Clin Path Final Dx.txt

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primo1289
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223887
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Clin Path Final Dx.txt
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2013-06-14 21:31:17
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UWS Clinical Pathology
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Essential Dx Cards for Final
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  1. ACUTE BACTERIAL PROSTATITIS
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Fever
    • -Irritative voiding symptoms
    • -Perineal or suprapubic pain; exquisite tenderness common on rectal
    • Examination
    • -Positive urine culture
  2. CHRONIC BACTERIAL PROSTATITIS
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Irritative voiding symptoms
    • -Perineal or suprapubic discomfort, often dull and poorly
    • -Localized
    • -Positive expressed prostatic secretions and culture
  3. BLADDER CANCER
    • ESSENTIALS OF DIAGNOSIS (CMDT 2011, p. 1570)
    • -Irritative voiding symptoms
    • -Gross or microscopic hematuria
    • -Positive urinary cytology in most patients
    • -Filling defect within bladder noted on imaging
  4. BENIGN PROSTATIC HYPERPLASIA
    • ESSENTIALS OF DIAGNOSIS (CMDT 2011, p. 921)
    • -Obstructive or irritative voiding symptoms
    • -May have enlarged prostate on rectal exam
    • -Absence of urinary tract infection, neurologic disorder, stricture
    • disease, prostatic or bladder malignancy
  5. PROSTATE CANCER
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Prostatic induration on DRE or elevation of PSA
    • -Most often asymptomatic
    • -Rarely: systemic symptoms (weight loss, bone pain).
  6. RENAL CELL CARCINOMA
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Gross or microscopic hematuria
    • -Flank pain or mass in some patients
    • -Systemic symptoms such as fever, weight loss may be prominent
    • -Solid renal mass on imaging
  7. ADULT RHEUMA TOlD ARTHRITIS
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Usually insidious onset with morning stiffness and pain in affected joints
    • -Symmetric polyarthritis with predilection for small joints of the hands and feet;
    • deformities common with progressive disease
    • -Radiographic findings; juxta-articular osteoporosis, joint erosions, and joint space
    • narrowing
    • -Rheumatoid factor and antibodies tcyclic citrul!inated peptides, (anti-CCP) are present in 70-80%
    • -Extra-articular manifestations: subcutaneous nodules, pleural effusion;
    • pericarditis, lymphadenopathy, splenomegaly with leukopenia and vasculitis
  8. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Occurs mainly in young women
    • -Rash over areas exposed to sunlight
    • -Joint symptoms in 90% of patients.
    • -Multiple system involvement
    • -Anemia, leukopenia, thrombocytopenia
    • -Glomerulonephritis, central nervous system disease, and complications of
    • anti phospholipid antibodies are major sources of disease morbidity
    • -Serologic findings: ANA (100%), anti-native DNA, antibodies (-213), and low
    • serum complement levels (particularly during disease flares)
  9. SYSTEMIC SCLEROSIS (SCLERODERMA)
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Limited disease (80%): thickening of skin confined tthe face, neck, and
    • distal extremities
    • -Diffuse disease (20%): widespread thickening of skin, including truncal
    • involvement, with areas of increased pigmentation and depigmentation
    • -Raynaud phenomenon and ANA are present in virtually all patients
    • -Systemic features of gastroesophageal reflux, hypmotility of Gl tract,
    • pulmonary fibrosis, pulmonary hypertension, and renal involvement
  10. IDIOPATHIC INFLAMMATORY MYOPATHIES (POLYMYOSITIS and DERMATOMYOSITIS)
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Bilateral proximal muscle weakness
    • -Characteristic cutaneous manifestation in dermatomyositis (Gottron
