Property of: MARA NATHANIELLA P. SEMAN | BSMT2B 7.

Visicles
- small, fluid-filled blisters
- characteristic of herpes infections, acute allergic
PATHOPHYSIOLOGY contact dermatitis, and some autoimmune blistering
MIDTERMS disorders
I. INTEGUMENTARY SYSTEM 8. Bullae
Composed of: - larger, fluid-filled blisters
- burns, bites, irritant contact dermatitis or allergic
Skin
contact dermatitis, and drug reactions
Dermal Appendages: Hair, Nails, Glands
9. Pustules
Functions: - vesicles that contain pus
 Barrier - common in bacterial infections and folliculitis
 Regulates body temperature - may arise in some inflammatory disorders
 Activates Vitamin D including pustular psoriasis.
10. Cysts
 Contains touch and pressure receptors
- contain liquids or semi-solid materials
1. EPIDERMIS 11. Crusts
Layers: - consist of dried serum, blood, or pus
 Stratum corneum - crusting can occur in inflammatory or infectious skin
 Stratum lucidum diseases (impetigo).
 Stratum granulosum 12. Telangiectasia
 Stratum spinousum - foci of small, permanently dilated blood vessels
 Stratum basale - discoloured veins/capillaries
2. DERMIS - spider veins
Consists of: 13. Scales
- heaped-up accumulations of horny epithelium that
 Papillary layer
occur in disorders such as psoriasis, seborrheic
 Reticular layer dermatitis, and fungal infections.
 Collagen 14. Petechiae
 Elastin - nonblanchable punctate foci of haemorrhage
 Proteoglycans 15. Purpura
 Hair follicles - larger area of hemorrhage that may be palpable
 Glands CELLULITIS
 Lymphatics CURBUNCLE
 Nerves - usually in diabetic patients
3. SEBACIOUS GLANDS - symptoms: swelling
- Active during adolescence (puberty) - treatment: oral medication, incission
- Affected by androgen PRURITUS
Abundant: Mainly for lubrications: Generalized Pruritus:
Face Eyelids  Skin diseases
Chest Niples  Endocrine: carcinoid, diabetes, thyroid dx
Back  Infection: Hep C, HIV
4. SWEAT GLANDS  Psychiatric diseases
- Produce odor  Systemic diseases: renal failure, biliary cirrhosis,
Ex. Hyperhydrosis or sweating (pasmado) blood dycrasias
Types:
1. Eccrine sweat glands Skin Manifestations of Systemic Disease
2. Apocrine sweat glands Chronic Renal Failure: bruising, hyperpigmentations, pale nails
Endocrine diseases: acanthuses nigricans, acne, hirsutism,
PRIMARY LESIONS atrophic skin, telengiestasia
1. Macule GI: jaundice
- flat lesion, less than, < 1cm in diameter
Hyperlipidemia: Xanthomas
- freckles, flat moles, tattoos, and port-wine stains,
and the rashes of rickettsial
infections, rubella, measles DIAGNOSTICS
2. Papule Biopsy: shave, punch, incisional, excisions, curettage, snip
- elevated lesion, < 10mm in diameter Dermoscopy
- nevi, warts, lichen planus, insect bites, seborrheic Diascopy
keratoses, actinic keratoses, some lesions of acne, Immunoflourescence
and skin cancers KOH test
3. Patch Patch Testing
- flat lesion, < 1cm Wood Lamp
4. Plaque Tzanck smear
- palpable lesion, > 10mm in diameter
- psoriasis, granuloma annulare INFLAMMATORY DISEASES
5. Wheal
Allergic Dermatitis
- a raised, itchy (pruritic) area of skin that is
Irritant Contact Dermatitis
sometimes an overt sign of allergy.
- during allergic reactions Atopic Dermatitis
- hives (Urticaria) Stasis Dermatitis
6. Nodules Seborrheic Dermatitis
- solid lesion (much hard) Cause: Malassezia furfur
- firm papules or lesions Affects: scalp, brows, eyelids, ear canals, nasolabial folds
- cyst, lipomas, fibromas Manifestations: burning, itching, scaling, orange
erythematous patches with dry or greasy scale
 - increased permeability
BACTERIAL INFECTIONS • Cellular changes
Folliculitis - decrease in number of neurons
- Inflammation of the hair - decreased myelin
- follicle due to infection - Lipofuscin deposition
- furuncle - decreased dendritic and synaptic connections
Cause: Staph aureus, Pseudomonas (hot tub folliculitis) - Neurofibrillary tangles
History: mild injury or irritation: tight fitting garment, obese - Neurotransmitter imbalance
S/Sx: superficial pustules or papules in the distribution of the • Functional changes
hair - decreased tendon reflexes
- taste and smell deficit
VIRAL INFECTIONS - vibratory sense
1. Varicella (Chickenpox) - decrease in accommodation, color vision
- remains dormant in sensory - change in gait and posture
nerve roots for life - sleep disturbance
- pruritic, mild, self-limiting - memory impairment
Cause: varicella zoster INJURIES AND TRAUMAS
Reactivation: Herpes Zoster (shingles) 1. Major Head Injury
Exanthem: crops of erythematous macule to oedematous - traumatic insult to the brain capable of producing
papule to vesicles (dew drops on rose petals) physical, intellectual, emotional, social, and
2. Herpes Simplex vocational changes.
- common oro-facial and - highest among 15-24 y/o, blacks, male
genital lesions - MC: mild concussion and classical cerebral
- subclinical primary episode concussion
- latency 2. Closed (blunt) trauma
- recurrence - head striking a hard or a fast moving object
- Rubeola (measles), Rubella (German Measles), - dura intact
Roseola - brain tissue not exposed
Cause: HSV 1 and HSV 2 - may have focal and diffuse axonal injuries
S/sx: burning, itching grouped umbilicate vesicles on Types of traumatic brain injury:
erythematous base  Direct-impact injury
