What is the classic definition of Acne?

Acne is a chronic inflammatory disease that involves sebaceous glands. Secretions increase and get infected and cause the gland to become inflamed.

Who tends to have more problems with acne and why is this?

Males tend to have a bigger problem with acne due to their testosterone levels.

True or False: Estrogen decreases sebaceous gland activity?

What is typically used to treat acne?

Antibiotics are typically used

(both topical and systemic)

        NOTE: Erythromyocins are usually used

What is Eczema?

Eczema refers to a whole group of red, scaly, itchy, thick lesions.

What form of Eczema is hereditary and when can it appear?

Atopic Eczema is hereditary and can appear at any age

(more in childhood).

Where does Atopic Eczema classically start at and what type of infections do people with this eczema tend to get?

          Classically starts at flexure areas such as elbows, knees, neck. These individuals tend to get secondary infections and there is not much we can do about this.

What is contact eczema?

Contact eczema is an allergic reaction to allergens such as poison ivy, metals, etc.

        NOTE: this is a localized antigen-antibody reaction

What is neurodermatitis?

When temperature is cold, skin gets dry and scratching occurs.

What regions on the body are most affected by neurodermatitis and why?

The hands, neck, and genital areas b/c the skin is not retaining moisture.

What is something you can do to help with neurodermatitis?

       Keep the skin lubricated and avoid inflammation

True or False: Neurodermatitis goes away when the temperature goes up?

What are hives characterized by?

Edema and Erythema

What are hives a result of and what can you do to treat them?

99.99% is the result of allergic reactions and you can treat them topically or internally

What is psoriasis characterized by?

Thick, silvery-white, scaly lesions.

They kind of look like fish scales.

Where is psoriasis commonly seen and when can it develop?

Commonly seen in the knees, elbow, and scalp and can occur at any age.

What is psoriasis correlated with?

Highly correlated with arthritis

 NOTE: may be auto-immune

True or False: psoriasis typically runs in the family?

TRUE: the gene is not found yet.

NOTE: pretty common 1-2% of the population has psoriasis

What can trigger the inflammatory response related to psoriasis?

An influx of T-Lymphocytes in tissue can trigger an inflammatory response

What can you do treat psoriasis?

You can use a topical treatment (steroid cream), but there is not much we can do for this disease.

Where is the problem in relation to psoriasis?

The problem is in the epidermal layer, these cells reproduce like crazy.

What are warts caused by?

Warts are caused by viruses (DNA).

True or false: Warts are not contagious

FALSE, warts are contagious (virus)

Where do flat warts occur?

Everywhere but the bottom of the feet

What are the warts that occur on the bottom of the feet called?

Plantar warts; they are angled down into the foot and can hit the nerve. These are very painful.

What are two ways to treat warts?

Plantar warts: topical vitamin A is recommended by dermatologists.

Compound W also works kind of by burning the tissue, but it will not work if the wart is deep.

What is herpes simplex I?

Considered simplex I if it is gotten on the lip or anywhere above the waist.

True or false: Herpes simplex I is a communicable virus

This is the STD form of the virus and is found below the waist.

When is the virus active?

36-48 hours before an outbreak

What is it called when a women delivers her baby vaginally and transmits the virus to the baby?

Disseminated herpes (head to toe).

The mortality rate for baby is 75%

What is chicken pox and shingles caused by?

These both are caused by the VZ virus

True or False: you can get shingles if you have not had chicken pox.

What is the most common age range of chicken pox?

Children 4-10

NOTE: chicken pox is very contagious and communicable

What is the infection rate amongst children that are not immunized?

90%

What % of strokes that happen in children are due to chicken pox?

What will you develop the second time the VZ virus is introduced to your system?

Shingles

NOTE: the reason we get shingles once we have had chicken pox is b/c we have an antibody to only part of the virus

What does shingles represent?

Shingles represents the reinfection of a partially immune host.

True or false: the chicken pox vaccine doesn’t truly immunize?

