Pathophysiology I

Final Exam Review

• Most diseases are multi-factorial, having a genetic predisposition and triggered by environmental factors

• Sign vs. symptom

• Sensitivity: on a specific test, the percentage of people with a disease who will test positive – True positives

• Specificity: the percentage of people who do not have the disease that will test negative using that test– True negatives

• Dementia vs. delirium

• Adaptive changes:

– Atrophy (↓ cell size/function)

– Hypertrophy (↑ cell size/function)

– Hyperplasia (↑ # cells)

– Metaplasia (reversible cell change)

– Dysplasia (abnormal cell growth/size/shape, more likely to transform into cancerous change)

• Apoptosis vs. necrosis

• Homozygote vs. heterozygote

• Dominant (abnormal regulatory or structural protein) vs. recessive (enzyme deficiency)

• Review diseases in each category

• Down syndrome characteristics, heart/GI malformations and leukemia most common causes of death

• Turners (monsomy X) vs. Kleinfelters(polysomy X)

• Effects of chronic stress, PTSD symptoms

• Non-infectious causes of fever (MI, PE, cancer, surgery, neurogenic)

• Glycogenolysis vs. gluconeogenesis

• Central vs peripheral obesity

• Marasmus (calorie) vs kwashiorkor (protein)

• Anorexia vs bulimia

• Osteoblasts vs osteoclasts

• PTH: regulates Ca++ and phosphate in order to ↑ calcium levels when they fall, ↑absorption and release of calcium, ↓ bone formation and excretion

• Calcitonin: ↓resorption and osteoclast activity, ↑ excretion to regulate dietary calcium

• Vitamin D: ↑absorption, osteoblasts and osteoclasts, bone formation

• Osteomyelitis: hematogenous vs. contiguous spread, chronic

• Osteonecrosis

• Osteopenia vs osteoporosis

Benign Bone Tumors

• Osteoma

• Chondroma

• Osteochondroma

• Osteoclastoma (can behave like a malignant tumor)

Malignant Bone Tumors

• Osteosarcoma

• Ewing’s sarcoma

• Chondrosarcoma

• Metastatic disease

Rheumatoid Arthritis

• PIP, MCP joints

• Symmetric involvement

• Deformities

• Swelling/stretching of synovium

• Bony erosions

• Systemic symptoms

• Rheumatoid nodules

• Rheumatoid factor and ESR

• Disease modifying treatment

Osteoarthritis

• Increased water in cartilage, collagen breakdown, cracks form and widen, cartilage eroded, bone thickens and is sclerotic

• Osteophytes

• Hard, enlarged joints

• PIP/DIP, knees, hips

• Mono- or polyarticular

• ESR

Juvenile Arthropathies

• JRA: Systemic, Pauciarticular, Polyarticular

• SLE similar, kidney involvement most severe

Elderly

• Pseudogout

• OA

• PMR

SLE

• Multi-system disease: joints, kidneys, skin, cardiac, pulmonary, CNS

• Autoantibodies and immune complexes

• ANA, anti-DNA antibodies

• Anemia, thrombocytopenia, abnormal WBCs

Scleroderma

• Excessive collagen deposition in skin

• Sclerodactyly, esophageal involvement

• Pulmonary/renal vascular involvement

• Associated with Raynaud’s

Ankylosing Spondylitis

• HLA-B27

• Starts in SI joints and moves caudally

• Loss of lumbar lordosis, thoracic kyphosis

• Spinal stiffness leading to spine fused in flexion

• Chest cavity restriction, OA

Seronegative Spondyloarthropathies

• Reactive: associated with GI or genitourinary infection

• Enteropathic: associated with IBD

• Psoriatic: associated with skin condition, presents like RA

Gout

• Monosodium urate or uric acid crystals

• Primary (overproduction, increased breakdown and decreased excretion) enzyme deficiency

• Secondary: tumor lysis, cell turnover

• Peripheral joints, monoarticular

• 1st MTP, feet, ankle, knee, wrists, fingers

• Tophi

Skin

• Flat lesions: macule, patch

• Solid palpable lesions: papule, plaque, nodule, tumor, wheal

• Elevated fluid-filled lesions: vesicle, bulla, pustule

• Pruritis vs. xerosis

• Review pictures, characteristics of skin conditions