Unit 1 Flashcards

Question

cancer risk factors

Answer 1

* age * ETOH * carcinogen exposure * chronic inflammation * diet * hormones * immunosuppression * infections * obesity * radiation * sunlight * tobacco

Answer 2

* ↓ animal fats, nitrites, red meat * ↑ * bran, cruciferous vegetables * vitamins A and C * limit ETOH: 1-2 drinks/day * breastfeed exclusively for ≥ 6 mo

Answer 3

* no smoking * limit * sun exposure * sexual partners * avoid * known carcinogens * tanning beds * sharing needles * unprotected sex

Answer 4

* moles * colon polyps * uterine polyps

Answer 5

drugs, chemicals, nutrients to reverse gene damage

Answer 6

colon cancer

Answer 7

breast cancer

Answer 8

prostate cancer

Answer 9

↓ deaths

Answer 10

* with **evidence** * differs among **experts**

Answer 11

* clinical breast exam * mammogram

Answer 12

* fecal occult blood test * colonoscopy

Answer 13

* change in bowel or bladder habits * a sore that doesn't heal * unusual bleeding or discharge * thickening or lump in breast or elsewhere * indigestion or dysphagia * obvious changes in warts or moles * nagging cough or hoarseness

Answer 14

prostate specific antigen

Answer 15

* X-ray * CT * MRI * PET * PET-CT * SPECT

Answer 16

* digital rectal exam * screening for prostate cancer

Answer 17

* for basal or squamous cell skin CAs * removes shallow layer of skin

Answer 18

* for deeper skin lesions * removes tissue with hollow, round cutting tool

Answer 19

for leukemias

Answer 20

for joints, respiratory system, body cavities, hollow organs

Answer 21

scope of respiratory system

Answer 22

scope of joints

Answer 23

scope into mediastinum

Answer 24

scope into thoracic cavity

Answer 25

scope of small intestine

Answer 26

scope of sigmoid colon

Answer 27

scope of GI tract

Answer 28

* for many soft-tissue tumors and skin * types * fine needle aspiration * core needle aspiration: takes larger sample, some tissue

Answer 29

* surgical Bx * types * incisional removes part * excisional removes all

Answer 30

* removal of nodes near tumor to look for metastasis * dye used to map lymph nodes fed by tumor * sentinel node studied * negative → others assumed negative * positive → dissection * [video](https://www.mayoclinic.org/tests-procedures/sentinel-node-biopsy/multimedia/sentinel-node-biopsy/vid-20084727)

Answer 31

first node fed by tumor

Answer 32

suspect lymph nodes removed, and sample viewed under microscope

Answer 33

* answer questions * ensure signed consent * NPO * baseline VS * labs as ordered * PT * Plt * renal fxn

Answer 34

* instruct pt on positioning * talk pt through process * meds as ordered for * moderate sedation * pain * anxiety * monitor VS

Answer 35

* post-op recovery * monitor * for bleeding * wound closure/dressing * teach * wound care * activity restrictions * when, why to follow up * urgent, emergent S/Sx

Answer 36

grade cannot be determined

Answer 37

* cells well-differentiated * malignant, but slow-growing

Answer 38

* intermediate * moderately differentiated * more malignant characteristics

Answer 39

* high * poorly differentiated * few normal cell characteristics

Answer 40

* high * poorly differentiated * determining origin is difficult or impossible

Answer 41

* extent of growth and spread * tumor size * spread to lymph nodes, other tissues

Answer 42

* understanding severity and chance of survival * Tx planning * ID of appropriate clinical trials

Answer 43

* stage at **diagnosis** * regardless of **metastasis** or **growth**

Answer 44

* commonly used cancer staging system * stands for * tumor size and extent * nearby lymph node involvement * metastasis

Answer 45

* TX-T4 * NX-N3 * MX-M1

Answer 46

* TX: cannot be measured * T0: cannot be found * T1-T4: size/extent of tumor ↑ with number

Answer 47

* NX: cannot be measured * N0: no CA in nearby lymph nodes * N1-N3: number/site of lymph nodes w/ CA

Answer 48

* MX: cannot be measured * M0: none * M1: metastasis present

Answer 49

* Stage 0 * abnormal cells, no spread * AKA carcinoma in situ (CIS) * could become cancer * Stages I-III * CA present * ↑ number = bigger tumor, more invasion * Stage IV: cancer has spread

Answer 50

* **in situ:** abnormal cells, no CA or spread * **localized:** no spread * **regional:** spread to nearby structures * **distant:** spread to distant structures * **unknown:** not enough info to stage

Answer 51

dramatic wt loss, muscle wasting

Answer 52

* anorexia * cachexia * fatigue * lethargy * weakness * pain * massess

Answer 53

* discomfort elsewhere * lymphadenopathy * distant masses * abd swelling * bone pain or Fx * confusion or personality change * incontinence * vision changes * loss of balance * HA * Sz

Answer 54

* chemo * radiation * surgery * stem cell/bone marrow transplant * biological therapy * photodynamic therapy * complementary alternative medicine (CAM)

Answer 55

CA spread beyond localized area

Answer 56

has some, but damages healthy cells, too

Answer 57

damages DNA, stopping or slowing fast-growing cells

Answer 58

combination

Answer 59

* cytotoxic * teratogenic

Answer 60

* lab values * RBC \< 3.8 million/μL * Hgb \< 11.5 g/dL * Hct \< 34% * S/Sx * extreme fatigue * pallor * dizziness * SOB

Answer 61

* schedule rest periods * energy-saving measures * possible Tx * O₂ therapy * erythropoietic meds * antianemic meds * transfusion (pRBCs)

Answer 62

* normal ANC: 1500-8000/μL * normal WBC: 3,000-12,000/μL * main concern: infection * may not have fever; even slight fever is big problem

Answer 63

* normal Plt: 150,000-450,000/μL * main concerns * bleeding * **hemorrhagic cystitis** * interventions * fall precautions * bleeding precautions * Plt transfusion

Answer 64

* electric shaver * no ASA * needles * small guage * ↓ sticks * protect from injury * soft toothbrush

Answer 65

low RBCs, WBCs, and Plt

Answer 66

* lowest point * in chemo * onset: 7-12 days after Tx * **HIGHEST RISK OF INFECTION** * duration: 5-7 days

Answer 67

* hair thinning or loss * in chemo * onset: 7-10 days after first Tx * regrowth ~ 1 mo after last Tx

Answer 68

* inflammation of mucous membranes from mouth to stomach * includes stomatitis (mouth) * interventions * mouthwashes * anesthetic, antifungal, coating * saline rinse * lubricants for xerostomia * soft toothbrush * rinse AC and PC * soft, bland foods * avoid * ETOH * tobacco * glycerin

Answer 69

chemo-induced nausea and vomiting

Answer 70

* meds * ondansetron: serotonin blocker * in combo with * corticosteroids * phenothiazines (compazine, phenergan) * diphenhydramine * interventions * mouth care to ↑ appetite * small meals * cold foods * uncover meal away from pt * **assess for dehydration**

Answer 71

* early S/Sx: symmetrical, distal to proximal * burning * tingling/pins-and-needles * numbness * redness * sensitivity to extreme temps * difficulty w/ fine motor skills * later S/Sx * loss of taste * orthostatic hypotension * constipation * can → sensory or motor dysfunction * cause: nerve damage * pt education: protect skin, avoid falls/injuries

Answer 72

* meds for pain, CINV, infection, etc. * monitor for SE * intervene PRN * regular med reconciliation * address psychosocial needs * pt and family education

Answer 73

external radiation therapy

Answer 74

* internal radiation therapy * radiation source in direct contact with tumor * placed in vagina, prostate, abdomen, etc.

