Test 3 Study Guide

Question 1

What vitamins are essential in clotting? How are they made?

Answer 1

Vitamin K is essential in clotting. It is used to create clotting factors. It is largely obtained through diet. Greens leafy veggies, and some fruits are great sources. A small amount of vitamin K is synthesized by the colon.

Question 2

Why do children require a vitamin k shot upon birth?

Answer 2

To prevent bleeding issues because babies are born with a vitamin k deficiency, this predisposes them to bleeding.

Question 3

What are the dietary recommendations for celiac disease?

Answer 3

Avoid gluten. Gluten is a protein that is found in rye, wheat, and barley. Oats are gluten free but are frequently contaminated with gluten cross contamination.

Question 4

What happens if a celiac patient eats gluten?

Answer 4

Gluten causes an autoimmune reaction in patients that have a celiac sensitivity. The body attacks the villi that are located in the small intestines. These villi are responsible for absorbing nutrients. Chronic exposure to gluten can cause villi erosion leading to malnutrition and other issues.

Question 5

Which medications affect the gastric mucosa? How do they do this?

Answer 5

NSAIDs, especially aspirin, are notorious for damaging the mucosa. NSAIDs inhibit prostaglandin secretions. Prostaglandins normally increase mucus and bicarbonate secretion which function to protect the stomach from the acidity of stomach acid.

Steroids, when taken over long periods of time, can reduce the gastric mucosa’s functioning ability. They can also increase stomach acid production.

Question 6

What medicines increase the risk for GI bleeds?

Answer 6

NSAIDs especially ASA. Anticoagulation medicines. Steroids.

Question 7

Describe the formation and excretion of bilirubin. How is bilirubin excreted?

Answer 7

Bilirubin is formed from the breakdown of hemoglobin. RBC have a lifespan of 120 days. After this time period they are broken down by the liver, spleen, and bone marrow. During breakdown heme is split from globin. Heme is converted through a serious enzymes (heme oxygenate converts heme into biliverdin and then biliverdin reductase converts biliverdin into bilirubin).

Bilirubin is initially in its unconjugated state, which is fat soluble. Uncomjugated is converted to conjugated by the liver. The conjugated form is water soluble and is excreted via urine and feces.

Question 8

What is bile? Where is it produced? What is its function? What happens if there is a lack of bile?

Answer 8

Bile is yellow/green digestive fluid that is produced by the liver. It travels down the bile duct to the gallbladder where it is stored. Bile is released from the gallbladder and travels to the small intestines where it aids in nutrient emulsification, absorption, and digestion.

Bile salts help breakdown fats into smaller particles which are more easily broken down and absorbed.

Lack of bile leads to poor fat absorption which irritates the subsequent digestive process leading to diarrhea, flatulence, bloating, pale stools, malabsorption.

Question 9

What is the role/function of bile? Where does it come from?

Answer 9

Bile is a green/yellow liquid that is created by the liver and stored in the gallbladder. The liver flows from the liver to the gallbladder via the bile duct.

Bile plays a primary role in digestion and absorption of fats and fat-soluble vitamins. Bile salts help to break down large fat particles, which are difficult to digest, into smaller, more manageable particles.

Bile is composed of bile salts, bilirubin, cholesterol, phospholipids, and electrolytes.

Question 10

Hepatitis A
1. What causes it?
2. Describe the presentation - S&S
3. Where is it most common?
4. HOW DOES IT TRANSFER AMONG AFFECTED?
5. Incubation time?

Answer 10

1. HAV - a virus
2. Most affected are asymptomatic with the disease being self-limiting. Rarely, the disease can progress to fulminant hepatitis leading to death. Presents with fever, malaise, anorexia, dark urine, jaundice.
3. The disease is most common in developing countries and areas of poverty.
4. The disease is transferred via fecal-oral route. Drinking contaminated milk, water, eating contaminated shellfish.
5. The incubation period is 14-28 days.

Question 11

Hepatitis B
1. What causes it?
2. Describe the presentation - S&S
3. HOW DOES IT TRANSFER?
4. Incubation time?

Answer 11

1. HBV - a virus. 296 million people chronically sick from it. 1.5 million new cases per year.
2. Presentation - can be seen as an acute or chronic. Acute symptoms are jaundice, fever, N/V, dark urine, clay-colored stool. Chronic symptoms are the same, but it can progress to complications - cirrhosis, liver failure, and liver cancer.
3. Transfers between affected individuals via blood. Can also be spread via sexual contact. Risk factors include IV drug users, multiple sexual partners, and homosexual sex. There was a large decrease in the number cases once Hep B vaccination was created and all pregnant mothers were screened for the disease prior to giving birth.

