Patho

Question 1

___ is the selective bulbous enlargement of the end of a finger or a toe.

Severity can be graded from 1-5 based on the extent of the nail bed hypertrophy and the amount of changes in the nails themselves

It’s painless and associated with diseases that disrupt the normal pulmonary circulation and cause chronic hypoxemia such as:

Bronchiectasis
Cystic fibrosis 
Pulmonary fibrosis 
Lung abscess
Congenital heart disease 
Rarely reversible

Answer 1

Clubbing

Question 2

__ __ results from the fracture of several consecutive ribs in more than one place or fracture of the sternum and several consecutive ribs.

The multiple fractures result in instability of a portion of the chest wall, causing * paradoxical movement* of the chest with breathing

During inspiration the unstable portion of the chest wall moves inward and during expiration it moves outward, impairing gas exchange

Chest wall restriction results in decrease tidal volume.
Diagnosis made by PFTs, ABG measurement (hypercapnia), and radiographs
Tx: aimed at any reversible underlying cause, but otherwise supportive, severe case, mechanical vents

Answer 2

Flail chest

Question 3

Type of pneumothorax

___ is caused by the rupture of blebs or blisters on the surface of the lungs

Answer 3

Spontaneous

Question 4

Type of pneumothorax

___ is a result of chest trauma such as stabbing, gunshot wound, and broken ribs.

Answer 4

Secondary

Question 5

Type of pneumothorax

___: air can enter but not escape. WORST TYPE. Life threatening

Answer 5

Tension

Question 6

___ ___ is presence of the fluid in the pleural space .

Source is usually from blood vessels or lymphatic vessels lying beneath the pleural space, but occasionally an abscess or other lesion may drain.

Can be:
Transudative (watery)
Exudative (high concentration of WBC and plasma protein)
Hemothorax (blood) 
Empyema(pus)
Chylothorax (chyle)

Small collections of fluid may not affect lung function and remain undetected. Most will be removed by the lymphatic system once the underlying condition is resolved.

Answer 6

In larger effusions, dyspnea, compression acetectasis with impaired ventilation, and pleural pain are common.
Manifestations:
Mediastinal shift
Cardiovascular manifestations
Decreased breath sounds and dullness on affected side
Pleural friction rub over inflamed area.

Dx: chest x ray and Thoracentesis (which can determine the type of effusion and provide symptomatic relief. If effusion is large drainage usually requires placement of chest tube and surgical interventions

Pleural effusion *****

Question 7

____ is infected pleural effusion; presence of pus in pleural space** and develops when the pulmonary lymphatics become blocked, leading to an outpouring of contaminated lymphatic fluid into the pleural space.

Occurs mostly in older adults and children.

Develops as a complication of pneumonia, surgery, trauma, or bronchial obstruction from a tumor. Infectious organisms include: staphylococcus aureus, E. coli, anaerobic bacteria, klebsiella pneumoniae

Manifestations: cyanosis, fever, tachycardia, cough, pleural pain, decreased breath sounds over affected side.
Dx: chest radiographs, thoracentesis, sputum culture
Tx: antimicrobials , chest tube

Answer 7

Empyema

Question 8

Aspiration pneumonia occurs when food, liquids, or vomit is breathed into the lungs or airways feeding to the lungs. Instead of being swallowed into the esophagus and stomach.

Right lung* particularly in the right lower lobe* is more susceptible to aspiration than the left lung because the branching angle of the right Main stem bronchus is straighter than the branching angle of the left main stem bronchus.

Aspiration of oral and pharyngeal secretions can lead to aspiration pneumonia*

Intubation of the trachea also can cause aspiration and bacterial pneumonia
Acid gastric fluid can cause severe pneumonitis
Bronchial damage includes inflammation, loss ciliary function, and bronchospasm.

In the alveoli, acidic fluid damages the alveolocapillary membrane, allowing plasma and blood cells to move from capillaries into the alveoli that results in hemorrhagic pneumonitis.
Lungs become stiff and non compliant as surfactant production is disrupted, leading to further edema and collapse.

Answer 8

Manifestations: sudden onset of choking. Intractable cough with or without vomiting, fever, wheezing, dyspnea, some have no symptoms but instead they have recurrent lung infections, chronic cough, or persistent wheezing over month and possible years.

Prevention measures: semi Fowler’s 30-45 degrees, surveillance of enteral feedings, promotility agents, avoidance of excessive sedation, NGT can also cause aspiration if fluid and particulate matter are regurgitated as the tube is being placed.

Tx: supplemental O2, mechanical vent with positive end expiratory pressure, corticosteroids,

Fluids are restricted to decrease blood volume and minimize pulmonary edema

Bacterial pneumonia may develop as a complication of aspiration pneumonitis and must be treated with broad spectrum antimicrobials

Question 9

___ is the collapse of lung tissue. Tends to occur after surgery, especially if general anesthesia was administered.

Postoperative patients are more often in pain, breathe shallowly, are reluctant to change position, and produce viscous secretions that pool in dependent portions of the lung.