Answer 75

* daily doses for set period * skin marked for guidance

Answer 76

* extreme fatigue * dysgeusia * injury to skin, mucous membranes * hair loss

Answer 77

* schedule rest * gentle exercise

Answer 78

* avoid red meat, other distasteful foods * gum, mints * try new flavors * plastic utensils * drink w/ meals

Answer 79

altered taste

Answer 80

* wash w/ mild soap and water and pat dry * wear soft clothing * avoid sun, heat * only use prescribed creams/ointments * no powders

Answer 81

* mucositis/stomatitis * prescribed mouthwashes * avoid ETOH, tobacco * bland, soft, smooth foods * small bites/meals * high-calorie and -protein * gastroenteritis * meds * abx * antidiarrheals * steroids * opioids * bland, lactose-free, low-fat diet

Answer 82

body wastes are radioactive until isotope is eliminated

Answer 83

* private room * door sign * visitors * ≤ 30 min * ≥ 6 ft from pt * restrict: PG or \< 18 yo * wear lead apron * face pt * have lead container, tongs for devices that could fall out

Answer 84

* prophylactic * diagnostic * curative * cytoreductive (debulking) * palliative * second-look * reconstructive/rehabilitative

Answer 85

to replace bone marrow destroyed by CA or chemo/radiation

Answer 86

* at risk for GvHD * rejection can occur anywhere in the body

Answer 87

* anti-rejection meds * protection from infection * monitor for SE/complications * GvHD * graft failure * infection * hepatic veno-occlusive dz (VOD) * interstitial pneumonitis

Answer 88

graft-versus-host dz

Answer 89

* hepatic veno-occlusive dz * possible complication of stem cell/bone marrow transplant * AKA sinusoidal obstruction syndrome (SOS)

Answer 90

* modify pt's biological response to tumor cells * types * antitumor * improved immune fxn

Answer 91

* seek and destroy * SE * chills * fever * fatigue * **confusion** * **NVD** * **↓ BP** * rare * arrhythmias * CP * ↑ dose must be given in hospital

Answer 92

* slow cell division, boost immune attack on CA cells * SE * chills * fever * fatigue * **HA** * **↓ appetite** * **N/V** * **↓ WBC** * **skin rash** * **thinning hair** * rare: PNS/CNS damage

Answer 93

monoclonal antibodies

Answer 94

* lab-produced antibodies * mimic immune system * SE * fever * chills * **weakness** * **HA** * **NVD** * **↓ BP** * **rashes** * **allergic rxn** * ↑ dose must be given in hospital

Answer 95

* targets molecules involved in growth and spread of CA * SE * rash * dry skin * nail changes * hair depigmentation * impaired * clotting * wound healing * ↑ BP * rare: GI perforation

Answer 96

* ↑ dose should be in ICU * monitor for SE, allergic rxn * promote comfort * identify neuro and psychosocial manifestations early * **no topical steroids**

Answer 97

* unscented moisturizers (if allowed) * mild soap * sun protection * no * swimming * topical steroids

Answer 98

* chest/facial hair growth * menstruation stops * breasts shrink * fluid retenion * acne * hypercalcemia * liver dysfunction

Answer 99

* men * thinning facial hair * smoother facial skin * body fat moves * gynecomastia * testicular/penile atrophy * bone loss * women * irregular menstruation * fluid retention * breast tenderness * both * bone loss * ↑ risk for clotting

Answer 100

* photosensitizing agent + special light = cell death * photosensitizers and wavelengths specific to body area * process * photosensitizer injected * tumor exposed to light 24-72 hr after injection * photosensitizer absorbs light → chemical rxn * rxn destroys CA cells * usually outpatient * can be repeated or used in combo

Answer 101

* alternative medical systems * ayurveda * homeopathy * traditional Chinese medicine * biological * diet * herbs * vitamins * manipulative * massage * osteopathic * chiropractic * mind-body * yoga * imagery * meditation * spirituality * energy * reiki * biolfields * magnets * qigong

Answer 102

complementary and alternative medicine

Answer 103

* sepsis * DIC * SIADH * spinal cord compression * hypercalcemia * sueprior vena cava syndrome * tumor lysis syndrome * cardiac tamponade

Answer 104

disseminated intravascular coagulation

Answer 105

syndrome of inappropriate antidiuretic hormone

Answer 106

systemic inflammatory response syndrome

Answer 107

* must have ≥ 2 of the following * T \> 38C or \< 36C * HR \> 90 * RR \> 20 * acute AMS * WBC \> 12,000 or \< 4,000 * hyperglycemia in absence of DM

Answer 108

2+ SIRS criteria + presence or suspicion of infection

Answer 109

sepsis + hypotension not reversed w/ ↑ volume

Answer 110

gram-negative sepsis in pts w/ CA

Answer 111

* bleeding * organ failure via microvascular thrombosis

Answer 112

* abnormal production of ADH * diluted serum Na⁺ * usually ≤ 115-120 mEq/L * ↓ UOP * weakness * muscle cramps * ↓ appetite * fatigue * wt gain (fluid retention) * **→ pulmonary edema and HF** * Tx: hypertonic saline

Answer 113

* S/Sx * pain * weakness * loss of sensation * tingling * incontinence * constipation * foot drop * unsteady gait * Tx/interventions * ↑ dose corticosteroids (↓ swelling) * back brace

Answer 114

* serum Ca \> 10.5 mg/dL (critical: \> 14 mg/dL) * S/Sx * excessive thirst * frequent urination * stomach upset, N/V, constipation * bone and muscle pain * weakness * confusion * lethargy, fatigue * depression * rare * palpitations * fainting * arrhythmia * Tx: fluid intake, bisphosphonates, furosemide, calcitonin, pamidronate

Answer 115

* compression/obstruction of SVC → ↑ pressure → edema * S/Sx * facial, upper estremity edema * SOB * HA * CP * facial plethora * NVD * chest vein distension

Answer 116

facial fullness

Answer 117

* S/Sx * hyperkalemia * hyperuricemia * hyperphosphatemia * **hypocalcemia** * → heart, kidney damage * prevention: hydration, 3-4 L/day as tolerated * Tx * kayexolate * allopurinol, rasburicase * calcium carbonate

Answer 118

* buildup of blood or other fluid in pericardial sac * S/Sx * → cardiogenic shock * dyspnea * **tachycardia** * tachypnea * pallor * cold extremities * hypotension * **NVD** * possible: pericardial friction rub, **muffled heart sounds** * Tx: pericardiocentesis * Dx: echo, CBC, ECG, CXR, CT, ABGs,

Answer 119

* practice of **nursing** * delivery of **care** * meet the needs of **society**

Answer 120

more than a **competent** level of **performance**

Answer 121

* **quality** of **care** * performance appraisal * collegiality w/ others in the profession * ethics * research and EBP * collaboration * education * resource management

Answer 122

obligation nurses have to every pt

Answer 123

* advance directives * advocacy * confidentiality * disruptive behavior * ethical practice * information security * information technology * informed consent * legal practice * pt rights

Answer 124

* ensure pt understands his or her rights * protect those rights during nursing care * advocate for pt

Answer 125

* be informed about ALL aspects of care * take active role in decision-making * accept, refuse, or request modification to plan of care * receive competent care * be treated with respect

Answer 126

* ensure * pts know rights * pts have adequate info * orders are appropriate for care * assist with decision-making * mediate when others' actions aren't in pt's best interest

Answer 127

**control** or **direct**

Answer 128

* end-of-life decisions (advance directives) * access to health care * protection of privacy * informed consent * substandard practice

Answer 129

* ensure * provider gave adquate info * provider answers/clarifies all questions * pt understanding * ***signed consent form present before pt is taken for procedure*** * ***witness*** pt signature * provider is to have pt sign consent form

Answer 130

* providing safe and competent care * advocating for pt rights * providing care in your scope of practice * discerning responsibilities of nursing in relation to those of other staff members * providing care consistent w/ current standards * shielding yourself from liability * **KNOW YOUR NURSE PRACTICE ACT**

Answer 131

* impaired coworkers * abuse * communicable dz

Answer 132

* incivility * lateral violence * bullying * cyberbullying

Answer 133

* autonomy * beneficence * fidelity * justice * nonmaleficence * veracity

Answer 134

ability of pt to make their own decision

Answer 135

care in best interest of pt

Answer 136

doing what you say you will

Answer 137

fair treatment

Answer 138

obligation to cause no harm

Answer 139

duty to tell the truth

Answer 140

having an obligation to pts and being responsible for your actions

Answer 141

responsibility

Answer 142

* transferring authority and responsibility to another team member to complete a task * you retain accountability for completion, outcome, and timeliness * requires supervision