Question 12

Hepatitis C
1. What causes it?
2. Describe the presentation - S&S
3. How does it transfer?
4. Incubation period

Answer 12

1. HCV virus. 185 million people worldwide. 1.5 million cases per year.
2. Same as the other hepatitis presentation. Jaundice, dark urine, fever, muscle pain, joint pain fatigue. Can also develop into a long-term chronic illness that can develop complications such as cirrhosis, ESRD, etc.
3. Transmitted via blood exposure. Blood transfusion, injections, and IV drug use.
4. Incubation period - 2 -26 weeks

Question 13

What diagnostic tests support malnutrition diagnosis?

Answer 13

• Albumin - indicates decreased protein intake but not particularly specific. Also, can be seen with increased inflammation, liver disease, kidney disease.
• Pre-albumin - more specific to poor protein intake.
• Total protein
• Transferrin
• Vitamin levels

Question 14

How is adipose tissue an endocrine organ? How does it control appetite?

Answer 14

Adipose tissue - fat tissue. Stores 90% of the body’s energy. Adipocytes are the main unit of the adipose tissue. These fat cells help with uptake, synthesis, storage, and mobilization of lipids.

The endocrine function of adipose tissue is the secretion of leptin, cytokines, TNF, and growth factors. Leptin affects the hypothalamus to decrease food intake and increase energy expenditure.

Question 15

What is the main hormone involved in appetite regulation?

Answer 15

The two hormones that play the biggest role in appetite are lectin and Ghrelin.

Leptin is the “satiety hormone” - produced by the adipocytes of the adipose tissue and affects the hypothalamus to decrease appetite and increase energy expenditure.

Ghrelin is produced in the stomach and is known as the hunger hormone. Also works on the level of the hypothalamus to make someone feel hungry.

Question 16

What hormones are released from the anterior pituitary gland? Describe their function?

Answer 16

The anterior pituitary gland releases: FLAT PiG

F - FSH - follicle stimulating hormone. A gonadotropin hormone that stimulates the regulation of women’s menstrual cycles and ovulation. In men it stimulates sperm production.

L - LH - Luteinizing Hormone. A reproductive hormone that plays a role in progesterone production in women and testosterone production in men.

A - ACTH - adrenocorticotropic hormone. Produced by the adrenal glands. Plays a large role in the body’s response to stress and function of the adrenal glands. Stimulates release of cortisol from the adrenal glands.

T - TSH - Thyroid stimulating hormone. Stimulates the thyroid to produce T3 and T4. These hormones play a role in energy expenditure, temperature regulation, HR, digestion, and growth and development.

P - PRL - prolactin. Milk production and menstrual cycles.

I - ignore

G - GH - growth hormone. Promotes growth, development, and metabolic processes.

Question 17

Compare and contrast type 1 and type 2 diabetes

Answer 17

Type1 - autoimmune destruction of the beta cells of the pancreas. These are the cells that make insulin. Typically is diagnosed in childhood or adolescence. Requires exogenous insulin use due to no intrinsic insulin production. More likely to develop DKA due to lack of insulin. Diagnosed in the same way as type 2, looking for elevated random and fasting glucose levels on lab draws. Checking A1C. Checking urine specimens for ketones. Obtaining a history and physical with attention paid toward hyperglycemia symptoms - polydipsia, polyuria, weight loss, N/V, dehydration.

Type 2 DM - a developed disorder of insulin resistance. Increased stores of adipose tissue, lack of activity, poor diet, and other factors come together to develop an environment of insulin resistance. Insulin resistance can be reversed through exercise, diet, and weight loss but many times it progresses to the point of requiring pharmacologic treatment.

Question 18

What is DKA? How does it affect the body? What are Kussmaul respirations?

Answer 18

DKA - diabetic ketoacidosis. An acute illness that is characterized by hyperglycemia and a build up of ketones in the blood creating an acidic environment. Ketones are created as a byproduct of fat break down in the process of lipolysis. More often affects T1DM than T2DM due to the lack of insulin.