TRUE, the chicken pox vaccine only decreases the probability of getting chicken pox

NOTE: the vaccine may also reduce the severity of the chicken pox

Where do shingles cause inflammation?

The nerve endings, this is very painful.

Usually follows nerves around the waist, down chest.

Can a patient with shingles give a child chicken pox?

Can a child with chicken pox give an adult shingles?

True or false: you can only get shingles once

What is a shingles outbreak mostly related to?

An outbreak of shingles is related to an immune-compromising event

What is Candidiasis?

What are vaginal infectons related to in females?

An upset in the normal flora

What is Thrush?

This is a yeast infection in the mouth of a newborn from the birth canal

What is the most common tumor of the skin called?

Where do 80% of basal cell carcinomas appear?

On routinely sun-exposed areas (think skin, neck, face, etc.)

What are some characteristics of basal cell carcinomas?

They are slow growing, rarely metastasize, and are inversely related to pigmentation (the lighter you are the more likely you are to get these)

Are basal cell carcinomas easy to treat?

Yes, easy treatment by removal

Why would a basal cell carcinoma metastasize?

If it was left untreated it would eventually metastasize

What is the second most common tumor of the skin?

What are some characteristics of squamous cell carcinomas?

These rarely metastasize if they occur on routinely sun-exposed skin such as the face, hands, neck, etc.

Where would a squamous cell carcinoma be most likely to metastasize?

Would most likely metastasize if it appeared in unexposed areas (butt)

What % of all skin cancers does basal cell and squamous cell carcinomas make up?

What is melanoma?

 It means “dark”+”new growth” and accounts for 3% of skin cancers

What is the mortality rate of melanoma?

Accounts for 60% of deaths from skin cancer

True or false: melanomas frequently metastasize?

TRUE

NOTE if diagnosed early there is a good cure rate

What is melanoma usually correlated with?

Age 40-70 years old, fair complexion and sun exposure

How do you assess these?

ABCDE assessment

What is the definition of a stroke (cva)?

Some kind of disturbance/alteration in cerebral circulation

True or False: strokes are the 3^rd most common death cause in the country?

TRUE they are very common

Name four different kinds of strokes:

Embolus, thrombosis, intracranial (hermorrages) bleeding, and aneurisms

What is the most common stroke?

Thrombosis occurs 40% of the time

What is a thrombosis the result of?

Plaque in the cerebral arteries. The plaque develops in the vessel turns and branches or curves

When is the peak age to have a thrombosis?

60-69 and hopefully they have a TIA (transient ischemic attack).TIA is the same as angina, but to the brain. So this is a warning sign more or less.

When are the normal onset of symptoms for patients with thrombosis?

Very early in the morning, or shortly after awakening.

What is the reason for early morning onset of symptoms in relation to thrombosis?

Platelets are stickier in the morning hours due to circadian rhythms.

True or false: symptoms for thrombosis are very step-like?

What is the 2^nd most common stroke?

What is the definition of an embolus?

Occurs generally in the younger population, occurs from thrombosis of the heart, it is a manifestation of heart disease and ended up in the middle cerebral artery.

NOTE: something inherent in the heart.

What is the 3^rd most common form of stroke?

Cerebral hemorrhage

What is the problem with a cerebral hemorrhage?

There is no place for the blood to go in the brain so it accumulates, there is then an increased pressure causing displacement and compression of the brain.

Why is it important to tell where the bleed is and if it is arterial or vascular?

If it is in the cerebral hemisphere then it is probably a venous bleed and we can put in blood and the patient is ok.

If it is in the brain stem and we give you 5 ml of blood we will kill you. This is why it is important.

What are some symptoms of a Cerebral Hemmorhage and how do we diagnose it?

Symptoms can be severe headache, nausea, vomiting and we would diagnose it by doing a CT scan.

NOTE: before there were CT scans they did a spinal tap

What is the least likely stroke to occur?

Where is an aneurysm most likely to occur?

The circle of willis due to a bulging of vessels and a rupture

True or False: aneurysms are symptomatic?

FALSE, they are asymptomatic.

