Medical Screening Part 3 Adults Flashcards
(279 cards)
1
Q
what MSK pathology can affect the adult populations?
A
fx
osteoporosis
fibromyalgia
2
Q
what are the 4 decision rules we can use to screen for knee fx?
A
Pittsburg knee rules
Weber and colleagues rules
Ottawa knee rules
Fagan and Davies rule
3
Q
what are the criteria in the Pittsburg knee rules?
A
inability to ambulate
fall or trauma
<12 or >50 yrs
4
Q
what are the criteria for the Weber rules?
A
inability to ambulate w/o limping
twist injury w/effusion
5
Q
what are the criteria for the Ottawa knee rules?
A
> 55 yo
tenderness of fibular head OR patella
flexion <90 deg
inability to WB 4 steps
6
Q
what are the criteria for the Fagen and Davies rules?
A
> 55 yo
inability to WB
hemarthrosis; effusion
bony point tenderness
7
Q
t/f: osteoporosis has a lot to do with calcium intake and WBing activity level
A
true
8
Q
what 2 things protect against osteoporosis?
A
WBing and ms pull
9
Q
what is a good option for a pt w/osteoporosis who needs to be doing WBing activities w/o as much of a fall risk?
A
aquatics
10
Q
what is a new med option for bone building in osteoporosis?
A
Evenity
11
Q
the bone building drug Evenity is approved for what populations?
A
high-risk, post-menopausal women who haven’t responded to other treatments
12
Q
how does Evenity work?
A
it blocks sclerostin, a protein that stops bone from forming
13
Q
t/f: Evenity is a monthly injection for bone building
A
true
14
Q
other than Evenity, what are the 2 other bone building treatments for osteoporosis?
A
Tymlos and Forteo
15
Q
do current RCTs show significant effects of calcium supplementation?
A
no, they have only showed moderate effects
16
Q
what are the serious adverse effects of calcium supplementation found in recent RCTs?
A
CV, kidney stones, acute GI sx, and constipation
17
Q
when should calcium be taken?
A
one in the morning and one at night with meals
18
Q
what are the risk factors for osteoporosis?
A
fam hx
low Ca2+
alcohol, tobacco, and caffeine abuse
below normal body weight
chronic medical conditions and meds
sedentary lifestyle
early menopause
19
Q
what are the s/s of osteoporosis?
A
severe and localized T-L spin pain
inc pain w/prolonged posture
dec pain in hooklying
inc pain with Valsalva maneuver
loss of ht>1”
kyphosis
dowager’s hump
20
Q
how much calcium should a child (1-12 yo) have?
A
800 mg/day
21
Q
how much calcium should a teen (13-18 yo) have?
A
700-1200 mg/day
22
Q
how much calcium should an adult have?
A
700-1000 mg/day
23
Q
how much calcium should a pregnant adult have?
A
1200 mg/day
24
Q
how much calcium should a postmenopausal adult have?
A
1500 mg/day
25
t/f: use of NSAIDs more than 3 days at higher doses during post-op or acute phase fx healing may lead to increased rate of nonunion, delayed union, and pseudoarthrosis in adults
true
26
what are the manifestations of fibromyalgia?
tender points (11 of 18)
arthralgia, myalgia
no restorative sleep
fatigue
tension HA
fxnal bowel disease
numbness, burning
brain fog
psychopathology
limb movt syndrome
27
growth hormone secretions occur most when?
at night
28
what happens if GH (growth hormone) is decreased?
ms repair at night is compromised and Ms endurance/pain is increased during the day
29
t/f: exercise inhibits somatostatin
true
30
t/f: strong evidence suggests that antidepressants Dec pain, fatigue, depression, and sleep disturbances
true
31
what can inhibit somatostatin release?
aerobic exercise
32
what is somatostatin?
growth hormone
33
does increased or decreased GH lead to inc ms repair and dec pain?
increased
34
what is the role of GH in fibromyalgia?
bc pts with fibro don't sleep well, they don't release as much GH which causes them to feel bad bc GH decreases pain and increases ms repair
35
what are the neuromuscular pathologies that can happen in adults?