DKA signs and symptoms include:
- N/V - a combination of dehydration from vomiting and polyuria in addition to the buildup of ketones in the blood leading to an irritating acidic environment leads to nausea and vomiting.
- Polyuria - glucose has an osmotic pull in the body. As the kidneys try to excrete the increased amounts of glucose from the system, the glucose has an osmotic affect, pulling water with it.
- Polydipsia - dehydration leads to increased thirst.
- Ketones - ketones accumulate in the blood as the body is forced to use protein and fat breakdown as a source of body fuel. Ketones are acidic and as more and more build up, it affects the patients pH.
- Hypokalemia - insulin is utilized in transporting potassium into cells. A lack of insulin leads to potassium remaining in the blood which leaves it vulnerable to diuresis due to the increased urinary output caused by hyperglycemia. The acidic environment of the body triggers a compensatory mechanism where hydrogen ions are shifted out of the cells and potassium ions are shifted into the cells leading to a deficiency of potassium in the blood.
- Kussmaul respirations - a breathing pattern that is seen in patients suffering from acidosis. The respiratory system is attempting to compensate for metabolic acidosis by blowing off more CO2. These respirations are characterized by fast, labored, deep breaths.

Question 19

What hormones are released from the posterior pituitary gland? What do these hormones do?

Answer 19

ADH - antidiuretic hormone. A hormone that reduces the amount of diuresis. Released when the body detects low circulating volume.

Oxytocin - hormone that stimulates contractions during pregnancy. Stimulates milk let down. Helps social bonding.

Question 20

Type 1 Diabetes
1. Etiology?
2. Patho?
3. Complications?

Answer 20

Type 1 Diabetes is an autoimmune condition where the body attacks and destroys the pancreatic beta cells, the cells responsible for insulin production. This leads to an absolute insulin deficiency which requires exogenous insulin to control blood sugar levels. The disease is typically diagnosed early in childhood or adolescence. Type 1 DM is more likely to experience DKA.

Question 21

How is Type 1 diabetes diagnosed?

Answer 21

History - polydipsia, polyuria, dehydration, weight loss
Physical - fruity breath
Labs - elevated glucose, ketones in the urine, A1C

Question 22

Why are type 1 diabetics more likely to experience DKA?

Answer 22

Type 1 diabetics have an absolute insulin deficiency. Since insulin is required to utilize glucose stores in the body for energy, a lack of insulin inhibits this basic function. Instead, the body begins to break down fat and protein as sources of fuel. Lipolysis is the process of fat break down into fatty acids with the byproduct of ketones. These ketones are what make DKA and can produce life threatening acidosis in the body.

Type 2 diabetics have insulin resistance. This means they still have some insulin production. This insulin availability is used to allow some energy production via glucose and also allows the blood sugar in HHS to be lower.

Question 23

What is cortisol? What does it do in the body?

Answer 23

Cortisol is a steroid hormone that sits on top of the adrenal glands. It is also known as the “stress hormone”.

Released in large quantities during stressful situations, cortisol works to reduce inflammation, increase gluconeogenesis (to provide a boost of energy), and affects the blood pressure.

Question 24

How does cortisol affect fat and protein metabolism? What does this lead to?

Answer 24

Cortisol suppresses lipolysis which leads to increased fat storage in the body. With diseases like Cushing syndrome, this increased fat storage is placed in stereotypical areas (buffalo hump, midsection, moon face).

Cortisol reduces the body’s ability to metabolize proteins. This leads to muscle breakdown which is apparent in the reduced arm and leg muscle size of patients with Cushing syndrome.

Question 25

How is Cushing syndrome diagnosed?

Answer 25

Subjective - Muscle weakness, fatigue. Objective - weight gain, fat deposits, elevated glucose levels, high cortisol levels on lab draw, reduced muscle size in arms and legs, high blood pressure, ACTH levels.

Question 26

What is HHS? How does it affect the body?

Answer 26

Hyperosmolar Hyperglycemic State. This is a condition of reduced circulating volume (dehydration) and hyperglycemia that most commonly affects T2DM patients. Severe dehydration is caused by a combination of polyuria, fluid shifts, and electrolyte imbalances. - Polyuria - extremely high levels of blood glucose creates an osmotic gradient where the kidneys attempt to secrete the excess glucose leads to water following the glucose. - Fluid shifts - the body senses a decrease in circulating volume and pulls fluid volume from the interstitial and intracellular spaces to compensate. This worsens dehydration but temporarily improves blood pressure. - Electrolyte imbalances - excessive excretion of sodium, potassium, and chloride with the polyuria worsens symptoms of HHS. Additional signs and symptoms include - hyperglycemia, polydipsia, confusion, lethargy, N/V, tachycardia, hypotension, decreased UO which may progress to AKI.

