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208 Cards in this Set

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APACHE
Acute Physiology and Chronic Health Evaluation
--System for prognosis development for critically ill patients
--Limitations: False-positive/negative, reference values, predictive value
Basic Metabolic Panel: how many tests?
8 Specific Tests that screen for diabetes/kidney disease: Na, K, Cl, Ca, BUN, Creatinine, Glucose, CO2
Measures: electrolyte level (acid/base balance, blood sugar, kidney status)
Electrolytes
Chemical substances that allow body fluids to conduct and electric charge
5 primary elements/chemicals (electrolytes)
Na, Ca, K, Cl, CO2
Bicarbonate Levels
Reflect acid-base status: role of lungs/kidneys in compensating for respiratory and metabolic acidosis/alkalosis
What occurs in renal dysfunction?
Metabolic waste products accumulate in the blood
What is creatinine?
Waste product of muscle metabolism
Blood urea nitrogen (BUN)
Increases with dehydration, renal disease, GI bleeding, increased protein intake, and metabolism

Decreases: with OVER-hydration and SEVERE liver disease
What is urea?
Waste product of protein metabolism
What are the 3 primary tests for blood glucose?
1. Fasting plasma glucose levels
2. Oral Glucose Tolerance Test
3. Hemoglobin A1C
What is an oral glucose tolerance test?
100g glucose is given to the patient, then glucose levels are monitored.

We expect levels to return to normal w/in 2 hours
What is a hemoglobin A1C test?
Test used to track blood glucose levels over 2-3 months.

Values above 7% are indicative of Type II diabetes
What is a BMP Plus?
Test of liver function (part of complete metabolic panel)

