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Questions and Answers

Which statement about the Antinuclear Antibody (ANA) test is true?

  • ANA has low sensitivity but high specificity for connective tissue diseases.
  • ANA can yield positive results in conditions other than connective tissue diseases. (correct)
  • A negative ANA test rules out all connective tissue diseases.
  • ANA is mainly used for its specificity in diagnosing Sjögren's Syndrome.

    • Double-Stranded DNA (dsDNA) antibodies are primarily associated with which condition?

  • Rheumatoid Arthritis
  • Systemic Lupus Erythematosus (SLE) (correct)
  • Sjögren's Syndrome
  • Systemic Scleroderma

    • Which of the following antibodies is highly specific for Systemic Lupus Erythematosus (SLE)?

  • Anti-Scl-70 (Topoisomerase 1) Antibodies
  • SS-A (Ro) Antibodies
  • SS-B (La) Antibodies
  • Anti-Smith Antibodies (correct)

    • In the context of connective tissue diseases, a positive ANA test typically indicates which of the following?

    <p>Further testing is needed to identify specific antibody types.</p> Signup and view all the answers

    What is a characteristic feature of systemic scleroderma?

    <p>Glassy skin sign indicating excessive collagen deposition.</p> Signup and view all the answers

    Which of the following conditions may cause a false positive result for ANA testing?

    <p>Viral Hepatitis</p> Signup and view all the answers

    What is the significance of the Anti-Scl-70 (Topoisomerase 1) Antibodies?

    <p>It is linked to systemic scleroderma.</p> Signup and view all the answers

    Which statement about ANA testing is correct regarding its specificity?

    <p>ANA has high sensitivity with low specificity.</p> Signup and view all the answers

    Which pulmonary function test is primarily used to measure the maximum speed of expiration?

    <p>Peak Expiratory Flow (PEF)</p> Signup and view all the answers

    What is the primary reason chest X-rays are not used to diagnose bronchitis?

    <p>Bronchitis involves inflammation of smaller airways not seen on X-ray.</p> Signup and view all the answers

    Which Finding is characteristic of pneumonia on a chest X-ray?

    <p>Consolidation with air bronchograms</p> Signup and view all the answers

    Which statement about the effects of cystic fibrosis on the pancreas is accurate?

    <p>It prevents digestive enzymes from reaching the intestines.</p> Signup and view all the answers

    What is typically observed in chest X-ray findings for chronic bronchitis?

    <p>Increased lung markings and hyperinflation</p> Signup and view all the answers

    Which condition is strongly associated with thickened secretions leading to bowel obstructions in children?

    <p>Cystic fibrosis</p> Signup and view all the answers

    In the context of obstructive sleep apnea, which method is primarily used for diagnosis?

    <p>Sleep studies</p> Signup and view all the answers

    Which X-ray finding is associated with tuberculosis?

    <p>Cavitary lesions and Ghon complex</p> Signup and view all the answers

    Which of the following is NOT a symptom that warrants a chest X-ray in symptomatic patients?

    <p>Increased appetite</p> Signup and view all the answers

    What characterizes the condition of limited scleroderma?

    <p>Primarily skin effects without major internal complications</p> Signup and view all the answers

    What is the effect of vitamin D deficiency associated with cystic fibrosis on bone health?

    <p>Poor bone mineralization leading to higher fracture risk</p> Signup and view all the answers

    Which of the following clinical findings is indicative of pneumonia infection?

    <p>Dullness over the area of consolidation</p> Signup and view all the answers

    What is the scoring criteria for low risk in the CURB-65 assessment?

    <p>0-1 points</p> Signup and view all the answers

    Which pathogen is commonly associated with lobar pneumonia?

    <p>Streptococcus pneumoniae</p> Signup and view all the answers

    Which symptom is specifically related to lung pathology in pneumonia?

    <p>Rusty sputum</p> Signup and view all the answers

    What type of joint involvement characterizes osteoarthritis?

    <p>Asymmetric joint involvement</p> Signup and view all the answers

    How is pneumonia typically confirmed aside from clinical signs?

    <p>Chest X-ray showing consolidation</p> Signup and view all the answers

    Which laboratory finding is typically abnormal in osteoarthritis?

    <p>Negative rheumatoid factor</p> Signup and view all the answers

    Which risk level is associated with scores of 3-5 in the CURB-65 criteria?

    <p>High risk, possible ICU consideration</p> Signup and view all the answers

    Which of the following is not a characteristic of anti-centromere antibodies?

    <p>Associated with diffuse scleroderma</p> Signup and view all the answers

    Which underlying lung disease is NOT commonly associated with Secondary Spontaneous Pneumothorax (SSP)?

    <p>Pneumonia</p> Signup and view all the answers

    What is the main physiological consequence of Multiple Sclerosis related to nerve fibers?

    <p>Destruction of myelin</p> Signup and view all the answers

    Which type of lesion is most prominently associated with Multiple Sclerosis?

    <p>Periventricular Lesions (Dawson's Fingers)</p> Signup and view all the answers

    What is NOT a common feature of epileptic seizures?

    <p>Provoked solely by environmental stimuli</p> Signup and view all the answers

    Which clinical feature is characteristic of Lhermitte’s sign in Multiple Sclerosis?

    <p>Shock-like sensations with neck movement</p> Signup and view all the answers

    What is the primary cause of lung cancer?

    <p>Cigarette smoking</p> Signup and view all the answers

    Which test is considered the main diagnostic test for cystic fibrosis?

    <p>Sweat test</p> Signup and view all the answers

    What is the primary management strategy for febrile seizures in children?

    <p>Prompt treatment of the underlying fever</p> Signup and view all the answers

    What characterizes Type I respiratory failure?

    <p>PaO2 &lt; 60 mmHg with normal PaCO2</p> Signup and view all the answers

    Which factor is NOT a risk for developing epilepsy?