Question 27

How is HHS treated?

Answer 27

1. The severe dehydration that is seen with HHS is the primary problem to fix. Rehydration with IV fluids is essential. close monitoring of fluid status is required to ensure there isn't a swing to too much fluid. This especially needs to be monitored in older adults. 2. Electrolyte replacement - potassium replacement. Hypernatremia is often present initially but corrects with correction of fluid volume status. 3. Insulin drip - to combat the hyperglycemia. Slow reduction in the glucose level is required to avoid cerebral edema.

Question 28

What are the microvascular complications of uncontrolled diabetes?

Answer 28

Poorly controlled diabetes leads to hyperglycemia, increased insulin production, alterations in nutrient metabolism, and a host of other issues. Nephropathy - damage to the kidneys. The kidneys are forced to work overtime to filter the excess amounts of glucose from the blood. Over time this causes wear and tear damage on the kidneys which slowly appears as swelling, proteinuria, and progresses to kidney disease and failure if not addressed. Neuropathy - hyperglycemia causes a build up of AGES (advanced glycation end products) which are harmful compounds that accumulate over time and damage nerves and blood vessels. Hyperglycemia increases oxidative stress and inflammation. Hyperglycemia and reduce blood flow to the most distal areas of the body which can damage nerves found there. Retinopathy - hyperglycemia can damage the retina (light sensitive part of the eye). The damage to the blood vessels and nerves here can result in leakage, blockage, and damaged of the structures which can manifest as blurred vision, floaters, or seeing dark spots.

Question 29

Counter-regulatory hormones that are released during stress?

Answer 29

1. Cortisol - released by the adrenal medulla. This "stress" hormone acts to prepare individuals for stressful situations. Increases sympathetic stimulation, gluconeogenesis, and alters metabolism to make use of lipolysis as a source of additional energy. This hormone inhibits the actions of insulin with the aim of creating more energy. 2. Epinephrine - aka adrenaline. This catecholamine is produced by the adrenal medulla in times of stress. It works to increase the heart rate, blood pressure, and gluconeogenesis. The effects are similar to cortisol in the role of a counter regulatory hormone in regards to its effects on insulin. Inhibits insulin so that more glucose (energy) is available to the body in stressful situations. 3. Glucagon - a hormone that is secreted by the alpha cells of the pancreas. This hormone's main function is to elevate glucose levels when they drop too low. When hypoglycemia is detected, glucagon stimulates the liver to make more glucose available to the body. 4. Growth Hormone - released from the pituitary gland. Works to maintain adequate glucose levels during times of stress or fasting.

Question 30

What is metabolic syndrome?

Answer 30

Metabolic syndrome is a collection of abnormalities that result in an increased risk for development of DM2, cardiovascular disease, and stroke. 1. Hypertension 2. Central obesity 3. Dyslipidemia (high triglyceride levels and low HDL levels. Metabolic syndrome can result in the development of T2DM by: - Central obesity - adipose tissue is resistant to insulin. Increased adipose tissue in the body results in increased insulin resistance which leads to increased insulin production and continues the cycle. A waist size of 40 inches for men and 35 for women. - Hypertension - Increases the risk for heart disease and stroke - Dyslipidemia - high triglycerides are seen when there is insulin resistance. Resistance to insulin leads to increased insulin production in the hopes that more will get the job done. Hyperinsulinemia leads to overproduction of VLDL a type of lipoprotein that transports triglycerides throughout the blood. Low levels of HDL leads to increased cholesterol in the blood which increases the risk for heart disease and stroke.

Question 31

What hormones are produced by the adrenal gland?

Answer 31

Epinephrine - fight or flight hormone. Released during stressful situations. Increases HR, BP, and energy availability. Glucocorticoids - cortisol. Released during stressful times. Works to suppress inflammation and immune function, alter metabolism, and increase energy availability. Has an effect on BP through sodium retention Mineralocorticoids - aldosterone. Regulates blood pressure, fluid status, and sodium levels. Sex hormones - androgens. Involved in testosterone and estrogen production. Norepinephrine - similar to epinephrine.

Question 32

What is the prostate? What is prostatitis? How do you differentiate between acute bacterial prostatitis, BPH, and chronic prostatitis?

