Week 7

Question 1

CM of Ulcerative Colitis

Answer 1

Bleeding
Diarrhea
Loss of fluid and electrolytes
Abdominal pain
Fever
Weight loss
Anemia
Tachycardia
Dehydration
Protein loss
Malnutrition.

Question 2

Diagnostic Tests for Ulcerative Colitis

Answer 2

CBC, serum electrolytes, serum protein, double-contrast barium enema, small bowel series, transabdominal ultrasound, CT, MRI, colonoscopy, sigmoidoscopy, patient history.

Question 3

Interintestinal Complications of Ulcerative Colitis

Answer 3

Hemorrhage (result of inflammation)
Perforation
Toxic Megacolon
Colonic Dilation
Increased risk for GI cancers

Question 4

Extraintestinal complications of Ulcerative colitis

Answer 4

Joint, skin, mouth, eye disturbances, anemia, leukocytosis, thrombocytosis, skin lesions, uveitis.

Question 5

What is ulcerative colitis?

Answer 5

Inflammatory condition of the bowel. Begins at the rectum and works its way up GI system.

Question 6

What layers of the intestine does ulcerative colitis involve?

Answer 6

Mucosa and submucosa.

Question 7

Where do abscesses develop in ulcerative colitis?

Answer 7

Can develop in the intestinal glands. Abscesses can break and leave ulcerations.

Question 8

What can inflamed mucosa form as a result of ulcerative colitis?

Answer 8

Psuedopolyps in bowel hymen.

Question 9

What are treatment options for Ulcerative colitis?

Answer 9

Nutritional support
Antimicrobial therapy
Corticosteroids
Antidiarrheal agents
Sulphasazaline
Total proctocolectomy with a permanent ileostomy.
Total proctocolectomy with ileoanal reservoir.
Low residue diet

Question 10

What ages are people most at risk for ulcerative colitis?

Answer 10

15-25 yrs and then again from 50-70 years.

Question 11

What is Crohn’s disease?

Answer 11

Caused by inflammation in GI system. Happens all over. Systematic autoimmune disorder.

Question 12

What parts of the GI system are most affected by Crohn’s disease?

Answer 12

Terminal ileum and colon.

Question 13

What organs are uncommon to be affected by Crohn’s disease?

Answer 13

Esophagus, stomach, and duodenum.

Question 14

What are skip lesions in Crohn’s disease?

Answer 14

Parts of the bowel are infected, with healthy parts in between.

Question 15

What layers of the bowel does Crohn’s disease affect?

Answer 15

All layers.

Question 16

What percent of patients are granulonmas present in patients with Crohn’s disease?

Answer 16

50%

Question 17

What are the clinical manifestations of Crohn’s disease?

Answer 17

Diarrhea
Fatigue
Weight loss
Abdominal Pain
Abdominal Distention
Finger clubbing and arthritis.

Question 18

What are some diagnostic tests for Crohn’s disease?

Answer 18

History, CBC, ESR, serum chemistries, stool occult, radiological studies, sigmoidoscopy, colonoscopy.

Question 19

What are some treatments for Crohn’s disease?

Answer 19

High calorie, high vitamin, high protein, low residue, dairy-free diet.
Antimicrobial agents, corticosteroid drugs, Immuno-suppressants, element diet, rest, surgery.

Question 20

What are some risk factors of Celiac disease?

Answer 20

Genetic predisposition, gluten ingestion, immune-mediated response.

Question 21

What is Celiac disease?

Answer 21

An autoimmune disease characterized by damage to the small intestinal mucosa. Tissue damage is a result of chronic inflammation.

Question 22

What is the gene associated with Crohn’s disease?

Answer 22

NOD2.

Question 23

What are some complications of Crohn’s disease?

Answer 23

Narrowing of lumen may cause strictures and obstruction. 
Fistulas
Perforation
Arthritis
Liver disease
Ankylosing spondylitis
Pyoderma gangrenosum
Erythema
Nodosum
Uveitis
Renal disorders
Nutritional abnormalities
Deficiency in fat-soluble vitamins.

Question 24

What peptide is found in gluten that causes problems in celiac patients?

Answer 24

Prolamins. They bind to human leukocyte antigens and activate an inflammatory response.

Question 25

Where is the damage most severe in celiac patients?

Answer 25

Duodenum decreases distally.

Question 26

What are the clinical manifestations of celiac disease?

