Test 2 Flashcards by Austin sides

Term for heart and stomach on the right and liver on the left

Situs inversus

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Term for heart as a mirror image

Dextrocardia

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Valve to pulmonary artery

Pulmonic valve

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Valve to right ventricle

Tricuspid valve

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Valve to aorta

Aortic valve

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Valve to left ventricle

Mitral valve

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Another name for the mitral valve, it separates what

Bicuspid valve left atria and ventricle

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What is s1

First heart sound, ventricles closing the mitral and tricuspid valves

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What is s2

Closing of the aortic and pulmonic valve after ventricular emptying

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What is a2

Part of s2, it’s aortic valve closer

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What is p2

Part of s2, pulmonic valve closer sound

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What is s3

After s2 during ventricular filling

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What is s4

Atria contracting

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What is split s2

When you here a2 and p2 seperatly

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A fetus right ventricle pumps where

Patent ductus arteriosus into circulation

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What is the hole on a neonate heart

Foramen ovale between the atrium

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We’re and what is a PDA

Patent ductus arteriosus from pulmonary vein to aorta

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When does the ductus arteriosus close

24 to 48 hours

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When does the Foramen ovale close

As soon as pressure in the left heart is higher than the right heart

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Substernal; provoked by effort, emotion, eating; relieved by rest and/or nitroglycerin; often accompanied by diaphoresis, occasionally by nausea

anginal

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Precipitated by breathing or coughing; usually described as sharp; present during respiration; absent when breath held

pleural

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Burning, substernal, occasional radiation to the shoulder; nocturnal occurrence, usually when lying flat; relief with food, antacids, sometimes nitroglycerin

esophageal

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Almost always infradiaphragmatic and epigastric; nocturnal occurrence and daytime attacks relieved by food; unrelated to activity

from a peptic ulcer

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Usually under right scapula, prolonged in duration; often occurring after eating; will trigger angina more often than mimic it

biliary

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Usually lasts for hours; local tenderness and/or pain with movement

arthritis, bursitis

Intensified or provoked by movement, particularly twisting or costochondral bending; long lasting; often associated with focal tenderness

musculoskeletal

Associated with/after anxiety; poorly described; located in intramammary region

psych

what is the proper sequence of cardiac assesment

beginning with inspection and proceeding to palpation, percussion, and then auscultation

apical impulse is visable were

about the midclavicular line in the fifth left intercostal space

a vigorous apical impulse is called what

heave or lift

what is PMI

point of maximal impulse, were you feel the apical pulse greatest

what if you feel a lift along the left sternal boarder

possible right ventricular hypertrophy

what pressure is used with a bell and a diaphragm

firm with the diaphragm and light for the bell

aortic valve

second right intercostal space at the right sternal border

pulmonic valve

second left intercostal space at the left sternal border

2nd pulmonic area

third left intercostal space at the left sternal border

tricuspid area

fourth left intercostal space along the lower left sternal border

mitral

at the apex of the heart in the fifth left intercostal space at the midclavicular line

Split S2 is best heard

in the pulmonic auscultatory area

Early systolic

Begins with S1, decrescendos, ends well before S2

Midsystolic (ejection)

Begins after S1, ends before S2; crescendo-decrescendo quality sometimes difficult to discern

Late systolic

Begins mid to late systole, crescendos, ends at S2; often introduced by mid to late systolic clicks

Early diastolic

Begins with S2

Mid-diastolic

Begins at clear interval after S2

Late diastolic (presystolic)

Begins immediately before S1

Holosystolic (pansystolic)

Begins with S1, occupies all of systole, ends at S2

Holodiastolic (pandiastolic)

Begins with S2, occupies all of diastole, ends at S1

Continuous

Starts in systole, continues without interruption through S2, into all or part of diastole; does not necessarily persist throughout entire cardiac cycle

High, medium, low

Depends on pressure and rate of blood flow; low pitch is heard best with the bell

Grade I

Barely audible in quiet room

Grade II

Quiet but clearly audible

Grade III

Moderately loud

Grade IV

Loud, associated with thrill

Grade V

Very loud, thrill easily palpable

Grade VI

Very loud, audible with stethoscope not in contact with chest, thrill palpable and visible

Crescendo

Increasing intensity caused by increased blood velocity

Decrescendo

Decreasing intensity caused by decreased blood velocity

Square or plateau

Constant intensity

Heard with bell at apex, patient in left lateral decubitus position Low-frequency diastolic rumble, more intense in early and late diastole, does not radiate; systole usually quiet; palpable thrill at apex in late diastole common; S1 increased and often palpable at left sternal border; S2 split often with accented P2; opening snap follows P2 closely Visible lift in right parasternal area if right ventricle hypertrophied Arterial pulse amplitude decreased Narrowed valve restricts forward flow; forceful ejection into ventricle Often occurs with mitral regurgitation Caused by rheumatic fever or cardiac infection

mitral stenosis

; ejection sound at second right intercostal border Midsystolic (ejection) murmur, medium pitch, coarse, diamond shaped,* crescendo-decrescendo; radiates along left sternal border (sometimes to apex) and to carotid with palpable thrill; S1 often heard best at apex, disappearing when stenosis is severe, often followed by ejection click; S2 soft or absent and may not be split; S4 palpable; ejection sound muted in calcified valves; the more severe the stenosis, the later the peak of the murmur in systole Apical thrust shifts down and left and is prolonged if left ventricular hypertrophy is also present Calcification of valve cusps restricts forward flow; forceful ejection from ventricle into systemic circulation Caused by congenital bicuspid (rather than the usual tricuspid) valve, rheumatic heart disease, atherosclerosis May be the cause of sudden death, particularly in children and adolescents, either at rest or during exercise; risk apparently related to degree of stenosis

aortic stenosis

Heard at apex and along left sternal border Murmur fills systole, diamond shaped, medium pitch, coarse; thrill often palpable during systole at apex and right sternal border; multiple waves in apical impulses; S2 usually split; S3 and S4 often present Arterial pulse brisk, double wave in carotid common; jugular venous pulse prominent Fibrous ring, usually 1 to 4 mm below aortic valve; most pronounced on ventricular septal side; may become progressively severe with time; difficult to distinguish from aortic stenosis on clinical grounds alone

subaortic stenosis

Heard over pulmonic area radiating to left and into neck; thrill in second and third left intercostals space Systolic (ejection) murmur, diamond shaped, medium pitch, coarse; usually with thrill; S1 often followed quickly by ejection click; S2 often diminished, usually wide split; P2 soft or absent; S4 common in right ventricular hypertrophy; murmur may be prolonged and confused with that of a ventricular septal defect Valve restricts forward flow; forceful ejection from ventricle into pulmonary circulation Cause is almost always congenital/98/8