Answer 32

The prostate is a small, walnut sized gland located below the bladder in men. It functions to nourish and transport sperm. Prostatitis is inflammation or infection of the prostate. Acute bacterial prostatitis is most commonly caused by E. Coli spread from the urinary tract to the prostate. Symptoms include fever, painful urination, frequent and urgent need to urinate, pain in the abdomen or lower back, and pain or blood in the semen. Chronic bacterial prostatitis. Persistent infection of the prostate gland. Uncommon. Associated with pelvic pain especially after urination or ejaculation. Painful urination. Reoccurring UTIs. BPH - benign prostatic hyperplasia. Noncancerous enlargement of the prostate gland. Symptoms include frequent urination, urgency, straining to urinate, dribbling after urination, incomplete urination, retention.

Question 33

Testicular cancer presentation? Treatment?

Question 34

What should be included in annual wellness exams when detecting prostate cancer?

Answer 34

PSA testing, digital rectal exam, and transrectal US are the diagnostic screening tools used to detect prostate cancer. People who are 40 years old with a high risk of developing prostate cancer (has a first degree relative that developed it at a young age) should have frequent screenings via PSA and digital rectal exam. People 50 years and older who are expected to live 10 years or longer should also have this screening performed.

Question 35

How does BPH manifest and what complications can it cause?

Answer 35

BPH - benign prostatic hyperplasia. Non-malignant increase in the size of the prostate gland. Common disease that affects males more often as they age. The enlargement of the prostate gland can compress the urethra which leads to the characteristic signs and symptoms of hesitancy, urgency, increased post-void residual, dysuria, dibbling, and frequency. Untreated BPH can lead to complications. - Bladder damage - chronic urinary retention can lead to increased bladder volumes which can over extend the bladder walls leading to weakness. Weakened bladder muscles have trouble completely emptying the bladder. - Urinary retention - inability to urinate. This can lead to a medical emergency in some cases. - Reoccurring UTIs - Kidney damage

Question 36

What is the cervix? What is acute cervicitis? What are the most common causes?

Answer 36

The cervix is the lower part of the uterus that connects to the vagina. Acute cervicitis is a sudden inflammation of the cervix most commonly caused by infections but can also be caused by irritants and trauma. STIs - particularly Chlamydia and Neisseria gonorrhoeae are common culprits. HPV is a frequent culprit too, Bacterial causes include - staph, strep, enterovirus and many other causes

Question 37

What are the clinical manifestations of acute cervicitis?

Answer 37

Acute cervicitis - sudden inflammation of the cervix which is the lower part of the uterus that connects to the vagina. Many causes - bacterial, STIs, and viral. S&S - erythema, leukorrhea, edema, lots of mucus discharge.

Question 38

What are the functions of the ovaries? Often times ovarian cancer can lead to?

Answer 38

The ovaries are located on each side of the pelvis. They are the female reproductive organ and create ova (eggs) and secrete female sex hormones. Ovarian cancer and even benign cysts and tumors can lead to infertilities and irregularities in a woman's menstrual cycle.

Question 39

How is cervical cancer prevented?

Answer 39

Cervical cancer is very preventable, the most preventable cancer of women's reproductive tract. Early detection and screenings play a large role but the biggest impact has come from HPV vaccines. During the first years of vaccine against HPV there was a drop of 65% new cases of cervical cancer.

Question 40

How does the Pap smear test work? What does it detect?

Answer 40

The pap smear test is used to detect the presence of cervical cancer or precancerous cells. It is done by taking a biopsy of highly vascular areas of the cervix and looking at those biopsies under microscope. There are a number of different abnormalities that are considered high risk. The abnormalities are graded in the cervical intraepithelial neoplasm (CIN). CIN 1 - dysplasia or atypical CIN 2 - moderate dysplasia CIN 3 - severe dysplasia

Question 41

What type of test is the Pap smear? What is collected during the sampling process?

Answer 41

A screening and cytological test. During the sampling process a physician or provider collects a swab or sample of cells from the transformation zone, which is an area of the cervix known for a higher rate of abnormal cells.

Question 42

What is an ectopic pregnancy? Most common site? Complications?

Answer 42

An ectopic pregnancy is one where a fertilized egg implants and begins to grow outside the uterus. This most commonly occurs in the fallopian tubes. Untreated ectopic pregnancies can be life threatening due to rupture and internal bleeding.

Question 43

How is ectopic pregnancy diagnosed?

