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Part 2 book “Pathophysiology flash cards” has contents: Endocrine system, reproductive system and urologic disorders, immune system, hematologic disorders, oncologic disorders, musculoskeletal, integumentary, and connective tissue disorders.
A 46-year-old male presents to his primary care physician with a complaint of trouble sleeping He states that he lies in bed for up to hours before falling asleep but does not have problems staying asleep Further questioning reveals that the patient lost his job 5 months ago and his family has been relying on his wife’s part-time income He states that he has been feeling depressed for the past several months, as he has not been able to find another source of employment to support his family He feels it is hopeless to continue to find a job, and now spends most of his time now on the couch watching TV He has no interest in activities he used to enjoy He reports a decreased appetite but denies weight loss, problems concentrating, substance abuse, or suicidal ideations His only past medical history includes stage I hypertension well controlled with hydrochlorothiazide Physical examination reveals an appropriately dressed male with a restricted affect and linear thought process Major Depressive Disorder This patient has major depressive disorder Although there are often several criteria for many diagnoses in psychiatry, it is important to first commit to memory the time requirements and number of symptoms For major depressive disorder, five symptoms must be present, one of which must be either depressed mood or anhedonia (lack of Interest), for a minimum of 2 weeks The rest of the nine possible symptoms are Sleep disturbance, feelings of worthlessness or inappropriate Guilt, lack of Energy, diminished Concentration, change in Appetite or weight, Psychomotor agitation or retardation, and Suicidal ideations A useful mnemonic is SIG E CAPS The vignette does not describe any history of manic episodes that could indicate bipolar disorder If the patient had not met at least five criteria, a diagnosis of adjustment disorder could be considered as his symptoms were precipitated by a major life stressor that was initiated within months of the stressor and had not persisted for more than months In dysthymic disorder, a patient exhibits a less severe form of depression on more than half of the days for a period of more than 2 years A 27-year-old female medical student is brought to the emergency department by her roommate who is concerned about her lack of sleeping The patient has not slept in 2 days and has been frantically cleaning their apartment The roommate also states that the patient has been acting unusually promiscuous over the past week and accumulated thousands of dollars in credit card charges buying new clothes The patient states she feels great and just has not been feeling tired Her past history is significant for one suicide attempt at 17 years after breaking up with a boyfriend She was subsequently treated with fluoxetine for years but currently takes no medications On examination, the patient is hyperverbal with psychomotor agitation and reports that she is on the verge of discovering the cure for cancer Bipolar Disorder This patient has bipolar I disorder This diagnosis requires the presence of at least one manic episode, usually with a history indicative of one or more episodes of major depressive disorder A manic episode consists of at least week of an abnormally elevated, expansive, or irritable mood or a required hospitalization with at least three symptoms Symptoms include distractibility, insomnia or decreased need for sleep, grandiosity (inflated self-esteem), flight of ideas (racing thoughts), psychomotor agitation or increase in goal-directed activities, pressured speech, and risk-taking (activities