Patho 3 exam notecards

PCOS: Pathophysiology

Insulin resistance with HPO axis dysfunction leading to hyperandrogenemia and ovulatory dysfunction

PCOS: Biochemical hallmark

Hyperandrogenemia is the key lab finding in PCOS

PCOS: Typical menstrual pattern

Oligo-amenorrhea with irregular or absent menses due to anovulation

PCOS: Classic manifestations

Hirsutism acne scalp hair loss central weight gain glucose intolerance

PCOS: Insulin link

Hyperinsulinemia worsens ovarian androgen production

NCLEX—PCOS first-line clue

Irregular cycles plus clinical hirsutism in a patient with central adiposity suggests PCOS

Active recall—Why does PCOS cause acne and hirsutism?

Excess androgens from ovarian dysregulation

Active recall—What is often elevated in PCOS besides androgens?

Insulin (hyperinsulinemia)

Endometriosis: Pathophysiology

Ectopic endometrial tissue outside uterus that bleeds with cycles causing inflammation scarring adhesions

Endometriosis: Pain pattern

Cyclic pelvic pain and dysmenorrhea often with dyspareunia

Endometriosis: Infertility link

Adhesions and inflammation can impair fertility

Active recall—Mechanism of pain in endometriosis

Ectopic tissue responds to hormones → bleeding inflammation adhesion pain

NCLEX—Common presentation

Reproductive-age patient with chronic pelvic pain worse during menses and dyspareunia

Pelvic Inflammatory Disease (PID): Cause

Ascending infection—commonly chlamydia or gonorrhea—spreads to uterus tubes ovaries

PID: Key exam finding

Cervical motion tenderness with pelvic pain fever abnormal discharge

Active recall—Long-term risk of PID

Scarring adhesions leading to infertility and ectopic risk

NCLEX—Likely pathogens in PID

Chlamydia trachomatis and Neisseria gonorrhoeae

Benign Prostatic Hyperplasia (BPH): Pathophysiology

Age-related prostate enlargement driven by DHT causing urethral compression

BPH: Lower urinary tract symptoms

Frequency urgency nocturia weak stream hesitancy incomplete emptying

Active recall—Why nocturia in BPH?

Bladder outlet obstruction increases residuals leading to nighttime voids

Menorrhagia: Definition

Excessive menstrual bleeding >80 mL or >7 days

Menorrhagia: Causes

Anovulation structural lesions (fibroids polyps) or coagulation disorders

Active recall—Clinical impact

Heavy flow with clots fatigue anemia symptoms affecting daily activities

Testicular cancer: Epidemiology

Most common solid tumor in men ages 15–35

Testicular cancer: Presentation

Painless testicular mass heaviness ± gynecomastia

Active recall—Key risk factor

History of cryptorchidism increases risk

Menopause: Endocrine pattern

Ovarian follicle depletion with ↓estrogen/progesterone and ↑FSH/LH

Menopause: Diagnostic feature

Amenorrhea ≥12 months with vasomotor symptoms

Active recall—Common symptoms

Hot flashes night sweats mood and sleep changes vaginal dryness bone loss risk

NCLEX—Lab expectation in menopause

Elevated FSH and LH with low estrogen

Cryptorchidism: Definition

Failure of one or both testes to descend into the scrotum

Cryptorchidism: Risks

Infertility and increased malignancy risk due to higher intra-abdominal temperature

Active recall—Exam clue

Nonpalpable testis or mass in inguinal canal with asymmetric scrotum

Erectile dysfunction: Etiologies

Vascular neurologic hormonal and psychogenic factors affect erection

ED: Manifestations

Trouble achieving or maintaining erection with reduced libido and performance anxiety

Meningitis: Pathophysiology

Inflammation of meninges with increased ICP; bacterial viral or fungal

Meningitis: Classic signs

Fever severe headache nuchal rigidity photophobia altered mental status

Meningitis: Special findings

Positive Kernig and Brudzinski signs ± petechial rash in meningococcal disease

NCLEX—Emergency action for suspected meningitis

Implement droplet precautions and urgently initiate evaluation

Active recall—Why is ICP increased in meningitis?

