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691 Cards in this Set
- Front
- Back
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Atrophy
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Decrease/shrinkage in cellular size
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Hypertrophy
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Increase in size of cells or organ
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Hyperplasia
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Increase in number of cells
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Metaplasia
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Reversible replacement of one mature cell type by another cell type
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Dysplasia
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Abnormal changes in size, shape, and organization of mature cells (cervical cancer)
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Mechanisms of Cell Injury
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1. Defects in membrane permeability. 2. ATP Depletion: no energy. 3. Increases in intracellular calcium --> Activate enzymes that attack cell membrane. 4. Free radicals; Highly reactive, disrupts pathways
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Hypoxia
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Decrease in oxygen to cells
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Apoptosis
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Programmed Cell Death
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5 types of Necrosis
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Coagulative; Liquefactive; caseous; fat; gangrenous
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Coagulative Necrosis
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Denaturation of proteins from gel to firm state; kidney
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liquefactive necrosis
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typically affect neurons/glial cells in the brain; cells digested by their own hydrolases, tissue becomes soft
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caseous necrosis
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combination of coagulative and liquefactive
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fat
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caused by lipases - breast, pancreas, abdominal structures
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Gangrenous necrosis
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severe arteriosclerosis or blockage of major arteries
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What are nociceptors?
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Free nerve endings that respond to chemical, mechanical, thermal stimuli
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Where are nociceptors found?
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Under epidermis; within joint and bone surfaces; deep tissues; muscles; tendons; subcutaneous tissue
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Specificity Theory of Pain
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The intensity of pain is directly related to the amount of associated injury
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What is costochondritis?
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Inflammation of the cartilage connecting a rib to the sternum
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S/sx costochondritis
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Sharp pain at connection of ribs to sternum; can mimic heart attack
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Causes of costochondritis
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usually unknown; trauma?
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Tx for costochondritis
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anti-inflammatory drugs
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What is angina pectoris?
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Chest pain caused by reversible myocardial ischemia
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s/sx angina pectoris
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sudden, severe chest pain that lasts for 3-5 minutes; pressure/squeezing; fatigue, nausea, shortness of breath
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causes of angina pectoris
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cardiovascular disease; anemias
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tx for angina pectoris
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rest; nitrates to dilate arteries and veins
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Tests for angina pectoris
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EKG may be normal; stress test; coronary angiography and cardiac catheterization; CBC: Increase cholesterol, increase CRP, anemia
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What two tests determine inflammation somewhere in the body?
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CRP (C-Reactive Protein) and ESR (Erythrocyte Sedimentation Rate)
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What is a myocardial infarction?
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Progressive ischemia with damage to myocardium
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What are the two types of myocardial infarction?
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Subendocardial; Transmural
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What is a subendocardial MI?
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Thrombus dislodges and only myocardium directly beneath endocardium involved
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What is a transmural MI?
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Thrombus remains and myocardium involved transcends to epicardium
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S/Sx MI
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dyspnea; sudden, severe chest pain with radiation; n/v; anxiety; dizziness; cough; diaphoresis
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causes of MI
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cardiovascular disease
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Tx for MI
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angioplasty within 90 minutes; thrombolytic therapy within 3 hours; cardioprotection after MI - betablockers block sympathetic innervation; ACE inhibitors
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Tests for MI
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EKG: STEMI or nonSTEMI
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What does a STEMI EKG indicate?
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Transmural MI
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What does a nonSTEMI EKG indicate?
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subendocardial MI
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What does this ECG indicate?
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//fce-study.netdna-ssl.com/2/images/upload-flashcards/89/28/66/4892866_m.jpg STEMI - transmural MI
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What does this ECG indicate?
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//fce-study.netdna-ssl.com/2/images/upload-flashcards/89/28/69/4892869_m.jpg NonSTEMI - subendocardial
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Testing for MI
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initial decrease in BP; SNS reflexively activates, temporary increase in HR and BP; Abnormal extra heart sounds - LV dysfunction; pulmonary congestion
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What is pancreatitis?
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acute and chronic inflammation of the pancreas
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Causes of pancreatitis
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alcoholism; cholelithiasis; trauma; cystic fibrosis; pancreatic duct or CBD is clogged and enzymes begin to attack
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S/sx pancreatitis?
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epigastric pain - back; N/V; fever; tachycardia; hypotension
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testing for pancreatitis?
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Enzymes - amylase, lipase; blood test - hyperglycemia?; CT
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what is Cholecystitis
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Inflammation of Gallbladder
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Causes of cholecystitis?
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female; overweight/obese; reproductive age, 40s.
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S/sx cholecystitis?
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RUQ pain - R lower shoulder blade referred; N/V, fever, chills
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Testing for cholecystitis
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Positive murphy's sign; US, CT; ^ amylase and lipase
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Tx for pancreatitis?
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Surgery
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What is appendicitis?
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inflammation of appendix
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S/sx of appendicitis?
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abd pain RLQ; perforation - peritonitis/sepsis; intestinal ileus - blockage
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Testing for appendicitis
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CBC - ^ WBC; CT, US; X-Ray, may see fecalith
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Tx for appendicitis?
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Surgery
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What is Peritonitis?
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Inflammation of serosa and organs
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Causes of peritonitis?
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Infection --> perforation of bowel, appendix, ulcer (gastric acid), pelvis, malignancy trauma, pancreatitis
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S/sx peritonitis
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abdominal pain; infection symptoms like fever, tachycardia; dehydration --> shock; rigid abdomen; inflammation
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Testing for peritonitis?
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CBC, UA, Amylase/lipase, BC, CT
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What is nephrolithiasis?
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Kidney stones
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Causes of nephrolithiasis?
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Dehydration, abnormal calcium metabolism, hypercalciuria, prolonged immobilization
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S/sx nephrolithiasis
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Flank or abdominal pain, N/V, dysuria, hematuria
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Testing for Nephrolithiasis?
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UA, CT, X-Ray of abdomen; renal function; calcium: parathyroid hormone
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What are ovarian cysts?
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fluid filled sacs
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Causes of ovarian cysts
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hormone imbalance; prior ocyst; BC pills reduce chances
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S/sx ovarian cysts
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usually no pain; lower abd or pelvic pain; lower abd or pelvic fullness or pressure sensation; pain may indicate rupture
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Testing for ovarian cysts
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US
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Tx for ovarian cysts
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usually resolve on their own; anti-inflammatories; pain meds; surgery
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What is Testicular torsion
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Twisting of spermatic cord
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Causes testicular torsion
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trauma, sports, exercise
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s/sx testicular torsion
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unilateral acute onset pain; swelling, N/V
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Testing for testicular torsion
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doppler US
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Tx for testicular Torsion
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within 6 hours to preserve normal testicular function; manually de-torse; surgery, suture for future prevention
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What is gout?
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uric acid crystal deposition
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Causes of gout?
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increase uric acid; obesity
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s/sx gout
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painful joint inflammation (big toe); typically attacks one joint at a time; kidney stones are more frequent
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Testing for gout
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Rheumatoid factor to rule out RA; arthrocentisis - joint aspiration; X-ray
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Tx for gout
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diet changes, anti-inflammatories; drugs to reduce uric acid; surgery is rare
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what is osteoarthritis?
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degeneration of cartilage; wear and tear
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causes of osteoarthritis
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age, overweight, overuse are secondary to trauma; articular cartilage is lost
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s/sx osteoarthritis
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pain: most common hands, wrists, knees, feet; morning stiffness; pain increases with use and decreases with rest
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testing for osteoarthritis
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DDX blood test: RF; S-ray; Synovial fluid aspiration
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Tx for osteoarthritis
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rest; PT to help maintain ROM; anti-inflammatories; chondroitin and glucosamine
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what is osteopenia/osteoporosis
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reduction in bone mass
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Causes of osteopenia/osteoporosis
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age, malignancy, hormonal - estrogen and hyperparathyroidism; chronic renal failure
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S/sx osteopenia/osteoporosis
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compression fractures
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testing osteopenia/osteoporosis
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bone density scans and x-rays
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Tx osteopenia/osteoporosis
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exercise; calcium and vit. D supplements; hormone replacement
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Osteopenia bone density?
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between -1 and -2.5
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What is Rheumatoid arthritis?
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Autoimmune joint inflammation
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Causes of RA?
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F>M, age, hereditary, smoking
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S/sx RA
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inflamed joints; decreased motor strength; fever, fatigue, pericarditis, effusion, pulmonary effusion, scleritis, morning stiffness
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Testing for RA
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^ ESR and ^ CRP, CBC, RF, S-ray
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Tx RA
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no cure; decrease inflammation and pain
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What is sciatica
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sciatic nerve pain with radiation
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causes of sciatica
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nerve compression
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s/sx sciatica
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radiation of pain from lower back to buttock to lower leg; neuropathies, parasthesias; loss of bladder and bowel control
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testing for sciatica
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X-ray, CT, MRI
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what is Osteomyelitis
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infection of the muscle and bone
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causes of osteomyelitis
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infection, DM patients
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S/sx osteomyelitis
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localized to systemic infection with skin ulceration; bone and joint pain
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testing for osteomyelitis
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blood test - ^ WBCs ^ CRP, BC, X-Ray, CT, Bone scan
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Tx for osteomyelitis
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antibiotics; surgical debridement; amputate
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What is cellulitis?
