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342 Cards in this Set
- Front
- Back
3 Levels of Defense System
|
1. Skin
2. Inflammatory Response 3. Immune Response |
|
Effects on Immune Response (9)
|
1. trauma
2. pollutants 3. drugs suppress 4. age (TCells) 5. gender 6. nutrition 7. stress 8. rest 9. exercise |
|
Functions of the Immune System (3)
|
1. protect the body from foreign substances
2. identify the foreign material 3. synthesize antibodies to destroy foreign cells |
|
Immunity Players
|
1. Antigens
2. Antibodies 3. Lymphocytes (T and B) 4. Other Cells (Natural Killer, Dendritic, Macrophages) |
|
Antigens
|
- no characteristic cell markers
- elicits immune response |
|
Antibodies
|
- protect host
- neutralize bacterial toxins - neutralize bacteria - opsonize bacteria - activate inflammatory response |
|
How do antibodies work?
Direct vs indirect |
direct:
1. agglutination 2. precipitation 3. neutralization Indirect 1. enhance phagocytosis 2. activate plasma proteins |
|
Lymphocytes
|
-originate from stem cells in bone marrow
- B Lymphocyte - T Lymphocyte |
|
T Cell Lymphocytes (function)
|
- hand to hand combat
- differentiate in thymus - CELL MEDIATED IMMUNITY -- seeks out hidden invaders -- kills on a cell to cell basis |
|
Types of T Cell Lymphocytes
|
1. T-Killer Cells (cytotoxic, Tc)
2. Helper Cells (T4, CD4 receptor) 3. Memory Cells 4. Suppressor Cells |
|
Function of Helper Cells
|
- B Cell Maturation
- Activate macrophages - Assist T-killer cells |
|
Function of Memory Cells
|
remember antigen for accelerated next response
|
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Function of Suppressor Cells
|
control cytotoxic and helper cells
|
|
B Lymphocytes - Function
|
- differentiate in bone marrow and other places
- HUMORAL IMMUNITY - makes antibodies/immunoglobulins |
|
B Cells differentiate into
|
- Plasma Cells
- Memory Cells |
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B Lymphocytes: Antigen-Binding Fragment (Fab)
|
- binds to antigen
- recognition sites for antigens - gives specificity |
|
B Lymphocytes: Crystalline Fragment (Fc)
|
- starts inflammatory process
- activates complement system - binds to phagocytes - transport of maternal antibodies to fetus |
|
1. IgG
2. IgA 3. IgM 4. IgE 5. IgD |
1. major class/ secondary response
2. body secretions (mucous membranes/external) 3. first response (made early in neonatal life) 4. allergic response ( lysis of mast cells) 5. unknown, surfaces of developing B Cells |
|
Types of Immunity
|
1. Natural
2. Acquired a. Active b. Passive |
|
Types of Responses
|
1. Primary (IgM)
2. Secondary (IgG) |
|
Mechanisms of Immunity
|
1. Humoral
2. Cell Mediated |
|
B Lymphocytes: Memory Cells
|
- remembers the antigen
- system acts faster when exposed again |
|
Mechanisms: Humoral Immunity
|
1. B Lymphocytes
2. Antibody Production (Immunoglobulins) 3. Memory Cells |
|
Age Effects on the Immune System
|
1. Declines with age
2. T Cell function declines 3. Increased autoantibody production 4. Diminished cell-mediated immunity |
|
Alterations: Immunodeficiency
|
- failure of self-defense mechanisms
- Hallmark sign: unusual or recurrent infections - congenital or acquired |
|
Infections Associated with Immunodeficiency: Cell Mediated vs Humoral
|
Cell Mediated:
- viral - fungal Humoral: - bacterial |
|
Alterations: Hypersensitivity
|
- inappropriate
- directed at host tissues - directed at beneficial foreign tissue - exaggerated response against environment |
|
Alterations: Hypersensitivity Autoimmune Responses
|
- breakdown in tolerance of self
- see p 179 for options |
|
Alterations: Hypersensitivity Alloimmune Responses
|
- reaction to tissue of another member of same species
- transplant rejection - transfusion reactions |
|
Alterations: Hypersensitivity Allergic Reactions
|
- increased immune response due to the presence of allergen
- results in tissue destruction - IgE released (histamine and anaphylotoxine) |
|
senescence
|
aging process of cells
- lose ability to divide - die and body rids the body of the cells |
|
apoptosis
|
cell suicide due to multiple mutations
|
|
Tumor Grading:
Grade I Grade II Grade III Grade IV |
Grade I: well differentiated
Grade II: moderately differentiated Grade III: poorly to very poorly differentiated Grade IV: very poorly differentiated |
|
Carcinogenesis
|
1. Initiation
2. Promotion 3. Transformation 4. Progression |
|
Oncogene
|
gene expression that will cause a gene to be cancerous
|
|
Proto-oncogene
|
normal gene that becomes oncogene
|
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DNA Repair Gene
|
detect damage and repair it
|
|
Benign Tumor
|
- appear in any part of the body
