Mini 3 Clinical correlates
Ross Med Semester 1 Mini 3 October 2013
Terms in this set (80)
Hereditary dynein defect leading to male sterility and infections
What do cytomegalovirus and cholera toxins do? ($)
Make tight junctions (zonula occludens) permeable.
food poisoning (fluid movement to lumen)
targets Z0 and Z1 (zonula cytoplasmic proteins) in stomach leading to gastric ulcers
Autoantibodies produced against desmosal skin disease proteins leading to blisters
Azygous arch collapse
via tracheal and right lung tumors and enlarged right superior tracheobronchial and hilar nodes
vascular ring anomaly leading to stridor (high pitched wheezing) and dysphagia
Injury to right laryngeal nerve
Due to compression. unilateral leads to voice hoarseness and bilateral leads to voice loss
Referred pain to phrenic nerves
hiccup reflex, stomach pain, involves C3-C5
Thoracic Aortic Anuerysm
Four locations abdominal variant has a high risk of rupture and dissection causing internal bleeding
Esophageal Diverticula Parabrachial diverticulum
is "true" traction and protrusion of all layers due to tumors "pulling force from outside"
Esophageal Diverticula Epiphrenic diverticulum
"false" pulsion, herniation of mucosa and submucosa through weakness in muscular coats due to neuromuscular dysfunction
lymph nodes in left supraclavicular fossa
indicative of gastric cancer through thoracic duct (enlarged Virchow's nodes)
Hayfever linked with...
Asthma linked with..
Hyperallergic reaction may lead to...
rupture of spongy urethra
bloody extraversion under scarpa's fascia and in scrotum
if internal, occurs under bladder
Hematoma of Rectus sheath
inferior epigastric artery and vein bleeding due to blunt trauma under umbilical.
may be inguinal, spegelian, epigastric or umbilical. Umbilical is congenital and prevalent in low birth weight infants who have high intra-abdominal pressure
acquired umbilical hernias prevalent in...
females and the obese
epigastric regression through linea alba
to locate appendix, it is 1/3 the way along the ASIS towards the umbilicus line
inflammation of appendix causing pain in umbilical and right lower quadrant leading to rupture (peritonitis as well), use a muscular splitting incision via fiber orientation
damage to conduction system
via ischemia: LAD supplies AV bundle, RCA supplies SA node. Leads to ventricles contracting independently (late asynchronous contraction).
Beck's Triad/ Cardiac Tamponade
Hypotension, jugular venous distension, muffled heart sounds.
Due to Cardiac Tamponade
premature foramen ovale closure
right heart hypertrophy and an under-developed left heart leading to death
Damage to the peritoneum causes inflammation, fibrin deposits, and scar tissue (adhesions). Treatment via adhesiotomy
Intraperitoneal injections are effective because...
High surface area leads to rapid absorption
Short term, temporary treatment for renal failure
Omental Bursa fluid accumulation
due to perforation leads to an inflamed pancreas.
small intestine hernias
causes bowl strangulation
inflammation of the peritoneum due to blood and pus accumulation leading to tender abdomen and fever with vomiting, lethal if widespread
accumulation of peritoneal fluid due to mechanical injury, pathology, starvation, or cancer. Treated with paracentesis and antibiotics.
Herpes simplex 1 is spread through...
affects myelin in CNS, autoimmune episodes of edema, inflammation, and scarring. Problems arise with muscle control, balance, speech, etc. depending on location.
HIV 1 attacks...
microglial cells which produce cytokines when damaged. These cytokines are toxic to neurons.
Esophageal constriction sites
Cervical (by cricopharyngeus), thoracic/bronchoaortic (aorta arch and left main bronchus), and diaphragmatic (esophageal hiatus).
Submucosal vein enlargement caused by portal hypertension and cirrhosis, no symptoms unless varice bleeds (fatal).
stomach protrusion into mediastinum through esophageal hiatus. Sliding (abd. esophagus) versus paraesophageal (fundus).
Tumor in stomach body or pyloric region causing difficulties in surgery due to lymphatics. Treated via gastrectomy.
Gastric: open lesion of stomach ulcer
peptic: lesion of pyloric/duodenum
Most assoc. with heliobacter pylori leading to gastric arterial bleeding and splenic artery erosion. Treated with vagotomy.
Congenital hypertrophic pyloric stenosis ($)
thickening of pylorus smooth muscle leading to stomach dilation, projectile vomiting and weight decrease.
Most injured organ, due to left 9-12th rib fractures or increased intra-abdominal pressure causing intraperitoneal hemorrhage and shock.
insert needle through right 10th inter costal space at midaxillary level, patients should hold their breath.
Large liver due to heart failure, tumors, alcoholism, or leukemia.
Hepatocyte destruction which becomes fibrous tissue. A cause of portal hypertension (portal venous pressure) due to Hepatitic C and alcoholism. Symptoms include jaundice, weakness, and pale stool. Treated with a transplant or portocarval shunt (portal vein anastamoses with IVC). Other complications of portal hypertension: Esophageal varices - "Gut", Rectal Varices - "Butt", Caput medusae - "Caput"
Can be based on cholesterol or bilirubin. Presents with bilary colic and jaundice symptoms.
cystic duct blockage leading to inflammation and pain in the right shoulder/ epigastric region.