systemic lupus erythematosus
GBS
MG
MS
ALS
36
how do statins work?
they inhibit the gene PCSK9 that provides instructions for making a protein that regulates cholesterol in the blood
37
what do statins do?
they decrease the amount of bad cholesterol
38
what are the adverse effects of statins?
loss of muscular coordination
trouble talking and enunciating words
loss of balance
loss of fine motor skills (difficulty writing)
trouble swallowing
constant fatigue
jt and ms aches and stiffness
vertigo and disorientation
blinding HAs
39
if a pt has changed their meds in the past ____ wks, we should know about this
2-3
40
evidence suggests that statins may have a role in what kind of CA prevention and tx?
colorectal CA
41
what are the s/s of lupus?
unexplained fever
swollen glands
constitutional sx
arthralgia (symmetrical)
swollen jts
skin rash (butterfly rash on the cheeks)
chest pain upon deep breathing
extreme fatigue
photosensitivity
unusual hair loss
pale/purple fingers/toes from cold or stress (Raynaud’s phenomenon)
CNS probs-seizures, HA, peripheral neuropathy, CVA, OBS
mouth, nose, vaginal ulcers
sx get worse during menstruation
42
is arthralgia in lupus symmetrical or asymmetrical?
symmetrical
43
when do sx of lupus get worse in women?
during menstruation
44
what are the s/s of GBS?
weakness-symmetrical LE>UE>respiratory
paresthesia starts in toes and progresses proximally
pain in LB and buttocks
CNs effected in 45-75% of cases
asymmetrical facial weakness, dysphagia, dysarthrias
unstable VSs (not as common)
dec reflexes and hypotonia
fever, nausea, fatigue
cannot go up the stairs
45
where is weakness the greatest in GBS?
LE>UE>respiratory
46
is weakness symmetrical or asymmetrical in GBS?
symmetrical
47
is tone increased or decreased in GBS?
increased
48
what is MG?
a chronic autoimmune disorder caused by a defect in the transmission of nerve impulses at the NM junction
antibodies block, alter, or even destroy the receptors
49
what are the s/s of MG?
diploplia and ptosis
proximal ms weakness
prob controlling eye movt and facial expressions
difficulty swallowing and chewing
dysarthria/dysphagia
dhange in voice quality
no sensory changes or change in DTRs
50
what are the 2 most common s/s of MG?
diploplia and ptosis
51
is ms weakness greater proximally or distally in MG?
proximally
52
are there sensory changes or changes in DTRs with MG?
no
53
can MS run in a family?
yes
54
what are two trigger for MS?
Epstein Barr virus
low levels of vit D
55
what is involved in a first attack of MS?
transverse myelitis causing dec strength and sensation
optic neuritis causing decreased vision and pain w/eye movts
56
what is the first demyelinating event in 20% of MS pts?
optic neuritis
57
what does transverse myelitis cause?
dec strength and sensation
58
what does optic neuritis cause?
dec vision and pain with eye movt
59
what are the s/s of MS?
intermittent UL visual impairment
blurring
diploplia
paresthesias
ataxia
vertigo
extremity weakness
B/B changes
reports a sensation of compression around a limb
hyperreflexia
(+) Babinski
dysmetria
(+) Lhermitte’s sign
sensitivity to temp changes
(+) neural tension testing (ie Brudzinski sign)
LBP 2/2 trunk hypotonia
60
53% of those w/MS reported a (+) ____ sign in the 1st 3 months of the disease
Lhermitte's
61
what is Lhermitte's sign?
electric shock sensation with fwd head flexion
62
Lhermitte's sign has not only been linked to MS, but also what?
myelopathy
63
a study found that what chemical compound found in cashew shells helps promote myelin repair?
anacardic acid
64
what is attacked in ALS?
neurons of the brain and SC
65
t/f: in 20% of ALS cases, a genetic link is found
true
66
t/f: there is a cognitive decline associated with ALS
false
67
new ALS research shows there is a buildup of what protein near neuromuscular junctions?