Answer 143

transferring authority, accountability, and responsibility of pt care to another staff member

Answer 144

* clear directions * reassessment * evaluation of outcome

Answer 145

* other RNs * LPNs * UAPs

Answer 146

* other LPNs * UAPs

Answer 147

* most **efficient** * time and **skills**

Answer 148

* predictability of outcome * potential benefit vs. harm to pt * complexity of care required * extent of problem-solving involved * appropriateness of task for delegatee * extent of interaction

Answer 149

* delegator * delegatee * acceptance of delegated task * ability * willingness * supervision, follow-up, and reassessment/evaluation

Answer 150

* right task * right circumstance * right person * right direction and communication * right supervision and evaluation

Answer 151

* should require little supervision * should be relatively noninvasive

Answer 152

* complexity of care should match delegatee's skill set * consider delegatee's workload

Answer 153

* delegatee should be competent to complete task * task should be in delegatee's scope of practice

Answer 154

* what data to collect * how to report it * specific task to be performed * expected results, timelines, and expectations for follow-up reporting

Answer 155

* delegator must supervise (directly or not) * monitor performance * provide feedback * intervene if necessary * evaluate pt and determine if goals are met

Answer 156

* personal qualities and experience * resources

Answer 157

* poor communication * poor interpersonal skills * poor time management * lack of trust and confidence * insecurity * inexperience in delegation * inadequate organizational skills * belief that others are incapable * belief that you are indispensable

Answer 158

* no one to delegate to * span of control * finances * educational resources * time

Answer 159

* burdens delegatees: don't overdelegate just because an employee is exceptional * can be a result of someone's insecurity to complete a task

Answer 160

* overdelegating * underdelegating * reverse delegation

Answer 161

* can be result of insecurity by manager * control freak/micromanager * lack of experience in delegation * difficulty assuming manager role

Answer 162

* common form of ineffective delegation * occurs when someone w/ lower rank delegates to one w/ more authority * often happens w/ individuals who are new to job

Answer 163

* delegatee is overwhelmed: tasks from multiple sources * delegatee believes self to be incapable of task * inherent resistance to authority

Answer 164

* nursing process * pt education * tasks that require nursing judgment

Answer 165

tasks appropriate to skill and education of delegate

Answer 166

* reinforcement of teaching * trach care * suctioning * NGT patency check * administration of meds, enteral feeds * insertion of foley

Answer 167

* ADLs * baths * toileting * ambulation * PO feeding * positioning * specimen collection * I&O * VS

Answer 168

* way of thinking about, strategizing about, and implementing solutions to improve pt status/outcomes * parallels scientific process * contains 5 steps

Answer 169

* assessment * diagnosis * planning * implementation * evaluation

Answer 170

framework to apply knowledge, skills, judgment, and experience to **formulate a nursing plan of care**

Answer 171

acronym for steps of nursing process

Answer 172

collecting data, subjective and objective

Answer 173

* clustering data * discriminating relevant from irrelevant data * identifying pt needs/problems

Answer 174

* setting priorities * establishing goals (SMART) * identifying desired outcomes * determining interventions to meet goals

Answer 175

performing interventions identified in planning stage

Answer 176

* determining if goals and outcomes * were met with planned interventions * are feasible * need more time

Answer 177

* thorough physical assessment * pt Hx * labs/imaging * pt reports

Answer 178

* guides nursing care * documents pt care * accountability * quality assurance * liability * substantiates care provided for * payers * legal entities * accreditors

Answer 179

* acronym for guidelines setting goals in care planning * specific * measurable * attainable * relevant * timed * "The patient will do something specific in a measurable way that is attainable and relevant by specific timeframe."

Answer 180

* separating actual from potential problems * prioritizing problems/needs * identifying goals * identifying nursing, provider, and other interventions to help meet goals

Answer 181

* comprehensive * ongoing * discharge

Answer 182

based on full head-to-toe assessment and pt interview (usually admission data)

Answer 183

* new info w/ each shift or as available * update, modify, and individualize care plan

Answer 184

* learning and anticipating pt's and family's needs after discharge * should begin during admission

Answer 185

separating actual from potential problems/needs

Answer 186

1. physiological 2. safety and security 3. love and belonging 4. self-esteem 5. self-actualization

Answer 187

* airway * breathing * circulation * disability * exposure

Answer 188

* necessary for breathing * look for blockage/obstruction * listen for stridor/wheezing * consider exposure (smoke inhalation)

Answer 189

* necessary for oxygenation of blood * auscultate breath sounds for crackles, wheezing, rhonchi * check SpO2 * common problems: COPD, asthma, pulmonary edema

Answer 190

* monitor BP * consider volume, pressure changes * IVF * vasopressors * diuretics * dialysis * trauma

Answer 191

* order depends on number and severity, but generally: 1. food/fluid 2. neurosensory 3. elimination 4. rest/activity 5. pain/discomfort 6. hygiene

Answer 192

* short-term: end of clinical day; baby steps toward long-term goal * long-term: by discharge; aimed at functionality outside hospital

Answer 193

* nurse-initiated/independent * don't need provider order * e.g. turn Q2H

Answer 194

* dependent interventions * by order or facility protocol * e.g. meds, blood products, treatments, etc.

Answer 195

* done in collaboration w/ other health professionals * e.g. wound care, PT, OT, speech therapy, etc.

Answer 196

instruction or education of pt and family

Answer 197

* be **specific** * include **actions** * on a **schedule**

Answer 198

* develop a plan * complete highest priority tasks first * finish one task before beginning another * reprioritize throughout shift based on new info

Answer 199

* systemic * potential * priorities * trends * emergent * standards

Answer 200

* risk reduction * assess safety risks * eliminate greatest risks first * survival potential * mass casualty, disaster triage * priority: pts w/ reasonable chance for survival with prompt intervention * least restrictive * implement least restrictive/invasive interventions first * move to more restrictive/invasive PRN * acute vs. chronic * urgent vs. nonurgent * stable vs. unstable

Answer 201

* evaluate **constantly** * remain **flexible** * **responding** to the "squeaky wheel"

Answer 202

toxin or other foreign substance that induces an immune response, esp. production of antibodies

Answer 203

blood protein produced in response to and counteracting a specific antigen

Answer 204

process whereby a person develops an inappropriate immune response to healthy, normal tissues

Answer 205

identifies if antinuclear antibodies are present in blood, which could indicate autoimmune d/o

Answer 206

antinuclear antibodies

Answer 207

**repair** of **damaged** tissues

Answer 208

* protection from illness or dz * maintained by body's physiologic defense mechanisms

Answer 209

* WBCs * stimulate inflammatory response and protect against various infections and foreign antigens

Answer 210

* neutrophils * lymphocytes * monocytes * eosinophils * basophils

Answer 211

percentages of types of total circulating WBCs

Answer 212

5,000-10,000/mm³

Answer 213

* total WBC \< 4,000/mm³ * causes * drug toxicity * autoimmune dz * bone marrow failure * overwhelming infection

Answer 214

* total WBC \> 10,000/mm³ * causes * inflammation * infection * some malignancies * trauma * dehydration * stress * steroids * thyroid storm

Answer 215

**WBC** count

Answer 216

* ANC \< 2,000/mm³ * \< 1,000/mm³ = neutropenic precautions are essential * ↑ risk of infection * causes * viral infections * overwhelming bacterial infections * radiation and chemotherapy

Answer 217

absolute neutrophil count

Answer 218

* no visitors * no live plants * no fresh fruits and veggies * avoid contamination from pt's own bacterial flora * no rectal temp * no IM injections

Answer 219

* increase in immature neutrophils (bands or stabs) that occure in acute infection * immature cells incapable of phagocytosis

Answer 220

* Epstein-Barr * CMV * hep A and B * parvovirus * flu * measles

Answer 221

mature neutrophils

Answer 222

immature neutrophils

Answer 223

* ability of the body's immune system to respond to pathogenic organisms and tissue damage * inflammation response + cell-mediated + antibody-mediated processes

