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280 Cards in this Set
- Front
- Back
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what are the key points in the definition of COPD?
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respiratory disorder, caused by smoking, progressive/partially reversible airway obstruction and lung hyperinflation, systemic manifestations, increasing frequency and severity of exacerbations
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what is emphysema
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abnormal permanent enlargement of airways distal to terminal bronchioles with destruction of their walls
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what is chronic bronchitis
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productive cough for more than 3 months in 2 consecutive years (no other dx)
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what is the smoking-linked pathogenic mechanism of COPD
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increased neutrophils (elastase, proteases) - good but not when munching on lungs (genetic components add b/c antitrypsin deficiency leaves less protease inhibitor)
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what parts of the lung make up the acinus?
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respiratory bronchioles, alveolar ducts, alveolar sacs, alveoli
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what pathologic changes does COPD cause?
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progressive tissue damage - destroys alveolar walls & septae
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what is panacinar/centrilobular emphysema?
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p - distal alveoli expanded; c - bronchioles expanded
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why does airtrapping/hyperinflation occur?
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loss of alveolar tissue and its elasticity (can't push the air out, damaged wall can collapse and obstruct)
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what is COPD's pathophysiologic impact?
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loss of gas exchange area (alveoli), loss of pulmonary capillaries, impact on O2 delivery and CO2 elimination, loss of elastic fibres affecting recoil
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describe epidemiology of COPD in Canada
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4th leading cause of death, more women are reporting being diagnosed
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what does spirometry measure
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lung volumes, pulmonary function
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what are the subdivisions of lung volume?
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maximal inspiration, maximal expiration, inspiratory reserve volume, tidal volume, expiratory reserve volume, residual volume, vital capacity, inspiratory capacity, functional residual capacity, total lung capacity
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how do the subdivisions of lung volume change when obstructed (copd, asthma, cystic fibrosis)
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total lung capacity increases, functional residual capacity decreases, reserve volume increases
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describe the ratio used to characterize lung disease
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FEV1/FVC (FVC - vital capacity after forced expiration) normally able to exhale 80% of FVC in 1s
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management of COPD
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education, smoking cessation, prevent exacerbations, vaccinations, bronchodilators, exercise, follow-ups, disease monitoring
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what does acetylcholine do and what blocks its effects
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narrows the airway, increases resistance; anticholinergics, B2 adrenergic agonists/bronchodilators
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what is flow limitation in copd
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there is little or no expiratory flow reserve for you to breath more quickly (can't increase expiratory flow)
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what are the key parts to the definition of asthma
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inflammatory disorder of airways, paroxysmal or persistent symptoms (dyspnea, chest tightness, wheezing, sputum prod., cough), variable airflow limitation, variable degree of hyperresponsiveness to endogenous/exogenous stimuli
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what are the immunohistopathological features of asthma
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inflammatory cell infiltration, hallmark feature eosinophils
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what is the pathophysiology of inflammation in asthma
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inflammation of mucosa w/ local edema, contraction of airway smooth muscle (airway narrowing, bronchoconstriction), mucous secretion, obstructed airway
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extrinsic asthma
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Type I hypersensitivity to inhaled antigen (IgE based); family history of atopy, allergies, childhood usually
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atopy
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genetic tendency to develop immediate allergic rx to substances
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intrinsic asthma
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adult onset, stimuli target hyperresponsiveness of airway (resp infection, cold air, exercise, drugs, stress)
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how do you diagnose asthma
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history and objective measures of lung fx (spirometry) - reversible airway obstruction after bronchodilator, variable airflow limitation over time, airway hyperresponsiveness
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what symptoms suggest asthma
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frequent episodes of breathlessness, tight chest, wheezing, cough; worse at night/early morning; develop w/ infection, exercise, allergens; after playing/laughing in kids; better w/ bronchodilators or corticosteroids
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what do endocrine glands and hormones do?
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secrete hormones directly into blood, act at receptors; control metabolism, reproduction, fluid/electrolyte balance, growth (produce a response or stimulate an endocrine response)
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what is negative feedback
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can be hormonal or not, output of system acts to oppose changes to input, if overall feedback is negative, then its stable
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how does negative feedback diagnose disease
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appropriate feedback response or lack thereof provides clues to pathophysiology; ex. hypercalcemia, find out what is regulation Ca levels to find where the problem is
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what does parathyroid hormone do
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increases Ca in the circulation (release from bone, absorption from kidneys/intestines)
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what are the causes of hypercalcemia? how do you differentiate?
