H & P Lecture #4

Tophi are defined as deposits of uric acid crystals that are characteristic of chronic tophaceous gout. These deposits typically form in the joints, tendons, and surrounding tissues of individuals with gout. Tophi can cause pain, inflammation, and deformity in affected areas. They are usually visible as lumps or nodules under the skin and can be felt as hard, chalky deposits. Tophi are a result of long-term elevated levels of uric acid in the blood, which leads to the formation of urate crystals.

Basal cell carcinoma is described as a raised nodule that is a common, slow-growing malignancy. It is the most common type of skin cancer and typically appears as a pearly or waxy bump on the skin. It is usually found on areas of the body that are frequently exposed to the sun, such as the face, neck, and arms. Basal cell carcinoma is known for its slow growth and is rarely life-threatening, but it should still be treated promptly to prevent further damage to the skin.

A cutaneous cyst is described as a dome-shaped lump in the dermis that forms a benign closed form sac attached to the epidermis. It is also known as a sebaceous cyst. This type of cyst is formed when the sebaceous gland becomes blocked, leading to the accumulation of sebum. The cyst is typically filled with a cheesy, foul-smelling material and may cause pain or discomfort. Treatment options include drainage or surgical removal of the cyst.

Angular chelitis is characterized by softening and fissuring of the angles of the mouth. This condition is commonly caused by a fungal or bacterial infection, which leads to inflammation and cracking of the skin at the corners of the mouth. It is often associated with factors such as poor oral hygiene, nutritional deficiencies, or denture use. Treatment typically involves addressing the underlying cause, such as antifungal or antibiotic medications, and improving oral hygiene practices.

A keloid is a firm, nodular, hypertrophic mass of scar tissue that extends beyond the area of injury. Unlike a normal scar, which remains within the boundaries of the original wound, a keloid grows and spreads beyond the site of the injury. It is characterized by its raised, thickened, and often shiny appearance. Keloids can be caused by various factors such as trauma, surgery, burns, or even minor skin injuries. They are more commonly seen in individuals with darker skin types and can be itchy, painful, and cosmetically bothersome. Treatment options for keloids include corticosteroid injections, cryotherapy, laser therapy, and surgical removal.

Petechiae is characterized by small red spots that result from blood escaping from capillaries into tissues. This can occur when there is trauma or injury, such as biting your cheek. Fordyce spots, herpes simplex, Koplik's spots, and aphthous ulcers are not associated with this specific characteristic.

Based on the information provided, the patient's headache is described as tight and pressing frontally, gradually worsening since yesterday. This is consistent with the symptoms of a tension headache. The fact that the patient was up all night studying and typing quizzes suggests that the headache may be related to stress and muscle tension. The slight photophobia and relief with head massage also support the diagnosis of a tension headache.

Actinic chelitis is the correct answer because it refers to a condition caused by excessive exposure to sunlight. It is characterized by the lip losing its normal redness and becoming scaly, thickened, and slightly everted. Angular chelitis, angioedema, herpes simplex, and hereditary hemorrhagic syndrome do not specifically relate to the symptoms described.

Herpes simplex is a viral infection that causes recurrent and painful vesicular eruptions of the lips and surrounding skin. It is characterized by the formation of small, fluid-filled blisters that can be painful and can recur periodically. The virus is highly contagious and can be transmitted through direct contact with the affected area.

Aphthous ulcers are round or oval ulcers that are white or yellow-ish gray in color and are surrounded by a halo of reddened mucosa. This description matches the characteristics of an aphthous ulcer. Leukoplakia refers to white patches on the oral mucosa, thrush is a fungal infection characterized by white patches, petechiae are small red or purple spots caused by bleeding, and Fordyce spots are small, yellowish-white bumps on the oral mucosa.

Presyncope is the correct answer because it refers to the feeling of being faint or lightheaded, which is a common symptom of dizziness. Vertigo, on the other hand, is a spinning sensation, while dysequilibrium refers to a sense of unsteadiness or imbalance. Psychiatric dizziness and multifactorial are not specific symptoms of dizziness, but rather describe the underlying causes or factors contributing to dizziness. Therefore, presyncope best matches the description given in the question.

Leukoplakia is a thickened white patch that can occur anywhere in the oral mucosa due to frequent chewing of tobacco. It is a precancerous condition that can potentially lead to cancer. Aphthous ulcer is a painful sore, Koplik's spots are small white spots on the inside of the cheeks, Petechiae are small red or purple spots caused by bleeding, and Candidiasis is a fungal infection. Therefore, the correct answer is Leukoplakia.