involving pleasure with painful consequences, i.e., excessive spending, sexual indiscretion, gambling) A useful mnemonic is DIG FAST For bipolar I disorder, the mood disturbance must be sufficient enough to cause social or occupational impairment, requires hospitalization, or has psychotic features If this is not the case, but at least three symptoms with mood change have been present for at least days, it is considered a hypomanic episode and the diagnosis would be bipolar II disorder It is important to distinguish the symptoms from personality disorders, as the personality disorders are reported under axis II diagnoses An 11-year-old boy is brought to the pediatrician by his mother, who is concerned about his behavior She states he has become increasingly rebellious since his parents divorced years ago He was recently suspended for making fun of a smaller classmate and his mother often receives calls from the teacher for talking back He refuses to do his homework and is verbally abusive to his mother Physical examination reveals a slightly overweight boy, appropriately dressed with normal affect, and linear thought process without psychomotor agitation Oppositional Defiant Disorder This patient is presenting with oppositional defiant disorder This is characterized by ongoing defiant and hostile behavior toward authority figures This differs from conduct disorder in that there are not serious violations of social norms, such as physical altercations, property destruction, animal cruelty, theft, or other activities that might rise to the level of concern to law enforcement Conduct disorder also often progresses to antisocial personality disorder after 18 years of age Other considerations might be separation anxiety disorder following the loss of an attachment figure in the divorce, which typically starts at around 7 to 8 years of age A 36-year-old male is presented at the emergency department by the police because he was found standing on the side of the highway The patient claims that he felt like he was unable to move and he does not remember how long he was standing there He thinks that FBI agents have been following him for the past months, and he does not feel safe at home anymore He also admits to having intermittent thoughts of committing suicide During the interview, he mentions that his thoughts of suicide are augmented due to the voices telling him to “end it.” The patient’s past medical history is significant only for wellcontrolled type DM His vital signs on admission are heart rate is 78/min, respiratory rate is 16/min, blood pressure is 118/82 mm Hg, temperature is 36.7°C (98.1°F), and oxygen saturation is 99% On further examination, the patient displays flat affect, paranoia, tangential and illogical thought processes, and disorganized speech Urine drug screening is negative for illicit substances Schizophrenia This patient meets the DSM-IV criteria for schizophrenia, which requires more than 6 months of disturbed functioning with at least 1 month of at least two of the following symptoms (unless delusions are bizarre or voices provide running commentary, then only one criterion is needed): delusions, hallucinations, disorganized behavior/catatonia, disorganized speech, and negative symptoms These symptoms arise from a decrease in dopaminergic activity Negative symptoms (anhedonia, flat affect, avolition) stem from the frontal cortical region, whereas positive symptoms (delusions and hallucinations) arise from the mesolimbic system Typical treatment consists of dopamine antagonists However, due to high incidence of tardive dyskinesia and extrapyramidal symptoms associated with D2 dopamine receptor blockade in typical antipsychotics, atypical antipsychotics are usually the first-line pharmacotherapy A 23-year-old male is brought to a psychiatrist by his mother She reports he has been