3. Alopecia  Acceleration-deceleration injury
- hair development  Shock wave injury
- Hair loss Causes: drugs, 3. Open (Penetrating) trauma
- endocrine, nutritional - dura broken
- Androgenic Male pattern - cranial contents exposed to the environment
- Female pattern - results in focal brain injury
Anagen - growing 4. Focal brain injury
Catagen - resting - specific, grossly observable brain lesions
Telogen - shedding o Contusion
4. Alopecia areata o Epidural haemorrhage
- autoimmune T-cell mediated disease in genetically o Subdural hematoma
predisposed persons well circumscribed area of hair o Intracerebral hematoma
loss “exclamation point” - compression to the skull
- Ddx: Telogen Effluvium - rebound effect (contrecoup)
5. Paronchia - Brain edema (swelling)
Nail disease caused by Signs and Symptoms:
infection: bacterial or fungal - immediate loss of consciousness
Acute: pain, swelling and redness by the base of the - loss of reflexes
redness by the base of the nail; abscess formation - transient cessation of respiration
Chronic: cuticle - bradycardia
breakdown; nail separation or deformity - increased CSF pressure
- headache
- vomiting
II. NERVOUS SYSTEM - confusion
Aging - seizure
Menter and Hudson: 5. Diffuse brain injury
3 processes - shaking effect
1. Physiologic changes of the body - Rotational acceleration – primary mechanism
2. Individual’s changing social roles - damage can only be seen under the electron
3. Self-realization microscope
 by age 24, neurons of the CNS decay - after concussion, brain cells fire at once
 decrease in short term memory, speed of motor - Glutamate is released; followed by potassium
activity, information processing - Calcium rushes into the cell mitochondria
• Structural changes - Cellular energy crisis
- decreased brain weight and size - Glutamine overstimulates NMDA receptors
- fibrosis, thickening of meninges
- narrowing of gyri; widening of sulci
- increase size of ventricles Manifestations:
• Cerebrovascular changes - Spastic paralysis, visual and hearing impairments
- Atherosclerosis
 - disorientation and confusion - Systemic diseases – hypothyroidism, diabetes,
- memory deficits sarcoidosis, multiple sclerosis
- Dysphasia, agitation, impulsiveness Symptoms:
- blunted affect Head trauma
Brain surgery
DEFECTS OF THE VEURAL TUBE Aging – decrease in the fibers of olfactory bulb
1. Neural plate – origin Toxic systemic or inhaled drugs
2. Neural fold/groove Neuropsychiatric disorders
3. Neural tube – with canal
Disorders:
 Anencephaly III. SKELETAL SYSTEM
 Encephalocele Composed of:
 Iniencephaly Bones
 Craniorachischisis Joints
 Open/Closed spina bifida Ligaments - BB supporting structures
 Meningocele Tendons - MB
 Myelomenigocele
MOST COMMON INJURIES
1. Hydrocephalus
- disturbance of cerebrospinal fluid formation, flow, 1. Trauma
and absorption leading to increase in volume - leading cause of death for ages 1-44 y/o
- AKA hydrodynamic CSF disorder - 150,000 deaths per year
Formation of CSF: - 500,000 permanently disabled
Formed: Lateral ventrical
2. Fractures
1. third ventricle
- most common type of bone lesion
2.
- break in the continuity of a bone
3. fourth ventricle
- force applied exceeds the tensile or compressive
4. synoses
strength of a bone
Symptoms:
- Healthy bones tibia, clavicle, lower humerus is
Poor feeding
mainly caused by trauma
Reduced activity
High incidence: young males and older age group
Vomiting
• Hand & foot - workplace accidents
Cognitive deterioration
• Upper humerus, upper femur, vertebrae, pelvis -
Neckpain
osteoporosis
Blurred vision/ double vision
Categories of Fractures
Drowsiness
According to CAUSE:
2. Otitis media
• Fractures from Sudden Injury
- inflammation of the middle ear
• Fatigue or Stress Injury
- after upper respiratory tract infection
• Pathologic Fractures
Types:
According to LOCATION:
• Acute otitis media
• Proximal
• Otitis media with effusion
• Mid shaft
• Chronic suppurative om
• Distal
• Adhesive om
Types of Fractures:
Symptoms:
1. COMPLETE FRACTURE - broken through and through
Otalgia Otorrhea Headache
2. INCOMPLETE FRACTURE - bone is left in one piece
Fever Irritability Loss of appetite
3. OPEN FRACTURE - compound fracture
Vomiting Hearing loss Tinnitus
4. CLOSED FRACTURE - simple fracture
Vertigo
5. COMMINUTED FRACTURE - a break or splinter of the
3. Hyposmia
bone into more than two fragments
- decreased ability to detect odors
According to DIRECTION OF FRACTURE LINE:
- conductive defect
• Linear Fracture - parallels to the long axis of the bone
- sensorineural defect
• Oblique - at an oblique angle to the shaft
Causes: • Spiral - encircles the bone
Aging • Transverse - fracture line is perpendicular to the long axis of
Nasal/sinus disease the bone
Viral urti Types of Incomplete Fractures:
Head trauma 1. GREENSTICK - perforates one cortex and splinters the
4. Conductive olfactory defect spongy bone
- Inflammatory process – rhinitis (allergic, acute, toxic, 2. TORUS - cortex buckles but does not break
chronic) 3. BOWING - bending; longitudinal force is applied to
- Masses – polyps, papilloma, tumor the bone
- history or prolonged tracheostomies/ laryngectomies 4. STRESS - occurs in normal bone that’s subjected to
repeated stress
Developmental abnormalities:
Encephaloceles
Dermoid
Cysts

