Chico Recommended Flashcards
(82 cards)
1
Q
necrosis vs apoptosis
A
Apoptosis is programmed cell death. It is a regulated and controlled part of a cell’s life cycle and is advantageous. Apoptosis can be used by the body to limit tissue expansion and to eliminate some precancerous cells. The nature of apoptosis is that cells die, but do not trigger inflammation, as cellular debris is cleaned out by other mechanisms. Insufficient apoptosis can lead to uncontrolled cell growth, which can lead to cancer. The average adult experiences 50-70 million programmed cell deaths per day.
Necrosis is defined as traumatic cell death. This is usually caused by factors external to the cell or tissue such as infection, trauma or toxins. In contrast to apoptosis, necrosis is almost always detrimental. It causes uncontrolled release of products into the extracellular space causing inflammation and local cell destruction.
2
Q
Cardinal signs of inflammation
A
pain, heat, swelling, redness, loss of function
3
Q
4 components of the tissue repair process.
A
- ) Hemostasis in which the bleeding stops.
- ) Inflammation occurs to clean up the dead/damaged tissue.
- ) Proliferation of local healing cells ( as you explained in the notes) bringing in the healing crew.
- ) Scar formation ( exception: regenerative tissue)……With regeneration, cells grow to replace the injured with virtually little to no scarring.
- ) Maturation: tightening up the tissue for long term.
4
Q
Differentiate between an embolus and a thrombus
A
A thrombus is a blood clot (solid mass of platelets and/or fibrin) that forms inside a vessel when clotting mechanism is activated with injury, and adheres at that location. It can happens at a site where artherosclerotic plaque has ruptured, further occluding blood flow.
An embolus is anything that travels through the blood vessels until it reaches a vessel that is too small to let it pass. When this happens, blood flow is stopped or severely limited by clot. Emboli are usually blood clots, such as pieces of thrombus that have broken free or blood that has become stagnant such as in atrial fibrillation, and start traveling through body
5
Q
ischemia vs. infarct
A
Ischemia is cell injury or distress due to hypoxia, generally to lack of blood flow. Cells are distressed but still viable, and as blood flow is restored, they recover. The classic example of ischemia is Angina Pectoris.
Infarct is cell death due to lack of oxygen/blood flow. Cells are no longer viable and necrose. The classic example of infarction is a Myocardial Infarction.
All cells pass through a period of ischemia before infarction occurs. For some cells, this is shorter, 1-3 hours (brain), while for others it can be as long as 6 hours (extremities).
6
Q
humoral and cellular immunity
A
The humoral response (or antibody‐mediated response) involves B cells that recognize antigens or pathogens that are circulating in the lymph or blood (“humor” is a medieval term for body fluid).
The cell‐mediated response involves mostly T cells and responds to any cell that displays aberrant MHC markers, including cells invaded by pathogens, tumor cells, or transplanted cells.
7
Q
Innate vs Adaptive
A
Innate immunity refers to nonspecific defense mechanisms that come into play immediately or within hours of an antigen’s appearance in the body. These mechanisms include physical barriers such as skin, chemicals in the blood, and immune system cells that attack foreign cells in the body. The innate immune response is activated by chemical properties of the antigen.Natural Killer T Cells and Neutrophils are the principle cells involved.
Adaptive immunity refers to antigen-specific immune response. The adaptive immune response is more complex than the innate. The antigen first must be processed and recognized. Once an antigen has been recognized, the adaptive immune system creates an army of immune cells specifically designed to attack that antigen. Adaptive immunity also includes a “memory” that makes future responses against a specific antigen more efficient. T Helper Cells, B cells that produce antibodies, Cytotoxic T Cells, and macrophages are the principle cells involved, along with antigen presenting cells such as macrophages and dendritic cells.
8
Q
Role of the HLA proteins in antigen presentation
A
The HLA system encodes for proteins on the surface of cells that are responsible for regulation of the immune system in humans. Among other functions HLAs present peptides from both inside the cell and outside the cell for T-cells to destroy.
The HLA system is used to identify ‘self’ from ‘non-self’, which can be seen in cases such as organ transplants and their rejection.
9
Q
4 types of immune hypersensitivity reactions
A
- Immediate (type I) hypersensitivity: is a rapid IgE (turns on histamine) and mast cell-mediated vascular and smooth muscle response that occurs in genetically susceptible people. We know these responses as allergies. Histamine reaction: is very immediate: hay fever, allergies. If it is anaphylaxis, then it is immediate and gone within an hour or so. Asymptomatic reaction: bronchial restriction. Associated with hives. Short lived unless ingested.
- Antibody-mediated (type II) hypersensitivity: Antibody-mediated (type II) reactions result when antibodies are directed against antigens on the surface of cells or other tissue components. The deposition of the antibody can have a variety of detrimental effects, including inflammation, opsonization and phagocytosis, or functional derangements Antibodies that attack the cells.
- Immune complex-mediated (type III) hypersensitivity: Immune complex-mediated (type III) hypersensitivity results when complexes of antibodies and antigens deposit in vascular walls or other tissues and cause an inflammatory response. This type of pathology is commonly implicated in vasculitis and arthritis. Could be virus or drug induced.
- Cell-mediated (type IV) hypersensitivity: Cell-mediated (type IV) hypersensitivity results from an inappropriate or excessive immune reaction that is mediated by a specific subset of CD4+ helper T cells (Th-1 and Th-17 cells) or by CD8+ Cytotoxic T cells. These reactions are the basis for disease such as Crohn’s disease and multiple sclerosis. Delayed hypersensitivity reaction. No antibody involvement.
10
Q
Benign vs Malignant
A
Benign neoplasms grow locally and their growth is limited. They do not spread to other tissues.
Three characteristics of Malignant neoplasms are that they i) grow uncontrollably, ii) invade into adjacent tissue, and iii) metastasize, to other, distant, tissues.