TDP-43
68
what does the protein TDP-43 do?
it translates signals into motor activity
69
what does the buildup of the TDP-43 protein near neuromuscular junctions do in ALS?
it causes motor neurons to degenerate and die by inhibiting mitochondrial production
70
what are the s/s of ALS?
ms weakness: hands, arms, legs
progressive weakness of ms of speech, swallowing, and eventually breathing
EMG fibrillations and fasciculations
denervation atrophy
elevated ms enzymes
painful UE cramps
no change in vision, hearing, taste, B/B
71
where is there ms weakness in ALS?
hands, arms, legs
72
what does EMG show with ALS?
fibrillations and fasciculations
73
t/f: there is a change in vision, hearing, taste, and B/B in ALS
false
74
is UE or LE weakness greater in GBS?
LE weakness
75
are DTRs and tone increased or decreased in GBS?
decreased
76
t/f: GBS has unstable VSs
true
77
is weakness greater proximally or distally in MG?
proximally
78
is there a change in DTRs and tone with MG?
no
79
what is a key sign of lupus?
the butterfly rash
80
is there a change in DTRs and tone in lupus?
nope
81
do DTRs and tone increase or decrease in MS?
increase
82
what are key signs of MS?
(+)Lhermitte's sign and visual changes
83
are DTRs and tone increased or decreased in ALS?
increased with cramping
84
what are the CVP concerns in adults?
HTN
AAA
thoracic aortic aneurysm
85
what are the consequences of HTN?
spontaneous epistaxis
occipital HA
dizziness
visual changes
nocturnal urinary frequency
flushed face
86
what are the risks for an AAA?
cerebrovascular disease
coronary artery disease
1st deg relative with AAA
other vascular aneurysms
high cholesterol
HTN
male
obese
smoker
87
if the aneurysm diameter is <3.0cm, what surveillance should be done?
none
88
if the aneurysm diameter is 3.0-3.9cm, what surveillance should be done?
US every 2-3 yrs
89
if the aneurysm diameter is 4.0-5.4cm, what surveillance should be done?
US or CT every 6-12 months
90
if the aneurysm diameter is >5.4cm, what surveillance should be done?
surgical consult
91
what is the lifetime rupture risk of an aneurysm 5cm in diameter?
20%
92
what is the lifetime rupture risk of an aneurysm 6cm in diameter?
40%
93
what is the lifetime rupture risk of an aneurysm 7cm in diameter?
50%
94
what do Ritter's rules tell us?
important info on how to recognize and treat AAA and thoracic aortic aneurysm to prevent them from killing people
95
t/f: a thoracic aortic dissection is a medical emergency
true
96
t/f: death rate of a thoracic aortic dissection increases 1% every hour the diagnosis and surgical repair are delayed
true
97
what is the #1 sx of AAA/thoracic aortic dissection?
severe pain of sudden onset in the chest, stomach, back, or neck
likely a sharp, tearing, ripping, moving or so unlike any other pain you've ever felt
98
why are aortic dissections often misdiagnosed?
bc they mimic heart attacks
99
what are the only imagings that can ID aortic aneurysm or dissection?
CT, MRI, and transesophageal echocardiogram
100
t/f: aortic dissection is often preceded by an aortic aneurysm
true
101
if you have an aortic aneurysm, you are at inc risk of what?
an aortic dissection
102
what are the risk factors for an aortic dissection?
hx of an aortic aneurysm
personal/fam hx of thoracic disease
Marphan syndrome, Loeys-Dietz syndromem, Turner syndrome, vascular EDS
bicuspid aortic valve disease
103
what are lifestyle triggers of an aortic dissection?
injury to the chest
extreme straining associated with body building
illicit drug abuse
poorly controlled HTN
discontinuing necessary BP meds
104
how can we prevent aortic dissection if you have thoracic aortic disease?
medical management including BP control and aortic imaging
105
what study of MI s/s only included males?
the Framingham study
106
what are the s/s of MI predominant in males?
substantial pressure, tightness, squeezing
pain unrelieved by position or nitroglycerin
dyspnea, nausea, vomiting, dizziness
palpitations, diaphoresis
107
what study on MI s/s included females?
the McSweeney study
108
what are the more common prodromal MI s/s in females?
unusual fatigue (71%)
sleep disturbance (48%)
SOB (42%)
indigestion (39%)
anxious (36%)
heart racing (27%)
weak/heavy arms (25%)
changes in thinking or remembering (24%)
vision changes (23%)
loss of appetite (22%)
hands/arms tingling (22%)
109
what are the more common acute s/s of MI in females?