Based on the information provided in the case study, the most likely diagnosis is otitis media. The patient presents with ear pain, decreased appetite, runny nose with yellow discharge, sneezing, and a mild fever. On physical examination, the right tympanic membrane is erythematous and bulging, which are typical signs of otitis media. The other options can be ruled out based on the absence of relevant symptoms or physical findings.

The given symptoms of nasal congestion, discharge, fever, and facial pain above the cheek are indicative of sinusitis. Sinusitis is an inflammation or infection of the sinuses, which can cause pain and pressure in the face. The fact that the pain worsens when coughing or sneezing suggests that there is increased pressure in the sinuses. Therefore, prescribing a decongestant and antibiotic would be appropriate for treating sinusitis.

Tympanosclerosis is described as a chalky white patch with irregular margins caused by a deposition of hyaline material within the layers of the tympanic membrane (TM). This condition can occur as a result of a severe case of otitis media, where inflammation and damage to the TM lead to the deposition of hyaline material. It is characterized by a white, opaque appearance on the TM and can cause hearing loss or a decrease in middle ear mobility.

Kaposi's sarcoma is a correct answer because it is a type of cancer that can cause deep purple lesions on the palate. It is commonly seen in patients with AIDS due to their weakened immune system. These lesions can be raised or flat and are one of the characteristic symptoms of Kaposi's sarcoma in HIV/AIDS patients.

Perforation of the eardrum is described as holes in the eardrum that usually result from purulent infections of the middle ear. These holes can be classified as central or marginal perforations. Tympanosclerosis refers to the hardening of the eardrum, serous effusion refers to the accumulation of fluid in the middle ear, acute otitis media refers to an infection of the middle ear, and bullous myringitis refers to a viral infection of the eardrum.

Peutz-Jeghers syndrome is described as pigmented spots on the lips that are more prominent than freckling of the surrounding skin. This genetic disorder is characterized by the development of hamartomatous polyps in the gastrointestinal tract and mucocutaneous hyperpigmentation, particularly on the lips, buccal mucosa, and perianal area. These pigmented spots, known as melanotic macules, are dark brown to black in color and can vary in size. They are typically larger and more prominent than freckles, which are usually smaller and lighter in color.

Diphtheria presents as a dull red throat with gray exudate on the uvula, pharynx, and tongue. This is a characteristic symptom of the disease. Mumps, Pharyngitis, Rubella, and Strep throat do not typically present with this specific symptom.

Vertigo is the correct answer because it is characterized by a spinning sensation, along with nystagmus (involuntary eye movements) and ataxia (lack of muscle coordination). Vertigo is a specific type of dizziness that is often caused by problems in the inner ear or the vestibular system, which is responsible for maintaining balance and spatial orientation. Other options like presyncope, dysequilibrium, psychiatric dizziness, and multifactorial do not specifically describe the spinning sensation, nystagmus, and ataxia associated with vertigo.

Angioedema is the correct answer because it is a condition characterized by diffuse, non-pitting, tense swelling of the dermis and subcutaneous tissue. This condition is caused by the rapid swelling of the deeper layers of the skin, often in response to an allergic reaction or an underlying medical condition. It can affect various parts of the body, including the lips, face, throat, and extremities. Unlike pitting edema, which leaves an indentation when pressure is applied, angioedema does not pit.

Koplik's spots are an early sign of measles characterized by small white specks on a red background on the buccal mucosa near the first and second molars. This is a distinct feature of measles and can help in early diagnosis of the disease. Petechiae are small red or purple spots on the skin caused by bleeding, Fordyce spots are small yellowish or white bumps on the skin, Leukoplakia is a condition characterized by white patches on the mucous membranes, and Aphthous ulcers are painful sores that form inside the mouth.

Closed-angle and acute-angle closure glaucoma are both terms used to describe the same condition, which is characterized by a sudden increase in intraocular pressure due to the blockage of the drainage angle of the eye. This blockage causes the iris to push forward, narrowing the angle and obstructing the flow of fluid out of the eye. As a result, pressure builds up and can lead to damage of the optic nerve and vision loss. Therefore, another name for this condition is narrow-angle glaucoma.

A subconjunctival hemorrhage is a red eye condition that looks much worse than it really is. It is commonly caused by trauma, bleeding disorders, or a sudden increase in venous pressure. This condition occurs when a blood vessel in the conjunctiva, the clear layer that covers the white part of the eye, breaks and causes blood to pool under the conjunctiva. Although it may appear alarming, it is usually harmless and resolves on its own without treatment.