11
Q
genetic mutations in etiology of cancer
A
Cancer cells are genetically mutated cells that have altered control of their cellular division, differentiation, and apoptosis. Once this occurs a clone of cells derived from the original mutated cell grows uncontrollably and becomes cancerous. Genetic mutations can vary depending on where they occur/originate, ie organs. Cancer generally involves several mutations before a cell becomes cancerous. Early mutations can affect policing mechanisms that repair defective DNA as it is transcribed, and this increases the rate of future mutations in this cell line.
12
Q
transmission of HIV
A
- -Penetrative sexual intercourse
- -Direct injection with HIV-contaminated drugs, needles, syringes, blood or blood products
- -From HIV-infected mother to fetus in utero, through intrapartum inoculation from mother to infant or during breast-feeding
- -Rare cases have been reported to the CDC of HIV transmission via acupuncture, artificial insemination , tattoo, and human bite. Most of the incidents have occurred due to the use of a used needle and the transfusion of body fluids such as blood.
13
Q
Presentation of HIV
A
After exposure to the HIV virus an incubation period lasting 2-4 weeks, but sometimes up to ten months occurs. After this time, HIV related factors are detectable in the blood and an individual will usually display primary infection symptoms such as fever, myalgias, headache, lymphadenopathy and nausea lasting up to 28 days. After the initial infection early stages of the AIDS disease will usually present around 6 months.
14
Q
Hep A
- Type:
- Incubation:
- Transmission:
- Acute Infection:
- Groups at Risk:
- Serious consequences:
- Leads to chronic Infection?
A
RNA, and theres a vaccine
- 2 to 6 wks
- Fecal-oral Route (contaminated water, on food)
- Acute Infection = Initial: Fever, nausea, Rt upper quadrant pain, diarrhea, fatigue. Within days: jaundice, dark urine, light stools, rash. Symptoms last 1-3 months, up to 6 months
- Groups at Risk = Low Socioeconomic areas of poor sanitation or travellers to these areas
- Serious consequences = Acute death is rare, more common w/ compromised LVR function and age
- Leads to chronic Infection? = Rarely leads to chronic illness
15
Q
Hep B
- Type:
- Incubation:
- Transmission:
- Acute Infection:
- Groups at Risk:
- Serious consequences:
- Leads to chronic Infection?
A
DNA, and theres a vaccine
- 4/ 6 wks to 6 months
- Blood/Body Fluids (needle sharing, blood transfusion, sexual contact, perinatal infection, rarely open sores)
-Acute infection (jaundice, anorexia, nausea, abdominal pain up to 3 months). Less severe than Hep A, but lasts longer. 30% don’t have chronic infection, 70% mild or asymptomatic
30% infected w/ acute hep B following resolution show low levels of virus even yrs later, but rare to progress to chronic Hep B (possible long lasting immune response)
- Groups at Risk = Individuals w/ high risk behaviors: IV Drug use, high risk sexual factors: multiple partners
- Serious consequences = ● Chronic active hepatitis ● Chronic LVR disease and cirrhosis ● Liver cancer ● Kidney failure ● Inflammatory arthritis
-Leads to chronic Infection = Most persons with acute disease recover with no lasting liver damage; acute illness is rarely fatal
16
Q
Hep C
- Type:
- Incubation:
- Transmission:
- Acute Infection:
- Groups at Risk:
- Serious consequences:
- Leads to chronic Infection?
A
RNA and NO VACCINE
- 1/2 wks to 6 months
- Blood Borne (IV Drug use, needle stick, perinatal, infected blood products or organs)
- Similar to B, but usually milder
- Groups at Risk = Individuals w/ high risk behaviors: IV Drug use, high risk sexual factors: multiple partners (same as B)
Americans born between 1945 -1965, or who received blood products prior to 1992
- Serious consequences = ● Chronic active hepatitis ● Renal failure ● Cirrhosis, liver failure ● Liver cancer ● Hematologic disease (lymphoma) ● Thyroiditis ● Diabetes type 2 *most common cause of LVR disease + LVR transplant in US although prevalence is 1.6%
- Leads to chronic Infection =
• 15%–25% of newly infected persons clear the virus
• 60%–70% of chronically infected persons develop chronic liver disease
17
Q
Define hemorrhage
A
an escape of blood from a ruptured blood vessel, especially when profuse
18
Q
Describe the process of hemostasis. What is the role of platelets? What is the role of the clotting factors?
A
Hemostasis allows blood to clot to stop bleeding. Platelets are stimulated by endothelial cell damage or other mediators, platelets adhere to the site of injury, causing a ‘plug’. Clotting factors activate prothrombin into thrombin, and this in turn activates fibrinogen into fibrin. Fibrin forms long molecular bands that stick to the site of injury, intermesh with platelets – both are needed!
19
Q
Describe clinical presentation and course of Bacterial Endocarditis
A
- Infection of the inner lining of the heart, generally affecting heart valves
- Presents acutely in most cases…days
- If unchecked, leads to dysfunction of the heart valve, usually with new onset regurgitation
- Acute regurgitation more symptomatic than chronic
- Aortic and mitral acute regurgitation can be serious with high mortality
Common signs…
∠ Fever
∠ Positive blood cultures for the infecting bacterium
∠ May have evidence of embolic disease or rash
∠ May have acute onset congestive heart failure
∠ Usually, but not always, in the setting of an acute infection
∠ High risk in IV drug abusers
20
Q
Describe clinical presentation and course of Meningitis
A
- Intense headache
- Stiff neck
- Fever
If the diagnosis is known, supportive measures are adequate and recovery usually complete
21
Q
Describe clinical presentation and course of Tuberculosis
A
- Incubation period….variable usually less than 4-6 weeks, symptoms usually resolve by 10 weeks
- Mycobacterium TB circulates throughout the body, but most has particular affinity for the lungs.
- The immune system kicks in, and cleans up ALMOST all of the bacteria.
