Pathophys Final Exam (copy)

Phimosis

Tight foreskin that cannot be retracted over the head of the penis

Paraphimosis

tight foreskin that, once retracted over the glans, cannot be returned, resulting in edema. can cut off blood flow is painful

Balantitis

Inflammation of the glans penis

Typically in uncircumcised, poor hygiene, or over washing

Hypospadias

urethral opening is located anywhere other than the normal location.

Abnormal spraying, downward curve to penis,

Epididymitis

Painful. tender, swollen, painful, scrotal edema due to gonorrehea and chlamydia commonly, or E coli (>35). Normal cremaster reflex, prhen sign positive (elevation of testicle relieves pain)

Hydrocele

Not painful. fluid accumulation within tunica vaginalis, smooth, will transilluminate (light shines through)

Varicocele

not painful. swollen pampiniform plexus, bag of worms looking and feeling in scrotum, will not allow light transmission, increases in size when standing

Testicular Torsion

extremely Painful and emergency. twisting of spermatic cord causing venous congestion and reduced blood flow, high riding and transverse lie of testicle.

Indirect Hernia

Most common, GI organs push through inguinal canal through inguinal ring

Direct Hernia

GI organs push through hesselbachs triangle most commonly

Femoral Hernia

more common in women, GI oragans push though inferior to inferior epigastric vessels, lateral to inguinal canal, medial to femoral vein

Strangulated Hernia

GI Organs push through some location and become twisted which can cut off blood flow and result in ischemia and death of area.

Benign Prostate Hypertrophy

Gradual growth of prostate starting at 40. Compresses the urethra and can result in retention, increased frequency, hesitancy, weak stream, and nocturia

Prostatitis

Fever, rectal pain, low back pain. men under 35 likely STD, over 35 likely E Coli. prostate tender, swollen, and warm

Prostate Cancer

Blood in urine or semen, erectile dysfunction, low back pain, hard nodule on prostate

Boundaries of Hesselbachs triangle

Rectus abdominis medially, inferior epigastric artery and vein superiorly/laterally, inguinal ligament inferiorly

Sequela of cryptorchidism

Testicles that do not descend completely which can lead to

testicular cancer and infertility

Polycystic Ovarian Syndrome

Irregular menses, Overweight, Acne, Hyperandrogenism, unwanted hair growth, Ultrasound reveals 12+ follicles.

Can lead to infertility, miscarriage, DM 2, and endometrial cancer.

Mastitis

breast tenderness, swelling, redness, lumps, pain when breastfeeding, abnormal discharge, from obstruction during breastfeeding

Fibrocystic breast

benign nodules, round, soft, mobile, can become larger during menses, dense bumpy breast tissue. May have dull breast tenderness and pain.

Fibroadenoma

benign growths: glandular and stromal tissue.

Peau d’ Orange

Dimpling around the areola, often associated with inflammatory breast cancer

Bacterial Vaginitis

Discharge: thin, watery, homogenous

pH: > 4.5 (Basic)

Whiff Test: Fishy odor, + whiff test

Wet Mount: Clue Cells

Yeast Vaginitis (Candidiasis)

Discharge: Thick, white discharge

pH: < 4.5 (Acidic)

Whiff Test: Negative

Wet Mount: Bud/Hyphae

Trichomoniasis

Discharge: Green/yellow, frothy

pH: > 4.5 (Basic)

Whiff Test: +/-

Wet Mount: Flagellated Mobile Protozoans

Initial Presentation of genital Herpes

raised papules, can be confluent. painful ulcers, low fever, malaise, swollen lymph nodes, tingling, burning.

Initial presentation of syphilis

1. Painless Ulcer

2. Rash on palms and soles, fever, headache, fatigue, swollen lymph nodes, condyloma lata

3. Neurosyphillis, ocular syphilis

Condylomata Acuminate

warts, burning, itchiness, associated with HPV

Condylomata Lata

benign painless wart-like lesions associated with secondary syphilis.

Pelvic Inflammatory Disease

Bilateral low abdomen pain, pain with intercourse, abnormal uterine bleeding, fever, cervical motion and tenderness

Cystocele

wall between bladder and vagina weakens causing the bladder to sag or drop into the vagina

can have urinary leakage or urge to urinate

Rectocele

wall between rectum and vagina weakens causing the rectum to bulge into the vagina or even out of the vagina

can have constipation, pain during intercourse,

Uterine Prolapse

muscles and tissues in pelvis weaken allowing the uterus to drop down out of the vagina

feels like “something is down there”

Stress Incontinence

involuntary leakage of urine with increased intra-abdominal pressure.

lack of mechanical support of urethra so it can’t close fully

Urge Incontinence

detrusor overactivity, constant feeling of having to urinate

Overflow Incontinence

detrusor underactivity, continuous leakage of urine, dribbling

Neurogenic Incontinence

muscles and nerves controlling the bladder are not communicating properly causing leakage of urine