Bilirubin, total protein, albumin

Serum levels are altered with compromised liver function
What are serum enzymes?
Liver enzymes: "tba"
Transaminases: ALT, AST, CCT (rise w/small intake of alcohol), and alkaline phosphate
Bilirubin; conjugated and unconjugated
Ammonia
What are the hematology tests?
CBC, RBC function, WBC function, Diff, ESR
Coagulation studies
Bone Marrow Aspiration
Describe blood chemistry
Iron and iron binding
Ferritin (protein that stores iron)
Vitamin B12 and Folate (important in blood formation)
Electrolytes
Blood glucose
Renal function tests
Lipids
Serum enzymes (liver) and markers
Serum hormones (liver)
What is a complete blood count?
The actual number of blood elements in relation to volume
Does a complete blood count test cell function?
NO
What does a complete blood count allow you to identify?
Identification of:
infection
anemia
arthritides
certain cancers
What are the 4 primary complete blood count tests?
Hemoglobin
Hematocrit
Platelets
White Blood Cells
What is hemoglobin?
Oxygen carrying capacity of RBCs
What is hematocrit?
% of blood occupied by RBCs
What makes up serum?
Iron and iron-binding
Ferritin
Vitamin B12
Folate
What is bone marrow aspiration, and why would it be performed?
"Biopsy"
Done to evaluate the production of RBCs, WBCs, and platelets in presence of hematologic disorders:
Infectious diseases, leukemia, lymphoma, multiple myeloma
Where is a bone marrow aspiration done in adults and children?
PSIS = adults
Proximal tibia = children
Define erythrocyte sedimentation rate
(ESR) rate at which the RBCs settle out of unclotted blood plasma in 1 hour
High rate = infection/inflammation
Nonspecific -- used as an index for MS dysfunction
What can ESR (erythrocyte sedimentation rate) be used to monitor?
Monitor the progression or response to treatment of:
Polymyalgia
Rheumatica
Giant Cell Arthritis
RA (rheumatoid arthritis)
SLE (lupus)
Hodgkin's disease
TB
What are the 5 types of WBCs?
Neutrophils
Eosinophils
Basophils
Lymphocytes
Monocytes
What are the 3 types of lymphocytes?
Helper Tcells -- "middleman" in adaptive immunity
Suppressor Tcells -- close down immune system after invading organisms are destroyed
B-lymphocytes -- produce antibodies against soluble antigens
What is a WBC differential?
The percentage of each type of WBC. It measures:
Maturity (left shift of neutrophils during a bacterial infection or acute necrosis)
Morphology
Qualitative abnormalities
What is the purpose of clotting studies?
Initiate clotting sequence
Diagnose hereditary clotting deficiencies
Monitor anticoagulant therapy
What is a reticulocyte count?
Measure of RBCs produced by bone marrow
What is the purpose of monitoring bleeding time?
Used to test the function of platelets
What is measured in a Prothrombin Time (PT)
Used to study clotting time
What is an International Normalized Ration (INR)?
A study for anticoagulation effects of heparin and warfarin
What is an Activated Partial Thromboplastin Time (aPTT)?
A study used to monitor effectiveness of low-molecular weight heparins (anticoagulants)
What are serum hormones used for?
Used to assess to assess endocrine function
What are Thyroid Function Reference Values?
Used to determine if a pt has hyper/hypothyroidism: 7%-8% of the therapy population is taking thyroid replacement medication
What are the 4 Immunologic Tests?
1. Polymerase Chain Reaction
2. Tumor-Associated Antigens
3. Rheumatoid Factor
4. Antinuclear Antibodies (human leukocyte antigen)
What 4 factors contribute to a urinalysis?
1. Specific gravity and occult blood
2. Glucose and ketone levels
3. Electrolytes
4. Drug screenng
(judged based on color and appearance)
What are the 2 primary microbiologic studies?
1. Gram stain
2. Cultures
What are the signs/symptoms of infectious diseases?
Signs: fever, chills, sweating, vomiting, enlarged lymph nodes, affected systems: integument, cardiovascular, CNS, GI, upper respiratory tract
Symptoms: nausea, malaise
What are 4 affects of aging on acquiring infections diseases?
1. Decreased cell-mediated immunity: can lead to reactivation of dormant infections (ex: decreased antibody response to flu vaccine)
2. Presence of chronic disease
3. Increased likelihood of exposure to nosocomial (acquired in a hospital)
4. Response to infection
Define "infection", and name the 5 characteristics of infection:
Def: process by which an organism establishes a parasitic relationship with its host
1. Localized vs. Systemic
2. Colonization
3. Incubation Period
4. Latent Infection
5. Communicable Disease
Define "colonization":
Infectious microorganisms are present in tissues of the host, but have yet to cause symptomatic disease.
Define "incubation period":
Period between the pathogen entering the host AND appearance of clinical symptoms (span from several days to a few months)
Define "latent infection":
Occurs after microorganism has replicated, but remains dormant or inactive in host, sometimes for several years
What is the "chain of transmission"?
How a disease is transmitted. Has 5 parts:
1. Reservoir (infected surface/agent)
2. Portal of Exit (exit from host)
3. Mode of Transmission
4. Portal of Entry
5. Host Susceptibility
What are the 5 modes of transmission of a disease?
1. Contact (direct/indirect, PRIMARY way of transmission)
2. Airborne (<5% of transmission)
3. Droplet (large particles that fall out w/in 3ft of source)
4. Vehicle (w/in something i.e. contaminated food)
5. Vector
What are the 3 lines of defense in host susceptibility to contracting a disease?
1. Normal flora
2. Inflammatory process
3. Immune response
What are the 5 ways to control transmission?
1. Standard precautions (VERY important)
2. Transmission-base precautions (apply to anyone w/a documented/suspected infection)
3. Immunizations
4. Prophylactic antibiotics
5. Correction of environmental factors (cleaning areas)
What is clostridium difficile?
Bacterial disease: causes of nosocomial/community-based diarrhea that occurs exclusively when exposed to antibiotics (anaerobic).
How is clostridium difficile transmitted?
Fecal - oral route: contamination of patient care environment, NONhuman reservoirs (clean tables, surfaces, etc).
How is staphylococcal aureus transmitted?
Bacterial disease spread by direct contact.

Colonization: skine, axilla, perineurm
How does staphylococcal present in the clinic?
Osteomyelitis, abscess, wound infection, endocarditis, toxic shock syndrome (TSS)
Define suppurative vs. nonsuppurative streptococcal infections:
Suppurative: occurring at sites where bacteria invades (causing necrosis and pus formation)

Nonsuppurative: immune related and triggered by previous strep infection
How are group A streptococcal infections transmitted?
Transmitted via respiratory droplets
How do group A streptococcal infections present in the clinic?
Streptococcal pharyngitis, poststreptococcal sequelae, scarlet fever, impetigo, cellulitis, necrotizing fascitis, myositis, puerperal sepsis
What are Group B Streptococcal Infections? (latin term)
Streptococcus Pneumoniae
What are the neonatal effects of group B streptococcal infections?
The leading cause of neonatal pneumonia, meningitis, sepsis
How are group B streptococcal infections transmitted?
Via direct contact or inhalation of droplets
What is gas gangrene, and what are its characteristics?
Bacterial disease characterized by the death of body tissue that occurs in wounds infected by anaerobic bacteria

Dry, moist wound site
What is "devitalized tissue", and what is it caused by?
Tissue that's broken down and needs to be cleaned/removed to prevent infection

Gas Gangrene
What are pseudomonas?
Opportunistic bacterial infections.