- Most people have NO symptoms with initial infection. Of those that do have symptoms…
⋅ Fever is most common, low-grade, noted in 70% of patients
⋅ Pleuritic chest pain in 25% of patients
⋅ Other rarer symptoms include arthralgias, cough, chest pain on swallowing
22
Q
BP: Systolic & Dysolic
A
- Systolic – highest pressure level achieved in cardiac cycle, reflecting pressure immediately after left ventricle is done ejecting blood.
- Dysolic – lowest pressure measurable, usually, at the end of ventricular filling when left ventricle is about to contract.
140/90 - if any more then these numbers then high
23
Q
pathogenesis of atherosclerosis and plaque formation
A
Start with microscopic damage to the wall from hypertension leading to fats deposit, it leaks over years, becomes calcified and slowly starts blocking the lumen
24
Q
relationship between angina, myocardial infarction, and coronary artery disease
A
Angina – is defined as ischemic disease, caused by coronary artery occlusion, which is reversible and by itself does not cause death to myocardial cells, but causes some ischemic changes in affected cells. (Heart tissue is still ok, haven’t lost any cells)
Myocardial infraction – is defined as ischemic disease, caused by coronary artery occlusion, which without treatment would cause death to myocardial cells. (Heart cells are actually dying because of lack of blood flow. Irreversible damage. )
Coronary artery disease – can be asymptomatic, but ACS almost always represents a symptom such as unstable angina or myocardial infarction. Atherosclerotic plaques, the hallmark of atherosclerosis, progressively narrow the coronary artery lumen and impair antegrade myocardial blood flow.
25
stable angina vs. unstable angina, and why this differentiation is important.
Stable Angina – whenever person starts to exert themselves, they get chest pain. Because they have fixed plaque, blood cant circulate faster. Caused by fixed plaque which is slowly getting bigger Is more manageable.
Unstable Angina – new or change in angina pattern in recent 1-2 weeks. Very often a ruptured of plaque with clot forming in location. Occurs more frequently and with much less level of exertion
26
3 fx of renin-angiotensin
physiology of the renin-angiotensin system
3 functions: (1) to maintain a proper blood pressure/blood flow, (2) to maintain the right concentration of sodium (Na+) in the blood, and finally, (3) to maintain the right amount of water in the blood.
i. Sensors in the kidney, the “Juxta-Glomerular Apparatus”, sense blood pressure in the artery
ii. If BP starts to fall, these cells secrete ‘Renin’ into the circulation
iii. Angiotensin I, constantly produced by the liver, circulates but is essentially inactive
iv. Under stimulation by Renin, an enzyme called “angiotensin converting enzyme (“ACE”) is activated, and Angiotensin I is converted to Angiotensin II
v. Angiotensin II is a potent vasoconstrictor, and causes resorption of sodium and water
vi. Both actions increase blood pressure
27
Define hypertension
Is defined as increase fluid pressure within arterial blood vessels above a generally accepted value.
28
Define anemia and name the most common causes.
Anemia results from the lack of red blood cells necessary to carry oxygen from alveoli of the lung to the organs and body tissues. The three primary etiologies of anemia include the following: the body does not make enough red blood cells (includes iron-deficiency type, folate and B vitamin deficiency type, pernicious type, anemia of chronic disease and aplastic type); blood loss causes a person to bleed out more RBCs than the body can replace from the bone marrow; or the body destroys its supply of RBCs (includes hemolytic type and sickle-cell type.) The fourth type is more unusual, and occurs when the body makes defective red blood cells. This type is called Thalassemia.
29
```
Define:
leukocytosis,
leukopenia,
neutropenia,
lymphocytosis,
splenomegaly,
hepatomegaly,
thrombocytopenia,
aplastic (anemia),
hemolysis
```
-Leukocytosis is a white blood cell count (the leukocyte count) above the normal range in the blood. It is frequently a sign of an inflammatory response, most commonly the result of infection, but may also occur in patients with some cancers. It may also occur after strenuous exercise, convulsions such as epilepsy, emotional stress, pregnancy and labour, anesthesia, and epinephrine administration
Leukopenia- A deficiency in the number of leukocytes.
Neutropenia- A deficiency in the number of neutrophils
Lymphocytosis- occurs when there is an elevated blood lymphocyte count
Splenomegaly- enlargement of the spleen.
Hepatomegaly- abnormal enlargement of the liver that is usually a sign of disease.
Thrombocytopenia- Thrombocytopenia is a blood disease characterized by an abnormally low number of platelets in the bloodstream
Aplastic anemia is condition marked by damage to the bone marrow and blood stem cells, which leads to an inability to produce, white and red blood cells, and platelets.
Hemolysis - the rupture or destruction of red blood cells.
30
Define lymphoma. Know the most common clinical presentations of lymphoma.
Lymphomas are malignancies that arise from blood cells or their precursors, and they form mass lesion tumors usually in lymphatic tissue.
Clinical presentations include rubbery stuck lymph nodes, nasal obstructions, neck swelling and tenderness.
31
Define leukemia. What cells do leukemias arise from. Know the most common clinical presentations of
leukemia.
a. Leukemia is a malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leukocytes. These suppress the production of normal blood cells, leading to anemia and other symptoms.
b. Common presentations: Fever or chills, Persistent fatigue, weakness, Frequent or severe infections, Losing weight without trying, Swollen lymph nodes, enlarged liver or spleen, Easy bleeding or bruising, Recurrent nosebleeds, Tiny red spots in your skin (petechiae), Excessive sweating, especially at night, Bone pain or tenderness
32
etiology of pernicious anemia and its presenting signs
Pernicious anemia is a condition caused by too little vitamin B12 in the body. Symptoms include nausea and vomiting, heartburn, abdominal bloating and gas, constipation or diarrhea, loss of appetite, and weight loss. An enlarged liver is another symptom and a smooth, thick, red tongue.
33
Define polycythemia vera and describe its clinical course
Polycythemia vera is a bone marrow disease that leads to an abnormal increase in the number of blood cells. The red blood cells are mostly affected.