Answer 224

* mucous membranes * tonsils * lymph system: vessels, nodes, spleen * thymus * skin * bone marrow

Answer 225

immune system uses proteins on cell surface (human leukocyte antigens) to determine whether a cell is foreign or not

Answer 226

protein sequence on cell surface determined by DNA and unique to each person

Answer 227

site for formation of all blood cells and majority of immune cells

Answer 228

* having multiple functions * as in stem cell, giving rise to multiple types of cells

Answer 229

* barrier: skin, mucous membranes * inflammation

Answer 230

* antibody-mediated immunity * cell-mediated immunity

Answer 231

* immediate, but short-term immune response * no lasting immunity to repeat exposure

Answer 232

* genetic risk for ↑ or ↓ immunity * OA * low socioeconomic status * nonimmunized * chronic illnesses that weaknes immunity * chronic drug therapy * substance abuse d/o

Answer 233

* severe combined immunodeficiency * congenital * missing important WBCs

Answer 234

* steroids * chemo * other CA drugs * anti-rejection meds

Answer 235

* ETOH * smoking * poor nutrition

Answer 236

* HIV * flu * mono * measles

Answer 237

20s and 30s

Answer 238

* sucsceptible to multiple types of infections * avoid large crowds; wash hands

Answer 239

* allergies: hypersensitivity rxn * autoimmune rxn or dz: remission vs. cure

Answer 240

* asthma * eczema * allergic rhinitis

Answer 241

allergen → atopic dermatitis

Answer 242

immune rxn in lungs → wheezing, coughing, trouble breathing

Answer 243

* allergens: mold, pollen * irritants: smoke

Answer 244

* indoor or outdoor allergens evoke immune response in upper airway * sneezing, runny nose, sniffling, swelling of nasal passages

Answer 245

* immediate, short-term immune response * does not result in future immunity to same organism/injury * response varies by injury * cardinal signs: edema, erythema, warmth, pain, ↓ fxn

Answer 246

* Plt * mast cells * neutrophils * macrophages * monocytes * basophils * eosinophils

Answer 247

* initial response to stop bleeding * release messengers to attract other immune system cells

Answer 248

* hang out near possible pathogen entry points * immediately open and release contents on contact w/ pathogens * bring other cells to site of entry

Answer 249

* short lifespan, high number * kill pathogens via phagocytosis

Answer 250

* phagocytosis * secretion of cytokines to recruit specific immunity cells to site

Answer 251

* monocyte = immature macrophage * migrate from bone marrow to site of pathogen when signaled

Answer 252

* release histamine * cause manifestations of inflammation

Answer 253

* release amines during allergic rxn * some phagocytic properties * major role in destruction of parasites

Answer 254

* Stage I: vascular * Stage II: cellular exudate * Stage III: tissue repair/replacement

Answer 255

* histamine and kinin release * → constriction of veins, dilation of arterioles * purpose: ↑ blood flow to area * capillaries become leaky * → inflammatory cells, mediators to injury site * → edema * macrophages start phagocytosis and send cytokines * → more WBCs and neutrophils come to site

Answer 256

* neutrophils arrive * exudate (purulent drainage) forms from debris * most protection from phagocytosis * more monocytes produced, send signals to continue response * production of neutrophils continues

Answer 257

* body begins to fill in gaps in injured tissue * may → * scar tissue * ↓ fxn of tissue

Answer 258

* self-perpetuating * duration: wks, mos, yrs * often * asymptomatic * switches away from neutrophil involvement * can → DNA damage, certain types of CA * common causes: irritants * foreign bodies: viruses (e.g. HPV), fungi * obesity: production of a cytokine used in inflammation

Answer 259

* heart dz * DM * CA

Answer 260

antibody-mediated immunity

Answer 261

* process: B cells * are sensitized/imprinted by contact w/ specific antigen * produce antibodies * divide and make memory B cells for future immunity

Answer 262

lymphocytes

Answer 263

* lymphocytes that begin as stem cells in bone marrow * enter blood circulation and mature in * spleen * lymph nodes * tonsils * mucosa of GI tract

Answer 264

**outside** cells

Answer 265

**infected** cells

Answer 266

* ***(B cells)*** * exposure * antigen recognition * sensitization * antibody production/release * antibody-antigen binding * inactivation of organism w/ antigen * sustained immunity

Answer 267

* allutination * lysis * complement activation and fixation * precipitation * inactivation

Answer 268

* IgG * IgA * IgM * IgE * IgD

Answer 269

most abundant and involved Ab

Answer 270

found in blood, body secretions

Answer 271

* largest * first Ab produced during primary response

Answer 272

* mediator in allergic responses * defends against parasites

Answer 273

* low serum concentration * found mostly on surface of developing B cells

Answer 274

* major cells * T lymphocytes * natural killer (NK) cells * dendritic cells * hang out in secondary lymph organs and wait for exposure to antigens

Answer 275

* helper (T_h, T₄) * suppressor (T_s, T₈) * cytotoxic (T_c)

Answer 276

activate macrophages, T_c cells, and B cells

Answer 277

control immune response to protect host

Answer 278

kill cells with antigen they've been exposed to

Answer 279

natural killer (cells)

Answer 280

direct cytotoxic effects on some non-self cells without prior sensitization

Answer 281

dendritic cells

Answer 282

process antigen material and present it on cell surface to T cells of immune system

Answer 283

* small hormones produced by WBCs * WBCs → monokines * T cells → lymphokines * regulate action of immune system * may have multiple roles or single role

Answer 284

* APCs * cells that process antigen material and present it on cell surface to T_h cells * mostly done by * B cells * DCs * macrophages

Answer 285

* APCs present to T_h cells * T_h cells recruit * T_h1 cells activate macrophages and T_c cells * T_h2 cells activate B cells * T memory cells formed for future immunity

Answer 286

* **self** from **non-self** * recognizes **CA**

Answer 287

cell-mediated immunity

Answer 288

* essentially an overreaction to an antigen * four major types that can occur alone or with one or more others

Answer 289

* Type I: rapid/immediate * Type II: cytotoxic * Type III: immune complex * Type IV: delayed

Answer 290

* rapid/immediate * ↑ production of IgE in response to antigen * excessive release of histamine from basophils, eosinophils → * anaphylaxis * allergic asthma * conjunctivitis * rhinitis * pruritis * edema * rash * urticaria * angioedema * methods of exposure * inhalation * ingestion * injection * contact

Answer 291

* pollen: apple, hazelnut, carrot, kiwi, apricots, peaches * mites: crustaceans * latex: exotic fruits such as banana, avocado, kiwi * bird dander: egg yolk * cat dander: pork

Answer 292

* Ab directed against foreign antigen on self cell * usually attacks a specific tissue type * mainly IgG or IgM * play a role in several autoimmune diseases

Answer 293

* autoimmune hemolytic anemia * hemolytic dz of the newborn (Rh dz) * blood transfusion rxn * myasthenia gravis (acetylcholine receptor)

Answer 294

autoimmune hemolytic anemia

Answer 295

* immune complex rxn * process * excess antigens → formation of immune complexes in blood * immune complexes precipitate, wedge into vessels in organs → inflammation and damage * types/conditions * serum sickness * SLE * RA

Answer 296

systemic lupus erythematosis

Answer 297

rheumatoid arthritis

Answer 298

* delayed * T cells recruit macrophages to attack hrs or days after exposure * examples * poison ivy * latex * graft rejection * positive TB skin test * sarcoidosis * IV drug rxn (e.g. abx)

Answer 299

* condition in which immune system recognizes proteins on self cells as foreign * body attacks self cells w/ that protein * can be Ab- and/or cell-mediated * no cure

Answer 300

* genetics: certain HLAs are more susceptible * infections * various viruses and bacteria can contribute * viruses or bacteria share epitope w/ host cells * adaptive immune system forms response to antigen w/ T and B cells * immune system attacks all cells w/ that epitope