Increases shunt, decreases compliance, and may lead to perioperative hypoxemia.

Clinical manifestations: dyspnea, cough, fever, leukocytosis

Prevention and tx:
Deep breathing exercises (incentive spirometry) promotes ciliary clearance of secretion, stabilizes the alveoli by redistributing surfactant, and promotes collateral ventilation through the pores of kohn, promoting expansion of collapsed alveoli. Position changes and early ambulation.

Answer 9

Atelectasis

Question 10

___ ___ is excess water in the lung due to changes in hydrostatic and oncotic pressure and capillary permeability.

Most common cause of this is left sided heart disease
Injury to capillary lining= permeability and fluid development. Blocked lymphatic channels=inability to remove excess fluid

Manifestations: dyspnea, hypoxemia, increased work of breathing, inspiratory crackles, pink, frothy sputum, C02 retention (hypercapnia)

Answer 10

Pulmonary edema

Question 11

ARDS is active lung inflammation and diffuse alveocapillary injury that results from injury or severe systemic inflammation.

Acute onset of bilateral infiltrates on chest radiograph

Progressive manifestations:

Dyspnea and hypoxemia despite supplemental oxygen
Hyperventilation (respiratory alkalosis), decreased tissue perfusion (metabolic acidosis) and organ dysfunction, increased work of breathing, decreased tidal volume, and hypo ventilation, hypercapnia (respiratory acidosis), respiratory failure, decreased cardiac output, hypotension=death.

Tx: early detection, ventilatory support, oxygenation, preventing infection, and prevention of further complication

Answer 11

Know

Question 12

___ is chronic inflammation of the airways

Causes: chronic hyper responsiveness, constriction of airways, and reversible airflow obstruction.

Answer 12

Asthma

Question 13

___ ___ is respiratory failure that comes with the worst form of acute severe asthma, or an asthma attack: if an attack comes quickly and doesn’t respond to regular treatment, it can lead to this.

Symptoms: exploratory wheezing, dyspnea, tachypnea.

Tx: peak flow meters (to measure expiratory flow rate- EFR), corticosteroids, beta antagonist inhalers, anti inflammatory.

FEV: forced expiratory volume.

Answer 13

Status asthmaticus

Question 14

A: adrenergics (beta 2 antagonists) (albuterol) 
S: steroids
T: theophylline 
H: hydration
M: mask o2
A: anticholinergics

Answer 14

Know

Question 15

___ ___ is the hyper-secretion of mucus and chronic productive cough that lasts for more at least 3 months of the year and for at least 2 consecutive years.

Manifestations: productive thick mucous with cough, hypo ventilation/difficulty breathing.

Tx: bronchodilator, expectorants, Chest physical therapy.

Answer 15

Chronic bronchitis

Question 16

___ is an abnormal permanent enlargement of the gas exchange airways accompanied by destruction of alveolar walls without obvious fibrosis.

Inherited deficit of A1- antitrypsin (inhibits proteolytic enzymes that destroy lung tissue), loss of elastic recoil, and air trapping.

Answer 16

Emphysema

Question 17

Acute bronchitis is an inflammation of the airways or bronchi.

Commonly follows a viral illness

Acute bronchitis causes symptoms similar to pneumonia but does not demonstrate pulmonary consolidation and chest infiltrates.

Answer 17

Know

Question 18

Pneumonia is a lower respiratory tract infection.

Types: community acquired (CAP), streptococcus pneumoniae, influenza, healthcare acquired, ventilator associated.

Manifestation: proceeded by upper respiratory infection

Consolidation: fever, chills, dry cough, pain, dyspnea, crackles

Answer 18

Know

Question 19

Tuberculosis:

Progressive fatigue, malaise, anorexia, weight loss, pleuritic pain, chest pain, chronic productive cough, night sweats, hemoptysis (advanced state), low grade temp in afternoon.

Answer 19

Know

Question 20

__ ___ occlusion caused by an embolus. Blood clot, tissue fragment, lipids, foreign body, air bubble, amniotic fluid. They originate commonly from DVT in the lower legs

Answer 20

Pulmonary embolus

Question 21

___ __ result off pulmonary hypertension.

Pulmonary hypertension creates chronic pressure overload in the right ventricle- right ventricle enlargement.

Answer 21

Cor pulmonale

Question 22

What is the main manifestation of laryngeal cancer?

Answer 22

Progressive hoarseness with voice loss

Question 23

What is a V/Q mismatch?

Answer 23

Ventilation perfusion mismatch occurs when either the ventilation (airflow) or perfusion (blood flow) in the lungs is impaired, preventing the lungs from optimally delivering O2 in the blood.

Question 24

___ GI bleed- caused by injury or inflammation. Consisting of the esophagus, stomach, or duodenum.

Bright red (active bleed) or dark “coffee ground” (digested blood)

Common causes: esophageal varices, peptic ulcers, esophageal tears.