pulmonic stenosis

Heard with bell over tricuspid area Diastolic rumble accentuated early and late in diastole, resembling mitral stenosis but louder on inspiration; diastolic thrill palpable over right ventricle; S2 may be split during inspiration Arterial pulse amplitude decreased; jugular venous pulse prominent, especially a wave; slow fall of v wave (see Chapter 15) Calcification of valve cusps restricts forward flow; forceful ejection into ventricles Usually seen with mitral stenosis, rarely occurs alone Caused by rheumatic heart disease, congenital defect, endocardial fibroelastosis, right atrial myxoma

tricuspid stenosis

Heard best at apex; loudest there, transmitted into left axilla Holosystolic, plateau-shaped intensity, high pitch, harsh blowing quality, often quite loud and may obliterate S2; radiates from apex to base or to left axilla; thrill may be palpable at apex during systole; S1 intensity diminished; S2 more intense with P2 often accented; S3 often present; S3-S4 gallop common in late disease If mild, late systolic murmur crescendos; if severe, early systolic intensity decrescendos; apical thrust more to left and down in ventricular hypertrophy Valve incompetence allows backflow from ventricle to atrium Caused by rheumatic fever, myocardial infarction, myxoma, rupture of chordae

mitral regurgitation

Heard at apex and left lower sternal border; easily missed in supine position; also listen with patient upright Typically late systolic murmur preceded by midsystolic clicks, but both murmur and clicks highly variable in intensity and timing Valve is competent early in systole but prolapses into atrium later in systole; may become progressively severe, resulting in a holosystolic murmur; often concurrent with pectus excavatum

mitral valve prolapse

Heard with diaphragm, patient sitting and leaning forward; Austin-Flint murmur heard with bell; ejection click heard in second intercostal space Early diastolic, high pitch, blowing, often with diamond-shaped midsystolic murmur, sounds often not prominent; duration varies with blood pressure; low-pitched, rumbling murmur at apex common (Austin-Flint); early ejection click sometimes present; S1 soft; S2 split may have tambour-like quality; M1 and A2 often intensified, S3-S4 gallop common In left ventricular hypertrophy, prominent prolonged apical impulse down and to left Pulse pressure wide; water-hammer or bisferiens or Corrigan pulse common in carotid, brachial, and femoral arteries (see Chapter 15) Valve incompetence allows backflow from aorta to ventricle Caused by rheumatic heart disease, endocarditis, aortic diseases (Marfan syndrome, medial necrosis), syphilis, ankylosing spondylitis, dissection, cardiac trauma

aortic regurgitation

Difficult to distinguish from aortic regurgitation on physical examination Valve incompetence allows backflow from pulmonary artery to ventricle Secondary to pulmonary hypertension or bacterial endocarditisDifficult to distinguish from aortic regurgitation on physical examination Valve incompetence allows backflow from pulmonary artery to ventricle Secondary to pulmonary hypertension or bacterial endocarditis

pulmonic regurgitation

Heard at left lower sternum, occasionally radiating a few centimeters to left Holosystolic murmur over right ventricle, blowing, increased on inspiration; S3 and thrill over tricuspid area common In pulmonary hypertension, pulmonary artery impulse palpable over second left intercostal space and P2 accented; in right ventricular hypertrophy, visible lift to right of sternum Jugular venous pulse has large v waves (see Chapter 15) Valve incompetence allows backflow from ventricle to atrium Caused by congenital defects, bacterial endocarditis (especially in IV drug abusers), pulmonary hypertension, cardiac trauma

tricuspid regurgitation

what is the first sign for newborn right sided heart failure

enlarged liver

pushing on the liver of a newborn you are looking for what

it increases right atrial pressure and will close a left to right shunt through the septal opening

Individuals with valvular defects, congenital or acquired, and those who use intravenous drugs are particularly susceptible ♦ Fever, fatigue ♦ Murmur ♦ Sudden onset of congestive heart failure ♦ Signs of neurologic dysfunctions ♦ Janeway lesion (small erythematous or hemorrhagic macules appearing on the palms and soles) ♦ Osler nodes (appear on the tips of fingers or toes and are caused by septic emboli)

bacterial endocaritis

♦ Decreased cardiac output causes decreased blood flow to the tissues ♦ May be left or right sided ♦ Left sided is characterized as systolic or diastolic ♦ Diastolic CHF is result of advanced glycation cross-linking collagen and creating a stiff ventricle unable to dilate actively ♦ Diastolic CHF occurs in older adults whose tissue is exposed to glucose for a longer period of time and in individuals with diabetes mellitus ♦ Fatigue ♦ Orthopnea ♦ Breath difficulty, shortness of breath ♦ Edema ♦ Symptoms can develop gradually or suddenly with acute pulmonary edema ♦ Systolic CHF has a narrow pulse pressure ♦ Diastolic CHF has a wide pulse pressure

congestive heart failure

If persists the pericardial effusion may increase and result in cardiac tamponade (Fig. 14-22) ♦ Initially, chest pain is sharp or stabbing ♦ Movement or inspiration may aggravate the pain ♦ Pain may be most severe when supine, relieved when leaning forward ♦ Scratchy, grating, triphasic friction rub on ascultation, comprises ventricular systole, early diastolic ventricular filling, and late diastolic atrial systole ♦ Easily heard just left of the sternum in third and fourth intercostal spaces

pericarditis

Seriously constrains cardiac relaxation, impairing access of blood to the right heart ♦ Common causes: pericarditis, malignancy, aortic dissection, and trauma ``` ♦ Anxiety, restlessness ♦ Chest pain ♦ Difficulty breathing ♦ Discomfort, sometimes relieved by sitting upright or leaning forward ♦ Syncope, light-headedness ♦ Pale, gray, or blue skin ♦ Palpitations ♦ Rapid breathing ♦ Swelling of the abdomen or arms or neck veins ``` ♦ Beck's triad (jugular venous distention, hypotension, and muffled heart sounds) ♦ Chronically and severely involved pericardium may also scar and constrict, limiting cardiac filling; heart sounds are muffled, blood pressure drops, the pulse becomes weakened and rapid, and paradoxic pulse (see Chapter 15) becomes exaggerated

cardiac tamponade

Enlargement of the right ventricle secondary to pulmonary malfunction ♦ Usually chronic, occasionally acute ♦ Chronic common cause: chronic obstructive pulmonary disease (COPD) ♦ Acute causes: massive pulmonary embolism and acute respiratory distress syndrome (ARDS) ♦ Results from chronic pulmonary disease; alterations in pulmonary circulation leads to pulmonary arterial hypertension, which imposes a mechanical load on right ventricular emptying ♦ Fatigue ♦ Tachypnea ♦ Exertional dyspnea ♦ Cough, hemoptysis ♦ Evidence of pulmonary disease ♦ Wheezes and crackles on auscultation ♦ Increase in chest diameter ♦ Labored respiratory efforts with chest wall retractions ♦ Distended neck veins with prominent A or V waves ♦ Cyanosis ♦ Left parasternal systolic heave ♦ Loud S2 exaggerated in the pulmonic region

