Intro to Clinical Med (Exam 1)

Beginnings of Medicine

Chinese traditional medicine over 5000 years old.

Who is considered the cradle of modern western medicine

Greece

Hippocrates

"Founder of Medicine" During the Golden Age in Greece he was a scientist that believed all diseases came from natural causes. He also had high ideals for physicians & an oath was made that is still used today. (Four humors)

Imhotep

Name of the architect who designed the Step Pyramid and physician to the pharaoh. "Shephard of the anus " (WHAT A NAME!)

Edwin Smith Papyrus

- Earliest know writing on medicine

- Imhotep speculated to be the original author

- Includes information on trauma surgery, anatomy, diagnosis and treatment.

Celsus

Roman physician

- Cardinal signs of inflammation

- translated cancer "crab" like growth (YES LIKE THE STAR SIGN!)

Galen

Greek physician considered one of the greatest physicians of all time.

Rudolf Virchow

First "cellular pathologist"

- Virchows node (enlarged left supra-clavicular lymph node sign of gastric cancer)

Signs

changes in a body that can be measured or observed as a result of disease (Ex: Blood pressure)

Symptoms

Subjective characteristics of disease felt only by the patient (Ex: Pain)

What are the four pillars to understanding disease?

- Disease etiology

- Pathogenesis

- Lesion

- Functional Changes

Disease etiology

cause of disease (WHAT CAUSES THE BAD)

Pathogenesis

disease process (HOW BAD STUFF DO THE BAD STUFF)

lesion

Morphologic changes/ultrasound

Functional Changes

impaired function of an organ system=clinical manifestation

Four cardinal signs of acute inflammation

1. Redness (rubor)

2. Heat (calor)

3. Swelling (Tumor)

4. Pain (Dolor)

0-4 hours of inflammation

Rubor, calor (antibodies and complement)

4-48 hours of inflammation

Rubor, calor, dolor, tumor (Influx of neutrophils)

24-96 hours of inflammation

Rubor, calor, dolor, tumor, functio laesa (Influx of macrophages)

>96 hours

adaptive immune response

Current illness

When did the symptoms/signs start? Circumstances?

Is this the first time?

Get better or worse?

Think EMS OPQRST!

Patient History

- current and past medical history

- are there other concurrent medical problems.

- family history

THINK SAMPLE HISTORY

The physical examination

- Cultivate the art of observation

- BE systematic in your examination

- Develop a routine that you follow

- know your tools

Non-invasive procedures

procedures that do not break the skin (NO HURT)

Invasive Procedures

procedures that DO break the skin (DO HURT)

True or False: There is no generally accepted definition for "invasive procedure"

True

Common blood test

CBC - complete blood count

CMP - Comprehensive metabolic panel

Plasma proteins

Antibodies

Hormones

Other important lab test

Urine: protein, microorganisms (cultures), pH, blood

Stool: blood, parasites, fat

Cerebrospinal fluid (CSF): cells, proteins, microorganisms

erythrocytosis or polycythemia

higher than normal number of red blood cells

anemia or erythroblastopenia

lower than normal number of red blood cells

Leukocytosis

increase in the number of white blood cells

Leukopenia

Abnormally low white blood cell count

Lymphocytosis

increase in lymphocytes

Lymphocytopenia

an abnormally reduced number of lymphocytes

granulocytosis

abnormal increase in granulocytes in the blood

Granulocytopenia

deficiency of granulocytes

Neutrophilia

increase in neutrophils

Neutropenia

deficiency of neutrophils

Eosinophilia

increase in eosinophils

Eosinopenia

decrease in eosinophils

Thrombocytosis

abnormally high platelet count

Thrombocytopenia

low platelet count

Fishbone

Tip used for CBC normal lab values in medical charts

ECG

Electrocardiogram measuring heart's electrical activity.

EEG

electroencephalogram, measures electrical activity of the brain

EMG

electromyogram measures muscle activity

SA node

pacemaker of the heart

AV node

relays electrical impulses from atria into ventricles

P wave

atrial depolarization

QRS complex

ventricular depolarization

T wave

ventricular repolarization

ST elevation

indicates myocardial infarction (HEART ATTACK!!!!!) usually referred as a STEMI

V-Fib

ventricular fibrillation (When your heart EKG looks like someone's signature your cooked)

This is active cardiac arrest!