SOB (58%)
weakness (55%)
unusual fatigue (43%)
dizziness (39%)
cold sweats (39%)
nausea (36%)
weak/heavy arms (35%)
arm aching (32%)
hot or flushed (32%)
indigestion (31%)
centered high chest pain (31%)
110
t/f: levels of cortisol differ in people who had an MI and those who didn't
true
111
what are non-cardiac causes of chest pain?
indigestion
esophagitis
ulcers
cholecystitis
bronchitis
ms strain
costochondritis
rib fx
herpes zoster
112
what integ conditions can affect adults?
herpes zoster
skin CAs
Lyme disease
113
describe the shingles rash?
UL blister rash following a dermatome
114
2/3 of pts with shingle are over ___ yo
50
115
what are the sx of shingles that may appear 3-5 days b4 the rash?
pain, tenderness, and paresthesia in the dermatome
116
prodromal sx of shingles amy mimic what?
cardiac pain
117
how long does erythema and the rash last in shingles?
2-3 wks
118
what are the most common dermatomes affected in shingles?
thoracic and the opthalmic division of the trigeminal nerve
119
how is shingles spread?
via respiratory droplets or direct contact with the blisters
120
can shingles spread in the blister phase?
yes
121
can shingles spread b4 the blister phase?
no
122
can shingles spread once the rash crusts over?
no
123
is shingles or chickenpox more contagious?
chickenpox
124
t/f: anyone who had chickenpox may develop shingles
true
125
t/f: if you've never had chickenpox, you won't get shingles, but you could get chickenpox
true
126
t/f: if you were vaccinated for chickenpox, you're protected from shingles
true
127
what are the ABCs of skin CAs?
Asymmetrical shape
Border irregularities
Color isn't uniform
Diameter >6mm
Evolution (change in status)
128
what is the role of PT in skin CA prevention?
screen skin exposed during PT session
educate pt
refer prn
129
how long does it take for B burgdorferi to migrate from the midgut of the tick to the salivary glands in Lyme?
36-48 hrs
130
t/f: removal of a tick w/in 24 hrs can usually prevent acquisition of Lyme disease
true
131
sx of early Lyme usually begin ____ wks after a tick bite
1-2
132
in the early localized stage of Lyme, when does the rash appear?
within 7-14 days
133
in the early localized stage of Lyme, how big is the rash usually?
5-6"
134
t/f: the rash in Lyme may or may not be warm to touch
true
135
is the rash in Lyme usually painful or itchy?
nope
136
what s/s accompany Lyme other than the rash?
fever
malaise
HA
ms aches
jt pain
137
what are the tx meds for Lyme?
Doxycycline, amoxicillin, cefuroxime (Ceftin), Azithromycin (zithromax)
138
what GI pathology may affect adults?
GI trauma
GI CA
obesity
celiac disease
ulcers
appendicitis
gallbladder probs
139
what factors in obesity are highly correlated with increased risk of CA reoccurance?
nutrition, weight, body comp
140
t/f: high salt diet increases risk of GI CA via direct mucosal damage and synergistically with H pylori
true
141
what kind of CA risk increases with diets high in
red meat, processed meats, and sat fats
142
when is the onset of celiac disease?
6-24 months after gluten is introduced to the diet
143
what are the s/s of celiac disease?
diarrhea, abdominal distention
impaired growth, ms wasting
decreased appetite, weight loss
lethargy, irritability
144
what causes a peptic ulcer?
break in the protective mucosal lining
145
what are the 2 types of peptic ulcers?
gastric and duodenal
146
t/f: the etiology behind peptic ulcers is multifactorial
true
147
what are the genetic factors associated with peptic ulcers?
familial tendencies, type O blood
148
what are the environmental factors associated with peptic ulcers?
smoking, ETOH, NSAIDs
149
t/f: there is a correlation bw NSAID usage and peptic ulcers
true
150
t/f: there is inc risk of gastric ulcers when taking PPIs
true
151
what are stress ulcers?
secondary ulcers that develop from psychological or physiological stress
152
t/f: gastric mucosal changes occur within 72 hrs in 80% of pts with burns over 35% of their body
true
153
GI ulcers occur in what % of adults taking NSAIDs?