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increased PTH (tumour on parathyroid gland), bone cancer (bone turnover); differentiate by measuring both (Ca high, but PTH low = not hyperparathyroidism; both high = no neg. feedback, hyper)
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what are the 2 categories of endocrine disorders?
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too much - often tumour, may be ectopic; too little - autoimmune response, destroyed by tumour, overworked
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how do you diagnose an endocrine disorder
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history and physical, measure hormones (immunoassay), imaging (ultrasound or MRI to locate lesion)
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what are the treatments for hormone deficiency and excess
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deficiency - replacement; excess - inhibitory drug therapy, ablation therapy (remove/shrink tumour)
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what is diabetes mellitus
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inadequate insulin production by beta cells of the pancreas
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what is the difference b/t type 1 &2 diabetes mellitus
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1 - insufficient insulin; 2 - normal or elevated, but insufficient b/c of insensitivity
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in fed an fasted states what dominates?
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fed - insulin; fasted - glucagon
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what is the initial pathology of diabetes
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hyperglycemia (increased blood glucose), polyuria, polydipsia, polyphagia, weight loss, fatigue, elevated fasting glucose, glucose tolerance test
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how do you treat the two types of diabetes
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1 - insulin (future = pancreatic transplants, stem cell therapy); 2 - diet (complex carbs, fibre, protein), exercise, drugs
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oral hypoglycemic drugs - sulfonylureas
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stimulate the beta cells of pancreas to release insulin; glyberide
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oral hypoglycemic drugs - biguanides
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increase sensitivity to insulin and reduce glucose production/absorption, inhibits gluconeogenesis; metaformin
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oral hypoglycemic drugs - glucovance
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combination of glyberide and metaformin
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what are some acute complications of diabetes
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insulin shock, ketoacidosis
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what is insulin shock, what causes it
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insulin-induced hypoglycemia; too much insulin in dose or skipping a meal, exercising, or vomiting after taking insulin
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what happens during insulin shock
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insulin pushes glucose to skeletal and adipose tissue, CNS fx depressed b/c neurons need glucose, SNS stim. b/c activation increases glucose
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what are the symptoms of insulin shock
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related to impaired neurological fx (alcohol intoxication), inability to concentrate, slurred speech, lack of coordination, staggering; sweating, tachycardia, pallor, tremor, anxiety
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how to treat insulin shock
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fruit juice, honey, candy, sugar, intravenous glucose
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what is ketoacidosis caused by
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inadequate insulin - infection, stress, underdosing, food or alcohol binge; hyperglycemia, lipid mobilization, ketones
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symptoms of ketoacidosis
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thirsty, dry mucosa, warm dry skin, low BP, oliguria, rapid resp, acetone/fruity breath, lethargy, unconsciousness, cramping, vomiting,
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tx of ketoacidosis
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more complicated b/c it happens over days, happens at hospital, administer insulin, rehydrate, replace electrolytes, treat acidosis w/ bicarbonate
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chronic complications of DM
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heart disease, stroke, blindness, neural, kidney disease, amputation, pregnancy complications
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vascular complications lead to
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stroke, heart attack, poor circulation, poor healing, glucose feeds bacteria, eyes (damage to retinal vessels), kidneys (thicken glomerular basement membrane, increase permeability)
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neural complications lead to
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demyelination of peripheral ns - numbness, autonomic ns - incontinence, erectile dysfunction
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causes of diabetes insipidus
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lack ADH (neurogenic, stimulates water absorption), resistance to ADH (nephrogenic), excessive thirst (dispogenic)
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PTH stimulates Ca release from bones - result
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osteoporosis, hypercalcemia (kidney stones, weakness, fatigue, depression, confusion)
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what are other causes of hyper and hypocalcemia
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hyper - bone cancer, immobility, high PTH, low calcitonin; hypo - renal disease, decreased vit D (Ca absorption) and increased PO4 (inhibits absorption)
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what are the pituitary hormones and abbrev.
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Thyroid stimulating hormone (TSH), Adrenocorticotrophin (ACTH), Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Growth Hormone (GH), Prolactin (PRL)
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symptoms of pituitary hormones
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adenoma - benign tumour; headache (intracranial pressure), drowsiness, seizure, visual defects (pressure on optic chiasm), abnormal hormone secretion
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what happens when prolactin, ACTH, and GH are abnormally secreted
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hyperprolactinemia - produce milk (galactorrhea), stop menstruating (amenorrhea); ACTH - Cushing's; GH - gigantism, acromegaly
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how does a tumour cause hypopituitaryism
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can destroy pituitary, compression compromises vascular supply, outgrowth can disrupt hypothalamic-pituitary connection
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what else can cause hypopituitaryism
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Sheehan's syndrome - vascular collapse following an obstetrical hemorrhage; pituitary stalk transsection - blunt force trauma, pregnancy, panhypopituitaryism (no pituitary hormones)
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how do you treat a pituitary tumour
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deficient - hormone replacement, multiple hormones if panhypo; excess - inhibitory drugs, ablation
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what are the two types of hypothyroidism
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primary - thyroid gland malfunction; secondary - pituitary deficiency of TSH, usually congenital, rare
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what are the causes of hypothyroidism
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autoimmune (hashimoto's), thyroiditis (inflam), congenital, surgery (hyperthyroidism, goiter, cancer)
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symptoms and tx of hypothyroidism
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reduced metabolism, endemic goiter, pale, cool, edematous, cold intolerant, slow HR, lethargic, decreased appetite, weight gain; thyroxine
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cretinism caused by, leads to
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untreated neonatal hypothyroidism, iodine deficiency; mental retardation, growth restriction
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what is Grave's disease
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form of hyperthyroidism, autoimmune disease, antibodies chronically stimulate TSH receptors
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thyroid nodules
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adenomas that produce thyroid hormone
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what is iatrogenic hyperthyroidism
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overmedication of hypothyroidism
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signs and symptoms of hyperthyroidism
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goitre, increased metabolism, weight loss w/o appetite loss, fatigue/muscle weakness, increased SNS, exopthalmus, nervousness/irritable, heat intolerant
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tx for hyperthyroidism
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radioactive iodine (targets thyroid gland), beta blocker for symptoms, antithyroid drug, surgery (cancerous thyroid nodules, goitre)
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what is pheochromocytoma (symptoms and tx)
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adrenal gland disease, benign tumour, secretes epinephrine and norepinephrine; headache, palpitation, sweating, anxiety, hypertension; surgery
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what is cushing's syndrome, causes
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excess glucocorticoids; ACTH secreting tumour, adrenal tumour, glucocorticoid therapy for chronic inflammatory conditions
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features of cushings
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trunkal obesity, moon face, buffalo hump, reduced limbic muscle mass, stria, increased hair growth, osteoporosis, insulin resistance, delayed healing, increase infect., reduced stress response
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what is addisons disease (cause, tx)
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deficiency of adrenocortical hormones; caused by autoimmune reaction, destructive tumours, infection; hormone replacement
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features of addisons
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risk of infect, poor stress response, weight loss, anorexia, hypotension, hyperpigmentation,
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what do the testes do
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sperm and testosterone production
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what do seminal vesicles do
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add seminal fluid (95% of ejaculate), energy source for sperm (fructose)
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what do the prostate and bulbourethral or cowper's glands do
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encapsulates urethra and ejaculatory duct, secretion raises sperm's ph; add alkaline mucous to ejaculate
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what are the parts of a semen analysis
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volume (2-4mL), viscosity, sperm density (greater than 20 mill/mL, average is 100 mill/mL), sperm motility (>40%), sperm morphology (<60% abnormal)
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tx of male infertility
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lifestyle (marijuana, cigarette, environment), insemination, IVF, intracytoplasmic sperm injection w/ IVF
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what is anovulation and what are the two types
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amenorrhea; primary - menarch never occurred, genetic disorders (turners), congenital disorders of brain, pituitary, ovary or uterus; secondary - cessation of cycle after a period of regular cycles
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tx of amenorrhea
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surgical resection of tumours, stress reduction, diet, exercise, osteoporosis therapy, endocrine therapy
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what is endometriosis
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endometrium outside uterine cavity - scarring, distortion, infertility, pain (dysmenorrhea, dyspareunia)
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testicular cancer facts
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most common for young men (15-35), familial component, increased in undescended testes
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signs, symptoms, tx of testicular cancer
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hard, painless unilateral mass, CT scan, tumour markers; ochiectomy (remove it), radiation, chemotherapy w/ cytotoxic drugs
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what is benign prostatic hyperplasia
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enlargement of prostate, formation of nodules around urethra, doesn't progress to cancer
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symptoms and tx for BPH
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hesitancy and reduced urine stream, urinary retention (cystitis/inflammation of the bladder); surgical, medical (anti-androgen, alpha adrenergic blocker)
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prostate cancer etiology and detection
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unknown; detect prostate specific antigen, elevated BPH and infection, rectal exam, confirm w/ ultrasound and biopsy
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tx of prostate cancer
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not always treated in younger men, prostatectomy and radiation, radiation implants if localized, anti-androgen if androgen sensitive
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pathology, signs/symptoms, detection of cervical cancer
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starts as dysplasia of squamous epithelial cells at columnar junction of the external os; spotting and watery discharge, anemia, weight loss; detect w/ pap smear
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etiology of cervical cancer
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linked to oncogenic STDS (herpes simplex virus type 2, HPV), increases w/ multiple sexual partners, takes 5-10 years to develop invasive disease
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tx for cervical cancer
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surgery, radiation, vaccine against HPV
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pathophysiology of carcinoma of the uterus
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endometrial hyperplasia leading to dysplasia, unopposed estrogen stimulation,
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diagnosis of carcinoma of uterus
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55-65, no screening test, unexpected bleeding, confirm w/ endometrial biopsy
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tx of uterine cancer
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hysterectomy, radiation,
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risk factors for ovarian cancer
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personal/family history of breast, ovarian, endometrial, prostate, colon cancer, gene mutation, increased by ovulation?