    <p>Participation in sports activities</p> Signup and view all the answers

    At what age is Multiple Sclerosis most commonly diagnosed?

    <p>20 to 30 years old</p> Signup and view all the answers

    What are common contributing factors to lung cancer aside from smoking?

    <p>Family history</p> Signup and view all the answers

    Which of the following imaging findings represents active inflammation in Multiple Sclerosis?

    <p>Bright lesions on T2-weighted imaging</p> Signup and view all the answers

    What is typically the most affected demographic for Primary Spontaneous Pneumothorax (PSP)?

    <p>Young adults, particularly tall males</p> Signup and view all the answers

    What is the most common scenario for febrile seizures to occur?

    <p>During the onset of fever in the absence of intracranial infection</p> Signup and view all the answers

    Which condition is characterized by a PaCO2 > 50 mmHg?

    <p>Hypercapnic respiratory failure</p> Signup and view all the answers

    What is a key feature of CPAP therapy for obstructive sleep apnea (OSA)?

    <p>It delivers a continuous stream of air</p> Signup and view all the answers

    What is the primary origin of pulmonary emboli?

    <p>Deep vein thrombosis (DVT)</p> Signup and view all the answers

    What symptom is NOT typically associated with cystic fibrosis?

    <p>Severe allergies</p> Signup and view all the answers

    Which of the following conditions is likely to be evaluated using imaging tests like chest X-rays?

    <p>Chronic obstructive pulmonary disease (COPD)</p> Signup and view all the answers

    Which of the following microorganisms is a known common cause of ventilator-acquired pneumonia (VAP)?

    <p>Klebsiella pneumoniae</p> Signup and view all the answers

    What is the primary mechanism by which Mycobacterium tuberculosis evades immune response?

    <p>Altering the phagolysosome pathway</p> Signup and view all the answers

    Which fungal pathogen is endemic to specific geographic regions?

    <p>Histoplasma capsulatum</p> Signup and view all the answers

    In the context of acute respiratory distress syndrome (ARDS), which condition is classified as a pulmonary cause?

    <p>Pneumonia</p> Signup and view all the answers

    What is the primary symptom observed in patients with ARDS?

    <p>Rapid onset of breathlessness</p> Signup and view all the answers

    Which type of TB is specifically characterized by affecting areas outside the lungs?

    <p>Extrapulmonary TB</p> Signup and view all the answers

    Which immune cells are primarily affected by the initial infection of tuberculosis?

    <p>Alveolar macrophages</p> Signup and view all the answers

    The formation of granulomas is a consequence of which type of immune response?

    <p>Cell-mediated immune response</p> Signup and view all the answers

    Which of the following is a potential complication of severe acute respiratory distress syndrome?

    <p>Lung fibrosis</p> Signup and view all the answers

    What role do cytokines play in the pathogenesis of ARDS?

    <p>Cause damage to lung tissues</p> Signup and view all the answers

    What is the primary mechanism by which thrombotic ischemic stroke typically occurs?

    <p>Formation of thrombus due to hyperlipidemia</p> Signup and view all the answers

    Which of the following is a significant risk factor for the development of focal cerebral ischemia?

    <p>Thrombi originating from the left atrial appendage</p> Signup and view all the answers

    What condition significantly raises the risk of thrombus formation following a heart attack?

    <p>Atrial fibrillation</p> Signup and view all the answers

    Which cerebral artery is most commonly involved in focal ischemia leading to movement disorders?

    <p>Middle cerebral artery</p> Signup and view all the answers

    What is the primary consequence of global ischemic stroke?

    <p>Widespread reduction in blood flow to the brain</p> Signup and view all the answers

    Which type of ischemic stroke may be exacerbated by conditions like temporal arteritis?

    <p>Focal ischemic stroke</p> Signup and view all the answers

    What is a possible outcome if a clot travels from the heart to the carotid arteries?

    <p>Occlusion of smaller cerebral blood vessels</p> Signup and view all the answers

    What is the main inflammatory condition associated with focal ischemic strokes?

    <p>Vasculitis</p> Signup and view all the answers

    Which situation is most likely to cause global ischemic stroke?

    <p>Acute blood loss leading to hypotension</p> Signup and view all the answers

    How does a plaque buildup in artery walls contribute to thrombotic ischemic strokes?

    <p>By obstructing blood flow to create a thrombus</p> Signup and view all the answers

    Which type of seizure involves loss of awareness?

    <p>Complex Partial Seizure</p> Signup and view all the answers

    What is a significant characteristic of bacterial meningitis when analyzing cerebrospinal fluid (CSF)?

    <p>Glucose ratio ≤ 0.5</p> Signup and view all the answers

    Which symptom is part of the classic triad present in approximately 50% of bacterial meningitis cases?

    <p>Altered mental status</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with Simple Partial Seizures?

    <p>Impaired consciousness</p> Signup and view all the answers

    What finding on physical examination indicates meningeal irritation in a patient with suspected meningitis?

    <p>Positive Brudzinski Sign</p> Signup and view all the answers

    Which statement about the symptoms of Absence Seizures is correct?

    <p>They result in brief episodes of staring.</p> Signup and view all the answers

    Which condition is indicated by a glucose-to-blood ratio of 0.6 in cerebrospinal fluid analysis?

    <p>Viral meningitis</p> Signup and view all the answers

    What is the initial symptom typically observed in Tonic-Clonic Seizures?

    <p>Stiffening of the body</p> Signup and view all the answers

    What is a primary concern associated with the rupture of a berry aneurysm?

    <p>Severe headache commonly referred to as a 'thunderclap' headache</p> Signup and view all the answers

    Which diagnostic test is best suited for detecting plaque-related infarction in the carotid arteries?

    <p>Carotid Ultrasound</p> Signup and view all the answers

    Which condition is most likely to cause pupil sparing with loss of pupillary constriction?

    <p>Diabetes-related nerve infarction</p> Signup and view all the answers

    What condition can lead to early morning awakening as a characteristic symptom of insomnia?

