1 What is an anorectal malformation? Anorectal malformation is a term used to designate a series of congenital defects characterized by the absence of an anal opening. However, most of the time, the rectum is abnormally connected to the perineum or to the urogenital tract. Actually, only 5% of all cases suffer from a real blind rectum and half of that particular group suffers from Down…
1 What signs and symptoms suggest intestinal obstruction in the neonate? Signs and symptoms vary according to the location of the obstruction. Proximal intestinal obstruction leads to early bilious vomiting, typically with minimal distention. Neonates with distal intestinal obstruction often present after the first day of life with distention and bilious emesis. Bilious emesis in infants and children deserves immediate investigation. An upper gastrointestinal (UGI) contrast…
1 What is hypertrophic pyloric stenosis (HPS)? HPS is the most common cause of gastric outlet obstruction in infants resulting in nonbilious vomiting. The pathogenesis of HPS is unknown; it is not thought to be a developmental defect. Hypotheses include nitric oxide deficiency, decreased neurotrophins, and alterations in growth factors and gastrointestinal peptides. It is more common in boys than girls (2:1). Offspring of an affected…
1 Why is the term dissecting aortic aneurysm really incorrect? The correct term should be dissecting aortic hematoma because the lesion is not an aneurysm. Blood passes into the media, creating a hematoma that separates the intima from the media or adventitia. It is unclear whether the inciting event is the intimal tear or blood from the media tearing through the intima. Hence, an intimal tear…
1 Does lung cancer screening save lives? The United States National Lung Screening Trial (NLST) reported a reduction in lung cancer mortality of 20%, and a 6.7% decrease in all-cause mortality. Low-dose computed tomography (CT) scans may prove beneficial in high-risk patients. Multiple other screening trials have not proven to be so optimistic; lung screening remains controversial. 2 What is a solitary pulmonary nodule? A solitary…
1 Is lung cancer a single disease? Traditionally, lung cancer has been stratified histologically as squamous/epidermoid, adenocarcinoma, and small/large cell lung cancers. Our current ability to profile cancers at the molecular level appears to have both prognostic and therapeutic value. 2 What are the major histologic types of lung cancer? The most important distinction is between small cell and non–small cell carcinoma because of fundamental differences…
Pleural Effusion 1 What is a pleural effusion? Pleural fluid is generated in normal adults at a rate of 5–10 L per 24 hours in the combined hemithoraces, but normal adults have only 20 mL of pleural fluid present at any time. Pleural effusions develop when there is either increased production or decreased resorption. Pathologic conditions leading to effusions include increased capillary permeability (inflammation, tumor), increased…
1 What does aortic valve disease mean? Aortic valve disease most often refers to obstruction of the aortic valve, aortic stenosis, or an aortic valve leak known as aortic regurgitation or aortic insufficiency. The vast majority of aortic valve disease is an adult-acquired condition with aortic stenosis predominant. However, because the aortic valve is anatomically integrated with the heart and the sinuses of Valsalva, many conditions…
1 What are the causes of mitral regurgitation? a. (Primary) degenerative mitral regurgitation is due to an abnormality of the mitral valve annulus, leaflets, or chordae tendineae. Principal causes include: Mitral valve prolapse Valvular degeneration Annular calcification Rheumatic fever Endocarditis Ruptured chordae tendineae Ruptured papillary muscle b. (Secondary) functional mitral regurgitation is due to an abnormality of the left ventricle causing valvular distraction and leak despite…
1 What is the most common cause of mitral valve stenosis in adults? Rheumatic fever. This usually occurs in early childhood, and many patients do not recall their illness. 2 Which gender is most commonly affected? Women, by a ratio of 2:1. 3 What is the main symptom of mitral valve stenosis? Dyspnea on exertion. 4 What are the physical examination findings associated with mitral valve…
1 What is angina, and what causes it? Angina pectoris reflects myocardial ischemia. Patients often describe the sensation as pressure, choking, or tightness. Angina typically worsens with exertion or stress and is relieved by rest. Angina is typically produced by an imbalance between myocardial oxygen supply and myocardial oxygen demand. The classic presentation is a man (male/female ratio of 4:1) out shoveling snow on a cold…
1 What is the role of the vascular diagnostic laboratory (VDL) in the assessment and treatment of patients with suspected vascular disease? Although traditional evaluation by an experienced physician remains the foundation of vascular diagnosis, clinical assessment has its limitations. For example, only one-third of cervical bruits are associated with significant carotid artery disease; conversely, as many as two-thirds of patients with severe carotid disease present…
1 What is deep venous thrombosis (DVT)? What initiates it, and what causes it to propagate? DVT means thrombosis in the deep veins of the extremities and neck, as opposed to the superficial veins. In the lower extremity, DVT includes thrombus found in any of the following veins—iliac, femoral, popliteal, tibial, and peroneal. The soleal and gastrocnemius venous plexuses are also considered to be part of…
1 What is an abdominal aortic aneurysm (AAA)? The aorta tapers in size from roughly 2.8 cm in the thorax to roughly 2.0 cm in the abdomen of adult men. Aneurysms are defined by a 50% increase in normal vessel diameter. The normal infrarenal aortic diameter is 2.0 cm, and, therefore, it is considered aneurysmal at 3.0 cm. 2 What is the incidence of AAA? Three…
1 What primary diseases affect the carotid arteries? Atherosclerosis is by far the most common disease affecting the carotid arteries, accounting for 90% of lesions in the Western world. The carotid artery also can be affected by kinking secondary to arterial elongation, fibromuscular dysplasia, extrinsic compression (e.g., neoplasm), radiation-induced changes, trauma (causing bleeding, occlusion, or dissection), and inflammatory arteriopathies (e.g., temporal arteritis, Takayasu’s arteritis). 2 What…
1 Describe claudication and its physiology Intermittent claudication consists of reproducible lower extremity muscular pain induced by exercise and relieved by short periods of rest. It is caused by arterial obstruction, which restricts the normal exercise-induced increase in blood flow, producing transient muscle ischemia. Studies have shown that more than half of patients with intermittent claudication have never complained of this symptom to their physicians, assuming…
1 Do you have to be old to have atherosclerosis? No. The initial (or type I) lesion, consisting of lipid deposits in the intima, has been well characterized in infants and children. 2 What is a fatty streak? Fatty streaks or type II lesions are visible as yellow-colored streaks, patches, or spots on the intimal surface of arteries. Microscopically, they are characterized by the intracellular accumulation…
1 What is a reasonable differential diagnosis for masses/lumps in the ipsilateral neck? Nonspecific lymphadenopathy Salivary gland tumor Viral or bacterial infectious process Lymphoma Carotid body tumor/chemodectoma Metastatic carcinoma Tuberculosis or a fungal disease Prominent normal anatomy 2 Could normal anatomy be a lump? Yes. The right and left neck are usually mirror images, and normal anatomy on one side is occasionally more prominent than its…
1 Describe the location and characteristics of the parotid gland The paired parotid glands are the largest of the three major salivary glands. The parotid gland is triangular in shape bounded superiorly by the zygomatic arch; posteriorly by the external auditory canal; inferiorly by the styloid process, the styloid muscle, and the jugular and internal carotid vessels; and anteriorly by the masseter muscle. The tail of…
1 What are the most common types of nonmelanoma skin cancer (NMSC)? Which type is the most prevalent? The most common types of NMSC are the keratinocyte carcinomas, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). BCC represents nearly 80% of NMSCs, while squamous cell carcinoma represents approximately 20% of NMSCs. There are several rare types of NMSC, such as Merkel cell carcinoma, sebaceous gland…