Rheumatoid Arthritis

autoimmune disease

tender, warm, swollen joints, symmetrical pattern of inflammation, stiffness lasting over an hour, swan neck deformity, MCP and PIP

Osteoarthritis

degenerative disease

stiff joints, DIP (Heberdens) and PIP (Bouchards), Hard boney enlargements, Morning stiffness less than 30 minutes, generally larger joints

Gout

Most commonly the big toe, intense joint pain, skin looks red and shiny, warmth and swelling, lingering discomfort, Uric crystals, beer, red meat,

Acromioclavicular separation

unable to lift arm, impact to acromion, arm tucked to side

Rotator cuff tear

patient cant resist pressure on outstretched arms (empty cans), patient can’t hold arms out to sides for long (drop arm). weakness lifting overhead, typically supraspinatus

anterior shoulder dislocation

sulcus on anterior shoulder, impact to shoulder, holds arm in neutral position

subacromial bursitis

Often from repetitive overhead work, pain with internal rotation and shoulder flexion (neers impingement), pain with internal rotation when shoulder and elbow at 90 degree flexion (hawkins impingement)

medial epicondylitis

inflammation from Excessive wrist flexion, tenderness near medial epicondyle, common in mechanics and carpenters

lateral epicondylitis

inflammation from Excessive wrist extension, tenderness near lateral epicondyle, common in mechanics and carpenters

olecranon bursitis

swelling and inflammation at elbow, erythema, warmth, pain, and inhibition of ROM, could be from trauma

nurse maid elbow

subluxation of radial head from annular ligament, occurs in children, from jerk on hand

Scaphoid Fracture

Pain in snuffbox area from FOOSH, low blood supply could lead to osteonecrosis, needs to be splinted

Fight bite

Injury to fist when hits a tooth, lots of dangerous bacteria, needs to be left open and treated with antibiotics.

Osteoarthritis of the hip

Hip pain, reduced ROM in rotation, swaying gait, onset of groin pain

Iliotibial band trochanteric bursitis

snapping and pain in lateral thigh, pain with laying on affected side, pain with adducting and rotating hip

hip fracture

laying with one leg externally rotated and shortened, common in elderly after a fall, fracture of neck of femur

Anterior Cruciate Ligament Tear

knee pain, mechanism seemingly random, usually from sports and twisting of knee, instability of knee

Posterior Cruciate Ligament Tear

knee pain, usually from falling on knee or collision with dashboard, can result in instability of knee, positive posterior drawer test

Meniscus tear

due to twisting injury to knee, clicking, popping, locking, pain, and stiffness

Lateral Collateral ligament tear

from trauma to the medial knee, causes knee pain and instability, buckling

Osgood Schlatter’s

edema and tenderness at tibial tuberosity, acolescent boys, microscopic tearing of the patellar ligament

Plantar fasciitis

pain with first few steps of walking, common in overweight,

Jones Fracture

fracture of 5th metatarsal from trauma, low blood supply can lead to necrosis

Mortons Neuroma

burning pain that radiates towards the toes, from increased pressure on the interdigital nerve from walking in heels

Lumbar Back Strain

low back pain, common, keep moving, rest doesn’t help, heating and NSAIDS

Lumbar disk herniation with radiculopathy

Compression of nerve root, could be from recent heavy lifting, also resulting in tingling, weakness, or numbness in legs or elsewhere

Spinal stenosis

some leg numbness, worse with standing, impingement of spinal cord, narrowing of central canal

Cauda equina syndrome

constipation, incontinence, foot drop, numb around anus, fall causes injury to nerve roots at end of spinal cord, medical emergency

Hypothyroid

Symptoms: depression, goiter, bradycardia, weight gain, constipation, fatigue

Thyroid test: High TSH, Low T3/T4

Graves Disease

Symptoms: Weight loss, tachycardia, dysrhythmias, hypertension, anxiety, irritability, difficulty concentrating, tremors, goiter, diarrhea, Expothalmos

Thyroid Test: Low TSH, High T3/T4

Undiagnosed Type 2 Diabetes

frequent urination, increased thirst, increased hunger, unintended weight loss, fatigue, blurred vision, numbness in hands or feet, slow healing

Biological Factors contributing to Obesity

genetic disposition to store fat, resting metabolism decreases with age, loss of muscle mass,

Social Factors contributing to Obesity

Consistent availability of inexpensive, calorie dense foods. increase in portion sizes, food advertising, decreased walking, decrease in leisure activity, less focus on physicality,

Psychological factors contributing to Obesity

Stimulus eating, plate size, variety of food, assumption of quality, lack of evidence of how much consumed, eating when distracted, emotional eating,

Hormonal influences on satiety and hunger

leptin hromone produced by fat cells that decreases your appetite,

Ghrelin hormone increases appetite

Osteoporosis

asymptomatic early on, bone fracture, osteopenia, bone pain, kyphosis, height reduction

Hyperparathyroidism

Bone pain, kidney stones, nausea, vomiting, constipation, headaches, depression, loss of appetite, anorexia, muscle aches