5. Sensorineural olfactory defect PATHOLOGIC FRACTURE

- Inflammatory – viral – olfactory neuroepithelium to - Break in an existing abnormality in:
respiratory epithelium • Tumors
• Osteoporosis
• Infections • Analgesics
• Metabolic bone disorders • Anti inflammatory drugs
BONE HEALING • Hyaluronic acid, Glucosamine and chondroitin
• Joint replacement Surgery
2. OSTEOMYELITIS
- Infectious bone disease
Causes:
• Contiguous invasion
• Hematogenous spread
• Skin infection from vascular insufficiency
• Bones have multiple microscopic channels trapping bacteria
• Microcirculation is vulnerable to ischemia and necrosis
CLINICAL MANIFESTATION
• MC: Staphylococcus aureus
• Deformity
• Swelling
• Muscle spasm
• Tenderness and pain
• Impaired sensation
• Decreased mobility
TREATMENT
• Immobilisation
• Reduction
• Closed
• Traction
• Open
• External fixation 4. OSTEOPOROSIS
• Internal fixation - Metabolic bone disease
INJURIES - Normal mineralization but decreased density and
1. DISLOCATION impaired structural integrity of trabecular meshwork
- Temporary displacement of a bone from a joint - Bone density: standard deviation from mean of
- Total loss of contact with opposing bone young healthy bone
- congenital, traumatic or pathologic
2. SUBLUXATION
- Partial loss of contact with opposing bone surface
• Sprain - ligament tear
• Strain - stretching injury to tendon; pain, swelling, stiffness
• Muscle strain
1st degree - muscle overstretched
2nd degree - muscle fibre tear
3rd degree - fascial tear
Treatments:
• Rest
• Ice compression
• Elevation Risk factors:

1. OSTEOARTHRITIS
- Non-inflammatory
- Degenerative joint disease
- Loss and damage or articular cartilage
- Load-bearing areas
Pathophysiology:
1. Initial Loss of glistening material
2. Cartilage flake off
3. Longitudinal fissures
4. Cartilage becomes thin and absent
5. Subchondral bone is unprotected — dense, hard
6. Cysts develop and build pressure in synovial cavity
7. Cartilage erodes
8. Osteophytes grow outward
Clinical features:
• 50-60 y/o
• Pain on weight bearing joints
• Relieved by rest; aggravated by movement
• Parenthesis
• Bouchard nodes Pathophysiology:
• Heberden nodes - Bone resorption exceeds bone formation
- Osteoclast > osteoblast

