Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
138 Cards in this Set
- Front
- Back
|
patho of HTN
|
unknown; multifactorial and plygenic (mutations in more than 1 gene)
increased ANS related to autonomic nervous system dysfunction increased activity of renin-angio system resistance to insulin |
|
|
Patho of Preeclempsia
|
Unknown
sensitivity to increase level of renin-angio-aldosterone activity ? related to placenta |
|
|
Patho of OHSS
ovarian hyperstimulation syndrome |
Hcg stimulate vascularization;
presentation is related to increaseed capillary permeability |
|
|
Patho of Gestational Diabetes
|
placenta secretes diabetogenic hormones (GH, Cortisol) and if pancreatic function not sufficient to overcome insulin resistance created by these hormones, develop GDM
|
|
|
Patho of Postpartum Depression
|
diagnostic tool: Edinburgh Depression scale
|
|
|
What are some characteristics of Malignant cells?
|
Automonous: independent from cellular controls
Transformed: changed from normal cell characteristics Anaplastic: "Poorly Differentiated" escape Senescence/aptosis: Don't get old and die Altered Cell-surface properties Lack density dependent inhibition of growth Low growth factor requirements May produce tumor marker cells |
|
|
What does Anaplastic mean?
|
Poorly differentiated
this is a characteristic of malignant cells |
|
|
give examples of the altered cell surfaces of malignant cells
|
loss of cohesiveness and adhesiveness
Impaired intercellular communication (Gap junctions) |
|
|
What does "contact inhibition" mean
|
the property of normal cells to slow own growth; malignant cells lack this
|
|
|
What are Tumor Suppressor Genes?
|
Code for protiens that inhibit cell growth
|
|
|
Give some examples of Tummor Suppressor Genes
|
Rb Gene (chr 13)
APC gene (colon CA) tp53 gene (chr 17); a variety of CA BRCA1, BRCA2 (Breast and ovarian Ca) |
|
|
why is Retinoblastoma the classice "two hit" model of carcinogenesis?
|
The TSG behaves as recessive (only one normal allele needed for tumor suppression to continue)
Need to hit (mutation on both alleles) to develop the tumor |
|
|
What are proto- oncogenes?
|
Encode protiens that control cell growth and differentiation.
when mutated, they may become oncogenes that lead to the deregulation of cell cycle control and tumor formation |
|
|
are proto-oncogenes recessive or dominant?
|
Behave as dominant; so if have one defective alelle, are presisposed to tumor formation
|
|
|
What are mutated prooncogenes called?
|
c-onc (cellular oncogenes)
|
|
|
are oncogene mutations germline or somatic?
|
mostly somatic;
|
|
|
Give an example of c-onc Activation
|
Philadelphia Chromosome: translocation b.t chr 9 and 22
activates the abl proto-oncogene and produces CML |
|
|
Give examples of C-onc
|
H-RAS
Nmyc RET |
|
|
Explain the Immune Surveillance theory
|
Healthy immune system can resist cancer; all immune cells and antibodies can participate
|
|
|
Give evidence to support the Immune surveillance theory
|
evidence of tumor specific antigens (immune system recognizes cancer cells as non-self)
Immunosuppressed people have increased cancer risk Immunotherapy has been successful *HIV patients die of Lympnoma* |
|
|
What is Cancer Cachexia?
|
weight loss and wasting of body fat and muscle tissue
profound weakness, anorexia, and anemia |
|
|
What is the cause of Cancer Cachexia?
|
Multifactorial:
Cytokines (ie TNF): early satiety suppression of enz. for fatty acid metabolism pro-inflammatory |
|
|
What is the most common cause of cancer related death?
|
Cancer Cachexia
|
|
|
List the clinical manifestations of cancer
|
Disruption of tissue integrity
cancer cachexia paraneoplastic syndromes Impaired immune and heme functions Pain, motor and sensory deficits Disruption of organ functions due to circulatory compression |
|
|
What is the mechanism of action of v-onc (oncogenic viruses)
|
Insertional mutagenensis: viral genes inserted into host gene and stimulate cell transformation
may act by impairing immune surveillance |
|
|
what is a common oncogenic virus?
|
retrovirus
|
|
|
what is the car-cancer analogy?
|
Proto-oncogenes: mutations jam on the accelerator
Tumor suppressor Genes: Mutations cause brakes to fail |
|
|
What are the 2 parts of the ANS (autonomic Nervous System)
|
1. Sympathetic "Fight or Flight"
2. Parasympathetic: maintanence of organ function (ie digestion) |
|
|
What is the Falx Cerebri?
|
Separates the Left and rigth hemispheres of the brain
|
|
|
Where does Ach work?
|
Preganglionic neurons in parasympathetic and sympathetic Nervous system
* All preganglionic action in the sympathetic nervous system is Ach Neuromuscular junctions (motor end plates) Goes to Adrenal Medulla and puts out Epi |
|
|
What is the only neurotransmitter involved in muscle contraction?
|
Ach
|
|
|
Do Epi and Norepi act in preanglionic or postganglionic synapses of sympathetic or parasympathetic nervous system?
|
postganglionic neurons in sympathetic nervous system
|
|
|
What is Diffuse Axonal Injury (DAI)
|
brain injury that involves shaking/ sheering; no bleed
|
|
|
what is the GCS score in moderate DAI?
|
4-8; may have permanent defecits
|
|
|
what are the 4 types of Focal lesions in Traumatic Brain Injury?
|
1. Contusions and Hemorrhages
2. Epidural Hematoma 3. Subdural Hematoma 4. Intracerebral Hematoma |
|
|
In focal Traumatic Brain injury, what is the time for loss of consciousness and GCS scoring?
|
LOC> 6 hours
mild 13-25 moderate 9-12 severe 3-8 |
|
|
Which type of brain injury is Post-concussion syndrome seen in?
|
Multifocal (diffuse) brain injury
LOC< 6 hours S/S: HA Visual disturbances, Depression *Common in Football players |
|
|
What is the Patho of MS
|
Demyelination on white matter of brain and spinal cord; sclerotic plaques form
Autoimmune response |
|
|
What is the Patho of Huntington's disease?
|
Destruction of cerebral cortex and basal ganglia
Autosomal Dominant; Huntington protien causes nerve damage S/S: jerky invol. movements, hallucinations, cognitive decline |
|
|
What is the Patho of ALS?
|
Destruction of Lateral Horn Cells and pyramidal tracts
ie Loe Gehrig's Disease |
|
|
What is the Patho of Parkinson's Disease?
|
Degeneration of Basal Ganglial Cells with decrease secretion of dopamine
Genetic predispostion |
|
|
What are the S/S of Parkinson's Disease?
|
Tremors, rigidity, bradykinetics, rigid facial expression
|
|
|
What are some characteristics of dimentia?
|
Insidious onset
Primary defect is in short term memory Attention is normal Does not fluctuate during day visual hallucinations less common than with Delirium |
|
|
What are Deterministic mutations in relation to alzheimer's Dis.?
|
Very rare
these mutations mean you will get the disease and usually at an early age amyloid Precursor Protein (APP) Presenilin 1 and 2 |
|
|
What is a susceptibility polymorphism in relation to Alzheimer's Disease
|
mutation in the ApoE gene; have risk of getting the disease
Homozygous: 15 -fold increased risk Heterozygous: 3- fold increased risk |
|
|
What is FAD
|
Familial Alzhiemer's Disease; have ApoE mutation
|
|
|
What is DAT?
|
Dimentia of Alzheimer's Type: cortical (frontal and temporal lobes)
|
|
|
What is the patho of alzheimer's
|
Senile plaques and neurofibrillatory tangles= degenerated nerve endings and axons, abnormal amyloid deposition
Can't Cure but can stop the progression |
|
|
What are the cardinal signs of IICP?
|
Bradycardia
widened pulse pressure respiratory changes (often depression) Posturing: decorticate or decerebrate Papilledema: |
|
|
What are the 3 things that are involved in cerebral hemodynamics?
|
Cerebral Blood Volume
Cerebral Blood Flow Cerebral Perfusion Pressure |
|
|
What 3 things does cerebral oxygenation depend on?
|
Cerebral Blood Volume
Cerebral Blood Flow Cerebral perfusion Pressure |
|
|
What determines ICP?
|
Pressure-volume relationship among the brain tissue, CSF, and blood in the intracranial cavity
|
|
|
What are the 3 types of Coma?
|
1. "cerebral death" (Homeostatic mechanisms intact)
2. PVS: Persistent Vegetative state 3. "minimally conscious state" |
|
|
What are the characteristics of Vegetative State
|
Absense of awareness of self and environment
Inability to interact with ithers Absence of voluntary behavioral responses Lack of Language comprehension Hypothalamic and Brain stem function to maintain life Bowel and Bladder Incontinencs Some preserved cranial nerve and spinal cord reflexes Condition has cont'd for at least 1 month |
|
|
What are the characteristics of Brain Death?
|
No response to light, noise, motion, and pain
nor reflexes no spontaneous respirations no cranial nerve reflexes (fixed pupils) EEG isoelectric Protocol at Hospital may vary |
|
|
What is Hydrocephalus?
|
Damage to the flow or absorption of CSF
"water on the brain" |
|
|
What are the 2 type of Hydrocephalus
|
Noncommunicating (congenital): Fld is blocked and cannot be reabsorbed
Communicating (Acquired): Fld is flowing, but still unable to be reabsorbed |
|
|
What is communicationg Hydrocephalus and give an example of it
|
Acquired
Fluid is flowing, but cannot be reabsorbed Meningitis Subarachnoid Hemorrhage Neoplasia |
|
|
What is Normal Pressure Hydrocephalus (NPH)?
|
The increased CSF cause ventricles to enlarge, but may not cause IICP
occurs in adults over 60 and in as many as 10% of all patients with symptoms of dementia Can be seen on CT may not have IICP / symptoms |
|
|
What are the S/S of Myasthenia Gravis
|
increased weakness of facial and extraocular muscles (ptosis, ocular palsy, diplopia)
Autoimmune; Caused by antibodies destroying Ach receptor sites so no muscle contraction can occur |
|
|
What is the patho/ cause of Myasthenia Gravis?
|
Autoimmune disease
Ach receptors at neuromuscular junctions are destroyed Thymus Gland Tumor or thymic Abnormalty |
|
|
What is the patho in GuillianeBarre Syndrome?
|
Autoimmune response to a viral/bacterial infection
demyelinization occurs in the distal nerves and ascends symmetrically Re-myelinization occurs proximal to distal |
|
|
What is a myelomeningocele Neuro tube defects?
|
spinal cord is herniated out of the area
nerves can't be restored child has SCI like affects |
|
|
What is Meningocele NTD?
|
cyst outside of spinal cord, but the nerves are not in it, so the sac/cyst can be removed
Better prognosis than for myelomeningocele NTD b/c the spinal cord is intact |
|
|
What is Spina Bifida Occulta?
|
NTD with small tuft of hair on outside of spinal cord
|
|
|
What is cause of Spinal Tube injury?
|
Low Folic Acid
Women with specific genetic metabolic enzyme defect detected by increased alpha Fetal Protein in utero |
|
|
What is Arnold Chiari I and II malformation?
|
Associated with spina bifida
parts of brain projecting below the foramen magnum caused Hydrocephalus |
|
|
What are Biological Response Modifiers?