Answer 24

Upper GI bleed

Question 25

__ GI bleed- slow to chronic blood loss, not obvious, occurring In the tract of the jenunum, ileum, colon, or rectum.

Common causes: polyps, diverticulitis, inflammatory disease, cancer, or hemorrhoids.

Diagnosed by guaiac or occult blood testing.

Melena- passage of black stools containing digested blood.

Hematochezia- bright red blood in stool.

Answer 25

Lower gI bleed

Question 26

___ is passage of black stools containing digested blood.

Answer 26

Melena

Question 27

___ is bright brown red blood in stool

Answer 27

Hematochezia

Question 28

___ is gastroesophageal reflux disease. The LES (lower esophageal sphincter) is relaxed and allows reflux of stomach contents such as acid, pepsin, or bile salts to Kobe from the stomach backward into the esophagus causing esophagitis. This causes injury and inflammation to the mucosal lining which leads to erosion or fibrosis.

Contributing factors: eating late at night, fried or fatty foods, alcohol, coffee, smoking, obesity, pregnancy, coughing, bending over and certain meds such as aspirin and NSAIDs.

Manifestations: burning sensation in chest usually after eating and worse at night, chest pain; difficulty swallowing, regurgitation of food or sour liquid, sensation of lump in your throat, chronic cough, laryngitis, asthma attacks.

Evaluation: endoscopy to identify edema, erosion or strictures.

Tx: PPI- Prilosec.

Answer 28

GERD

Question 29

___ ___ is a diaphragmatic hernia, a protrusion of the upper part of the stomach through the diaphragm and into the thorax.

Manifestations: heartburn, regurgitation, dysphasia, Epigastric pain.

Evaluation: radiologic barium swallow test, endoscopy, chest x ray.

Tx: eat small frequent meals, sit upright after eating, control weight, anatacids, elevate head of bed.

Answer 29

Hiatal hernia

Question 30

___ ___ is a functional obstruction. It is the failure of intestinal motility due to the paralysis of the intestinal muscles

Answer 30

Paralytic ileus

Question 31

__ bowel obstruction is the most common of bowel obstruction- partial or complete blockage of the small intestine which results in accumulation of fluid, gas, and substances in the intestines causing fluid and electrolyte imbalance and vomiting. Plasma volume decreases= dehydration, hypotension, tachycardia

Manifestations: colicky pain, distention, nausea, vomiting.

Answer 31

Small bowel obstruction

Question 32

__ bowel obstruction less frequent partial or complete blockage of the large intestine, normally seen in critically ill or immobilized client.

Answer 32

Large bowel obstruction

Question 33

___ ___ disease- ulceration in the protective mucosal lining of the stomach , duodenum or esophagus caused by NSAIDs or more commonly H pylori. Rapidly relieved by indigestion of food or antacids. Most common type is duodenal ulcers.

Answer 33

Peptic ulcer disease

Question 34

___ ___ are an ulceration in the Antral region of the stomach. Food ingestion causes pain with these ulcers.

Answer 34

Gastric ulcers

Question 35

Stress related mucosal disease is an acute form of peptic ulcer that is related to severe illness or major trauma.

Types: ischemic ulcers: within hours of trauma, burns, hemorrhage, heart failure or sepsis.

Curling ulcers: ulcers that develop because of brain injury.

Cushing ulcers: ulcers that develop because of a brain injury or brain surgery

Answer 35

Know

Question 36

___ ulcers are within hours of trauma, burns, hemorrhage, heart failure or sepsis

Answer 36

Ischemic

Question 37

___ ulcers: develop bc of a brain injury.

Answer 37

Curling

Question 38

___ ulcers: ulcers that develops because of brain injury or brain surgery

Answer 38

Cushing

Question 39

Post-gastrectomy syndromes:

S/S that occur after gastric resection.

Dumping syndrome- rapid emptying of stomach contents into the duodenum.

Alkaline reflux gastritis- bile reflux disrupts the barrier in the small stomach that is left and antacids do not help.

Afferent loop obstruction- severe pain or fullness after you eat due to mechanical blockage- relieved by vomiting.

Diarrhea, weight loss, anemia, bone and mineral disorders.

Answer 39

Know

Question 40

Lactose intolerance-

Inability to break down lactose which prevents lactose indigestion and absorption causing gas pain, cramping, and diarrhea. Treated by limiting milk and other dairy products or taking lactase enzyme supplement.

Answer 40

Know

Question 41

Fat soluble vitamins:

A,D,E,K

Disorders linked to deficiency:

A- night blindness
D- decreased calcium absorption, bone pain, osteoporosis, fractures
E- uncertain
K- prolonged prothrombin time, purapura, petechiae.

Answer 41

Know

Question 42

___ ___ is idiopathic, inflammatory disorder, affects any part of the digestive tract from mouth to anus, causes “skip lesions” can produce fissures that extend into the lymphatics, anemia due to malabsorption of vitamin b12 and folic acid.