Answer 301

* systemic AID affecting mostly synovial joints * → damage to joint and cartilage * also affects * blood vessels * pleurae * pericardium * iris and sclerae * typically affects upper joints first

Answer 302

* body makes Abs that attack synovium, articular cartilage, joint capsule, ligaments, and tendons * thought to be initiated by CD4 cells * CD4s recruit mediators that attack synovial membrane * also involves B cells * process * synovium thickens * fluid accumulates * pannus forms * more blood vessels form in synovial membrane → perpetuation of inflammatory response * result: permanent damage to bone * early Dx and Tx can prevent damage

Answer 303

* female gender * age: 20-50, then OA * genetics * exposure to Epstein-Barr * possible other environmental factors: smoke, silica, insecticides * exacerbations linked to stress

Answer 304

* generalized weakness, fatigue * anorexia, wt loss * persistent low-grade fever * joints: stiff, red, painful, tender, swollen, warm * usually in hands first * pain at rest and with movement

Answer 305

* progressive inflammation * ↑ pain * morning stiffness (gel phenomenon) lasting 45 min to several hrs * joints feel soft, look puffy (synovitis and effusions) * joint deformity, lack of fxn * ulnar deviation * swan neck * boutonniere

Answer 306

* RF: Abs present in connective tissue dz (IgG, IgM) * ANA: Abs targeted at host DNA * anti-CCP antibodies: specific to RA, + for most RA pts * ESR: measure of general inflammation; repeated w/ Tx * CRP: possible sub for ESR * serum complement proteins: lower in RA, other AIDs * HLA tissue typing (HLA-B27 antigen) * CBC: ↑ WBCs during exacerbation; anemia (iron unavailable)

Answer 307

rheumatoid factor

Answer 308

anti-cyclic citrullinated peptide antibodies

Answer 309

erythrocyte sedimentation rate

Answer 310

* X-ray * CT * MRI * arthrocentesis * bone scan

Answer 311

↑ WBCs and RF

Answer 312

1. NSAIDS 2. Cox-2 inhibitor 3. corticosteroids 4. DMARDs

Answer 313

* first-line med * pain and fever relief, anti-inflammatory * often w/ H2 blocker to protect GI; monitor for bleed * experimentation w/ types usually needed

Answer 314

* celecoxib * ↓ GI Sx * ↑ cardiac dz risk

Answer 315

* prednisone * fast anti-inflammatory * often used in high dose for flares * **not for long-term** * SE * immunosuppression * osteoporosis * hyperglycemia * **cataracts**

Answer 316

* antimalarial: hydroxychloroquine * abx w/ anti-inflammatory properties: minocycline * sulfonamide: sulfasalazine * biological response modifiers * etanercept * infliximab * adalimumab * cytotoxic meds * methotrexate * leflunomide * azathioprine * cyclophosphamide

Answer 317

* ↓ pain * used with mild dz

Answer 318

* anti-inflammatory properties * used for mild RA

Answer 319

* ↓ pain and swelling * prevent damage * ↓ risk of long-term disability

Answer 320

* slows progression * typically given w/ methotrexate * risk of immunosuppression * bing w/ part of inflammatory process to ↓ response * must rule out TB and MS (can cause flare) * lab monitoring: TB, hep B, LFTs, CBC, hCG

Answer 321

* folic acid antagonist * blocks several enzymes in immune response * 1x/wk * relatively inexpensive * onset: 4-6 wks * avoid PG

Answer 322

* ↑ mobility * ↓ joint swelling * severe SEs * alopecia * diarrhea * ↓ WBCs, Plt * liver damage

Answer 323

methotrexate

Answer 324

* immunosuppressants * interrupt immune process * ↓ inflammation * slow joint damage

Answer 325

* uncontrolled growth of abnormal cells in specific epithelial cells of skin * types * squamous * basal * melanocytes

Answer 326

1. exposure to UV rays * fair complexion * age * being male * family Hx * chemical exposure * radiation exposure * living in upper elevations or near equator * presence of many moles

Answer 327

* primary * ↓ sun exposure * no tanning beds * secondary/screening * early detection * body spot map * frequent skin checks (self and/or provider)

Answer 328

* most common skin CA * growth * slow * rarely metastasizes * can cause local tissue destruction * presentation * generally painless * usually in sun-exposed areas (head, face, neck) * nodular lesion most common

Answer 329

* second most common skin CA * appearance: firm, crusty, or ullcerated * vulnerable areas * sun-exposed areas (head, neck lower lip) * (chronic irritation) scars, irradiated skin, ulcers * growth * rapid invasion * metastasis in 10% * larger tumors more likely to metastasize

Answer 330

* **deadliest** form of skin cancer * growth: metastasizes * presentation * irregular red, blue, white, or dark-colored lesions * almost always a change in a skin lesion over months * vulerable areas: **all** * upper back * lower legs * soles of feet * palms

Answer 331

* Hx * skin injury * sunburns/exposures * mole or other lesion removals * **assess all areas** of skin, including in hair * **ABCDE** * asymmetry * borders * color * diameter * evolving

Answer 332

* asymmetry * borders * color * diameter * evolving

Answer 333

when half the mole doesn't match the other

Answer 334

when the border of the mole is ragged or irregular

Answer 335

when color of mole varies throughout

Answer 336

if the mole's diameter is larger than a pencil eraser

Answer 337

the appearance of the mole changes over time

Answer 338

* no blood tests * Bx is gold standard

Answer 339

* shave * punch * incisional * excisional

Answer 340

part of tumor is removed for testing

Answer 341

all of tumor is removed, then tested

Answer 342

* cryosurgery * topical chemo * radiation

Answer 343

* curettage and electrodessication ([video](https://www.youtube.com/watch?v=IpmNtNMLz80)) * excision * **gold standard: Mohs excision** * removal of nearby lymph nodes and tissue ([sentinel node Bx](https://www.mayoclinic.org/tests-procedures/sentinel-node-biopsy/multimedia/sentinel-node-biopsy/vid-20084727))

Answer 344

* gold standard for skin CA excision * surgeon removes visible CA and small margin of surrounding healthy tissue * allows surgeon to verify all CA cells are removed at time of surgery

Answer 345

* interventions based on AE of Tx * surgical site care * monitor for complications * pt education * tests * Tx and AE * meds * ways to ↓ UV exposure

Answer 346

* among most common forms of CA * most common cell types * non-small cell * small cell * survival * 5-year: 16% * w/ early detection, small tumor: 52% * most detected late * generally poor prognosis

Answer 347

* most are bronchogenic * bronchial tumor → obstruction of bronchus * lung tumor → obstruction of alveoli, nerves, blood vessels, lymph vessels * can metastasize to surrounding tissue, blood, lymph system

Answer 348

* tobacco smoke * smoking: 85% of deaths * second-hand smoke exposure * radiation exposure * environmental exposure → chronic inflammation * pollutants * irritants

Answer 349

* no smoking * use appropriate mask to minimize exposure to pollutants/irritants

Answer 350

annual CT for those at high risk

Answer 351

* Sx * chronic cough * chronic dyspnea * fatigue * chest wall pain * signs * hoarseness * chest wall masses * fingernail clubbing * low SpO₂ * visible massess or fluid on imaging * late * wt loss, anorexia, cachexia * hemoptysis

Answer 352

* CXR * chest CT * PET * pulmonary fxn test * cytology * sputum culture * thoracentesis (for pleural effusion) * ABGs * Bx * bronchoscopy * CT-guided

Answer 353

* chemo * radiation * targeted therapy * photodynamic therapy * radiofrequency ablation

Answer 354

mostly for SCLC

Answer 355

* shrink tumor → assist w/ Tx or palliate * primary Tx for high-risk pts

Answer 356

* used in bronchial tumors via scope * for small, easily accessed tumors

Answer 357

electric current delivered directly to tumor via CT-guided needle

Answer 358

* wedge resection * segmental resection * lobectomy * pneumonectomy

Answer 359

very small area of tumor near surface of lung is removed

Answer 360

removal of one or more lung segments w/ attached bronchiole and alveoli

Answer 361

removal of entire lobe of lung

Answer 362

removal of entire lung

Answer 363

* monitor respiratory status * tracheal deviation * dyspnea * SpO2 * coloration * maintain chest tube/drain * patency/adequate drainage * monitor drainage color, amount * insertion site * empty container * incisional site care * encourage * ambulation * incentive spirometry * T, C, DB exercises w/ splinting