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bacterial skin infection
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Causes of celulitis
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staph; strep; injury; dermatitis; insect bites; DM; edema; fungal infections; IV Drug use
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S/sx cellulitis
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usually seen in lower legs; signs of infection
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testing for cellulitis
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c&s
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acute gout is associated with which lab finding?
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hyperuremia (hyperuricemia)
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Total body water =
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ICF + ECF
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What is ICF?
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all fluids within cells
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What is ECF?
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interstitial + intravascular + misc.
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what is blood plasma?
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liquid portion of blood, no cells
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What is edema?
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excessive accumulation of fluid in the interstitial spaces
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causes of edema?
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1. venous obstruction - Increases capillary hydrostatic pressure. 2. loss of albumin - decreases plasma oncotic pressure. 3. Increase in capillary permeability - allows leakage into IS spaces (Shock, allergies)
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What is ascites?
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Accumulation of protein-containing fluid in peritoneal space; portal HTN
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What are the hormones that regulate fluid balance?
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ADH - ↓ water loss; Aldosterone - reabsorb Na, excrete K; ANP, BNP - stimulate renal elimination of Na+
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↑ Aldosterone = ??
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Increase BP
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↑ ADH = ??
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Increase BP
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↑ ANP = ??
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Decrease BP
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↑ BNP = ??
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Decrease BP
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What are the normal values for Na+?
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136-145 mEq/L
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Facts about Na+
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Major cation outside of the cell; maintains ECF osmotic balance
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Function of Na+?
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Maintain Tonicity of ECF; Facilitate nerve conduction and glandular secretions
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What qualifies hyponatremia?
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<135 mEq/L
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Causes of hyponatremia?
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vomiting, diarrhea, diuretics, decrease Na in diet, prolonged sweating, total body weight increases more than Na increases - kidney, heart, liver dysfunction
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s/sx hyponatremia?
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lethargy, headaches, confusion, restlessness, irritability, muscle weakness, spasms, coma
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What is hypernatremia?
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> 147 mEq/L
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Causes of hypernatremia?
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↑ Na: oversecretion of aldosterone, Cushings; too little H2O; diabetes insipidus: ↓ ADH
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S/sx hypernatremia
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thirst, restlessness, dry mucous membranes, oliguria, tachycardia, muscle twitching, hyperreflexia, convulsions
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What is SIADH?
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Syndrome of Inappropriate ADH Secretion - excessive secretion of ADH
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Causes of SIADH
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Idiopathic; brain injury; infection; trauma; stroke; hemorrhage; ADH Secreting tumor
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S/sx SIADH
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electrolyte imbalance; hyponatremia
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Testing for SIADH
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↓ serum osmolarity vs ↑ urine osmolarity - more concentrated; CT/MRI of tumor
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What is diabetes insipidus
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Lack of ADH
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Causes of DI
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neurogenic - absence of ADH; nephrogenic - inadequate response of renal tubules to ADH; Psychogenic - excessive fluid intake that suppresses ADH
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S/sx DI
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Excessive urination and thirst; excretion of large volume dilute urine, dehydration
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Testing DI
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↑ serum osmolarity vs ↓ urine osmolarity; plasma ADH levels
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What are the normal values for K+?
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3.5-5 mEq/L
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K+ facts
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Major cation inside the cell
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Function of K+
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maintains ICF osmotic balance; glycogen/glucose deposition; transmission of nerve impulses; maintenance of normal cardiac rhythms, skeletal and smooth muscle contractions
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what is Hypokalemia
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<3.5 mEq/L
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Causes of hypokalemia
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reduced intake of K, increased entry of K into cells; Increased losses of body K: vomiting, diarrhea, diuretics.
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S/sx hypokalemia
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muscle weakness and cramps; arrhythmias - shallow T wave
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What is hyperkalemia?
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>5.5 mEq/L
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Causes of hyperkalemia?
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increased intake of K; increased exit of K from cells; decreased renal excretion of K
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S/sx of hyperkalemia
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weakness, paralysis, arrhythmias - widened QRS and Tall peaked T wave
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What is a normal pH?
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7.4
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what is a normal pH range?
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7.35-7.45
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What's the formula for acid-base balance?
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CO2 + H2O (lungs) <---> H2CO3 <---> H+ + HCO3- (kidneys)
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What is the function of bicarbonate?
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chemical buffer to regulate pH balance; carbon dioxide is converted to bicarbonate
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Respiratory Acidosis
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hypoventilation: COPD, pneumonia, non-pulmonary causes
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Metabolic Acidosis
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Shock; diabetic ketoacidosis; renal failure
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Respiratory Alkalosis
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Hyperventilation
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Metabolic Alkalosis
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Vomiting: acid loss; Gastric Suctioning; Diuretics; antacids; Hypokalemia
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Metabolic Acidosis process
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Decrease in HCO3, increase in H2CO3
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S/sx metabolic acidosis
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lethargy, HA, Coma, N/V, Abdominal pain
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Compensation for metabolic acidosis
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respiratory - Kraussmaul respiration, deep and rapid to blow off CO2 and to reduce H2CO3; Kidneys - conserve HCO3 and excrete H+ in acidic urine
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Metabolic Alkalosis process
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increase in HCO3, excessive loss of H+
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s/sx metabolic alkalosis
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weakness, mm cramps, tetany, hyperreflexive, confusion, convulsions, atrial tach.
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Compensation for Metabolic Alkalosis
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respiratory - suppressed breathing to retain CO2; kidneys - conserve H+ and excrete HCO3 in alkaline urine
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Respiratory Acidosis process
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PaCO2 > 45 mmHg, hypercapnia, depressed ventilation, RETAIN CO2
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s/sx Respiratory Acidosis
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HA, blurred vision, restlessness, lethargy, mm. twitch, tremors, convulsions, coma, warm flushed skin
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compensation Respiratory Acidosis
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kidneys - conserve HCO3 and excrete H+ in acidic urine
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Respiratory Alkalosis process
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PaCO2 < 35 mmHg; hypocapnia, hyperventilation, blowing off CO2
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s/sx respiratory alkalosis
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vertigo, confusion, paresthesia, convulsions, coma, tetany, carpopedal spasm, cerebral vasoconstriction
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compensation respiratory alkalosis
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kidneys - conserve H+ and excrete HCO3 in alkaline urine
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pH Metabolic Acidosis?
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↓
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PaCO2 metabolic acidosis?
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↓
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HCO3 metabolic acidosis?
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↓
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pH metabolic alkalosis?
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↑
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PaCO2 metabolic alkalosis?
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normal or ↑ due to compensation
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HCO3 metabolic alkalosis
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↑
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pH Respiratory acidosis
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↓
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PaCO2 respiratory acidosis?
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↑
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HCO3 respiratory acidosis?
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normal or ↑ due to compensation
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pH respiratory alkalosis
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↑
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PaCO2 respiratory alkalosis
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↓
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HCO3 respiratory alkalosis
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normal or ↓ due to compensation
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anion gap is a ddx in what?
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metabolic acidosis
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Define anemia
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a decrease in red blood cell mass; accompanied by decrease in O2 carrying capacity of the blood
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polycythemia
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excess in RBC in circulation
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what RBC indices determine if anemia is normocytic, microcytic, or macrocytic?
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MCV Mean Cell Volume
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What RBC indices determine if anemia is normo or hypochromic?
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MCH mean cell Hb; and MCHC mean cell Hb concentration (avg concentration of Hb in a given volume of packed RBC
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S/sx Anemia?
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fatigue, weakness, dizziness, pallow, SOB/dyspnea, chest pain, arrythmias, tachycardia, orthostatic hypotension or syncope, cold hands and feet, nail changes, decreased growth and development, neurological symptoms with B12 Def
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Causes of anemia?
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production, loss, destruction
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Anemia of acute blood loss
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trauma, peptic ulcer, hemorrhoids, GI bleed; normocytic, normochromic.
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anemia of chronic blood loss
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rate of loss exceeds ability to regenerate; iron reserves depleted; microcytic, hypochromic
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Testing anemia of chronic blood loss
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MCV Low, MCH low
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Macrocytic/Megaloblastic anemia
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B12/folate deficiency; macrocytic, normochromic; pernicious anemia
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what anemias are associated with neurologic conditions?
