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177 Cards in this Set
- Front
- Back
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areas not subject to hyperplasia
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nerves, cardiac, skeletal muscle
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example of metaplasia
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smoking; ciliated columnar cells are injured, grow as stratified squamous for protection
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example of dysplasia
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varying cell sizes found in an abnormal pap smear of cervix, precursor to cancer
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mechanisms of cell injury (3)
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depletion of ATP, free radicals, disruption of intracellular Ca2
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describe autosomal dominant
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single affected allele, 50% chance passing on, delayed onset
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example of autosomal dominant disease
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huntington's
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describe autosomal recessive disorder
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affect only when both parents carry the gene, early onset, 1/4 chance of having it, 1/2 carriers, 1/4 non-effected
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example of autosomal recessive disease
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tay-sachs
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etiologies of iron-deficiency anemia (2)
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decreased Fe intake, blood loss
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manifestations of iron-deficiency anemia
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weakness, dyspnea, pallor, murmur, tachycardia, epithelial atrophy (smooth tongue, brittle hair/nails)
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etiologies of megablastic anemia (2)
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folic acid, B12 deficiencies
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etiology of pernicious anemia
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AI atrophic gastritis
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manifestations of pernicious anemia
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weakness, dyspnea, pallor, murmur, tachycardia, paresthesias, loss of vibratory senses
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describe aplastic anemia
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stem cell disorder, decrease in all blood cells ->pancytopenia
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acute pain episode
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exacerbation of sickle cell anemia; temp, stress, infection leads to tissue microinfarction
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primary polycythemia
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polycythemia vera; too many blood cells
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manifestations of primary polycythemia/ polycythemia vera
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plethoric, HTN, DVT, angina
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Hematocrit for polycythemia vera
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>55%
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etiologies of secondary polycythemia (2)
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chronic cardiopulmonary disease, high altitude
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pathophysiology of secondary polycythemia
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increased erythropoietin production
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mechanism of hemostasis
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vessel spasm, platelet plug formation, fibrin clot formation, clot retraction, clot dissolution
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normal platelet count
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150,000-450,000
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thrombocytosis platelet count
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>1,000,000
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thrombocytopenia platelet count
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<100,000
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etiologies of thrombocytosis (2)
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malignancies, splenectomy
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etiologis of thrombocytopenia (2)
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idiopathic, drug-induced
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manifestations of idiopathic thrombocytopenia purpura (ITP)
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petechiae, ecchymoses, prolonged PTT
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platelet count for ITP
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<20,000
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Type 1 hypersensitivity rxn
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IgE
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mediators of Type 1 rxn; IgE
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histamine, Ach, chemotactics, proteases
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result to histamine release
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vasodilation, lower BP, tachycardia, increased capillary permeability, swelling, edema
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result of Ach release
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bronchial contraction ->wheezing, SOB; vasodilation
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effects of proteases
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similar to histamine & Ach, but later in hypersensitivity rxn
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early/initial response; Type 1, IgE rxns
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5-30 min., subsides in 1 hr, histamine & Ach release
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secondary response; Type 1, IgE rxns
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2-8 hrs, mucosa swelling, mucous production, bronchospasm
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manifestations of systemic Type 1 rxns
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anaphylaxis; HTN, respiratory distress, GI cramping (mast cells), tachycardia, hives, pruritis, angioedema
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types of local/atopic Type 1 rxns
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rhinnitis (allergy), dermatitis/rash, asthma, food allergis
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Type 2 hypersensitivity rxn
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Ab mediated; IgG or IgM
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example of type 2 hypersensitivity rxn
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blood/Rh incompatibility
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Type 3 hypersensitivity rxn
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immune-complex disorder; insoluble Ab/Ag complexes are made and deposited
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etiologies of Type 3 rxns (4)
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virus/bacteria, IV drugs, foods, insect bites
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areas of Type 3 Ab/Ag complex deposits (4)
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vessels, kidneys, joints, heart
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examples of Type 3 rxn (3)
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serum sickness, penecillin allergy, insect venom
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manifestations of Type 3 rxns
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rash, lymphadenopathy, arthralgia
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Type 4 hypersensitivity rxn
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cell-mediated; T cells
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example of Type 4 rxn
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Tb test
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describe SLE
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Type 3 rxn; formation of large Ab/Ag immune complexes deposited and causing inflammatory response
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manifestations of SLE
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arthritis, butterfly facial rash, pericarditis, seizure, stroke
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etiologies of lupus-like disorder (2)