Answer 43

S&S - missed periods, abdominal pain (typically occurring on one side, vaginal bleeding, shoulder pain, dizziness, and/or fainting. Blood tests: - hCG test to detect pregnancy. A slow rise or plateau can indicate an abnormal pregnancy when monitoring this hormone. Normally, hCG increases x2 every 2 to 3 days during early pregnancy. - Progesterone levels being low Imaging: - US - the most effective in diagnosing the condition.

Question 44

What is candidiasis? How does it manifest?

Answer 44

Candidiasis is also known as yeast infection or thrush. It is a common and is not considered a sexually transmitted infection but is frequently found in women being tested for STIs. Candia Albican is the most common culprit but there are other strands of fungi that can cause the presentation and most cause a worse one. Risk factors for developing candidiasis include antibiotic therapy which disturbs the normal bacteria flora found in the vagina which have protective mechanisms. Increase hormone production during pregnancy, use of oral contraceptives which increase the vaginas stores of glucose. And uncontrolled diabetes or HIV infection both of which decrease the ability of the immune system to work adequately. Clinical presentation - pruitus, erythema, swelling, dysuria, dyspareunia, and a white, ordorless discharge.

Question 45

What is pelvic inflammatory disease? What is the most common cause?

Answer 45

PID is polymicrobial infection of the upper reproductive tract found in women. The most common cause of PID is STIs particularly N. Gonorrhea and Chlamydial trachomatis infections. Bacterial infections can also occur H. Influenzae and strep infections can occur. IUD placement is a cause of increased risk.

Question 46

What structures are normally affected by PID? What are the symptoms of PID?

Answer 46

PID is an infection of the upper reproductive tract of women. This includes he Follopian tubes, uterus, ovaries. Symptoms of PID - lower abdominal pain, dyspareunia, purulent discharge, back pain, fever.

Question 47

What is Trichomonas? What are the S&S? Why is it essential to diagnosis trichomonas infections early in pregnancy?

Answer 47

Trichomonas is a STI that is the second most common one in the United States. Males typically do not show symptoms and are carriers. Women who are infected show symptoms which can progress to complications if the illness is not treated. S&S - frothy, copious, malodorous, yellow/green discharge. Itching. Strawberry cervix. Complications - untreated Trichomonas infections can lead to infertility, atypical PID, and in pregnant women it can result in premature birth.

Question 48

What is the most significant difference between chlamydia and gonorrhea?

Answer 48

Chlamydial infections tend to be asymptomatic or clinically nonspecific. Otherwise the diseases are pretty similar.

Question 49

How is chlamydia diagnosed? What are the benefits of using NAAT?

Answer 49

There are traditional forms of testing for this illness: - Identification of polymorphicneuclear leukocytes on sampled discharge collected from the vagina or penis - The direct fluorescent antibody test and the immunosorbent assay are rapid ways to detect. Nucleic acid amplification test are newer forms of testing that are highly specific and easy to use. Samples for testing can be gathered from urine, swabs of the distal vagina (both of which can be collected at home) or they can be collected in the office in a more traditional method.

Question 50

Chlamydial and Gonorrheal infections in women of childbearing age.

Answer 50

Both infections, if left untreated, can result in sterility via scarring secondary to PID. Untreated infections can disrupt pregnancy, resulting in termination of pregnancy. Even if the pregnancy is carried to term, there can be defects seen in the children due to infection. It is essential to diagnose these illnesses early

Question 51

How does syphilis affect a fetus if the mother is untreated?

Answer 51

Syphillis, caused by the bacteria Treponema pallidum, can cross the placenta and directly infect the growing fetus. It can also affect the baby during delivery with direct contact. Potential complications: - Early miscarriage - Stillbirth - Premature birth - Birth defects - deafness, blindness, bone deformities, heart defects - Neuro issues - hydrocephalus, seizures, developmental delays - Fever, rashes, spleen and/or liver enlargement

Question 52

What are the three stages of syphilis? Describe the stages.