It usually affects adults in middle age. Abnormal blood flow causes particularly low blood pressure (particularly on the venous side.) Patients are plethoric and cyanotic, have headaches and dizziness, hypertension, and gastrointestinal symptoms. Peptic Ulcer may also occur
34
Risk factors for venous thromboembolism and describe possible outcomes of deep vein thrombosis
Thrombocytopenia is a deficiency in the number of blood platelets. A minor decrease in platelet count may present with mild symptoms, such as a tendency to bruise easily or excessively. There may be mild superficial bleeding, often presenting as small, purpuric lesions in the extremities. For more severe deficiencies, major risks include internal bleeding events such as GI bleed or intracranial hemorrhage, which can be fatal.
DVT - If you have a clot in a deep vein, you're at risk for damage to your veins and organs as well as other life-threatening problems.
35
Define atelectasis, dyspnea, hemoptysis, and asthma
Atelectasis - a complete or partial collapse of a lung or lobe of a lung — develops when the alveoli within the lung become deflated
Dyspnea: difficult or labored breathing; shortness of breath
Hemoptysis: coughing up blood
Asthma: a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.
36
Define COPD. What is the most common causes of COPD
a. COPD stands for chronic obstructive pulmonary disease. It is defined as impairment of airflow in lungs (small airways [bronchioles], lung parenchyma [alveoli]), usually progressive, which is not fully reversible. Two types (mixture of both always present): Chronic Bronchitis and Emphysema.
b. Most common cause is due to cigarette smoke 80%
37
What is cor pulmonale? What is the relationship between cor pulmonale and COPD?
a. Cor pulmonale is defined as an alteration in the structure and function of the right ventricle (RV) of the heart caused by a primary disorder of the respiratory system. Pulmonary hypertension is often the common link between lung dysfunction and the heart in cor pulmonale.
b. Lung conditions that cause a low blood oxygen level in the blood over a long time can also lead to cor pulmonale such as COPD
38
Describe the role of bronchospasm and inflammation in the etiology of asthma.
In an acute asthma attack, a trigger (usually by histamine and other mediators) activates an immediate or “early response” bronchospasm of smooth muscle, in which airways close off. This onset occurs within minutes to 2-3 hours after the exposure.
39
Describe the usual clinical course of macular degeneration. Understand the differences between “wet” macular degeneration and “dry” macular degeneration.
Macular degeneration is the leading cause of blindness in US. Macula is 2.1% of retina, but uses over 50% of visual cortex. Macular degeneration leads to loss of viability of the macula and loss of central vision. Peripheral vision remains intact, so its not total blindness, but ability to look at anything directly is lost.
Dry macular degeneration is a build up of a protein and lipid extracellular material beneath the retina. The build up swells in macula causing macula retinal detachment and macular loss of vision.
Wet macular degeneration is caused by small vessels accumulating in the space beneath the retina and again swelling, causing local retinal detachment. The wet type is more likely to progress to blindness than the dry type. It also progresses more quickly than the dry type.
40
Define leukoplakia and describe its relationship to tobacco use and squamous carcinoma of the mouth
‘Leukoplakia’ are white patches; the term is usually used to refer to white or gray patches that develop in the mouth - on the tongue, inside of cheek or floor of the mouth - in response to chronic irritation of the mucous membranes. Tobacco use, including smoking and chewing, is one of the main known causes of oral leukoplakia. Oral leukoplakia is considered to be “precancerous” and there is some chance of it (less than 20%) developing into squamous cell carcinoma. Leukplakia can also refer to white patches in the GI tract, urinary tract, or genitals.
41
Define tinnitus, rhinitis, sinusitis, pharyngitis, epiglottitis and laryngitis
Tinnitus: The perception of sound within the human ear (ringing of the ears) when no actual sound is present.
Rhinitis: Irritation and inflammation of the mucous membrane inside the nose. Common symptoms of rhinitis are a stuffy nose, runny nose, and post-nasal drip.
Sinusitis: or rhinosinusitis is inflammation of the paranasal sinuses. It can be due to infection, allergy, or autoimmune problems.
Pharyngitis: An inflammation of the throat. In most cases it is quite painful, and is the most common cause of a sore throat.
Epiglottitis: An inflammation of the epiglottis — the flap at the base of the tongue that keeps food from going into the trachea (windpipe). Due to its place in the airway, swelling of this structure can interfere with breathing, and constitutes a medical emergency
Laryngitis: is an inflammation of the larynx. It causes hoarse voice or temporary complete loss of the voice because of irritation to the vocal folds (vocal cords)
42
Define: polyuria, oliguria, anuria, dysuria, nocturia, azotemia, hematuria, proteinuria
Polyuria - production of abnormally large volumes of dilute urine.
Oliguria – production of abnormally small amounts of urine
Anuria – failure of kidney’s to produce urine
Dysuria – pain or difficult urination
Nocturia – excessive urination during the night
Azotemia – medical condition characterized by abnormally high levels of nitrogen-containing compounds in blood (such as: urea, creatinine, various body waste compunds, and other nitrogen-rich compounds)
Hematuria – the presence of blood in urine
Proteinuria – presence of excess proteins in the urine
43
Understand the most important fxn of the Kidney, and describe how disturbances in these fxn lead to sxs in Kidney disease
Kidney’s are the organs that filter waste products from the blood. They also regulate blood pressure, electrolyte balance, and red blood cell production in the body.
Sxs of kidney failure are due to build-up of waste products and excess fluid in the body that may cause weakness, SOB, lethargy, swelling, and confusion. Inability to remove potassium from the bloodstream may lead to abnormal heart rhythms and even sudden death.
44
Describe the relationship between GERD and esophageal cancer.
Adenocarcinoma of the esophagus is almost entirely due to Gastroesophageal Reflux Disease. GERD is reflux from stomach acid into the esophagus due to a breakdown in the competence of the gastroesophageal sphincter. Acid in the esophagus damages the lower esophageal tissue, and if this happens chronically the tissue changes and becomes precancerous.
45
Describe the relationship between peptic ulcers and Helicobacter pylori.