Examples: pneumonia, wound infections, UTI, sepsis, respiratory tract infections
How are pseudomonas transmitted?
They grow/thrive on moist environmental surfaces (commonly infect skin/soft tissue)
What are 3 blood bourne viral diseases?
1. Hep B (HBV): irritation/swelling of liver
2. Hep C (HBC): inflammation of liver, abdominal pain/swelling, esophagus/stomach bleeding, dark urine
3. HIV
What are 5 herpesviruses?
(Viral diseases)
1. Herpes Simplex (Type 1 = cold sores, Type 2 = genital herpes)
2. Varicella/Herpes Zoster (chickenpox/shingles via droplets)
3. EBV (infectious mononucleosis via oral contact)
4. CMV (cytomegalovirus via contact with infected secretions)
5. Roseola
What is lyme disease?
Infectious disease cause by an infected tick injecting bacteria into a human (MOST prevalent vector-born infectious disease in US)
What is the incubation period of lyme disease?
3-32 days
What are the 4 clinical manifestation stages of lyme disease?
1. Expanding bulls-eye rash (erythema migrans)
2. Days-->weeks post infection (targets heart, nervous system, and joints. Can develop Bell's Palsy)
3. Months post infection (intermittent arthritis, painful swelling in large joints)
4. Post-infection (persistent symptoms after antibiotic treatment = post-lyme syndrome resembles fibromyalgia)
What are some implications to the therapist regarding STDs?
When working with pts w/ACTIVE disease, we must follow precautions, frequently wash hands, and avoid touching the affected area
Define "antigen":
Something foreign that the body recognizes
What are 4 types of immunity?
1. Innate (natural/native)
2. Acquired (adaptive/specific)
3. Natural (natural resistance to infection)
4. Artificial (immunity that comes from direct exposure to an antigen)
What are the types of innate immunity?
1. Skin/mucosal barriers
2. Nonspecific: doesn't distinguish between different types of invaders
3. Nonadaptive: there's no memory of specific infections to assist in future encounters
What are the types of acquired immunity?
Adaptive or Specific: characterized by specificity and memory
What are the 4 types of acquired immunity?
1. Active acquired
2. Passive acquired
3. Humoral Immunity
4. Cell-mediated immunity
What is active acquired immunity?
Protection acquired by introduction of an antigen into a responsive host (vaccination)
What is passive acquired immunity?
Protective antibodies or sensitive lymphoctyes produced by one person are transferred to another (transplacental transfer)
What is humoral immunity?
Acquired immunity in which activity of circulating antibodies (blood, saliva) is predominant
What is cell-mediated immunity?
Role of T lymphocytes is predominant (they seek out and destroy viruses and bacteria hiding in cells)
What are MHCs?
Major Histocompatibility Complex proteins = immune cells distinguish between self and nonself by specific cell surface markers or molecules
What are Human Leukocytic Antigens (HLAs)?
Antigens that determine which antigens and how strongly an individual responds to them.
What are 2 factors that affect immunity?
Aging (changes occur in both innate and acquired defenses)
Exercise Immunology (intense/strenuous exercise may lead to a temporary decrease in immune resistance and may be detrimental)
What are the immune diseases?
1. Primary
2. Secondary
3. Iatrogenic Immunodeficiency
4. HIV/AIDS
5. Chronic Fatigue and Immune Dysfunction Syndrome
6. Hypersensitivity Disorders
7. Autoimmune Diseases
8. Fibromyalgia
What defines a primary immune system disease?
The immune response is absent or depressed as a result of defective T cells, B cells, or lymphoid tissue
What defines a secondary immune system disease?
Results from an underlying disease or factor that depresses/blocks the immune response: leukemia, Hodgkin's disease, malnutrition, alcoholism, autoimmune diseases, diabetes, cancer
What is Iatrogenic Immunodeficiency?
A medical complication caused by medical treatment. Primary cause: immunosuppressive drugs-->corticosteroids (radiation therapy, splenectomy)
What are the 3 ways HIV/AIDS can be transmitted?
1. Blood
2. Birth
3. Sex
What is the pathogenesis of HIV/AIDS?
Infection of HIV retrovirus predominantly infects human T4 helper cells and lymphocytes (aka CD4), and destroys/inactivates them. Macrophages and B cells are also infected.
What is the window period for HIV/AIDS?
Virus takes approx 11 days to show in the blood
What is the HIV Seropositive Period?
Antibodies are detected in blood, but pt is asymptomatic for HIV for 3-6 weeks while the virus infects lymph tissues. Decline of CD4 cells results in loss of immune system function
What are AIDs direct and opportunistic affects?
Direct: HIV cells are toxic (force CD4 cells to release toxins)
Opportunistic: AIDS defining illnesses (about 20 illnesses that're uncommon in healthy people)
Define "viral load" in relation to HIV/AIDS:
Number of HIV particles/mL blood (measures plasma HIV RNA levels)
<5000 copies = lower risk of disease progression (GOOD)
>10,000 copies = much more at risk of developing AIDS
What are the clinical manifestations of stage 1 HIV?
Asymptomatic stage: CD4 count = 500 cells