- slow growing - well-defined cystology and histology - well-defined edges - do not invade surrounding tissues - frequently encapsulated - lethality usually d/t organ compression |
|
Malignant Tumor
|
- rapidly growing
- abnormal mitosis - loss of differentiation - increased motility- can spread - poorly defined edges - directly invade surrounding tissues - no encapsulation - usually has own blood supply |
|
Primary Tumor
|
- originating tumor
|
|
Secondary Tumor
|
- metastatic tumor
- similar to primary tumor - less well differentiated - may appear several years after primary tumor - frequently migrates to well vascularized site |
|
Direct extension
|
invades organs/tissues next to primary tumor
|
|
Hematogenous
|
through blood
|
|
Common metastatic sites
|
- bone
- lymph nodes - lung - liver - brain |
|
differentiation
|
process of acquiring specific characteristics that result in changes in cellular function
|
|
anaplasia
|
cancer cell does not function normally
- no differentiation or control over growth/division |
|
hyperplasia
|
increase in tissue size
- due to increase in # of cells - may not be abnormal |
|
metaplasia
|
fully differentiated cell is replaced by another type
- reversible, generally benign |
|
dysplasia
|
abnormal disorganized cell growth
- no normal division |
|
In Situ cancer
|
pre-invasion tumor
- haven't broken through basement layer - hasn't invaded other tissue |
|
Carcinoma
|
epithelial tissues; organ secretes something
|
|
Sarcoma
|
connective tissues; muscle, bone, blood vessels, nerves
|
|
Lymphoma
|
lymphoid tissue, spleen
|
|
Leukemia
|
blood forming tissue, bone marrow
|
|
benign
|
-oma
|
|
malignant
|
-sarcoma
|
|
adeno
|
gland
|
|
chondro
|
cartilage
|
|
erythro
|
RBC
|
|
hemangio
|
blood vessels
|
|
lipo
|
fat
|
|
myelo
|
bone marrow
|
|
myo
|
muscle
|
|
osteo
|
bone
|
|
T
N M |
T=size of primary tumor
N=extent of lymph node involvement M=presence/absence of metastases |
|
Screening for Cancer
|
- age older than 50
- previous hx of cancer - female with chest, breast, axillary pain, unknown origin - back, pelvic, groin, hip pain with vague abdominal complaints, palpable mass - change in size, shape of lymph nodes >1 location, >4 weeks - weight loss of 10 lbs or more within 1 month |
|
C
A U T I O N |
Change in bowel/bladder
A sore that won't heal Unusual bleeding or discharge Thickening or lump Indigestion or difficult swallowing Obvious change in wart/mole Nagging cough or hoarseness |
|
PT-specific diagnosis
|
- bone pain-burning, aching, poorly loaclized
- Hx of cancer and back, shoulder, joint pain of unknown origin - proximal muscle weakness - change in DTR's - unexplained fatigue |
|
Blood Tests
|
- CBC
- alkaline phosphatase - uric acid - calcium - electrolytes - cancer-specific proteins |
|
CBC
|
- decreased Hgb, Hct in hematological cancers
- increased WBC in leukemias |
|
alkaline phosphatase
|
increase in liver and bone disease
|
|
uric acid
|
increase in hematological cancers
|
|
calcium
|
increased in cancer that has metastasized to bone, multiple myeloma
|
|
electrolytes
|
Na, K, Cl - nutritional status
|
|
Cancer-specific proteins:
1. PSA 2. IgG, IgA 3. CEA 4. CA 15-3, CA 27-29 5. AFP |
1. prostate cancer (<4-5 mg/ml)
2. multiple myeloma 3. cancers of colon, rectum, lung, breast 4. breast cancer 5. liver cancer, testicular cancer |
|
Imaging Techniques
|
- x-rays
- nuclear scans - CT scan, MRI - ultrasound - mammography |
|
Genetic Screening
|
- HER-2
- BRCA1 - BRCA2 |
|
Methods of Cancer Diagnosis
|
1. self-exams/routine screening
2. CAUTION 3. Blood Tests 4. Tests of fluid and stools 5. Bone Marrow Analysis 6. Biopsies 7. Imaging Techniques 8. Endoscopy 9. Genetic Screening 10. Cytological Studies |
|
Signs/Symptoms of Cancer for the PT
|
1. Bone Pain
2. Hx of cancer + back, shoulder, or joint pain of unknown cause 3. Proximal muscle weakness 4. Change in DTR's 5. Unexplained fatigue |
|
Complete Remission
|
tumor completely gone
- temporary or permanent |
|
Cure
|
CR for at least 5 years
|
|
Partial Remission
|
tumor decreased more than 50% but not gone
|
|
stabilization
|
tumor neither shrinks nor grows
|
|
progression
|
tumor keeps growing
|
|
clinical remission
|
# of abnormal cells less than 1 billion
|
|
Cancer treatment options
|
1. surgery
2. radiotherapy 3. chemotherapy 4. biological therapy |
|
Cancer treatment determination
|
- type and location of tumor
- stage and grade of disease - pt's general health and age - pt and family beliefs and desires |
|
Uses for surgery
|
- prevent/lower risk for developing cancer
- diagnose/stage disease - tumor removal - reconstruction - RTX, chemo adjunct |
|
Side effects of surgery
|
- loss of function
- infection - increased pain - deformity - swelling |
|
If you patient has cancer...