Answer 364

* care of SE r/t Tx * maintain airway, suction PRN * high Fowler's * O₂ therapy * bronchodilators, steroids * fluids * anxiety ↓ * support * palliative care

Answer 365

* cancer of bone marrow * most common malignancy in children and young adults

Answer 366

* uncontrolled proliferation of immature WBCs * CA cells replace normal cells in marrow → ↓ healthy WBCs, RBCs, and Plts

Answer 367

* speed of progression * acute * chronic * type of blood cells affected * lymphocytic/lymphoblastic * myelogenous

Answer 368

* (exact cause unknown) * genetics * previous chemo * ionizing radiation * certain chemicals * immunodeficiency * smoking

Answer 369

* fever/chills * persistent fatigue, weakness * frequent or severe infection * wt loss w/o trying * lymph node swelling * enlarged liver or spleen * easy bleeding/bruising * recurrent epistaxis * petechiae * excessive sweating, esp. at night * bone pain or tenderness

Answer 370

* bone marrow aspiration and Bx * ↑ immature leukemic blast cells * determines cell type involvement * CBC * WBC: ↑, ↓, or WNL * ↓ H&H * ↓ Plt * INR, aPTT: ↑ w/ acute types * CXR, CT, PET, bone scan to check for metastasis

Answer 371

* chemo * three phases * induction * consolidation * maintenance * may require re-induction * biologic response modifier (filgrastim) after chemo * bone marrow/stem cell transplant

Answer 372

* aggressive chemo Tx for leukemia * 4-6 wks in hospital * usually continuous chemo infusion

Answer 373

* second phase of leukemia chemo Tx * lower dosage * possibly different meds * about 6 mo

Answer 374

* third phase of leukemia chemo Tx * even lower doses * months to years to prevent relapse

Answer 375

* bone marrow destroyed using full-body radiation or chemo * marrow replaced with healthy cells via infusion * pt at high risk for infection and bleeding until transplanted cells start working

Answer 376

* pancytopenia * interventions based on AE * monitor for complications (GvHD) * pt education * tests * Tx * AE * meds

Answer 377

* Hodgkin's (HL) * non-Hodgkin's (NHL)

Answer 378

Hodgkin's lymphoma

Answer 379

non-Hodgkin's lymphoma

Answer 380

* contains Reed-Sternberg cells * population: teens and young adults, 50s-60s * progression * single node or chain of nodes * predictable metastasis, starting w/ closest nodes

Answer 381

* no Reed-Sterberg cells * more common in **men, OA** * \> 65 subtypes * complicated Dx and classification * metastasis **unpredictable**

Answer 382

* mostly unknown * possibly viral infections or exposure to certain chemicals

Answer 383

* gene damage * viral infections * radiation * AID * chemicals: ↑ incidence w/ exposure to pesticides, insecticides, dust

Answer 384

* often asymptomatic * large, painless swelling of lymph node * NHL: multiple nodes * HL: usually starts in neck * may c/o * fevers \> 101.5 * night sweats * wt loss * infections * general malaise

Answer 385

* extensive testing required; difficult to classify * gold standard: **lymph node Bx** * CBC * r/o similar conditions * check for met to bone marrow (pancytopenia) * bone marrow Bx * staging, mapping, metastasis: CT, CXR, PET, bone scan

Answer 386

* chemo * radiation * immunotherapy * NHL only: targeted therapy

Answer 387

* intervene based on AE of Tx * monitor for complications * pt education: tests, Tx, meds, AE

Answer 388

* cancer of plasma cells * accumulates in bone marrow, crowds out healthy cells

Answer 389

* cancerous plasma cells * create abnormal Abs (myeloma proteins)

Answer 390

* myeloma protein * abnormal Ab made by cancerous plasma cells

Answer 391

multiple myeloma

Answer 392

* OA: Dx usually ≥ 65 yo * male sex * African-American race (2x as common as caucasian) * Fm Hx * obesity * personal Hx of other plasma cell dz * monoclonal gammopathy of undetermined significance (MGUS) * solitary plasmacytoma

Answer 393

* varies and may be asymptomatic * bone pain, esp. spine or chest * weakness, numbness in legs * GI * nausea * constipation * loss of appetite * wt loss * abd pain * mental fog, confusion * fatigue * infections * GU * excessive thirst * renal dz/failure * polyuria

Answer 394

* CBC * usually anemia * thrombocytopenia, leukopenia possible * chemistry * Cr to test kidney fxn * albumin: ↓ in MM * Ca: ↑ in advanced MM * lactic dehydrogenase: ↑ in advanced, poor prognosis * urine: M protein * bone marrow Bx * CT, PET, bone scan, MRI

Answer 395

* chemo * bone-strengthening meds * immunotherapy * stem cell transplant * [management of bone damage](https://www.youtube.com/watch?v=bmYblbQv4dw)

Answer 396

* interventions for AE of Tx * monitor for complications * pt education: tests, Tx, AE, meds

Answer 397

* sarcomas starting in osteoblasts or osteoclasts * common types * osteosarcoma * chondrosarcoma * Ewing's sarcoma

Answer 398

* most common * starts in bone cells * population * 10-30 yo or 60-70 yo * rare: middle age * male \> female * usually in arms, legs, or pelvis

Answer 399

* second most common bone CA * sites: starts in any cartilage cells * trachea * larynx * chest wall * scapula * ribs * skull * population * rare: \< 20 yo * more common: 20-75 yo * men = women

Answer 400

* third most common bone CA * population * rare in adults \> 30 yo * most common in whites * rare in African- and Asian-Americans * sites * pelvis * chest wall * long bones of arms, legs

Answer 401

* retinoblastoma ↑ risk * possible genetic tendency * multiple enchodromatosis ↑ risk for chondrosarcomas * Paget dz * radiation

Answer 402

cartilaginous bumps on bones

Answer 403

* pre-cancerous condition * → formation of abnormal bone tissue * affected bones become heavy, thick, brittle, and weak

Answer 404

* **pain in affected bone** (most common) * swelling of area around bone * Fx * numbness, tingling * wt loss * fatigue

Answer 405

* Ca may be ↑ in blood, urine * CBC * ↑ alkaline phosphatas, lactate dehydrogenase * imaging * X-ray * bone scan * CT * MRI * PET * **Bx: definitive**

Answer 406

* surgery * radiation * chemo

Answer 407

* type of surgery depends on type and severity * ranges from curettage with cryotherapy to amputation

Answer 408

* most types not killed easily * requires high doses * used when * cannot be completely removed w/ surgery * positive margins found after excision

Answer 409

usually for Ewing's sarcoma of bone, osteosarcoma, or metastatic bone CA

Answer 410

* interventions based on AE of Tx * peri-op care * monitor for complications * pt education: testing, Tx, AE, meds

Answer 411

* most start as polyps, but not all polyps become cancer * **adenomatous polyps: pre-cancerous** * hyperplastic, inflammatory polyps mostly not cancerous * could become cancer if * \> 1 cm * \> 2 polyps * dysplasia present (abnormal, but not cancerous cells)

Answer 412

* polyp → cancerous → grows into wall of colon/rectum * innermost layer → outer layer * 95% are **adenocarcinoma** * site: anywhere in colon or rectum * proximal: ascending, transverse * distal: descending, sigmoid * most common: **rectosigmoid**

Answer 413

* colorectal: women \> men * rectal: men \> women * adenomatous polyps * age \> 50 * African-American descent * ulcerative colitis, Crohn's dz * diet ↑ fat and red meat, ↓ fiber * smoking * ETOH abuse * inactivity * HPV * family Hx

Answer 414

* change in stool consistency * pencil-thin stools * blood in stool * hematochezia * melena * occult * cramps * mass * wt loss * fatigue * vomiting * abd fullness, distention, pain