Inflammatory edema and impaired CSF dynamics

Abnormal posturing: Decorticate

Flexed arms with extended legs indicates cortical damage with intact brainstem

Abnormal posturing: Decerebrate

Extended arms and legs with head arched back indicates brainstem dysfunction

Active recall—Prognosis clue

Persistent abnormal posturing signals severe brain injury and poorer outcomes

Multiple Sclerosis: Core mechanism

Autoimmune T-cell mediated CNS demyelination with sclerotic plaques

MS: Common manifestations

Optic neuritis fatigue numbness spasticity coordination and cognitive changes

MS: Course

Often relapsing–remitting with variable neurologic deficits

Active recall—Consequence of demyelination

Impaired nerve conduction causing neurologic symptoms

Stroke vs TIA: Distinction

Stroke causes permanent brain injury; TIA causes transient deficits without infarction

Stroke/TIA: FAST

Facial droop Arm weakness Speech difficulty → Time to call 911

Active recall—TIA time course

Symptoms typically resolve within 24 hours often under 1 hour

Alzheimer’s disease: Pathology

Amyloid plaques neurofibrillary tangles ACh deficiency with cortical/hippocampal atrophy

Alzheimer’s: Manifestations

Progressive memory loss disorientation poor judgment personality changes loss of ADLs

Active recall—Neurotransmitter change

Decreased acetylcholine in cortical pathways

Seizures/Epilepsy: Mechanism

Abnormal excessive neuronal firing with excitatory-inhibitory imbalance

Seizure types: Tonic-clonic

LOC rigidity rhythmic jerking followed by postictal confusion and fatigue

Seizure types: Absence

Brief staring spells with impaired awareness

Active recall—Postictal state

Period of confusion and fatigue after generalized seizures

Cerebral palsy: Definition

Nonprogressive motor disorder from early brain injury affecting tone posture movement

CP: Presentations

Spastic athetoid or ataxic patterns with delayed motor milestones ± seizures or intellectual disability

Huntington’s disease: Genetics

Autosomal dominant CAG repeat expansion causing basal ganglia degeneration and GABA loss

Huntington’s: Manifestations

Choreiform movements progressive cognitive decline and psychiatric symptoms

Parkinson’s disease: Pathophysiology

Degeneration of substantia nigra dopaminergic neurons with Lewy bodies

Parkinson’s: Motor signs

Resting tremor bradykinesia rigidity postural instability shuffling gait masked facies

Active recall—Neurotransmitter imbalance

↓Dopamine relative to acetylcholine in basal ganglia circuits

Spinal cord injury: Injury phases

Primary mechanical damage followed by secondary inflammation ischemia apoptosis

SCI: Deficits

Loss of motor/sensory function below lesion with autonomic bowel bladder and sexual dysfunction

Spinal shock: Definition

Transient areflexia and flaccid paralysis below injury resolving over weeks to months

Active recall—Vitals clue in spinal shock

Bradycardia hypotension and loss of temperature regulation (poikilothermia)

Migraine: Mechanism

Neurovascular disorder with trigeminal activation cortical spreading depression and CGRP/serotonin roles

Migraine: Symptoms

Unilateral throbbing headache with photophobia phonophobia N/V ± aura

Active recall—Common triggers

Stress certain foods hormones and sleep changes

Increased intracranial pressure (ICP): Concept

Elevated pressure in rigid skull from increased brain blood or CSF lowers perfusion

ICP: Signs

Morning headache vomiting altered LOC papilledema Cushing triad (↑BP ↓HR irregular respirations)

Active recall—Herniation risk

Rising ICP can cause brain herniation and death

Hydrocephalus: Types

Communicating (absorption problem) vs non-communicating (flow obstruction) CSF accumulation

Hydrocephalus: Age-based signs

Infants with large head/bulging fontanelle; adults with headache nausea cognitive and gait changes

Brain cancer: Effects

Mass effect increases ICP causing headaches seizures focal deficits cognitive and personality changes