Hereditary hemorrhagic telangiectasia is a genetic disorder that causes abnormal blood vessels to form, leading to the development of small red spots on the lips. This condition is characterized by recurrent nosebleeds, telangiectasias (dilated blood vessels), and arteriovenous malformations (abnormal connections between arteries and veins). It is an inherited condition and can also affect other organs in the body, such as the lungs, liver, and brain.

Fordyce spots are normal sebaceous glands that appear as yellowish spots in the buccal mucosa or on the lips. Petechiae are small red or purple spots caused by bleeding under the skin. Koplik's spots are small white spots with blue or red borders that are a characteristic sign of measles. Angioedema is swelling caused by fluid buildup in the deep layers of the skin. Leukoplakia is a condition characterized by thick white patches on the mucous membranes.

Psychiatric dizziness is the correct answer because it is described as being associated with anxiety, panic disorder, and depression. Vertigo refers to a spinning sensation, Presyncope refers to feeling lightheaded or faint, Dysequilibrium refers to a sense of unsteadiness or imbalance, and Multifactorial refers to dizziness caused by multiple factors. Therefore, Psychiatric dizziness is the most appropriate option that aligns with the given description.

Chrondrodermatitis helicis is described as a chronic inflammatory lesion on the helix or antihelix that becomes red, ulcerated, and crusty. It is a condition that affects the cartilage of the ear and is often caused by pressure or trauma to the area. The inflammation leads to the development of a painful nodule or ulcer on the ear, which can become crusty and may bleed. Treatment usually involves avoiding pressure on the affected area and using medications to reduce inflammation.

Rheumatoid nodules are small lumps that can develop on the helix or antihelix in individuals with chronic rheumatoid arthritis (RA). These nodules are a characteristic feature of RA and are formed due to the accumulation of inflammatory cells and fibrous tissue. They can vary in size and are usually painless. Rheumatoid nodules can be found in various locations throughout the body, including the ears. Therefore, in individuals with chronic RA, the presence of small lumps on the helix or antihelix is most likely due to rheumatoid nodules.

Thrush and candidiasis are both yeast infections in the mouth that appear as thick, white plaques. Thrush is caused by the Candida fungus and is commonly seen in infants, elderly individuals, and those with weakened immune systems. Candidiasis, on the other hand, refers to a broader range of infections caused by Candida, including oral thrush. Both conditions can cause discomfort and may require antifungal treatment to resolve.

A subarachnoid hemorrhage is a type of bleeding that occurs in the space between the brain and the thin tissues that cover it. It is often described as the "worst headache of my life" because it is typically sudden and severe. In addition to the intense headache, other symptoms such as nausea, vomiting, loss of consciousness, and neck pain are commonly associated with a subarachnoid hemorrhage. This condition requires immediate medical attention as it can be life-threatening.

Conjunctivitis is described as a pattern of red peripheral conjunctival injection, usually caused by bacterial or viral infection. It causes mild discomfort but no pain, and has ocular discharge present. Subconjunctival hemorrhage is characterized by blood in the conjunctiva, not redness or infection. Acute uveitis and acute iritis are both conditions that involve inflammation of the uvea, which is the middle layer of the eye, and typically present with pain and discomfort. Narrow-angle glaucoma is a condition characterized by increased pressure in the eye, which can cause severe pain and vision loss. Therefore, the correct answer is conjunctivitis.

Grave's disease is the most common cause of HYPERthyroidism and is an autoimmune disease where antibodies stimulate the thyroid to produce excessive thyroid hormone. This explanation provides the necessary information without explicitly stating "The correct answer is Grave's disease."

Based on the patient's symptoms of throbbing and achy headache, sensory and motor auras, phonophobia, photophobia, nausea, and vomiting, along with the trigger of drinking alcohol, the most likely diagnosis is a migraine headache. Migraines are often triggered by various factors, including alcohol consumption. The symptoms described, such as sensory and motor auras, sensitivity to light and sound, nausea, and vomiting, are consistent with a migraine. The patient's preference for lying down in a dark room also aligns with typical migraine behavior.

Dysequilibrium is the correct answer because it refers to a symptom of dizziness characterized by imbalance when walking. This means that individuals experiencing dysequilibrium may feel unsteady or have difficulty maintaining their balance while walking. Vertigo refers to a spinning sensation, presyncope refers to feeling lightheaded or faint, psychiatric dizziness refers to dizziness caused by mental health issues, and multifactorial refers to dizziness caused by multiple factors.

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A primary headache is not associated with any underlying pathology and is the most common type of headache. On the other hand, a secondary headache can be attributed to an underlying pathologic condition but is much rarer.