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drug-related; hydralazine, procanamide/prenestal
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Host vs. Graft
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cell-mediated type 4 rxn
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types of host vs. graft rxns (3)
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hyperacute, acute, chronic
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hyperacute host vs. graft
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min.-hrs; sometimes during surgery
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acute host vs. graft
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6 mos- yrs; depends on immunosuppressive therapy
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chronic host vs. graft
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slow, ongoing, gradual
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graft vs. host etiologies (2)
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bone marrow transplant, blood or blood product transfusions in immunocompromised
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manifestations of graft vs. host
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rash, bloody stool, nausea, jaundice
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3 enzymes needed for HIV
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reverse transcriptase, integrase, protease
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primary HIV infection/ "window period"
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Ab test - even w/ exposure to HIV, little/no symptoms
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Acute phase HIV
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HIV Ab +, N/V, h/a, fatigue, CD4 decline, 2-4 wks after exposure
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latent phase HIV
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~10 yrs; gradual drop in CD4 levels
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norm CD4 count
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800-1,000
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AIDS
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CD4 <200; and/or AIDS defining illness in conjuction w/HIV
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examples of AIDS-defining illnesses
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cervical cancer, HIV encephalopathy, herpes, Kaposi's sarcoma, non-hodgkin's lymphoma
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manifestations of AIDS
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HIV wasting syndrome, lymphadenopathy, opportunistic infectino
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examples of opportunistic infections (3)
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PCP, thrush, Tb
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HIV/AIDS typical progressors
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60-70%; transition to AIDS in 10-11 yrs.
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HIV/AIDS rapid progressors
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10-20%; develop AIDS in <5 yrs
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HIV/AIDS slow progressors
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5-10%; no CD4 dip, do not progress to AIDS in over 15 yrs
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category 1 AIDS CD4 count
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>500
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category 2 AIDS CD4 count
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200-499
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category 3 AIDS CD4 count
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<200
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category A HIV/AIDS
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no AIDS defining symptoms
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category B HIV/AIDS
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symptoms not AIDS-defining
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category C HIV/AIDS
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AIDS defining illness
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neutropenia neutrophil count
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<1500
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infectious mononucleosis
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insidious, 4-8 wk incubation; severe pharyngitis, fever, lymphadenopathy, splenomegaly
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AML
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80% of adult leukemia
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Dx of AML
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anemia, thrombocytopenia, marrow aspiration, huge # immature cells on blood smear
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manifestations of AML
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bone pain, w/l, easy bruising and bleeding, opportunistic infection
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ALL
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most commonly <15 y/o, high blast #, thick blood
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manifestations of ALL
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lymphadenopathy, malaise, hepatosplenomegaly, h/a, vomiting, seizure
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complication of ALL
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leukoblastic emboli
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CML
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all cell lines affected
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etiology of CML
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philadelphia chromosome
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manifestations of CML
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anemia, WBC>30,000, splenomegaly
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CLL
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men >60 y/o; affects B lymphocytes
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lymphoma
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tumor in secondary lymphatic organ (ex. spleen)
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risks for lymphoma
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herbicides, pesticides, EB virus
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stage 1 lymphoma
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infiltration of single lymph node
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stage 3 lymphoma
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+ lymph nodes on both sides of diaphragm
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stage 2 lymphoma
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2 adjacent lymph nodes affected, but not crossing diaphragmatic barrier
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stage 4 lymphoma
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disseminated
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risks for hodgkin's lymphoma
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immunosuppressed; HIV, organ transplant; peaks in 20's and 50's
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manifestations of hodgkin's lymphoma
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nontender rubbery lymph nodes in mediastina, dry cough/hack, w/l, splenomegaly, thrombocytosis, anemia, immunocompetence
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Dx of hodgkin's
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Reed-sternberg cells- double nucleated cells found
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manifestations of non-hodgkin's lymphoma
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painless, diffuse lymphadenopathy, GI symptoms, immunoincompetence, no hilar adenopathy
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multiple myeloma
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uncontrolled proliferation of plasma cells
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etiology of multiple myeloma
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agent orange
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characteristic of multiple myeloma
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increase in bence-jones proteins, increased blood viscosity
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manifestations of multiple myeloma
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bone pain, Fxs, hypercalcemia, raynaud's, neuropathy, HF
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bence-jones protein effects
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activates osteoclasts
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risks for atelectasis (3)
