Path 2 Lab Final

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nakomarose
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Path 2 Lab Final
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2010-09-12 16:10:26
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Path 2 Lab Final
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  1. What is chorea syndrome?
    Jerky movements predominately of facial muscles & extremities
  2. What is Huntington's chorea/disease?
    An incurable, inherited, autosomal dominant disorder characterized by jerky movememnts & progressive dementia (leads to loss of intellect)
  3. What causes Huntington's?
    Atrophy of the striatal neurons (caudate, putamen, & globus pallidus nuclei) resulting in motor fxn disturbances such as jerky movements
  4. What part of body is involved in Huntington's?
    The entire body, but mostly the extremities & facial muscles
  5. When does Huntington's develop?
    normally b/w 30-35 yoa
  6. What is the Huntington gene?
    Gene that regulates the normal fxn of striatal nuclei. Normally the body has 33 CAG triplets but in Huntingtons there are extra. The more extra, the earlier the onset.
  7. What diseases/disorders sometimes accompany Huntington's?
    Parkinson's or hypokinesia/rigidity
  8. How long before death occurs in Huntington's patients?
    Usually within 15 years from onset of infection from a weakening immune system (#1 cause) or suicide (#2 cause)
  9. What is ex-vacuo hydrocephalus?
    Atrophy of the neurons along the ventricular walls causes distention of the ventricles; does not lead to increased ICP
  10. What is Syndeham's Chorea?
    An acquired disorder associated w/ rheumatic fever
  11. When is onset of Syndeham's?
    In pts younger than 15 yoa, usually female
  12. What symptoms are associated w/ Syndeham's?
    Mild vasculitis of cerebral vessels
  13. Is Syndeham's curable?
    Yes
  14. What is syringomyelia?
    Condition in which a tubular cavity in the central area of the SC gradually expands & produces neuronal & tract damages. Accumulation/obstruction of CSF in the central canal causes distention
  15. About 95% of syringomyelia pts develop what disorder?
    Type 1 Arnold-Chiari malformation
  16. What is Type 1 Arnold-Chiari malformation?
    • Inborn inclanation of cerebellar tonsils into the CSF
    • Associated w/ the cerebellum & medulla protruding through the foramen magnum which leads to compression of the brainstem (which causes breaking of the fibers) & hydrocephalus (lumen narrows, CSF can't leave)
  17. How does Type 1 Arnold Chiari Malformation affect the body?
    • Affects the spinothalamic tract causing loss of pain & temp sensation
    • Cervical involvement of the shoulder jt shows shawl/cape like distribution, shoulder may swell, & humeral head may undergo lysis (just shoulder jt)
  18. What is meningitis?
    Inflammation of the dura mater & tissues around the subarachnoid space
  19. What are factors that influence meningitis infection?
    • Pathogen virulence
    • Strength of immunity
    • Predisposing risk factors
  20. What are some predisposing risk factors to meningitis?
    • Exposure of head to cold
    • Sinusitis
    • Otitis media or accumulation of pus in the middle ear
    • Pneumonia leading to pleural empyema (widespread accumulation of pus in pleural cavity)
    • Basal skull fracture
  21. 2 causes of meningitis that have the highest fatality rate
    • Epidural abscess- in SC can compress nerve roots
    • Subdural empyema- can spread to other meninges
    • MC by staph/strep
  22. What are the types of meningitis?
    • Acute (purulent) leptomeningitis
    • Acute lymphatic (viral) leptomeningitis aka aseptic meningitis
    • Chronic Meningitis
    • TB meningitis
    • Syphilitic meningitis
  23. Causes of acute (purulent) leptomeningitis in infants & young children
    • Bacteria:
    • Hemophilus influenza- pus around the bottom of the brain
    • Streptococcus pneumoniae- pus around the hemispheres
  24. Causes of acute (purulent) meningitis in older children & young adults
    Neisseria meningitis
  25. Causes of acute (purulent) leptomeningitis in older adults & elderly
    • Streptococcus pneumoniae
    • Listeria monocytogenes
  26. Clinical manifestations of acute (purulent) leptomeningitis
    • HA
    • Hydrocephalus & increased ICP
    • Fever
    • Neck pain (stiffness)
    • Mental disorder (disorientation or decreased cognitive fxn)
  27. CSF findings in acute (purulent) leptomeningitis
    CSF from lumbar puncture will show increased neutrophils, increased proteins from exudate, & decreased glucose
  28. Causes of acute lymphatic (viral) leptomeningitis aka aseptic meningitis
    • Caused by virus, not bacterial
    • Mumps virus- parotiditis (may cause viral meningitis or orchitis)
    • Echo virus
    • Coxsackie virus
    • Epstein-Barr virus
  29. Clinical Manifestations fo acute lymphatic (viral) leptomeningitis
    • HA
    • Hydrocephalus & increased ICP
    • Fever
    • Neck pain (stiffness)
    • Mental disorder (disorientation or decreased cognitive fxn)