Clinically healthy, capable of normal activities, but fatigue and swollen/firm lymphnodes may be reported
What are the clinical manifestations of stage 2 HIV?
Symptomatic stage: CD4 count = 200-500 cells

Persistent generalize adenopathy, diarrhea, wt loss, fatigue, night sweats, fevers, neurological symptoms, OPPORTUNISTIC INFECTION

Half of adults in this stage report fatigue that limits physical/recreational activities, and are unable to attend school/work
What are the clinical manifestations of stage 3 HIV?
HIV Advanced Disease Stage: neurological symptoms (CNS more commonly attacked than PNS), HIV associated dementia (HAD), dermatologic conditions, peripheral neuropathy, pain

Patient NOW has AIDS
Pain indirectly and/or directly related to HIV infection/ immunosuppression
What are some implications for PTs in regards to infectious diseases?
Assist in screening for HIV by including questions in history questionnaire that ask about high-risk behavior, especially for neuromuscular/musculoskeletal symptoms of unknown origin.

Use STANDARD PRECAUTIONS (wash hands, wear gloves/masks/goggles if needed)
What is chronic fatigue and immune dysfunction syndrome?
A subset of chronic fatigue (unexplained fatigue for more than 6 months).
How does chronic fatigue and immune dysfunction syndrome present in the clinic?
Onset: sore throat, fever, muscle pain/weakness
Progression: muscle pain, forgetfulness, prolonged/overwhelming fatigue exacerbated by minimal physical activity
Progression is cyclical: condition varies between remission and relapse
How is chronic fatigue and immune dysfunction syndrome diagnosed?
There's NO definitive physical signs/diagnostic tests to diagnose CFIDS
What is the treatment for chronic fatigue and immune deficiency syndrome?
Target: symptom relief and improved function

Cognitive behavior therapy, graded exercise therapy
What is the prognosis for chronic fatigue and immune deficiency syndrome?
Early diagnosis improves outcomes. There's a small remission rate, but management is beneficial:

Improvement rate = 8%-63%
Total remission = 5%-10%
What is a hypersensitivity disorder?
Increased immune response to the presence of an antigen resulting in tissue destruction = allergic response
What is the first type of hypersensitivity disorder (allergic reaction), and how does it present in the clinic?
Immediate hypersensitivity, allergic disorders

Anaphylaxis (systemic widespread release of histamine causing vasodilation, bronchospasm, edema)

Pt will present with wheezing, hypotension, swelling
What is the second type of hypersensitivity disorder (allergic reaction), and how does it present in the clinic?
Cytotoxic reactions to self-antigens or cross-reaction.

Weakness, malaise, hives, sneezing, UA/LA issues
What is the third type of hypersensitivity disorder (allergic reaction)?
Immune Complex Disease (antigen/antibody complexes are deposited in tissue around small blood vessels, and once there, they're activated causing acute inflammation and local tissue injury)
What is the fourth type of hypersensitivity disorder (allergic reaction)?
Cell-mediated immunity, hypersensitivity. A delayed response occurring 2-3 days after a test occurs. Also commonly occurs in rejection of transplants
What is an autoimmune disease?
A self-destructive condition in which the body fails to distinguish self from non-self. MOST are organ specific, but some are systemic
What is Systemic Lupus Erythematosus (SLE)? How does it present in the clinic?
An autoimmune disease affecting young women (15-40 years) whose cause is unknown. Since the cause is unknown, no 2 people with SLE have the same symptoms (which range from musculoskeletal, cardiopulm, CNS, renal, skin)
How is SLE officially diagnosed?
Official diagnosis is made when 4 out of 11 criteria are present
What are the risk factors for SLE?
1. Genetic predisposition
2. Stress
3. Strep OR viral infection
4. Exposure to UV light
What is the medical management of SLE (prevention, treatment, prognosis)?
Prevention: primarily to reduce risk of flare-up
Treatment: reverse autoimmune/inflammatory process (a lot of emphasis on the prevention of exacerbations/complications)
prognosis: improved w/EARLY detection/intervention
What is fibromyalgia?
An autoimmune disease characterized by CHRONIC, widespread mm pain with trigger point pain at 11 out of 18 points.
How is fibromyalgia diagnosed?
There's no definitive test, but increased substance P and decreased serotonin are indicative of the disease