cor pulmonale

Ischemic myocardial necrosis caused by abrupt decrease in coronary blood flow to a segment of the myocardium ♦ Most commonly affects left ventricle ♦ Atherosclerosis and thrombosis are the common underlying causes ♦ Deep substernal or visceral pain that often radiates to the jaw, neck, and left arm ♦ Discomfort may be mild, especially in older adults or patients with diabetes mellitus ♦ Dysrhythmias are common ♦ S4 is usually present ♦ Distant heart sounds ♦ Soft, systolic, blowing apical murmur ♦ Thready pulse ♦ Blood pressure varies, although hypertension is usual in the early phases

myocardial infarction

Focal or diffuse inflammation of the myocardium ♦ Results from infectious agents, toxins, or autoimmune diseases such as amyloidosis ``` ♦ Initial symptoms vague ♦ Fatigue ♦ Dyspnea ♦ Fever ♦ Palpitations ``` ``` ♦ Cardiac enlargement ♦ Murmurs ♦ Gallop rhythms ♦ Tachycardia ♦ Dysrhythmias ♦ Pulsus alternans ```

myocarditis

what is CANADA

use when your looking for reasons of syncope C Cardiac: valve stenosis, Stokes-Adams attacks, other conduction disturbances A Arteriovenous: “steal” syndromes N Nervous: psychologic, autonomic, vagal, coughing A Anemia, altered blood (CO) D Drugs, diabetes, alcohol, poisons A Altitude, acute fevers

Arrhythmias caused by a malfunction of the sinus node ♦ Occurs secondary to hypertension, arteriosclerotic heart disease, or rheumatic heart, or idiopathically ♦ Fainting, transient dizzy spells, light-headedness, seizures, palpitations, and angina ♦ Dysrhythmias ♦ Congestive heart failure

sick sinus syndrome

Four cardiac defects: ventricular septal defect, pulmonic stenosis, dextroposition of the aorta, and right ventricular hypertrophy ♦ Surgical correction is recommended, currently initiated after the first “spell” ♦ Dyspnea with feeding, poor growth, exercise intolerance ♦ Paroxysmal dyspnea with loss of consciousness and central cyanosis (tetralogy spell) ♦ Parasternal heave and precordial prominence, systolic ejection murmur over the third intercostal space, sometimes radiating to the left side of the neck; a single S2 is heard (Fig. 14-24) ♦ Older children develop clubbing of fingers and toes

TETRALOGY OF FALLOT

♦ Significant number (30% to 50%) of small defects close spontaneously, during the first 2 years of life ♦ Recurrent respiratory infections ♦ If large VSD, rapid breathing, poor growth, symptoms of congestive heart failure ♦ Arterial pulse is small, and jugular venous pulse is unaffected ♦ Holosystolic murmur, often loud, coarse, high-pitched, and best heard along the left sternal border in the third to fifth intercostal spaces ♦ Distinct lift is often discernible along left sternal border and the apical area ♦ A smaller defect causes a louder murmur and a more easily felt thrill than a large one

ventricular septal defect VSD

♦ Blood flows through the ductus during systole and diastole, increasing pressure in the pulmonary circulation and consequently workload of the right ventricle ♦ Small shunt can be asymptomatic; a larger one causes dyspnea on exertion ♦ Dilated and pulsatile neck vessels ♦ Wide pulse pressure ♦ Harsh, loud, continuous murmur heard at the first to third intercostal spaces and the lower sternal border, with a machine-like quality ♦ Murmur is usually unaltered by postural change, unlike murmur of a venous hum

patent ductus arteriosus

♦ Often asymptomatic ♦ Heart failure rarely occurs in children but can often occur in adults ♦ Diamond-shaped systolic ejection murmur often loud, high pitched, and harsh, heard over the pulmonic area ♦ May be accompanied by a brief, rumbling, early diastolic murmur ♦ Does not usually radiate beyond the precordium ♦ Systolic thrill may be felt over the area of the murmur, along with a palpable parasternal thrust ♦ S2 may be widely split ♦ Sometimes murmur may not sound particularly impressive, especially in overweight children; if there is a palpable thrust and radiation to the back, it is more apt to be significant

atrial septal defect

Systemic connective tissue disease occurring after streptococcal pharyngitis or skin infection ♦ Characterized by a variety of major and minor manifestations (Box 14-10) ♦ May result in serious cardiac valvular involvement of mitral or aortic valve; tricuspid and pulmonic are not often affected ♦ Affected valve becomes stenotic and regurgitant ♦ Children between 5 and 15 years of age are most commonly affected ♦ Prevention—adequate treatment for streptococcal pharyngitis or skin infections—is the best therapy ♦ Fever ♦ Inflamed swollen joints ♦ Flat or slightly raised, painless rash with pink margins with pale centers and a ragged edge (erythema marginatum) ♦ Aimless jerky movements (Sydenham chorea or St. Vitus dance) ♦ Small, painless nodules beneath the skin ♦ Chest pain ♦ Palpitations ♦ Fatigue ♦ Shortness of breath ♦ Murmurs of mitral regurgitation and aortic insufficiency ♦ Cardiomegaly ♦ Friction rub of pericarditis ♦ Congestive heart failure

acute rheumatic fever

what are jones criteria

guide for diagnosing rheumatic fever, must have 2 major or 1 major and two minor symtpms following a strep infection

Condition causing inflammation in walls of small and medium-sized arteries throughout the body, including coronary arteries ♦ Also called mucocutaneous lymph node syndrome because it also affects lymph nodes, skin, and mucous membranes ♦ Frequently (80% of the time) affects infants and children under 5 years of age (Council on Cardiovascular Disease in the Young; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, American Heart Association, 2001) ♦ High fever, lasting longer than 5 days ♦ Conjunctivitis ♦ Cracked, red, and inflamed lips ♦ Strawberry tongue, white coating on tongue or prominent papillae on the back of the tongue ♦ Cervical lymphadenopathy ♦ Erythema of the palms of the hands and soles of the feet ♦ Joint pain (arthralgia) and swelling, frequently symmetric ♦ Irritability ♦ Tachycardia ♦ Diagnosis is usually made based on the patient having most of the classic symptoms