Helicobacter Pylori is a bacteria found in the digestive tract. The bacteria can be avoided by drinking clean water and living in sanitary conditions. The bacteria attacks the lining of the stomach, breaking it down and causing sores or ulcers. Peptic ulcers are sores on the lining of the stomach or the duodenum. Stomach ulcers are usually caused by the Helicobacter Pylori bacteria, prolonged use of NSAIDS or cancer. Duodenal ulcers are virtually always caused by Helicobacter. Ulcers can be healed by removing acid for a period of time, but if the Helicobacter Pylori is not eradicated, ulcers quite often recur.
46
Define constipation, and list the most common causes
Constipation is a disorder of the digestive system. It occurs when the feces becomes too hard and is difficult to expel or fully expel. The common causes of constipation are as follows: Lack of fiber in diet, lack of movement or exercise, medications such as opiates, channel blockers, calcium, antacids, dehydration, pregnancy, Irritable Bowel Disease, tumors or growths.
It is also more common in the elderly. New onset of unexplained constipation in people over age 50 that persists should be evaluated to exclude colon cancer.
47
Crohn’s disease vs Ulcerative Colitis
Crohn’s Disease: Usually involves small intestine and/or colon, but it may involve any of GI system from mouth to perineum. Presenting symptoms vary depending on location of disease. Commonly fatigue, prolonged diarrhea with abdominal pain, weight loss, and fever, with or without gross rectal bleeding, are the hallmarks of Crohn's disease. There is a high likelihood for formation of fistulae, between loops of bowel or from bowel to other viscous organs (ie bladder) or skin. 80% of patients will require at least some surgery to remove diseased bowel. It is a chronic and usually lifelong disease.
Ulcerative Colitis: This only affects the colon and/or rectum. It presents with inflammation, and consequently symptoms are usually episodes of rectal bleeding, tenesmus (urgency), diarrhea with blood or mucous, crampy abdominal pain, and fevers. Chronic symptoms depend on the severity of the disease, and can range from intermittent bouts of mild to moderate rectal pain to full colonic inflammation, with mostly rectal, with diarrhea, more abdominal pain, weight loss, anemia, and fever. Rarely, the entire colon becomes ischemic, infected, and markedly dilated, a condition called ‘toxic megacolon’, and if not removed within hours, can lead to shock and death. Many patients survive recurrent flares of Ulcerative Colitis without surgery, but some will require removal of the colon.
Both conditions can increase risk for of colon cancer, but moreso Ulcerative Colitis, and both can be associated with extra intestinal manifestations such as eye disease, inflammatory arthritis, and rashes. Both are autoimmune in etiology
48
jaundice, and describe the pathophysiology
Jaundice-A discoloration of the skin and mucous membranes that appears yellowish that is caused by hyperbilirubinemia.
Jaundice pathophysiology:One of the liver’s essential clean up duties for the body is to collect hemoglobin and convert it to bilirubin, which is secreted in the bile. Conjugated bilirubin is excreted in bile into the duodenum. In the intestine, bacteria metabolize bilirubin to form urobilinogen. Some urobilinogen is eliminated in the feces, and some is reabsorbed, extracted by hepatocytes, reprocessed, and re-excreted in bile. Jaundice is caused by a build up in the blood stream of excess bilirubin. Before excretion in bile, bilirubin is processed the liver, or “conjugated”. Sometimes jaundice comes from excess bilirubin production, and “unconjugated bilirubin” backs up, waiting to be processed. Sometimes jaundice occurs if the liver is impaired, can process, but cannot excrete the bilirubin, so processed, or “conjugated bilirubin” builds up.
A wide range of diseases that affect the liver can cause jaundice, including hepatitis of any cause, cirrhosis, and conditions that plug the biliary system such as stones, infection, or tumors. Jaundice can also be caused by excess production of bilirubin, usually from destruction of RBCs, such as in hemolytic anemia.
49
functions of the hepatocyte, and how these functions correspond to the signs of cirrhosis
- Pass portal blood by hepatocytes, en route to the central vein and circulation
- Collect the bile they synthesize and direct it to the bile ducts
- Produce a wide variety of proteins, such as albumen and clotting proteins
- Clear other wastes in the body, such as ammonium and other wastes that can impair CNS functioning
- Clear bilirubin which is formed from destroyed RBCs into the bile, and
- Store glucose in the form of glycogen to help maintain blood glucose
In the case of cirrhosis, these functions cannot be completed by the liver. The consequence are the symptoms seen in cirrhosis…
- Ascites and Esophageal varices, caused by elevated pressures in the portal vein circulation….. Pass portal blood by hepatocytes, en route to the central vein and circulation
- Edema and easy bleeding/bruising….Produce a wide variety of proteins, such as albumen and clotting proteins
- Obtundation (‘Hepatic encephalopathy’)…Clear other wastes in the body, such as ammonium and other wastes that can impair CNS functioning
- Jaundice….Clear bilirubin which is formed from destroyed RBCs into the bile
50
Define cirrhosis and 3 most common causes
Cirrhosis: a chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue. It is typically a result of alcoholism, chronic active hepatitis (B or C), or increasingly fatty liver from obesity (‘NASH’).
51
pathophysiology of cholecystitis
Cholecystitis is inflammation of the gallbladder. It is most often associated with gallstones blocking the cystic duct, causing bile to build up in the gallbladder. This build up causes increased pressure and inflammation. Inflammation and inability to empty can lead to damage and necrosis of the gallbladder, often accompanied by infection. It usually presents with fever, Right upper quadrant pain that does not remit, and occasionally jaundice.
52
Define insulin resistance, and understand how it relates to the etiology of diabetes type 2 and the metabolic syndrome.
a. Broadly defined as a subnormal biological response to normal insulin concentrations. Type 2 makes insulin but their body needs more then the normal amount in order to be used.
b. Metabolic syndrome includes high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. The syndrome increases a person's risk for heart attack and stroke. It’s in an insulin resistant state where we see most of these factors.
53
Compare DM Types 1 and 2 with respect to cause and outcomes.