Serous effusion is usually caused by viral upper respiratory infections (URIs) or sudden changes in atmospheric pressure. In this condition, the Eustachian tube is unable to equalize air pressure, causing air to be partially absorbed into the bloodstream and fluid to accumulate behind the tympanic membrane (TM). Symptoms of serous effusion include fullness, popping, mild conductive hearing loss, and pain.

Hashimoto's thyroiditis is an autoimmune disease in which the immune system attacks and destroys the thyroid gland. This leads to the gland producing insufficient thyroid hormones, resulting in hypothyroidism. It is not a cause of hyperthyroidism, where the thyroid produces too much thyroid hormone. Therefore, the three true statements about Hashimoto's thyroiditis are: it is one of the most common causes of hypothyroidism, it is an autoimmune disease in which the immune system attacks and destroys the thyroid gland, and it causes the gland to make insufficient thyroid hormones (low T3 and T4).

A chancre of syphilis is described as a firm, button-like lesion that ulcerates and may become crusted. Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The primary stage of syphilis is characterized by the development of a painless sore called a chancre at the site of infection. The chancre typically appears as a small, raised bump that can evolve into an ulcer with a firm, button-like texture. If left untreated, syphilis can progress to more serious stages and cause a wide range of complications.

Cluster headaches are associated with unilateral lacrimation, rhinorrhea, miosis, ptosis, eyelid edema, and conjunctival injection. They occur episodically for hours at a time and then go into remission for weeks or months. Alcohol can provoke cluster headaches, and there is no known way to relieve the pain. Therefore, the correct answer is cluster headache.

The most appropriate diagnosis for this patient is acute glaucoma. The patient presents with severe, aching, and deep pain in his right eye, along with a decrease in vision. The right pupil is dilated and fixed, and the cornea is cloudy. These findings suggest increased intraocular pressure, which is characteristic of acute glaucoma. The other options, such as conjunctivitis, chronic glaucoma, corneal abrasion, and vitreous hemorrhage, do not fit the patient's symptoms and physical exam findings.

A full and torturous retinal artery, with increased light reflex is called copper wiring, and an artery that is so opaque that no blood is visible within it at all is called silver wiring.

Migraine headache is not considered a "secondary" headache because it is a primary headache disorder. Secondary headaches are caused by an underlying medical condition or injury, whereas primary headaches occur without any identifiable cause. Migraine headaches are typically recurrent and can be triggered by various factors such as stress, hormonal changes, certain foods, and environmental factors. They are characterized by severe throbbing pain, often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound. Therefore, migraine headache is the correct answer as it does not fall under the category of secondary headaches.

This answer describes the condition of Horner's syndrome. It states that the affected pupil is small but reacts briskly to light and near effort. It also mentions the presence of ptosis of the eyelid, loss of sweating on the forehead, and a lighter iris in the affected eye compared to the normal eye.

Bullous myringitis is a viral infection characterized by painful hemorrhagic vesicles that appear on the TM (tympanic membrane), the ear canal, or both. The symptoms mentioned in the hint, including earache, blood-tinged discharge from the ear, and conductive hearing loss, are commonly associated with bullous myringitis. Perforated eardrum, tympanosclerosis, acute otitis media, and serous effusion are different conditions and do not present with the specific symptoms mentioned.

Adie's (tonic) pupil is characterized by one pupil being larger, regular, and having a slowed or absent reaction to light. This condition also causes slow accommodation, leading to blurred vision. Additionally, deep tendon reflexes (DTRs) are often decreased in individuals with Adie's pupil.

Open-angle glaucoma is a condition that often has no symptoms and does not show a shadow when testing the depth of the anterior shadow. However, increased intraocular pressure (IOP) can lead to damage to the optic nerve and gradual vision loss over time. Unlike narrow-angle glaucoma, which can cause sudden symptoms and is a common cause of red eye, open-angle glaucoma progresses slowly and is not typically associated with redness or acute symptoms. Therefore, open-angle glaucoma is the correct answer in this context.

Corneal arcus, senile arcus, and arcus senilis are all correct answers because they are all associated with normal aging. These conditions present as a grayish-white arc near the edge of the cornea and can suggest hyperlipidemia. They may also be seen in young people occasionally.

Argyll Robertson pupils are characterized by small, irregular pupils that are able to accommodate (constrict and dilate in response to near effort), but do not react to light. This condition is often associated with neurosyphilis, a late stage of syphilis that affects the nervous system. The other options describe different conditions or symptoms, but do not specifically describe the characteristics of Argyll Robertson pupils.