Exam 4 Group Study Guide PDF

Exam 4 Group Study Guide Week 11 Musculoskeletal Types of fractures (buckle, avulsion, greenstick, stress, compound, spiral, Colles’, Salter Harris, etc.) Type of Fracture – Common Location What is looks like / How we know Radial...

Exam 4 Group Study Guide Week 11 Musculoskeletal Types of fractures (buckle, avulsion, greenstick, stress, compound, spiral, Colles’, Salter Harris, etc.) Type of Fracture – Common Location What is looks like / How we know Radial Head Fracture , Elbow Supracondylar Fracture = Most common in kids * Posterior Fat Pad Sign Scaphoid Fracture , Wrist/Hand Avascular Necrosis Spiral Fracture , Fibula/Tibia Colle’s , Wrist Fall from outstretched hand May Require Surgery, Will need a splint Salter Harris (Pediatrics) Involves growth plate Type 1-5 , Type 2 is MOST common Buckle(Torus) - incomplete Partial Compression of cortex - Any long bone Immobilize & pain control - Usuallly wrist Greenstick – incomplete Only a portion of the cortex - May require a doc to break again Apophyseal Avulsion Fracture Apophysis torn off by muscle - Anterior superior iliac crest - Tibial tubercle  Toddler’s - Spiral Fracture in distal tibia - Usually only in kids Secondary signs of fracture on x-ray - Joint Effusion - Periosteal reaction (may be a sign of healing) AKA callus formation Characteristics of Parkinson's - Bradykinesia*: slow, shuffling gait, loss of coordination - Tremor: resting tremor, emotional excitement - Rigidity*: resistance to passive movement - Postural Instability - Motor: speech, blurred vision, dysphagia - Nonmotor: constipation, sexual dysfunction, urinary trouble, depression/anxiety, dementia, insomnia Cause of chorea - Hyperkinetic - Involuntary abrupt irregular movement o One part of the body to the other - Hereditary = Huntington's & Wilsons - Drugs = Neuroleptics & dopaminergic - Toxic/Metabolic = ETOH, CO2, Thyrotoxicosis - Immunologic= SLE, Strep - Pregnancy - Vascular Differentiate myoclonus, dystonia, and tremors Myoclonus Sudden lightening movement produced by abrupt and brief muscle contraction - Epileptic - Hiccups Dystonia Sustained muscle contraction - Repetitive twisting - Abnormal Posture  - Focal – Segmental – Generalized - Think of this as a muscle cramp Tremors Continuous bouncing movement Hyperkinetic Resting = Parkinsons Postural* = Essential Action = Cerebellar outflow Pathway of movement control Patho of Wilson’s disease - Impaired excretion of copper into bile > copper toxicity from damage to liver - Decreased incorporation of copper into apo ceruloplasmin > copper accumulates in tissues What is Brown-Sequard syndrome? - Spinal cord injury that results in a hemisection of the spinal cord o Leads to weakness, and paralysis on one side of the body with sensory loss on the other o Usually caused by penetrating trauma ▪ Also cx by MS, herniation, tumors, hematomas, injections (TB, meningitis) Complications of Salter-Harris Type III fracture - SCFE = Slipped Capital Femoral Epiphysis o Usually in African Americans, obese, boys o Femoral head slips posteriorly and medially to rest of femur Patho of Multiple Sclerosis, ALS, and Myasthenia Gravis MS White matter has inflammatory lesions - Multiple plaques form - Plaques occur beside lateral ventricle > Dawson’s Fingers - Can form in brainstem & spinal cord, and optic nerve* ALS Exact is UNK - Reduced uptake of glutamate - Gene mutation > dysregulation of RNA Myasthenia Gravis Antibodies directed against postsynaptic acetylcholine receptors Clinical manifestations of ALS - Earliest sign = asymmetrical weakness  - Limb weakness, cramping in the AM, gait instability, falling, fatigue, stiffness, pain Treatment of MG - Acetylcholinesterase inhibitors = pyridostigmine - Steroids - Steroid sparing agents = cyclosporin, methotrexate - IVIG & plasmapheresis - Thymectomy Causes of bone loss in women - Menopause - Osteoporosis - Diet, lifestyle(sedentary), medications (glucocorticoids), age, low BMI*, smoking*, family history* Ottawa ankle rules - Pain at medial malleolus or distal (6cm) of posterior medial tibia - Pain at lateral malleolus (6cm) or along posterior fibula - Inability to bear weight immediately and for four consecutive steps in ER When to order an MRI for fractures - When you can't visualize on an Xray o Common with snuff box fractures AKA scaphoid fracture Understand EMG nerve conduction testing - Electromyography - Can help diagnose MG - Jitter = variability between 2 adjacent muscle fibers within the same muscle unit - Small needles are placed around the eyes, forehead, and arms > measure electrical activity of motor units > MG shows increased jitters with normal muscle fiber density Physical exam techniques to assess carpal tunnel - Numbness in radial 3 and ½ digits - Heaviness in hands - Decreased grip strength - Thenar muscle wasting - Tinel sign*= tapping on medial nerve elicit tingling pain - Phalen's sign* = tingling in median nerve with hyperflexion of wrist - Compression test* = full compression of carpal tunnel to elicit symptoms  - Evaluating Paget’s Disease - Lab Studies = Isolated alkaline phosphatase 500 u/l+ HALLMARK SIGN* - Plain Films o 1st: Osteoporosis from osteolytic o 2nd mixed phase sclerosis and osteolytic o 3rd mainly sclerosis with cortical thickening - Bone Scan (most sensitive): Can show areas of increased uptake Ankle sprain management - Exercises ROM & functional rehab - NSAIDS - MAY need surgical repair What is radiculopathy? - Pinched nerve Week 12 Reproductive Breast cancer risk factors Unmodifiable factors: - Family history: o Breast cancer in 1st- or 2nd-degree relatives (mother, grandmother, sister) o Ashkenazi Jewish descent - Hormonal influences: long hormone exposure due to early Menarche and/or late menopause - Genetic mutations (examples): o BRCA1 (on chromosome17q) o BRCA2 (on Chromosome 13q) o p53 (on chromosome 17) - Increasing age - Breast cancer on the contralateral side Modifiable risk factors: - Lifestyle factors that increase the risk:  o High-fat diet o Obesity (especially after menopause) o Heavy alcohol use o Tobacco - Hormonal influences that increase the risk: o Higher age at 1st delivery (> 30 years of age) o Nulliparity o Hormone replacement therapy after menopause (> 5 years) - Hormonal influences that decrease risk: breastfeeding for at least 6 months Understand the normal menstrual cycle The menstrual cycle is divided into 2 components: ovarian cycle and endometrial cycle: - Average adult menstrual cycle is 28–35 days. - “Normal” cycle length is defined as 24–38 days. - “Regular ” cycles are when variation in cycle length is ≤ 7‒9 days. - Intervals in cycles usually remain consistent until perimenopause, when follicular phases become shorter and more frequent. Ovarian cycle phases: - Follicular phase: o Represents the time during which the follicle and its oocyte develop, leading up to ovulation o Spans from menses onset (day 1) to the day before the surge of luteinizing hormone (LH), leading to ovulation o Length: 14 to 21 days (may be shorter, especially in perimenopause) - Luteal phase: o The time after ovulation when the ovary produces hormones to support a potential pregnancy and maintain a healthy endometrium. o Spans from the day of LH surge until the onset of the next menses o Length: 14 days Endometrial cycle phases: - Desquamation: shedding of the endometrial lining (menses) - Proliferative phase: endometrial proliferation with straight, tubular glands - Secretory phase: maturation of the spiral arteries and endometrial glands, preparing the endometrium for potential pregnancy Understand hormones related to menstrual cycle, pregnancy, and menopause FSH 1) Stimulates follicular development and egg maturation 2) Stimulates granulosa cells to produce E2 LH Simulates theca cells to make testosterone which is converted to E2 Estrogen E2: primary estrogen E1: weak estrogen seen in menopause Estirol: made in pregnancy Progastrin Made afer ovulation Menstrual Estrogen & progesterone = inhibit FSH & LH Estrogen provides a negative feedback loop Review the Hypothalamic-pituitary-ovarian (HPO) axis - HPO uses GnRH to release FSH, LH o Aids in the release of estrogen, progesterone Defining puberty and expected changes Definition: Puberty is the time period from the 1st appearance of secondary sexual characteristics until achieving complete sexual development. Puberty involves a complex series of physical, psychosocial, and cognitive changes. Thelarche Breast development= 1st sign in girls - Usually 7-14 YO Pubarche Armpit hair and pubic hair - 8-15 Growth Spurt Insulin growth hormone Menarche 1st menstural bleed - 9-16 - 1 year after growth spurt Identifying precocious puberty or delayed puberty - Secondary sex characteristics are isosexual - Major growth restriction