|
1. avoid superficial heat
2. deep heat increases tumor growth 3. avoid cold for chemotx-induced nerve injury 4. pathologic fracture risk |
|
Goals of radiation therapy
|
1. cure
2. control of cancer 3. decrease tumor size 4. palliation |
|
dosage of radiation
|
rads, or centigray (cGy)
- site-specific, size and stage - fractionated schedule - 5x/week, 2 to 8 weeks - dosage limited by normal tissue toxicity |
|
radiosensitization
|
given drug to make cells more sensitive to radiation
|
|
hyperfractionation
|
smaller doses more often
|
|
Side effects of radiotherapy:
|
1. immunosuppression with long bones, ilium, sternum (dec WBC, platelets, Hgb)
2. integumentary: skin reactions, burns, tissue fibrosis, myofascial adhesions 3. GI: nausea, vomiting 4. fatigue: may continue after treatment |
|
Side effects of radiation (cont)
|
5. avascular necrosis
6. mouth: dry, loss of taste, sores, cavities 7. doesn't stop with treatment (6-12 months) |
|
PT implications of Radiotherapy
|
1. fatigue after RTX (energy conservation, active rest)
2. skin care 3. lymphedema 4. proper hydration and nutrition 5. seating solutions |
|
chemotherapy
|
- systemic using drugs
- stops cells from growing/dividing - lacks tumor cell specificity - usually involves combo of drugs |
|
Goals for chemotherapy
|
1. cure
2. slow progression 3. shrink the tumor to decrease cancer load 4. shrink the tumor to allow surgical resection |
|
alkylators
|
damage proteins that control growth in the genes of the tumor cell
|
|
antimetabolites
|
act as false building blocks in cancer cell's genes, causing it to die as it gets ready to divide
|
|
antitumor antibiotics
|
inhibits gene replication
|
|
antimitotics/alkaloids
|
inhibit the ability of cellular genes to replicate during division; blocks mitotic spindle or microtubule formation
|
|
Hormones
|
give messages that either encourage or stop growth or activities in certain cells or organs
|
|
How chemo is given
|
1. topically
2. by injection (IM, SC) 3. by mouth 4. by IV (catheter, port, pump) |
|
CSF
|
Neupogen
- stimulates WBC production |
|
EPO
|
Procrit
- stimulates RBC production |
|
Chemo side effects (8)
|
1. drug specific
2. nausea, vomiting 3. mouth sores 4. hair loss 5. neuropathies 6. immunosuppression 7. sterility 8. chemobrain |
|
immunosuppression from chemo
|
1. anemia
2. leukopenia 3. thrombocytopenia |
|
PT Implications for Chemo
|
1. cancer-related fatigue
2. deconditioning 3. careful monitoring/precautions 4. peripheral neuropathies 5. fall precautions 6. pathological fracture |
|
Biological Therapy (definition)
|
using biological response modifiers (BRM) to activate immune system
|
|
Biological Agents
|
- immunomodulating agents
- interferons (IFNs) - Lymphokine-activated killer cell (LAK) therapy - colony stimulating factors - bone marrow/stem cell transplants |
|
Immunomodulating Agents
|
- inject tumor with bacterium
- activate immune system - tumor growth is slowed down |
|
Interferons (Types)
|
1. IFN-alpha
2. IFN-beta 3. IFN-gamma |
|
Interferons (Effects)
|
- makes tumor cells more foreign
- inhibits tumor growth - enhance natural killer cells |
|
Interferons (uses)
|
- Leukemia
- Kaposi's sarcoma - melanoma - renal cell CA |
|
LAK Therapy
|
- experimental
- Tc cells taken from patient - grown in culture with interleukin-2 - injected back in - infiltrate tumor and kill - melanoma and renal cell carcinoma |
|
Side Effects of Biological Therapy
|
1. injection site swelling/redness
2. flu-like symptoms 3. fatigue 4. elevated liver function tests 5. CNS toxicity 6. arrythmias, hypotension 7. edema 8. skin rash |
|
Top 2 infectious diseases that lead to death in US
|
#8: pneumonia/influenza
#10: septicemia |
|
Factors of spread of infection
|
1. new organisms
2. increased environmental mobility 3. organisms linked to other diagnoses 4. antibiotic resistant strains |
|
pathogenicity
|
ability of organism to cause disease
- depends on ability to divide - extent of tissue damage - strength of toxins |
|
colonization
|
successful invasion, not sick
|
|
subclinical
|
presence of colonization, no signs/symptoms
|
|
incubation period
|
time from exposure to clinical signs
|
|
latent infection
|
replicated but inactive
|
|
carriers
|
carrier, no evidence of disease (HIV)
|
|
nosocomial infections
|
acquired in hospitals/ long term care/ direct exposure
|
|
types of organisms
|
1. viruses
2. bacteria 3. rickettsiae 4. protozoa 5. prions 6. fungi (mycoses) |
|
Bacteria:
- Classification - Shapes |
1. shape
2. staining 3. motility 4. spore producing 1. cocci 2. bacilli 3. spirilla (spirochetes) |
|
Rickettsiae
|
- animal pathogen
- vectors - susceptible to antibiotics - Typhus and Rocky Mountain Fever |
|
Protozoa
|
- single cell unit or group of cells
- malaria -amebic dysentary |
|
Prions
|
- proteinaceous particle
- neurodegenerative - Creutzfeldt-Jacob Disease - Mad Cow disease |
|
Fungi (Mycoses)
|
- single-celled yeast
- multicellular molds - often skin and mucosa - like warmth and moisture - athlete's foot and candida (thrush) |
|
Signs and Symptoms of Infection
|
1. fever
2. chills 3. malaise 4. others |
|
Modes of transmission of infection
|
1. contact (casual, sexual, blood borne)
2. airborne 3. enteric 4. vectorborne |
|
Host susceptibility
|
1. general health
2. nutritional status 3. living conditions 4. life style 5. age 6. comorbidities 7. invasive equipment |
|
Staphylococcus Aureus
|
- common but can't invade skin
- enters through traumatic break in skin |
|
Manifestations of Staph Infection
|
1. furuncles
2. carbuncles 3. osteomyelitis 4. infections of burns or surgical sites 5. URI 6. endocarditis 7. toxic shock syndrome |
|
furuncles
|
small round tender central area of pus
|
|
carbuncles
|
2 or more furuncles
|
|
endocarditis
|
inflammation of heart valves
|
|
MRSA
|
-methicillin resistant
- produce penicillinase (deactivates penicillin |
|
Myobacterium Tuberculosis: transmission
|
- airborne droplets
- tubercle - may remain dormant for life |
|
Group A Streptococci
|
Causes:
- pharyngitis - scarlet fever - impetigo - necrotizing fasciitis - gangrene |
|
Hepatitis C Virus
|
- bloodborne pathogen
- leading indication for liver transplant - chronic liver disease (70%) - jaundice, fatigue, N&V, abdominal pain |
|
Hepatitis B Virus
|
- major cause of viral hepatitis
- weakness, fatigue, headache, jaundice, N&V - can survive in dried blood |
|
HIV
|
- virus causes AIDS
- attacks T4 lymphocytes - intimate contact - 8-10 year incubation - never dormant, always transmittable |
|
HIV testing
|
- enzyme immune assay
- enzyme-linked immunosorbent assay - Western blot - Oraquick test |
|
pneumonia
|
- inflammation of lung accompanied by bronchitis and pleurisy
|
|
types of pneumonia
|
1. aspiration pneumonia
2. community acquired 3. nocosomial pneumonia 4. immunocompromise |
|
aspiration pneumonia
|
- hacking productive cough
- pleuritic chest pain - dyspnea |
|
community acquired pneumonia
|
- streptococcus pneumoniae
- haemophilus influenzae - influenza virus |
|
nosocomial pneumonia
|
- psuedomonas
- staphylococcus aureus - klebsiella pneumoniae - E-coli |
|
immunocompromise
|
- pneumocystitis carinii (jerovici)
- myobacterium tuberculosis - fungi - protozoa |
|
TB: symptoms
|
- fatigue
- weight loss - lethargy - anorexia - low grade fever - cough with purulent sputum |
|
Hepatitis C: Risk Groups
|
- highest: IV drug users, risky sexual behavior
- hemodialysis pts - organ transplant prior to July 1992 - recipient of blood prior to 1987 - healthcare workers |
|
West Nile Virus
|
- flavivirus (Africa, West Asia, Middle East)
- in US since 1999 - humans, birds, mosquitoes, horses - mild flu-like symptoms - severe: encephalitis, meningitis |
|
Leishmaniasis
|
- Baghdad Boil
- 4 cases in TX - bite of sand flies or wood rat bitten by sand fly - up to 1 year to heal |
|
Avian Influenza
|
- bird flu
- carried by wild birds - viruses in saliva, nasal secretions and feces - low or high pathogenic |
|
Subtypes of Human Bird Flu
|
- H1N1
- H1N2 - H3N2 - H5N1: deadly |
|
Bird Flu: symptoms
|
- flu-like symptoms
- eye infections - pneumonia - severe respiratory distress |
|
H5N1 Virus
|
- largest # of cases/deaths
- Cambodia, Thailand, Indonesia, Viet Nam - does not spread easily human to human |
|
Pandemic
|
- whn new virus subtype emerges
- infects humans - spreads easily among humans - concern b/c no vaccine |
|
Standard Precautions
|
any body fluid infectious
|
|
Universal Precautions
|
blood products or contaminated with blood infectious
|
|
Transmission-Based Precautions
|
- more cautious depending on what's going on
|
|
exocrine
|
secretes products into a duct
|
|
endocrine
|
secretes products into extracellular space
|
|
Classification of Hormones
|
1. amines
2. proteins and peptides 3. steroids |
|
amines
|
- simplest hormone molecules
- epi- and norepinephrine |
|
proteins and peptides
|
- chains of amino acids
- pituitary or parathyroid - water-soluble |
|
steroids
|
- from cholesterol, liipid soluble
- end in -one except estrogen |
|
Hormonal control
|
- negative feedback
- indirect: hypothalamus - direct: pituitary gland |
|
Neural Control
|
- norepinephrine
- epinephrine - oxytocin |
|
positive feedback
|
- high levels of a substance stimulate secretion
- low levels suppress |
|
negative feedback
|
- high levels suppress
- low levels suppress |
|
water-soluble receptors
|
- substance binds to receptor
- 2nd messenger does action |
|
lipid-soluble receptors
|
- cross cell membrane
- bond in cytosol - direct effect |
|
Hormonal Interactions
|
- permissive effects
- direct effect - antagonistic effect |
|
permissive effect
|
- estrogen and progesterone
- two hormones have to be there together |
|
direct effect
|
obvious change in cell due to hormone
|
|
antagonistic effect
|
- insulin and glucagon
- calcitonin and PTH |
|
Overall effects of Hormones
|
1. controls internal environment
2. responds to changes in environment 3. smooth, sequential integration of growth and development 4. coordination of reproductive systems 5. regulates organic metabolism and energy balance |
|
Changes with age
|
- inc dysfunction
- Pituitary: anatomic and histologic changes - Thyroid: shrinks and dec T3 T4 - adrenal gland: more fibrous, dec clearing of glucocorticoids |
|
Hypothalamus
|
- master of the pituitary
- hypothalamic regulating hormones - ADH -oxytocin |
|
Pituitary Gland
1. anterior 2. posterior |
1. adenohypophysis
2. neurohypophysis |
|
Anterior Pituitary Hormones
|
1. Human Growth hormone
2. prolactin 3. adrenocorticotropic hormone 4. thyroid stimulating hormone 5. follicle stimulating hormone 6. luteinizing hormone |
|
Human Growth Hormone
|
- increased protein synthesis
- fat breakdown - inc blood glucose |
|
prolactin
|
lactation after pregnancy
|
|
ACTH
|
stimulates adrenal gland to release glucocorticoid hormones
|
|
TSH
|
stimulates thyroid to make thyroxine (T4) and triiodothyronine (T3)
|
|
FSH
|
- follicle growth
- secretion of estrogen - spermatogenesis |
|
LH
|
- promotes ovulation
- secretion of progesterone |
|
Dysfunction of Anterior Pituitary:
Hypofunction |
1. panhypopituitarism
2. pituitary dwarfism 3. post-partum ischemic necrosis (Sheehan's syndrome) |
|
panhypopituitarism
|
decrease in all pituitary hormones (life threatening)
|
|
pituitary dwarfism
|
decrease in growth hormone
- don't grow but proportional - not same as achondroplasia |
|
Post-partum ischemic necrosis
|
- Sheehan's syndrome
- woman after delivery - hemorrhage, shock - pituitary gland does not receive blood |
|
Dysfunction of Anterior Pituitary: hypersecretion
Symptoms |
1. giantism
2. acromegaly - arthritic pain - jaw pain - increased blood sugar - increased ring size - increased shoe size - increased hat size |
|
giantism
|
- inc GH before growth plates close
- overgrowth of long bones - proportions normal |
|
acromegaly
|
- inc GH after growth plates closed
- tumor of pituitary gland - inc growth in hands, feet, frontal, mandible, maxilla |
|
Posterior (Neurohypophysis)
|
1. ADH: vasopressin; vasoconstriction
2. Oxytocin: stimulates uterine contractions-milk let down while nursing |
|
Diabetes Insipidus
|
- hyposecretion of ADH
- polyuria - polydipsia - no problem with glucose - treat with synthetic ADH |
|
Diabetes Insipidus: Causes
|
- damaged pituitary gland (head trauma)
- cranial surgery - anoxic encephalopathy - tumor |
|
Components of Adrenal Gland
|
1. adrenal cortex
2. adrenal medulla |
|
Adrenal Cortex
|
1. mineralocorticoids
2. glucocorticoids 3. androgens |
|
mineralocorticoids
|
- aldosterone
-- released during dehydration and blood loss -- makes kidneys retain Na and H2O |
|
hormones that retain water
|
- ADH
- aldosterone |
|
glucocorticoids
|
cortisone:
- increases rate of protein breakdown - provides additional glucose - blood vessels more responsive - suppresses inflammatory response - interferes with connective tissue regeneration |
|
androgens
|
- low production relative to gonads
- may not be physiologically important - can affect secondary sex characteristics |
|
Adrenal Medulla
|
- epinephrine
-norepinephrine - fight or flight response - mimics sympathetic nervous system response |
|
Dysfunction of Adrenal Gland
|
1. Cushings syndrome
2. Addison's Disease |
|
Cushing's Syndrome: causes
|
- tumors of pituitary
- tumors of adrenal gland - external source of cortisol |
|
Cushing's Syndrome: treatment
|
- remove tumors
- wean off cortisone |
|
Cushing's Syndrome: symptoms
|
- moon face
- buffalo hump at neck - protuberant abdomen - muscle wasting - osteoporosis - easy bruising - women become masculinized |
|
Addison's Disease: causes
|
- autoimmune process
- infectious disease - vascular occlusion - abrupt withdrawal from corticosteroids |
|
Addison's Disease: treatment
|
- exogenous cortisol
- aldosterone? |
|
Addison's Disease: symptoms
|
- dark pigmentation of the skin
- hypotension - lethargy - hyperkalemia - weight loss |
|
Thyroid Gland
|
1. thyroxine (T4)
2. tri-iodothyronine (T3) 3. calcitonin |
|
T4
|
- increased protein synthesis, breakdown carbs, fats
- regulate growth/development - regulate nervous system |
|
Calcitonin
|
- calcium homeostasis
- from blood to bones - decreases blood Ca+ - inhibit osteoclasts to prevent bone breakdown - "thyrocalcitonin" |
|
Dysfunction of Thyroid Gland
|
1. goiter
2. hyperthyroidism (thyrotoxicosis, Graves disease) 3. hypothyroidism 3. |
|
Goiter
|
- deficiency in iodine
- symptoms: -- enlarged thyroid gland -- possibly dysphagia or hoarseness - treatment: iodine supplement |
|
hyperthyroidism
|
- autoimmune disease: produces long-acting thyroid stimulator (LATS)
- treatment: -- inhibit thyroid hormone synthesis -- destory thyroid tissue -- surgically remove |
|
hyperthyroidism: symptoms
|
- symmetrical goiter
- exopthalmos - heat intolerance - tachycardia - palpitations - UE tremors |
|
Hypothyroidism disorders
|
1. cretinism
2. throiditis (Hashimoto's disease) 3. myxedema |
|
Cretinism
|
- newborn
- causes: -- thyroid agenesis -- insufficient iodine in mother's diet |
|
Thyroiditis: Hashimoto's Disease
|
- autoimmune response
- symptoms: -- enlarged hard painless thyroid -- dysphagia - treatment: -- thyroid hormone -- surgery to remove goiter |
|
Myxedema
|
- decrease in thyroid function
- treatment: thyroid hrt - symptoms: - periorbital edema - non-pitting puffiness of face - sluggishness - irritability - dry skin - muscular weakness - slow heart rate |
|
Parathyroid Hormone
|
- antagonist to calcitonin
- activation of osteoclasts - inhibition of osteoblasts - release of Ca+ from bones - reabsorption of Ca+ by kidneys - conversion of VitD to most active form |
|
Hyperparathyroidism: types
|
- primary: something wrong with gland
- secondary: chronic renal disease -- loss of Ca+ in dialysis -- increased PTH-PTG's fine |
|
Hyperparathyroidism: treatment
|
Primary: removal of gland
- all four, radio-guided minimally invasive to remove part - renal transplant secondary: restore normal Ca and P balance |
|
Hyperparathyroidism: symptoms
|
- moans: psychological
- stones: kidney stones - bones: fx or osteoporosis - groans: abdominal distress |
|
Hypoparathyroidism: causes and treatment
|
- decreased plasma Ca+
- elevated phosphate levels -treatment: -- Ca supplement -- Vitamin D -- decrease phosphorus intake |
|
Hypoparathyroidism: symptoms
|
- paraesthesis
- muscle spasm and tetany - psychiatric disturbances |
|
Pancreas
|
1. Glucagon
2. Insulin |
|
Glucagon
|
- secreted from alpha cells
- glycogen breakdown in liver - gluconeogenesis |
|
Insulin
|
- secreted from beta cells
- promotes glucose entry into cells - promotes glycogen synthesis - promotes lipogenesis - promotes protein synthesis |
|
Type 1 DM (Immune Mediated, IDDM, Juvenile, Type I)
|
- little or no insulin
- autoimmune response - mostly in adolescence - less genetic tendency than type 2 - more rare |
|
Type 2 DM (NIDDM, Adult-onset, Type II)
|
- ineffective insulin
- strong genetic component - associated with obesity and lack of exercise - receptor ineffective or insulin ineffective - more genetic tendency |
|
Risks for developing Type 2 DM
|
- overweight
- under 65 with little to no exercise - between 45 and 64 years of age - woman who gave birth to a baby over 9 lbs - sibling with DM2 - parent with DM2 |
|
Symptoms of DM 2
|
- polyuria
- polydypsia - polyphagia - weight loss - hyperglycemia - glycosuria - ketonuria |
|
Diagnosing Diabetes
|
- fasting blood glucose levels (70-110 mg/dl)
- Oral Glucose Tolerance Test (normal: glucose rises than drops rapidly to normal) |
|
glucose tolerance tests
1. normal response 2. impaired fasting glucose 3. impaired glucose tolerance 4. Diabetes |
1. 2-hour level <= 100 mg/dl
2. fasting >100 but <126 mg/dl 3. 2-hour level >=140 but <200 4. 2-hour level is >200 mg/dl |
|
Blood Tests for Cardiovascular Diseases (6)
|
1. arterial blood gases
2. O2 saturation 3. fasting lipid profile test 4. C-reactive protein test 5. total homocysteine 6. ischemia modified albumin |
|
arterial blood gases
|
pH, PaO2, PaCO2
|
|
C-reactive protein test
|
- synthesized in liver in response to inflammation
- predictive of 1st CV event and recurrence - > 3.0 mg/dl |
|
total homocysteine
|
>15 mmoles/L
|
|
ischemia modified albumin
|
- appears within minutes of onset of ischemia, returns to baseline in 6 hours
- marker of ischemia BEFORE infarction |
|
fasting lipid profile test
|
- LDL >130
- cholesterol >200 - HDL <40 |
|
Serum Enzymes that indicate MI
|
1. lactate dehydrogenase (8x above normal)
2. troponin (I or T) (30x above normal) 3. creatine kinase (6x above normal) |
|
Chest sounds: gallop
|
- fast, soft rhythmic extra-sound mimicked by saying ken-tuc-ky or ten-nes-see
|
|
Chest sounds: murmur
|
soft blowing or rasping sound following the 1st or 2nd heart sound
|
|
rub
|
described as squeaky, screechy, or grating (pericarditis)
|
|
snap
|
sounds like the wind snapping a sail (mechanical valve replacement)
|
|
click
|
high pitched and relatively loud (valve replacement)
|
|
Thallium Stress Test
|
- nmi that assesses myocardial perfusion
- extent of coronary artery blockage - prognosis following MI - causes of chest pain - level of exercise patient can safely perform |
|
Thallium Stress Test: procedure
|
- stress test
- injection with thallium - immediate scan - delayed scan |
|
Ultrafast Computed Tomography
|
- noninvasive
- 3D view of heart at work - measures calcification of coronary vessels |
|
Holter Monitor
|
- portable ECG
- detects arrhythmias - find silent ischemia - see if arrythmia meds working -non-invasive - very reliable |
|
Echocardiography
|
- non-invasive
- finds if valves closed properly - finds hypertrophy of tissue |
|
Cardiac catheritization
|
- invasive
- monitors narrowing of vessels - ejection fraction - RA, RV pressure |
|
hypertension
|
- persistent elevation of systolic blood pressure over 140 mmHg or diastolic blood pressure over 90 mmHg
- measured 2 occasions, 2 wks apart |
|
Types of hypertension
|
1. primary hypertension (idiopathic, 90%)
2. secondary (identifiable cause, alcohol, renal, stress, etc.) 3. borderline - intermittent increase in BP mixed with normal readings |
|
risk factors for hypertension
|
- age older than 55
- ethnicity: african americans, hispanic - family history of cv disease - stress - smoking - DM - long-term alcohol use - high Na intake - obesity |
|
hypertension: clinical manifestations
|
- usually asymptomatic
- headache - occipital; worse on waking - vertigo - SOB |
|
hypertension: treatment
|
- increased activity
- reduction in Na+ - diruetics - vasodilators - ACE inhibitors - Ca channel blockers |
|
Mechanisms of atherosclerosis
|
1. injury to intimal layer
2. macrophages to site, collect LDL 3. migrate under intima; fatty streak 4. smooth muscle cells penetrate lining 5. plaque formation 6. cracks in wall as plaque enlarges 7. platelets stick |
|
Risk factors for ischemic heart disease: modifiable
|
1. smoking
2. hypercholesterolemia 3. HTN, DM 4. physical inactivity 5. obesity 6. Personality 7. excessive alcohol 8. elevated homocysteine 9. elevated C-reactive protein |
|
Risk factors for ischemic heart disease: non-modifiable
|
1. age
2. gender 3. ethnicity 4. family hx |
|
Defense for elevated homocysteine
|
1. Vitamin B12
2. Vitamin B6 3. Folic Acid |
|
Areas of body affected by atherosclerosis
|
1. brain
2. heart 3. kidney 4. aorta and/or visceral arteries |
|
Precipitating factors of angina
|
1. exposure to cold
2. heavy meals 3. exercise 4. emotion |
|
Types of angina
|
1. stable angina
2. unstable angina 3. prinzmetal angina 4. asymptomatic "silent" angina |
|
Stable Angina
|
- most common
- effort angina - relieved by rest, vasodilators - narrowed vessels can't deliver sufficient blood |
|
Unstable Angina
|
- crescendo angina
- unpredictable - pre-infarction angina - pain at rest - may predict imminent MI - symptoms longer than 15 min |
|
Prinzmetal angina
|
- variant (rest) angina
- cause: coronary spasm - intermittent pain at rest at night |
|
Stable Angina: clinical manifestations
|
-squeezing, burning, pressing
- substernal, C3-4 dermatome - 1-3 min, up to 20 min - relieved by rest, nitroglycerin - HR, BP elevated - EKG ST depression |
|
transmural MI
|
- necrosis transverses entire ventricular wall
- "Q wave infarction" |
|
subendocardial MI
|
- necrosis limited to 1/3 of ventricular wall
- problem with ST segment |
|
treatment for MI
|
- monitoring
- pharmacological -- thrombolytics -- anticoagulants - surgery --PTCA --coronary stents --CABG - stem cells |
|
PT considerations post MI
|
- monitoring
- post-surgical precautions - gentle exercise w/i 24 hrs - watch valsalva - watch hypotension 2nd meds - avoid tissue trauma-ac - avoid hot-tubs 6 wks |
|
peripheral vascular disease
|
- venous disorders
- arterial or occlusive disorders - vasomotor disorders - inflammatory disorders |
|
risk factors for PVD
|
- smoking
- trauma - previous DVT - DM - age > 60 - oral contraceptives, pregnancy, HRT - bed rest - air travel |
|
diagnosis of DVT
|
- Homan's sign + in 30% of cases
- Doppler ultrasound - contrast venography |
|
treatment for DVT
|
- medications; anti-coagulants, heparin, coumadin
- smoking cessation - elastic stockings - thromboectomy |
|
Arterial Disorders
|
- tissues not oxygenated
- ischemia - gangrene can develop - pulses poor or absent - intermittent claudiaction - pale Goal: inc O2 w/o inc demand |
|
Venous
|
- tissues oxygenated
- blood not moving-stasis - skin discolored - edema prominent - normal arterial pulses goal: create compressive pumping force to move fluid |
|
Raynaud's Disease
|
- intermittent small artery constriction
- pallor and cyanosis of digits - 2ndry to cold, strong emotion, anxiety - women>men |
|
Congestive Heart Failure
|
- heart unable to pump sufficient blood to meet needs
1. Left Heart Failure 2. Right Heart Failure "cor pulmonale" |
|
CHF: systolic dysfunction
|
dilated LV with impaired contractility
|
|
CHF: diastolic dysfunction
|
normal or intact LV with impaired ability to relax and receive blood
|
|
FACES
|
F - fatigue
A - altered activity C - congestion in chest E - edema S - short of breath |
|
NYHA Functional Classification
Class 1 Class 2 Class 3 Class 4 |
1 - no limitation of activity
2 - slight limitation of activity 3 - marked limitation of physical activity, comfortable at rest 4 - unable to carry on activity w/o discomfort at rest also |
|
Risk factors for CHF
|
- HTN
- pre-existing CAD - past MI - other heart diseases - obesity - pulmonary, renal disease - long-term NSAID use - Paget's disease |
|
Clinical Manifestations of LV failure
|
- progressive dyspnea
- paroxysmal nocturnal dyspnea - productive cough - fatigue - pulmonary edema - use of accessory breathing muscles |
|
Clinical Manifestations of RV failure
|
- dependent edema
- jugular vein distension - abdominal distension - weight gain - R upper quadrant pain (liver) - cyanosis |
|
Diagnosis for CHF
|
- clinical symptoms and signs
- echocardiogram - chest x-ray - elevated BNP - from ventricles in response to wall tension and pressure overload |
|
Treatment for CHF
|
- Na+ restriction
- pharmacological -- cardiac glycosides (digoxin, lanoxin) -- diuretics (furosemide, hydrodiuril, lasix) -- B blockers, ACE inhibitors, vasodilators |
|
dilated cardiomyopathy
|
- ventricular dilation
- impaired systolic function - diminished contractility - decreased EF - increased EDV - biventricular failure |
|
Dilated Cardiomyopathy: symptoms
|
- dyspnea
- fatigue - weakness - palipations - pulmonary emboli - HTN |
|
Dilated Cardiomyopathy: treatmnet
|
- salt restriction
- meds to inc contractility (Digoxin) - vasodilators - anticoagulants |
|
Hypertrophic Cardiomyopathy
|
- autosomal dominant
- thickening of interventricular septum - increased contractility - increased EF - angina, syncope, palpitations, dyspnea, exercise intolerance, left heart failure - treatment: B blockers |
|
Restrictive Cardiomyopathy
|
- infiltrative disease of myocardium
- rigid and noncompliant - increased filling pressures - rt heart failure - ex intolerance, dyspnea, fatigue, neck vein distention, peripheral edema - treat: heart transplant - death from failure or dysrhythmia |
|
Valvular Heart Disease: causes
|
congenital or rheumatic fever
|
|
VHD: types
|
1. stenosis: narrowing, does not open completely
2. insufficiency/regurgitation: does not close completely 3. prolapse: 50% mitral, shaped different, won't close completely, congenital |
|
Mitral Stenosis
|
cause: bacterial infection, rheumatic fever
severe: LA pressure inc, pulmonary congestion |
|
Mitral regurgitation
|
causes: bacteria, RF
- backflow of blood from LV into LA severe: LV hypertrophy - failure - pulmonary congestion |
|
Mitral valve prolapse
|
- benign
- floppy valve syndrome - blood leaks back into LA not significant - most asymptomatic - no significant tx |
|
aortic stenosis
|
cause: congenital
- most common valve lesion in US - dec peripheral pulse tx: balloon angiography or O.R. |
|
aortic regurgitation
|
- blood leaks back into LV during diastole
- dec cardiac output - ventricle dilates and hypertrophies - diastolic murmur |
|
Fetal Circulation/Post-natal circulation problems
|
- foramen ovale/ductus arteriosus
- murmur on auscultation - cyanosis (inc with crying) - high RR - dec ability to suck |
|
Ventricular Septal Defect
|
- most common heart defect
- blood shunts left to right - systolic murmur - usually discovered at first check-up - cardiac catheterization |
|
Atrial Septal Defect
|
- 2d most common defect
- systolic murmur and splitting of 2d sound - discovered by echo - surgery |
|
Patent Ductus Arteriosus
|
- prostaglandin PGE1 and dec O2 keeps it open
- assess: wide pulse pressure and continuous machinery murmur - prostaglandin inhibitor (indomethacin) |
|
Tetralogy of Fallot
|
1. VSD
2. ovveriding aorta 3. pulmonary valve stenosis 4. right ventricle hypertrophy |
|
Coarctation of the aorta
|
- stricture of aorta
- usually above ductus - inc pressure in upper body |
|
CoA: Assessment and Management
|
-headache
-HTN in UE, pounding pulse - weak or no femoral pulse - leg pain - left congestive heart failure - go in and open aorta |
|
Pulmonary Stenosis
|
- stricture of pulmonary artery and/or valve
- RVH - manage: PGE2 to open ductus or balloon angioplasty |
|
Transposition of the Great Arteries
|
- mixed defect
- blind end circulation - critical, life threatening, hypoxemia, cyanosis - open heart surgery to repair |
|
Rheumatic Fever
|
- strept throat, scarlet fever
- autoimmune to group A beta hemolytic streptococcus - inc in 6-15 year-olds - antibiotics, ASA, motrin, corticosteroids, phenobarbitol for chorea |
|
FEV1
|
forced expiratory volume in 1 second
|
|
status asthmaticus
|
dilator does not work, life threatening
|
|
Asthma: diagnosis
|
- history and physical exam
- allergy testing - dec FEV1 and FEV1/FVC ratio (<75%) - marked response to bronchodilator (15% change in FEV1) - dec FEV1 after exercise - inc eosinophil |
|
Acute Bronchitis: S/S
|
- dry, irritating cough
- wheezing - sore throat - malaise - mild fever - laryngitis |
|
risk factors for COPD
|
- genes
- exposure to particles - lung growth/development - oxidative stress - gender - age - respiratory infections - socioeconomic status - nutrition - comorbidities |
|
Chronic Bronchitis: S/S
|
- early stages: smokers cough
- frequent clearing of throat - dyspnea, prolonged expiration - dec exercise tolerance - cyanosis |
|
Blue Bloater
|
- cyanotic
- edematous - productive chronic cough - typical of chronic bronchitis - overweight |
|
Etiology of Emphysema
|
- environmental pollutants
- deficiency of alpha-1 antitrypsin - factors cause inflammatory response |
|
COPD: diagnosis
|
- symptoms progressive and persistent
- Hx of smoking - PFT changes (dec FEV1 & FEV1/FVC ratio <75% predicted) - dec O2 stats - chest x-rays, flattened diaphragm, inc pulmonary vascular markings, bullous lesions - alpha 1-antitrypsin in blood |
|
Emphysema/COPD: Treatmen
|
- smoking cessation
- bronchodilators - antibiotics for infections - O2 therapy - exercise training - surgery (LVRS, lung transplant, segment, lobe |
|
Cystic Fibrosis: Diagnosis
|
- genetic test
- positive sweat test (NaCl >60 mEq/liter) - pulmonary function tests - glucose tolerance test |
|
Cystic Fibrosis: Treatment
|
- proper diet
- vitamin supplement - replace pancreatic enzymes - remove pulmonary secretions - prompt treatment of pulmonary infections - gene therapy - prevent cross infection from Burkholderia Cepacia |
|
Maturation causes of RLD
|
1. abnormal lung development (hyaline membrane disease-respiratory distress syndrome)
2. normal aging |
|
Pulmonary causes of RLD
|
1. idiopathic pulmonary fibrosis
2. occupational lung disease 3. lung cancer 4. pleural effusion |
|
Cardiovascular causes of RLD
|
1. pulmonary edema
2. pulmonary emboli |
|
Neuromuscular causes of RLD
|
1. SCI
2. ALS 3. GBS 4. Myasthenia Gravis 5. muscular dystrophy |
|
Musculoskeletal causes of RLD
|
1. diaphragmatic paralysis
2. kyphosis of scoliosis 3. ankylosing spondylitis |
|
Other causes of RLD
|
1. pregnancy
2. obesity 3. trauma 4. burn 5. surgery 6. radiation Rx 7. drug-induced |
|
Pulmonary Fibrosis: S&S
|
- rapid, shallow respiratory pattern
- limited lung expansion - dry cough - exertional breathlessness - fine crackles on auscultation - digital clubbing |
|
Pulmonary Fibrosis: Diagnosis
|
- spirometry (dec TLC, pulmonary compliance, pCO2, impaired CO2 diffusing capacity)
- chest x-ray - CT scans - lung biopsy |
|
Pneumonia: Types
|
- aspiration pneumonia
- viral pneumonia - bacterial pneumonia - walking pneumonia - lobar pneumonia - bronchopneumonia |
|
Pneumonia: Tx
|
- anti-microbial agents
- rest and fluids - supp O2 - most cases resolve in 1-2 weeks - vaccine - 65 yo - deep breathing, coughing |