|
Used in Cancer therapy
Cytokines (ie interferons) Monoclonal Antibodies Hematopoietic Growth |
|
|
How do Cytokines (like Interferons) work as Biological response modifiers?
|
Antiviral
Inhibition of tumor Growth Enhance NK Cell activity |
|
|
Give some examples of Hematopoietic growth factors
|
G-CSF
EPO Thrombopoietin these are biological response modifiers |
|
|
Give some examples of immunotherapy in the treatment of Cancer
|
Immunostimulating Agents: BCG (Tb Vaccine) injected into the tumor
|
|
|
What are paraneoplastic syndromes and give some examples
|
alterations produces in tissue remote from a tumor or its metastases
Endocrine: tumor secretes ectopic hormones; ADH-- fluid retention Neurologic: antibodies prod. inresponse to tumor damage neural tissue Hematologic: DIC Renal: Immune complexes settle in glomular basement membrane |
|
|
Name the classes of chemotherapy Drugs
|
Antimetabolites
Antitumor antibodies Alkylating Agents Antimitotic Agents *combination is the rule* |
|
|
Name some examples of Hormone Therapy in treating cancer
|
Tamoxifen: Breast Ca
Lupron: Prostate Ca Corticosteroids n many types of Ca |
|
|
What are Unbound hormones?
|
Water soluble hormones
required Plasma cell membrane receptors to get through cell membrane |
|
|
Is insulin a bound or unbound hormone?
|
Unbound
|
|
|
What are Bound Hormones?
|
Lipid Soluble Hormones
bound to transport carriers in bloodstream can diffuse through cell membrane b/c are small and hydrophobic Use Intracellular Receptors |
|
|
What Hormones use intracellular receptors, bound or unbound
|
Bound
|
|
|
Gvie some examples of Bound hormones
|
Steroids and Thyroid Hormones
|
|
|
What are the 3 mechanisms of hormone regulation?
|
1. Receptor Modulation
2. Negative Feedback 3. Neural Regulation of Hormonal Acitivity |
|
|
What mechanism is most common in hormone regulation
|
Negative feedback
|
|
|
What are the 2 types of receptor modulation in hormone regulation?
|
1. Up- Regulation: when low concentration of a hormone increase the number of receptors per cell
2. Down regulation: when high concentrations of a hormone, decrease the number of receptors per cell |
|
|
Give an example of Negative feedback hormone regulation
|
Hypothalamic-Hypophyseal-adreanl axis
Hypothalamus secretes CRH and Ant. Pituitary secretes ACTH and Adrenal Cortex Secretes Cortisol Corticol inhibits the further production of ACTH |
|
|
What is SIADH
|
Syndrome of Inapropriate ADH
ADH is secreted by posterior pituitary Gland causes 1. Ectopic secretion of ADH by paraneoplastic tumor 2. Post-op crani/pituitary surgery 3. Meds: antidepressants, anesthetics, barbituates S/S: Hyponatremia |
|
|
What is Neurogenic DI
|
Decreased Synthesis of ADH by Posterior Pituitray Gland
Multiple Causes: infection, head injury cancer, hereditary |
|
|
What is Nephrogenic DI?
|
Failure of nephrom to respond to ADH
|
|
|
What is the treatment for DI?
|
Vasopressin (Pitressin) or DDAVP (desmopressin)
|
|
|
What is the most common Anterior Pituitary Disorder?
|
Hyperprolactinemia
treat with drugs that stimulate dopamine receptor in the brain |
|
|
List Hormones secreted by Anterior Pituitary Gland
|
Growth Hormone
TSH Prolactin ACTH LH FSH |
|
|
List the hormones secreted by the Adrenal Cortex
|
Androgens
Mineralcorticoids (Aldosterone) Glucocorticoids (Cortisol) |
|
|
What is "Primary" Adrenal Insufficiency?