    • papules, heliotrope rash)
    • -Diagnostic tests: elevated creatine kinase, muscle biopsy, EMG, MRI
    • Increased risk of malignancy, particularly in dermatomyositis
  11. SJOGREN SYNDROME
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Women are 90% of patients; the average age is 50 years
    • -Dryness of eyes and dry mouth (sicca components) are the most
    • common features; they occur alone or in association with rheumatoid
    • arthritis or other connective tissue diseases
    • -Rheumatoid factor and other autoantibodies common
    • -Increased incidence of lymphoma
  12. POL YMYALGIA RHEUMATICA (PMR) & GIANT CELL ARTERITIS (GCA)
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Age over 50 years
    • -GCA is characterized by visual abnormalities, and a markedly
    • elevated ESR
    • -The hallmark of PMR is pain and stiffness in shoulders and hips
    • lasting for several weeks without other explanation
  13. ANKYLOSING SPONDYLITIS (AS. MARIE-STRUMPELL DISEASE)
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Chronic low backache in young adults, generally worst in the morning
    • -Progressive limitation of back motion and of chest expansion
    • -Transient (50%) or persistent (25%) peripheral arthritis
    • -Anterior uveitis in 20-25%
    • -Diagnostic radiographic changes in sacroiliac joints
    • -HLA-827 testing is most helpful when there is an indeterminate probability
    • of disease
  14. PSORIATIC ARTHRITIS
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Psoriasis precedes onset of arthritis in 80% of cases
    • -Arthritis usually asymmetric, with "sausage" appearance of fingers and
    • toes but a polyarthritis that resembles rheumatoid arthritis alsoccurs
    • -Sacroiliac joint involvement common; ankylosis of the Sl joints may occur
    • -Radiographic findings: osteolysis, pencil-in-cup deformity,; relative lack of osteoporosis, bony ankylosis; asymmetric Sl and atypical
    • -syndesmophytes
  15. REACTIVE ARTHRITIS (formerly called REITER'S SYNDROME)
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -50-80% of patients are HLA-B27 positive
    • -Oligoarthritis, conjunctivitis, urethritis, and mouth ulcers most common
    • features
    • -Usually follow dysentery or a sexually transmitted infection
  16. GOUTY ARTHRITIS
    • ESSENTIAL OF DIAGNOSIS (CMDT)
    • -Acute onset, typically nocturnal and usually monarticular, often involving
    • the first MTP joint
    • -Polyarticular involvement more common in patients with long-standing
    • disease
    • -Identification of urate crystals in joint fluid or tophi is diagnostic
    • -Dramatic therapeutic response to NSAIDs
    • -With chronicity, urate deposits in subcutaneous tissue, bone, cartilage,
    • joints, and other tissues
  17. NONGONOCOCCAL SEPTIC ARTHRITIS
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Acute onset of inflammatory monoarlicular arthritis, most often in large
    • weight-bearing joints and wrists
    • -Previous joint damage or injection drug abuse common risk factors
    • -Infection with causative organisms commonly found elsewhere in body
    • -Joint effusions are usually large, with WBC counts commonly > 50KimcL
  18. GONOCOCCAL SEPTIC ARTHRITIS
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Prodromal migratory polyarthralgias
    • -Tenosynovitis most common sign
    • -Purulent monarthritis in 50%
    • -Characteristic skin lesions
    • -Most common in young women during menses or pregnancy
    • -Symptoms of urethritis frequently absent
    • -Dramatic response tantibiotics
  19. LYME DISEASE (LYME ARTHRITIS, LYME BORRELIOSIS)
    • ESSENTIALS OF DIAGNOSIS (CMDT 2011, p. 1415)
    • -Erythema migrans
    • -Headache or stiff neck
    • -Arthralgias, arthritis, and myalgias; arthritis is often chronic and recurrent
    • -Wide geographic distribution, with most US cases in NE, mid-Atlantic,
    • upper Midwest, and Pacific coastal regions
  20. ACUTE RHEUMATIC FEVER (ARF)
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Uncommon in the US; more common in developing countries