  30. CSF findings of acute lymphatic (viral) leptomeningitis
    CSF shows increased lymphocytes, increased proteins, & normal glucose levels
  31. Causes of chronic meningitis
    • Myobacterium TB
    • Treponema pallidum
    • Cryptococcus neoformans
    • Brucella species
  32. CSF findings in chronic meningitis
    CSF shows increased monocytes, increased protein, & decreased glucose
  33. What is TB meningitis?
    Accumulation of fibrous tissue at the base of the brain which results in changes in anatomy that compromise the fxn of vessels & nerves
  34. What is tuberculotic spondylitis aka Pott's disease?
    Casseous necrosis of vertebral bodies which leads to formation of hump from collapse of vertebrae
  35. When does syphylitic meningitis usually occur?
    Usually develops in the second stage of syphilis
  36. Charateristics of syphilitic meningitis (from secondary syphilis)
    • Generalized lymphadenopathy (cervical & groin)
    • Skin rash- condylomata lata
    • Chronic meningitis
    • Serologically positive
    • Duration 2 months
  37. Symptoms of tertiary syphilis
    • Gummatous necrosis
    • Involvement of posterior columns- Tabes dorsalis
    • Associated w/ atrophy of the cortical layer of the brain
    • aka general paresis of the insane
    • Grey matter atrophy (stupid)
    • Cardiovascular- syphilitic aortitis (aortic insufficiency)
  38. Time frame b/w onset of secondary & tertiary syphilis?
    10-15 years
  39. Any inflammatory disease leads to what?
    Full jt fusion (eventually)
  40. What is seronegative spondyloarthritis?
    Inflammation of verterbral jts
  41. Characteristics of seronegative spondyloarthritides
    Pathological changes beginning in the ligamentous attachments to the bone, rather than in the synovium
  42. What is an -enthesis?
    Insertion of the ligament/tendon to bone; very rich w/ nociceptors (painful) and has a poor blood supply (limited healing)
  43. What joints are involved w/ seronegative spondyloarthritis?
    100% involvement of SI jts along w/ 50-75% involvement w/ peripheral inflammatory arthritis
  44. What lab factors are associated w/ seronegative spondyloarthritis?
    • Absence of rheumatoid factor
    • HLA-B27- 95-97% of people w/ AS are HLAB27 +, while only 5% of gen population are +
  45. What is inflammatory enthesopathy?
    Ossification of the outer layers of the annulus fibrosis (sharpey's fibers)
  46. What is a syndesmophyte?
    Complete ossification forming a bony bridge (in AS- of ivd so that 2 vertebrae can't move)
  47. What 2 inflammatory bowel diseases are associated w/ seronegative spondyloarthritis?
    Crohn's & ulcerative colitis
  48. What are aka's of ankylosing spondylitis?
    • Marie-Strumpells
    • Bechterew's
  49. What are symptoms of ankylosing spondylitis?
    • Severe low back pain (young people- age crucial)
    • Non-mechanical pain that is severe in the morning & diminishes during the day
    • Relieved by exercise
  50. What tests can be used to determine if a pt has AS?
    • Measure under the nipple line w/ full inspiration & full expiration - normal chest expansion is 6-12 cm & less than 3 cm indicates AS
    • Finger to floor exam will show decreased flexibility
    • Decreased ROM in all 3 plane
    • All signs b/c spine fuses together
  51. What are some complications of AS?
    • Iridocycitis
    • Dilation of the aortic ring w/ aortic insufficiency
  52. What is iridocycitis?
    • aka Iritis
    • Irregularly shaped pupil due to adhesion of the iris to lens from inflammation/exudates