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B12 anemia
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Macrocytic anemia testing
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MCV High; MCH High; Serum B12 low; IF Antibodies serum Positive
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Folate deficiency anemia
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a deficiency of folic acid results in megaloblastic anemia with the same characteristics as those of vit B12 deficiency - BUT neurologic changes do not occur
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Iron deficiency anemia causes
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dietary lack; impaired absorption; increased requirements; chronic blood loss
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s/sx Iron deficiency anemia
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fatigue, tachycardia, palpitations, tachypnea, pallor, tongue shiny red with no papillae; pica
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Testing for iron deficiency anemia
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microcytic, hypochromic; MCV Low, MCH Low, RBC Low, Hb low, Hct Low; Total iron-binding capacity increased
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Aplastic anemia
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bone marrow dysfunction characterized by anemia, leukopenia, thromobocytopenia;
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Causes of hypothyroidism
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autoimmune; lack of intake - iodine; surgery; radiation; meds
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Primary hypothyroidism
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^^ TRH, ^^ TSH, v T3/T4
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Secondary hypothyroidism
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^ TRH, v TSH, v T3/T4
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Tertiary hypothyroidism
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v TRH, v TSH, v T3/T4
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What is hypothyroidism
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decreased production of thyroid hormones
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s/sx hypothyroidism
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childhood - impaired development of skeletal system and central nervous system; children and adults - fatigue, pallor, edema, wt gain, arthralgia, cold intolerance, decreased DTR's; myxedema coma
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Hashimoto's thyroiditis
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autoimmune; painless unilateral or bilateral enlargement of the thyroid
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testing for hashimotos
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TSH, T3.T4, antibodies - anti-thyroid microsomal Ab, anti-thyroglobulin
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Subacute De Quervain's Thyroiditis
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inflammation of thyroid
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causes of Subacute De Quervain's Thyroiditis
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viral URI
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s/sx Subacute De Quervain's Thyroiditis
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neck pain, viral sxs, transient hyperthyroidism followed by transient asymptomatic hypothyroidism, no myxedema, complete recovery
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testing Subacute De Quervain's Thyroiditis
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thyroid Antibodies negative
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Valvular defects
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dysfunction of the heart valves
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kinds of valvular defects
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stenosis - valve doesn't open fully; Regurgitation/insufficiency - valve doesn't close fully
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causes Valvular defects
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mitral valve stenosis - rheumatic fever; aortic valve stenosis - congenital; tricuspid valve regurgitation - R ventricular dilation and failure, usually secondary to pulmonary HTN; Mitral valve regurgitation - MV prolapse, infective endocarditis, MI, CT disease
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s/sx Valvular defects
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Heart murmur, chest pain, cough, dyspnea, orthopnea, palpitations
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Testing Valvular defects
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chest X-ray, EKG, Echocardiogram, TEE
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What is cardiomyopathy
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diseases of myocardium
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causes of cardiomyopathy
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HTN, Valvular defects, hyperthyroid, thiamine def, ETOH, Drug use
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s/sx cardiomyopathy
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dyspnea on exertion or rest, dizziness, edema, arrhythmias, palpitations
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testing for cardiomyopathy
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EKG, echocardiogram, Chest X-ray, BNP
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What is aneurysm
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arterial bulging
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causes of aneurysm in brain
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age, HTN, smoking, genetic - AV malformation
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causes of AAA
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HTN, smoking, Marfan's syndrome (connective tissue disorder)
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S/sx brain aneurysm
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HA, eye pain, vision changes, numbness/weakness in the face, ALOC --> Increased ICP
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s/sx Abd Aorta aneurysm
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pain in abdomen and back, abd mass, N/V, diaphoresis, tachycardia, shock
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testing aneurysm
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CT, MRI, Cerebral arteriogram, Abd US
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what are esophageal varices
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extremely dilated submucosal veins in the lower third of the esophagus
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What is mallory-weiss syndrome?
|
esophagogastric lacerations as a result of severe retching - stretching of esophagus leads to bleeding
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barret esophagus
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metaplasia
|
|
|
What is a peptic ulcer?
|
ulceration of stomach lining
|
|
|
gastric ulcer
|
not dependent on gastric acid secretion
|
|
|
duodenal ulcer
|
hypersecretion of gastric acid
|
|
|
three kinds of peptic ulcers
|
gastric, duodenal, lower esophagus
|
|
|
Causes of peptic ulcers
|
H. pylori, NSAIDS, smoking, stress, ETOH
|
|
|
Peptic ulcer s/x
|
N/V, weight loss, hemoptysis, hematemesis, melena
|
|
|
Gastric ulcer - pain?
|
Not related to food consumption
|
|
|
duodenal ulcer - pain?
|
decreases after eating
|
|
|
testing for peptic ulcers?
|
Upper GI Transit, endoscopy, H. pylori blood breath and stool
|
|
|
what is gastritis?
|
focal damage to gastric mucosa, acute inflammation, necrosis and hemorrhage; multiple lesions
|
|
|
causes of gastritis?
|
NSAIDS, smoking, heavy OH
|
|
|
UA Hematuria
|
color: blood, pus, dilp; RBC, WBC, crystals, nitrites, glucose, protein
|
|
|
Hemophilia a - factor?
|
factor VIII deficiency
|
|
|
Hemophilia B - factor?
|
Factor IX deficiency
|
|
|
Von Willebrand's - factor?
|
Factor VIII deficiency
|
|
|
What is DIC?
|
state of hypercoagulation; thrombosis and hemorrhage occur simultaneously. Widespread clotting leads to ischemia and multiple end organ failure; clotting consumes platelets and clotting factors, leading to hemorrhage
|
|
|
causes of DIC?
|
sepsis, bacterial infection, cancer, retained placenta, anesthesia, burns, major trauma
|
|
|
s/sx DIC?
|
bleeding, bruising, hypotension, thrombocytopenia
|
|
|
testing for DIC
|
Prothrombin time, partial thromboplastin time, platelet count, fibrinogen, fibrinogen/fibrin degradation products
|
|
|
Name the four kinds of dysfunctional uterine bleeding
|
Monorrhagia, metrorrhagia, menometrorrhagia, polymenorrhea
|
|
|
menorrhagia
|
prolonged, excessive bleeding at regular intervals
|
|
|
metrorrhagia
|
irregular, frequent uterine bleeding
|
|
|
menometrorrhagia
|
combination of menorrhagia and metrorrhagia
|
|
|
polymenorrhea
|
regular bleeding at <21-day intervals
|
|
|
Causes of DUB?
|
leiomyomas, polyps, ectopic pregnancy, endometriosis, cancer, IUD injury, PID, Trauma, Endometriosis, foreign bodies
|
|
|
what is a leiomyoma?
|
uterine fibroids - benign smooth muscle tumors
|
|
|
causes of leiomyomas?
|
genetic, hormonal, idiopathic
|
|
|
s/sx leiomyomas
|
menorrhagia, dysmenorrhea, metrorrhagia, pain, pressure in lower abdomen, urinary frequency, constipation, backache, abd fullness, cramping with periods, enlarged and assymetrical uterus on pelvic exam
|
|
|
Testing for leiomyomas
|
transvag. US, CBC, hormone levels, endometrial biopsy to rule out cancer
|
|
|
endometriosis
|
abnormal growth of endometrial tissue outside uterus
|
|
|
causes of endometriosis
|
unknown, hormonal, fetal development, FHX, Caucasian, Asian
|
|
|
s/sx endometriosis
|
onset after menses and stops after menopause; pelvic pain, infertility, dysmenorrhea, menorrhagia, dyspareunia, GI sxs
|
|
|
Testing for endometriosis
|
exam, US, laparoscopy, R/O other causes of DUB, pelvic pain
|
|
|
What regulates temperature and homeostasis
|
hypothalamus
|
|
|
What are the functions of fever?
|
stimulate the immune system; create an environment inhospitable for invading pathogens
|
|
|
benefits of fever
|
increased antibody, interferon, and WBC production and mobilization; Increased lymphocyte recruitment to nodes; sequestered Fe; Increased temperature directly inhibits pathogen replication
|
|
|
Leukemia
|
Malignant disorders of the blood or bone marrow with uncontrolled proliferation of malignant leukocytes
|
|
|
pancytopenia
|
shortage of RBCs, WBCs, and Platelets
|
|
|
Symptoms of Acute Leukemia
|
Anemia, fatigue, pallor, neutropenia, fever, infections, thrombocytopenia, petichiae, ecchymoses, epistaxis, night sweats, clotting disorders, bone pain, lymphadenopathy, hepatosplenomegaly, upper quad fullness, DIC
|
|
|
Age range for ALL
|
<15 and >50
|
|
|
Acute lymphocytic leukemia
|
Accumulation of blast cells in the bone marrow suppress normal hematopoiesis --> physical crowding; 5 yr survival rate = 80%
|
|
|
Age for AML
|
Adults ~~ 65, but can be any age
|
|
|
Acute myelogeneous leukemia
|
idiopathic; prior chemotherapy or radiation; exposure to chemicals; AUER RODS
|
|
|
Symptoms of chronic leukemia
|
progresses more slowly, permits greater numbers of mature, functional, normal cells to be produced; often asymptomatic; fatigue, anorexia, splenomegaly, night sweats, low fever, leukemic cells infiltrate liver, lymph nodes, and spleen
|
|
|
Chronic Lymphocytic leukemia
|
most common leukemia in adults; incidence usually >40; B cell origin; suppression of Ab production so risk of infections; poor prognosis
|
|
|
Chronic myelogenous leukemia
|
adults 25-60 yrs; philadelphia chromosome; 3 phases
|
|
|
3 phases of CML
|
chronic, accelerated, blast crisis
|
|
|
chronic phase of CML
|
most patients, milder symptoms
|
|
|
accelerated phase of CML
|
increased blast cells, splenomegaly; hard to control WBC levels with normal chemotherapy
|
|
|
blast crisis phase of CML
|
increased blast cells, anemia, thrombocytpenia, neutropenia
|
|
|
diagnosis of leukemias
|
CBC, PT/PTT, bone marrow aspiration and biopsy, X-Ray and CT
|
|
|
what is lymphoma
|
cancer of the lymphocytes in the nodes
|
|
|
What is hodgkin's lymphoma?