15-30%
154
what are the s/s of ulcers?
hx of NSAIDs or presence of H pylori infection
dull gnawing/burning into midline T6-12 and radiating suprascapula
antacids provide temporary relief
nausea, coffee-grounds vomitus
bloody or black-tarry stools (melenia)
may have wks of remission
155
where may there be a dull, gnawing/burning pain with a gastric ulcer?
into the midline of T6-12 and radiating to the suprascapula
156
if pain occurs 30-60 min post eating, is it more likely a gastric or duodenal ulcer?
gastric
157
if pain occurs 2-3 hrs after eating, is it more likely a gastric or duodenal ulcer?
duodenal ulcer
158
where is the pain with a gastric ulcer?
LUQ
159
where is the pain with a duodenal ulcer?
R of the midline
160
what can help dx a peptic ulcer?
dec hematocrit and hemoglobin values
blood in feces or urine
test for H pylori can ID those likely to benefit from antimicrobial tx
161
what is the H pylori breath test?
a test to ID those with H pylori in which the pt swallows a substance containing urea treated with carbon atoms
if H pylori is present, the bacteria converts the urea into carbon dioxide which is detected and measured with an exhale after 10 min
162
t/f: the H pylori test can also be used to confirm that H pylori has been fully treated
true
163
what are the tests for H pylori when there is a GI bleed?
blood tests
stool tests
tissue biopsy
164
what is involved in tx of a peptic ulcer?
remove irritant
meds to restore mucosa
anti-microbial (H pylori)
avoid coffee (caffeinated and decaf)
165
t/f: no known dietary changes have been found to reduce gastric acid secretion
true
166
what are the 8 Fs that increase risk for gallbladder issues?
female
fair
flatulent
forty
fat
fertile
fatty foods
fam hx
167
what are the s/s of GB pathology?
RUQ, scap pain
sx inc after fatty meal
pain doesn’t respond to analgesics
abdominal bloating/belching
clay-colored stools
vomiting, nausea
jaundice (small %)
(+) Murphy’s sign
168
how can GB pathology be dx?
US
MRI
cholescintigraphy (HIDA scan)
oral cholecysteogram (OCG)
169
what is involved in a cholescintigraphy (HIDA scan) for dx of GB pathology?
a radioactive chemical is injected (IV) into the pt
a camera over the abdomen senses radioactivity
170
what is involved in an oral cholecysteogram (OCG) for dx of BG pathology?
pt takes iodine-containing tablets for 1-2 nights
in the GB, iodine becomes concentrated along w/the bile then an x-ray of abdomen in taken
171
what is oral dissolution therapy for gallstones?
the med is a naturally-occurring bile acid called ursodeoxycholic acid or ursodiol (Actigall, Urso)
ursodiol reduces the amt of cholesterol secreted in bile; the bile then has less cholesterol and becomes capable of dissolving the cholesterol in the gallstones
172
what are important limitations to the use of ursodiol?
it is only effective for cholesterol not pigment gallstones
it is only for small gallstones <1-1.5cm in diameter
it takes 1-2 yrs for the gallstone to dissolve and many of the gallstones reform following cessation of tx
173
bc of its limitations, ursodiol is generally only used for what pts?
pts at high risk for surgery
174
what does ECSW lithotripsy do for gallstones?
it produces shockwaves outside the body that are then focused on the gallstone
the shockwaves shatter the gallstone and the resulting pieces either drain into the intestine on their own or are extracted endoscopically
175
what are the s/s of appendicitis?