Answer 52

Primary stage - appearance of a chancres. Chancres are indurated papules that are several cm in size. They are painless. These are easily seen and identified on the male's external penis. It is more hidden in females due to infection of the inner vagina or cervix. This chancre will heal within 3-12 weeks with or without treatment. This leads to a often undiagnosed carrier. Secondary stage - appearance of rashes (hands, mucous membranes meninges, and lymph nodes. Sore throat, fever, stomatitis, loss of hunger. These symptoms can last anywhere from 3 to 6 months. Condylomas lesions can also appear, these are elevated, red-brown lesions that can ulcerate and exude malodorous and highly infective fluid. Tertiary stage - this phase is achieved when there is lack of treatment of the disease in the first couple stages. Gummas - ranging from small lesions to large tumor like lesions. These are necrotic tissues. These can leave large craters in the skin wherever they occur. Cardiovascular issues - scarring of the thoracic aorta, resulting in aneurysm formation. Neurologic issues - dementia, blindness, or spinal cord issues.

Question 53

What happens to the muscles during the aging process?

Answer 53

Sarcopenia - age related loss of muscle mass. Begins around age 30. Individuals lose on average 3-8% of their muscle mass per decade. Decreased muscle mass means everyday tasks are more difficult. Loss of muscle mass means loss of muscle strength which can manifest in more difficult ADLs, more frequent falls. Reduction in muscle fiber size, especially the fast twitch fibers that are responsible for fast, explosive movements. This leads to a reduction in reflex time. Longer muscle regeneration periods. It takes older adults a longer amount of time to recover from strenuous activity.

Question 54

What complications can arise from impaired/poor healing of fractures?

Answer 54

Malunion - healing with a deformity or angle. Caused by inadequate reduction or alignment of the fracture. Non-union - failure of the bone ends to reunite. Results in mobility at the fracture site which causes pain with certain movements, especially with weight bearing. Delayed union - failure of the fracture to heal in the expected amount of time

Question 55

What is compartment syndrome? How is it diagnosed?

Answer 55

Increasing pressure within a confined space that restricts or inhibits circulation and function of the involved areas. Compartment syndrome can result due to a decrease in compartment size or an increase in the volume within the compartment. Decreased compartment size can be seen with restrictive devices or clothing and burns. Increased volume within the compartment can be seen with trauma, vascular injury, swelling, and venous obstruction. Compartment syndrome is diagnosed via symptoms (severe pain that does not match the injury). Paresthesia (nerves are being compressed). Weakness. History of trauma or other associated causes. You can also measure the intercompartmental pressure, typically compartment syndrome is considered when the pressure is above 30mmHg.

Question 56

What is osteomyelitis? What are the four main causes?

Answer 56

Osteomyelitis is bone infection. It can be acute or chronic and can be caused by bacteria, fungi, viruses, and parasites. 1. Direct penetration from an outside source (exogenous) 2. Traveling through the blood stream 3. Skin issues in people with vascular insufficiency 4. Extension from a contiguous site

Question 57

Osteogenesis imperfecta

Answer 57

Hereditary disease that affects collagen formation. Transmitted via autosomal dominant and autosomal recessive means. The disease impacts bones, joints, ears, ligaments, sclera, teeth, and skin. The bones don't develop well and are prone to fractures. Many different types. Type 2 is lethal as a fetus or soon afterwards.

Question 58

What are the possible causes of gout? What is the pathophysiology of gout?

Answer 58

Gout is a form of inflammatory arthritis that occurs when uric acid builds up in the blood and forms crystals in the joints. These uric acid crystal cause pain, swelling, redness. Purine breakdown leads to uric acid release. Normally uric acid is filtered by the kidneys and excreted in the urine. Too much production or too little excretion can result in hyperuricemia. High uric acid levels result in crystal formation that affects the joints, in particular, the great toe. Causes of gout: - Diet - red meat, organ meats, seafood, alcohol, sugary drinks - Obesity - Kidney dysfunction - Dehydration - Medications

Question 59

What happens in the vascular phase? Phase of what?

Answer 59

The vascular phase of inflammation. This involves arterioles, venules, and capillaries (all the local small blood vessels). Changes are seen not long after injury and are due to vasodilation, increased vascular permeability, and leakage of fluid into the extravascular tissues. One of the earliest manifestations of inflammation is vasodilation. Fluid is allowed to seep into local tissues. Protein rich fluid flows into the surrounding tissue, exerting osmotic pressure drawing more fluid from the vasculature.

Question 60

What causes swelling seen with inflammation? What is the purpose of swelling?

Answer 60

Swelling is caused by increased blood flow to the affected area brining in leukocytes, oxygen, nutrients, and take away waste products. Increased vascular permeability allows this increased fluid amount to leak into the surrounding tissue.