  53. What are the 3 MC causes of aortic insufficiency
    • 1 Bacterial endocarditis
    • 2 Syphilis
    • 3 Ankylosing spondylitis
  54. What part of the body does psoriatic arthritis affect?
    Joints more so than spine
  55. How much of the population has psoriatic arthritis?
    • 2-7% have psoriasis w/ an avg 5%
    • 2-7% of those people have arthritis & spondylitis
  56. Is psoriatic arthritis slow or rapid?
    Very rapid
  57. What bone can be destroyed by psoriatic arthrits?
    Occiput
  58. What are the signs & symptoms of psoriatic arthritis?
    • Dermatosis
    • Joint involvement
    • Pitting of nails
    • Pencil in cup deformity (on x-ray)
  59. What is dermatosis?
    Non-inflammatory disease of skin; common areas include the scalp, axilla, belly button, groin (hair portions), & elbows
  60. What joints are involved w/ psoriatic arthritis?
    • Asymmetrical involvement of jts of hands/feet
    • Advanced-> chaotic deformity of jts
    • Axial arthritis- one entire finger/toe
  61. What is axial arthritis & what diseases is it involved in?
    • Only in psoriatic & Reiter's
    • Asymmetrical
    • Involvement of one entire finger/toe
    • Causes sausage toe
  62. What is arthritis mutilans?
    • Special type of psoriatic arthritis
    • Marked by intra-articular osteolysis
    • Bone is lost & tissue retracts resulting in shrinking toes/fingers
    • Painless
  63. What are charateristics of Reiter's syndrome?
    Infection, typically chlamydia (MC std in US) or various intestinal infections often in children
  64. Are men or women more predispositioned to get Reiter's?
    Men
  65. What percentage of pts fully recover from Reiter's?
    20%
  66. What are the signs & symptoms of Reiter's syndrome?
    • 4 major signs: Can't see, can't pee can't dance w/ me
    • Bilateral conjuctivitis
    • Urethritis
    • Arthritis of peripheral & spinal jts
    • Keratoderma
  67. What part of the body does arthritis associated w/ Reiter's syndrome affect?
    • Spine almost all of the time
    • Larger or medium sized jts
    • Assymetrical
    • Mostly leg jts rarely arms
    • Bilateral & symmetrical SI jts
  68. What is urethritis?
    painful urination or balanitis
  69. What is keratoderma?
    pustules on the soles or palms
  70. What are manifestations of Reiter's syndrome?
    • achillobursitis associated w/ localized osteopenia stemming from inflammation of soft tissue near the bone
    • Tearing of the achilles tendon (possible not always)
    • Achillodynia
  71. What is achillobursitis?
    swelling of the ankle
  72. What is achillodynia?
    pain in the bursa/tendon; may be w/ or w/o inflammation & bursitis
  73. What is the treatment for Reiter's syndrome?
    Injection of corticosteroids into bursa
  74. What is atelectasis?
    • aka Collapsed lung
    • Loss of lung volume due to incomplete expansion of air spaces
  75. What are the 4 types of atelectasis?
    • Obstructive aka Resorption/Absorption
    • Compressive aka Passive/Relaxation
    • Pathcy aka Microatelectasis
    • Contraction
  76. What is obstructive aka resorption/absorption atelectasis?
    Obstruction of the airways in the alveolar ducts which causes space to become void of air as it is absorbed into circulation which creates a vacuum. The total pressure in the lungs becomes lower than atmospheric pressure which leads to collapse & compression. The decreased space causes the mediastinum to deviate toward the lower pressure (involved side)
  77. What causes obstructive atelectasis?
    • Aspiration of foreign body
    • Excessive secretion of exudates within smaller bronchi (as in COPD)
    • Tumor of any organ in chest, leading to obstruction of the airway
    • Other lung pathologies- bronchial asthma, chronic bronchitis, bronchiectasis
  78. What is compressive atelectasis?
    • Compression of the lung tissue from accumulation of fluid, air, or tissue in the pleural cavity (pleurisy or pneumothorax) which causes the mediastinum to deviate away from the involved lung
    • Reversible
  79. What are causes of compressive atelectasis?
    • Right sided cardiac failure (from vena cava congestion & pooling of blood into the cavities
    • Neoplastic effusions (tumor)
    • Pleural empyema
    • Mesothelioma
    • TB
    • Nephritic syndrome
    • Pleurisy or pneumothorax
  80. What are 2 types of pneumothorax?
    • Traumatic= stabbing- damage to parietal layer
    • Non-tramatic or spontaneous= sickness- damage to visceral layer (#2 cause of death by TB)
    • Rib fracture can involve both layers
    • Causes immediate lung collapse
  81. What are the top 3 causes of pneumothorax?
    • 1 TB
    • 2 Emphysema
    • 3 Interstitial lung disease
  82. What is patchy atelectasis?
    • aka Microatelectasis
    • Due to a loss of pulmonary surfactant
    • Surfactant decreases adhesion strength of the alveoli- w/o surfactant alveoli adhese together
    • Respiratory distress syndrome, common in peds
  83. What is contraction atelectasis?
    • Intersitial lung disease causing replacement of normal lung tissue w/ fibrous CT or scar tissue
    • Irreversible

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