Answer 42

Crohn disease

Question 43

___ ___ is chronic inflammatory disease that causes ulceration of the colon mucosa - sigmoid colon and rectum

Answer 43

Ulcerative colitis

Question 44

___ is the disorder of the “brain gut” interaction- recurrent abdominal pain with altered bowel habits, more common in women, associated with anxiety, depression, and reduced quality of life.

Answer 44

IBS

Question 45

___ is an asymptomatic diverticular disease

Flare ups are triggered by foods that contain seed, nuts, certain fruits, apples, pears, plums, dairy foods, fermented foods, beans, cabbage, Brussel sprouts, opinions, and garlic.

Answer 45

Diverticulosis

Question 46

___ the inflammatory stage of diverticulosis

Flare ups are triggered by foods that contain seed, nuts, certain fruits, apples, pears, plums, dairy foods, fermented foods, beans, cabbage, Brussel sprouts, opinions, and garlic.

Answer 46

Diverticulitis

Question 47

Most common surgical emergency of the abdomen?

Appendicitis: inflammation of appendix

Answer 47

Know

Question 48

___ ___ are enlarged veins in the esophagus.

See them with the following conditions:
Cirrhosis, portal hypertension, chronic alcohol abuse.

What happens if they rupture? Then it is a life threatening emergency. Ruptured lead to severe bleeding where the person may vomit blood or have black tarry stools.

Answer 48

Esophageal varices

Question 49

___ is accumulation of fluid of the peritoneal cavity- most caused by cirrhosis.

Treatment: is a paracentesis to remove the fluid accumulation

Answer 49

Ascities

Question 50

___ is caused by elevated bilirubin in the blood.

Causes: virus’s: hep a, chronic hep B and C, Epstein bar virus. Alcohol abuse, autoimmune disorders, genetic metabolic defects.

Answer 50

Jaundice

Question 51

___ ___ is a neurologic syndrome of impaired behavioral, cognitive, and motor function. May develop rapidly with hepatitis or slowly with liver disease.

Early symptoms: changes in personality, memory loss, irritability, disinhibition, lethargy, sleep disturbances.

Late symptoms: confusion, disorientation to time and space, flapping Tremor of hands(Asterixis), slow speech, bradykinesia, stupor, convulsions, coma.

Answer 51

Hepatic encephalopathy

Question 52

Symptoms of hep B:

Fever
Fatigue
Loss of appetite 
Vomiting 
Abdominal pain 
Dark urine
Clay colored bowel movement

Answer 52

Know

Question 53

Symptoms of hep C:

Bleeding easily 
Bruising easily 
Fatigue
Poor appetite 
Yellow discoloration or skin and eyes(jaundice) 
Dark colored urine
Itchy skin
Fluid buildup in abdomen (ascities)
Swelling in legs
Weight loss
Confusion, drowsiness, slurred speech (hepatic encephalopathy) 
Spider like blood vessels on skin (spider angiomas)

Answer 53

Know

Question 54

__ is formation of gallstones

Answer 54

Cholelithiasis

Question 55

___ is redness and swelling of the gallbladder

Answer 55

Cholecystitis

Question 56

___ pancreatitis is the inflammation of the pancreas from direct cellular injury from alcohol, drugs, or viral infection. Cardinal manifestation is epigastric or mid abdominal constant pain that can radiate to the back.

Answer 56

Acute pancreatitis

Question 57

___ pancreatitis is the process of progressive fibrotic destruction of the pancreas related to chronic alcohol abuse. Presents as continuous or intermittent abdominal pain and weight loss is common. It is a risk factor for pancreatic cancer.

Answer 57

Chronic pancreatitis

Question 58

What is stomach cancer associated with?

Most commonly associated with helicobacter pylori bacteria

Answer 58

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Question 59

Bone remodeling: internal structure of bone is maintained. Allows the Skeleton to respond to mechanical loading, quality control (repair), allows the release of growth factors and minerals.

Three phases:

Activation- osteocytes sense signals for initiating remodeling

Resorption- osteoclasts digest old bone

Formation- osteoblast lay down new bone until the resorbed bone is completely replaces.

Severe injuries heal like a soft tissue injury, fractures, surgical wounds, new bone results instead of scar tissue.

Stages: inflammation/ hematoma, procallus formation, callus formation, replacement of the callus with lamellar or trabecular bone, remodeling of the previous size and shape of bone, speed of repair.

Answer 59

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Question 60

Dislocation is the displacement of a bone in a joint (loss of contact between articular cartilage

Answer 60

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Question 61

Subluxation- contact between articular surfaces is only partially lost, associated with fractures , muscle imbalance, rheumatoid arthritis, or other forms of joint instability

Answer 61

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Question 62

Rhabdomyolysis:

Rapid muscle breakdown leading to release of myoglobin from the muscle cells into the extra cellular space and blood stream. Can result in acute renal failure and electrolyte imbalances.

Triad of manifestations: muscle pain, weakness, dark urine.

The clinical manifestations include myalgias, weakness, red to brown urine due to myoglobinuria, and elevated serum muscle enzymes including creatine kinase.