Question 61

Immediate Transient Response Immediate Sustained Response Delayed Hemodynamic Response

Answer 61

ITR - this is seen with small injures to the body. The area of inflammation is small and the time of swelling is short. ISR - this is seen with larger damage to the body. Probably direct damage to the vasculature. Swelling and inflammation lasting several days. DHR - seen with radiation type injuries like sunburns or radiation therapy. Delayed response to damage of the tissues.

Question 62

What negatively affects wound healing?

Answer 62

Negatively affect wound healing - age, infection, decreased immune or inflammatory response, malnutrition, impaired blood flow or oxygen delivery, and wound separation.

Question 63

What are the three phases of wound healing? Describe each phase.

Answer 63

1. Inflammatory phase - begins at the time of injury. Includes homeostasis, vascular phase, and cellular phase. - Homeostasis - blood vessel constriction at the site of injury as the body restricts the amount of blood that is lost. Blood begins to clot through platelet aggregation. - Vascular phase - venioles, capillaries, and arterioles vasodilate and have increased permeability. This allows WBC, oxygen, and waste to be transported to and from the site of injury. - Cellular phase - arrival of WBC to phagocytize the invading organisms. Neutrophils are first and are then followed by macrophages. 2. Proliferative phase - fibroblast build new tissue to fill the space left from the wound. The final part of the proliferative phase is epithelization. 3. Remodeling phase - scar tissue formation

Question 64

What is impetigo? Clinical manifestations? How is it treated?

Answer 64

Superficial bacterial skin infection caused most commonly by staphylococci and group A beta hemolytic strep. It most commonly affects infants and young children. Especially in warmer months. Appear as small vesicles or pustules or large bulla (less common). These lesions erupt leading to the discharge of honey-colored serous fluid. This serous fluid then dries. Puritius is a common symptom. Bactroban ointment is the most common treatment.

Question 65

What is cellulitis? How is it treated?

Answer 65

A deeper bacterial skin infection affecting the dermis and subcutaneous tissue. Most often caused by group a beta hemolytic strep or S. aureus. Preexisting wounds are often a means of invasion. The lesions are red plaques that have irregular borders. Tenderness, fever, pain, and heat are associated signs and symptoms. Treatment includes prescribing correct antibiotics both IV and oral. Incorrect treatment can lead to severe disease and even death.

Question 66

What is herpes zoster? What it's clinical manifestations? Complications?

Answer 66

Shingles - acute localized vesicular eruption following a dermatomal segment. Caused by the same herpes virus as the one that causes chickenpox. Can go into remission, but remerge when the affected persons immune system is weakened. Has a prodrome period where the affected person may experience burning, tingling, extreme sensitivity to touch along the dermatome that is about to be affected. Vesicles then erupt along the dermatome. They are usually unilateral. They progress along the dermatome. Eventually they erupt, crust, and fall off. Serious complications are possible but rare. If the dermatome involved involves the eyes, blindness can occur.

Question 67

First-degree VS Secondary-degree VS Third-degree burns

Answer 67

First - degree burns: involve only the outer layers of the epidermis. Red or pink, dry, and painful. Usually no blisters. Second-degree burns: affect the epidermis and parts of the dermis. Broken into partial thickness - where the epidermis and a portion of the dermis are affected and full thickness where the entire epidermis and dermis are affected. Lesions are red, moist, painful, and blistered. Third degree burns: involve the epidermis, dermis, and subcutaneous tissue. Even bone and muscle can be involved. The apperance varies but the skin is dry and leathery. Pain is largely absent, especially considering the extent of the injury. This is due to destruction of pain receptors in the skin.

Question 68

Who is at the greatest risk for development of a fungal disorder of the skin?

Answer 68

Immunocompromised (immunosuppressed, systemic disease, age), diabetes, open portal of entry (chronic wounds), obesity (warm and moist in the skin folds), individuals living in warm and moist environments.

Question 69

How to care for eczema? What is eczema?

Answer 69

Eczema is also known as atopic Dermatitis. Chronic inflammatory skin condition where the skin becomes red, itchy, and dry. Corticosteroids can be used to reduce inflammation and itching. Moisturizing lotion can keep the skin hydrated and combat the dryness. Antihistamines at night time for itching. In severe cases, immunosuppressants can be used Most people have certain triggers that make the eczema worse. Lotions, soaps, perfumes, laundry detergents can all trigger a bout of eczema. When identifying the cause of the outbreak, be slow in removal of suspects to determine the correct one. Also keep in mind when trying new products.