    <p>Affective disorder</p> Signup and view all the answers

    Which of the following is least likely to be a secondary headache?

    <p>Migraine</p> Signup and view all the answers

    What is a major risk factor contributing to the formation and rupture of berry aneurysms?

    <p>Hypertension</p> Signup and view all the answers

    What type of stroke is typically characterized by bleeding into the subarachnoid space?

    <p>Hemorrhagic Stroke</p> Signup and view all the answers

    Which of the following symptoms is commonly associated with larger berry aneurysms compressing nearby structures?

    <p>Pupil dilation or mydriasis</p> Signup and view all the answers

    What type of stroke may result from hypertension and presents with a thunderclap headache?

    <p>Hemorrhagic stroke</p> Signup and view all the answers

    Which artery is the most common site for hemorrhagic strokes due to hypertension?

    <p>Basal ganglia</p> Signup and view all the answers

    In the context of cerebrovascular accidents, which of these terms refers specifically to difficulty in swallowing?

    <p>Dysphagia</p> Signup and view all the answers

    Which factor is NOT typically associated with the development of berry aneurysms?

    <p>Low blood pressure</p> Signup and view all the answers

    What type of diagnostic imaging is essential to evaluate the presence and location of cerebral aneurysms?

    <p>CT Angiography</p> Signup and view all the answers

    What is an immediate management step for a patient diagnosed with a hemorrhagic stroke?

    <p>Provide fresh frozen plasma</p> Signup and view all the answers

    Which condition can lead to intracerebral hemorrhage due to metastatic spread?

    <p>Choriocarcinoma</p> Signup and view all the answers

    What is the primary clinical manifestation of a large cerebral aneurysm compressing the third cranial nerve?

    <p>Blown pupil</p> Signup and view all the answers

    Which of the following is a potential consequence of using cocaine in relation to stroke?

    <p>Increased risk of hemorrhagic stroke</p> Signup and view all the answers

    What is a common cause of hypertension that may lead to intracerebral hemorrhage?

    <p>Chronic kidney disease</p> Signup and view all the answers

    What condition is specifically characterized by a vascular malformation that may lead to hemorrhagic stroke?

    <p>Arteriovenous malformation</p> Signup and view all the answers

    Which factor is critical for differentiating between ischemic and hemorrhagic strokes?

    <p>Baseline severity score</p> Signup and view all the answers

    What neurotransmitter is exclusively utilized by postganglionic neurons in the parasympathetic nervous system?

    <p>Acetylcholine</p> Signup and view all the answers

    In Horner’s syndrome, which symptom is characterized by an absence of sweating?

    <p>Anhidrosis</p> Signup and view all the answers

    What is the primary neurotransmitter released by most postganglionic sympathetic neurons?

    <p>Norepinephrine</p> Signup and view all the answers

    Which receptor type is NOT found on target cells for sympathetic neurons?

    <p>Muscarinic Receptors</p> Signup and view all the answers

    Which characteristic differentiates the sympathetic nervous system from the parasympathetic nervous system in terms of preganglionic fibers?

    <p>Parasympathetic has longer preganglionic fibers.</p> Signup and view all the answers

    Which location of lesion is most likely to cause Horner’s syndrome?

    <p>T1</p> Signup and view all the answers

    What role does epinephrine play in the sympathetic nervous system?

    <p>It is released into the bloodstream during stress responses.</p> Signup and view all the answers

    Which neurotransmitter is released at the synapse of sympathetic postganglionic neurons except in sweat glands?

    <p>Norepinephrine</p> Signup and view all the answers

    Which symptom is NOT typically associated with the classic triad of Horner’s syndrome?

    <p>Tremor</p> Signup and view all the answers

    What factors can contraindicate a lumbar puncture?

    <p>Anticoagulation therapy</p> Signup and view all the answers

    What characterizes a migraine headache?

    <p>Unilateral, throbbing pain often with nausea and possible aura.</p> Signup and view all the answers

    Which manifestation is NOT typically associated with tension-type headaches?

    <p>Severe nausea with vomiting.</p> Signup and view all the answers

    What is a defining feature of cluster headaches?

    <p>Abrupt onset of severe, unilateral orbital pain.</p> Signup and view all the answers

    Which condition is described by a thunderclap headache?

    <p>Subarachnoid Hemorrhage.</p> Signup and view all the answers

    What type of headache is often triggered by sexual activity?

    <p>Post-Coital Headache.</p> Signup and view all the answers

    Which of the following headaches presents with altered consciousness as a symptom?

    <p>Meningitis.</p> Signup and view all the answers

    What is a common manifestation of temporal arteritis?

    <p>Intermittent, unilateral temporal headache.</p> Signup and view all the answers

    What can be a symptom of a brain tumor headache?

    <p>Gradual onset with worsening in the morning.</p> Signup and view all the answers

    Which condition is associated with focal neurological deficits during headache?

    <p>Intracerebral Hemorrhage.</p> Signup and view all the answers

    Which headache type is commonly linked with severe, uncontrolled hypertension?

    <p>Hypertensive Urgency.</p> Signup and view all the answers

    What is the primary role of tau protein in healthy brain tissue?

    <p>To bind to and stabilize microtubules</p> Signup and view all the answers

    Which of the following proteins is chiefly recognized for forming neurofibrillary tangles in Alzheimer's disease?

    <p>Tau</p> Signup and view all the answers

    Which pathological change is primarily associated with chronic exposure to acid in GERD?

    <p>Barrett's esophagus</p> Signup and view all the answers

    What is a consequence of impaired esophageal clearance in GERD?

    <p>Reflux of stomach contents</p> Signup and view all the answers

    What type of cells in the stomach are responsible for producing gastric acid?

    <p>Parietal cells</p> Signup and view all the answers

    Which factor can lead to increased intra-abdominal pressure, potentially exacerbating GERD symptoms?

