Patho Exam 5


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A patient with chronic reflux esophagitis is evaluated for which possible complication?
to see if the cells of the lower esophagus have changed to precancerous cells through metaplasia, also called Barrett esophagus
How would you tell if your patient had a paralytic ileus?
loss of peristalsis and colicky pain
Which type of gastritis puts a patient at risk for gastric carcinoma?
chronic fundal gastritis
Differentiate the clinical manifestations of a duodenal ulcer and a gastric ulcer.
duodenal ulcer: chronic intermittent pain in the epigastric area. The pain usually begins 2 to 3 hours after eating, when the stomach is empty.

gastric ulcer: pain immediately after eating (food-pain pattern), anorexia, vomiting, and weight loss.
What clinical manifestations are associated with Crohn Disease?
Diarrhea, rectal bleeding occurs if the colon is involved. Weight loss occurs with moderate to severe abdominal pain
What is the treatment for diverticulosis?
an increase in dietary fiber which often relieves the symptoms and helps prevent the formation of more diverticuli. ; nonabsorbable antibiotics.
What clinical manifestations occur with diverticulitis?
fever, leukocytosis (high white blood cell count), and abdominal tenderness
What clinical manifestation usually signals the appendix has ruptured?
periumbilical pain then right lower quadrant pain; N/V, anorexia, low grade fever; rebound tenderness; elevated WBC

***an abrupt relief of symptoms followed by increasing pain
Differentiate anorexia nervosa and bulimia nervosa.
anorexia: fear of becoming obese; distorted body image; body weight 15% of normal; absence of three consecutive menstrual periods

bulimia nervousa: binging followed by purging, two binging episodes per week for at least 3 months; abuse of laxatives
What are clinical manifestations of portal hypertension?
first: subtle changes in personality, memory loss, irritability, lethargy, and sleep disturbances--then progresses to confusion, flapping tremors of the hands (asterixis), stupor, seizures, and coma. Varices, splenomegaly, ascities, hepatic encephalopathy
Which type(s) of hepatitis can cause jaundice?
HAV, Hep B, Hep D, Hep C, and Hep E
During which phase(s) is hepatitis transmissible?
prodromal phase--2 weeks after exposure and ends with the onset of jaundice

but also transmissible during all phases
What clinical manifestations usually accompany jaundice in a patient with hepatitis?
dark urine, light stools, and liver enlargement (hepatomegaly) with tenderness.
How is hepatitis transmitted?
Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis D virus (HDV) associated with HBV, hepatitis C virus (HCV), and hepatitis E virus (HEV). HAV and HEV are transmitted through the fecal oral route. HBV, HDV, and HCV are transmitted through parenteral (blood) and sexual contact. HDV only occurs with HBV.
What puts a patient at risk for developing cirrhosis?
The most common causes are the hepatitis virus (HBV and HCV) and excessive alcohol intake. Other causes include biliary disease, either from an autoimmune response (primary biliary cirrhosis) or from prolonged partial or complete obstruction of the common bile duct (secondary biliary cirrhosis).
What are clinical manifestations of gall bladder disease?
including heartburn, flatulence, epigastric discomfort, and food intolerances, especially to fats and cabbage. The pain usually occurs 30 minutes to several hours after eating a fatty meal. *pain is located Right upper quadrant, radiating to the mid-upper area of the back.
What lab results are characteristic of acute pancreatitis?
**elevated serum lipase

also used: elevated serum amylase
What are the risk factors for esophageal cancer?
change in structure/function, malnutrition, reflux esophagitis, alcohol/tobacco, obesity
What are the screening recommendations for colon/rectal cancer?
starting at age 50 for the avg risk.

FOBT (fecal occult blood test) every year, sigmoidoscopy (Q5 yr) or virtual colonoscopy (Q5 yr) or colonoscopy (Q10 yr)
Primary gall bladder cancer is most commonly associated with which other disease?
cholelithiasis (gallstones)
What characterizes normal synovial fluid?
clear, straw colored, moderately viscous, WBC less than 200 cells/ml
What characterizes oblique fractures?
an angle across the bone, less stable and harder to keep in proper alignment than a transverse fracture, caused by a slanted blow to the bone

frequently seen in the long bones of the arms and legs
What characterizes spiral fractures?
encircles the bone and is usually cased by twisting of the limb; commonly occurs in snow skiing accidents
What characterizes stress (fatigue) fractures?
occurs in individuals who engage in new or different activity that is both repetitive and strenuous, such as occurs with joggers, skaters, dancers, or military recruits.
What characterizes greenstick fractures?
perforates one side of the bone and splinters the spongy inside of the bone
What are clinical manifestations of osteoporosis?
the bones become fragile and falls or bumps that would not have caused a fracture previously now cause the bone to break

loss of bone density, hunchback (kyphosis) and decreased height
What are clinical manifestations of osteoarthritis?
pain in one or more joints, joint tenderness and stiffness; loss of joint flexibility, grating sensation may be heard when using the joint

Most commonly affects the joints in the hands, knees, hips and spine
Deformities: Bouchard and Heberden nodes
What are clinical manifestations of rheumatoid arthritis?
tender, warm, swollen joints; morning stiffness lasting more than one hour; firm nodules under the skin of the arms (rheumatoid nodules); and fatigue, fever, and weight loss

Most commonly affects fingers, wrists, elbows, shoulders, knees and ankles.

In the hands: boutonniere deformity of the thumb (hyperflexion of the thumb), ulnar deviation of the metatarsophalangeal joints and the swan neck deformity of the fingers (hyperflexion)
What are clinical manifestations of ankylosing spondylitis?
low back or buttock pain that is worse in the morning or awakens the patient in the early morning. The pain tends to improve with exercise and worsen with rest.
What joints are commonly affected by gout?
synovial joints -- crystallization of uric acid in the joints causes swollen painful joints; commonly in the big toe
Compare dermatitis and eczema.
they are the same thing

itchy rash on red swollen skin, chronic but not dangerous or contagious
What are treatments for acne rosacea?
topical and oral antibiotics

Corticosteroids --reduce inflammation

Avoid smoking and drink/eating foods that cause flushing and temperature extremes
What are clinical manifestations of pityriasis rosea?
rash, herald patch followed by smaller patches, pruritus, worsens when skin becomes overheated
What infections are caused by viruses?
warts--caused by HPV

Herpes Zoster
Differentiate the different fungal infections
tinea captitis: fungal infection of scalp, oval patches of hair loss; ring worm; hair shaft breaks off "mowed wheat" appearance

tinea cruris: fungal infection of groin, "jock itch" spreads over inner and upper surfaces of thigh; occurs with heat and high humidity

tinea pedis: fungal infection of the feet; athletes foot-- causes erythema and scaling between the toes.

onychomycosis: fungal infection of the nails; nails become yellow-brown, thickened, and brittle.
What is the connection between chickenpox and herpes zoster?
After chickenpox, the virus lies dormant in the nerve root until reactivated. This usually occurs in older adults when the immune system has been weakened by another condition
and become herpes zoster (shingles)
The varicella vaccine is given to prevent chickenpox in children and herpes zoster in adults.
Which skin condition looks like psoriasis but can develop into squamous cell carcinoma?
What is the most deadly type of skin cancer?
What makes a mole suspicious for melanoma?
color change, size change, irregular notched border, itching, bleeding or oozing, nodularity, scab formation, and ulceration.

asymmetry of lesion
border irregularity
color variation
diameter greater than 6 mm
What causes menstruation to start?
when estrogen and progesterone levels start to drop
What treatments are used for premenstrual syndrome?
stress reduction, exercise, counseling, biofeedback, imagery, and rest, diet changes (eating 6 small meals per day, increase carbs, fiber, and water, decrease caffeine, alcohol, sugar)

selective serotonin reuptake inhibitors
What causes cervical cancer?
cervical human papillomavirus (HPV) -- strains 16 and 18
What are screening recommendations for cervical cancer?
pap smear every 3 years between the ages of 21 of 64 -- and pelvic exams
What are risk factors for endometrial cancer?
primary: unopposed estrogen exposure

others: diabetes, gallbladder disease, physical inactivity, high-fat, low-fiber diet, hypertension, and family history of colon, endometrial, or ovarian cancer.
Which cancers have common genetic markers with breast cancer?
ovarian and colon
What are clinical manifestations of fibrocystic breasts?
lumps, pain, tenderness

size change, non bloody nipple discharge

occurs in both breasts during luteal phase
How many women who get breast cancer have a family history of the disease?
less than 15%
What determines survival rate in breast cancer?
directly related to the tumor size and the axillary lymph node status. The larger the tumor, the worse the prognosis

Axillary lymph node involvement indicates a poorer prognosis. As the number of lymph nodes increases beyond four, the mortality rate greatly increases
What is the treatment for testicular torsion?
surgical emgergency--must be performed within 6 hours after the onset of symptoms to preserve normal testicular function

if the testicle is necrotic--an orchidectomy is performed to remove the testicle
Why would you hold a light behind the scrotum?
can help distinguish a hydrocele from a solid mass.
What usually causes recurrent urinary tract infection in men?
Chronic bacterial prostatitis
What are clinical manifestations of a varicocele?
There may be no symptoms or the person may have a feeling of heaviness and tenderness of the scrotum. On palpation, it feels like a "bag of worms."

Could be nonproblemattic but can be surgically repaired if affecting fertility
What can cause epididymitis?
sexually transmitted organism or a response to infection or trauma
What complication can occur in adult males from the mumps?
orchitis -- inflammation of the testis; may lead to infertility
What are the screening recommendations for prostate cancer?
digital rectum exam; serum prostate-specific antigen (annually for all men over 50 years and annually at 45 for AA or family history) AND monthly testicular self exam for all men starting at age 15
What characterizes testicular cancer?
painless swelling or lump in one testis accompanied by a feeling of testicular heaviness or a dull ache in the abdomen. Up to 10 percent have symptoms related to metastasis at the initial diagnosis. Lumbar pain may be related to retroperitoneal lymph node metastasis, cough and bloody sputum may be related to lung metastasis, dysphagia may be due
to supraclavicular lymph node metastasis, and altered mental status may be due to central nervous system metastasis.
What are the stages of syphilis if untreated?
If the person is not treated for syphilis, the disease moves from the secondary to the latent (hidden) stage, when there are no symptoms.

The latent stage can last for years before progressing to the tertiary stage.

In the late stages, the disease may damage the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. These problems may occur many years after the original, untreated infection.
How is herpes simplex virus spread?
direct contact with the virus
What causes both genital warts and cervical cancer?