Kawasaki disease

Caused by deposition of cholesterol, other lipids, and by a complex inflammatory process ♦ Leads to vascular wall thickening and narrowing of the lumen ♦ May be asymptomatic ♦ Angina pectoris, shortness of breath, palpitations ♦ Family history of close relatives with atherosclerotic disease, early death, or dyslipidemia ♦ Dysrhythmias and congestive heart failure

atherosclerotic heart disease

Amyloid, fibrillary protein produced by chronic inflammation or neoplastic disease, deposition in the heart ♦ Heart contractility may be reduced ♦ Causes heart failure ♦ Palpitations, lower extremity edema, fatigue, reduced activity tolerance ``` ♦ Pleural effusion ♦ Arrhythmia ♦ Lower extremity edema ♦ Dilated neck veins ♦ Hepatomegally or ascites ♦ Electrocardiography or echocardiography shows small, thickened left ventricle; right ventricle may also be thickened ```

senile cardiac amyloidosis

Thickening and calcification of aortic valves ♦ Does not usually cause symptoms ♦ Midsystolic (ejection) murmur

aortic sclerosis

what are the two types of immunity

humoral and cellular, humoral involves the antibodies produced by b cells and cellular involves attacking invaders by cells themselves

what lymphocyte has a short life span and how prevelent are they

b cells, 3 to 4 days, not as prevelent as t cells

what does the thymus do and were is it

lower neck, develops t lymphocytes and the agents controlling the response of b cells.. dosnt do much in the adult

what are the two systems of the spleen

the white pulp, made of lymph nodes and lymph tissue, and the red pulp made of venous sinusoids

what are peyer patches

small raised areas of lymph tissue on the mucosa small intestine

how long does the umbilical cord stay attached

1 to 2 weeks

describe lymphadenopathy

enlarged lymph nodes

describe lymphadenitis

inflamed and enlarged nodes

describe lymphpharangitis

—inflammation of the lymphatics that drain an area of infection; tender erythematous streaks extend proximally from the infected area; regional nodes may also be tender

describe lymphedema

edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate lymph drainage

describe lymphangioma

congenital malformation of dilated lymphatics

small nodes that feel like BBs or buckshot under the skin, nodes description

shotty

wavelike motion that is felt when the node is palpated, nodes descritpion

fluctuant

group of nodes that feel connected and seem to move as a unit, nodes description

matted

what node warns of malignancy

anterior to the sternocleidomastoid muscle the supraclavicular node

Inflammation of one or more lymphatic vessels

ACUTE LYMPHANGITIS

Infection and inflammation of a lymph node; may affect a single or localized group of nodes

ACUTE SUPPURATIVE LYMPHADENITIS

stage lymphedema Latent or subclinical Swelling is not evident despite impaired lymph transport.

stage lymphedema Pitting may occur. There is early accumulation of fluid relatively high in protein content (e.g., in comparison with “venous” edema), and it subsides with limb elevation.

stage lymphedema Tissue fibrosis is present. Limb elevation alone rarely reduces tissue swelling. Pitting may be present. Late in stage II, the limb may or may not pit as tissue fibrosis supervenes.

stage lymphedema Pitting is absent. Trophic skin changes are present (acanthosis, fat deposits, and warty overgrowths).

Congenital malformation of dilated lymphatics

LYMPHANGIOMA/CYSTIC HYGROMA

Massive accumulation of lymphedema throughout the body; the most common cause of secondary lymphedema worldwide

LYMPHATIC FILARIASIS (ELEPHANTIASIS)

Malignant neoplasm of the lymphatic system and the reticuloendothelial tissues

NON-HODGKIN LYMPHOMA

Malignant lymphoma

HODGKIN DISEASE

Initially infects oral epithelial cells; after intracellular viral replication and cell lysis with release of new virions, virus spreads to contiguous structures such as the salivary glands, with eventual viremia and infection of the entire lymphoreticular system, including the liver and spleen ♦ Incubation period of infectious mononucleosis in adolescents is 30 to 50 days ♦ Malaise, fatigue, acute or prolonged (longer than 1 week) fever, headache, sore throat, nausea, abdominal pain, and myalgia ♦ Prodromal period may last 1 to 2 weeks ♦ Generalized lymphadenopathy most commonly in the anterior and posterior cervical nodes and the submandibular lymph nodes and less commonly in the axillary and inguinal lymph nodes ♦ Epitrochlear lymphadenopathy is particularly suggestive of infectious mononucleosis ♦ Hepatomegaly; symptomatic hepatitis or jaundice is uncommon, but elevated liver enzymes are common ♦ Splenomegaly to 2 to 3 cm below the costal margin is typical; massive enlargement is uncommon (Kleigman et al, 2007) ♦ Moderate to severe pharyngitis with tonsillar enlargement, occasionally with exudates ♦ Petechiae at the junction of the hard and soft palate frequently seen ♦ Diagnosis with mononucleosis spot test

EPSTEIN-BARR VIRUS MONONUCLEOSIS

Ingestion or inhalation of oocysts in soil/fomites, undercooked meat or raw eggs; cat feces or litter ♦ Infection persists for life without signs of disease ♦ In immunosuppressed persons, quiescent parasites multiply, resulting in neurologic disease or other organ manifestations ♦ May cause serious congenital infection if a woman is exposed during pregnancy, particularly in the first trimester; transmitted directly from pregnant mother to fetus ♦ No significant symptoms ♦ History of eating raw or rare meat or uncooked eggs ♦ History of direct contact with cat feces, cleaning the litter box, gardening in feces-contaminated soil ♦ Single node, chronically enlarged and nontender ♦ Node is usually in the posterior cervical chain

TOXOPLASMOSIS

ommon in infancy with peak age of acquisition 2 years ♦ Virus present in the saliva of most adults and is readily transmitted by oral secretions ♦ Latency permits persistence of the virus in the presence of a fully developed immune response and allows lifelong infection of the host ♦ Through periodic reactivation of latent virus and the production of recurrent infection; virus shedding occurs at intervals throughout life, allowing the virus to be spread to new susceptible hosts (Cohen et al, 2004) ♦ Fever—usually high grade and persistent over 3 to 4 days ♦ Sometimes associated with a mild respiratory illness and lymphadenopathy ♦ Adenopathy, discrete and not noted for tenderness, involves the occipital and postauricular chains and may last a while ♦ When the fever diminishes, a morbilliform fine maculopapular rash occurs, spreading from the trunk to the extremities; the child begins feeling much better

ROSEOLA INFANTUM (HHV-6)

Caused mainly by Bartonella henselae and less commonly by B. quintana or Afipia felis; usually follows a bite, scratch, or other penetrating injury from a kitten or cat; the organisms, however, rarely cause illness in the cat ♦ Bite, scratch, or wound from cat or kitten ♦ Inoculation lesion: a papule or pustule lasts 3 to 5 days and then becomes vesicular and crusts in 2 to 3 days ♦ Painful enlarged lymph nodes ♦ Inoculation lesion; may be healing ♦ Lymphadenopathy develops in 1 to 2 weeks in the region that drains the primary lesion ♦ Single lymph node most often, but multiple nodes are involved occasionally ♦ Tender nodes commonly in head, neck, and axillae; the accessible nodal areas in the arms and legs are less often involved ♦ Nodes can be very large—up to several centimeters; often red and tender and occasionally suppurate ♦ Diagnosis can be made in the presence of a nodal enlargement lasting longer than 3 weeks, accompanied by an inoculation lesion of the skin and following an interaction with a cat, a cat scratch, or cat lick on a break in the skin ♦ Lymphadenopathy can last for 2 to 4 months or even longer