Treatment: Treatment:
• Weight loss • Avoid risk factors
• Rest • Avoid caffeine beverage
• Regular exercise
• Adequate calcium and Vitamin D intake
• Hormonal replacement therapy, calcitonin,
bisphosphanates, Selective Estrogen Receptor Modulators
(SERMs)

IV. MUSCULAR SYSTEM

• Type I - slow twitch, red muscle
- Aerobic activity
• Type II - fast twitch, white muscle
- Anaerobic bursts of activity
BENEFITS OF STRETCHING
• Lengthens musculotendinous unit to maintain range of Treatment:
motion of joints  Acetylcholinesterase inhibitor (Pyridostigmine or
• Prevents muscle imbalance Neostigmine)
• Prevents injuries  IVIg
• Useful as pre-workout warm up and post workout stretch  Plasmapheresis (have Igs)
 Longterm immunosuppression (steroids)
1. MUSCLE CRAMPS 6. BELL’S PALSY
- Sudden, involuntary contractions - Idiopathic Facial Paralysis
- Overuse, dehydration - Unilateral facial nerve paralysis
- Low electrolytes - Most common neurologic disorder of the cranial
- Low blood supply nerves
2. FIBROMYALGIA - CN VII - Facial Nerve
- Chronic, widespread pain and tenderness Clinical Manifestation:
- Young or middle-aged women • Acute onset of upper and lower facial paralysis (48hr period)
- Stiffness • Posterior auricular pain
- Fatigue • Decreased tearing
- Cognitive difficulties • Taste disturbances
- Sleep disturbance • Weakness of facial muscles
3. MUSCULAR DYSTROPHY • Poor eyelid closure
- Dystrophy = abnormal growth • Flattening of forehead and nasolabial fold
- Genetic disorder Course and Treatment:
- Progressive deterioration due to mixed muscle • Resolves gradually
hypertrophy, atrophy and necrosis • Goal: improve CNVII function, reduce neuronal damage,
4. DUCHENNE MUSCULAR DYSTROPHY prevent corneal complication
- 3 per 100,000 male children • Corticosteroid
- X-linked recessive inheritance • Antivirals
- Dystrophin - defective form of a large muscle protein; • Eyesore
fails normal attachment for contractile proteins • Surgical Treatment as needed
- Necrosis of fibres, continuous effort of repair &
regeneration and progressive necrosis
Clinical Course:
IV. ENDOCRINE SYSTEM
• Muscles of hip and shoulder MC affected
• Frequent falls by age 3 - Involved in all integrative aspect of life.
• Abnormal posture, contractures, immobility  Growth
• Distal muscles well preserved  Sex difference
• Weak ineffective cough  Metabolism
• Cardiomyopathy  Adaptation
5. MYASTHENIA GRAVIS  Electrolyte and water metabolism
- Rare, acquired, autoimmune disorder
HORMONES
- Antibody-mediated blockade of NM transmission
- MUSCLE WEAKNESS - Highly specialized organic molecules
- HALLMARK: fluctuating fatigable muscle weakness, - Chemical messengers
worsens w activity and improves w/ rest - Transported by body fluids
- Ocular symptoms (ptosis) - Exert action on specific target cells distant to their
- More severe proximal origin
Triggers: - Do not initiate reaction
 Warm weather - One hormone can have various effects in different
 Surgery tissues
 Immunisation o Estradiol in ovaries, uterus, breasts, pituary
 Emotional stress
glands – 1 func. Is regulated by several
 Menstruation
hormones
 Intercurrent illness
o Lipolysis under catecholamines, glucagon,
 Tapering Immunosuppression
and severetin –
 Post-partum period
 Certain medications Types:

1. Paracrine – act locally on cells other than those that

Pathophysiology: produce the hormones
• Antibody attacks ACh receptors 2. Autocrine – act on cell from which they were
• Reduction in number of receptors produced
• Progressively reduced muscle strength w repeated use
• EMERGENCY case: neuromuscular respiratory failure Classes of Hormones based on Chemical Structures:
RECEPTORS

- Recognize specific hormonal signals

- Linked to affector
 Hypothalamus – releasing
 Anterior Pituary
 Posterior Prituary
 Adrenal Cortex
 Adrenal Medulla

Control of Hormones: