Flashcards in Block 1 Deck (268):
Study of disease. Especially changes in cells/tissues/organs that cause or are caused by disease
Functional changes associated with disease
This is the where and when of disease. The disease occurrence and spread.
Underlying cause of disease
Disease comes from an infection
You don't know what caused the disease
Treatment of another disease caused the disease
Disease acquired from a hospital
Something that you as a doctor measure
Things the patient tells you
Rapid onset and short duration - not necessarily severe but some can turn chronic over time
Disease that lasts for a long duration - longer than 3 months
___ of 10 chronic diseases we can prevent and cure
What type of diseases are the biggest killers in the U.S?
Poorly defined time between acute and chronic
Things form the outside that attack and cause disease
Micro organisms and parasites
Any chemical that can cause harm
Mechanical injury, temperature extremes, electricity, radiation
Excess or deficiency type of extrinsic factor
Things from the inside of our bodies
Inherited gene or chromosomal mutation
- Down's - trisomy 21 - non disjunction in meiosis
Defects in embryological development
Immune deficiency, misdirection, or autoimmunity
Anxiety, strong or persistent psychological stress
Genetic, congenital, immunological, psychological. These types of factors are called:
Biological, chemical, physical, and nutritional imbalances. These types of factors are called:
This is the phase of disease when no signs or symptoms are present. It is silent.
This stage of disease is when there are flu-like symptoms. It is hard to separate symptoms from other diseases
This is the phase of disease when there are very classical symptoms and it is more easily diagnosable.
What is incomplete recovery from a disease?
Stuck with something chronic
What are the top chronic disease killers for Americans?
1. Heart Disease
4. Type 2 Diabetes
Which 2 chronic diseases make up 46% of the top killers of Americans?
Heart disease and cancer
What are lifestyle factors that lead to chronic disease?
Lack of physical activity
Pace of life
Smoking and tobacco use
This is any chemical that can cause harm to the body. Airborne pollutants, contaminants in food/water, human waste products, heavy metals, fire
These are any non-chemical, non-biological agents that cause disease. Outside the body that are denaturing or damaging. Electromagnetic radiation, vibration, heat stress, mechanical force
These are any foreign pathogenic organism. Bacteria, viruses, fungi, protozoan
The three categories of endogenous causes of disease are:
A. Microbiological, immunological, metabolic
B. Physical, vascular, metabolic
C. Metabolic, immunologic, vascular
D. Chemical, microbiological, vascular
Study of factors affecting occurrence of chronic and infectious disease?
How do you determine the rate of health-related events in a population?
Actual cases / potential cases
What are potential cases?
The people who are at risk for a particular disease. They DON'T already have it
What is horizontal transmission of disease?
Person to person, could be direct or indirect
What is vertical transmission of disease?
Type of direct transmission
To offspring in utero, during birth, through colostrum or suckled milk
To monitor and calculate expected frequency so that abrupt changes in frequency can be observed
The number of NEW cases of an infectious disease within a defined population over a defined period of time
The number of ACTIVE cases at any given time
A disease that has a relatively stable and expected incidence and prevalence within a geography area
And abrupt and unexpected increase in the incidence of disease over endemic rates
Spread of disease beyond continental boundaries
What happens if a new effective treatment is initiated?
Incidence stays the same
What happens if a new effective vaccine gains widespread use?
What happens if the number of deaths from the condition declines?
Incidence stays the same
What happens if recovery is more rapid than it was 1 year ago?
Incidence stays the same
What is a cross sectional study and what does it measure?
It is the status of something at a snapshot
It measures disease prevalence
What is a case-control study? And what does it measure?
It compares a group of people with the disease to a group with disease
Looks for prior exposure or risk factor
Starts with disease
What is a cohort study and what does it measure?
It looks to see if exposure affects the likelihood of disease
Starts with exposure
This is typically used in case-control studies. It is the chance that a group with the disease (cases) was exposed to a risk factor divided by the chance a group without the disease (controls) was exposed
This is typically used in cohort studies. Risk of developing disease in the exposed group divided by the risk in the unexposed group
What does it mean for the odds ratio and relative risk if prevalence is LOW?
They are practically equal and interchangeable
Which measurements are about the DISEASE?
Sensitivity and Specificity
Which measurements are about the TEST?
Positive and negative predictive values
What does true positive mean?
Sick and test sick
What does false positive mean?
Healthy and test sick
What does true negative mean?
Healthy and test healthy
What does false negative mean?
Sick and test healthy
This is the likelihood that a sick person tests positive
Think: Needs treatment b/c they are sick
This is the likelihood that a non-sick person tests negative.
This is the likelihood that a positive test is found only in sick people
Positive predictive value
Likelihood that a negative test is found only in non-sick people
Negative predictive value
Everyone that is sick
Everyone that is healthy
Positive predictive value
Negative predictive value
Prevalence has a huge impact on _______?
Positive predictive value!
What does +/- 2 standard deviations cover?
It is a range that covers 95% of the healthy population
What does 1 standard deviation cover?
68% of the healthy population
As far as percentage of normal standard deviations, why is there an occasional test result from a healthy person that falls into the high or low side of normal?
What 2 numbers have to be low to be considered anemic?
HCT (hematocrit - packed red blood cell volume)
Why would a person in Denver have higher HGB range than a person in dallas?
It higher b/c of elevation and less oxygen available
What does glucose/HgA1c levels tell you?
What do calcium levels tell you?
If they are increased without any other explanation - cancer (typically lung cancer)
What do electrolyte readings tell you?
Involved with blood pressure and metabolism
What do kidney tests (BUN/creatinine) tell you?
What do ALT, AST, ALP, bilirubin levels tell you?
Injury vs. function of liver
What is the most specific test for heart injury?
What is the threshold of FASTING levels for diabetes?
126 mg/dL or higher
What is the random blood sugar reading needed to diagnose diabetes?
What is the gold standard percentage for diagnosing diabetes?
Hemoglobin A1c of 6.5% or higher
What is normal hemoglobin A1c reading?
Less than 5.7%
What precedes diabetes?
What is the best liver damage enzyme? And where is it found?
ALT! In the hepatocytes
Also AST is good too, but ALT is best
Which comes first, liver damage or loss of function?
Liver damage! Then loss of function
What is the best test for loss of liver function?
What are 2 things important for blood pressure?
Sodium and albumin
Identify the blood test that best supports liver failure?
A. Rising ALT and AST levels
B. Dropping ALT and AST levels
C. Rising Bilirubin levels
D. Dropping Bilirubin levels
Which levels estimate glomerular filtration rate?
BUN and creatinine
What does doubling serum creatinine levels do?
Halves glomerular filtration rate (GFR)
If creatinine levels are 1, what is kidney function?
If creatinine levels are 2, what is kidney function?
If creatinine levels are 4, what is kidney function?
If GFR/clearance are less than 30 ml/min?
30% kidney function! See a nephrologist
If GRF/creatinine is less than 15 ml/min?
15% kidney function - dialysis or transplant!
Why are BUN levels not as reliable as creatinine?
BUN is impacted by diet so it fluctuates a lot
If you damage muscle, what is released?
What is one of the EARLIEST signs of heart attack?
Myoglobin levels high
What is the most specific test for heart attack?
Troponin - proteins found in heart muscle only
What is the goal level of total cholesterol?
Less than 200mg/dL
MUST be drawn fasting!
What is the max level of total cholesterol?
Over 240mg/dL - bad news, lipid lowering drugs
What is the high-density lipoprotein cholesterol (HDL-C)?
This is the good cholesterol - it transports cholesterol to liver (away from vessels)
What is the goal level for HDL-C?
Greater than 40mg/dL
What is low-density lipoprotein cholesterol (LDL-C)?
Bad cholesterol - deposits cholesterol into vascular walls
What is the goal level for LDL-C?
Less than 100mg/dL
Which lipid is NOT affected very much by fasting?
Which lipid is hugely affected by fasting?
What is the goal level for triglycerides?
Less than 150mg/dL
What is the high level of triglycerides (over 500 mg/dL) associated with?
What does the Comprehensive Metabolic Panel (CMP) have that the Basic Metabolic Panel (BMP) doesn't have?
CMP has liver function!
Where is ALP located?
Ducts of liver
Where is ALT and AST located and what do they measure?
Measure liver damage!
What does Bilirubin test for?
What do hemoglobin (HBG) and Hematocrit (HCT) test for?
Best test for anemia!!
Both need to be low to diagnose though
After diagnosed with anemia, what is the primary test for what TYPE of anemia it is?
MCV - it determines how big the RBCs are
What is the ESR?
How fast RBCs settle out in a tube (mm per hour)
Normal is 20mm/hr or less
What do the ESR and CRP test for?
They are indicators of inflammation!
What do high ESRs suggest?
What happens after inflammation?
IL-6 causes liver to produce fibrinogen. Fibrinogen sticks to RBCs and those precipitate out faster
NOT specific to disease - it detects any sort of inflammation
What are the vit. K dependent factors?
II, VII, IX, X
Which of the factors is ultra dependent on vitamin K?
The others are only kinda dependent
What is the intrinsic pathway?
Activated by naked collagen
What is the extrinsic pathway?
Cell explodes causing path to start
What factor is the common pathway?
What factor does Warfarin (Coumadin) target?
Targets VII big time! Shuts it down
What factor does Heparin target?
X big time!! (Technically prevents Xa, not just X alone)
Also II, but not as big
What must happen in order to form a clot?
Fibrinogen must be converted to Fribrin
It must be tightly regulated for safety reasons
What does PTT monitor?
What does PT monitor?
Helps watch VII!
Why is VII affected by PT?
VII has a short half life which causes it to be affected
What is the most common bleeding disorder?
Which factor is absent?
What is used to monitor?
Factor VIII is absent!
Use PTT to monitor!
How is PT measured?
It is a ratio= patient clot time/average clot time
It monitors warfarin/Coumadin therapy and liver function
What is the target PT range for deep vein thrombosis prophylaxis?
2.0 - 3.0
What is the target PT range for mechanical heart valve?
2.5 - 3.5
The term for high WBC count is?
The term for low WBC count?
What is happening if there is an elevation of WBC?
What type of infection causes high neutrophils?
What type of infection causes high lymphocytes?
What is the significance of PMNs, Segs, BANs, Myelos?
Add them all together to get total neutrophil count
What type of infection does eosinophilia suggest?
Allergies or worms
What is something that you should keep in mind if patient is either very high or very low WBC count?
What is the HGB x3 rule?
This formula tell you what the hematocrit level is
OR take HCT/3 to get HGB
What is a trademark of Polycythemia Vera?
High HCT, HGB, and high RBC count
What should the RBC be in anemic patients?
It's NOT always low! It could be normal or high
What is the HGB criteria for anemia in women?
Less than 12 g/dL
What is the HGB criteria for anemia in men?
Less than 13.5 g/dL
At what level should you start thinking about transfusing in anemia?
What what level do you need to transfuse for anemia?
What is MCV?
The mean corpuscular volume - the average RBC size - common anemia classification
What is microcytic anemia?
Most common in the world!
Iron-deficiency anemia - tiny RBCs but usually high or normal RBC count
MCV less than 80
What is macrocytic anemia?
Vitamin B12 deficiency and folic acid deficiency
Cell volume is huge but low RBC count
MCV greater than 110
What antigen/antibody indicates current or recent infection? (Acute)
What antigen/antibody indicates past infection?
What is the most common syphilis screen?
It must be followed by either FTA-ABS or MHA-TP
Sensitive but NOT specific
Syphilis you can't culture it because it's too tiny to see on a gram stain
What does ANA screen for?
Lupus erythematosus (SLE) - 95% of time
Scleroderma - 60-90% of time
If we suspect lupus what do we do?
Screen with ANA
Confirm with anti-dsDNA and Anti-Sm
What is the best test to run for UTI?
What are 3 things that show up in urinalysis with a UTI?
Blood, Nitrite, Protein
When interpreting a urinalysis, how will you know if someone is on a low carb diet?
Ketones in urine
Previous was a starvation marker, but burning fats = ketone spike
What will urinalysis look like for uncontrolled diabetes?
Glucose will be in urine
Uncontrolled diabetes causes blood glucose to go above kidneys ability to reabsorb it so it ends up in urine
How do you determine if liver function is improving, worsening, or staying the same?
If ALT/AST/BILI are going up, liver damage is worsening
If they go down it is improving
If they stay unchanged, it may mean the damage is unchanged
When do providers become concerned with fatigue?
If it is persistent fatigue - may include psychological or physical causes (depression, anxiety, substance abuse)
What is the virus that causes chronic fatigue?
Epstein Barr virus
When do clinicians become concerned about weight loss?
Unintentional - may indicate serious physical or psychological issues (depression, anorexia, bulemia, stress, anxiety)
What is the threshold for a low grade fever?
Less than 101
What is a moderate fever?
What is a high grade fever?
103 or higher - treatment! Proteins could start to denature
What is a high fever in newborns and infants?
99 or above
What are 2 proinflammatory cytokines that drive fever?
IL-1 and TNFalpha
What is the prostaglandin that drives fever?
What is the ANTI inflammatory cytokines?
What are the 3 criteria used to define fever of unknown origin (FUO)?
Illness at least 3 weeks in duration
Temp of 101 on several occasions
Failure to diagnose after 3 outpatient visits or 3 days of hospitalization
What are the top 3 causes of FUOs?
Autoimmune disorders (10-20%)
Which of the causes of FUO will linger if not treated?
Autoimmune disorder - the others will eventually clear on their own and fever will go down if not diagnosed
Which headache alarms always indicate serious etiology?
Confusion or lethargy
New onset seizure
What is claudication?
Pain produced by a lack of blood flow - usually in the jaw
What is GCA?
Giant Cell Arteritis - Medium to large vessels that become inflamed and modular - cause claudication - usually in the jaw
What is thunderclap headache?
Sudden severe headache
What are migraines?
Pain that is throbbing or pulsing
Evolves - keeps getting worse
Typically last 4-72 hours!
Who is afflicted by migraines?
Young women (20-30 years old)
What is a tension head ache?
Band-like distribution with varying intensities
Occur late in the day on weekdays
Last 30 minutes to 1 week
Who is afflicted by tension headaches?
All ages, both genders
What is a cluster headache?
Unilateral - orbital or temporal
Wake people up!!
Present with red eyes and/or nasal stuffiness
May cause transient or permanent ipsilateral Horner's syndrome!
Maybe abnormal pupil size
Who is afflicted by cluster headaches?
Middle aged men (30-50 years old)
What is temporal arteritis/GCA?
Pain in temporal scalp area, jabbing neck pain, jaw claudication, and fever
Ischemic optic neuropathy may occur is not treated
What should you do if GCA is suspected?
Get on steroids (prednisone) immediately!!
Who is affected by GCA?
Patients over 60
Do brain tumors cause headaches?
Occur in all ages
Interrupts sleep, causes nausea, vomiting, and visual changes - steadily becomes more severe
Tend to be worse in the morning
Likely to produce one or more physical symptoms and one or more neurological deficit - less that 1% don't do this
What does FAST mean?
Use tactic when you encounter someone with a STROKE!!
What does the F in FAST stand for?
Face - is face paralyzed - does their smile seem even or does one side droop
What does A in FAST stand for?
Arms - can they hold them both out and parallel to the ground or will one drop
What does S in FAST stand for?
Speech - is their speech slurred
What does T in FAST stand for?
Time - very critical get them to a hospital immediately
After 3 hours, they will have permanent damage
What are 4 mechanisms of cell injury?
Free radical formation, Hypoxia, disruption of intracellular Ca, and membrane damage
What is the role of free radical injury in diabetes-related complications?
Oxidative stress from free radicals results in modifications of proteins, which is the key to multiple diabetes related complications
What are the fat soluble vitamins?
D, A, K, E
How are free-radicals produced?
It is oxidative damage caused by glucose oxidizing
What causes glucose to oxidize?
Hyperglycemia (high blood sugar) via diabetes
What happens when proteins are oxidatively modified?
Immunologic component - trigger systemic inflammation
Structural component - impact normal function
Hypoxia (not enough oxygen for cells to work properly) causes a depletion of ATP. What are the effects?
Na+/K+ pump and protein synthesis disrupted
What does it mean if we see large amounts of lactic acid?
Significant damage to body - the body is under stress
What does the activation of ATPases, Phosphatases, proteases, and endonucleases cause?
Disrupts calcium homeostasis - causes cellular destruction
What does cytoskeleton damage, increased cytosolic Ca+, and reactive oxygen species cause?
What are the five mechanisms that cause membrane damage?
Increased cytosolic Ca+
Loss of membrane phospholipids
Reactive oxygen species
Lipid breakdown products
What is neoplasia?
Cancer - can't revert cells back to normal
This is shrinkage in the size of the cell
What is atrophy due to?
Lack of use, loss of innervation, diminished blood flow, inadequate nutrition, loss of endocrine stimulation, aging, pressure
This is when cells increase in size, but not in numbers.
What causes hypertrophy?
Increased functional demand or specific hormonal stimulation
Ex. Physiologic - body builders, breasts during pregnancy and lactation
Ex. Pathological - heart due to faulty valves
This is an increase in the number of cells, usually results in increased tissue volume
What is a physiologic example of hyperplasia?
Hormonal - uterine and breasts growth during pregnancy
Compensatory - connective tissue in wound healing
What is a pathologic example of hyperplasia?
Growth factors - benign prostatic hyperplasia - may give rise to cancerous proliferation
This is when one mature cell type is replaced by another mature cell type - it is REVERSIBLE
This is the abnormal cell growth of a specific tissue that results in cells that vary in size, shape, and organization. It is strong implicated as a precursor of cancer
What is cervix dysphasia most commonly caused by?
HPV! - its a concern because it can lead to neoplasia
Which image is least valuable for visualizing soft tissue?
What is the most common precursor for cancer?
What is the most toxic vitamin?
Don't eat polar bear liver!
What vitamins are toxic but will just make you sick?
Vit E and D
Which vitamin will cause kidney stones?
What is a Xanthoma?
Yellow translucent growth caused by CHOLESTEROL accumulations
What type of product is a xanthoma?
What is the buildup of substances that cells cannot immediately use or dispose of?
What are the 2 categories of intracellular accumulations?
Endogenous products or exogenous products
These are normal body substances present in abnormally large amounts? (Lipids, proteins, carbs, bilirubin)
They are also abnormal products from the inside of the body (inborn errors of metabolism)
These are environmental agents and pigments (eat too many carrots get orange tint to skin)
What is hepatitis?
Bilirubin concentration increases
Jaundice in all body tissues
Protein production stops
What can be induced by acetaminophen?
Symptoms include jaundice
Acetaminophen is toxic to the liver at high doses
What is Wilson's disease?
Damage to the liver - the copper binding protein is NOT produced.
It often present with psychiatric episodes and Kayser-Fleischer rings
Give zinc to remove excess copper
What is the earliest sign of Wilson's disease?
Accumulates copper in Descemet's around the iris
Is Wilson's disease endogenous or exogenous?
What is an example of exogenous accumulations?
Argyria! From ionic silver in high doses
What is Argyria?
Permanent blue discoloration of the skin due to ionic silver
What is necrosis?
UNCONTROLLED! The messy lysis of dead cells
When you perform surgery, which type of cell death do you NOT want?
Necrosis - it inhibits healing
What is apoptosis?
PROGRAMMED cell death
The cytoplasmic membrane blebs
Pyknotic - shrinking, clumping, and pinching off
Which cell death involves cell shrinking?
Which cell death involves cells swelling?
Why are CKMB and troponin levels elevated following an MI?
The cells are bursting (necrosis)
What happens to the organelles in Apoptosis?
They shrink and stay intact until phagocitized
What happens to the organelles in Necrosis?
They swell and blow apart with everything else inside the cell
This is when necrosis produces inflammation, and inflamed vessels leak fluid and cells making pus.
What is the protein concentration of an exudate?
The protein levels are very high!
They appear cloudy in a tube because of lots of protein precipitate
This is when fluid is pushed through capillaries due to high pressure.
It just forces out the fluid, the proteins stay trapped inside
Predict the protein concentration of a transudate.
Protein levels are very low
The tube would be clear - no precipitate
In acute inflammation, what are the fundamental cells involved?
Neutrophils! TONS involved because of the inflammation
Also but less important, mast cells, platelets, basophils
In chronic inflammation, what are the fundamental cells involved?
B and T lymphocytes
Plasma cells and antibodies
What are granulomas a sign of?
What are granulomas?
A core made of dead material and macrophages (epithelioid cells) surrounded by a rim of lymphocytes just one cell thick!
What are epithelioid cells?
Active macrophages at the center of a granulomas
What are the first apparent cellular changes in apoptosis?
What are the first apparent cellular changes in necrosis?
What are the cell membrane changes in apoptosis vs necrosis?
Surface protrusions resulting in blebs
Membrane smoothing, lysis, causing inflammation
What are the nuclear changes in apoptosis vs. necrosis?
Apoptosis: condensation, segmentation, DNA fragmentation
What are mitochondrial changes in apoptosis vs. necrosis?
What are cellular mechanisms of aging?
Cross-linking DNA and proteins
Telomere shortening - end piece of genetic cells - our biological clock
What is Werner's Syndrome?
What is another name for them?
It is early signs of aging.
Also called Pangeria
What are other aging changes?
Loss of lens elasticity - opacity - vision