Widespread (4 quadrant) pain: present for 3+ months
What are the risk factors of fibromyalgia?
Trauma, prolonged anxiety/stress, hypothyroidism, rapid steroid withdrawl

Women (75%-80%) are more at risk than men
Ages 14-68 years old
What is the treatment for fibromyalgia?
Exercise NEEDS to be done with these pts

They fatigue easily, so must progress easily
What are some things PTs should stress when working with oncology pts?
1. Physical activity and exercise are the PRIMARY means of cancer prevention
2. We should help treat side-effects of cancer
3. Prevention, restoration, supportive care, palliative care
What are 4 key oncology prevention points?
1. Screeining: it's vital for the PT to help pts understand risk factors and get them screening appts if necessary
2. Primary Prevention: disease prevention (exercise, good diet, etc)
3. Secondary Prevention: any step taken to identify early diagnosis/prompt treatment
4. Tertiary Prevention: measures taken to restore function/limitation of disability in clients with chronic/irreversible disease
Define "differentiation" in regards to oncology:
Cells are different in different areas/tissues/organs
What are "anaplastic cells?"
Undifferentiated cells. Cells that you can't tell where they came from
Define "dysplasia" in regards to oncology:
Cells are DISORGANIZED (sounds like the term). At this point, cell changes ARE reversible. Abnormal development in cell type
Define "metaplasia" in regards to oncology:
Early cell dysplasia (disorganization)/change in cell type
Define "hyperplasia" in regards to oncology:
Increases in cell numbers/population (cells can be normal/abnormal)
What are the 2 types of tumors?
1. Benign: not as serious, their primary harm is placing pressure on organs
2. Malignant: more harmful. Cells break away from PRIMARY tumor, travel through the blood, and begin to grow secondary tumors in other organs (tumor metastasizes)
Define "carcinoma":
Malignant neoplasm (tumor) of the skin
Define "sarcoma":
Malignant neoplasm (tumor) of CT/muscle
Define "leukemia/multiple myeloma":
Malignant neoplasm (tumor) of the blood
What are the ABCDs of skin cancer?
A = asymmetry
B = border irregularity
C = color (black/multiple colors)
D = diameter (1/4 in or size of pencil eraser)
What is "actinic keratosis", and what are its characteristics?
Condition commonly seen on farmers'/construction workers' heads:
Precancerous conditions: 10% advance to become squamous cell carcinoma
Characteristics: small, dry, crusty bumps on the back of hands, face, lips, arms, shoulders, top of head
Define "staging" in regards to oncology:
A means of classification based on:
1. Rate of growth and extent of tumor
2. Treatment planning
3. Prognosis
**These are specific for each type of cancer
What is the "TNM Staging System"?
T = Primary Tumor
N = Regional Lymphnodes
M = Distant Metastasis
What are the different classifications within the TNM Staging System of oncology?
X = cannot be assessed
O = no evidence of disease (NOD)
IS = in situ (premalignant/precancerous)
1-4 = staging levels
Ex: Tx, To, TIS, T1-4
Nx, No, N1-3
Mx, Mo, M1
Define "grading" in regards to oncology:
Defines the tumor in terms of:
1. Degree of malignancy
2. Cell differentiation
What does it mean for an cancer to be "endogenous"?
A genetic predisposition has been shown for:
1. Prostate Cancer
2. Breast Cancer
3. Ovarian Cancer
4. Colon Cancer
What does it mean for a cancer to be "exogenous"?
An environmental/external factor (carcinogen) causes the cancer
Why is there a strong susceptibility to cancer with aging?
1. Prolonged exposure to carcinogens
2. The loss of telomere function coincides with an INCREASE in cellular aberrations (structural changes)
What are the 3 factors of oncogenesis?
1. Somatic Mutation Theory: chromosomal aberrations
2. Oncogenes: transform normal cells into malignant cells
3. Tumor Suppressor Genes: proteins that regulate cell cycle or promote apoptosis to suppress tumor growth (these are dysfunctional in cancer)
What are the 3 primary processes of tumor growth (pathogenesis)?
1. Hyperplasia: increase in the number of cells (proliferation)
2. Metaplasia: change in cell type
3. Dysplasia: abnormal development in cell type (maturation abnormality)
What are the 3 types of carcinoma pathogenesis?
1. Carcinoma in situ: early stage (absence of invasion of tumor cells into surrounding tissue/BL/BM)
2. Invasive Carcinoma: cancer that has invaded BL/BM
3. Metastatic Carcinoma: Skin cancer that has spread to other regions of body
Define "tumor angiogenesis":