|
Addison's Disease
all 3 layer of adrenal gland are destroyed Char. by elevated ACTH (there is no cortisol to give negative feedback and stop ACTH secretion) |
|
|
What is "Secondary" Adrenal Insuffisciency?
|
Iatrogenic
Rapid withdrawal of glucocorticoids Adrenalectomy |
|
|
What is Cushing's Disease?
|
Hypercortisolism; Excessive ACTH from pituitary
Primary: problem with adrenal gland Secondary: pituitary adenoma |
|
|
What is Cushing Syndrome?
|
Chronic hyperfunction of adrenal cortex (too much steroids)
|
|
|
What are S/S of Cushing Syndrome?
|
Weight gain, moon face, Buffalo Hump, glucose intolerance, poor wound healing
|
|
|
List the 4 types of Anemia
|
Hemorrhagic
Hemolytic Decreased RBC production Anemia Hemodilution Anemia |
|
|
What is Pernicious Anemia?
|
Anemia due to deficiency in B12 (Cyanobalamine); usually poor absorption
|
|
|
What kind of RBC's do you see in pernicious anemia?
|
macrocytic, normochromic
B12 deficiency anemia Large, ineffective cells |
|
|
Name the 3 types of anemia due to deficient essential factors
|
Pernisious (B12--Cyanobalamine)
Folic Acid Deficiency (needed for synthesis of RBCs) Iron Deficiency |
|
|
What drug can cause Iron deficiency anemia
|
some drugs can inhibit absorption
ie Dilantin |
|
|
What type of cell due you see in Iron deficiency?
|
Microcytic, hypochromic
|
|
|
Name the types of Hemolytic Anemias
|
RBC cell membrane Deficits (hereditary spherocytosis)
Immunohemolytic anemia (autoimmune) Hemolytic Blood transfusion anemia Hemoglobinopathies (Sickle-cell anemia, thalassemia) |
|
|
What are the clinical manifestations of hemolytic anemias?
|
hemoglobinemia, hemoglobinuria
jaundice, Hypercactive Bone Marrow -skeletal abnormalties |
|
|
What is Aplastic Anemia
|
anemia due to decreased RBC producction b/c of defective bone marrow
|
|
|
What kind of cell do you see in aplastic anemia?
|
Macro or normocytic and normorchromic
|
|
|
What are the 3 kinds of Aplastic Anemia
|
Idiopathic (?autoimmune)
Acquired: chemo, radiation EBV, RF Hereditary: Fanconi Anemia |
|
|
Whcih type of anemia due you see pancytopenia with?
|
Aplastic anemia
Bone Marrow not functioning -loss of pluripotent stem cells |
|
|
What type of anemia is Fanconi Anemia?
|
Aplastic Hereditary Anemia
-BM not functioning |
|
|
What anemia is Hand-Foot syndrome related to?
|
Sickle Cell Anemia
(ie Dactylitis) sweeling of hands and feet occurs 6 mo- 2 yrs |
|
|
What is the patho of Sickle cell anemia?
|
autosomal recessive disorder
nucleotiddes code for Valine instead of Glutanic acid Valine makes HbS instead of HbA |
|
|
What is the treatment goal for Sickle cell anemia?
|
keep hydrated and minimized hypoxia
PCN prophylaxis Analgesic for pain Blood transfusion BMT |
|
|
What is multiple Myeloma?
|
Plasma cell Neoplasm
median age 70 antibodies secreted by mutated plasma cellls cause osteolytic bone lesions |
|
|
What are the 4 types of WBC disorders
|
Neutrophilia
Neutropenia (<15) Lumphocytosis Malignancies |
|
|
What are Bence-Jones proteins?
|
Proteins prod. in multiple myeloma by the malignant plasma cells
they have light chains that are detectable in the blood |
|
|
What are "M protiens"
|
mononuclear antibodies prod. by plasma cells in Multiple Myeloma (either IgG or IgA)
|
|
|
What are MMPs in relation to multiple myeloma?
