Patho #2

skin lesions

The physical appearance of the lesion is necessary to make a diagnosis.

Types of lesions

Location

Length of time lesion has been present

Changes occurring over time

Physical appearance-> color, elevation, texture, type of exudate

Presence of pain or pruritus (itching)

Macule:

flat, circumscribed

Nodule:

firm, raised, deep

Papule:

small, solid elevation

Pustule:

raised, often w/ a head filled w/ exudates (pus)

Vesicle/ blister:

thin wall, raised, filled

Plaque:

slightly elevated, flat, scale like lesion

Ulcer:

cavity in tissue

Fissure:

crack in tissue

pruitus

(Itches) scratching

contact dermatitis

Inflammation because of direct exposure

Hives (urticaria)

Highly itchy, often part of anaphylaxis

eczema

Common in infants/ dry, scaly, pruritic (rash w/ serous exudate)

Psoriasis

Chronic inflammatory skin disorder, happens b/c of abnormal T cell activation

Pemphigus

Autoimmune disorder (epidermal cells) which causes blisters, skin sheds

Pemphigus leads to

Stevens-Johnson syndrome 10% fatal

scleroderma

Increased collagen deposition Inflammation & fibrosis (hard, tight, immovable areas of skin)

Cellulitis

Secondary to an injury, usually caused by staphylococcus aureus/sometimes streptococcus, proximal to infected area, red streaks develop

Boils

Begins at hair follicles, frequently drains large amounts of purulent exudate

Impetigo

Common infection in infants/ children, commonly on face, which treatment is topical(surface) antibiotics

Acute necrotizing fasciitis

Severe tissue necrosis, caused by group A beta-hemolytic streptococcus resulting in a massive tissue destruction, which treatment is amputation, aggressive antimicrobial therapy, fluid replacement

Leprosy

Chronic disease caused by 2 types of bacteria tuberculoid & lepromatous, which damage can lead to loss of limbs

Herpes simplex Type 1

(HSV-1) most common cause of cold sores or fever blister

Herpes simplex type 2

(HSV2) genital herpes, virus remains in sensory ganglia

Malignant melanoma

highly metastatic form of skin cancer, which develops in melanocytes- form a mole

FX (fracture)

Break in the integrity of a bone

Fibroblasts

Collagen fibers

Chondroblasts

form new cartilage

Osteoblasts

Generate new bone

Simple fx

Closed/ contained

compound fx

Open/ not contained

greenstick Fx

One side breaks other side bends

Continued fx

3 or more pieces breaks

Transverse fx

across the bone

Displaced fx

Moves out alignment

Oblique fx

Diagonal break

Colle's fx

Distal radius

Pott's fx

Distal ankle

Dislocation

Comes out

Separation

Overlap, one under the other

Sprain

Tear in a ligament

Strain

Tear in a tendon

Osteoporosis

Loss of compact bone

osteomalacia

Soft bone, result of deficit in vitamin D

Osteomyelitis

bone infection

Osteosarcoma

Most common primary neoplasm of bone in shaft of long bones of the leg, common in children. Bone pain at rest is a warning sign

Chondrosarcoma

arise from cartilage cells; more common in adults

Ewing sarcoma

Common in adolescents and usually occurs in the shaft of long bones

Benign bone tumors

Osteoblastoma, osteoid osteoma usuallyb in tibia

rheumatoid arthritis

Autoimmune disorder which causes chronic systemic inflammatory disease

rheumatoid arthritis treatment

Disease-modifying antirheumatic drugs such as hydroxychloroquine, gold salts, methotrexate (first method used).