The growth of NEW tumor cells from pre-existing vessels. These cells break away, travel through the body vai blood/lymphatic system, become trapped in capillaries of organs
What is the path of metastasis in the body?
Bones-->lungs-->brain
How does a pt present when a tumor metastasizes to the lungs?
Pt is asymptomatic, has a dry, persistant cough, pleural pain, shortness of breath (SOB), hemoptysis
How does a pt present when a tumor metastasizes to the liver?
Pt has abdominal/RUQ pain, general malaise, fatigue, anorexia, early satiety, wt loss
When you have a tumor in the bones, it metastasizes to the lungs. What are the favored sites for solid tumor metastasis in this case?
Osteolytic: lung, kidney, thyroid, breast
Osteoblastic: prostate and breast
What happens when a tumor metastasizes to the brain?
1. Life-threatening and debilitating; dependent upon location
2. Primary (1*) tumors rarely metastasize
What happens when a tumor metastasizes to the spinal cord?
1. Cord compressions occur with bone changes
2. Progressive loss of neurologic function as tumor grows
What happens to the lymphatic system when a tumor metastasizes?
Pt can get lymphedema secondary (2*) to radiation/chemo
How is metastasis diagnosed?
Dr. has to look at the characteristics of the cells at the PRIMARY site
Define "paraneoplastic syndrome" in regards to oncology:
Conditions/symptoms that are a byproduct of the presence of cancer in the body
What are the 4 mechanisms of paraneoplastic syndromes?
1. They're initiated by vasoactive tumor products
2. Destruction of NORMAL tissues
3. Unknown mechanisms
4. Autoantibodies: antibodies produced by the body to keep cancer at bay
What are 3 clinical signs of paraneoplastic syndromes?
1. Neurologic changes, anorexia, malaise, diarrhea, fever
2. Manifestations in the skin, MS system, joints
3. Stiff-person syndrome
How does one medically manage paraneoplastic syndromes?
Corticosteroid therapy is useful in treatment of stiff joints (stiff-person syndrome), however primary treatment should continue to be focused on underlying cancer
What are the 4 components to cancer diagnosis?
1. Initial cancer indication: found through medical history and physical evaluation
2. Secondary cancer screens: (initiated when one of the above shows an abnormality) lab tests, radiographs, CT scan, mammography, MRI
3. Tissue biopsy
4. Tumor markers: measure of substances made/secreted by tumor cells (sign of malignancy)
What is meant by "disorder of the endocrine glands?" What are the 3 different types of disorders?
Disorder results from excess/insufficiency of hormonal secretions
1. Primary: dysfunction of the gland itself
2. Secondary: dysfunction of an outside stimulus to the gland
3. Iatrogenic disorders: occur following surgical removal of a gland, therapy for a non-endocrine disorder, or excessive therapy for an endocrine disorder
What are the 4 specific endocrine disorders for the pituitary gland?
1. Acromegaly
2. Hypopituitarism
3. Diabetes Insipidus
4. SIADH (symptom of inappropriate secretion of antidiuretic hormone)
What are the 5 specific endocrine disorders for the thyroid gland?
1. Hyperthyroidism (grave's disease)
2. Hypothyroidism
3. Goiter
4. Thyroiditis
5. Thyroid Cancer
What are the 2 specific endocrine disorders for the parathyroid glands?
1. Hyperparathyroidism
2. Hypoparathyroidism
What are the 5 specific endocrine disorders for the adrenal glands?
1. Addison's Disease
2. Secondary Adrenal Insufficiency
3. Acute Adrenal Insufficiency
4. Adrenocortical HYPERfunction (Cushing's Syndrome, Conn's Syndrome)
What 3 cells do the Islets of Langerhans produce, and what do those cells produce?
1. Alpha cells = produce glucagon
2. Beta cells = oroduce insulin
3. Delta cells = produce somatostatin
What is diabetes mellitus?
Chronic systemic disorder caused by HYPERglycemia (disrupts the metabolism of carbs, fats, proteins)
What sort of organ/tissue damage is long-term hyperglycemia associated with?
1. Eyes
2. Kidneys
3. Nerves
4. Heart
5. Blood vessels
Describe Type 1 diabetes:
"Juvenile diabetes": absolute deficiency in production/secretion of insulin caused by beta-cell destruction
What are 3 risks of type 1 diabetes?
1. Prone to ketoacidosis and other metabolic dysfunctions
2. Pt requires exogenous insulin
3. Pt at risk if 1* relative has it
Describe Type II diabetes:
"Adult onset": cellular RESISTANCE to insulin and inadequate compensatory insulin secretory response
What are the 3 diabetes tests?
1. 2-Hour Oral Glucose Tolerance Test (prediabetes = 140-199mg/dL, diabetes = >200mg/dL)

2. Fasting Plasma Glucose Test: 8 hours w/o eating (prediabetes = 100-125mg/dL, diabetes = >125mg/dL)

3. HbA1c: looks at blood glucose levels over 2-3 months (^6.5% is diabetic, diabetic patients want to aim for 170mg/dL which is equivalent to 7%)
What is the incidence of diabetes in the US?
*14.6M Americans are diagnosed (6.2M undiagnosed)
*Leading cause of death from disease in US
* Black, Native American, Hispanic, and Asian Americans are 1.5-2X more likely than Caucasians to get it
*90% of cases are Type 2 (10% type 1)
Describe the pathogenesis of DM:
Insulin is used to transport glucose into the cell for energy use and storage as glycogen. When a person is either resistant to insulin or doesn't create it (type 2, type 1), the kidneys excrete excess glucose into the urine and increased fat metabolism (using fat stores as energy) occurs. Ketones are created by this process
What is the recommendation for prevention of DM?
150min of moderate activity/wk
What is the official diagnosis of DM?
Classic symptoms:
1. FPG >100mg/dL on 2 days
2. 2-hr postload glucose >200mg/dL during OGTT
3. HbA1c test of 6.5% or higher
PLUS plasma glucose >200mg/dL
What are 5 primary disorders of the Hematologic System?
1. Disorders of Iron Absorption
2. Disorders of Erythrocytes
3. Disorders of Leukocytes
4. Disorders of the blood and lymph (neoplastic diseases/lukemias)
5. Diseases of Hemostasis
What is the disorder of iron absorption?
Hereditary hemochromatosis-excessive iron absorption of the small intestine
What are the disorders of erythrocytes?
The Anemias
What are the 9 disorders of leukocytes?
1. Leukocytosis
2. Leukopenia
3. Basophilia
4. Eosinophilia
5. Neutrophilia
6. Neutropenia
7. Lymphocytosis
8. Lymphopenia
9. Monocytosis
Describe Leukocytosis and leukopenia
Leukocytosis-increase number of WBCs in the blood (develops with 1-2 hours after acute hemorrhage and is usually a normal protective response.

Leukopenia-reduction of WBCs caused by HIV, alcohol abuse/nutritional deficiencies.
Is leukopenia ever beneficial?
NO
Describe basophilia, eosinophilia, neutrophilia and neutropenia
1. Basophilia-degranulation of basophils causing release of histamine and local inflammatory/allergic reactions.
2. Eosionphilia-increased number of eosinophils and is commonly seen in allergic reaction to drugs
3. Neutrophilia-increased neutrophils-inflammation, acute infection, cancer of liver, GI or bone marrow
4. Neutropenia-decrease in neutrophils=increase risk of infection.
Describe lymphocytosis, lymphopenia and monocytosis
1. Lymphocytosis-increased lymphocytes. Occurs in active viral infections, endocrine disorders and malignancies.
2. Lymphopenia-low levels of lymphocytes. Can have congenital, drug, virus or radiation cause.
3. Monocytosis-increased monocytes. Is seen in CHRONIC infections and is present in 50% of people with collagen vascular disease.
What is chronic myeloid leukemia?
A genetic defect that is a blood-forming stem cell neoplasm.
What is chronic lymphocytic leukemia?
Mutated B cells that enter the proliferative phase where they may mutate, which predisposes it to be cancerous. Is more common in adults and is difficult to treat/usually fatal.
What is Von Willebrand’s Disease?
Inherited bleeding disorder where there is lack of the VW factor (the factor forms a platelet plug at sites of vascular injury)
What is hemophilia?
Lack of clotting factors
What is thrombocytopenia?
Inadequate platelet or increased platelets
What are 3 hemoglobinopathies?
1. Sickle Cell Disease
2. Sickle Cell Trait
3. Thalassemias
What is Sickle Cell Disease and Sickle Cell Trait?
Sickle Cell Disease-sickle shaped RBCs caused decreased capacity of cell to carry oxygen.