Cushings

ecchymosis (bruises), depression, thin arms, trunk obesity, round faces, dorsal fat pad, striae (red lines on skin), edema, acne, male pattern balding, Excessive adrenal function

Addison’s disease

usually undetected until crisis. Salt craving, hypotension, hyperpigmentation, vitiligo (loss of skin color in patches), abdominal tenderness, auricular calcifications, irregular menses, anorexia, myalgia, GI symptoms, weakness,

Sepsis

tachycardia, hypotension, fever, hypothermia, shaking, chills, warm, clammy, confusion, SOB, rash, extreme pain or discomfort. In response to an infection

Malaria

irregular sudden fevers every other day or so, shaking chills, flu-like illness, muscle pain, altered consciousness, jaundice, diarrhea, bloody stool, seizure, spleen enlargement,

Life cycle of Malaria

Mosquito with sporozoite (malaria) bites a human and transmits the disease into the blood. The sporozoites travel to the liver and infect hepatic cells. The parasite replicates and eventually bursts the liver cells and gets into the blood. Parasites then infect the blood cells and replicate again causing them to burst and symptoms to begin. Additionally, within RBC’s gametocytes are formed. A female mosquito bites the human and within the guts of the mosquito, the gametocytes mature into sporozoites which make their way to the salivary glands of the mosquito. The mosquito then bites a human and the cycle begins again.

Tuberculosis

Typically in third world countries, cough, fever, dyspnea, night sweats, weight loss, anorexia, fatigue, hemoptysis (cough blood), rales (rattling sound of lungs)

HIV

fever, swollen lymph nodes, sore throat, fatigue, headache, anorexia, night sweats, rash, thrush, vaginal candidiasis, oral hairy leukoplakia (white patches on tongue), herpes zoster,

AIDS

Mycobacterium Avium Complex (similar to TB), Cytomegalovirus, pneumocystis jiroveci, Kaposi sarcoma (cancer in GI), Burkitt Lymphoma, Candidiasis of esophagus, toxoplasmosis of brain, Wasting syndrome

CD4 levels below 200

Microcytic anemia

CBC:

Reticulocytes:

MCV:

Iron:

B12/Folate:

Peripheral Blood Smear:

Haptoglobin:

Erythropoietin:

Guaiac stool:

macrocytic anemia

CBC:

Reticulocytes:

MCV:

Iron:

B12/Folate:

Peripheral Blood Smear:

Haptoglobin:

Erythropoietin:

Guaiac stool:

nomocytic anemia

CBC:

Reticulocytes:

MCV:

Iron:

B12/Folate:

Peripheral Blood Smear:

Haptoglobin:

Erythropoietin:

Guaiac stool:

hemolytic anemia

CBC:

Reticulocytes:

MCV:

Iron:

B12/Folate:

Peripheral Blood Smear:

Haptoglobin:

Erythropoietin:

Guaiac stool:

Leukemia

persistent fatigue or weakness, frequent infections, fever, chills, weight loss, easy bleeding or bruising, red spots on skin, excessive sweating, bone pain

Risk Factors and Prevention of Cervical Cancer

Risk Factors and Prevention of Colon Cancer

Risk Factors and Prevention of Lung Cancer

Risk Factors and Prevention of Breast Cancer

Risk Factors and Prevention of Skin Cancer

Depression

Sadness, hopelessness, outbursts, irritability, loss of interest, sleep disturbances, reduced appetite, slowed movements or thinking, trouble concentrating, thoughts of suicide

Binge Eating

feeling as if you don’t have control over eating, eating when not hungry, eating quickly, eating until very full, often eating alone, feeling disgusted or guilty about eating.

Anorexia

extreme weight loss, thin appearance, fatigue, insomnia, dizziness, thin hair, amenorrhea, constipation, dehydration, intolerance of cold, dysrhythmias,

Bulimia

fear of gaining weight, eating large amounts of food in one sitting, vomiting on purpose after binge eating, medicating to pass stools when not needed, fasting, being unhappy with body, mood swings,

Schizophrenia

Delusions - false beliefs not based in reality

Hallucinations - seeing or hearing things that don’t exist

Disorganized thinking - communication is impaired

Extremely disorganized or abnormal motor behavior - childlike silliness to unpredictable agitation, hard to focus on goal

Negative symptoms - neglect hygiene, lack emotion, lose interest in life,

Bipolar 1

Fluctuating from manic episodes to depressive episodes.

Mania - increased energy, inflated self image, excessive spending, hypersexuality, substance abuse,

Depressive - depressed mood, loss of pleasure, low energy, guilt, thoughts of suicide

Bipolar 2

Fluctuate from hypomanic (not full mania) episodes and depressive episodes, often in depressive state

Mania - exaggerated self confidence, rapid and loud speech, increased energy, no need for sleep, flying from idea to idea

Depressive - Loss of pleasure, low energy, guilt, thoughts of suicide

Alcohol Withdrawal