Biological response- modifying agents, such as infliximab, anakinra, rituximab

Mascullar dystrophy (MD) **no curative treatments available

Group of genetic disorders, dúchenme's MD most common type, affects young Boys, blood test show abnormal low dystrophin levels which S&S are: waddling gait, grower manuver, Duchenne's MD early motor weakness, cardiac myopathy

Gout

Metabolic, results from deposits of Uric acid(UA) and crystal in joints treated by reducing levels of UA, dietary changes (high Purine diet )

Rhabdomyolysis

Crush syndrome, direct muscle injury(crush), muscle pain, fatigue, dark urine, **myoglobin(is toxic): muscle hemoglobin, creatine kinase levels are 5x high

Glasgow Coma Scale (used to identify level of consciousness)

1 eye opening, 3 verbal response, 2 motor response

Vegetative stage

Loss of awareness

Locked-in syndrome

Aware and capable of thinking but paralyzed

Brain death

Cessation of brain function

Flat/ inactive electroencephalogram (EEG)

Brain no longer functions

Evaluation

Twice by different physicians

Damage to upper motor neurons

Interference with voluntary movements

Weakness or paralysis on the contralateral side of the body

Damage to lower motor neurons

Weakness or paralysis on the same side of the body

At and below the level of spinal cord damage

Decorticate and decerebrate posturing

severe brain damage

aphasia

The inability to understand and/or express language

Receptive or sensory aphasia

Inability to read or understand the spoken word Occurs when Wernicke's area damage

Expressive or motor aphasia

Impaired ability to speak or write fluently or appropriately Occurs when Broca's area damage

mixed/global aphasia

damage to both areas or to the fibers and tracts between them

Dysarthria

Words can't be articulated clearly

Agraphia

inability to write

Alexia

inability to read

Agnosia

inability to recognize objects

Convulsions or seizures

Caused by spontaneous, excessive discharge of neurons in the brain

Generalized onset

both sides of brain

Focal onset

Partial/ one area of the brain -(aware/impaired awareness)

motor symptoms (seizures)

Non motor- absence of seizures

Atypical absence- starring spells

Tonic- tense/rigid muscles

Clonic-jerking motion

Atonic: muscles weak or limp

Myoclonic: brief muscle twitching

Continuous seizures

(status epilepticus) repeated for over 5 min

Increased Intracranial Pressure (ICP)

Increase in fluid or additional mass causes increase in pressure in the brain -> Ischemia and eventual infarction of brain tissue

ICP s&s

Lethargic, decreased pupillary response, severe headache, vomiting, papilledema

Vs of ICP

Ptosis(droopy eyelid), increase of systemic BP, slowing heart rate

Transtentorial herniation

(tissue going to different place) high, downward

Uncal herniation

Temporal lobe, middle

infratentorial herniation

Cerebral tonsillar, low (cerebral tonsils) always cause death

Gliomas

Largest group of primary brain tumors, composed of malignant glial cells which first sign is seizure

primary malignant tumors

rarely metastasize outside the CNS

secondary malignant tumors

-Metastasizing from breast or lung tumors

-Cause effects similar to those of primary brain tumors

cerebrovascular accident (CVA)

Stroke/ infarction of brain tissue that results from lack of blood

CVAs Treatment

Clot-busting agents

Surgical intervention

Glucocorticoids

cerebral aneurysm

weakness in the wall of a cerebral artery

brain abscess

Localized infection which may result from acute bacterial endocarditis

encephalitis

inflammation of the brain

Western Equine Encephalitis & West Nile Fever are ?

spread by mosquitoes

St. Louis Encephalitis

Affects older more severe than younger

Neuroborreliosis (Lyme Disease)

Transmitted by ticks, typical bull's eye lesion

Herpes simplex encephalitis

Spread from herpex simplex I

Reye's syndrome

Cause not fully determine, linked to viral infection in children treated w/ aspirin

GUILLIAN-BARRE' SYNDROME

Post infection polyneuritis, acute idiopathic, polyneuropathy, demyelination, axon destruction- changes cause impaired nerve conduction, ascending flaccid paralysis

Epidural heamtoma

bleeding between the dura mater and the skull

subdural hematoma

between dura and arachnoid, hematoma may be acute or subacute

subarachnoid hemorrhage

Blood mixed w/ CSF, no localized hematoma formation