The immediate consequences of rhabdomyolysis include hyperkalemia, which may cause fatal cardiac dysrhythmias, and hypo calcemia due to calcium binding by damaged muscle proteins and phosphate.

Answer 62

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Question 63

Compartment syndrome:

Result of increased pressure within a muscle compartment (casting and edema)

Caused by any condition that disrupts the vascular supply to an extremity

Muscle ischemia causes edema, rising compartment pressure, and tamponade that leads to muscle infarction and neural injury.

*pain, pulselessness, parenthesia, pressure, pallor, paralysis.

Volkmann ischemic contracture: diagnosis confirmed by measurement of intra- compartmental pressure

Surgical intervention indicated when pressure reaches 30mm Hg

Answer 63

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Question 64

Malignant hyperthermia:

MH treatment memory aid: some hot dude better give fluids fast.

Hyper metabolic reaction to certain anesthetics. Mutations in genes result in continuous muscle contraction. Also causes hyper metabolism with extremely high body temperature, muscle rigidity, rhabdomyolysis, and death if not quickly treated with dantrolene infusion.

Preorder evaluation is critical. May be predicted with muscle contracture test.

Answer 64

Know

Question 65

Osteoporosis:

Causes: endocrine dysfunction. Parathyroid hormone, cortisol, thyroid hormone, and GH.

Medications: vitamin d deficiency, underlying diseases, low physical activity, abnormal bmi.

Major complications: spontaneous fractures.

Post menopausal, estrogen deficiency, remodeling imbalance between activity of osteoclasts and osteoblasts.

Answer 65

Know

Question 66

Osteomyelitis: is a bone infection caused by bacteria usually staphylococcus aureus: fungi, parasites, and viruses can cause infection.

Hematogenous: pathogens carried through the bloodstream. Cutaneous, sinus, ear, and dental infections.
Insidious onset.
Vague symptoms: fever, malaise, anorexia, weight loss, and pain.
Contiguous- infection spreads to an adjacent bone. Open fractures, penetrating wounds, surgical procedures.
Manifested by s/s of soft tissue infection: low grade fever, lymphadenopathy, local pain, and swelling.

Brodie abscess: characterize subacute or chronic osteomyelitis. Circumscribed lesions, usually In The ends of long bones.

Answer 66

Treatment: antibiotics, debridement, surgery, hyperbaric oxygen therapy.

Question 67

Osteomalacia-
Inadequate or delayed mineralization of osteoid.

Remodeling cycle proceeds through osteoid formation but calcification does not occur, the result is soft bones. Pain, bone fracture, vertebral collapse, bone malformation.

Result from vitamin d deficiency

Treatment varies by etiology.

Answer 67

Know

Question 68

Rheumatoid arthritis: swollen inflammed, synovial membrane. Erosion of bone, autoimmune disease, symmetrical.

Symptoms: pain, stiffness, and inflammation. Morning stiffness lasting more than 30 minutes.

Answer 68

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Question 69

Osteoarthritis: loss of articular cartilage, bone ends rub together, degenerative disease, asymmetrical.

Pain and stiffness in movement

Morning stiffness lasting less than 30 mins

Answer 69

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Question 70

Osteoarthritis

Loss of damage of articular cartilage
New bone formation at joint margins
Inflammation 
Mild synovitis 
Thickening of joint capsule
Risk factors: increased age, joint trauma, long term mechanical stress, obesity. 

Manifestations: pain (worse w activity) stiffness(diminishes with activity) enlargement of joint, heberden and Bouchard nodes in hands. Tenderness, limited motion, muscle wasting, partial dislocation.

Deformity: conservative treatment: exercise and weight loss, pharmacological therapy, analgesics, anti inflammatory, nutritional supplement.

Surgical treatment: improves joint movement, corrects deformity or malalignment or creates a new joint with artificial implants.

Answer 70

Joint disease: classic inflammatory; inflammatory damage or destruction in the synovial membrane or articular cartilage. Systemic sigs of inflammation, rheumatoid arthritis, ankylosing spondylitis, gout.

Infectious or noninfectious.

Question 71

Rheumatoid arthritis:
Inflammatory autoimmune joint disease.

Systemic autoimmune damage to connective tissue, primarily In the joints (synovial membrane) similar symptoms to osteoarthritis.

Cause is unknown; multifactoral with strong genetic predisposition. Rheumatoid factors.
Cartilage damage from three processes:
1. Neutrophils and other cells in the synovial fluid become activated
2. T cells also interact with synovial fibroblasts, converting synovium into a thick, abnormal layer of granulation tissue (pannus)
-insidious onset

Systemic manifestations: inflammation, fever, fatigue, weakness, anorexia, weight loss, and generalized aching and stiffness. Painful tender and stiff joints. Joint deformities, rheumatoid nodules, diagnosed with presence of auto antibodies ACPA or RF. Early treatment with disease modifying anti rheumatic drugs.