|
b cell lymphoma - high cure rate
|
|
|
Causes of Hodgkin's lymphoma
|
Epstein-Barr Virus, FHX
|
|
|
S/sx hodgkin's lymphoma
|
painless lymphadenopathy, all other leukemia s/sx discussed; REED STERNBERG CELLS
|
|
|
Non-Hodgkin lymphoma
|
fever, weight loss, night sweats, disease is more wide spread, worse prognosis than hodgkins
|
|
|
tx for non hodgkin lymphoma
|
rituximab - commercial Ab that attacks B cell antigen; lack Reed-S cells
|
|
|
S/sx Burkitt's lymphoma
|
tumors manifest at extranodal sites; african - mass involving the maxilla or mandible; sporadic - maxx in abd organs, rare
|
|
|
testing for Burkitts
|
biopsy - starry sky pattern
|
|
|
Multiple myeloma
|
plasma cell neoplasm - involvement of the skeleton at different sites - too many plasma cells
|
|
|
Causes of multiple myeloma
|
idiopathic; possible chromosome 13 deletion; link to infection by human herpes virus 8
|
|
|
s/sx multiple myeloma
|
men; peak age 65; suppression humoral immunity - recurrent infections; anemia; hypercalcemia - confusion, weakness, lethargy, constipation, punched out lesions - pathological fractures
|
|
|
Testing for multiple myeloma?
|
M protein - due to large number of malignant plasma cells; bence jones protein frequently found
|
|
|
What is rheumatic fever
|
inflammatory disorder - not autoimmune
|
|
|
cause of rheumatic fever?
|
strep throat; delayed and exaggerated immune response
|
|
|
s/sx rheumatic fever
|
carditis; polyarthritis; chorea; erythema marginatum
|
|
|
testing for rheumatic fever?
|
rapid strep, ASO, CBC
|
|
|
What is pericarditis
|
inflammation of the pericardium
|
|
|
cause of pericarditis
|
viral, MI, AI diseases, or trauma
|
|
|
S/sx pericarditis
|
acute onset chest pain; dyspnea; low grade fever; feeling sick; pain may radiate to the back - phrenic nerve irritation; pericardial effusion
|
|
|
testing for pericarditis
|
EKG, ECG, CT, CBC
|
|
|
what is infective endocarditis
|
infection of the endocardium
|
|
|
cause of infective endocarditis
|
poor dental health, indwelling, IV drug use; artificial heart valves
|
|
|
S/sx infective endocarditis
|
infectious sxs; new onset murmur, arthritis, SOB, cough, edema
|
|
|
testing infective endocarditis
|
CBC, BC, EKG, echocardiogram
|
|
|
what is pleurisy and pleural empyema?
|
inflammation of the pleura and pleural space
|
|
|
causes of pleurisy and pleural empyema
|
viral, bacterial, AI, TB, PE
|
|
|
s/sx pleurisy and pleural empyema
|
SOB, chest pain increases with respiration; infectious symptoms
|
|
|
testing pleurisy and pleural empyema
|
CXR, BC, CBC, Thoracocentesis
|
|
|
Causes of HIV/AIDS
|
STD, blood, maternal, equipment
|
|
|
s/sx HIV/AIDS
|
2-4 weeks -- fever, sore throat, lymphadenopathy, rash; chronic - weight loss, diarrhea, cough, opportunistic infections, night sweats
|
|
|
testing for HIV/AIDS
|
ELISA, western blot, rapid HIV test
|
|
|
what is sepsis
|
massive inflammatory response to trigger
|
|
|
cause of sepsis
|
bacterial/viral - release of toxins
|
|
|
s/sx sepsis
|
fever, tachycardia, tachypnea, diarrhea, ALOC, hypotension
|
|
|
testing sepsis
|
CBC, BC, ABG, CMP, UA
|
|
|
what is TSS
|
life threatening bacterial infection
|
|
|
cause of TSS
|
staph aureus, strep, tampons, contraceptive sponges, wounds
|
|
|
S/sx TSS
|
sudden onset - high fever, hypotension, V/D, rash, ALOC
|
|
|
Testing for TSS
|
CBC, BC, C&S
|
|
|
what is syphilis
|
infections with Treponema pallidum; STD, childbirth, transfusion
|
|
|
Primary syphilis
|
painless sore at site of transmission 10-90 day incubation period; lymphadenopathy
|
|
|
secondary syphilis
|
3-6 weeks after sore appears - non-itchy rash on body, palms, soles; feeling ill
|
|
|
tertiary syphilis
|
systemic - cardiac, CNS
|
|
|
What is Multiple Sclerosis?
|
Chronic demyelination of CNS that results in scarring
|
|
|
What are the 4 different types of MS?
|
Remitting-relapsing; primary progressive; secondary progressive; progressive-relapsing
|
|
|
Causes of MS?
|
FHX; F>M;
|
|
|
What is Down syndrome?
|
Trisomy 21 with physical and mental disorders
|
|
|
What are the causes of Down syndrome?
|
Chromosomal disorder on chromosome 21; maternal age
|
|
|
S/sx Down syndrome?
|
Small head with flat facial features; slanted eyes; single crease in palm of hand; heart defects, leukemia, dementia; may have decreased IQ and speech difficulties.
|
|
|
Testing for Down syndrome?
|
Prenatal care; karyotype test
|
|
|
What is Klinefelter syndrome?
|
Chromosomal disorder XXY - Males with an extra X chromosome
|
|
|
S/sx of Klinefelter syndrome?
|
Both male and female sexual characteristics; decreased testosterone - less body and facial hair, gynecomastia; weak muscles and bones; shy; infertility (due to low sperm count); impaired language development
|
|
|
Testing for Klinefelter's?
|
clinical exam; chromosomal testing; hormones
|
|
|
Tx for Klinefelter's?
|
Testosterone Replacement Therapy (TRT); Language therapy
|
|
|
What is Turner Syndrome?
|
Chromosomal disorder XO
|
|
|
S/sx Turner syndrome?
|
Short stature; No/irregular menstrual periods; no breast development, widely spaced nipples; infertility; low posterior hairline; webbed neck; infants have swollen hands and feet
|
|
|
Tx for Turner syndrome?
|
Hormone therapy - GH and Estrogen
|
|
|
What organ produces GH?
|
Anterior Pituitary
|
|
|
What is Gigantism/acromegaly?
|
Abnormal excess secretion of GH
|
|
|
Cause of gigantism?
|
Pituitary adenoma
|
|
|
S/sx gigantism?
|
enlarged organs and structures; hyperglycemia
|
|
|
Testing for gigantism?
|
GH; CT
|
|
|
Tx for Gigantism?
|
surgery to remove pituitary adenoma; meds to block GH
|
|
|
What is dwarfism?
|
GH deficiency; adult height of less than 4 feet 10 inches or less
|
|
|
What is the most common form of dwarfism?
|
Achondroplasia
|
|
|
Causes of dwarfism?
|
Decreased GH; genetic
|
|
|
What type of inheritance does achondroplasia have?
|
autosomal dominant - older father has link for new mutation
|
|
|
What type of inheritance does primordial dwarfism have?
|
autosomal recessive
|
|
|
S/sx dwarfism?
|
Hip deformities; club foot; scoliosis; lordosis
|
|
|
Testing for dwarfism?
|
clinical exam - height percentiles; hormones; X-ray/CT;
|
|
|
S/sx for achondroplasia?
|
Disproportionate head to body; short limbs; diverging ring finger; normal intelligence
|
|
|
What is cryptoorchidism?
|
undescended testicle
|
|
|
What is the most common genital pediatric problem?
|
Cryptoorchidism
|
|
|
When does the testis usually descend?
|
28-40 weeks of gestation
|
|
|
Causes of cryptoorchidism?
|
idiopathic
|
|
|
S/sx cryptoorchididsm?
|
uneven testicular height; empty scrotum - not palpable
|
|
|
Testing for cryptoorchidism?
|
clinical; imaging
|
|
|
Tx for cryptoorchidism?
|
orchipexy - surgery to move undescended testicle into scrotum; hormonal therapy
|
|
|
What is hypospadias?
|
Congenital urethral opening is at underside
|
|
|
What is epispadias?
|
Congenital urethral opening is at topside
|
|
|
Causes of hypospadias/epispadias?
|
idopathic; common congenital abnormalities
|
|
|
S/sx hypospadias/epispadias?
|
Abnormal stream during urination; downward curvature
|
|
|
Tx for hypospadias/epispadias?
|
surgery at 3-18 months
|
|
|
What is polycystic kidney disease?
|
kidneys with fluid-filled cysts
|
|
|
Causes of polycystic kidney disease?
|
autosomal dominant: onset in adults; autosomal recessive: onset right after birth or in childhood
|
|
|
S/sx polycystic kidney disease?
|
HTN; pain; abd or back mass; hematuria; freq kidney infections
|
|
|
What risks are associated with Polycystic kidney disease?
|
Higher risk of cerebral/aortic aneurysms; mitral valve prolapse and diverticulosis
|
|
|
What is sickle cell anemia?
|
Genetic RBC disorders
|
|
|
Causes of sickle cell anemia?
|
genetic - autosomal recessive; African American; Hb S instead of Hb A; Sickle cell trait
|
|
|
What is the sickle cell trait?
|
1 allele for Hb S and 1 allele for Hb A
|
|
|
S/sx of sickle cell anemia?
|
sickling of cells; hemolytic crisis; splenic sequestration crisis; aplastic crisis (RBCs live 10-20 days); lack of oxygen and dehydration increase sickling
|
|
|
Testing for sickle cell anemia?
|
Hemoglobin electrophoresis; anemia
|
|
|
Tx for sickle cell anemia?
|
Antibiotics, hydroxyurea (stimulates Hb F)
|
|
|
What is scoliosis?
|
Lateral curvature of the spine
|
|
|
Causes of scoliosis?