RLQ pain, (+) McBurney’s point-->R thigh/testicle
nausea, vomiting, night sweats
guarding of rectus abdominis
(+)Psoas sign
(+)Obturator sign
low grade fever
(+) rebound tenderness
176
how do we palpate the thyroid?
hands on either side of the throat and have pt swallow to observe any masses
177
what are the endocrine pathologies that can affect adults?
hypothyroidism (Hashimoto's disease)
hyperthyroidism (Grave's disease)
hypoparathyroidism
hyperparathyroidism
178
do clinical features of hypothyroidism develop fast or slowly?
slowly, so clinicians may fail to notice them
179
is there a genetic link in hypothyroidism?
yes, those with a fam member who has had hypo/hyperthyroidism, hair that turned gray int heir 20s, or had an immune problem/juvenile DM are at increased risk
180
what clinical questions can we ask a pt we suspect of having hypothyroidism?
Do you feel less energetic?
Do you lack interest in your surroundings?
Has the skin of your arms or legs become more dry or rough?
Do you think you have put on weight?
Have you or any of your family members/friends noticed that your voice has become huskier or weaker?
181
what are the physical exam findings in hypothyroidism
course skin
sluggish movts
PRL <60 bpm=bradycardic
pretibial edema
puffiness of the face
prolonged ankle reflex
182
how can we measure "sluggish movts"?
ask to fold a 2m long bed sheet
if it takes >1 min it is considered sluggish
183
what are the s/s of hypothyroidism?
dec basal metabolic rate
dry skin
ms/jt pain
lethargy, depression, apathy
confusion
weight gain
edema around the eyes
loss of lateral eyebrow
women>men
184
what does loss of eyebrow hair in hypothyroidism cause?
infection, skin conditions, hormonal changes, an overactive immune system, nutritional deficiencies, physical trauma, or emotional stress
185
what is a common name for hypothyroidism?
Hashimoto's disease
186
what is a common name for hyperthyroidism?
grave's disease
187
what are possible causes of hyperthyroidism?
auto-immune: triggered by environmental factors or stress
nodules on the thyroid (goiters)
excess thyroid meds (for hypothyroid)
excess iodine
thyroiditis
188
what would be seen in the initial physical exam with hyperthyroidism?
enlarged thyroid
tachycardia
tremor of the DIP
smooth, velvety skin
inflammation/bulging of the eyes
189
does inflammation/bulging of the eyes occur more in males or females in hyperthyroidism?
females
190
what are additional s/s of hyperthyroidism?
fatigue
sweaty palms
inc appetite/weight loss
hyperactive reflexes
inc sweating (heat intolerance)
restlessness and insomnia
dec attention span
191
when does prevalence of hyperthyroidism peak?
in the 3rd and 4th decades of life
192
does hyperthyroidism occur more in males or females?
females
193
what is the tx for hyperthyroidism?
anti-thyroid drugs (PTU and Tapazole)
radioactive iodine
surgery
194
t/f: anti-thyroid drugs work in most cases to tx hyperthyroidism
false, it only works in 20-30% of cases
195
what is involved in radioactive iodine to treat hyperthyroidism?
a liquid or capsule taken orally
goes to stomach and into bloodstream
taken up by thyroid where it destroys thyroid cells to dec thyroid hormone production
196
t/f: in surgical tx of hyperthyroidism, only a small amount of the thyroid is removed just enough to dec thyroid hormone
true
197
how many parathyroid glands are there?
4
198
what is the purpose of the parathyroids?
to make parathyroid hormone that controls all Ca2+ levels in the body
199
t/f: it's not uncommon for pts with hyperparathyroidism to have intermittent "normal" levels of Ca2+
true
200
what are the sx of hypocalcemia as a result of hypoparathyroidism?
irritability
cardiac arrythmia
skeletal ms cramping
tingling in fingers
dry/scaly skin
pigment changes
thin hair and brittle nails
(+) Chvostek sign
201
what is a (+) Chvostek sign?
hyperiritability of the facial nerve when tapped at the zygomatic arch
202
what is a (+) Trosseau's sign?
carpal spasm when inflated BP cuff is maintained >SBP for 3 min
203
what is a (+) Trosseau's sign indicative of?
hypoparathyroidism
204
how many glands are usually effected in hyperparathyroidism?
usually only 1
205
does hyperparathyroidism effect more men or women?