behaving strangely since he graduated from college months ago He stopped socializing with his friends and now spends the entire day in his room Upon questioning, he is reluctant to answer simple questions He eventually reveals that God has been speaking to him and providing him instructions for creating a device, which will allow him to read other people’s thoughts Examination reveals an unkempt, disheveled male with restricted affect and circumstantial thought process Urine drug screening was negative Schizophreniform Disorder This patient has schizophreniform disorder The length of time of continuous signs of disturbance differentiates the disorders presenting with symptoms of schizophrenia Brief psychotic disorder denotes less than 1 month of symptoms, usually related to stress More than but less than months of disturbed behavior including occupational/social declines or negative symptoms including month of psychotic symptoms is classified as schizophreniform disorder Symptoms persisting for more than months indicate schizophrenia Schizophrenia criteria plus major depression, manic episodes, or both indicates a diagnosis of schizoaffective disorder It is important to distinguish axis I disorders from the schizoid and schizotypal personality disorders that are part of axis II Cerebral artery thromboembolic stroke, 127 Cervical cancer, 232 Childhood disorders, oppositional defiant disorder, 132 Choledocholithiasis, 93 Closed-angle glaucoma, 113 Clostridium difficile infection, 81 Coagulation disorders disseminated intravascular coagulation (DIC), 209 hemophilia, 207 von Willebrand disease, 208 Colorectal cancer, 215 Combined B/T cell disorders ataxia-telangiectasia syndrome, 184 severe combined immunodeficiency disease (SCID), 182 Wiskott-Aldrich syndrome, 183 Complement deficiencies, C5 deficiency, 188 Complex acid–base disorder, 58 Coronary syndromes, acute non-ST segment elevation myocardial infarction (NSTEMI), 3 ST segment elevation myocardial infarction (STEMI), 2 Crohn’s disease, 92 Cushing syndrome See Hypercortisolism Cystic fibrosis, 38 D Deep vein thrombosis, 22 Dementia Alzheimer’s disease, 107 normal pressure hydrocephalus, 108 Demyelinating disorders Guillain–Barré syndrom, 122 multiple sclerosis, 121 Diabetes insipidus, 144 Diabetes mellitus type 1, 152 type 2, 153 Diarrheal disorder, acute Clostridium difficile infection, 81 DiGeorge syndrome See Thymic dysplasia, chronic Digitalis toxicity, 10 Dilated cardiomyopathy (end stage), 12 Diseases of the small intestine celiac disease, 88 irritable bowel syndrome (IBS), 89 small bowel obstruction (SBO), 87 Disseminated intravascular coagulation (DIC), 209 Diverticular disease, 91 Drug-induced acute tubulointerstitial nephritis, 69 Duodenal ulcer, 85 Dysfunctional uterine bleeding (DUB), 157 Dysphagia, 82 E Eating disorders anorexia nervosa, 137 Ectopic pregnancy, 163 Emphysema, 35 Encephalitis, herpes simplex virus, 110 Endocrine neoplasia, multiple, 154 Endocrine pancreas disorders type 1 diabetes mellitus, 152 type 2 diabetes mellitus, 153 Endocrine system pituitary gland disorders acromegaly, 142 anterior hypopituitarism, 141 diabetes insipidus, 144 hyperprolactinemia, 143 Endometrial cancer, 231 Endometriosis, 161 Epidural hematoma, 106 Epilepsy/seizure absence seizures, 109 alcohol withdrawal seizures, 111 herpes simplex virus encephalitis, 110 Erectile dysfunction, 174 Esophageal adenocarcinoma, 217 Esophageal/upper GI tract disorders dysphagia and achalasia, 82 gastroesophageal reflux disease (GERD), 83 gastroparesis, 84 Esophageal variceal hemorrhage, 97 Essential hypertension, 23, 78 F Folate-deficiency anemia, 202 Functional urinary incontinence, 172 G Gastric adenocarcinoma, 216 Gastrinoma, 218 Gastroesophageal reflux disease (GERD), 83 Gastrointestinal carcinomas carcinoid syndrome, 220 colorectal cancer, 215 esophageal