Answer 71

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Question 72

Ankylosing spondylitis:
Inflammatory joint disease of the spine or sacroiliac joints causing stiffening and fusion of the joints

Systemic, autoimmune inflammatory disease
Causes is unknown, but there is strong association with HLA-B27 antigen.
Begins with inflammation of fibrocartilage
Inflammatory cells infiltrate and erode fibrocartilage
As repair begins, the scar tissue ossifies and calcifies
End result is fibrosis, ossification, and joint fusion causing joint fusion.

Early symptoms: low back pain begins in early 20 and progresses over time, stiffness and pain, restricted motion, loss of normal lumbar curvature (lordosis): increased concavity of upper spine (kyphosis)

Treatment: physical therapy to maintain skeletal mobility to prevent the natural progression of contractures. NSAIDS used for pain

Answer 72

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Question 73

Gout: inflammatory response to excess quantities of uric acid.
Hyperuremia (uric acid level in blood)
Other body fluid, including synovial fluid.
Elevated levels lead to formation of mono sodium irate crystals in joints. Causes acute painful inflammation. Joint damage: gouty arthritis.

Crystals under subcutaneous tissues. Tophi.
Manifestations: hyperuremia, recurrent attacks of mono articular single joint arthritis. Tophi(crystal accumulation) in and around joints. Renal disease involving glomerular, tubular, and interstitial tissues and blood vessels. Formation of Uric acid renal stones.

Primary symptom is severe pain.
More likely to develop renal stones than general population.

Answer 73

Manifestations of gouty attack: severe pain, especially at night.
Hot red tender joint, signs of systemic inflammation, increased sed rate, fever, leukocytosis

Tophaceous deposits can cause limitation of joint movement and grotesque deformities.

Question 74

Fibromyalgia:

80-90% female
Peak age 30-50 years
Inflammation may play a role.
Alterations in genes affecting serotonin, catecholamine, and dopamine

Diagnosis:

Left AND right-sided pain, upper AND lower segment pain, and symptom severity score

SS score includes symptoms such as fatigue, walking unrefreshed, and cognitive difficulty

Answer 74

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Question 75

Osteosarcoma:

Most common malignant bone forming tumor
Predominately in persons under 20 years
Secondary peak in 60 and older if they have a history of radiation therapy
Tumors contain osteoids- deposited as thick masses or “streamers”
Located in ends of long bones
50% occur around the knees

Answer 75

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Question 76

Where does fibrosarcoma metastasize to?

Firm, fibrous mass of collagen, malignant fibroblasts, and osteoclast- like giant cells

Usually affects metaphyses of the femur or tibia

Metastasis to the lungs is common.

Answer 76

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Question 77

Where are osteosarcomas usually found

-mostly found in the long bones, more often the legs but sometimes the arms

Answer 77

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Question 78

Alterations in integument

Epidermis- superficial layer

Dermis- true skin; deeper layer

Subcutaneous (hypodermis)- lowest layer, connective tissue (fat cells, vessels, hair follicle roots, nerves, etc)

Dermal appendages: nails, hair,
sebaceous glands-secrete sebum (oils stop skin drying)
Eccrine- for thermoregulation (cooling of the body)
Apocrine- produce most sweat, ducts open to hair follicles.

Blood supply: papillary capillaries

Answer 78

Know

Question 79

___ is a flat circumcised area that is a change in color of skin, less than 1 cm in diameter

Example: freckles, flat moles (nevi) petechiae, measles, scarlet fever

Answer 79

Macule

Question 80

___ an elevated, firm, circumscribed area less than 1 cm in diameter

Example: wart (verruca), elevated moles, lichen planus, fibroma, insect bite

Answer 80

Papule

Question 81

___ elevated, firm, and rough lesion with flat top surface greater than 1 cm in diameter

Example: psoriasis, seborrheic, and actinic keratosis

Answer 81

Plaque

Question 82

___ a flat, non palpable, irregular shaped macule more than 1 cm in diameter

Example: vitiligo, port-whine stains, Mongolian spots, cafe au lait spots

Answer 82

Patch

Question 83

___ elevated, irregular- shaped area of cutaneous edema, solid, transient, variable diameter

Example: insect bites, urticaria, allergic reaction

Answer 83

Wheal

Question 84

___ elevated, firm, circumscribed lesion, deeper in the dermis than a papule, 1-2 cm in diameter

Example: erythema nodosum, lipomas

Answer 84

Nodule

Question 85

___ elevated, solid lesion, may be clearly demarcated; deeper in dermis, more than 2 cm in diameter

Examples: neoplasms, benign tumor, lipoma, neurofibroma, hemangioma

Answer 85

Tumor

Question 86

___ elevated, superficial lesion, similar to a vesicle but filled with purulent fluid

Examples: impetigo, acne

Answer 86

Pustule

Question 87

__ is a elevated circumcised, superficial, does not extend into the dermis, filled with serous fluid, less than 1 cm in diameter.