Hepatopancreatic amulla blockage
lodged gallstones at major duodenal papilla opening which blocks bilary and pancreatic duct systems. Nothing can properly enter duodenum.
ductular adrenocarcinoma in pancreas head compresses common bile duct and hepatopancreatic ampulla, if in pancreas neck portal vein and IVC are obstructed. Juandice symptoms.
failure to recanalize duodenum, associated with polyhydrominios a "double bubble" and bilirious vomiting.
fossa lies left to 4th part of duodenum. care must be taken to not injure the inferior mesenteric artery and vein (of the left colic artery).
most common developmental bowel anamoly, due to failure of involution of vitteline duct. Always on site of omphaliteric duct attachment on anti-mesenteric border. Ileum diverticulum may become inflammed. Types: fibrous cord between small intestine and umbilicus, cord with cyst, umbilicointestinal fistula, and umbilical sinus
when terminal ileum protrudes into cecum causing cecal obstruction and bloody stools. prevalent in children
having diverticula (wall outpocketing) in colon, if symptomatic it is called diverticular disease.
internal:called piles, rectal mucosa prolapse containing veins and covered by mucous membrane.
external:thromboses (blood clots) in veins of external rectal venous plexus covered by skin.
Digital rectal examination
structures in males: prostate, seminal glands, rectovesical pouch
in females: cervix of uterus, rectouterine pouch.
both: sacrum/coccyx, ischial spine, internal iliac nodes, thickened uterers, ischioanal fossa swelling and inflamed appendix
compression of left renal vein between abdominal aorta and superior mesenteric artery, may cause scrotum swelling due to left testicular vein occlusion
Ischemia of intestines
emboli occlude vasa recta causing ischemia which leads to necrosis and paralytic ileus. Symptoms: colicky pian, vomiting, and dehydration
appearance of distended and engorged paraumbilical veins which join systemic veins. Umbilical veins can be recanalized in portal hypertension.
most common hernia, especially in males, has bimodal distribution. Is classified as direct if medial to epigastric vessels and the hernia will be made of peritoneum and bowel. Classified as indirect if lateral to vessels and the hernia is made of peritoneum, bowel and spermatic cord. Caused by COPD, obesity, pregnancy, heavy lifting, ascites, etc. Treated by Bassini repair (triple suture). Examine by inserting finger in external inguinal ring and feel for cough impulse.
Torsion of spermatic cord
leads to testis necrosis, located above upper pole of testis obstructs venous draining with signs of edema and hemorrhage
Cancer of tests and scrotum
Testis: metastases to lumbar lymph nodes (retroperitoneal, may spread to supraclav. nodes)
scrotum: metastases to superficial inguinal lymph nodes
bilateral incisions to small scrotal wall and vas /ductus deferens. Sperm may be present in first few ejaculation but afterwards only fluid secretions from prostate and seminal vesicles. Causes infertility.
Undescended/ cryptorchid testes
30% premature newborn males, 3% in full term, 95% unilateral.
common 4 locations: ab. cavity, inguinal canal (most common), superficial ring, upper scrotum
If maldescent, location are: root of penis, perineum, thigh, and superficial fascia (above superficial inguinal ring).
Hydroceles (2 main types)
presence of excess fluid in persistent processus, congenital, may arise in spermatic cord
non. communicating hydrocele: obliterated p. vaginalis and tunica vaginalis has fluid (no fluid movement between abdominal wall and scrotum)
communicating hydrocele: open p.vaginalis allowing fluid movement, associated with indirect hernia.
hematocele is a variant with blood pools in tunica vaginalis
pampiniform plexus becomes varicose and torturous, "worm" feeling, disappears when person lies down. Due to defective valves in testicular veins/ obstruction.
Canal of Nuck
potent processus vaginalis in females causing cysts and indirect inguinal hernias (relevant to female infants).
What type of inheritance?
Sickle cell anemia
Albinism: autosomal recessive
Sickle cell anemia: autosomal recessive
Cystic fibrosis: autosomal recessive
Huntington's: autosomal dominant
Marfan syndrome: autosomal dominant
Hemophilia: X-linked recessive
crystals that cause problems when migrating to urinary pathways, chance of kidney stones is increased with horseshoe kidney
Kidneys are not separated but joined in the middle by connective or functional tissue, can be asymptomatic but due to lowering of the renal pelvis the chance of kidney stones is higher
fluid gathers in kidney tissue, a more severe form is polycystic kidney disease (congenital) where the kidney grows large in size but loses function
involuntary diaphragm contractions, sudden inhalation occurs but is blocked by glottis
potential causes: indigestion, diaphragmatic irritation, alcoholism, and cerebral, abdominal, or thoracic lesions
Psoas signs ($)
indicates irritation to iliopsoas group in abdomen and that inflamed appendix is retrocaecal in orientation.
use Psoas test: with patient in supine position move right flexed leg against hand
with patient on left side push right leg upward
abscess under psoas fascia, diagnosed by a positive psoas sign
caused by TB (esp. in children), may flow into thigh as well
Abdominal aortic aneurysm
due to genetics and physical damage
aorta expands (with a thickened wall), aneurysm may rupture leading to quick death
common location: right before the bifurcation of the aorta
Bronchial hyper-reactivity/sensitivity ($)
physiological state in which patient is susceptible to bronchospasm (lower threshold to Histamine).
Diagnosis: patients breathe in nebulized histamine. degree of constriction is measured. Link to rotten fish susceptibility.
Clinical uses of H1 antagonists
treatment/prevention of hayfever, hives, atopic/contact dermatitis, motion sickness. Used as a prophylactic if taken before allergen encounter
adverse effects of H1 antagonists
sedation (first generation only) especially with alcohol, acute overdose leads to hallucinations, coma, and cardio-resp. collapse.
Most problematic is promethazine- CNS effects, respiratory depression, and gangrene. Contraindication in children less than 2 years old and people with respiratory problems along with certain injection types.