|
3 types: idiopathic - 80%; congenital - hemivertebrae; teratologic - systemic syndrome
|
|
|
s/sx of scoliosis?
|
uneven height --> shoulders, hips, leg length
|
|
|
Testing for scoliosis?
|
X-Ray; R/O pathologies
|
|
|
Tx for scoliosis?
|
>25 degrees --> bracing (16 hours/day); >50 degrees --> spinal fusion
|
|
|
What is tetralogy of fallot?
|
congenital heart defect; transposition of the great vessels; ventricular septal defect; aortic transposition; pulmonary stenosis; R ventricular hypertrophy
|
|
|
Causes of tetralogy of fallot?
|
congenital
|
|
|
S/sx tetralogy of fallot?
|
cyanosis, difficulty feeding (infants), failure to thrive, clubbing, sudden death
|
|
|
Testing for tetralogy of fallot?
|
EKG, CBC, Echocardiogram, cardiac catheterization
|
|
|
Extreme burning or shock-like pain episodes on one side of face
|
Trigeminal neuralgia
|
|
|
Nasal congestion/discharge, loss of smell, fever, pressure HA, sore throat/postnasal drip, along with pain over sinuses
|
Sinusitis
|
|
|
Fever, HA, photophobia, irritability, clouding of consciousness, nuchal rigidity, positive Kernig's sign
|
Meningitis
|
|
|
Inflammation and swelling throughout the brain, fever, HA, increased ICP, stiff neck, photophobia, and may progress to seizures
|
Encephalitis
|
|
|
Inflammation of temporal arteries, > 50 y/o, throbbing temporal pain, visual changes, weakness, loss of appetite, jaw pain/fatigue, can lead to irreversible vision loss
|
Temporal Arteritis
|
|
|
Bleeding in the epidural or subdural space; history of head trauma or aneurysm
|
Intracranial hematomas
|
|
|
List the signs and symptoms of an intracranial hematoma
|
HA, N/V, visual changes, seizures, ALOC, hemiparesis, speech disorders
|
|
|
Swelling of the optic disc; HA, N/V, vision problems (double vision)
|
Papilledema
|
|
|
Name some of the causes of Papilledema (swelling of the optic disc)
|
Intracranial pressure, brain tumor, trauma, meningitis, encephalitis
|
|
|
Often asymptomatic until it ruptures
|
Aneurysm
|
|
|
This is caused by a DNA mutation and can affect such hormones at prolactin, ACTH, and GH
|
Pituitary Adenoma
|
|
|
This is caused by atherosclerosis, anxiety/stress, excess Na intake, or a kidney disorder and is often asymptomatic
|
Hypertension
|
|
|
List five factors included in the metabolic syndrome
|
1. Insulin resistance 2. HTN 3. cholesterol abnormalities 4. increased risk for clotting 5. abdominal obesity
|
|
|
If you have the metabolic syndrome what are you at an increased risk for?
|
Cardiovascular disease
|
|
|
Distinguish between dizziness and vertigo.
|
Dizziness = disorientation in space, unsteady, lightheadedness, confused; Vertigo = spinning (either you or the environment)
|
|
|
List some of the causes of vertigo.
|
Dehydration, hypotension, motion sickness, ear infection, lybrynthitis, MS, head trauma, migraine
|
|
|
An inner ear disease that causes vertigo and hearing changes; S/S triad: vertigo, tinnitus, hearing loss
|
Meniere's disease
|
|
|
What does thyroid hormone do?
|
It regulates metabolism
|
|
|
The most common cause of hyperthyroidism that causes an enlargement of the thyroid, heat intolerance, anxiety and bulging eyes (exophthalmos):
|
Graves Disease
|
|
|
Explain the pathology of Graves disease.
|
The body produces and antibody that mimics TSH and causes and oversecretion of TH
|
|
|
Name the second most common cause of hyperthyroidism (15-30% of US cases) in which a benign or malignant thyroid nodule appears.
|
Toxic Nodular Goiter (TNG)
|
|
|
What is phoechromocytoma and what are its classic triad of symptoms?
|
It is a tumor of the adrenal medula with excess secretion of catecholamines (epi and norepi). Symptom Triad: Diaphoresis, episodic HA, and tachycardia
|
|
|
AVPU is what?
|
It is a way to assess consiousness. AVPU: Alert, Verbal Communication, Pain Stimulation, Unconscious
|
|
|
What is the Glasgow technique?
|
It is a scale method to assess consiousness based on eye opening, verbal response, and motor response
|
|
|
PEARLL is what?
|
It is a way to assess consiousness. PEARLL: Pupil, Equal, And, Round, Reg. in size, Light reactions
|
|
|
An extensive network of nuclei and interconnecting fibers in the upper pons, midbrain, and posterior diencephalon is called what?
|
Reticular Activating System (RAS)
|
|
|
A progressive degeneration of nerve cells; loss of GABA neurons (inhibitory) within the basal ganglia; A genetic autosomal dominant disease
|
Huntingtons Disease
|
|
|
What are the signs and symptoms of Huntingtons Disease?
|
Chorea (irreg spasmodic, involuntary movements), dementia, problems with speech, balance, and swallowing
|
|
|
What is the prognosis for a patient with Huntingtons disease?
|
Life expectancy after diagnosis is 10-25 years; mean age of death is 51-57 years old
|
|
|
What does "tonic" refer to in reference to seizures?
|
Stiffening
|
|
|
What does "clonic" refer to in reference to seizures?
|
Jerking movements
|
|
|
What does a person experiencing an absence seizure look like?
|
They appear to be daydreaming
|
|
|
What does thiamin do and what is a consequence of its deficiency?
|
Thiamin helps produce energy needed to make neurons function properly. Insufficient thiamin can lead to damage or death of neurons.
|
|
|
Loss of brain function due to thiamin (B1) deficiency caused by alcoholism, AIDS, weight loss procedures or extreme N/V is what? (Hint "wet brain")
|
Wernicke-Korsakoff Syndrome
|
|
|
What does Wernick-Korsakoff Syndrome cause?
|
It causes visual, coordination, and memory changes along with problems making new memories; patients often confabulate (make up info that can't remember)
|
|
|
Is Werkicke-Korsakoff syndrome curable?
|
High doses of B! will stop destruction but previous damage cannot be repaired
|
|
|
What are the two common causes of a stroke?
|
1. Ischemia: Thrombus/embolus; 2. Hemorrhage: dissected aneurysm, subarachnoid hem, arteriovenous malformations (AVM)
|
|
|
What are the signs of a stroke? (Hint: S-T-R-O-K-E)
|
Speech, Tingling, Remembering, Off-balance, Killer H/A, Eyes
|
|
|
Name the degenerative disorder caused by a depletion of dopamine resulting in hypertonia (tremor & rigidity) and akinesia; loss of substantia nigra, dopamine producting neurons; excess cholinergic activity in basal ganglia
|
Parkinsons Disease
|
|
|
What are the signs and symptoms of Parkingsons disease?
|
Resting tremor, rigidity, bardykinesia/akinesia, shuffling gate, stooped posture, disequalibrium, muffled/slurred speech, diminished facial expression, and dimentia (usually over 70 y/o)
|
|
|
What is the common onset age of Parkinsons disease and about what age does it peak?
|
Onset: 40;Peaks: 58-62
|
|
|
Define hypertonia.
|
Increased rigidity, tension, and spasticity of the muscles
|
|
|
Define akinesia.
|
Absense, loss, or impairment of voluntary movement
|
|
|
Define bradykinesia.
|
Abnormal slowness of physical movement
|
|
|
What is antiproliferative factor (APF) and what kinds of patients is it found in?
|
It blocks normal growth of cells in the bladder and is found in patients with interstitial cystitis (IC).
|
|
|
What are the signs and symptoms of insterstitial cystitis (IC)?
|
Symptoms of UTI w/o bacteria; Irritation of bladder wall; - bleeding/pain; - inflam/fibrosis; - hemorrhagic (Hunner) ulcers; - polyuria;
|
|
|
What is the treatment for IC?
|
No cure but 30% of pts will improve w/ Elmiron (meds); Diet changes (cut out alc and caffeine)
|
|
|
What does SIADH stand for?
|
Syndrome of Inappropriate ADH secretion
|
|
|
What causes SIADH?
|
Idiopathic; brain inj, infection, trauma, stroke, hemorrhage, ADH secreting tumor
|
|
|
What is the MOST COMMON cause of SIADH?
|
Bronchogenic cancer (it produces ADH)
|
|
|
What are the symptoms of SIADH?
|
Weakness, nausea, muscle twitching, HA, and wt gain; urine vol decreases but its osmolarity increases; serum volume increases while its sodium and osmolarity decreases
|
|
|
What is diabetes insipidus (DI)?
|
Lack of ADH
|
|
|
What are the three causes of DI?
|
Neurogenic, nephrogenic, psychogenic
|
|
|
Nephrogenic cause of DI?
|
renal tubules don't respond to ADH
|
|
|
Psychogenic cause of DI?
|
excesses fluid intake suppresses ADH
|
|
|
Signs and symptoms of DI?
|
Excess urination (polyuria) and thirst (polydipsia); Excretion of large volumes of dilute urine; dehydration
|
|
|
What kind of testing is done to confirm a DI diagnosis?
|
Check serum osmolarity (up) vs. urine osmolarity (down); check plasma ADH levels
|
|
|
A patient presents with plasma osmolarity of 500 mOsm/kg (norm is 275-299). What is most likely the diagnosis?