Sickle Cell Trait-rarely symptomatic and often effects manifest in high altitudes
What is thalassemias?
A genetic defect leading to a decreased of no ability to make hemoglobin
What is Anemia?
The most common hematologic abnormality. Reduction in the oxygen-carrying capacity of blood due to abnormality in quantity and/or quality of RBCs.
What are the 3 primary causes of Anemia?
1. Excessive blood loss
2. Hemolytic conditions
3. Decreased production of RBCs
What are common examples of excessive blood loss?
GI bleeding secondary to long-term NSAID use, peptic ulcers, hernias, gastric carcinomas, hemorrhoids or colon cancer
What are hemolytic conditions?
Destruction of erythrocytes. Is mainly caused by autoimmune conditions such as SLE, CLL and lymphoma, where antibodies produced that clump RBCs together cause those RBCs to be recognized as nonself and thus are phagocytosed in the spleen.
What are 4 primary causes of decreased production of RBCs?
1. Chronic disease- failure of the body to compensate for lower RBC lifespan caused by SLE, TB or cancer
2. Nutritional deficiency which leads to deficiency in iron, protein, vitamin B12 (loss of B12 is also associated with chronic alcohol abuse).
3. Folic Acid deficiency 4) bone marrow disorders
What are 6 secondary causes of anemia?
1. Malabsorption syndrome
2. Alcohol abuse
3. Infectious diseases
5. Inflammatory conditions or chronic diseases
6. Neoplastic diseases or cancer chemo and radiation treatment.
When does anemia clinically manifest and what are the effects?
When hemoglobin/hematocrit fall below ½. Effects are weakness, easy fatigue, tachycardia, DOE (dyspnea on exertion/shortness of breath), yellowish skin, increased pain with pre-existing CAD or CNS symptoms and Koilonychia (spooning occurring in nails).
How do you treat Anemia? Is it a disease?
Anemia is NOT a disease, it is a symptom. Thus, you must treat the underlying cause. If the cause is nutritional deficiency, is a good prognosis. If the cause is hemolytic, is a poor prognosis.
What are malignant lymphomas and how are they classified?
They are cancer of the lymphatic system. Are classified by clinical behavior (Indolent or Aggressive)
What are three common types of lymphomas?
1. Hodgkin’s lymphoma
2. Non-Hodgkin’s lymphoma
3. Multiple Myeloma
What is Non-Hodgkin’s lymphoma?
An AIDs defining illness--good prognosis for those <60 years old. Exact cause is unknown.
What is Hodgkin’s lymphoma?
Immunodeficiency disease of lymphoid tissue distinguished by presence of Reed-Sternberg cell. Has 2 peaks of incidence: between 25-30 and older than 55.
What are the 4 stages of Hodgkin’s lymphoma?
Stage I – SINGLE node, group of nodes OR extralymphatic site
Stage II – 2+ nodes on the SAME side of the diaphragm
Stage II – 2+ nodes on DIFFERENT sides of the diaphragm
Stage IV – Widespread EXTRALYMPHATIC involvement
To where does Hodgkin’s lymphoma metastasize? What are the clinical manifestations?
To the spleen, liver, bone marrow and lungs. Pruitis, Irregular fever and progressive anemia.
What are 3 specific situations of Hodgkin’s lymphoma?
1. Pregnant women (disease has NO effect on baby)
2. Older adults (the symptoms of the lymphoma are the same as aging)
3. Patients with HIV/AIDS.
What is the medical management of Hodgkin's Lymphoma? What are PT implications?
Can diagnose with a lymph node biopsy. Treatment goal is to cure with radiation or chemo. Prognosis is GOOD. PT implications include palpation of the lymphnodes, focusing the plan of care on improving pt.’s quality of life, impairments and physical condition.
In regards to Hodgkin’s lymphoma, what are normal lymph node characteristics?
Are up to 1cm, are firm and move freely without tenderness
What is multiple myeloma?
Malignant neoplasm of plasma cells in bone marrow. Is incurable. Renal impairment is common.
What is leukemia and what are the 4 types?
Cancer that starts in the bone marrow and spreads to the blood and other organs.
1. Acute leukemia
2. Chronic leukemia
3. Lymphocytic leukemia
4. Myeloid leukemia.
What are acute and chronic leukemia?
Acute leukemia-bone marrow cells cannot mature, so the immature cells reproduce and build up.
Chronic leukemia-bone marrow cells partially mature. Progresses over a longer period of time compared to acute and is more difficult to treat.
For both, survival period is very low without treatment.
What is lymphocytic leukemia?
Leukemia that starts in the lymphocyte WBC.
What is myeloid leukemia?
Leukemia that starts in early forms of myeloid cells (WBCs other than lymphocytes, RBCs or platelet making cells).
Describe Leukemia in Children
Leukemias are the most common childhood cancers. The most common leukemia for children is ALL-acute lymphocytic leukemia which is caused by uncontrolled growth of lymphoid cells. The 2nd most common leukemia is AML-acute myeloid leukemia which is uncontrolled growth of myeloid cells. Has a lower survival rate than ALL. With AML, there is increased likelihood of the leukemia to travel to the CNS.