First symptom is funeral

What are some common characteristics of aneurysms?

They can run in the family, people may say, “feels like something snapped in my head”, also referred to as “berry” aneurysms

When are you most likely to have an aneurysm?

During activities such as running, jogging, sex (usually males)

What can cause headaches?

Can be from different things: bleeds, head injuries, eye strain, sinusitis, etc. Lots of things

What are the 4 types of sinuses?

Frontal, Ethmoid, Sphenoid, and maxillary.

What will someone with a sinus headache complain of?

True or False: Sinus infections are common?

FALSE, sinus infections are not common and they can kill you

What is a vascular headache commonly referred to?

 MIGRAINE

Are Vascular (migraine) headaches more common in men or women?

Women under 40 years of age.

Most common between ages 25-35

NOTE: 10% of females have migranes, 1/3 of the population

What are migraines highly correlated with and what should you avoid?

Highly correlated with the menstral cycle and don’t allow prescriber to put you on the pill to alleviate your migraines. It often makes them WORSE

True or False: 70% of the time there is a positive family history for migraines?

What three things do migraines involve?

Vasoconstriction, Vasodilation, and localized vessel inflammation

What happens during the period before the headache?

 The cerebral blood flow is decreased.

What happens during the actual headache?

There is vasodilation

What are the two presentations of migraines?

Classic and common

What happens in a classic presentation migraine?

There is a prodromal phase: there is a warning sign the headache is coming (tingling, smell changes, some kind of perceivable aura that migraine is about to take place)

What happens in a common migraine?

There are no warning signs, no pre phase

What are some characterisitics of both classic and common migraines?

There is a dull, unilateral pain and then it is throbbing.

They are touch, and light sensitive.

Sleep will alleviate the migraines.

What did we use 20 years ago to manage migraines?

Morphine in hopes to knock them out or Ergot which caused hallucinations (salem witch trials)

What do migraine drugs work by?

 Vasoconstriction

If you have CVC you cannot take any of the rescue drugs for migraines, so what do you have to rely on?

Things such as tricyclic antidepressants, beta blockers, and calcium channel blockers.

How can you tell if your migraine drug is not working and you need to change to another medication?

You will have rebound headaches and they are usually more severe than the original migraine.

What are some things that can trigger a migraine?

Red wine, caffeine, chocolate, etc.

True or False: 50% of the people that have an aura with their migraines have payton foramen ovale?

What are some characterisitics of cluster headaches?

May be a form of a migraine

They are in a category by themselves

They appear in a cluster of time (intermittent)

They can occur nightly, for a few weeks, or months

Who are cluster headaches more common in?

How would a patient describe the pain of a cluster headache?

Not a throbbing pain, but a constant, unilateral (around orbits), pain that you cannot sit still through

What are Cluster headaches highly correlated with?

REM sleep habits: Headache (sudden acute pain) wakes them up, then back to sleep, 1.5 hours later will wake them up again

What is a muscular tension headache?

This is a muscle pain (somebody that plays in a symphony)

Where is the pain in a muscular tension headache?

Pain is in the forehead, tightness of muscles. Band-like tightness

What do you take for these and why?

Take ibuprofen because it is an anti-prostiglandin and an anti-inflammatory. Prostaglandin comes from muscles, they cause cramps (think your uterus)

What is the age of the general population with the highest incidence of primary epilepsy?

The younger population, 75% occurs before age 20

What are the two classes of epilepsy?

Partial (Focal) and Generalized

What is a Partial (focal) seizure?

It is not a generalized (entire cerebral cortex) disorder of the brain, there are two presentations: Jacksonian and Psychomotor

What are some characteristics of a Jacksonian seizure?

Spasm of the muscles, always on the one side of the body (small, isolated, identifiable lesions) may begin with a finger twitching, then moves to the arm, then chest, and so on. ~NOTE~ can last 1-2 min or be very quick

What are some characteristics of a Psychomotor seizure?

Involves purposeless movements such as clapping of the hands, blinking eyes, smacking lips, etc.