adenocarcinoma, 217 gastric adenocarcinoma, 216 gastrinoma/Zollinger–Ellison syndrome, 218 pancreatic head adenocarcinoma, 219 Gastroparesis, 84 GI tract disorders, upper dysphagia and achalasia, 82 gastroesophageal reflux disease (GERD), 83 gastroparesis, 84 Glaucoma closed-angle, 113 open-angle, 112 Glioblastoma multiforme, 238 Glomerular disorders Goodpasture syndrome, 68 IgA nephropathy, 66 membranoproliferative glomerulonephritis, 67 minimal change disease, 64 primary focal segmental glomerulosclerosis, 65 Goodpasture syndrome, 68 Gout, 246 Graft-versus host disease, 193 Granulomatous disease, chronic, 186 Granulosa cell tumor, 230 Guillain–Barré syndrom, 122 H Hb bart disease See α-Thalassemia trait HbH disease See α-Thalassemia trait Heart block, 8 Heart failure biventricular heart failure, 16 left ventricular failure, 17 HELLP syndrome, 165 Hematologic/lymphoid cancers acute myeloblastic leukemia, 222 chronic myelogenous leukemia, 221 Hodgkin’s lymphoma, 223 multiple myeloma, 224 polycythemia vera, 225 Hemolytic anemias hereditary spherocytosis, 206 sickle-cell anemia, 205 Hemophilia, 207 Hemorrhagic stroke, 27 Heparin-induced thrombocytopenia, 213 Hepatitis, acute, 95 Hepatorenal syndrome, 62 Hereditary hemochromatosis, 96 Hereditary spherocytosis, 206 Herpes simplex virus encephalitis, 110 Hirsutism, 166 Hodgkin’s lymphoma, 223 Huntington’s disease, 115 Hyperacute rejection, 192 Hypercoagulable disorders factor V leiden thrombophilia, 210 Hypercortisolism, 150 Hyperkalemia, 11, 77 Hyperlipidemia, 18 Hypernatremia, 75 Hyperprolactinemia, 143 Hypersensitivity pneumonitis, 43 Hypertension essential hypertension, 78 secondary hypertension, 79 Hyperthyroidism-Graves’ disease, 146 Hypertrophic obstructive cardiomyopathy, 14 Hypervolemia, 73 Hypogonadism See Male hypogonadism Hypokalemia, 76 Hyponatremia, 74 Hypopituitarism, anterior, 141 Hypoproliferative anemias iron-deficiency anemia, 199 sideroblastic anemia (lead poisoning), 200 β-thalassemia major (β-thalassemia minor), 197 α-thalassemia trait (HbH disease, Hb bart disease), 198 Hypothyroidism-Hashimoto’s disease, 145 Hypovolemia, 72 Hypovolemic shock, 21 I Idiopathic pulmonary fibrosis, 42 Idiopathic thrombocytopenic purpura, 211 Idioventricular rhythm (accelerated), 7 IgA nephropathy, 66 Immune thrombocytopenic purpura See Idiopathic thrombocytopenic purpura Inflammatory bowel disease Crohn’s disease, 92 Intestine diseases See Large intestine, diseases Iron-deficiency anemia, 199 Irritable bowel syndrome (IBS), 89 Ischemic colitis, 90 Ischemic heart disease, 19 Ischemic stroke, 26 K Kidney disease, chronic, 71 Kidney injury, acute acute tubular necrosis, 60 hepatorenal syndrome, 62 nonsteroidal anti-inflammatory drugs, 61 obstructive uropathy, 63 pre-renal azotemia, 59 renal injury, 61 Kwashiorkor See Protein-energy malnutrition L Lacunar infarcts, 128 Large intestine, diseases diverticular disease, 91 ischemic colitis (chronic mesenteric ischemia), 90 Leukocyte adhesion defect, 187 Liver and biliary system disorders acute hepatitis, 95 choledocholithiasis, 93 esophageal variceal hemorrhage, 97 hereditary hemochromatosis, 96 liver cirrhosis and ascites, 94 primary biliary cirrhosis, 98 Liver cirrhosis/ascites, 94 Lobar pneumonia, 51 Lumbar spinal stenosis, 117 Lung cancer pancoast tumor, 226 small cell carcinoma, 228 squamous cell carcinoma, 227 Lung diseases, restrictive/interstitial/environmental asbestosis, 45 hypersensitivity pneumonitis, 43 idiopathic pulmonary fibrosis, 42 sarcoidosis, 46 silicosis, 44 Lymphoid cancers See Hematologic/lymphoid cancers M Macrocytic anemias See Megaloblastic anemias Male hypogonadism, 173 Male urologic disorders benign prostatic hyperplasia, 175 erectile dysfunction, 174 male hypogonadism, 173 prostatitis, 176 Malnutrition protein-energy malnutrition (Kwashiorkor), 99 vitamin A deficiency, 100 Megaloblastic