Answer 26

``` Smelly diarrhea Flatulence Abdo distention Malnutrition Rash may be present. Anemia Calcium and Vit D deficiencies may cause osteoporosis and weak bones. ```

Question 27

What are some atypical symptoms of Celiac disease?

Answer 27

Decreased bone density, osteoporosis, dental enamel hypoplasia, iron and folate deficiencies, peripheral neuropathy, reproductive problems.

Question 28

How is Celiac diagnosed?

Answer 28

Biopsy of small intestine, patient history and symptoms. Histological evidence disappears when gluten-free diet is followed. IGA and tTG lab testing also used.

Question 29

Which diseases are associated with Celiac?

Answer 29

Other autoimmune diseases: thyroid disease, T1D, RA.

Question 30

What are potential complications of Celiac?

Answer 30

Risk for non-hodgkins lymphoma, chronic inflammation, hyperplasia, GI cancers.

Question 31

What is the treatment for Celiac Disease?

Answer 31

Gluten free diet, corticosteroids.

Question 32

What is asthma?

Answer 32

Chronic inflammatory disorder of airways.

Question 33

What does asthma cause?

Answer 33

Causes airway hyper-responsiveness, leading to wheezing, breathlessness, cough and chest tightness.

Question 34

What are environmental triggers of asthma?

Answer 34

Cold air, exercise, air pollutants, emotional stress.

Question 35

What are some allergy triggers of asthma?

Answer 35

Dust mites, cockroaches, animals, mold, pollen.

Question 36

What are some respiratory triggers of asthma?

Answer 36

Increased inflammation due to hyperresponsiveness of tracheobronchial system.

Question 37

What are some drug/food additives that trigger asthma?

Answer 37

Beta-adrenergic blockers, NSAIDS, ASA, sensitivity to salicylates.

Question 38

What is the patho for the early phase of asthma?

Answer 38

Characterized by bronchospasm. Peaks 30-60 min after trigger exposure, subsides between 30-90 min after exposure.

Question 39

What are the CM in the early phase of asthma?

Answer 39

Increased mucous secretions, edema, increased amount of tenacious sputum.

Question 40

What is the patho for the late phase of asthma?

Answer 40

Primarily inflammation, can be more severe. Peaks 5-12 hrs after trigger. May last several hours to days. Can lead to irreversible lung damage if not treated.

Question 41

What is an effective treatment of late-stage asthma?

Answer 41

Corticosteroids.

Question 42

What are the clinical manifestations of asthma?

Answer 42

Recurrent episodes of wheezing, breathlessness, cough and tight chest.

Question 43

What time is the most common time for an asthma attack to occur?

Answer 43

0200 to 0500 hrs in the morning.

Question 44

What are the inspiration to expiration ratios?

Answer 44

1:2, 1:3, 1:4.

Question 45

What are some signs that the client is having difficulty with air movement during an asthma attack?

Answer 45

Client may be anxious, restless, sitting upright and slightlightly forward.

Question 46

What are the symptoms of cough variant asthma?

Answer 46

cought is the only symptom, bronchospams not severe enough to cause obstruction.

Question 47

What hormones are the mast cells releasing when aggravated by allergins?

Answer 47

Bradykinin, prostaglandins, luekotrinins,

Question 48

What do goblet cells do?

Answer 48

Responsible for mucus production.

Question 49

What are the signs of hypoxemia?

Answer 49

Increased anxiety and restlessness, increased pulse and BP, pulsus paradoxus, increased respiratory rate, use of accessory muscles, O2 stat less than 95%, cyanosis, poor tissue perfusion, difficulty speaking.

Question 50

What are the diagnostic tests for Asthma?

Answer 50

Detailed history and physical exam, pulmonary function test, peak flow monitoring, chest x-ray (not diagnostic), ABGs, oximetry, allergy testing, blood levels of eosinophils, sputum culture and sensitivity.

Question 51

What is the overall goal of asthma care?

Answer 51

Achieve asthma control with minimal pharmocotherapy.

Question 52

What is the green zone?

Answer 52

Peak flow results, 80%-100%. Medications continued.

Question 53

What is the yellow zone?

Answer 53

50%-79%. Indicates caution, something is triggering asthma.

Question 54

What is the red zone?

Answer 54

Less than 60% of personal best. Indicates a serious problem. Action needed.

Question 55

What is COPD?

Answer 55

Chronic Obstructive Pulmonary Disorder, a progressive respiratory disorder characterized by airflow obstruction, systematic manifestations, exacerbations of increasing frequency.

Question 56

What is emphysema?

Answer 56

enlargement of the airspaces distal to terminal bronchioles. Radiologically defined.

Question 57

What is chronic bronchitis?

Answer 57

Mucus gland hyperplasia and airway structure design, clinically defined.

Question 58

What are the major symptoms of COPD?

Answer 58

Dyspnea with activity limitation. Mucus production and cough.

Question 59

What are the risk factors for COPD?

Answer 59

Smoking, Pollution, Asbestos, alpha-1-antitrypsin deficiency (AAT) (autosomal recessive disorder causing destruction of lung tissue), aging.

Question 60

What is the defining characteristic of COPD?

Answer 60

Chronic inflammation.

Question 61

What happens to the body as a result of chronic inflammation in COPD?

Answer 61

Inflammation of the brionchioles and alveoli and pulmonary blood vessels cause a) airflow obstruction due to mucus, edema and bronchospasm. b) airflow limitation due to loss of elastic recoil.

Question 62

What does oxidative stress inactivate and stimulate?

Answer 62

Inactivates anti-proteases | Stimulates mucus secretion

Question 63

What type of tissue does protease break down?

Answer 63

Connective tissue.

Question 64

Where is protease found?

Answer 64

Neutrophils and macrophages.

Question 65

What inhibits proteases?

Answer 65

Anti-proteases like AAT.

Question 66

What factor increases proteases and decreases anti-proteases?

Answer 66

Smoking.

Question 67

What happens when their is an imbalance of proteases and anti-proteases?

Answer 67

Alveolar walls are destroyed.