    <p>Obesity</p> Signup and view all the answers

    What is the structural manifestation of beta-amyloid protein aggregates in Alzheimer's disease?

    <p>Plaques</p> Signup and view all the answers

    What type of esophageal damage is typically caused by chronic GERD?

    <p>Esophageal stricture formation</p> Signup and view all the answers

    Which role do enteroendocrine cells play in the stomach?

    <p>Regulation of digestive processes through hormones</p> Signup and view all the answers

    Which condition is associated with scarring and narrowing of the esophagus due to GERD?

    <p>Esophageal stricture</p> Signup and view all the answers

    Which symptom is least likely associated with Crohn disease?

    <p>Bloody diarrhea</p> Signup and view all the answers

    What complication is most commonly associated with ulcerative colitis rather than Crohn disease?

    <p>Colorectal cancer</p> Signup and view all the answers

    Which of the following findings indicates the presence of Crohn disease?

    <p>Non-caseating granuloma</p> Signup and view all the answers

    What is a potential complication that can arise from diverticulitis?

    <p>Peritonitis</p> Signup and view all the answers

    What is the role of Kupffer cells in liver pathology?

    <p>Act as the liver's macrophages</p> Signup and view all the answers

    What is NOT a characteristic clinical manifestation of cirrhosis?

    <p>Increased albumin levels</p> Signup and view all the answers

    Which diagnostic method is primarily used for identifying GI cancers?

    <p>Esophagogastroduodenoscopy (EGD)</p> Signup and view all the answers

    In the context of IBS, what differentiates IBS-D from IBS-C?

    <p>Frequency of bowel movements</p> Signup and view all the answers

    Which feature is characteristic of Linitis Plastica?

    <p>Generalized thickening of stomach wall</p> Signup and view all the answers

    What consequence results from recurrent hepatocyte injury?

    <p>Excessive stellate cell activation and fibrosis</p> Signup and view all the answers

    Which of the following cells found in the corpus of the stomach secretes hydrochloric acid and intrinsic factor?

    <p>Parietal Cells</p> Signup and view all the answers

    In the antrum, which cells secrete somatostatin and help regulate gastrin release?

    <p>D Cells</p> Signup and view all the answers

    Which condition is attributed to Helicobacter pylori and is a major cause of duodenal and gastric ulcers?

    <p>Peptic Ulcer Disease</p> Signup and view all the answers

    What effect do NSAIDs have on gastric function that can lead to the development of ulcers?

    <p>Decrease mucosal blood flow</p> Signup and view all the answers

    What is the primary cause of projectile vomiting in infants with pyloric stenosis?

    <p>Gastric outlet obstruction</p> Signup and view all the answers

    Which type of cell is primarily involved in hunger signaling in the stomach?

    <p>Ghrelin-secreting Cells</p> Signup and view all the answers

    Which hormonal imbalance could increase gastric acid production and potentially lead to ulcers?

    <p>Excess gastrin</p> Signup and view all the answers

    What is the lifespan of parietal cells found in the corpus of the stomach?

    <p>90-120 days</p> Signup and view all the answers

    What role does histamine-secreting enterochromaffin-like (ECL) cells play in gastric function?

    <p>Stimulate acid secretion</p> Signup and view all the answers

    Which symptom is NOT typically associated with pyloric stenosis in infants?

    <p>Biliary vomiting</p> Signup and view all the answers

    What distinguishes Crohn's disease from ulcerative colitis in terms of lesion patterns?

    <p>Crohn's disease has skip lesions, while ulcerative colitis has continuous lesions.</p> Signup and view all the answers

    Which of the following symptoms is less commonly associated with Crohn's disease compared to ulcerative colitis?

    <p>Bloody diarrhea</p> Signup and view all the answers

    Which clinical manifestation is NOT typically associated with celiac disease?

    <p>Perianal fistulas</p> Signup and view all the answers

    In what way does the autonomic nervous system influence the enteric nervous system?

    <p>It modulates the enteric nervous system's activities.</p> Signup and view all the answers

    Which statement regarding the treatment of Crohn's disease is accurate?

    <p>Antibiotics can alter microbiota and influence inflammation.</p> Signup and view all the answers

    Which symptom is typically a result of fat malabsorption in celiac disease?

    <p>Bloating and flatulence</p> Signup and view all the answers

    What is a common complication of ulcerative colitis that is not typically associated with Crohn's disease?

    <p>Toxic megacolon</p> Signup and view all the answers

    What is the initial location of abdominal pain in appendicitis?

    <p>Around the belly button</p> Signup and view all the answers

    Which of the following is a sensory function regulated by the enteric nervous system?

    <p>Detection of mechanical changes in the gut</p> Signup and view all the answers

    Which sign is indicated by pain in the right lower quadrant when palpating the left lower quadrant?

    <p>Rovsing Sign</p> Signup and view all the answers

    Which method is NOT a reliable indicator for detecting early-stage gastric carcinoma?

    <p>Barium imaging</p> Signup and view all the answers

    Which extra-intestinal manifestation is often seen in patients with celiac disease?

    <p>Dermatitis herpetiformis</p> Signup and view all the answers

    Which feature is characteristic of the smooth muscle contractions involved in gastrointestinal motility?

    <p>They are involuntary and rhythmic.</p> Signup and view all the answers

    What is the term for pain resulting from stretching the psoas muscle in the context of appendicitis?

    <p>Psoas Sign</p> Signup and view all the answers

    Which symptom is commonly associated with appendicitis aside from abdominal pain?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What is the primary characteristic of an olive-like mass found in the abdomen?

    <p>It indicates hypertrophied pylorus.</p> Signup and view all the answers

    In relation to high-risk individuals for gastric carcinoma, why is EGD preferred over barium imaging?

    <p>EGD provides direct visualization of the stomach lining.</p> Signup and view all the answers

    Which type of colitis is primarily linked to antibiotic use?

    <p>Pseudomembranous Colitis</p> Signup and view all the answers

    How does osmotic diarrhea occur?