women
206
when is hyperparathyroidism most prevalent?
during the 5th, 6th, and 7th decades of life
207
t/f: it's a mistake to say “mild” elevation in blood calcium means you have “mild” hyperparathyroidism
true
208
are parathyroid operations very involved?
no, pts usually go home within 2 hrs of the operation
209
what are the effects of high Ca2+?
makes you feel bad
ruins kidneys, liver, and arteries
causes strokes and cardiac rhythm problems
causes kidney stones and osteoporosis
increased chance of CA: breast, kidney, and prostate
210
what are the s/s of hyperparathyroidism?
inc DTRs
fatigue, drowsiness
proximal weakness
arthralgia/myalgia
reflux/peptic ulcer
kidney stones
inc BP
heart palpitations
pancreatitis, gout
thinning hair
mental slowing or memory problem
emotional irritability
hypercalcemia
difficulty sleeping
HAs
211
are there drugs that will make parathyroid disease better?
nope, NONE
212
t/f: nearly all parathyroid pts have sx
true
213
do sx of parathyroid disease correlate to level of Ca2+?
no
214
t/f: ALL pts with with parathyroid disease have Ca2+ levels and PTH levels that go up and down
true
215
t/f: fluctuating levels of Ca2+ are not typical of parathyroid disease
false, it is typical
216
t/f: all pts with hyperparathyroidism will develop OA
true
217
do osteoporosis drugs help with bone density in hyperparathyroidism?
no
218
t/f: parathyroid disease will get worse in all pts with time
true
219
what is the only tx for hyperparathyroidism?
surgery
220
t/f: nearly all parathyroid pts can be cured w/a minimal operation
true
221
the success rate and complications for parathyroid surgery is VERY dependent on what?
the surgeon's experience
222
t/: following surgery for hyperparathyroidism, osteoporosis begins to improve immediately
true
223
how long does it take bone pain to resolve following parathyroid surgery?
6-12 hrs
224
how long does it take acid reflux to be gone following parathyroid surgery?
2-4 days
225
how long does it take for HAs to go away following parathyroid surgery?
1 wk
226
how long does it take HTN to improve following parathyroid surgery?
a few wks
227
how long does it take arrhythmias to subside following parathyroid surgery?
1 month
228
how long does it take CNS sx to improve following parathyroid surgery?
1-2 months
229
how long does it take hair loss to resolve following parathyroid surgery?
3-4 months
230
what scan can we use to pick up the parathyroids?
PET scan
231
what are the risk factors for breast CA?
>40 yo
fam hx
nonpregnancy
other cancers
fibrocystic disease
232
what are the s/s of breast CA?
palpable mass
retraction of the nipple
dimpling of skin over mass
skin may be red, warm, edematous, firm, and painful over the mass
fixation of mass to skin or chest wall
enlarged axillary lymph nodes
discharge from the nipple
pain with movt of breast
unilateral UE swelling
brachial plexus related dysfxn
233
what are the urogenital pathologies that may effect adults?
UTIs
endometriosis
kidney stones
234
what are the risk factors for a UTI?
immobility and inactivity-impaired bladder emptying
catheterization
DM
obstructions: renal calculi
235
what are the s/s of a UTI?
pain with micturition
leukocytes and bacteria in urine (white casts)
cloudy urine
back pain
pain with percussion over kidneys
fever, chills
nausea
loss of appetite
236
is the avg time to initial dx of bladder CA greater in men or women?
women
237
is the avg time to initial dx of UTI greater in men or women?
it is about equal
238
what age group is most predominantly effected by endometriosis?
30-40 yo
239
what are the s/s of endometriosis?
worse pre and during menses
pain w/intercourse
infertility
recurrent lumbosacral pain
240
what are the 3 common sites of obstruction by kidney stones?
ureteropelvic junction
ureter that crosses over iliac vessels
ureterovescical junction
241
what are the 4 types of kidney stones?
Ca2+ oxalate=80-90%
Mg2+ ammonium phosphate
uric acid
cystine
242
what is the most common type of kidney stone?