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immobility, post-op, anesthesia
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patho of atelectasis
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V<Q
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manifestations of atelectasis
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low-grade fever, tachypnea, tachycardia, crackles, dyspnea
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Dx atelectasis
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CXR
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etiologies of pneumonia (4)
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aspiration, inhalation of organisms, hematogenous spread, inhalation of chemical irritants
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types of CA pneumonia bugs (2)
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strep. pneumoniae, influenza
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types of HA/nosocomial pneumonia bugs (2)
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usually gram - bacteria, 90% bacterial; E.coli, staph. aureus (gram +)
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risk factors for pneumonia
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very young, very old, immunocompromised, lack of cough reflex, COPD, immobility, smoking, malnutrition, trach, NG
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patho of "typical"/bacterial pneumonia
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inflammation of alveoli, exudates form, consolidation begins, shunting, hypoxemia; V<Q
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"typical"/bacterial pneumonia manifestations
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sudden onset of fever, chills, pain, cough, purulent sputum (possibly bloody), elevated WBCs, pleuritic pain, <90% pulse ox.
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Dx of pneumonia
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CXR
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etiology of viral "atypical" pneumonia (3)
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influenza (most common), measles, chicken pox
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manifestations of viral/"atypical" pneumonia
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flu-like s/s, dry cough, h/a, fever, fatigue
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complications of pneumonia
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granulomas, cavitation of lungs, abscess formation, pleural effusion, bacteremia, viral pn. can lead to bacterial pn.
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risks for Tb (2)
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immunosuppression, crowded living spaces
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two pathways for Tb
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primary exposure to bacteria causes s/s, secondary rxn after having dormant lesion/Ghon's focus
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Tb skin test
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+ 2-3 wks after exposure
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manifestations of Tb
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productive cough >3 wks, fever, chils, night sweats, w/l, hemoptysis, dyspnea, consumption
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false + Tb skin test
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cross response to similar microbacteria
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false - Tb test
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immunocompromised people unable to mount an immune response
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characteristics of bronchogenic carcinoma (3)
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aggressive, locally invasive, highly metastatic
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small cell carcinoma
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clusters of highly malignant cells, early metastasis, rarely surgical; die 10-12 wks
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types of non-small cell carcinoma (3)
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squamous cell, adenocarcinoma, large-cell carcinoma
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squamous cell carcinoma
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most common in male smokers, usually early detection, causes hypercalcemia
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adenocarcinoma
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most common type of lung cancer; found in smokers but also common in nonsmokers and women; poor prognosis
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large-cell carcinoma
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in lung periphery, early distant metastisis, poor prognosis
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manifestations of bronchogenic carcinoma
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cough, DOE, wheezing, hemoptysis, dull chest pain, hoarseness
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restrictive disorders of the pleura (3)
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pleuritis, pleural effusion, pneumothorax
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etiology of pleuritis
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viral infections
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manifestations of pleuritis
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shallow breathing (b/c of pain), hypoventilation, unlateral chest pain, tachypnea, pleural friction rub
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causes for pleural effusion (4)
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hydrothorax, exudate/chylothorax, empyema/pus, hemothorax
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patho of hydrothorax
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change in hydrostatic (high) or oncotic (low) pressure favors movement of fluid out of capillaries into interstitial space
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patho of chylothorax
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impaired lymphatic drainage or increased capillary permeability causes collection of milky lymph in interstitial space
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manifestations of pleural effusion
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dull/flat percussion, diminished breath sounds, dyspnea, mild hypoxemia (PaO2 ~ 70)
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types of pneumothorax (2)
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spontaneous, traumatic
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risks for spontaneous pneumothorax (3)
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smoking, tall young male, lung diseases
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patho of spontaneous pneumothorax
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rupture of a bleb
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manifestations of spontaneous pneumothorax
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pain, tachypnea, dyspnea, tachycardia, inspiration lag, hyperresonance, diminished lung sounds
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etiologies of traumatic pneumothorax (3)
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chest trauma, needle aspiration, mechanical ventilation
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types of traumatic pneumothorax (2)
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open, tension
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cause of tension pneumothorax
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intrapleural pressure exceeds atmospheric pressure; ventilators
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manifestations of tension pneumothorax
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tracheal deviation, JVD, hypotension, tachycardia
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treatment of tension pneumothorax
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chest tube
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flail chest
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more than one broken rib causes free floating portions to move counter current to chest wall with breathing
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etiologies of asthma (2)
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hypersensitivity of tracheobronchial tree, exposure to inhaled/ingested irritants
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early response asthma (patho)
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10-20min; IgE + mast cells, degranulation of mast cells, chemical mediator release, bronchi restriction, mucous prod.