    <p>Because of the presence of unabsorbed substances.</p> Signup and view all the answers

    What is indicated by tenderness at McBurney’s point?

    <p>Appendicitis</p> Signup and view all the answers

    Which mechanism is NOT a cause of small bowel obstruction?

    <p>Colorectal cancer</p> Signup and view all the answers

    Which clinical manifestation suggests systemic inflammation in appendicitis?

    <p>Fever and chills</p> Signup and view all the answers

    How is the obturator sign tested?

    <p>Flexing the hip and rotating it inward</p> Signup and view all the answers

    What is a defining characteristic of ulcerative colitis?

    <p>Bloody diarrhea often with mucus.</p> Signup and view all the answers

    Which of the following neurotransmitters is associated with the sympathetic nervous system's innervation of the GI tract?

    <p>Norepinephrine</p> Signup and view all the answers

    What lifestyle factors are associated with the promotion of ulcer formation?

    <p>Alcohol consumption and smoking</p> Signup and view all the answers

    Which condition is characterized by abdominal pain and chronic watery diarrhea that is not visible to the naked eye?

    <p>Microscopic Colitis</p> Signup and view all the answers

    What distinguishes ischemic colitis from other types of colitis?

    <p>It results from reduced blood flow to the colon.</p> Signup and view all the answers

    What role does the enteric nervous system (ENS) play within the GI tract?

    <p>Manages motility and secretion autonomously.</p> Signup and view all the answers

    Which of the following is NOT a functional cause of bowel obstruction?

    <p>Adhesions</p> Signup and view all the answers

    Study Notes

    Labs to Assess Connective Tissue Diseases

    • Antinuclear Antibody (ANA): High sensitivity, low specificity; positive results may also occur in aging, HIV, and certain cancers.
    • Double-Stranded DNA (dsDNA): Indicates autoimmune activity; often associated with systemic lupus erythematosus (SLE).
    • Anti-Smith Antibodies: Highly specific for SLE; targets specific nuclear proteins.
    • SS-A (Ro) and SS-B (La) Antibodies: Linked to Sjögren's Syndrome and sometimes SLE.
    • Anti-Scl-70 (Topoisomerase 1) Antibodies: Associated with systemic scleroderma; characterized by thickened skin and potential lung issues.
    • Anti-Centromere Antibodies: Indicate limited scleroderma (CREST syndrome); primarily affects skin without significant internal organ involvement.

    RA versus OA

    • Osteoarthritis (OA): Typically affects small joints, develops with age (45-55 years), worsens with activity; lab tests show normal ESR and negative RF.
    • Rheumatoid Arthritis (RA): Can be indicated by specific markers, different pathophysiology than OA.

    Evaluation and Diagnosis of Pneumonia

    • Chest X-ray: Essential for identifying pneumonia; shows consolidation in affected alveoli.
    • Clinical Signs: Dullness over consolidation, crackles, fever, malaise, and respiratory distress.
    • Lung-Related Symptoms: Cough with purulent sputum, pleuritic chest pain, shortness of breath.

    Pneumonia Pathogens

    • Community-Acquired Pneumonia (CAP): Common pathogens include Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, and Legionella pneumophila.
    • Hospital-Acquired Pneumonia (HAP): Includes Klebsiella pneumoniae, Staphylococcus aureus (MRSA), and Acinetobacter baumannii.
    • Immunocompromised Hosts: Vulnerable to fungal (Histoplasma, Coccidioides) and viral pathogens (CMV).

    TB Pathogenesis

    • Transmission: TB spreads via inhalation of droplets from an infected person.
    • Survival Mechanism: TB bacteria evade immune responses, surviving within macrophages.
    • Granulomas: Formed as immune response aggregates; key sign of TB.
    • Types of TB: Pulmonary TB (lungs) and extrapulmonary TB (other body parts).

    Pathology of ARDS

    • Inflammatory Response: Triggered by various factors leading to endothelial and epithelial damage.
    • Fluid Leakage: Results in pulmonary edema, causing hypoxemia.
    • Clinical Presentation: Rapid breathlessness, hypoxemia, bilateral shadowing on chest X-rays.

    Evaluation of Wheezing

    • History and Physical Exam: Assess frequency, triggers, allergies, and overall respiratory function.
    • Pulmonary Function Tests (PFTs): Spirometry assesses airway obstruction; peak expiratory flow indicates asthma.

    Chest X-rays and Pulmonary Diseases

    • Emphysema: Shows hyperinflation and flattened diaphragm.
    • Pneumonia: Identified by consolidation and air bronchograms in imaging.
    • Tuberculosis: Characterized by cavitary lesions and Ghon complexes.

    Cystic Fibrosis Pathophysiology

    • Genetic Defect: CFTR gene mutation leads to thick mucus in lungs and pancreas.
    • Pulmonary Complications: Chronic infections, respiratory failure, and bronchiectasis.
    • Gastrointestinal Effects: Malabsorption, meconium ileus, and liver disease.

    Diagnosing Cystic Fibrosis

    • Sweat Test: Elevated chloride levels confirm CF diagnosis.
    • Clinical Manifestations: Persistent cough, lung infections, and pancreatic insufficiency.

    Common Causes of Lung Cancer

    • Primary Cause: Cigarette smoking accounts for 90% of lung cancer cases.
    • Non-Smoker Cases: Adenocarcinoma prevalent in females; other factors include asbestos and radon exposure.

    Chronic Hypoxemia and Hypercapnia

    • Type I Respiratory Failure: Characterized by low oxygen levels; often seen in pneumonia.
    • Type II Respiratory Failure: High CO2 levels; associated with conditions reducing lung function (e.g., COPD).

    CPAP Therapy for OSA

    • Mechanism: Delivers continuous air pressure to keep airways open during sleep, preventing obstructive episodes.

    Origin of Pulmonary Emboli

    • Deep Vein Thrombosis (DVT): Most emboli originate from blood clots in leg veins; clots travel to pulmonary arteries.