CAT SCRATCH DISEASE

an immune complex disease Systemic type III hypersensitivity reaction in response to antigens ♦ Mediated by the tissue deposition of circulating immune complexes, the activation of complement, and the ensuing inflammatory response ♦ Patient can react similarly to repeated exposure to the stimuli; subsequent reactions may be even more severe and even fatal ♦ Enlarged lymph nodes ♦ Pain, pruritus, and erythematous swelling at the injection site ♦ Urticaria, other rashes, lymphadenopathy, joint pain, fever, and at times facial edema ♦ Medications: Beta-lactam antibiotics (especially cefaclor), sulfonamide antibiotics, minocycline ♦ Organ transplant ♦ Findings become apparent about 7 to 10 days following administration of the provoking substance ♦ Urticaria, maculopapular or purpuric lesions ♦ Lymphadenopathy most prominent in the area draining the injection site; can be generalized ♦ Facial and neck edema ♦ Symptoms subside slowly, recurring at times over several weeks

SERUM SICKNESS (TYPE III HYPERSENSITIVITY REACTION)

describe the pulse amplitude pulse score

4 Bounding, aneurysmal 3 Full, increased 2 Expected 1 Diminished, barely palpable 0 Absent, not palpable

what is claudication

muscle pain from ischemia, from peripheral artery disease

what are the Ps

``` looking for arterial occlusion pallor pain pulselesness paresthesia paralysis ```

Korotkoff sounds

the first time you here a pulse when checking BP

what is homan sign

flex the knee slightly then dorsiflex the foot calf pain is a positive sign that may mean a venous thrombosis

grade edema

1+ Slight pitting, no visible distortion, disappears rapidly 2+ A somewhat deeper pit than in 1+, but again no readily detectable distortion, and it disappears in 10 to 15 seconds 3+ Noticeably deep pit that may last more than a minute; the dependent extremity looks fuller and swollen 4+ Very deep pit that lasts as long as 2 to 5 minutes, and the dependent extremity is grossly distorted

Etiology is unknown ♦ Inflammatory infiltrates develop in the thoracic aorta and neighboring arterial structures ♦ Arterial intimal thickening and thrombosis can lead to ischemia of supplied structures such as the masseter muscle, tongue, or optic nerve ♦ Usually affects persons older than 50 years of age ♦ Flulike symptoms (e.g., low-grade fever, malaise, anorexia) may be accompanied by polymyalgia involving the hips and shoulders ♦ Headache in the temporal region on one or both sides, although the headache can occur in other regions ♦ Ocular symptoms, including loss of vision, are common ♦ Ischemia can also cause tongue pain and jaw claudication ♦ Area over the temporal artery can become red, swollen, tender, and nodular ♦ Temporal pulse may be variously strong, weak, or absent

TEMPORAL ARTERITIS (GIANT CELL ARTERITIS)

Usually the result of atherosclerosis; with family history, tobacco use, and hypertension playing important roles ♦ Abdominal aneurysms are four times more common in men than in women ♦ Generally asymptomatic until they dissect or compress an adjacent structure ♦ With dissection, the patient may describe a severe ripping pain ♦ Pulsatile swelling along the course of an artery ♦ Occurs most commonly in the aorta, although renal, femoral, and popliteal arteries are also common sites ♦ A thrill or bruit may be evident over the aneurysm

ARTERIAL ANEURYSM

May be congenital or acquired ♦ Damage to vessels caused by catheterization is the most common acquired etiology ♦ If the fistula is large, there may be significant arterial-to-venous shunting of blood ♦ Patients may present with lower extremity edema, varicose veins, or claudication due to ischemia ♦ If severe, high output cardiac failure can develop ♦ May result in an aneurysmal dilation ♦ A continuous bruit or thrill over the area of the fistula suggests its presence ♦ Edema or ischemia may develop in the involved extremity

ARTERIOVENOUS FISTULA

Most common cause is peripheral atherosclerosis ♦ Diabetes, hypertension, dyslipidemia, and tobacco use are all risk factors ♦ Can also be a result of vascular trauma, radiation therapy, or vasculitis ♦ Intermittent claudication produces pain, ache, or cramp in the exercised muscle that is receiving an inadequate blood supply ♦ The amount of exercise necessary to cause the discomfort is predictable (e.g., occurring each time the same distance is walked) ♦ Limb appears healthy, but pulses are weak or absent ♦ Progressive stenosis results in severe ischemia, in which the foot or leg is painful at rest, is cold and numb, and has skin changes (e.g., dry and scaling, with poor hair and nail growth) ♦ Edema seldom accompanies this disorder, but ulceration is common in severe disease, and the muscles may atrophy

PERIPHERAL ARTERIAL DISEASE

occurs most commonly in young, otherwise healthy individuals, most commonly women, with no evidence of underlying cause ♦ Secondary is associated with an underlying connective tissue disease such as scleroderma or systemic lupus erythematosus ♦ Involved areas will feel cold and achy, which improves on rewarming ♦ In secondary, there can be intense pain and digital ischemia with necrosis at the tips ♦ With primary , there is a triphasic demarcated skin pallor (white), cyanosis (blue), and reperfusion (red) within the extremities ♦ The vasospasm may last from minutes to less than an hour ♦ In secondary, ulcers may appear on the tips of the digits and eventually the skin over the digits can appear smooth, shiny, and tight from loss of subcutaneous tissue

RAYNAUD PHENOMENON

Emboli can also be caused by atherosclerotic plaques, infectious material from fungal and bacterial endocarditis, and atrial myxomas ♦ Pain is the most common symptom ♦ Paresthesias may also develop ♦ Occlusion of small arteries and necrosis of the tissue supplied by that vessel ♦ With endocarditis, you can see splinter hemorrhages in the nail beds

ARTERIAL EMBOLIC DISEASE

what is the number for hypertension

140/90

Most commonly due to conditions that lead to dilation of the right ventricle (e.g., hypertension, pulmonary thrombosis) ♦ Less frequently it can also result from primary valvular disease ♦ With mild to moderate tricuspid regurgitation, there are typically no symptoms ♦ With severe disease, you may see symptoms of right-sided heart failure such as ascites or peripheral edema ♦ The v wave is much more prominent and occurs earlier, often merging with the c wave (Fig. 15-20; see also Fig. 15-7) ♦ A holosystolic murmur in the tricuspid region, a pulsatile liver, and peripheral edema

tricuspid regurgitation

is a stenosis seen most commonly in the descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum Frequently due to congenital defect of the underlying vascular wall ♦ May also be acquired due to inflammatory aortic disease or severe atherosclerosis ♦ Most patients are asymptomatic unless severe hypertension or vascular insufficiency develops ♦ In those settings, patients may develop symptoms of heart failure or vascular insufficiency of an involved upper extremity with activity ♦ Differences in systolic blood pressure readings when the radial and femoral pulses are palpated simultaneously

COARCTATION OF THE AORTA

An acute vasculitic illness of uncertain cause affecting young males more often than females; the critical concern is cardiac involvement in which aneurysms of a coronary artery may develop The etiology of the vasculitis is unknown ♦ Immune-mediated blood vessel damage can result in both vascular stenosis and aneurysm formation ♦ The symptoms are diffuse and typified by fever lasting a few days to several weeks ♦ The effects of a systemic vasculitic illness, such as weight loss, fatigue, myalgias, as well as arthritis, may develop ♦ Findings may include conjunctival injection, strawberry tongue, and edema of the hands and feet ♦ Lymphadenopathy and polymorphous nonvesicular rashes

KAWASAKI DISEASE

how many calories are in a carb

what % of food should be protein

14-20