Type 1- usually autoimmune disease, with antibodies forming directed against Pancreatic Beta Cells. Genetic and environmental causes, more common in children. Without insulin….
i. Body acts as if sugar levels are low
ii. Proteins broken down to synthesize more glucose. Byproduct of this reaction is creation of acidic ketones
iii. Fat and glycogen stores also broken down to further raise glucose
iv. So, despite high blood sugar, the body acts as if it were fasting….” famine in the midst of plenty”
Type 2 - defined as elevated blood glucose in face of ongoing (albeit relatively abnormal) insulin secretion and increased resistance to action of insulin. Its gradual. Causes are in a genetically susceptible individual, physiologic stresses develop that render the person more “insulin resistant” (stresses can include) obesity, inactive lifestyle, others.
i. Obesity patterns, with upper body / abdominal obesity most significant, may alter fat delivered to the liver and exacerbate insulin resistance.
ii. Sxs are similar to Type 1 except: ketoacidosis uncommon in Type 2 Diabetes, onset is usually more gradual, over months or even years
54
Describe diabetic ketoacidosis and understand it’s time course, causes, and clinical outcome. Why is this common in DM Type 1 but uncommon in DM Type 2?
a. Generally happens in diabetes type 1, or diabetes with widespread pancreas destruction, and only rarely and in certain individuals with diabetes type 2. Lack of insulin (type 1) prompts breakdown of fat (“lipolysis”), which is then transported to the liver. In the liver, fat is broken down to 2 carbon fragments, called Acetyl-CoA, and either enters the Krebs cycle to make ATP, or enters the cytoplasm and is eventually converted into keto- acids,
b. Insulin pumps widely used here, otherwise multiple injections used to control glucose levels, ability to self monitor glucose levels essential to good control
55
Define hemoglobin A1c, and explain its use in managing diabetes.
a. Hemoglobin A1c is a test that measures the level of hemoglobin A1c in the blood as a means of determining the average blood sugar concentrations for the preceding two to three months
b. All measures to lower blood glucose help prevent complications, for example targeting Hemoglobin A1c 7.0 or less
56
Describe the tissues at greatest risk and complications from DM. List the major reason individuals die from diabetes type 2 and how this impacts on disease management.
a. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual. Type 2 diabetes affects your ability to heal and resist infections.
b. Type 2 diabetes can be easy to ignore, especially in the early stages when you're feeling fine. But diabetes affects many major organs. Long-term complications of diabetes develop gradually, they can eventually be disabling or even life-threatening. Some of the potential complications of diabetes include: heart and blood vessel disease, nerve damage, kidney damage, eye damage, foot damage, hearing impairment, and skin conditions.
57
Compare hyper and hypothyroidism with respect to cause and symptoms.
a. Hypothyroidism's deficiency of thyroid hormones can disrupt such things as heart rate, body temperature, and all aspects of metabolism. Hypothyroidism is most prevalent in older women. Major symptoms include fatigue, cold sensitivity, constipation, dry skin, and unexplained weight gain.
b. Hyperthyroidism is the production of too much thyroxine hormone. It can increase metabolism. Symptoms include unexpected weight loss, rapid or irregular heartbeat, sweating, and irritability, although the elderly often experience no symptoms.
58
Compare causes and clinical presentation of Addison’s disease and Cushing’s Syndrome.
a. Addison’s: A disorder in which the adrenal glands don't produce enough hormones. Specifically, the adrenal glands produce insufficient amounts of the hormone cortisol and sometimes aldosterone, too. When the body is under stress (e.g. fighting an infection), this deficiency of cortisol can result in a life threatening Addisonian crisis characterized by low blood pressure. Symptoms tend to be non-specific and include fatigue, nausea, darkening of the skin, and dizziness upon standing.
b. Cushing’s: A condition that occurs from exposure to high cortisol levels for a long time. The most common cause is the use of steroid drugs, but it can also occur from overproduction of cortisol by the adrenal glands. Signs are a fatty hump between the shoulders, a rounded face, and pink or purple stretch marks.
59
Describe the relationship between polycystic ovary syndrome (PCOS) and hyperinsulinemia.
a. Hyperinsulinemia causes or exacerbates hyperandrogenemia. Increased insulin levels at the ovarian level lead to increased androgen production from the ovarian thecal cells.
60
Define and describe the signs and symptoms of an ectopic pregnancy
The signs and symptoms of an ectopic pregnancy typically occur 6-8 weeks after the last normal menstrual period, they are: amenorrhea or light intermittent vaginal bleeding, nausea and vomiting with pain, lower abdominal cramps, sharp abdominal cramps, pain on one side of the body, dizziness/weakness, pain in the shoulder, neck, or rectum, fainting. Ectopic pregnancy can occur anywhere in the abdomen, but a large majority of cases occur in the fallopian tube. If there is rupture of the fallopian tube, there can be life-threatening internal bleeding, shock, and if not rapidly corrected, death.
61
Define and describe the signs and symptoms of preeclampsia
Preeclampsia is extreme high blood pressure during pregnancy which can lead to damaging other organs. Signs and symptoms of preeclampsia are very sudden onset of Blood pressure that exceeds 140/90. Other signs include proteins in urine, severe headaches, light sensitivity, upper costal pain, vomiting and decreased urine output. Preeclampsia has a high risk to progress to eclampsia, which is even more serious and includes seizures and blood abnormalities. The only cure for these is delivery of the baby.
62
Define gynecomastia
enlargement of a man's breasts, usually due to hormone imbalance or hormone therapy.
63
endometriosis and describe its clinical presentation
A disorder in which tissue that normally lines the uterus grows outside the uterus.
With endometriosis, the tissue can be found on the ovaries, fallopian tubes or the intestines.
The most common symptoms are pain and menstrual irregularities.
Effective treatments, such as hormones and excision surgery, are available.
