|
Cholecystitis is characterized by inflammation of gallbladder and is common among which type of pts?
|
Fat, fertile, female over forty
|
|
|
Which type of headache also involves "fat fertile female over forty"?
|
Pseudotumor cerebri
|
|
|
Murphy's sign is present in which dz?
|
Cholecystitis
Pain when you push on right upper quadrant |
|
|
Acute pancreatitis is secondary to which systemic dz?
|
Alcohol abuse
Gallstones |
|
|
Where is the pain in pancreatitis?
|
Around belly button
|
|
|
Lab work show increase in ____ and ___ in acute pancreatitis.
|
Amylase and lipase
|
|
|
Fatty stools is seen in (acute/chronic) pancreatitis?
|
Chronic
|
|
|
What is the prognosis for pancreatic cancer?
|
Very poor. 6 months
|
|
|
What is the leading cause of COPD?
|
Smoking
|
|
|
Emphysema is _______. While Chronic Bronchitis is ______.
|
Emphysema = pink puffers
Chronic Bronchitis = blue bloaters. |
|
|
Which type of COPD includes a productive cough for 3 consecutive months in 2+ yrs?
|
Chronic Bronchitis
|
|
|
What are the signs/sx of emphysema?
|
Shortness of breath (dyspnea)
Decreased breath sounds Tachycardia |
|
|
What are the symptoms of chronic bronchitis?
|
Wheezing/crackling of lungs
Cyanosis of fingers and toes |
|
|
What are the two components of asthma?
How are they treated? |
1) Acute reversible bronchoconstriction
-Tx w/ bronchodilators (albuterol, isoproterenol, metaproterenol) 2) Chronic inflammation of airways -Tx w/ steroids |
|
|
What is bronchiectasis?
|
Chronic infxn --> dilated airways, purulent sputum, hemoptysis.
|
|
|
What is walking pneumonia caused by?
|
Mycoplasma pneumoniae
|
|
|
Which eye drop will cause the eye to dilate in pancoast's tumor?
|
Pancoast tumor = apex of lungs = preganglionic
Eye dilates w/ hydroxyamphethamine in preganglionic Horner's syndrome |
|
|
What is the radiologic features of interstitial dz (Carbon Dust-Coal worker pneumoconiosis, Silicosis, Asbestosis)?
|
Diffuse infiltrates w/ ground glass appearance
|
|
|
Which type of dz is more common?
|
Type 2 Diabetes Mellitus
|
|
|
What is the difference b/n Type 1 and Type 2?
|
Type 1 = lack of insulin
Beta cell destruction => loss of pancreatic cell mass => pancreas is unable to produce insulin => no insulin means no glucose into cells => cells must break down fat for energy => increased free fatty acids => ketoacidosis Type 2 = insulin resistance or abnormal beta cell secretion of insulin |
|
|
Type 2 DM is associated w/ what health condition?
|
80% of pts are obese
|
|
|
What is the tx for type 1 diabetes?
|
Insulin
|
|
|
What is the tx for type 2 diabetes?
|
Oral glycemic agents
Sometimes insulin |
|
|
Lab testing shows increased glucose and HbA1C in which type of diabetes?
|
Both
|
|
|
What is a sign of diabetic ketoacidosis?
|
Fruity sweet breath
|
|
|
What are the 3P's in diabetes insipidus?
|
Polyuria = frequent urination
Polydipsia = frequent thirst Polyphagia = excessive hunger |
|
|
Type 1 should have DFE w/in how many yrs of dx?
|
5 yrs
|
|
|
Type 2 should have DFE w/in how many yrs of dx?
|
Immediate
|
|
|
How does uncontrolled blood sugar affect refractive state?
|
Causes myopic shift
|
|
|
How is Diabetes Insipidus different from Diabetes Mellitus?
|
DI causes 3P's due to lack of anti-diuretic hormones
|
|
|
What are the tx for DI?
|
ADH analog
Indomethacin HCTZ |
|
|
What is low in hypothyroidism?
|
Low T4 and T3 => results in pituitary gland sending more TSH
|
|
|
Which two hormones are stored in posterior pituitary gland?
|
Oxytocin
Vasopressin (ADH) |
|
|
What are the sx of hypothyroidism?
|
Cold intolerance
Weakness Decreased appetite Dry cool skin and coarse hair |
|
|
What is Hashimoto's Thyroiditis?
|
Autoimmune mediated
Attacks thyroid gland => decrease production of T4 Common in Female ages 45-65 |
|
|
What is hyperthyroidism?
|
Hyperplasia caused by TSH receptor antibodies
Antibodies block receptors => high T4 and T3 but low TSH |
|
|
In 85% of cases, hyperthyroidism is caused by which dz?
|
Graves
|
|
|
What are the ocular effects of Graves?
|
Upper lid retraction
Swollen EOMs => proptosis Muscles affected at IMSlow |
|
|
Superior Limbic Keratoconjunctivitis is associated w/ which dz?
|
Thyroid dz
|
|
|
What causes primary hyperparathyroidism?
|
Hypercalcemia
Too much parathyroid hormone => reabsorption of calcium and excretion of phosporus |
|
|
What are the sx of of hyperparathyroidism?
|
BONES (pain and fractures), STONES (renal), ABDOMINAL GROANS (constipation), PSYCHIC MOANS (mental changes), AND FATIGUE OVERTONES
|
|
|
What is the cause of hyperpituitarism?
|
Adenoma of anterior pituitary
Hypothalmic disorders |
|
|
Is hypoparathyroidism short term or permanent?
|
Short term (due to thyroidectomy)
|
|
|
What are the ocular sx of hypoparathyroidism?
|
Cataract (posterior)
Uveitis Alopecia |
|
|
How does EKG pattern change w/ hypoparathyroidism?
|
Prolonged QT intervals
T wave abnormalities |
|
|
What is the tx of hypoparathyroidism?
|
Serum calcium
|
|
|
What is hypopituitarism?
|
Single or multiple hormone deficiency fr mass lesions
|
|
|
What is Addison's dz?
|
Chronic adrenocortical deficiency due to autoimmune atrophy of adrenals
|
|
|
In Addison's dz, serum Na is (low/high), K+ is (low/high), and Ca is (low/high)
|
Na = low
K = high Ca = high |
|
|
What is the cause of Cushing's Syndrome?
|
Excessive/chronic corticosteroid use
|
|
|
What do Cushing's Syndrome pts present w/?
|
Central obesity
Moon face Buffalo hump |
|
|
What is Cushing's dz?
|
Excessive PRODUCTION of corticosteroids
|
|
|
What is pheochromocytoma?
|
Tumor of adrenal glands or sympathetic nervous chain caused by tumor secreting norepi and epi
|
|
|
What does pheochromocytoma cause?
|
Increased BP
Severe HA Perspiration Heart palpations Anxiety *Affects sympathetic chain => sx are similar to fight or flight response. (hyper sympathetic sx) |
|
|
What is the ocular effect of pheochromocytoma?
|
Papilledema due to quick elevation of blood pressure
|