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late response asthma (patho)
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4-8hr; inflammatory cell migration, epithelial injury, secretion retention, airway obstruction and air trapping
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manifestations of asthma
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dyspnea, wheezing on expiration, dry cough, hyperinflation
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Dx of asthma (2)
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PEF, FEV1
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etiologies of chronic bronchitis (2)
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excessive mucous production; smoking, pollution
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patho of chronic bronchitis
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increase in number or size of goblet cells, inflammation, recuced cilia
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manifestation of chronic bronchitis
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BLUE BLOATERS; productive cough, recurrent respiratory infections, DOE, prolonged expiration, wheezing, crackles, hypercapnea (>50), hypoxemia (<60), increased erythropoietin ->polycythemia
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etiology of secondary pulmonary HTN
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PaO2 <55; vasoconstriction
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Cor Pulmonale
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R-sided HF
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manifestations of cor pulmonale
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peripheral edema, hepatomegaly, ascites
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emphysema
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abnormal enlargement of alveoli and ducts, alveolar wall destruction
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etiologies of emphysema (5)
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Alpha 1 antiprotease deficiency, smoking, aging, pollution, infections
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effects of A-1 antiprotease
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enzyme protects lungs from injury by proteases secreted from infectious microorganisms, causing destruction of elastic tissue
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check valve obstruction
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PINK PUFFERS
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manifestations of check valve obstruction
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pursed lip breathing, dyspnea, thin, barrel chest, diminished breath sounds
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patho of cystic fibrosis
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autosomal recessive disorder of chromosome 7; less CFTCR prod., decreased Cl tranport, increased reabsorption of Na/H2O, increased viscosity of secretions
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manifestations of cystic fibrosis
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increased Cl in sweat, obstruction of exocrine pancreas-> DM, respiratory infections, malabsorption, cough, barrel chest, clubbing, oily stool, steatorrhea, diarrhea, abdominal pain
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etiology of PE
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DVT movement
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risks for PE (2)
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immobility, ortho/gyno surgery
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Dx of PE (3)
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V/Q scan, spiral CT, inc. D-dimer
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manifestations of PE
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dyspnea, chest pain, hypoxia w/o hypercapnea, tachypnea, tachycardia, restlessness
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hypoventilation
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decreased V:Q
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etiologies of hypoventilation (3)
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narcotic/sedation OD, guillain-barre, muscular dystrophy
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manifestations of hypercapnic RF
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respiratory acidosis, vasodilation, IICP, h/a, conjuctiva hyperemia, coma
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etiology of shunting
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pulmonary edema, PE, lung diseases
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manifestations of shunting
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hypoxemia w/exercise, prolonged expiration (1:3-1:4), restlessness, combativeness, confusion, fatigue, tachycardia, HTN
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ARDS
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sudden, progressive respiratory failure w/damage and increased permeability to alveolar capillary membranes
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etiology of ARDS (3)
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lung injury/trauma, gram - sepsis, aspiration
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patho of ARDS
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damage to Type 2 alveolar cells, decreased surfactant production, stiff non-compliant lungs, formation of hyaline membrane
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manifestations of ARDS
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dyspnea, tachypnea, cough, restless, fine crackles, mild hypoxemia, respiratory alkalosis, pulmonary HTN
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complications of ARDS
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nosocomial pneumonia, barotrauma, stress ulcers, renal failure
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