what % of diet should be fat, how many calories per gram

25-35, 9

what is a major risk factor for an eating disorder

having a first degree relative with one

what five nutrients may lac in a vegeterian diet

calcium, protein, iron, b 12, vitamin d

what is the rule of thumb for weight changes in calories

25 per kg for loss, 30 per kg for same, 35 per kg for gain, 35 to 50 per kg for hypermetabolic

how are overweight, obese, and extreme obese defined in BMI

Adult classification of BMI: overweight 25 to 29.9; obesity 30 to 39.9; extreme obesity >40

how long is chronic pain

over 6 months

what is nociception

the transmission of pain impulses from the site of injury or tissue damage to the dorsal horn of the spinal cord and brain

A form of chronic pain caused by a primary lesion or dysfunction of the central nervous system that persists beyond expected after healing

NEUROPATHIC PAIN

The presence of regional pain (beyond the site of specific nerve injury) with motor, sensory, and autonomic changes following a predominantly traumatic noxious event with or without specific nerve injury

COMPLEX REGIONAL PAIN SYNDROME

what does the frontal lobe do

motor cortex associated with voluntary skeletal movement and fine repetitive motor movements, as well as the control of eye movements

what does the parietal lobe do

processing sensory data as it is received. It assists with the interpretation of tactile sensations (i.e., temperature, pressure, pain, size, shape, texture, and two-point discrimination), as well as visual, gustatory, olfactory, and auditory sensations. Recognition of body parts and awareness of body position (proprioception)

what does the occipital lobe do

contains the primary vision center and provides interpretation of visual data

what does the temporal lobe do

the perception and interpretation of sounds and determination of their source. It is also involved in the integration of taste, smell, and balance. The reception of speech and interpretation of speech is located in the Wernicke area

what does the basal ganglia do

functions as the extrapyramidal pathway and processing station between the cerebral motor cortex and the upper brainstem. Through its interconnections 704705with the thalamus, motor cortex, reticular formation, and spinal cord, the basal ganglia refine motor movements.

what does the cerebellum do

aids the motor cortex of the cerebrum in the integration of voluntary movement. It processes sensory information from the eyes, ears, touch receptors, and musculoskeleton. Integrated with the vestibular system, the cerebellum uses the sensory data for reflexive control of muscle tone, balance, and posture to produce steady and precise movements.

what does the brainstem do

pathway between the cerebral cortex and the spinal cord, and it controls many involuntary functions

name four structures in the brain stem

medulla oblongata, pons, midbrain, and diencephalon

what does the pons do

transmits information between the brainstem and the cerebellum, relaying motor information from the cerebral cortex to the contralateral cerebellar hemisphere

what does the thalamus do

the major integrating center for perception of various sensations such as pain and temperature (along with the cortical processing for interpretation). The thalamus also relays sensory aspects of motor information between the basal ganglia and cerebellum

what is the term for loss of smell

anosmia

how do you test cn 1

diffrent smells

how do you test cn 2

snellel eye chart

how do you test cn 3

movement of the eye through the feilds of gaze and pupil response.

ho wdo you test cn 4

movement of the eye through the feilds of gaze and pupil response.

how do you test cn 6

movement of the eye through the feilds of gaze and pupil response.

how do you test cn 5

sensation and movement of the face

how do you test cn 7

movement of the face

how do you test cn 8

hearing test

how do you test cn 9

taste test

how do you test cn 10

gag the pt

how do you test cn 11

move the neck and shoulders and head

how do you test cn 12

move the tongue

how do you test for cerebellar function, name three

rapid alternating movements, finger to finger, heel to shin

how do you test balance

romberg test

describe the deep tendon reflex grading

0 No response 1+ Sluggish or diminished 2+ Active or expected response 3+ More brisk than expected, slightly hyperactive 4+ Brisk, hyperactive, with intermittent or transient clonus

how long do infants make a fist

3 months

when do infants start reaching and grsping

2 months

when do infants use 1 hand insted of two

6 months

when do infants let go of things on purpose

10 months

in an infant how do you test cn 2, 3, 4, and 6

shine a bright light in the babys eyes, it should close them and pull away

in an infant how do you test cn 5

rooting reflex or sucking reflex

in an infant how do you test cn 7

facial movement when crying

in an infant how do you test for cn 8

clap loudly and look for a startle

in an infant how do you test cn 9 and 10

swalloing and gag reflex

what age do the achilles and brachioradial reflexes appear

6 months

what is the moro reflex, when does it go away

leaning the pt back like they are falling, and arms going out, 6 months

what is fencing and when does it go away

head is turned right and the right arm and leg extend the same happens on the other side, 6 months

A progressive autoimmune disorder characterized by a combination of inflammation and degeneration of the myelin of the brain's white matter leading to decreased brain mass and obstructed transmission of nerve impulses

MULTIPLE SCLEROSIS (MS)

An autoimmune disorder of neuromuscular transmission involving the production of autoantibodies directed against the nicotinic acetylcholine receptor, leading to the destruction and inflammatory changes in the postsynaptic membranes

MYASTHENIA GRAVIS

An autoimmune-mediated destruction of peripheral nerve myelin sheaths and inflammation of nerve roots that occurs following a nonspecific gastrointestinal or upper respiratory infection 1 to 3 weeks earlier or following an immunization

GUILLAIN-BARRÉ SYNDROME

Recurrent paroxysmal sharp pain that radiates into one or more branches of the fifth cranial nerve

TRIGEMINAL NEURALGIA (TIC DOULOUREUX)

A permanent disorder of movement and posture development associated with nonprogressive (static) disturbances that occurred in the developing fetal or infant brain

CEREBRAL PALSY (CP)

A congenital defect of one or more vertebrae (commonly the lumbar or sacral) permits a meningeal sac filled with a portion of the spinal cord to protrude

MYELOMENINGOCELE (SPINA BIFIDA)

A slowly progressive, degenerative neurologic disorder in which deficiency of the dopamine neurotransmitter results in poor communication between parts of the brain that coordinate and control movement and balance

PARKINSON DISEASE

A syndrome simulating degenerative diseases that is caused by noncommunicating hydrocephalus (dilated ventricles with intracranial pressure within expected ranges)

NORMAL PRESSURE HYDROCEPHALUS

The reappearance of neurologic signs in survivors of the polio epidemics

POSTPOLIO SYNDROME

what is a fan-shaped fold of the peritoneum, covers most of the small intestine and anchors it to the posterior abdominal wall

greater and lesser omentum

what is the ALIMENTARY TRACT

tube from mouth to anus

what are the three sections of the stomach

fundus then body then pylorus

what are the 9 sections of the abdomen

epigastric, unmbilical, right and left hypochondriac, right and left lumbar, right and left inguinal

how far below the costal margin is the liver

2 to 3 cm

were do you start precussion to find the liver

costal margins and midclavicular line

what is the usual vertical span of the liver

6 to 12 cm

you wack the back with your fist were and for what

at the costal margins to asses kidney tenderness

what is the pneumonic for causes of constipation