64
Define uterine leiomyoma, and discuss its clinical presentation and whether or not it is precancerous
These are uterine Fibroids and most often are benign. They affect women of child bearing years and older and develop from the muscle cells that begins dividing abnormally and creates a rubbery mass. These masses can be very small or very large and can be asymptomatic, but also can cause difficulty in conception. They are usually found bimanual exam or ultrasound but can be externally palpated if large enough. Very rarely the fibroids can transform into sarcomas.
65
Define menarche, menopause, dysmenorrhea, menorrhagia, metrorrhagia, amenorrhea
Menarche- the first occurrence of menstruation.
Menopause- the ceasing of menstruation.
Dysmenorrhea- painful menstruation, typically involving abdominal cramps.
Menorrhagia- abnormally heavy bleeding at menstruation.
Metrorrhagia- uterine bleeding at irregular intervals, particularly between the expected menstrual periods
Amenorrhea- an abnormal absence of menstruation.
66
Define cerebral infarct and list common causes and risk factors.
Infarction is death to tissue in the body caused by local lack of oxygen, due to an obstruction of the tissues blood supply. In the brain, Cerebral Infarctions (Ischemic Stroke) may be due to an embolism or thrombosis. Risk factors for thrombotic strokes include high blood pressure, smoking, diabetes, and obesity. Risk factors for embolic strokes include atrial fibrillation and disorders that lead to hypercoagulability of the blood (Lupus, others). Cerebral infarction may lead to neurological problems, or in some cases death.
67
Compare a TIA (transient ischemic attack) to a CVA (cerebral infarct)
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Cerebrovascular accidents (CVA) are caused by local interruption of blood flow to the brain causing tissue death. There are three types: thrombotic, when an artery in the brain is occluded by atherosclerotic plaque; embolic,when a clot forms elsewhere and flows up the carotid arteries into the brain; and hemorrhagic, when a blood vessel in the brain ruptures and bleeds into surrounding tissue. The consequences of a CVA are more serious, permanent and sometimes fatal.
A transient ischemic attack (TIA) is when arterial blockage in the brain occurs briefly and resolves on its own, without causing tissue death. Symptoms of a stroke develop, but clear completely within 24 hours. TIA's are risk factors for ischemic stroke.
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68
Compare the presentations of migraine, cluster, tension, cervical and sinus headaches
Cluster headaches - Cluster headaches affect men more than they do women. These headaches are intense, lasting a few hours each, and occur daily or every few days for weeks or months. After this, they disappear, sometimes for year. These often run in families.
Migraine headaches- A migraine headache is usually one-sided, pounding, and lasts from hours to three days or more. These are usually accompanied by nausea, vomiting, and photophobia, and rarely have neurologic symptoms. Mostly adults experience migraines, and 75% of them are women. The migraines tend to be worse around menstrual periods. They may improve during pregnancy, but can sometimes worsen. Migraines in children, which is less common is split 50/50 between boys and girls.
A migraine with an aura will start with a visual or olfactory sensation, and usually this sensation lasts minutes. It is followed by a throbbing unilateral headache that is increasingly severe, and lasts hours but sometimes 1-2 days. Usually there is nausea, vomiting and photophobia.
A "common migraine" is a typical migraine but with no aura. It is the most common type, around 80% of migraines
Atypical migraines present with atypical aura, the headache may be bilateral, and rarely will present with neurologic deficient such as temporary paralysis.
Tension headaches - Tension headaches are said to be felt in musculoskeletal ways, or feel more as muscle tension. These are usually bilateral, and often in the occipital region. Usually there is no nausea or photophobia. These headaches sometimes feel like a "vice", with pressure around the head. They can last minutes to days, but usually are only a few hours.
Sinus headaches - Sinus headaches are characterized by pain, pressure and fullness in the cheeks, brown or forehead. These tend to worsen if the person bends forward or lies down. Other symptoms that will accompany this are a stuffy nose, fatigue and an achy feeling in the upper teeth. Also there may be congestion, facial pressure, a clear watery nasal discharge. These headaches can overlap with migraines though so its important to find the differences - if a migraine, a person would be more likely to have nausea, vomiting, and be aggravated by bright light. Migraines can also get worse when a person bends forward and can be accompanied by various nasal signs and symptoms. Approximately 90 percent of people who see a doctor for a sinus headache are found to have migraines instead.
Cervical headaches- Cervical headaches are one of the most unusual headache disorders because the pain truly isn't in the head. It is perceived to be in the head but is actually from a source in the neck. It is a secondary headache, which means that it is caused by another illness or physical issue, in this case, it is due to a neck disorder or lesion. A cervical headache is exacerbated by neck movement or certain posture. It is tenderness of the upper three cervical spine joints. Usually it is associated with neck pain or dysfunction. A definitive diagnosis is made through selective nerve blocking through injection of specific sites. Compared to migraine headaches and control groups, cervical headache patients tens to have increased tightness and trigger points in the upper trapezius, levator scapule, scales and suboccipital extensors. They may have weakness in their neck and increased activity in their superficial flexors.
69
Define insomnia and list numerous causes.
Insomnia is a persistent disorder that can make it hard to fall asleep, hard to stay asleep or both, despite the opportunity for adequate sleep.
Insomnia has many causes, including stress, anxiety, depression, change in work schedule, poor sleep habits, medications, caffeine, alcohol, or aging.
70
Define restless leg syndrome
A neurological disorder that involves sensations in the legs that can be described as throbbing, antsy, pulling, creepy, or uncomfortable. There is then an uncontrollable urge to move the legs. It is worse at night and often impairs a good night’s sleep. It is more common in those with diabetes and in older patients. Cause is unknown, but may involve abnormalities in brain iron.
71
Define Alzheimer’s disease and describe its clinical course and presentation
Alzheimer’s is the most common form of dementia. Usually an individual has a hard time remembering recent events, though they might recall things from years ago. As time goes by, they may have a harder time focusing on ordinary activities, feeling confused or frustrated (usually at night), dramatic mood swings, and feeling disoriented or lost. Eventually patients can lose ability to ambulate, perform essential acts of daily living, recognize anyone around them, and communicate.
72
Define Parkinson’s disease and describe its clinical course and presentation.
Parkinson's disease is a progressive disorder of the nervous system that affects movement. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand. Some individuals only develop tremor, but no other signs, and this is called ‘parkinsonism’. Most individuals develop some rigidity and stiffness, which is the hallmark of the disease. While a tremor may be the most well-known sign of Parkinson's disease, the disorder commonly causes stiffness or slowing of movement
73
Define peripheral neuropathy and be able to list numerous causes.
Peripheral neuropathy is dysfunction of one or more peripheral nerves (the part of a nerve distal to the root and plexus). It includes numerous syndromes characterized by varying degrees of sensory disturbances, pain, muscle weakness and atrophy, diminished deep tendon reflexes, and vasomotor symptoms, alone or in any combination. Peripheral neuropathy may affect a single nerve (mononeuropathy), or many nerves (polyneuropathy) simultaneously.
Causes: Diabetes mellitus, Alcoholism, Autoimmune diseases (Sjogren’s syndrome, Lupus, Rheumatoid arthritis, etc,), Exposure to toxic substances, Infections (Lyme disease, Shingles, Epstein-Barr virus, Hepatitis C, Leprosy, Diphtheria, HIV), Trauma or pressure on the nerve, Tumors, etc.
74
Define dermatitis
Dermatitis is inflammation in the dermal layer of the skin. This can be from irritation from an outside agent, called ‘contact dermatitis, such as poison ivy or an allergic reaction. It can also be from internal derangement of the dermis which allows water to evaporate out too rapidly and dries the skin. This is called ‘atopic dermatitis, or eczema.
75
Melanoma signs can include:
- A large brownish spot with darker speckles
- A mole that changes in color, size, or smoothness of border, feel, or that bleeds
- A small lesion with an irregular border and portions that appear red, white, blue or blue-black
- Dark lesions on your palms, soles, fingertips or toes, or on mucous membranes lining your mouth, nose, or even vagina or anus
76
Describe a vesicle, pustule, macule, papule.
Vesicle: a small blister full of clear fluid
Pustule: a small blisterlike elevation of the skin containing pus.
Macule: Circumscribed, flat changes in skin color.
Papule: Small rounded circumscribed, Raised bumps on skin
77
Define systemic lupus erythematosus (SLE) and list one symptom from at least 5 body systems potentially involved in its clinical presentation.
SLE is a systemic autoimmune disease that is characterized by the body’s immune system attacking its own tissues. The clinic diagnosis for SLE is confirmed by the presence of autoantibodies against normal tissue and DNA. Common musculoskeletal symptoms include arthritis and myositis. Rash can develop, often on the face and worsened by exposure to sunlight. Hematological symptoms include autoimmune hemolysis, leukopenia, and coagulopathy. Systemic symptoms include fatigue, loss of weight, and fever or night sweats. Cardiovascular symptoms include pericardititis and vasculitis. Complete renal failure can occur with SLE. Pleural effusion and pleurisy can affect the pulmonary system.
78
Describe the clinical presentation of classic rheumatoid arthritis.
Rheumatoid Arthritis (RA) usually has an insidious onset of persistent symmetric polyarthritis, particularly of the hands and feet, although any joint lined by a synovial membrane may be involved. It may be preceded by fever, malaise, arthralgias and weakness. The patient may complain of fatigue , malaise, morning stiffness, weight loss and a low grade fever. They may have trouble dressing, standing, walking, and difficulties with personal hygiene related to problems in using their hands. In some cases, Nodules under the skin can develop, and lung damagecan occur. RA increases the risk of serious coronary artery disease.
79
Define osteoporosis, and list risks for its development as well as complications it leads to
Osteoporosis is a disease of the bones. It happens when you lose too much bone, make too little bone or both. As a result, your bones become weak and may break from a minor fall or, in serious cases, even from simple actions, like sneezing or bumping into furniture.
Some risk factors for osteoporosis, including:
- Sex. Women are much more likely to develop osteoporosis than are men.
- Age. The older you get, the greater your risk of osteoporosis.
- Race. You're at greatest risk of osteoporosis if you're white or of Asian descent.
- more...
80
Compare osteoarthritis to rheumatoid arthritis with respect to clinical presentation, age of onset, clinical course, pathophysiology and complications.
Osteoarthritis is inflammation in the joints, caused by what we consider to be “normal wear and tear.” It is very common in the elderly. Osteoarthritis in the hands is most likely to affect the distal interphalangeal joint (DIP) or the base of the thumb.
Rheumatoid arthritis (RA), on the other hand, is an autoimmune condition in which the body attacks its own joints. This can happen to a person at any age. RA tends to be more common in people who have a family member or more than one family member with RA or some other autoimmune condition. RA in the hands is most likely to affect the proximal interphalangeal joint (PIP) or the wrist. RA is extremely painful, until the disease has completely destroyed the joint, and then it ceases to be painful, but the joint also ceases to be functional. This can be a devastating condition.
81
Define rickets/osteomalacea and identify the nutritional deficiency it represents
Osteomalacea is a disorder characterized by the softening and weakening of bones. When this disorder occurs in children, it is called rickets. Soft bones are more likely to bow and fracture than harder, healthy bones. Symptoms include dull, aching bone pain and weakness.
In children, there may also be delayed growth, bowed legs, thickened wrists and ankles, and breastbone projection. Generally, the softening and weakening of bones is caused by a prolonged vitamin D deficiency, which could be from lack of exposure to sunlight, intestinal malabsorption, or disorders of any of the organs involved in vitamin D synthesis (skin, liver or kidney). Vitamin D deficiency makes it difficult to maintain proper calcium and phosphorous levels in bones.
82
Define osteomyelitis, and describe its clinical presentation.
Osteomyelitis is an infection of the bone, a rare but serious condition. The infection can spread through the bloodstream into the bone or an open fracture or surgery may expose the bone to infection. Symptoms include fever, fatigue, nausea, tenderness and warmth at place of infection, lost range of motion and swelling around infection.