Examples: varicella (chickenpox), herpes zoster (shingles), herpes simplex

Answer 87

Vesicle

Question 88

___ elevated, circumscribed, encapsulated lesion, in dermis or subcutaneous layer, filled with liquid or semisolid material

Example: sebaceous cyst, cystic acne

Answer 88

Cyst

Question 89

___ fine, irregular red lines produced by capillary dilation, can be associated with acne rosacea (face) venous hypertension (spider vein in legs), systemic sclerosis, or developmental abnormalities (port-wine birthmarks)

Answer 89

Telangiectasia

Question 90

___ is a vesicle more than 1cm in diameter

Examples: blister, pemphigus vulgaris

Answer 90

Bulla

Question 91

___ is a heaped up, keratinized cells, flaky skin, irregular shape, thick or thin, dry or oily, variation in size

Examples: flaking of skin with seborrheic dermatitis following scarlet fever or flaking of the skin following a drug reaction, dry skin

Answer 91

Scale

Question 92

___ is a thin to thick fibrous tissue that replaces normal skin following injury or laceration to the dermis

Examples: healed wound or surgical incision

Answer 92

Scar

Question 93

__ is a rough, thickened epidermis, secondary to persistent rubbing, itching, or skin irritation, often involves flexor surface of extremity

Answer 93

Lichenification

Question 94

____ is a loss of epidermis, linear, hollowed out, crusted area.

Examples: abrasion or scratches, scabies

Answer 94

Excoriation

Question 95

___ is irregular shaped, elevated, progressively enlarging scar, grows beyond boundaries of wound, caused by excessive collagen formation during healing.

Keloid formation following surgery.

Answer 95

Keloid

Question 96

___ is linear crack or break from the epidermis to the dermis, may be moist or dry

Examples: athletes food, cracks at the corner of mouth, anal fissure, dermatitis

Answer 96

Fissure

Question 97

___ is loss of part of the epidermis, depressed, moist, glistening, following rupture of a vesicle or bulla or chemical injury

Example: chemical injury

Answer 97

Erosion

Question 98

___ is thinning of skin surface and loss of skin markings, skin appears translucent and paper like

Example: aged skin, striae

Answer 98

Atrophy

Question 99

___ is loss of epidermis and dermis, concave, varies in size:

Examples: pressure ulcer, stasis ulcer

Answer 99

Ulcer

Question 100

Pressure ulcer stages

1. Non blanch-able reddened intact skin
2. Partial skin loss into the dermis layer (blister)
3. Full skin loss through dermal layer with visible adipose tissue
4. Full skin loss with exposure of muscle and bone

Answer 100

Know

Question 101

Difference in keloids and hypertrophic scars:

Keloids- elevated rounded firm scars- irregular claw like margins that extend beyond the original site of injury.

Hypertrophic scars- elevated red fibrous lesions that do not extend beyond the border of injury, appears 3-4 months after injury.

Both caused by abnormal wound healing, collagen formation, repair, and regeneration

Answer 101

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Question 102

Allergic contact dermatitis

Causes by T cell mediated or delayed hypersensitivity (Type IV)

Allergen in contact with skin stimulates various antigen reactions causing rash several hours after exposure.

Pattern of rash helps identify allergen

Manifestations: erythema(redness), swelling, pruritus (itching), vesicular lesions(blisters)

Irritant contact dermatitis;
Caused by activation of the innate immune system
Severity related to concentration of the irritant, length of exposure, and disruption of the skin barrier
Symptoms like allergic contact dermatits
Removing source of irritation is effective treatment

Answer 102

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Question 103

Atopic dermatitis

Also called allergic dermatitis

Also have history of hay fever or asthma

Associated with IgE antibodies.

Avoid triggers causing exacerbation of rash.

Keep skin hydrated.

Most common childhood eczema

Answer 103

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Question 104

Stasis dermatitis:

Occurs in the legs as a result of venous stasis and edema

Initial symptoms:
Erythema and pruritus

Followed by: scaling, petechiae, hyperpigmentation, ulceration.

Treatment: elevate legs, reduce standing, reduce te use of tight clothing around legs

Answer 104

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Question 105

Seborrheic dermatitis

Chronic inflammation on scalp, eyebrows, eyelids, ear canals, axilla, chest or back.

Cradle cap in infants

Scaly, white, or yellowish plaques

Answer 105

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Question 106

__ is a group of rare diseases that more often affects women between 30-50.

Localized or systemic

Causes thickening sclerosis of skin

Lesions are hard or tight shinny patches

Progression to body organs may occur

Associated with several antibodies.

Answer 106

Scleroderma

Question 107

Manifestations of psoriasis;

Chronic, relapsing, proliferating skin disorder

Cascade of inflammatory mediators

Dermal and epidermal thickening

Plaques- most common, typical lesion, well demarcated, thick, scaly, silvery, erythematous, surrounded by normal skin.

Psoriatic arthritis may affect hands, feet, knees, ankle joints (up to 30% cases)

Psoriatic nail disease- pitting, onycholysis(fungal) nail plate dystrophy.