|
DI
|
|
|
A 60 y/o male presents w/ increased urge to urinate but has a weak stream. He recently starting getting up in the night to urinate and sometimes leaks urine. What is a likely diagnosis (from Mod 11)?
|
Benign Prostatic Hyperplasia (BPH)
|
|
|
Which bladder d/o is characterized by detrusor muscle overactivity?
|
Overactive bladder syndrome
|
|
|
Which bladder d/o is caused by neurologic d/o's?
|
Neurogenic bladder
|
|
|
What is it called when the bladder leaks or there is incontinence while laughing, sneezing, coughing, and/or lifting?
|
Stress incontinence
|
|
|
Distiguish between diverticulosis and diverticulitis.
|
Diverticulosis is an outpouching of the GI tract; when those outpouchings become inflamed and/or infected it becomes diverticulitis
|
|
|
Inflammation of the colon that causes ulceration is called what?
|
Ulcerative Colitis (UC)
|
|
|
What parts of the colon is UC most common?
|
Rectum and sigmoid colon (which is why left sided pain is more common)
|
|
|
What age group is UC most common?
|
20-40 y/o
|
|
|
What is melena?
|
Black, tarry stools
|
|
|
An inflammation in the GI, most commonly in the ascending and tranverse colon is what?
|
Crohn's disease
|
|
|
What are the signs and symptoms of Crohn's disease?
|
Abdominal pain, cramping, diarrhea, bloody stools, "skip lesions," transmural inflam., and wt. loss
|
|
|
If the ileum is affected by Crohn's, what additional s/s are involved?
|
Malabsorption of vit. B12, folic acid, and vit. D (anemia)
|
|
|
Blocked, non-working intestines, hypomotility of GI tract is called what?
|
Ileus
|
|
|
What is the most common setting for the development of ileus?
|
Post-op
|
|
|
What organ produces GH?
|
Anterior pituitary
|
|
|
Neurogenic cause of DI?
|
absence of ADH (pit. prob)
|
|
|
What is interstitial cystitis?
|
Chronic painful bladder disorder
|
|
|
S/Sx of interstitial cystitis?
|
Sxs of UTI without bacteria; Irritation of bladder wall; Bleeding and pain; Inflammation --> Fibrosis; Hunner ulcers; Urinary frequency (up to 60x day/night)
|
|
|
What are Hunner ulcers?
|
Hemorrhagic ulcers
|
|
|
Causes of interstitial cystitis?
|
Antiproliferative factor (APF) blocks normal growth of cells in bladder
|
|
|
Testing for interstitial cystitis?
|
Urinary frequency; urinary urgency; dysuria without infection
|
|
|
Tx for interstitial cystitis?
|
No cure, but 30% of patients improve on pentosan polysulfate sodium
|
|
|
A patient presents with plasma osmolarity of 500 (normal range 275-299). What is the most likely disorder?
|
B: Diabetes Insipidus
|
|
|
What is benign prostate hyperplasia?
|
Enlargement of the prostate
|
|
|
S/sx benign prostate hyperplasia?
|
Usually > 40; Hesitant, interrupted, weak stream; Urgency; Frequency; Nocturia; Leaking/dripping
|
|
|
Causes of benign prostate hyperplasia?
|
Decreased T and increased E ratio
|
|
|
Testing for benign prostate hyperplasia?
|
DRE; PSA - DDX from prostate cancer; Biopsy
|
|
|
Tx for benign prostate hyperplasia?
|
Meds; Surgery; Laser
|
|
|
What is a neurogenic bladder?
|
Flaccid or spastic bladder disorder; bladder unable to relax or sphincter is unable to close; urinary incontinence with constant dripping
|
|
|
What is an overactive bladder?
|
Involuntary bladder contractions with possible incontinence
|
|
|
What is stress incontinence?
|
Decreased bladder muscle strength; incontinence when laughing, coughing, sneezing, lifting.
|
|
|
What is diarrhea?
|
Loose, watery stools with increased frequency.
|
|
|
What qualifies chronic diarrhea?
|
> 4 weeks
|
|
|
What is constipation?
|
Infrequent bowel movements < 3x a week
|
|
|
Causes of constipation?
|
Dehydration, decreased fiber, age, decreased exercise, pregnancy, meds
|
|
|
Name three inflammatory bowel diseases.
|
Diverticulitis; Ulcerative colitis; Crohn's disease
|
|
|
What is diverticulosis?
|
Out-pouching of GI tract - usually asymptomatic
|
|
|
What is diverticulitis?
|
Out-pouching of GI tract that becomes inflamed, infected, or ruptures.
|
|
|
S/sx diverticulitis?
|
Abd pain, cramping, N/V; Can lead to perforations (bleeding, peritonitis); Scarring can lead to blockage
|
|
|
Testing for diverticulitis?
|
Colonoscopy; CT, Abd. US
|
|
|
Tx for diverticulitis?
|
high fiber diet; antibiotics; surgery
|
|
|
What is ulcerative colitis?
|
Inflammation of the colon that causes ulceration
|
|
|
Where does ulcerative colitis usually occur?
|
Rectum and sigmoid colon
|
|
|
Causes of ulcerative colitis?
|
Unknown; Jewish descent
|
|
|
S/sx ulcerative colitis?
|
Left sided pain more common; diarrhea; tenesmus; abd. pain; melena; Remission; Pseudopolyps*
|
|
|
What is Crohn's disease?
|
Inflammation of GI; both small and large intestines; Rectum seldom involved; most commonly ascending and descending colon
|
|
|
Causes of Crohn's disease?
|
Unknown; Smoking ^^^ risk
|
|
|
S/sx Crohn's disease?
|
Abd. pain, cramping, diarrhea, bloody stools; skip lesions, transmural inflammation; weight loss; illeum involved - malabsorption of B12
|
|
|
Testing for Crohn's?
|
CBC; colonoscopy
|
|
|
Tx for Crohn's?
|
Meds; surgery to remove affected portion
|
|
|
What is Ileus?
|
non-working intestines; hypomitility of GI
|
|
|
Causes of Ileus?
|
Surgery, peritonitis, meds
|
|
|
S/sx ileus?
|
abd pain, cramping, distention
|
|
|
Testing for ileus?
|
clinical; x-ray
|
|
|
Tx for ileus?
|
tube to relieve pressure; fluids, electrolytes
|
|
|
What is IBS?
|
Abdominal pain: relief by defecation; change in frequency/consistency of stool
|
|
|
S/sx pancreatitis?
|
Pain either suddenly or over a few days; acutely ill; increased pulse; low respirations; BP and temp vary; semicoma; scleral icterus; atelectasis; ascites; CV, resp failure
|
|
|
Testing for pancreatitis?
|
Increased amylase and lipase; WBC, Hct, Blood sugar, bilirubin; decreased Ca; Abd x-ray, US.
|
|
|
Tx for pancreatitis?
|
fludis, fasting, drugs, antibiotic, drainage
|
|
|
Complications of strep throat
|
rheumatic fever; post-strep. glomerulonephritis
|
|
|
s/sx post streptococcal glomerulonephritis
|
inflammation of the glomeruli; red or cola-colored urine due to damaged filter (hematuria); hypertension; decrease in GFR
|
|
|
What is mononucleosis?
|
B Cell infection
|
|
|
causes of mono
|
EBV (Epstein Barr)
|
|
|
s/sx mono
|
malaise, HA, fatigue, arthralgia, viral, dysphagia, fever, pharyngitis, lymphadeopathy, enlarged spleen
|
|
|
Triad for mono?
|
Fever, pharyngitis, lymphadeopathy
|
|
|
causes of GERD
|
abnormal esophageal sphincter; foods; etoh; meds; stress; smoking; obesity; peptic ulcer
|
|
|
S/sx GERD
|
heartburn >2x week - worse at night; chest pain, dysphagia, sore throat, cough, Barrett's esophagus - metaplasia
|
|
|
What is dysphagia
|
difficulty swallowing
|
|
|
causes of dysphagia?
|
stress, esophageal strictures, tumor, thyroid goiter, GERD; neurological - parkinson's, achalasia
|
|
|
S/sx dysphagia
|
odynophagia, choking, weight loss
|
|
|
What is tonsilitis
|
inflammation of the tonsils
|
|
|
causes of tonsilitis
|
viral - most cases, EBV; bacterial - group A beta hemolytic strep
|
|
|
S/sx tonsilitis
|
pain, lymphadenopathy, white patches, fever, laryngitis, swelling of airway, abscess, strep
|
|
|
Broca's Area
|
speech production - motor control tongue, lips, jaw
|
|
|
Wernicke's Area
|
understanding of written and spoken language
|
|
|
Dysphasia
|
impairment of comprehension or production of language
|
|
|
aphasia
|
loss of the comprehension or production of language
|
|
|
S/sx Trigeminal neuralgia
|
extreme burning or shock-like pain on one side of the face; episodic
|
|
|
causes of trigeminal neuralgia
|
not definite; MS, blood vessel pressing onto trigeminal nerve
|
|
|
S/sx sinusitis
|
Nasal congestion and discharge; loss of smell; fever; headache - pressure; sore throat and postnasal drip; pain over sinuses
|
|
|
causes of sinusitis
|
common cold; allergies; deviated septum
|
|
|
what is meningitis?
|
inflammation of the meninges
|
|
|
s/sx meningitis?
