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• 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