    Types of Pneumothorax

    • Primary Spontaneous Pneumothorax (PSP): Common in tall, young males; often idiopathic.
    • Secondary Spontaneous Pneumothorax (SSP): Associated with chronic lung diseases in older adults.

    Multiple Sclerosis Overview

    • Autoimmune Condition: Attacks CNS; causes demyelination and formation of lesions.

    • Clinical Features: Includes visual impairment, ataxia, and urinary symptoms.

    • Types of Lesions: Periventricular, juxtacortical, infratentorial, and spinal cord lesions with specific implications for function.### Types of Seizures

    • Bright lesions indicate active inflammation and fluid accumulation.

    Epilepsy

    • Characterized by unprovoked seizures resulting from hypersynchronous electrical activities in the brain.
    • Risk factors include:
      • TORCH infections (Toxoplasma, Rubella, Cytomegalovirus, Herpes)
      • Prematurity
      • Hypoxic ischemic injury at birth
      • Family history of seizures
      • History of febrile seizures in childhood
      • History of meningitis, encephalitis, or head trauma

    Epidemiology

    • Up to 10% of individuals will experience a seizure at some point in their lives.
    • After one unprovoked seizure, there is a 30% chance of experiencing a second seizure.
    • Approximately 1% of the population has epilepsy.
    • New onset seizures are most common in very young children and older adults.

    Febrile Seizures

    • Most prevalent cause of new onset seizures in children.
    • Typically occur in children aged six months to five years.
    • Triggered by fever; usually absent of any intracranial infection.
    • Can be generalized at onset and may recur with future fevers.
    • Not classified as epilepsy since they are provoked by fever.

    Clinical Pearls

    • Seizures in children generally have a favorable prognosis.
    • Focal onset seizures may occur with prolonged duration.
    • Presence of other neurologic abnormalities or family history of epilepsy can be noted.
    • A small percentage of children with febrile seizures may develop epilepsy with unprovoked seizures in the future.

    Management

    • Involves prompt treatment of fever.
    • Antiepileptic drugs may be considered if seizures are prolonged or if fever control is insufficient.

    Seizure Types

    • Focal Seizures: Affect one part of the brain.

      • Simple Partial: No loss of awareness, symptoms include twitching or tingling. Mnemonic: "Simple, Stay Sharp."
      • Complex Partial: Awareness impaired; features repetitive actions like lip-smacking. Mnemonic: "Complex, Conscious Cloudy."

    • Generalized Seizures: Involve the entire brain.

      • Tonic-Clonic (Grand Mal): Whole body shaking, consists of tonic (stiffening) and clonic (jerking) phases. Mnemonic: "Tonic-Clonic, Total Chaos."
      • Absence: Brief periods of being "absent" or spaced out, typically involves staring. Mnemonic: "Absence, Away Awhile."

    Clinical Presentation of Meningitis

    • Common Symptoms: Headache, neck rigidity, nausea/vomiting.

    • Classic Triad in Bacterial Meningitis:

      • Altered Mental Status: Glasgow coma scale score < 14.
      • Fever: > 38℃.
      • Stiff Neck.

    • Symptoms of Meningitis: Severe headache, lethargy, nausea, vomiting, photophobia.

    • Signs of Meningeal Irritation:

      • Stiff Neck: Difficulty touching chin to sternum.
      • Kernig Sign: Pain when extending knee while hip is flexed.
      • Brudzinski Sign: Involuntary knee flexion when neck is flexed.

    • CSF Analysis:

      • Normal CSF-to-blood glucose ratio: 0.6; ≤ 0.5 indicates bacterial meningitis.
      • Elevated lactate (≥ 35 mg/dL) and protein in bacterial cases.

    Neurotransmitters and Their Functions

    • Acetylcholine (ACh):

      • Primary neurotransmitter for preganglionic neurons in both sympathetic and parasympathetic systems.
      • Nicotinic Receptors: Found on postganglionic neurons.
      • Muscarinic Receptors: Target cells in parasympathetic and some sympathetic systems (e.g., sweat glands).

    • Norepinephrine (NE):

      • Main neurotransmitter for most postganglionic sympathetic neurons utilizing adrenergic receptors.

    • Epinephrine:

      • Released by the adrenal medulla during sympathetic response; acts on adrenergic receptors similarly to NE.

    Sympathetic vs. Parasympathetic Nervous System

    • Preganglionic Fibers:
      • PSNS: Long preganglionic, short postganglionic fibers.
      • SNS: Short preganglionic, long postganglionic fibers.
    • Neurotransmitters:
      • Both release ACh from preganglionic neurons; PSNS also releases ACh from postganglionic neurons, while SNS typically releases NE (except in sweat glands).

    Clinical Manifestations of Horner’s Syndrome

    • Characteristics:
      • Unilateral condition involving ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (absence of sweating).
    • Common Cause: Pancoast lung tumor affecting sympathetic structures.

    Ischemic Stroke Types

    • Focal Ischemic Stroke:

      • Occurs due to compromised blood vessel; commonly caused by thrombi from the heart (e.g., atrial fibrillation).

    • Global Ischemic Stroke:

      • Results from low systemic blood pressure affecting brain blood supply.

    Stroke Causes and Common Affected Areas

    • Focal Cerebral Ischemia: Atherosclerosis is the most common cause.
    • Global Cerebral Ischemia: Linked to hypotension from acute blood loss.
    • Thrombus Formation: Often occurs at the bifurcation of the carotid artery.

    Hemorrhagic Stroke

    • Causes:
      • Intracerebral hemorrhage due to hypertension, berry aneurysms, and mass lesions (e.g., cancer).
    • Clinical Presentation:
      • Thunderclap headache indicates subarachnoid hemorrhage; observational features may include motor deficits depending on the affected region.
    • Diagnosis and Management:
      • Fresh frozen plasma is used for coagulopathy; surgical management is for deteriorating patients.