``` constipated congenital like hirschsprung disease obstruction neoplasms stricture of colon topical hemorrhoids impaceted feces prolapse of the rectum anorexia and depression temperature high and dehydration endrocrine hypothyroidism diet divertictulitis and drugs ```

what is murphy sign

pressing at the gallbladder when it is pushed on during pateint inspiration it will hurt and they will stop breathing its a sign of gallbladder inflamation

what three sign show ascites

flank dullness, bulging flanks, and presence of a fluid wave

what are three sore tools for appendicitis

Ohmann, alvarado or mantrels, and the pediatric appendicitis score

describe rebound tenderness

push with your fingers and let go fast, the return of the organ causes a sharp pain and is a sign of peritineal inflamation

what is blumberg sign

rebound tenderness showing peritineal inflamation

what is what is mcburney sign

rebound tenderness in the right lower quadrent showing appendicitis

what is kehr sign

pain in the upper outer left shoulder from spleen injury

what is cullen's sign

bruising around the umbilicus possible pancreatitis

what is turners sign

bruising around the flanks possibly from pancreatitis

what is aaron sign

Pain or distress occurs in the area of the patient's heart or stomach on palpation of McBurney's point could be appendicitis

what is ballance sign

Fixed dullness to percussion in left flank, and dullness in right flank that disappears on change of position could be peritoneal irritation

what is dance sign

Absence of bowel sounds in right lower quadrant, intussusception

what is markle sign

Patient stands with straightened knees, then raises up on toes, relaxes, and allows heels to hit floor, thus jarring body. Action will cause abdominal pain if positive, appendicitis or peritoneal irritation

what is romberg-howship sign

Pain down the medial aspect of the thigh to the knees, could be strangulated obturator hernia

what is rovsing sign

Right lower quadrant pain intensified by left lower quadrant abdominal palpation, peritoneal irritation or appendicitis

what is psoas sign

from the iliopsoas muscle test, laying flat lift the right leg at the hip pressing down on it, if the right lower quad hurts it could be appendicitis

spider nevi may indicate what

liver disease

A seperation 1 to 4 cm wide in the space between the xiphoid process and umbilicus, in infants, what is it called and what does it mean

diastasis rectus abdominis, it is okay as long as no hernia develops

if you can visably see peristalic waves what does this mean

should be examined for pyloric stenosis

what is felt as a sauasage shaped mass in the upper right or left abd in the infant

intussusception

how long is abdominal breathing expected

6-7 years

Frequent liquid or loose stools lasting less than 4 weeks’ duration

acute diarrhea

Backward flow of gastric contents, which are typically acidic, into the esophagus

GERD

Disorder of intestinal motility

Irritable Bowel Syndrome

Localized epigastric pain that occurs when the stomach is empty and is relieved by food or antacids ♦ With upper gastrointestinal bleeding, symptoms include hematemesis and melena; significant blood loss may result in dizziness and syncope

Duodenal ulcer

Chronic inflammatory disorder that can affect any part of the gastrointestinal tract that produces ulceration, fibrosis, and malabsorption; the terminal ileum and colon are the most common sites Colonoscopy and pathology show characteristic cobblestone appearance of the mucosa perianal skin tags are common

crohns disease

Chronic inflammatory disorder of the colon and rectum that produces mucosal friability and areas of ulceration

ulcerative colitis

Most patients are asymptomatic ♦ With diverticulitis (when diverticula become inflamed), may experience left lower quadrant pain, anorexia, nausea, vomiting, and altered bowel habits (usually constipation) ♦ Pain usually localizes to the site of inflammation ♦ May have abdominal distention and tympanic to percussion with decreased bowel sounds and localized tenderness (see Table 17-2) ♦ Lower gastrointestinal bleeding may occur

diverticular disease

Diffuse hepatic process characterized by fibrosis and alteration of normal liver architecture into structurally abnormal nodules

Cirrhosis

what are two diffrences in uti vs pyelonephritis

cva tenderness and fever with pyelo

who often has a meconium ileus

cystic fibrosis

Congenital obstruction or absence of some or all of the bile duct system resulting in bile flow obstruction; most have complete absence of the entire extrahepatic biliary tree

Biliary Atresia

Outpouching of the ileum that varies in size from a small appendiceal process to a segment of bowel several inches long, often in the proximity of the ileocecal valve

Meckel Diverticulum

Most common intraabdominal tumor of childhood; usually appears at 2 to 3 years of age

Wilms Tumor (Nephroblastoma)

Primary absence of parasympathetic ganglion cells in a segment of the colon, which interrupts intestinal motility

Hirschsprung Disease (Congenital Aganglionic Megacolon)

Triad of microangiopathic hemolytic anemia, thrombocytopenia, and uremia

Hemolytic Uremic Syndrome (HUS)

grade prostate elargement

1- 1 to 2 cm into rectum 2- 2 to 3 cm 3- 3 to 4 4- more than 4

what is pruritus ani

itching of the anus often from fungal or parasites in children

whats the mneumonic for bph

nuts | nocturia, urine dribbles, tried to void but cant, small stream.