Ventricular flutter

250-350

- smooth sine-waves w/ similar amp

- can lead to deadly arryth

goes right into vfib

True or False: Did ancient doctors know or have some knowledge of heart disease?

True, Ebers's papyrus of ancient Egypt describes heart disease 3500 years BC

Who discovered x-rays

Wilhelm Roentgen

What is radiation measured in

Sieverts (Sv)

Sievert to rem

1 Sv = 100 rem

How much radiation is a chest X-ray

0.10 mSv

Natural radiation we're all exposed to, per year

2.00 mSv

Recommended limit for radiation workers every five years

100 mSv

CT

computed tomography, think many x-rays taken over and over!

Nuclear Medicine

Patients are injected with radioactive material that is then enriched in areas of highest activity.

MRI

magnetic resonance imaging, Uses very strong magnets (no radiation)

- Superior for viewing soft tissues

T1 vs T2

T1- fat is bright (Better for anatomy)

T2- fluid and fat is bright (Better for Pathology)

PET scan

positron emission tomography, Injection of radioactive material

- mostly used for looking at activity

Ultrasound

Sound waves with frequencies above 20,000 Hz.

Biopsies

Obtain tissues for histologic examination.

Histology

Examination of tissue with microscope

Cytology

Single cells are usually recovered and tissue structure is not preserved.

Tissue processing steps

- embedded in paraffin or frozen section

- Sections are cut into thin slices

- Sections must be stained with dyes before they can be examined by pathologist

H&E stain

Hematoxylin and Eosin stain

- Hematoxylin stains nucleic acid / nucleus (BLUE)

- Eosin stains the cytoplasm (RED)

PAS stain

Stains glycogen (PASs the sugar)

Dx of Whipples dx (tropheryma whipplei)

Masson's Trichrome Stain

1. Dark blue: nuclei

2. Red: muscle, keratin, cytoplasm

3. Light blue: mucinogen, collagen

Immunofluorescence staining

specific staining that uses fluorescently labeled antibodies

Macroscopic changes

Organ level

- Hypertrophy, atrophy, dysplasia

- Pigmentation, Calcification

- Fatty change

Microscopic changes

Cellular level

- Pigmentation, inclusions

- Multi-nucleation

- Apoptosis, necrosis

Hyaline inclusions in the liver

mallory bodies = Alcohol (Fun)

How does tissue respond to increased demand or chronic stimulation

Hypertrophy, hyperplasia

Hypertrophy

cells get bigger (When you hit the gym)

Hyperplasia

more cells

How does tissue respond to decreased demand, lack of stimulation

atrophy (When you don't hit the gym)

atrophy

Smaller cells

Metaplasia

only with dividing cells, change from one cell type to a different cell type (columnar to squamous), Increases the risk of cancer

Hypertrophy can be physiologic or pathologic

Muscle growth is physiologic muscle hypertrophy, Adapted myocyte hypertrophy is pathological hypertrophy in the heart from chronic heart failure and hypertension.

Example of pathologic hyperplasia

Prostate hyperplasia.

Pathologic and Physiological examples of atrophy

Physiologic: Shrinkage of the uterus after pregnancy

Pathologic: brain with Alzheimer's

Three types of epithelium

squamous, cuboidal, columnar

squamous epithelium

flat, scale-like cells composing the epidermis

cuboidal epithelium

Type of epithelial tissue with cube-shaped cells. (Lining nephrons, thyroid glands, surface of ovaries)

columnar epithelium

Single layer column shaped cells - lining stomach, small intestine - secrete and absorbs

Simple Epithelium vs Stratified epithelium

Simple epithleium is only one layer of cells, stratified epithelium is more than one layer.

Necrosis vs Apoptosis

Necrosis: bad, damage to nearby cells caused by lysis

Apoptosis: good; for normal functioning of cell. Cell shrinkage, caspase activation,

Classical apoptosis sign

DNA laddering

Apoptosis pathways

intrinsic and extrinsic

Extrinsic apoptosis pathway

death signals bind to death receptors on the plasma membrane --> pro-caspase 8 is activated and becomes caspase 8 --> activates caspase 3 --> apoptosis

Intrinsic Pathway

mitochondria-mediated apoptosis

Coagulative necrosis

Dry necrosis, Cells keep their outline but lose nuclei (Ex: Hypoxic cell death)

liquefactive necrosis

"Liquid necrosis", Tissue dissolves, all cell structure is lost.

Clinical types of necrosis

- Gangrene

- Caseous necrosis

- Fat necrosis