|
Matrix-metalloprotienase; enzymes that cause osteolytic bone lesions
|
|
|
What are the stages of Hogdkin's Disease?
|
Stage I: single lymph node region
Stage II: 2 or more lymph node regions on same side of diaphragm Stage III: Lymph node regions on both sides of diaphragm are involved Stage IV: multiple foci of invlvement of oneor more extralymphatic organs or tissues |
|
|
What are Reed-Sternberg cells?
|
seen in Hodgkin's Lymphoma
giant multinucleated lymphocytes |
|
|
Whichhas high cure rate NHD or HD
|
HD
|
|
|
Which lymphocytes are involved in Non-Hodgkin's Lymphoma
|
can be T cell or B cell
80% B cell treatment depends on whcih cell is involved |
|
|
What is the patho of HIT
|
Heparin Induced Thrombcytopenia
IgG recognizes Heparin and platelet Factor 4 and causes: 1. platelet aggregation and removal from circulation 2. Clotting as antibodies bind to vessel walls Both lead to DVT, PE, arterial Emboli |
|
|
What is the other name for DIC
|
"Consumptive Thrombohemorhagic Disorder"
|
|
|
What is the initiating factor in DIC
|
Endothelial damage (Extrinsic)
or Tissue injury (Intrinsic) Thrombin and Plasmin are activated |
|
|
what are some causes of DIC?
|
Extrinsic: Trauma, sepsis, acidosis, burns, hypoxia, Gram negative sepsis, shock, vasculitis
Intrinsic: Ob complications, Cancer |
|
|
What is the patho of Rett Syndrome
|
X-LInked Dominant neurodevelopmental disorder
mutation on X chromosome missing MECP2 protein that regulates genes in brain development |
|
|
What is the patho of graft vs host disease?
|
Donor tissue attacks the recipient's body
CD8 and CD4 cells attack the host b/c seen as "foreign" |
|
|
What is the Patho of Cushing's Syndrome?
|
Hypercortisolism
Cortisol is prod. by adrenal glands in response to ACTH |
|
|
What is the most common cause of Cushing Syndrome
|
Excess glucocorticoid meds (steroids)
lab values willshow a high corticol level and decreased ACTH b/c of the neg. feedback mechanism |
|
|
How is the degree of DKA measured
|
the pH
pH< 7.3 for diagnosis |
|
|
what is the patho of Guilliane-Barre Syndrome?
|
rare temporary inflammation of the nerves causing weakness and numbness
Acute Inflammatory Demyelinating Polyneruopathy (AIDP) usually triggered by acute infectious proscess Starts in extremities |
|
|
What are the Thyroid Hormones?
|
T4 and T3: control rates of metabolism
Calcitonin: decreases serum calcium |
|
|
What is Grave's Disease?
|
Excess Thyroid Hormone
Autoimmune Hypermetabolism, exopthalamus, goiter |
|
|
What is Thyroid Storm?
|
Life threatening excess Thyroid hormone
increased HR, fever, agitation, confusion |
|
|
What is Cretenism?
|
Autosomal Recessive Disorder; Hypothyroidism
congenital defect in thyroid hormone biosynthesis |
|
|
What is Hashimoto's Disease?
|
Hypothyroidism
caused by autoimmune destruction, iodine deficiency, Iatrogenic |
|
|
What is Myxedema Coma?
|
occurs if hypothyroidism goes untreated
"mucinous edema" hypothermia Progressive respiratory depression high mortality rate |
|
|
What is Syndrome X?
|
Insulin Resistance syndrome:
central obesity high blood pressure high triglycerides |
|
|
What is HHNK
|
Hyperglycemic Hyperosmolar Nonketotic Syndrome:
occurs mostly in type 2 diabetics, usually have concurrent illness (GI bug) Profound dehydration Glucose > 600 Serum Osmolarity > 310 70% mortality rate b/c there is other organ dysfunction too |