    Cerebral Aneurysm

    • Berry Aneurysm:
      • Weakened blood vessel wall leads to a sac-like bulge, commonly resulting in rupture and subarachnoid hemorrhage.
    • Location:
      • More prevalent in the anterior portion of the Circle of Willis; can compress nearby cranial nerves leading to pupil abnormalities.

    Characteristics of Insomnia

    • Difficulty initiating or maintaining sleep, waking too early, daytime impairments, and symptoms persisting for at least three months.

    Clinical Manifestations of Headache Types

    • Primary Headaches: Include migraines (throbbing pain, nausea), cluster headaches (severe, unilateral pain), and tension-type headaches (band-like pressure).
    • Secondary Headaches: Result from underlying conditions like subarachnoid hemorrhage, meningitis, or tumors, presenting acute or chronic pain based on the etiology.

    Common Causes of Headaches

    • Triggered by stress, hormonal fluctuations, or specific foods for primary headaches; secondary headaches may arise from infections, vascular issues, or brain masses.### Headache Types
    • Cluster Headache: Severe, unilateral pain around the eye; associated with autonomic symptoms like lacrimation and nasal congestion.
    • Post-Coital Headache: Sudden, intense headache occurring during or after sexual activity.

    Secondary Headaches

    • Intracerebral Hemorrhage: Acute headache with focal neurological deficits; results from ruptured brain blood vessel.
    • Subarachnoid Hemorrhage: Sudden, severe headache ("thunderclap"); often caused by a ruptured aneurysm.
    • Meningitis: Severe headache accompanied by fever and neck stiffness; caused by infection of the meninges.
    • Temporal Arteritis: Unilateral, continuous headache with scalp tenderness; results from inflammation of temporal arteries.
    • Hypertensive Urgency: Dull, bilateral headache; linked to severe, uncontrolled hypertension.
    • Venous Sinus Thrombosis: Diffuse headache with papilledema; caused by blood clot in the brain's venous sinuses.
    • Brain Tumor: Insidious headache worsening in the morning; associated with tumor growth in the brain.

    Alzheimer’s Disease Pathophysiology

    • Key Proteins Implicated: Beta-amyloid and tau.
    • Beta-Amyloid: Formed from amyloid precursor protein (APP) breakdown; abnormal levels pool as neuritic plaques that disrupt neuron function.
    • Tau: Stabilizes microtubules; undergoes abnormal changes in Alzheimer's, leading to neurofibrillary tangles that disrupt neuron functions.

    Gastroesophageal Reflux Disease (GERD) Pathophysiology

    • LES Dysfunction: Inadequate closure allows stomach acid to backflow.
    • Transient LES Relaxations: Occurs inappropriately, causing acid reflux.
    • Hiatal Hernia: Stomach bulges through diaphragm, disrupting LES function.
    • Impaired Esophageal Clearance: Reduced peristalsis allows acid reflux.
    • Delayed Gastric Emptying: Accumulated pressure increases reflux risk.
    • Increased Intra-Abdominal Pressure: Factors like obesity exacerbate reflux.
    • Esophageal Mucosal Damage: Chronic acid exposure causes esophagitis and complications like Barrett's esophagus.

    Risks of Chronic GERD

    • Esophagitis: Inflammation from acid exposure.
    • Esophageal Stricture: Narrowing from scar tissue; difficulty swallowing.
    • Barrett’s Esophagus: Pre-cancerous changes; increased risk of esophageal adenocarcinoma.
    • Esophageal Ulcers: Sores due to acid exposure.
    • Chronic Cough/Laryngitis: Irritation from acid.
    • Asthma Exacerbation: Triggered by reflux.
    • Dental Erosion: Acid effects on tooth enamel.
    • Increased Cancer Risk: Particularly adenocarcinoma from chronic inflammation.
    • Aspiration Pneumonia: Stomach contents aspirated into lungs.

    Cells of the Stomach

    • Parietal Cells: Produce gastric acid and intrinsic factor.
    • Chief Cells: Produce pepsinogen for protein digestion.
    • Mucous Cells: Protect stomach lining.
    • Enteroendocrine Cells: Secrete hormones for digestive regulation.
    • Stem Cells: Renew stomach lining.

    Gastric Anatomy

    • Cardia: Secretes mucus for protection; contains foveolar and sensory tuft cells.
    • Corpus (Body): Major site for acid production; contains parietal and chief cells.
    • Antrum: Regulates acid production; contains G cells (gastrin) and D cells (somatostatin).

    Etiology of Peptic Ulcer Disease (PUD)

    • Helicobacter pylori: Major contributor; causes most duodenal and gastric ulcers.
    • Medications: NSAIDs reduce mucosal defenses.
    • Alcohol/Smoking: Increase acid secretion and reduce mucus.
    • Hormonal Factors: Excess gastrin increases acid production.
    • Chronic Diseases: Poor blood supply from conditions like COPD.
    • Stress: Elevates glucocorticoids affecting GI vasculature.

    NSAID Impact on GI Function

    • Reduced Protective Prostaglandins: Leads to gastric irritation and bleeding.
    • Decreased Mucosal Blood Flow: Impairs mucosal defense against acid.
    • Increased Acid Secretion: Causes further mucosal damage.
    • Impaired Healing: Complicates recovery from ulcers.

    Clinical Presentation of Pyloric Stenosis

    • Projectile Vomiting: Forceful, occurring shortly after feeding.
    • Persistent Hunger: Despite frequent vomiting.
    • Dehydration Signs: Dry mouth, low urine output.
    • Weight Loss: Due to inadequate intake.
    • Olive-like Mass: Palpable mass in the right upper quadrant.
    • Hypochloremic Metabolic Alkalosis: Lab findings from loss of gastric acid.
    • Visible Peristalsis: Movements in the abdomen after feeding.