Ca2+ oxalate
243
t/f: with formation of a kidney stone, there is increased blood levels and urinary excretion of it principle component
true
244
what are the risk factors for kidney stones?
males 4x>females from 30-50 yo
females>males 60-80 yo
Caucasians 3x>African Americans
high protein, low fiber diet
dehydration
warm climate; summer>winter
poor mobility
fam hx
245
what are the s/s of kidney stones?
stabbing pain at costovertebral angle
intermittent, excruciating pain into ipsilateral genitals (comes in waves)
ureter spasms radiate into medial thigh
pain starts when stone moves into narrow ureter-->pressure build up in kidney
chills, nausea, vomiting
frequent urge to urinate
burning sensation with urination
bloody, cloudy, smelly urine
increased BP
246
what tests can be used to dx a kidney stone?
US, CT, MRI
urinalysis
247
what are we looking at in the urinalysis for kidney stones?
hematuria
infection
crystals
pH
248
t/f: formation of various types of kidney stones is strongly influenced by urinary pH
true
249
alkaline pH favors crystallization of ___ and ____ containing stones
calcium, phosphate
250
acidic urine pH promotes ______ or ______ stones
uric acid, crystine
251
t/f: 90% of renal calculi are radiopaque
true
252
stones <____mm pass spontaneously
5-6
253
what are tx options for kidney stones?
pain meds
antibiotics
drainage if there is a fever
removal
254
how can kidney stones be removed?
USE: ureteroscopic stone extraction
ESWL: extracorporeal shock wave lithotripsy
255
kidney stones recoccur within how many yrs in 50% of ppl?
5 yrs
256
is Hodgkin's lymphoma common in children <5 yo?
no
257
when is the peak of lymphoma?
25-30 yo
258
does lymphoma occur in more males or females?
males (5:1 ratio)
259
what CA causes painless swelling of the lymph nodes in the neck or axilla, fever and night sweat, and weight loss?
lymphoma
260
most normal lymph nodes are about how big?
0.5-2.0cm
261
t/f: size of lymph nodes caries depending on location of the node and what activity is going on
true
262
what can cause lymph nodes to expand?
infections
CA
other conditions
263
what are the s/s of lymphoma?
lymph nodes >1cm-tender, firm, rubbery (lasting longer than 4 wks)
pruritis (greater at night)
fever, night sweats
anorexia, cyanosis
jaundice
edema
non-productive cough, dyspnea
chest pain
264
what CA accounts for 15% of CA deaths?
colon CA
265
what two things are behind the etiology of colon CA?
environmental and familial factors
266
what are the risk factors for colon CA?
increasing age
polyps
ulcerative colitis
Crohn’s disease
diet high in animal fat and low in fiber
267
what can reduce the risk for colon CA?
daily aspirin (ASA)
estrogen
268
what is the second most common female urogenital CA but the most lethal?
ovarian CA
269
what are the risk factors for ovarian CA?
age (40-60 yo), race (Caucasian and Hawaiian)
geographic location (NW Europe, US, Canada)
nulliparity (hx of infertility)
fam hx
endometrial or breast CA
270
what age group is most effected by ovarian CA?
40-60 yo
271
t/f: ovarian CA is either symptomatic or has vague sx
true
272
what are common sx of ovarian CA?
bloating
frequent abdominal fullness after eating
nausea and vomiting
flatulence
abnormal bleeding
general abdominal discomfort
273
what are the sx of metastatic disease?
unexplained weight loss
weakness
ascites
274
what are the pulmonary sx of metastases?
cough, dyspnea, fecal odor breath, constant pleural pain, onset of wheezing
275
what are the CNS sx of metastases?
confusion, change in memory, depression, irritability, drowsy, blurred vision, HA< balance problem, weakness
276
what are the skeletal sx of metastases?
significant pain relief with ASA, pain with WBing, pain at night, prior hx of CA
277
what are the common bone sites of metastasis?
vertebrae, pelvis, ribs, femur
278
t/f: statins have been associated w/reduction in various CAs
true
279
why do researchers peculate that statins may protect against some CAs?
statins interfere w/cell growth and metastasis by blocking cholesterol production, thereby affecting molecular pathways and inflammatory response