anemias folate-deficiency anemia, 202 pernicious anemia (vitamin B12 deficiency), 201 Melanoma, 236 Membranoproliferative glomerulonephritis, 67 Menopause, 158 Menstrual disorders dysfunctional uterine bleeding (DUB), 157 endometriosis, 161 menopause, 158 polycystic ovarian syndrome (PCOS), 156 primary amenorrhea, 159 secondary amenorrhea, 160 Mesenteric ischemia, chronic See Ischemic colitis Metabolic acidosis, 57 Microcytic anemias See Hypoproliferative anemias Migraine headache, 118 Minimal change disease, 64 Mitral regurgitation, 29 acute, 30 Mitral stenosis, 28 Mood disorders bipolar disorder, 131 major depressive disorder, 130 Movement disorders Huntington’s disease, 115 Myasthenia gravis, 116 Parkinson’s disease, 114 Multifocal atrial tachycardia, 6 Myasthenia gravis, 116 Myeloblastic leukemia, acute, 222 Myelogenous leukemia, chronic, 221 Myeloma, multiple, 224 Myeloperoxidase deficiency See Granulomatous disease, chronic N Nephrolithiasis, 167 Nonsteroidal anti-inflammatory drugs and renal injury, 61 Non-ST segment elevation myocardial infarction (NSTEMI), 3 Normal pressure hydrocephalus, 108 Normocytic anemias anemia of chronic disease, 203 aplastic anemia, 204 O Obesity common obesity, 101 Obstructive pulmonary diseases asthma, 34 chronic bronchitis, 36 emphysema, 35 Obstructive uropathy, 63 Open-angle glaucoma, 112 Osteoarthritis, 247 Osteomalacia, 148 Osteopenia See Osteoporosis Osteoporosis, 250 Overflow urinary incontinence, 170 P Paget’s disease, 252 Pain lumbar spinal stenosis, 117 migraine headache, 118 temporal arteritis, 120 trigeminal neuralgia, 119 Pancoast tumor, 226 Pancreatic head adenocarcinoma, 219 Pancreatitis acute, 102 chronic, 103 Parathyroid glands disorders osteomalacia, 148 primary hyperparathyroidism, 147 primary hypoparathyroidism, 149 Parkinson’s disease, 114 Pemphigus vulgaris, 242 Peptic ulcer disease duodenal ulcer, 85 Zollinger–Ellison syndrome, 86 Peripheral vascular disease, 25 Pernicious anemia (vitamin B12 deficiency), 201 Phagocyte disorders chronic granulomatous disease (myeloperoxidase deficiency), 186 leukocyte adhesion defect, 187 Pheochromocytoma, 234 Pityriasis rosea, 244 Platelet disorders heparin-induced thrombocytopenia, 213 idiopathic (immune) thrombocytopenic purpura, 211 thrombotic thrombocytopenic purpura (TTP), 212 Pleural disorders pleural effusion, 48 pulmonary edema, 47 pulmonary embolism, 49 pulmonary hypertension, 50 Pleural effusion, 48 Pneumococcal conjugate vaccine in sickle-cell disease, 194 Polycystic ovarian syndrome (PCOS), 156 Polycythemia vera, 225 Potassium balance disorders hyperkalemia, 77 hypokalemia, 76 Preeclampsia/eclampsia syndrome, 164 Pregnancy disorders ectopic pregnancy, 163 HELLP syndrome, 165 preeclampsia/eclampsia syndrome, 164 spontaneous abortion, 162 Premature atrial contractions, 5 Pre-renal azotemia, 59 Primary amenorrhea, 159 Primary biliary cirrhosis, 98 Primary focal segmental glomerulosclerosis, 65 Primary hyperparathyroidism, 147 Primary hypoparathyroidism, 149 Prostate cancer, 233 Prostatitis, 176 Protein-energy malnutrition, 99 Psoriasis, 245 Psychotic disorders schizophrenia, 133 schizophreniform disorder, 134 Pulmonary edema, 47 Pulmonary embolism, 49 Pulmonary hypertension, 50 Pulmonary infections atypical pneumonia, 53 lobar pneumonia, 51 tuberculosis, 52 R Rejection, acute, 191 Renal/adrenal gland carcinoma pheochromocytoma, 234 renal cell carcinoma, 235 Reproductive system/breast, carcinoma of See Carcinoma, of reproductive system and breast Respiratory acidosis, chronic, 56 Restrictive cardiomyopathy, 13 Rheumatic disorders ankylosing spondylitis, 249 gout, 246 osteoarthritis, 247 rheumatoid arthritis, 248 Rheumatoid arthritis, 248 Rhinitis, allergic, 179 S Sarcoidosis, 46 Sclerosis, multiple, 121 Secondary amenorrhea, 160 Secondary hypertension, 24, 79 Severe combined immunodeficiency disease (SCID), 182 Shock cardiogenic shock, 20 hypovolemic shock, 21 Sickle-cell anemia, 205 Sideroblastic anemia (lead poisoning), 200 Silicosis, 44 Sjégren’s syndrome, 190 Skeletal disorders achondroplasia, 251 osteoporosis (osteopenia), 250 Paget’s disease, 252 Skin cancer basal cell carcinoma, 237 melanoma, 236 Skin disorders atopic dermatitis, 241 bullous pemphigoid, 243 pemphigus vulgaris, 242 pityriasis rosea, 244 psoriasis, 245 Sleep disorders breathing disorders, 54 obstructive sleep apnea, 138 Small bowel obstruction (SBO), 87 Small cell carcinoma, 228 Sodium/water balance disorders hypernatremia, 75 hypervolemia, 73 hyponatremia, 74 hypovolemia, 72 Somatoform disorders somatization disorder, 139 Spinal cord disorders amyotrophic lateral sclerosis, 123 Brown-Séquard syndrome, 124 Spontaneous abortion, 162 Squamous cell carcinoma, 227 Stress urinary incontinence, 171 Stroke amaurosis fugax, 126 cerebral artery thromboembolic stroke, 127 lacunar infarcts, 128 ST segment elevation myocardial infarction (STEMI), 2 Subacute airway obstruction, 40 Subarachnoid hemorrhage, 125 Systemic lupus erythematosus, 189 T T cell disorders chronic thymic dysplasia (DiGeorge syndrome), 185 Temporal arteritis, 120 Tetanus, 194 β-Thalassemia major, 197 β-Thalassemia minor See β-Thalassemia major α-Thalassemia trait, 198 Thrombophilia, factor V leiden, 210 Thrombotic thrombocytopenic purpura (TTP), 212 Thymic dysplasia, chronic, 185 Thyroid gland disorders hyperthyroidism-Graves’ disease, 146 hypothyroidism-Hashimoto’s disease, 145 Transplantation acute rejection, 191 Graft-versus host disease, 193 hyperacute rejection, 192 Trigeminal neuralgia, 119 Tuberculosis, 52 Tubular necrosis, acute, 60 Tubulointerstitial disease drug-induced acute tubulointerstitial nephritis, 69 urinary tract infection, 70 Tumor lysis syndrome, 239 U Urge urinary incontinence, 169 Urinary tract disorders functional urinary incontinence, 172 nephrolithiasis, 167 overflow urinary incontinence, 170 stress urinary incontinence, 171 urge urinary incontinence, 169 urinary tract infection, 168 Urinary tract infection, 70, 168 Urologic disorders See Male urologic disorders; Urinary tract disorders V Vaccines pneumococcal conjugate vaccine in sickle-cell disease, 194 tetanus, 194 Valvular heart disease acute mitral regurgitation, 30 aortic regurgitation (chronic), 32 aortic stenosis, 31 mitral regurgitation, 29 mitral stenosis, 28 Vascular disorders deep vein thrombosis, 22 essential hypertension, 23 hemorrhagic stroke, 27 ischemic stroke, 26 peripheral vascular disease, 25 pleural effusion, 48 pulmonary edema, 47 pulmonary embolism, 49 pulmonary hypertension, 50 secondary hypertension, 24 Ventricular failure, left, 17 Vitamin A deficiency, 100 Vitamin D disorders osteomalacia, 148 primary hyperparathyroidism, 147 primary hypoparathyroidism, 149 Von Willebrand disease, 208 W Water disorders See Sodium/water balance disorders Wiskott-Aldrich syndrome, 183 Wolff–Parkinson–White syndrome, 9 Z Zollinger–Ellison syndrome, 86, 218 ... than half of the days for a period of more than 2 years A 27 -year-old female medical student is brought to the emergency department by her roommate who is concerned about her lack of sleeping The patient has not slept in 2 days and has been frantically cleaning their apartment... disorders from the schizoid and schizotypal personality disorders that are part of axis II A 34-year-old woman is being seen in the emergency department for chest pain that started hours ago She states it came on quickly and lasted less than 20 minutes The event was accompanied by palpitations, sweating, and shortness of... Menarche occurred at the age of 12 years Her blood pressure is 85/55 mm Hg, pulse is 66/min, respiratory rate is 14/min, and temperature is 36.8°C (98.1°F) She is 157 cm (5 ft 2 in) tall and weighs 65 kg (143 lb); BMI is 26 kg/m2