Answer 415

bright red blood in stool

Answer 416

black, tarry stool

Answer 417

* CBC: ↓ H&H * carcinoembryonic antigen (CEA): + * fecal occult blood test * colonscopy, sigmoidoscopy w/ Bx **(Bx definitive)** * CT, MRI * barium enema

Answer 418

cracinoembryonic antigen test

Answer 419

* polypectomy: local excision during colonoscopy * abd-perineal resection: anus, rectum, and sigmoid colon removed * colectomy: all or part of colon and nearby lymph nodes removed * proctocolectomy: colon and rectum removed * reanastamosis: if not possible, will need ostomy: * colostomy * ileostomy * stoma: pink or red and moist * temporary or permanent

Answer 420

* chemo * adjuvant: extra chemo after surgery to ↓ risk of recurrence * targeted med therapy: monoclonal antibodies to inhibit growth * radiation

Answer 421

* interventions based on AE * peri-op care * monitor for complications * pt education * tests * Tx, AE * meds * ostomy care

Answer 422

* physical and psych health * quality of life * financial * family dynamics

Answer 423

process that filters blood, removes harmful Abs

Answer 424

* plasmapheresis * synovectomy * total joint arthroplasty

Answer 425

* excision of synovial membrane * types * open: ↑ morbidity * arthoscopic: incomplete removal

Answer 426

removal and replacement of articulating bone parts in joint

Answer 427

* ↓ pain and stiffness * rest * gentle, low-impact exercise when tolerated * ROM exercises (stiffness) * heat therapy * ice for ↓ edema * proper nutrition * CAM (usually anti-inflammatory) * fish oil * turmeric * glucosamine and chondroiton

Answer 428

* assist w/ ROM * heat for stiffness, pain * ice for edema * encourage gentle exercise * cluster care/activities to conserve energy * give meds properly * monitor lab values

Answer 429

* S/Sx to report * fever * s/sx of infection * pain on inspiration * nutrition * high-protein * small, frequent meals * meds * SEs * importance of adherence * S/Sx of bleeding

Answer 430

* interstitial lung dz (ILD) * bronchiectasis * bronchiolitis obliterans

Answer 431

interstitial lung dz

Answer 432

* any of a large group of diseases w/ different causes but the same or similar clinical and pathological changes * cause: chronic, nonmalignant, noninfectious dz of lower respiratory tract w/ inflammation, disruption of alveolar walls * manifestations * limited O₂ transfer from alveoli to capillaries * dyspneic * first w/ exercise * later, even at rest * risk factors * ↑ RF and anti-CCP * smoking * age

Answer 433

* chronic dilation of a bronchus or bronchi * usually in lower portions of lung * caused by damaging effects of long-standing infection

Answer 434

* inflammation of the bronchioles * bronchioles and sometimes smaller bronchi are partly or completely obliterated by nodular masses * massess contain granulation and fibrotic tissue

Answer 435

* Sjogren's syndrome * secondary osteoporosis * vasculitis → organ ischemia * interstitial lung dz

Answer 436

* dz → ↓ production of tears, saliva, vaginal secretions * can result from RA * can → * light sensitivity * blurred vision * corneal damage * Tx: eye drops, artificial saliva, vaginal lubricants

Answer 437

* cause: long-term glucocorticoid use * encourage * weight-bearing exercise * Ca and vitamin D supplements

Answer 438

* → * organ ischemia * infarction and necrosis of tissue * usually involves smaller arteries in * skin * eyes * brain * inflammation of arteries 2/2 deposition of immune complexes

Answer 439

systemic lupus erythematosus

Answer 440

* vague early manifestations, many diagnostic challenges * series of remissions and exacerbations * still no definitive test * ANA usually +, but + is not exclusive to SLE

Answer 441

* discoid (DLE) * systemic (SLE) * medication-induced

Answer 442

discoid lupus erythematosus

Answer 443

* only affects skin * scaling, red, macular, pruritic rash * some pts have arthritis and/or arthralgia

Answer 444

* affects skin and connective tissue of multiple organs * → multi-organ inflammation

Answer 445

* temporary * induced by * procainamide * hydralazine * isoniazid * goes away w/ D/C of meds

Answer 446

* autoimmune w/ likely environmental factors * autoantibodies, mainly attacking cell nucleus * → buildup of immune complexes in serum and organs * → initiation of inflammatory process, damage of organs w/ possible vasculitis

Answer 447

* female \> male: possibly linked to estrogen * 20-40 yo * minority race * genetics: some familial involvement

Answer 448

* fatigue * blurred vision * general pain * photosensitivity * joint pain * mostly small joints: hands, wrists, and knees * w/o deformity * anorexia * depression * fever * anemia * **butterfly rash** * alopecia * muscle atrophy * pleural effusion * pericarditis * hematuria * peripheral edema (lupus nephritis?) * CNS * sz * migraine * avascular necrosis of femur * tendon rupture

Answer 449

* inflammation (swelling or scarring) of small vessels that filter wastes in kidneys * can → peripheral edema

Answer 450

* CBC * BUN, creatinine * UA * immunologic * ANA * serum complement (C3, C4) * ESR * other labs for Abs

Answer 451

* skin Bx for DLE * renal Bx * echo * other imaging based on affected organs/systems

Answer 452

* NSAIDs * corticosteroids: topical and PO * hydroxychloroquine: ↓ absorption of UV light * immunosuppressants

Answer 453

* monitor * and treat pain * BP for HTN * renal fxn * respiratory status * provide small, frequent meals * pt education

Answer 454

* avoid UV esposure, use sunscreen * avoid infection * S/Sx of renal failure * peripheral edema * SOB * ↑ fatigue * PG risk factors w/ lupus meds

Answer 455

* hematuria * protein in urine (frothy/foamy) * edema * wt gain * ↑ BP

Answer 456

* lupus nephritis * pericarditis ([friction rub](https://depts.washington.edu/physdx/audio/rub2.mp3)) * pleural effusion ([friction rub](https://depts.washington.edu/physdx/audio/pleuralr%5B1%5D.mp3))

Answer 457

* "hardening of skin" * AKA systemic slerosis * uncommon * induration of various body parts * **skin** mainly, but can also affect other body systems * lungs and kidneys (primary COD) * SubQ tissue * muscles * other organs * manifestations vary greatly

Answer 458

* ↑ of fibrous elements in tissue * associated w/ inflammation * marked by loss of elasticity, pliability

Answer 459

* involves humoral (Ab) and cell-mediated immune responses * immune attack on body structures → inflammatory process * affected areas become hardened and fibrotic * common presentation: skin or microvascular changes * exact etiology unknown

Answer 460

* severe fibroproliferative vascular lesions of small arteries, arterioles * excessive, often progressive deposition of collagen and other ECM macromolecules in skin and internal organs * alterations of humoral and cellular immunity

Answer 461

extracellular matrix

Answer 462

* diffuse cutaneous systemic sclerosis * limited cutaneous systemic sclerosis (milder) * fulminant systemic sclerosis: rapid onset/progression

Answer 463

* over most of body * skin is thickened on trunk, face, and extremities

Answer 464

* milder form * limited to sites distal to elbows and knees * may involve face and neck * pts usually have CREST syndrome

Answer 465

* a variant of progressive systemic sclerosis * presence of * calcinosis * Raynaud phenomenon * esophageal dysfunction * sclerodactyly * telangiectasia

Answer 466

condition marked by abnormal deposition of Ca salts in tissues

Answer 467

* intermittent vasospastic attacks of small arteries and arterioles of fingers * pallor → cyanosis (numbness, cold) → erythema 2/2 hyperemia (throbbing, paresthesia) * triggered by cold temps or emotion * associated w/ * scleroderma * SLE * Buerger dz * nerve entrapment * anorexia-bulimia

Answer 468

induration of the skin on toes and fingers

Answer 469

* AKA spider veins * vascular lesion formed by dilatation of a group of small blood vessels * usually on face or thighs * causes: sun exposure, birth mark, CREST syndrome, etc.