NOTE: Video games can trigger these seizures if the child already has the disorder, so can flashing lights and bass beat drum (auditory and visual stimulus precipitate)

True or false: patients are unable to recall what went on around them during Jacksonian or psychomotor seizures?

What are the two presentations of generalized seizures?

Absence/petit mal and tonic/clonic=grand mal

What are some characteristics of an absence/petit mal seizure?

Sudden, lapse of consciousness, blinking eyes or blank stare—brief periods of “just not being here”

Who are absence/petit mal seizure almost exclusively seen in?

Children, after the age of 20 these are very rare.

NOTE: can be very dangerous to children, think: if a kid is riding their bike and has one of these and rides out into traffic, not good.

How long does an absence/petit mal seizure last?

What are some classic presentations of a tonic/clonic (grand mal) seizure?

Usually there is an aura (neurological cue), lose upright position and bladder control, may last for 3-5 min, jerking movements. Patient will be unconscious during and after seizure for a bit.

What can a person do if they do not have an aura as a warning sign for their grand mal seizure?

Get a seizure dog that can smell the seizure coming

What are some characteristics of a febrile tonic (gerneralized but not neurological)?

Almost exclusively in children under 5, will have a grand mal seizure, increase in body temp (nothing you can do but cool body down), they run in the family, vast majority of children grow out of these by 10.

What is amyotrophic lateral sclerosis (ALS)/Lou Gehrig’s disease?

A progressive neurological disease

When do patients usually start to develop Lou Gehrig’s disease symptoms?

Between 40-60 yrs, can be earlier due to the head injuries they endured in their youth

What is the etiology of Lou Gehrig’s?

Unknown, but genetics, virus, and auto-immune are some possibilities

What happens to your neurons in Lou Gehrig’s disease?

There is a deterioration of neurons, specifically motor neurons in the cerebral cortex, not sensory neurons.

True or False: intellectual and sensory abilities are completely gone in Lou Gehrigs?

FALSE, intellectual and sensory abilities are completely unaffected.

What is the average life span of a patient with Lou Gehrig’s and what do they normally die of?

3-5 years after the onset of symptoms and the patient usually dies of pneumonia and respiratory failure.

What % of NFL players have Lou Gehrig’s?

What is Huntington’s disease?

Cell decrease in the basal ganglia and cerebral cortex (losing neurons), as you lose these cells you lose intellectual ability, muscle coordination and are eventually bed-ridden in extended care

Is Huntingtons disease genetic?

Yes, the abnormality is on chromosome 4 and we can test for this

What is the 1^st symptom of Huntington’s disease?

A very subtle decline in motor function: clumsy

What is the medium onset age for Huntington’s?

What is Parkinson’s?

Syndrome that is characterized by rhythmic tremors and bradykinesia (slow movements). Also can have resting tremors (pill rolling tremors with hands)

What is a common treatment for parkinson’s?

Deep brain stimulation is used for treatment by sending constant electric stimuli to dopamine stimulating areas. It is implanted under the skin. This can be adjusted by phone.

NOTE: this is just buying time, not treating the disease

How would you change an Eldopa dosage over time?

You would need to increase the Eldopa, because Dopamine is continuously decreasing.

What is deep brain stimulation?

It is a pacemaker for the brain.

Note: wires in Dopamine producing areas of brain that stimulates Dopamine

How long does it take to see the effects of Eldopa in a parkinson’s patient?

30 min and the patient is moving perfectly fine

True or false: deep brain stimulation can cure parkinson’s.

False, just buys time. Eventually you lose all dopamine

What is the most common neurological disorder that affects the young population (30 years of age)?

Multiple sclerosis, more common in females

What is the etiology of MS?

The etiology is unknown, but people think it may be viral, autoimmune or genetic

True or False: MS is more common in tropical climates

False, more common in cold climates

Why do MS patients develop lesions? Where are these lesions located?

They develop lesions because they lose myeline sheath and these lesions are only in the white matter in the CNS.

