GroupExam4SG.docx

**[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 | **What is looks...

**[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 | **What is looks like / How we | | Location** | know** | +===================================+===================================+ | Radial Head Fracture , Elbow | Posterior Fat Pad Sign | | | | | Supracondylar Fracture = Most | | | common in kids \* | | +-----------------------------------+-----------------------------------+ | 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 - 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 - Leads to weakness, and paralysis on one side of the body with sensory loss on the other - 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 - Usually in African Americans, obese, boys - 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 - 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 - 1^st:\ Osteoporosis\ from\ osteolytic^ - 2^nd\ mixed\ phase\ sclerosis\ and\ osteolytic^ - 3^rd\ 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: - Breast cancer in 1st- or 2nd-degree relatives (mother, grandmother, sister) - Ashkenazi Jewish descent - Hormonal influences: long hormone exposure due to early Menarche and/or late menopause - Genetic mutations (examples): - *BRCA1* (on chromosome17q) - *BRCA2* (on Chromosome 13q) - *p53* (on chromosome 17) - Increasing age - Breast cancer on the contralateral side Modifiable risk factors: - Lifestyle factors that increase the risk: - High-fat diet - Obesity (especially after menopause) - Heavy alcohol use - Tobacco - Hormonal influences that increase the risk: - Higher age at 1st delivery (\> 30 years of age) - Nulliparity - 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: - Represents the time during which the follicle and its oocyte develop, leading up to ovulation - Spans from menses onset (day 1) to the day before the surge of luteinizing hormone (LH), leading to ovulation - Length: 14 to 21 days (may be shorter, especially in perimenopause) - Luteal phase: - The time after ovulation when the ovary produces hormones to support a potential pregnancy and maintain a healthy endometrium. - Spans from the day of LH surge until the onset of the next menses - 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 - 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= 1^st^ sign in | | | girls | | | | | | - Usually 7-14 YO | +===================================+===================================+ | Pubarche | Armpit hair and pubic hair | | | | | | - 8-15 | +-----------------------------------+-----------------------------------+ | Growth Spurt | Insulin growth hormone | +-----------------------------------+-----------------------------------+ | Menarche | 1^st^ 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:** **Males:** **Know common gynecology terms (amenorrhea, menorrhagia, etc.)** - Oligomenorrhea -- periods that occur more than 35 days apart, less than 9 cycles per year - Polymenorrhea -- Periods that occur less than 21 days apart - Menorrhagia -- now called AUB/HMB -- more than 80ml of blood in 7 days - Metrorhagia - irregular bleeding between menses - Dysmenorrhea -- painful periods - Primary type begins with adolescents that attain ambulatory cycles, no pelvic pathology - Secondary type is due to pelvic pathology or a recognized medical condition such as endometriosis - Amenorrhea -- No menses **Differentiating primary and secondary amenorrhea, evaluation, and management** - Primary type begins with adolescents that attain ambulatory cycles, no pelvic pathology - Secondary type is due to pelvic pathology or a recognized medical condition such as endometriosis - Amenorrhea -- No menses [SECONDARY AMENORRHEA:] Osteopenia/Osteoporosis screening **[Osteopenia/Osteoporosis screening ]** **OSTEOPOROSIS IN WOMEN:** **DEXA INTERPRETATION:** Screening for secondary osteoporosis -- primary hyperparathyroidism or secondary hyperparathyroidism with chronic renal failure Hyperthyroidism Multiple myloma Biochemical markers occur in response to repair, fatigue, damage, and microfracutures in the bone = serum C telopeptide CTX and Urinary NTX Also test for alkaline phosphatase and osteocalcin Bone turnover markers for borderline patients Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to the rise of fracture Decreased bone density Bone remodeling - equilibrium between formation by osteoblasts and resorption by osteoclasts Peak bone mass is achieved at thirty years Bone loss occurs in 0.3-.5% per year around the 4^th^ to 5^th^ decade Loss is accelerated with menopause **Criteria for diagnosing HIV/AIDS** - 4th-generation enzyme immunoassay (EIA) for HIV-1 and --2 - If -- do nothing - If + test for HIV 1 & 2 antibodies - Western blot test - 2 bands = + - Reverse transcriptase polymerase chain test RT-PCT **Labs before initiating HIV treatment** - Viral Load - Should decrease if trtmt is working - CD 4 t-cells - Should increase with trtmt Risks, presentation, and treatment of common male GU abnormalities (priapism, hypospadias, epispadias, Peyronie's, balanitis, etc.) +-----------------+-----------------+-----------------+-----------------+ | Priapism | Medications | Prolonged rigid | Intracavernosal | | | | erection | phenylephrine | | | Age (30) | | injection | | | | | | | | Sickle cell | | Surgery | | | | | | | | Leukemia | | | +=================+=================+=================+=================+ | Hypospadias | Environmental | Abnormal | Surgery | | | | opening of | | | | Genetic | urethera on | | | | | ventral side of | | | | Endocrine | penis | | +-----------------+-----------------+-----------------+-----------------+ | Epispadias | Abdominal wall | Abnormal | Surgery | | | defects | opening of | | | | | urethera on | | | | Exstorphy of | dorsal side of | | | | bladder | penis | | +-----------------+-----------------+-----------------+-----------------+ | Peyronie's | Catheterization | Fibrotic | Pentoxyfilline | | | | plaques \> ED | | | | Cytoscopy | | Verapamil | | | | Puckering of | | | | TRP | penis \> | Collegenase | | | | curving | | | | Genetics | | | | | | | | | | Diabetes | | | | | | | | | | Smoking & ETOH | | | +-----------------+-----------------+-----------------+-----------------+ | Balantis | Trauma | Inflammation of | Hygiene | | | | glans penis | | | | Allergy | | Trt underlying | | | (soaps/lubes) | | infection | | | | | | | | Bacterial | | | +-----------------+-----------------+-----------------+-----------------+ 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 - Painless testicular mass\* - Prostate - Usually asymptomatic - \+ PSA levels greater than 4 **Phimosis versus Paraphimosis** Phimosis Paraphimosis -------------------------------------------------- ----------------------------------------------------- Inability to retract the prepuce over the glands Prepuce of penis gets trapped and cannot be 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.)** - Thrushà candida - Impetigoà staph or strep - Varicellaà chickenpox - Folliculitisà Staph Aureus - Shinglesà herpes zoster - WartsàHPV - Erythema infectiosum (Fith Disease) "Slapped face"à Human parvovirus - Hand, foot and mouth à Coxsackie virus - Erythema migransàBorrelia 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 àmalathion. - **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 - Differs in color from surrounding skin (hypopigmented/hyperpigmented or erythematous) - Not raised or depressed compared to the skin surface - Examples: Freckles, Moles,Café-au-lait macules, Macules in rubella, Macules in measles - **Patch**: A flat skin lesion measuring \> 1 cm in size - Differs in color from the surrounding skin - Nonpalpable and larger than a macule - Examples include vitiligo and melasma - **Papule**: A [raised], palpable skin lesion measuring ≤ 1 cm in diameter - Red, black, brown - Examples. Nevi, warts, lichen planus, seborrheic keratoses, angioma, skin CA - **Plaque**: palpable Raised skin lesion \> 1 cm in diameter - Example: Psoriasis, eczema, seborrheic dermatitis, granuloma - **Nodule**: Large, firm raised lesion. Measures 1-5cm. - Surface may be smooth. Keratotic, ulcerated or fungating. - Examples: Neurofibromas, cyst, lipomas. - **Vesicle**: Small, fluid filled blister. Raised, translucent fluid. - ExampleL Chickenpox, Herpes zoster, impetigo, dermatitis herpetiformis. - **Bulla**: A LARGE, clear-fluid blister. - Ex. Burns, bites, contact dermatitis, drug reaction. Autoimmune bullous pemphigoid. - **Urticaria** (Hives): Sharply demarcated and elevated lesions. Disappear w/in 24 hrs. - Insect stings, medication hypersensitivity, autoimmune. - **Pustule**: Vesicle filled with pus. - 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 - 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, - **[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