Answer 470

expansion of an organ or vessel beyond normal size

Answer 471

* found in all races, all geographic areas * female 4-9x \> male * age 25-55 yo * Hx of connective tissue dz * some chemical exposures * for more severe prognosis * younger age * African descent * rapid progression of skin Sx * involvement * ↑ skin * pulmonary * cardiac * renal * anemia * ↑ ESR

Answer 472

* joint pain and stiffness * LES incompetence + ↓ esophageal peristalsis → * GERD complaints * dysphagia * aspiration pneumonia * hoarseness * hiatal hernia * painless, symmetric pitting edema * fingers, hands, forearms * → carpal tunnel syndrome * loss of skin elasticity: tight and shiny * Raynaud's phenomenon * fibrosis of myocardium and lung alveoli * stone face * malignant HTN (renal effect) * telangiectasia

Answer 473

* 70% * 95%

Answer 474

* general AID labs like SLE * findings like SLE * ESR * almost always normal * if ↑, usually poor outcome

Answer 475

* dependent on organ involvement * CT, X-ray, echo, EGD, colonoscopy * upper and lower GI series common

Answer 476

* to slow progression * often unsuccessful * ID organ involvement early and treat * meds * systemic steroids + ↑ dose immunosuppressants * bosentan (endothelium receptor antagonists) for pulmonary arterial HTN * H2 blockers + antacids for GERD * NSAIDs for inflammation/joint pain * *future: tocilzumab (IL-6 antagonist)*

Answer 477

* monitor and treat pain * mild soap, skin care * keep pt warm * esophageal involvement: collaboration w/ speech therapy, dietitian * small, frequent meals

Answer 478

* S/Sx of organ involvement * how to avoid Raynaud's * dietary: avoid foods that worsen GERD * meds * importance of adherence * take w/ food to avoid GI distress * avoid infection * stress, smoking can worsen Sx

Answer 479

* fibrosis of * myocardium * lungs → pulmonary HTN * esophagus * intestines * renal failure * med-related * infection * cataracts

Answer 480

* highest **mortality** * pulmonary **HTN** and **fibrosis** (ILD) * **renal** crisis

Answer 481

human immunodeficiency virus

Answer 482

acquired immune deficiency syndrome

Answer 483

* very deadly because of the way it attacks the body * HIV → AIDS * HIV: retrovirus w/ 3 stages

Answer 484

* enters body via blood, semen, or vaginal secretions * binds to CD4 molecule on surface to enter T_h cells * hijacks replicative mechanisms of cell to produce billions of virus particles * new particles enter other T_h cells and continue cycle * window period * undetectable for first 1-3 mo * can still infect others * loss of CD4+ T_h cells → * opportunistic infections * neoplastic processes

Answer 485

* hep B and C * human herpes virus 8 * HHV8 * AKA Kaposi sarcoma herpes virus (KSHV)

Answer 486

* created by CDC * based on CD4+ cell counts * stages * I: acute infection * II: clinical latency * III: AIDS

Answer 487

* acute infection * 2-4 wks after infection * flu-like illness for a few wks

Answer 488

* clinical latency: inactivity or dormancy * asymptomatic/chronic * still active, but produces at low levels

Answer 489

* AIDS * most severe stage * opportunistic infections occur

Answer 490

* **4** clinical stages * based on clinical **manifestations**

Answer 491

* unprotected sex * esp. receptive anal intercourse * ↑ rate of transmission w/ mucosal disruptions * multiple sex partners * exposure in workplace * fetal exposure * IV drug use, shared needles * blood transfusion before 1985 in U.S. * maternal HIV infection: birth, breastfeeding

Answer 492

mother-to-child transmission

Answer 493

* subjective * flu-like Sx * chills and/or night sweats * malaise * anorexia, nausea * weakness * fatigue * HA * objective * rash: flat and red * fever * cough/SOB * wasting syndrome, wt loss * enlarged lymph nodes * poor wound healing * opportunistic infections

Answer 494

in HIV → flu-like illness: fever, malaise, rash

Answer 495

* AIDS-associated dementia/encephalopathy * wasting syndrome: chronic diarrhea and wt loss w/ no identifiable cause * fluid/electrolyte imbalance

Answer 496

* fungal * TB * CMV * toxoplasmosis * herpes * HHV-8 * Epstein-Barr

Answer 497

* human herpesvirus 8 * → Kaposi's sarcoma in HIV pts

Answer 498

adrenal dysfunction

Answer 499

Hodgkin's lymphoma

Answer 500

* side effect of protease inhibitor Tx * → * abnormal accumulations of body fat (upper back) * hypercholesterolemia * hyperglycemia/insulin resistence * hypertriglyceridemia

Answer 501

* CBC * cell counts * CD4+ T_h cells * CD8+ T_s cells * antigen/antibody * ELISA * Western blot assay * PCR * viral load * testing for other viruses

Answer 502

can detect HIV RNA in blood earlier than antigen/antibody tests

Answer 503

* enzyme-linked immunosorbent assay * test for antibodies and antigens in blood

Answer 504

* previously used to confirm HIV-positive ELISA * test for antibodies in blood

Answer 505

* PPD * CMV * other STDs * hepatitis A, B, and C

Answer 506

* purified protein derivative * TB skin test

Answer 507

* none * imaging based on S/Sx indicating co-infection

Answer 508

highly active antiretroviral therapy

Answer 509

* 3+ drugs working @ different stages of replication * 90% adherence required

Answer 510

* ↓ viral load * slow dz progression * prevent immune deterioration

Answer 511

* nucleoside reverse transcriptase inhibitors (NRTIs) * nonnucleoside reverse transcriptase inhibitors (NNRTIs) * protease inhibitors (PIs) * fusion inhibitors * entry inhibitors * CD4-directed post-attachment inhibitors * CCR5 co-receptor antagonists * HIV integrase strand transfer inhibitors

Answer 512

* nucleoside reverse transcriptase inhibitor * antiretroviral

Answer 513

* nonnucleoside reverse transcriptase inhibitor * antiretroviral

Answer 514

* protease inhibitor * antiretroviral

Answer 515

antiretrovirals * abacavir * didanosine * emtricitabine * lamivudine * stavudine * tenofovir * zidovudine

Answer 516

antiretrovirals * delavirdine * efavirenz * etravirine * nevirapine * rilpivirine

Answer 517

antiretrovirals * atazanavir * darunavir * fosamprenavir * indinavir * lopinavir/ritonavir * nelfinavir * saquinavir * tipranavir

Answer 518

antiretroviral * enfuvirtide

Answer 519

antiretrovirals, entry inhibitors * maravirac

Answer 520

antiretrovirals, entry inhibitors * ibalizumab

Answer 521

* 1: asymptomatic * 2: mildly symptomatic * 3: moderately symptomatic * 4: severely symptomatic → AIDS

Answer 522

* antiretrovirals for prevention * for select, high-risk population * must be HIV– * labs * renal fxn * HIV * onset: 4 days' consistent dosing

Answer 523

pre-exposure prophylaxis

Answer 524

* PO daily * Truvada (emtricitabine/tenofovir disoproxil fumarate) * Descovy (emtricitabine/tenofovir alafenamide) * IM monthly: Cabenuva (cabotegravir/rilpivirine)

Answer 525

* diarrhea * nausea * HA * fatigue * stomach pain

Answer 526

* **precautions** * **standard** * **immunocompromise** * monitor * wt * I&O * labs * assess * skin and provide care PRN * respiratory fxn

Answer 527

* importance of * medication adherence * follow-ups * infection control principles * support groups

Answer 528

* KS * malignancy in lining of blood and lymph vessels * lesions: painless, purplish * etiology: HHV-8

Answer 529

* Kaposi sarcoma-associated herpesvirus * HHV-8

Answer 530

**area** of **origin**

Answer 531

serotonin and other vasoactive substances

Answer 532

* imaging technique * single photon emission computerized tomography

Answer 533

sinusoidal obstruction syndrome

Answer 534

* disruption in normal flow of venous blood from liver * complication of stem cell transplant, within 3 wks * S/Sx * hepatomegaly * RUQ pain * jaundice * ascites