    Types of Colitis

    • Ulcerative Colitis (UC): Chronic, affects colon/rectum, bloody diarrhea.
    • Crohn's Disease: Affects any GI tract section; patchy inflammation.
    • Infectious Colitis: Caused by pathogens; presents with bloody diarrhea.
    • Ischemic Colitis: Reduced blood flow; sudden pain and bloody diarrhea.
    • Microscopic Colitis: Chronic watery diarrhea, not visible.
    • Chemical Colitis: Caused by harsh chemicals; leads to abdominal issues.
    • Radiation Colitis: Post-radiation therapy complications.
    • Pseudomembranous Colitis: Linked to C. difficile; severe diarrhea.
    • Eosinophilic Colitis: Eosinophil increase; linked to allergies.

    Causes of Bowel Obstruction

    • Small Bowel Obstruction: Commonly caused by adhesions, hernias, or tumors.
    • Large Bowel Obstruction: Often due to colorectal cancer or volvulus.

    Osmotic Diarrhea

    • Mechanism: Occurs when substances remain unabsorbed, drawing water and leading to bacterial fermentation.
    • Clinical Features: Loose stools and gas production.

    GI System Innervation

    • Extrinsic Innervation: Managed by the autonomic nervous system (SNS and PNS).
    • Intrinsic Innervation: Enteric nervous system (ENS) controls local functions.
    • Coordination: ENS operates independently, but influenced by SNS and PNS.

    Clinical Manifestations of Celiac Disease

    • Gastrointestinal Symptoms: Diarrhea, steatorrhea, bloating, and cramping.
    • Extra-Intestinal Symptoms: Malnutrition, anemia, and dermatitis herpetiformis.

    Differences Between Crohn’s Disease and Ulcerative Colitis

    • Crohn's Disease: Skip lesions, can affect any GI section, typically non-bloody diarrhea.
    • UC: Continuous lesions, rectal onset, classical bloody diarrhea.

    Complications of Diverticulitis

    • Abscess Formation: Pocket of pus in the colon wall.
    • Perforation: Leads to peritonitis.
    • Fistulas: Abnormal connections between colon and other organs.
    • Bowel Obstruction: Due to scarring/inflammation.
    • Bleeding: From diverticula inflammation.

    Hepatic Injury

    • Hepatocyte Damage: Releases inflammatory mediators and activates Kupffer cells.
    • Stellate Cell Activation: Regenerates hepatocytes and causes fibrosis with recurrent injury.

    Clinical Manifestations of Cirrhosis

    • Liver Changes: Irregular, scarred liver structure.
    • Portal Hypertension: Causes ascites and varices.
    • Spleen Issues: Enlarged spleen and low platelet count.
    • Liver Dysfunction: Impaired synthetic and metabolic functions.

    Types of Irritable Bowel Syndrome (IBS)

    • IBS-D: Predominance of diarrhea.
    • IBS-C: Predominance of constipation.
    • IBS-M: Mixed symptoms of diarrhea and constipation.### IBS Types
    • IBS-D (Diarrhea-predominant): Symptoms include frequent, loose, watery stools, urgency, and potential incontinence. Pain is often relieved by bowel movements.
    • IBS-C (Constipation-predominant): Characterized by hard, dry stools, infrequent bowel movements, and straining. Pain may improve with bowel movements but frequently is linked to discomfort from constipation.
    • IBS-M (Mixed): Symptoms alternate between diarrhea and constipation. Pain can vary based on bowel movement patterns.

    Diagnostics for GI Cancers

    • Primary Diagnostic Method: Esophagogastroduodenoscopy (EGD), which uses a flexible tube to examine the esophagus, stomach, and duodenum.
    • Specific Findings:
      • Ulcerated Masses: Open sores in the stomach lining that do not heal.
      • Irregular, Heaped-Up Margins: Uneven or raised edges in the stomach.
      • Induration: Hardness or thickening within the stomach wall.
    • Linitis Plastica Characteristics: A subtype of gastric carcinoma indicating stiffening of the stomach wall, absence of normal folds, and diffuse infiltrative appearance.
    • Less Effective Method: Barium imaging, which has lower sensitivity than EGD, potentially missing early gastric carcinoma signs, thus less reliable for diagnosis.
    • Early Surveillance: Regular EGD is essential for high-risk individuals for early detection of gastric carcinoma, improving treatment effectiveness.
    • Benefits of EGD: Direct visualization of the stomach lining allows for accurate detection of abnormalities.
    • Barium Imaging Limitations: Less invasive, but lower sensitivity may necessitate reliance on EGD for definitive diagnosis and monitoring.

    ETOH and PUD

    • Alcohol and smoking contribute to ulcer formation by decreasing mucus production and increasing gastric acid secretion.

    Clinical Manifestations of Appendicitis

    • Abdominal Pain: Begins around the belly button, later shifting to the lower right quadrant (McBurney's point).
    • Nausea and Vomiting: Commonly accompany the abdominal pain.
    • Loss of Appetite: Often noted with the onset of pain and nausea.
    • Fever and Chills: May indicate systemic inflammation.
    • Tenderness: Notable at McBurney’s Point (2/3 from umbilicus to anterior iliac spine).
    • Psoas Sign: Pain on hip flexion against resistance or extension of the hip when on the left side indicates irritation of the psoas muscle.
    • Obturator Sign: Pain on internal rotation of the right hip when flexed indicates irritation of the obturator muscle.
    • Rovsing Sign: Pain in the right lower quadrant when the left lower quadrant is palpated, suggesting appendicitis.

    Explanation of Signs

    • Psoas Sign Testing: Pain during hip flexion against resistance or hip extension when on the left side indicates inflammation.
    • Obturator Sign Testing: Pain during internal rotation of the hip while flexed suggests irritation.
    • Rovsing Sign Testing: Pain in the right lower quadrant when palpating the left indicates possible appendicitis.

    These tests are crucial for diagnosing appendicitis by assessing pain responses to specific movements or palpation.

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