Know Tanner Stages: Females: Prepubertal – Tanner 1 Pubic hair – villus hair only Breasts – Evelation of papilla only Adrenarche and ovarian growth  8-11.5 years – Tanner 2 Pubic hair – sparse along the labia Breasts – Buds are palpable – first sign of puberty in females, areole are enlarged. Clitoral enlargement, labial pigmentation, growth of uterus 11.5-13 years – Tanner 3 Pubic Hair – coarse and curly Breast tissue – grows with no contour or separation Axilliary hair, acne 12-15 – Tanner 4 Pubic Hair – adult hair that doesn’t spread to thigh Breasts – enlargement and areole form secondary mound on breast Menarche and development of menses Over 15 years old – Tanner 5 Pubic hair – adult hair reaching the thigh Breasts – adult breast contours present, only papilla is raised Adult genitalia Males: Prepubertal – Tanner 1 Pubic Hair – villus only Genitalia – testes ED Pentoxyfilline Cytoscopy Puckering of penis > Verapamil TRP curving Collegenase Genetics Diabetes Smoking & ETOH Balantis Trauma Inflammation of Hygiene Allergy (soaps/lubes) glans penis Trt underlying Bacterial infection Identifying testicular abnormalities (torsion, hydrocele, spermatocele, varicocele, cancer, etc.) Torsion Cremasteric reflex, prehn sign - Elevated testicle - Effected testicle is horizontal  Hydrocele Extreme scrotal mass - Can shine pen light through it to see fluid Spermatocele Incidental scrotal mass at head of epididymis Varicocele Testicles will look like a bag of worms with Valsalva maneuver Cancer Often painless mass Negative transillumination test Identifying male GU cancers - Testicular o Painless testicular mass* - Prostate o Usually asymptomatic o + PSA levels greater than 4 Phimosis versus Paraphimosis Phimosis Paraphimosis Inability to retract the prepuce over the Prepuce of penis gets trapped and cannot be glands reduced What is a male GU emergency? - Torsion Organisms of common sexually transmitted infections - Stages of syphilis and clinical presentation Primary Chancre* = primary lesions Painless local infection Secondary 2-12 weeks after intial infection Fever headaches swellling, rash Full body involvement = hepatitis, nephrosis, etc.. Latenet Period between secondary and tertiary Can be less than or more than a year Tertiary Occurs 1-30 years after Can lead to neurosyphillis > meningitis Cardiosyphillis, etc... Week 13 Dermatology Sequela of varicella Diffuse vesicular rash. Small % neurologic impact. Pneumonia. What is onychomycosis? Fungal nail infection Furuncle, carbuncle, and abscess A furuncle, also known as a boil, is a painful, pus-filled bump that forms on the skin when bacteria infects a hair follicle. The bacterium that causes furuncles is Staphylococcus aureus (S. aureus), which is commonly found on the skin and in the nose. While S. aureus is usually harmless, it can cause infections of varying severity if it enters deeper tissue A carbuncle is a skin infection that's a cluster of boils that form a connected area of infection. It's caused by bacteria entering the skin through a broken area, such as a cut, scratch, or puncture wound, and infecting multiple hair follicles. The immune system responds by sending white blood cells to the area, which causes inflammation and the formation of a pus-filled carbuncle An abscess is a painful, swollen lump filled with pus that can develop anywhere in the body. It's usually caused by a bacterial infection, such as E. coli, enterococcus, staphylococcus, or streptococcus. When the body's immune system fights an infection, white blood cells travel to the infected area and build up in the damaged tissue, causing inflammation and the formation of a pocket. This pocket fills with pus, which is made up of living and dead white blood cells, germs, fluid, and dead tissue Symptoms of atopic dermatitis Associated with Asthma/ allergic rhinitis. Highly pruritic, eczema. Management: Gentle bathing, generous emollients.  exposure to triggers. Severe: Topical steroids and antihistamines. Organisms causing common skin d/o (thrush, impetigo, varicella, etc.) Thrush→ candida Impetigo→ staph or strep Varicella→ chickenpox Folliculitis→ Staph Aureus Shingles→ herpes zoster Warts→HPV Erythema infectiosum (Fith Disease) “Slapped face”→ Human parvovirus Hand, foot and mouth → Coxsackie virus  Erythema migrans→Borrelia burgdorferi (Lyme Disease) Risks, presentation, and treatment of common derm abnormalities (scabies, impetigo, tinea, atopic dermatitis, rosacea, acne, seborrheic dermatitis, folliculitis) Scabies: (Mite) Rash. Tx permethrin. 1 st line. If ineffective →malathion. Tinea (Ringworm): Dermatophytoses (Fungal infection). annular Localized lesion. Tx topical antifungal (Clotrimazole, ketoconazole, miconazole, naftine, terbinafine). Widespread infection. Tx oral Terbinafine, itraconazole, fluconazole, griseofulvin. Atopic dermatitis: Highly pruritic, eczema. Associated with Asthma/ allergic rhinitis. Tx. Gentle bathing, generous emollients.  exposure to triggers. Severe: Topical steroids and antihistamines. Rosacea. adults of Northern European heritage. Facial erythema, no comedones. Tx Azelaic acid Acne. Comedones. Teenagers. Benzoyl peroxide, tetracycline or Accutane. Seborrheic dermatitis: Older age. Greasy, yellow scale. Tx. Antifungal agents, topical steroids. Folliculitis: Tx. oral antibiotics. Verruca: Liquid nitrogen, cantharidin, podophyllin. Imiquimod (Genital warts). Condyloma lata : syphilis. Shingles. Varicella virus. Tx Acyclovir. Unilateral-not symmetrical lesions. Impetigo. Children. Honey-colored crust lesions. Staph/strep. Oral antibiotics. Topical mupirocin. > Severe. IV Abx (Nafcillin/Vanco) Trush. Candida albicans. Tx Topixal azoles, nystatin powder/cream/mouthwash. Clinical features associated with rosacea Usually in adults of Northern European heritage. Central of the face with flushing(erythema). No comedones. Triggered: Sun light, ETHO, caffeine, spicy food. Management: Azelaic acid (Antibacterial, Keratolytic , comedolytic, anti-inflammatory) Know terminology associated with common skin lesions (papule, pustule, comedone, etc.) Macule: A flat, non-palpable skin lesion measuring ≤ 1 cm in size o Differs in color from surrounding skin (hypopigmented/hyperpigmented or erythematous) o Not raised or depressed compared to the skin surface o Examples: Freckles, Moles,Café-au-lait macules, Macules in rubella, Macules in measles Patch: A flat skin lesion measuring > 1 cm in size o Differs in color from the surrounding skin o Nonpalpable and larger than a macule  o Examples include vitiligo and melasma Papule: A raised, palpable skin lesion measuring ≤ 1 cm in diameter o Red, black, brown o Examples. Nevi, warts, lichen planus, seborrheic keratoses, angioma, skin CA Plaque: palpable Raised skin lesion > 1 cm in diameter o Example: Psoriasis, eczema, seborrheic dermatitis, granuloma Nodule: Large, firm raised lesion. Measures 1-5cm. o Surface may be smooth. Keratotic, ulcerated or fungating. o Examples: Neurofibromas, cyst, lipomas. Vesicle: Small, fluid filled blister. Raised, translucent fluid. o ExampleL Chickenpox, Herpes zoster, impetigo, dermatitis herpetiformis. Bulla: A LARGE, clear-fluid blister. o Ex. Burns, bites, contact dermatitis, drug reaction. Autoimmune bullous pemphigoid. Urticaria (Hives): Sharply demarcated and elevated lesions. Disappear w/in 24 hrs. o Insect stings, medication hypersensitivity, autoimmune. Pustule: Vesicle filled with pus. o Examples: Folliculitis, acne, scabies, postular psoriasis. Comedone: Black heads. skin oil glands are clogged. Clinical findings with psoriasis. (Autoimmune disorder) Chronic Plaque Psoriasis * Symmetric well defined salmon colored plaques Thick silvery scales Auspitz Sign= pinpoint bleeding Guttate Psoriasis Strep infection Dew drop fine scales Small salmon colored papules Pustular Psoriasis Painful plaques Erythrodermic Psoriasis Erythema When is sentinel lymph node biopsy indicated with melanoma? - First draining of a lymph node in the lymphatic system of a tumor - Performed for clinically negative nodes o Lesions > 0.8mm thick OR that have any ulceration Know ABCDE Patho of acne vulgaris Accumulation of lipids and keratin in follicular unit. Common bacteria: Cutibacteria acne. Bacteria converts sebum into fatty acid and elicits and inflammatory response. Comedones, nodules, nodulocystic lesions. Management: Benzoyl peroxide, doxycycline, o Isotretinoin: For severe nodulocystic scarring acne oral. Teratogenic. What is folliculitis? Inflammation and infection of hair follicles. Treatment. Oral abx. Furuncle, carbuncle, and abscess. Understand urticaria patho and management IgE – Type I. Release of histamines causes vasodilation. Blanching redness. Management: Antihistamines. (Cetirizine, loratadine) Define nevus - A benign neoplasm of the skin