what is the term for producing blood cells

hematopoiesis

what do bursae do

they form as fluid filled sacks between connective tissue and bones to reduce friction

what is the radiocarpal joint

the wrist

what is a condyloid joint

it moves in two places like the wrist

what is another name for the glenohumeral joint

shoulder

what is used to measure the angle of a joint

ganiometer

what does the ottawa scale look for

ankle injury if it needs a x ray

what is tinel sign

strike the median nerve in the wrist and if the hand tingels then they prob have carpel tunnel

what is the phalen test

press both backs of hands together while chiken wing and if the hands go numb its positive for carpel tunnel

what is the neer test for

a shoulder irritation or tear

what is the hawkins test

bending the shoulder and elbow 90 degrees then bringing it in, it will hurt and that a tear or irritation

what is the thomas test

hip flexion contracture, lay supine and have one leg straight the other is brought to the chest and if flat leg comes up it the bad sign

what is the trendelenburg test

stand on one foot if the unsuported hip drops it is a weak abductor muscle

how much movement is positive for the drawer test

greater than 5mm

what is the lachman test

heel on bed with knee bent. pull on tibia, more than 5mm is a torn acl

what is the barlow ortolani maneuver for

infant hip dislocation screening

A hereditary, chronic inflammatory disease, initially affects the lumbar spine and sacroiliac joints Inflamed intervertebral disks and longitudinal ligaments ossify ♦ Leads to eventual fusion and severe deformity of the vertebral column

ANKYLOSING SPONDYLITIS

herniation of a lumbar disk that irritates the corresponding nerve root Generally caused by degenerative changes of the disk ♦ Most commonly occurring at the L4, L5, and S1 nerve roots ♦ Greatest incidence occurs between 31 and 50 years of age

LUMBOSACRAL RADICULOPATHY (HERNIATED LUMBAR DISK)

usually caused by hypertrophy of the ligamentum flavum and facet joints that results in narrowing of the spinal canal Canal narrowing from bone and ligament hypertrophy may lead to entrapment of the spinal cord as it traverses the spinal canal

LUMBAR STENOSIS

Compression on the median nerve

CARPAL TUNNEL SYNDROME

a form of arthritis, is a disorder of purine metabolism that results from an elevated serum uric acid level

gout

Constitutional symptoms of fatigue, anorexia, and headache may develop ♦ Three phases of the disease are recognized: early localized, early disseminated, and late disease ♦ Most patients will have erythema migrans, a slowly expanding rash with central clearing ♦ With time, arthritis and neurologic symptoms of facial palsy, meningitis, or encephalitis may develop

lyme disease

A focal metabolic disorder of the bone Appears in persons older than 45 years ♦ Excessive bone resorption and bone formation produce a mosaic pattern of lamellar bone ♦ The bones of the skull are often affected, which can produce symptoms of vertigo and headache ♦ Progressive deafness from involvement of the ossicles or neural elements may develop ♦ Bowed tibias, misshapen pelvis, or prominent skull forehead may be evident ♦ Frequent fractures may occur

PAGET DISEASE (OSTEITIS DEFORMANS)

The deterioration of the articular cartilage covering the ends of bone in synovial joints As a result of cartilage abrasion, pitting, and thinning, the bone surfaces are eventually exposed ♦ The bones begin to grind against each other, leading to remodeling of the bone surface and formation of bone spurs ♦ The hands, feet, hips, knees, and cervical or lumbar spine are most commonly affected ♦ Onset usually begins after 40 years of age and develops slowly over many years ♦ The incidence increases as people age, with nearly 100% of people older than 75 years being affected ♦ The joints may become enlarged due to bone growths (osteophytes) (see Fig. 21-18, B) ♦ Crepitus and limited, painful range of motion develop

OSTEOARTHRITIS

A chronic systemic inflammatory disorder of the synovial tissue surrounding the joints

RHEUMATOID ARTHRITIS

strain is what

muscle

Avascular necrosis of the femoral head

LEGG-CALVÉ-PERTHES DISEASE

A traction apophysitis (inflammation of a bony outgrowth) of the anterior aspect of the tibial tubercle Inflammation of a bony outgrowth of the anterior aspect of the tibial tubercle ♦ Develops in association with inflammation of the anterior patellar tendon ♦ This self-limiting disorder is most common in boys between 9 and 15 years of age ♦ The child may present with a limp ♦ Often complains of knee pain (especially with activity) ♦ Knee swelling that is aggravated by strenuous activity ♦ Especially prominent with activity involving the quadriceps muscle

OSGOOD-SCHLATTER DISEASE

Known as nursemaid's elbow, this is a dislocation injury

RADIAL HEAD SUBLUXATION

Contractures involving the flexor hand tendons Cause is unknown, although there may be a hereditary component ♦ Flexion contractures develop insidiously ♦ The incidence increases after the age of 40, occurring more frequently in men (Fig. 21-75) ♦ Flexor tendons generally of the fourth and fifth digits contract, causing the fingers to curl with impaired extension ♦ These tendons are easily palpable

DUPUYTREN CONTRACTURE

what cells produce milk

acini

Benign fluid-filled cyst formation caused by ductal enlargement Usually bilateral and multiple • Most common in women 30 to 55 years of age • Associated with a long follicular or luteal phase of the menstrual cycle * Tender and painful breasts and/or palpable lumps that fluctuate with menses * Usually worse premenstrually

Fibrocystic Changes

Benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process in a single terminal ductal unit May occur in girls and women of any age during their reproductive years • After menopause, the tumors often regress * Painless lumps that do not fluctuate with the menstrual cycle * May be asymptomatic with discovery on clinical breast examination or mammogram

Fibroadenoma

Ductal carcinoma arises from the epithelial lining of ducts; lobular carcinoma originates in the glandular tissue of the lobules

Malignant Breast Tumors

Benign tumors of the subareolar ducts that produce nipple discharge Epithelial hyperplasia produces a wartlike tumor in a lactiferous duct • 2 to 3 cm in diameter • May occur singly or in multiples * Spontaneous nipple discharge * Usually unilateral * Usually serous or bloody

Intraductal Papillomas and Papillomatosis

Benign condition of the subareolar ducts that produces nipple discharge Subareolar ducts become dilated and blocked with desquamating secretory epithelium, necrotic debris, and chronic inflammatory cells • Occurs most commonly in menopausal women * Spontaneous unilateral or bilateral nipple discharge * Often green or brown in color * May be sticky

Duct Ectasia

Lactation not associated with childbearing * Elevated levels of prolactin, resulting in milk production, occur as a result of disruption of the communication between the pituitary and hypothalamus glands * Common causes include pituitary secreting tumors, hypothalamic-pituitary disorders, systemic diseases, numerous medications and herbs, physiologic conditions, or local causes

Galactorrhea

Surface manifestation of underlying ductal carcinoma Crustiness of the nipple, areola, and surrounding skin * Red, scaling, crusty patch on the nipple, areola, and surrounding skin (Fig. 16-26) * May be unilateral or bilateral * Appears eczematous but, unlike eczema, does not respond to steroids

Paget Disease

Breast enlargement in girls before onset of puberty

PREMATURE THELARCHE

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