NOTE: it demyelinates their nerve cells

Explain why the loss of myelin sheath is responsible for the symptoms of MS:

When the current hits the spot on the neuron where the myelin sheath once was it is forced to go in a different direction.

NOTE: you will see numbness and loss of peripheral vision

True or false: it is impossible to remyelinate the neurons

How can the injection of bovine myelin (cow myelin) be affective in reducing symptoms of MS?

The antibody deactivates the cow myelin and leaves the patients myelin alone

What is the survival rate of MS?

It is on a continuum, from 40 years of survival down to 5 years of survival

What is classicaly the first presentation of MS?

Nystagmus (bouncing of the eyeballs)

What does Myasthenia Gravis mean?

It means grave or severe muscle weakness

What is the peak age for MG? What are patients with MG likely to die from?

Peak age is 20 years old, likely to die of respiratory problems

NOTE: this disease affects 1 in 10,000

How are acetylcholine receptors related to MG?

In MG patients we find antibodies to proteins in the ACH receptor site so they have decreased ACH receptors, this helps prove that this is probably an autoimmune disease

What symptoms are present in 90% of MG patients?

Difficulty controlling ocular muscles

(involuntary eye movement)

Explain mortality in relation to MG staying in the eye muscles and MG moving to the facial muscles.

If MG stays in the eye muscles there is no relation to mortality, but most of the time it moves to the facial muscles, laryngeal, pharyngeal and respiratory. This generally causes pneumonias and the patient will die

What percent of the population is affected by alzeheimers?

10% of the population over 65

What two things are decreased in Alzheimers?

Hippocampal and cortical neurons

NOTE: a decrease in acetylcholine is correlated with dementia.

What are three things that are thought to be the etiology of alzheimers?

Viral, autoimmune or aluminum toxicity

What is found in the spinal fluid that is unique to Alzhemiers patients?

ADAP = alzheimers disease associated protein, this can be found by doing an invasive spinal tap

(trying to determine if this protein can be picked up by a simple blood test so they don’t have to do a spinal tap)

How much is your chance of getting alzhemiers increased with the first degree relative?

What are the initial, later, and final signs and symptoms of alzheimers?

Initial: recent or short term memory loss

Later: they begin having problems understanding things they read, things that are said to them and organizing daily activities

Finally: become completely confused and disoriented

What is the prognosis of Alzeheimers and what do they die of?

6-8 years from onset to death and they die from repiratory stuff

What three chromosomes are correlated with alzheirmers?

14, 19, 21 (downs syndrome correlated with this chromosome too)

What is disease commonly seen in a down’s patient and what age does this manifest?

Alzheimers around the age of 40

Is it more common in males or females to develop alzheimers between the ages of 45-50?

True or False: There is no way to diagnose alzheimers at this time.

True, only dx by exclusion of things

What is the normal range for intercranial pressure (ICP)?

It is 50-200 mmH2O

NOTE: the ICP is normally pretty low

What happens to the blood flow if the ICP is increased?

The blood flow will be decreased

What time frame is it a big deal to see sustained increases of ICP?

If the ICP increase is sustained for 36-48 hours, you risk completely cutting off blood supply to the brain

(pressure moves brain to immovable skull)

NOTE: you would remove part of the skull to reduce pressure on the brain

True or False? A concussion is an acute swelling of the brain

False, it is a slow swelling

What is the cascade of closed head trama?

- Head trauma

- Brain tissue injury or damage

- Breakdown of blood brain barrier/leak protein out of vessels 

- Cerebral edema

- Increased ICP

- Decreased cerebral blood flow

- Hypoxia (ischemia)

- Increased PCO2, potassium and decreases PH

- Dead brain tissue

What symptoms are most common in a head trauma (increased ICP)?

Headache, vision changes, altered speech, seizure, projectile vomiting (very classic)

What are we looking for in each of the three responses in the coma scale (eye opening, verbal responses, motor responses)?

We are looking for 1-4 on eye opening such as spontaneious eye opening, following finger and no eye opening

Verbal responses 1-5, looking to see if they converse

Motor responses 1-6, do they obey commands or is there no response