|
fever, HA, photophobia, irritability, clouding of consciousness, and neck stiffness
|
|
|
culture of CF in bacterial meningitis?
|
cloudy - ^neutrophil and protein levels, v glucose levels
|
|
|
culture of CF in viral meningitis?
|
^ leukocyte count, mild to moderate protein elevation, normal glucose levels
|
|
|
s/sx encephalitis
|
most commonly viral - mild to severe, fever, HA, increased ICP, stiff neck, photophobia, progress to seizure
|
|
|
what is temporal arteritis?
|
inflammation of temporal arteries
|
|
|
s/sx temporal arteritis
|
>50 yo; throbbing pain, vision changes, weakness, loss of appetite, jaw pain, fatigue while chewing; can lead to irreversible vision loss
|
|
|
Tx temporal arteritis?
|
corticosteroids 1-2 years
|
|
|
what are intracranial hematomas
|
epidural - bleeding in epidural space; subdural - bleeding in subdural space
|
|
|
causes of intracranial hematomas
|
head trauma, skull fracture, aneurysm
|
|
|
s/sx intracranial hematomas
|
HA, N/V, vision changes, seizures, ALOC, hemiparesis, speech disorders
|
|
|
what is papilledema?
|
swelling of the optic disc
|
|
|
s/sx papilledema?
|
HA, N/V, vision problems
|
|
|
causes papilledema
|
^ ICP, brain tumor, cerebral trauma, meningitis, encephalitis
|
|
|
Pituitary adenoma
|
mostly benign tumors of the pituitary
|
|
|
causes pituitary adenoma
|
DNA mutation
|
|
|
S/sx pituitary adenoma
|
N/V, HA, vision changes, pituitary function
|
|
|
what is metabolic syndrome
|
an association between certain factors and cardiovascular disease
|
|
|
what are the metabolic syndrome factors?
|
insulin resistance, hypertension, cholesterol abnormalities, increased risk for clotting, abdominal obesity
|
|
|
what is meniere's disease?
|
inner ear disorder that causes vertigo and hearing changes
|
|
|
Meniere's Triad?
|
Vertigo, tinnitus, hearing loss
|
|
|
causes of meniere's?
|
fluid changes/imbalance in inner ear; trauma, infection, allergies, anxiety/stress
|
|
|
s/sx meniere's disease
|
sudden onset, severe N/V
|
|
|
tx for Meniere's
|
low salt diet, meds, diuretics, surgery
|
|
|
What is dyspnea
|
difficult or labored breathing; SOB; air hunger
|
|
|
S/sx dyspnea
|
wheeze, anxious or distressed expression; flaring nostrils; gasping
|
|
|
What is orthopnea
|
dyspnea on lying down
|
|
|
What is Kraussmaul resp pattern
|
Consistent, very deep breathing; metabolic acidosis
|
|
|
what is tuberculosis
|
infectious lung disease - previously called consumption; airborne droplets
|
|
|
causes of tb
|
mycobacterium tuberculosis
|
|
|
S/sx tb
|
cough that produces purulent sputum develops slowly; night sweats, fatigue, fever, chills, pleurisy, caseous necrosis
|
|
|
What are Ghon complexes?
|
granulomas of Tb
|
|
|
Tx for TB?
|
Combinations of 4 drugs at once to reduce the chance of antibiotic resistance; 6-9 months
|
|
|
What is pneumonia
|
inflammatory process that can involve all or part of the lungs
|
|
|
cause of pneumonia
|
infection of respiratory tract
|
|
|
S/sx Pneumonia
|
High fever, cough, malaise, breathlessness, symptoms vary upon individual, severity of infection, and causative agent
|
|
|
Tx for pneumonia
|
antibiotics for bacteria, no effective tx for viral pneumonia; supplemental O2
|
|
|
What are two major differences between pneumonia and tuberculosis?
|
Tb can affect other tissues and organs; Tb requires significantly longer treatment than pneumonia does.
|
|
|
what is acute bronchitis
|
inflammation of the bronchial tree caused by infection or irritating factors (smoke)
|
|
|
s/sx of acute bronchitis
|
Productive cough*, chest pain, congestion, wheezing, fever, chills, Difficulty breathing
|
|
|
Tx for acute bronchitis
|
antibiotics, rest
|
|
|
what are the three main types of COPD?
|
Chronic bronchitis; emphysema; asthma
|
|
|
What is chronic bronchitis?
|
inflammation of bronchioles with excess mucus production; bronchitis > 3 months for two or more consecutive years; airway obstruction and hyperplasia of mucus-producing glands
|
|
|
Causes of chronic bronchitis
|
long term pulmonary disorders; smoking; scarring and damage of tissue
|
|
|
S/sx chronic bronchitis
|
BLUE BLOATERS; hypoxemia and polycythemia; productive cough, sob, dib, wheezing
|
|
|
What is emphysema?
|
alveolar destruction - alveoli don't collapse
|
|
|
causes of emphysema?
|
smoking/secondhand smoke, genetic
|
|
|
S/sx emphysema?
|
PINK PUFFERS; increased RR; cough, dyspnea, fatigue, weight loss, clubbing, barrel chest
|
|
|
what kind of patient is this?
|
//fce-study.netdna-ssl.com/2/images/upload-flashcards/91/40/01/4914001_m.png pink puffer - emphysema; ↑ ventilation & ↓ cardiac output
|
|
|
what kind of patient is this?
|
//fce-study.netdna-ssl.com/2/images/upload-flashcards/91/40/07/4914007_m.png Blue bloater - chronic bronchitis; ↓ventilation & ↑ cardiac output
|
|
|
what is asthma?
|
inflammatory airway disorder with bronchoconstriction
|
|
|
causes of asthma
|
allergies, URI, exercise, cold air, pollution
|
|
|
s/sx asthma
|
cough, wheezing due to difficulty breathing out, mucus production, use of accessory muscles, SOB
|
|
|
what is pulmonary embolism
|
occlusion of a portion of the pulmonary vascular bed by an embolus; can cause infarction; if no infarction, clot will be dissolved by fibrinolytic system
|
|
|
S/sx of pulmonary embolism
|
sudden onset - chest pain and SOB; wheezing, cyanosis, syncope;
|
|
|
S/sx cystic fibrosis
|
persistent cough, wheezing, frequent infections, clubbing and barrel chest develop over time; frequent loose, oily stools
|
|
|
what is bronchiectasis
|
obstruction or infection with inflammation and destruction of the bronchi so that there is permanent dilation
|
|
|
causes of bronchiectasis
|
infection - acute or chronic; CF, TB
|
|
|
S/sx bronchiectasis
|
productive cough - foul-smelling, bloody; DIB, fatigue, clubbing, cyanosis
|
|
|
what is atelectasis?
|
collapsed lung
|
|
|
causes of atelectasis?
|
immobility - bed rest or anesthesia; lung diseases, foreign objects, tumors; obstruction
|
|
|
s/sx atelectasis
|
DIB, chest pain, cough
|
|
|
what is coccidioidomycosis (valley fever)?
|
fungal infection acquired by inhaling the arthrospores in the southwest dust
|
|
|
what are erythema nodosum?
|
painful nodules in the lower legs - valley fever
|
|
|
What is Graves disease?
|
autoimmune hyperthyroidism; instead of destroying, it activates thyroid
|
|
|
s/sx Graves disease
|
hyperthyroid symptoms; exophthalmos; pretibial myxedema; goiter
|
|
|
what does parathyroid hormone do?
|
increases Ca in the blood
|
|
|
What is thyroid crisis (Storm)?
|
rare but dangerous worsening of the thyrotoxic state; death can occur in 48 hours without Tx
|
|
|
causes of thyroid crisis?
|
spontaneous; usually occurs in undiagnosed or partially treated Grave's disease
|
|
|
s/sx thyroid crisis
|
hyperthermia, tachycardia, delirium, N/V, diarrhea - dehydration
|
|
|
What is toxic nodular goiter
|
benign or malignant thyroid nodule
|
|
|
s/sx TNG
|
hyperthyroid s/s; NO Exophthalmos or pretibial myxedema
|
|
|
what is pheochromocytoma?
|
tumor of the adrenal medulla with excess secretion of catecholamines
|
|
|
s/sx pheochromocytoma
|
HTN, anxiety, chest/abd pain, pallor, orthostatic hypotension, hyperglycemia, weight loss
|
|
|
Pheochromocytoma TRIAD
|
diaphoresis, episodic HA, tachycardia
|
|
|
what are primary skin lesions?
|
physical changes in the skin considered to be caused directly by the disease process
|
|
|
what are secondary skin lesions?
|
may evolve from primary lesions, or may be caused by external forces such as scratching, trauma, infection, or the healing process
|
|
|
What are the kinds of primary skin lesions?
|
macule, vesicle, pustule, papule, nodule, wheal, telengieactasia
|
|
|
what is a macule
|
small, circular, flat, different color - freckle
|
|
|
what is a vesicle
|
small raised, filled with clear fluid - blister if large
|
|
|
what is a pustule
|
raised lesion filled with pus - acne
|
|
|
what is a papule
|
solid raised lesion - plaque
|
|
|
what is a nodule
|
solid lesion that is moveable to area around it
|
|
|
what is a wheal
|
skin elevation with itching - allergic reaction
|
|
|
what is telengieactasia
|
dilated blood vessels on surface of skin
|
|
|
what are the types of secondary skin lesions
|
ulcer, scale, crust, erosion, scar, lichenification, atrophy
|
|
|
what is an ulcer
|
loss of dermis and possible epidermis with deep crack
|
|
|
what is a scale
|
dry scaly dead skin with flaking - psoriasis
|
|
|
what is a crust
|
dried substance - blood, pus, scab
|
|
|
what is an erosion
|
loss of epidermis - scrape
|
|
|
what is a scar
|
discolored fibrous tissue that replaces normal skin
|
|
|
what is lichenification
|
rough epidermis
|
|
|
what is atrophy (dermatology)
|
thin, wrinkled skin
|
|
|
what is polycythemia vera?