    • -Peak incidence ages 5-15 years
    • -Diagnosis based on Jones criteria and confirmation of streptococcal
    • infection
    • -May involve mitral and other valves acutely, rarely leading to heart failure
  21. OSTEOPOROSIS
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Fracture propensity of spine, hip, pelvis, and wrist from
    • demineralization
    • -Serum PTH, calcium, phosphorus, and alkaline phosphatase usually
    • normal
    • -Serum 2-hydroxyvitamin D levels often low as a comorbid condition
  22. OSTEOMALACIA
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Painful proximal muscle weakness (especially pelvic girdle); bone pain and
    • tenderness
    • -Decreased bone density from defective mineralization
    • -Laboratory abnormalities may include increases in alkaline phosphatase,
    • decreased 25 OH-D3, or hypocalcemia, hypophosphatemia, secondary
    • -hyperparathyroidism
    • -Classic radiologic features may be present
  23. PAGET'S DISEASE (OSTEITIS DEFORMANS)
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Often asymptomatic
    • -Bone pain may be first symptom
    • -Kyphosis, bowed tibias, large head, deafness, and frequent fractures
    • -Serum calcium and phosphate normal, ALP elevated, urinary
    • hydroxyproline elevated
    • -Dense, expanded bones on radiographs
  24. PRIMARY HYPERPARATHYROIDISM (PHPT)
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Frequently detected incidentally by screening
    • -Renal calculi, polyuria, hypertension, constipation, fatigue, mental changes
    • -Bone pain; rarely, cystic lesions and pathologic fractures
    • -Serum and urine calcium elevated; urine phosphate high with low to
    • normal serum phosphate; alkaline phosphatase normal televated
    • -Elevated PTH
  25. HYPOPARATHYROIDISM
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Tetany, carpopedal spasms, tingling of lips and hands, muscle and
    • abdominal cramps, psychological changes
    • -Positive Chvostek sign and Trousseau phenomenon
    • -Serum calcium low; serum phosphate high; alkaline phosphatase normal;
    • calcium excretion reduced
  26. HYPOTHYROIDISM
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Weakness, fatigue, cold intolerance, constipation, weight change,
    • depression, menorrhagia, hoarseness
    • -Dry skin, bradycardia, delayed retum of deep tendon reflexes
    • -Anemia, hyponatremia, hyperlipidemia
    • -FT 4 level is usually low
    • -TSH elevated in primary hypothyroidism
  27. THYROTOXICOSIS- HYPERTHYROIDISM
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Sweating, weight loss or gain, anxiety, palpitations, loose stools, heat
    • intolerance, irritability, fatigue, weakness, menstrual irregularity
    • -Tachycardia; warm, moist skin, stare, tremor
    • -In Grave's disease: goiter often with bruit, ophthalmopathy
    • -Suppressed TSH in primary hyperthyroidism, increased T4, FT4, T3, FT3
  28. TYPE 1 DIABETES MELLITUS
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Polyuria, polydipsia, and weight Joss associated with random plasma
    • glucose >= 200 mgldL
    • -Plasma glucose of 126 mgldL or higher after an overnight fast,
    • documented on more than one occasion
    • -Ketonemia, ketonuria, or both
    • -Islet autoantibodies are frequently present (not present in Idiopathic
    • Type 1)
  29. TYPE 2 DIABETES MELLITUS
    • ESSENTIALS OF DIAGNOSIS (CMDT)
    • -Most patients are over 40 years and obese
    • -Polyuria and polydipsia
    • -Ketonuria and weight loss generally are uncommon at time of diagnosis
    • -Candidal vaginitis in women may be an initial manifestation
    • -Many patients have few or nsymptoms
    • -Plasma glucose of 126 mgldL or higher after an overnight fast on more
    • than one occasion
    • -After 75 g oral glucose, diagnostic values are 200 mgldL or more 2
    • hours after the oral glucose
    • -Hypertension, dyslipidemia, and atherosclerosis are often associated

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