Answer 107

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Question 108

Frostbite;

Occurs when tissues freeze slowly with ice crystal formation.

Numbness and no sensation of pain until thawing, then severe pain

Classified by depth of injury similar to burns and pressure injury classifications

Answer 108

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Question 109

___ infection of hair follicle, pustules with surrounding erythema “pimple”

Answer 109

Folliculitis

Question 110

___ abscesses or “boils” of hair follicles, affect dermis, deep, firm, red, painful nodule, 1-5 cm as initial

Answer 110

Furuncles

Question 111

___ collection of furuncles, usually on back of neck, upper back and lateral thighs, swollen abscess that drains through many openings

Answer 111

Carbuncles

Question 112

___ infection of the dermis and subcutaneous tissue, extension of skin wound or ulcer, warm, erythematous (red) swollen, painful.

Answer 112

Cellulitis

Question 113

___ ___- rapidly spreading infection, starts in fascia, muscles, and subcutaneous fat, with necrosis.

Answer 113

Necrotizing fasciitis

Question 114

___- disruption in the skin barrier with blister formation.

High incidence in hot, humid climates.

Honey-colored lesions often located on the face, around nose and mouth.

Answer 114

Impetigo

Question 115

Lyme disease-

Multi-system inflammatory disease

Causative agent transmitted by tick bite (spirochete)

“Bullseye” lesion at bite site

Occurs in stages:

Localized infection
Disseminated infection 9 months after bite
Late persistent infection continuing for years

Treatment with antibiotics

Answer 115

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Question 116

Varicella (chickenpox)-

Primary infection of herpes virus, virus remains latent until activation layer in life as zoster

Answer 116

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Question 117

Herpes zoster (shingles)-

Caused by the same herpes virus- varicella zoster virus (VZV)

Vesicular rash follows a dermatone (nerve root)

Does not cross body midline

Answer 117

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Question 118

The rule of nines is a tool used to estimate a burns percentage of your total skin. It divides your body into sections by multiples of 9% each.

Answer 118

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Question 119

First degree: epidermis only, local and erythema.

Second degree: partial thickness, epidermis, some or all dermis. Deep or superficial

Third degree: full thickness, epidermis, dermis, and subcutaneous tissue.

Fourth degree: full thickness and deeper tissue. Epidermis, dermis, and subcutaneous, tendons, muscle, bone.

Answer 119

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Question 120

20% TBSA considered to be major burn injuries:

Massive evaporative water losses and fluctuations of large amounts of fluid, electrolytes, and plasma proteins.

Burn shock.

Burn consequences:

1. Results of immunologic response to burn injury: immunosuppression
2. Evaporative water loss

Loss of the skins barrier function and ability to regular evaporative water loss

Fluid replacement is mandatory

Answer 120

Treatment: complex prolonged recover with major burns,
Provide adequate fluids and nutrition (fluid losses),
Meticulously manage wounds, early surgical excision and grafting
Treat infection or sepsis aggressively (immunosuppressed)
Promote thermoregulation (exposure)

Goal: wound debridement and closure to promote survival

Scar formation with Contractures often a consequence with a deep partial thickness and third degree burns

Question 121

____ is acute or chronic infection of the cuticle

Answer 121

Paronychia

Question 122

___ is fungal or dermatophyte infection of the nail plate.

Answer 122

Onychomycosis

Question 123

___ is a fungus normal flora on mucous membranes; changes from flora to pathogens in immunosuppressed

Answer 123

Candidiasis

Question 124

___ __ is most common fungal infection of childhood

Scaly, pruritic scalp with bald areas, hair breaks easily.

Answer 124

Tinea capitis (scalp ringworm)

Question 125

___ ___ circular, clearly circumscribed, scaly patches with slightly elevated ring like border, with clearing in the center

Answer 125

Tinea corporis (ringworm)

Question 126

Tinea pedis is athletes foot

Fungal infection that usually begins between the toes.

Commonly occurs in people whose feet have become sweaty while confined within tight fitting shoes.

Answer 126

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Question 127

Basal cell carcinoma-

Most common cancer in the world

Numerous subtypes

Grows slowly, often ulcerated, develop crusts, and is firm to the touch

Metastasis is rare

Answer 127

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Question 128

Squamous cell carcinoma

Tumor of the epidermis

Rarely invade surrounding tissue

Sun exposed areas

Answer 128

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Question 129

Cutaneous melanoma

Originates from melanocytes

In basal layer of skin

Answer 129

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Question 130

Kaposi sarcoma

Vascular malignancy associated with immunodeficiency (HIV/AIDS)

Pruritic and painful, red, purple, or brown lesions

Answer 130

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Question 131

Herpes simplex one

HSV1

Transmitted by contact with infected saliva

Associated with oral infection

Lesions: clusters or inflamed and painful vesicles on erythematous base

Answer 131

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Question 132

Herpes simplex 2

HSV2

Transmitted by skin to skin mucous membranes contact

Genital infections are more commonly caused by HSV2

Answer 132

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