|
abnormal, idiopathic proliferation of RBC at bone marrow
|
|
|
S/sx polycythemia vera?
|
d/t inc blood volume and hyperviscosity, splenomegaly, thrombus, HA, tinnitus, chorea, delirium, vision changes, angina, thrombosis, ischemia, infarction, pruritis after warm bath, plethora in the face, palms, nail beds, mucosa, and conjunctiva
|
|
|
what is eczema
|
a term for a group of medical conditions that cause the skin to become inflamed or irritated
|
|
|
causes of eczema
|
unknown; overactive immune response?
|
|
|
s/sx eczema
|
intense itching, burning, dry flaky erythematous skin
|
|
|
causes psoriasis
|
AI T-cell reaction to skin triggered by alcohol, stress, infections, injury to skin, cold weather, certain meds
|
|
|
s/sx psoriasis
|
red skin with silvery scales and inflammation; pitting of nails
|
|
|
what is systemic lupus erythematosus
|
inflammatory AI disorder - can affect any/all systems
|
|
|
s/sx systemic lupus erythematosus
|
join pain/swelling, rash, renal disease, hematologic abnormalities, cardiovascular diseases, malar rash, butterfly rash
|
|
|
testing for systemic lupus erythematosus
|
4 of 11 findings
|
|
|
what is discoid lupus erythematosus
|
subset of SLE, but cutaneous manifestation is the only symptom
|
|
|
s/sx discoid lupus erythematosus
|
1-2 cm raised red plaque with a brownish scale; alopecia, teleangiectasias, hives, raynaud phenomenon (white, numb, and cold digits followed by cyanosis)
|
|
|
testing for DLE
|
skin biopsy will reveal lumpy deposits of immunoglobulins - immunofluorescent observation
|
|
|
tx for DLE
|
topical creams, avoid sunlight
|
|
|
what is tinea
|
fungal skin infection
|
|
|
causes of tinea
|
ringworm, athlete's foot, jock itch
|
|
|
s/sx tinea
|
itching, burning, redness
|
|
|
what is candidiasis
|
yeast infection
|
|
|
causes of candidiasis
|
hormonal, obesity, antibiotics, DM, weakened immune system, AIDS
|
|
|
s/sx candidiasis
|
asymptomatic, vaginal or vulvar pruritis; thick white discharge; dyspareunia; dysuria
|
|
|
Warts
|
benign lesions of the skin caused by HPV; round and elevated with a rough, greyish surface
|
|
|
what are abscesses
|
collection of pus surrounded by inflammation
|
|
|
causes of abscesses
|
infection
|
|
|
s/sx abscesses
|
painful, red, warm area with pus/infectious material; sepsis if not treated
|
|
|
What is an intussusception?
|
telescoping of one part of the intestine to another; idiopathic; viral infection; bowel obstruction and cut off blood supply; vomiting, abd. pain, red currant jelly stools;
|
|
|
what is a volvulus?
|
twisting of intestines - malrotation in development; intestinal obstruction and cut off blood supply; acute and severe; bilious vomiting; immediate surgery
|
|
|
causes Hirschsprung's Disease - congenital megacolon
|
missing intestinal/rectal ganglion cells
|
|
|
S/sx hirschsprung's disease
|
delayed meconium stool at birth, vomiting, colic, distended abdomen, ribbon-like stool; life threatening; fever, swollen abd.; explosive and bloody diarrhea
|
|
|
Meckel's Diverticulum
|
outpouching of small intestine in kids
|
|
|
causes of meckel's diverticulum
|
idiopathic - developmental
|
|
|
s/sx meckel's diverticulum
|
asymptomatic; painless rectal bleeding; diverticulitis
|
|
|
Causes Polycystic Ovarian Syndrome
|
hormone imbalance; increased insulin causes increase in androgen production
|
|
|
s/sx PCOS
|
ovaries with multiple cysts; irregular or absent menses; infertility; virilization; obesity; insulin resistant
|
|
|
Diabetes Mellitus
|
abnormal blood glucose metabolism
|
|
|
Type 1 diabetes
|
AI attacks beta cells
|
|
|
Type 2 diabetes
|
lifestyle, meds
|
|
|
DM 3 Ps
|
polyuria, polydipsia, polyphagia
|
|
|
DM Type 2-- 3 pathological changes
|
Insulin prod. decrease; insulin resistance; excessive glucose production by the liver
|
|
|
What is glomerulonephritis?
|
decreased ability of the kidneys to filter
|
|
|
causes of glomerulonephritis
|
SLE, AI, Post-strep, bacterial endocarditis; HTN, DM, Berger's Disease
|
|
|
S/sx glomerulonephritis
|
proteinurea, hematuria, HTN, Edema, Decreased urinary output
|
|
|
Berger's Disease (IgA Neuropathy)
|
IgA deposition in Glomeruli
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causes Berger's
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FHX, vasculitis
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S/sx Berger's
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progresses slowly over years; young men; dark brown, bloody, or rust colored urine; can lead to renal failure
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testing for Berger's
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proteinurea, hematuria, HTN, Edema, Decreased urinary output, UA
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What is renal failure?
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loss of kidney function
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Causes of renal failure
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prerenal, renal, postrenal
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s/sx renal failure
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decreased U/O, edema, dyspnea, fatigue, confusion, seizures
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What is Wilm's tumor?
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mixed tumor of the kidney in children
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Causes of wilm's tumor?
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unknown; Chromosome 11; inherited mutation
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S/sx Wilm's Tumor
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< 5yo peak age 2-3 yo; lacking of iris; asymptomatic upper abd. mass; HTN due to tumor secreting Renin; Parent feels an abd. mass when bathing child
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What is consciousness?
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A clear state of awareness of self and the environment in which attention is focused on immediate matters, as distinguished from mental activity of an unconscious or subconscious nature.
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What is the RAS?
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An extensive network of nuclei and interconnecting fibers in the upper pons, midbrain, and posterior diencephalon.
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What is a coma?
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A state of altered arousal characterized by: extreme unresponsiveness from which pt cannot be aroused, and absence of voluntary movement.
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What are some differences between confusion and dementia?
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1. Confusion is acute; dementia is not. 2. Dementia is progressive, confusion is not. 3. Confusion will return to normal, dementia will not (because dementia is brain damage).
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What is Alzheimer's?
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Progressive destruction of the brain.
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What is the most common cause of dementia in the elderly?
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Alzheimer's
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Causes of Alzheimer's?
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Chromosome 21 mutation
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S/sx of Alzheimer's?
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Amyloid plaques; neurofibrillary tangles; memory, judgment, behavior, and reasoning problems.
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What is Huntington's?
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Progressive degeneration of nerve cells and loss of GABA (inhibitory) neurons within basal ganglia
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Causes of Huntington's?
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Chromosome 4 mutation
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S/sx Huntington's?
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Chorea; dementia; speech, balance, swallowing problems
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Testing for Huntington's?
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CT/MRI; genetic atrophy
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Number to remember for Huntington's regarding genes?
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28!
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Causes of UTI?
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Cystitis - E. coli; pyelonephritis; < F, DM, urinary catheters, poor hygiene, dehydration, compromised immune system
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S/sx UTI?
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dysuria, frequency, urgency, fever, flank pain, N/V, hematuria, leukocytosis
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Causes of hepatic failure?
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Cirrhosis; hepatitis; cancer; hemachromatosis
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S/sx hepatic failure?
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Hepatic encephalopathy and nervous system changes
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Testing for hepatic failure?
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Blood NH3 test; liver biopsy
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What is a seizure?
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A brief disruption in the brain's electrical functions
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What is Wernicke-Korsakoff Syndrome? (AKA Wet brain)
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Loss of brain function due to thiamine deficiency
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Causes of wet brain?
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alcoholism, AIDS, weight loss procedures, extreme N/V
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S/sx Wernicke-Korsakoff?
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Confabulations; vision, memory (new ones), and coordination problems;
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Testing for wet brain?
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Decreased thiamine, liver function test (for alcoholism), TSH, T3/T4
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Tx for wet brain?
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High dose of B1 (thiamine); no reversal of damage
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What is a stroke?
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Decreased blood flow to brain
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Causes of a stroke?
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Ischemia, homorrhage
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S/sx stroke?
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difficulty - walking, talking, vision, memory; HA, paresthesias, paralysis
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Testing for stroke?
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CT/MRI, Carotid US
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Signs of stroke?
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S: Speech; T: Tingling/numbness; R: Remembering/thinking; O: off-balance/coordination; K: Killer headache; E: Eyes/vision
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What is Parkinson's?
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Degenerative disorder; depletion of dopamine resulting in hypertonia and akinesia.
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S/sx Parkinson's?
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Resting tremor, rigidity, bradykinesia, akinesia, stooped posture, shuffling gait, disequilibrium, muffled/slurred speech, dimished facial expression, dementia
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