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tx for ovarian cancer
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surgery - debulking tumour, remove obstruction, chemo, radiation, palliation (bowel/bladder problems); prophylactic oophorectomy
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breast cancer etiology and tx
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family, increased w/ delayed childbirth, older women; surgery, radiation, chemo, tamoxifen, aromatase inhibitor
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what are the 2 types of muscle cells in the intestine
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skeletal and smooth
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describe pain perception in the GI tract
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key symptom of intestinal pathology, lack pain receptors, poorly localized
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fx of the epithelial cell
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barrier b/t lumen and body, secretion, absorption, lubrication; constantly growing, target of chemo
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what do intrinsic and extrinsic innervation do
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I - regulates fx; E - modulates, conveys info to CNS
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parts of stomach and fx
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fundus, body, antrum; secrete acid, mucus, proenzymes, mixing, storage
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what is the stimulus and consequences of vomiting
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distention, GI irritation, drugs, motion, intracranial pressure, strong noxious perceptions; aspiration, electrolyte imbalance
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process of vomiting
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glottis closes, LES relaxes, reverse peristaltic waves, abdominal muscles contract
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what are some chronic gastric conditions
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infection - H.pylori, ulceration (local erosion), carcinoma
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what is gastric dumping syndrome and why does it occur
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food passes through largely undigested, usually due to surgery - less gastric area/volume, idopathic
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name/describe two kinds of bariatric surgery
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restrictive operations - reduce gastric vol. and therefore capacity; malabsorptive - bypass of part small intestine
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what is gastroparesis, what condition leads to it
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delayed emptying; fx disorder of stomach; normally a balance of luminal, hormonal, and neural signs; diabetes b/c of peripheral neuropathy
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what is pyloric stenosis and why does it happen
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no emptying; sphincter defect in neonate, ENS abnormality - no local inhibitory innervation
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primary role of liver and gall bladder
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secrete bile, receive nutrients, blood-borne factors (detox); store bile
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what is biliary colic, what does it lead to, tx
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blockage of bile outflow; stones and pain; remove stones or gall bladder, lithotripsy (sound waves) or dissolution, drugs
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causes of jaundice
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high levels of bilirubin in blood, too much created in blood, not enough removed by/from liver, hepatitis
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Hepatitis A - kind, where found, length of infection
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infectious hepatitis, water/environment, acute
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Hepatitis B - kind, found, length
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serum hepatitis, blood/secretions, chronic/carrier
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Hepatitis C - kind, found, length, at risk for
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non-A non-B, blood, chronic, cancer risk
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Hepatitis D and E - goes w/, found, length
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D goes with B, blood/environment, acute
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what is cirrhosis and its effects
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loss of liver cell fx, bilirubin and bile production, fat absorption, glucose/glycogen, detox, ammonia-urea conversion, encephalopathy, effects blood flow
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what is cirrhosis' affect on blood flow
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fibrosis restricts flow, increased portal vein pressure, collaterals acquire increasing pressure, affects spleen and lower esophagus, ascites due to fluid shift to peritoneum
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fx of the pancreas
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exocrine secretion of enzymes and bicarbonate, endocrine secretion of insulin, synthesis/storage and secretion of proteases
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problems that occur w/ pancreas
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alcoholic pancreatitis, infectious pancreatitis (decrease fx, pain, sepsis), cystic fibrosis (impaired secretion of digestive enzymes), cancer
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pathologies of small intestine
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allergy, intolerance, celiac disease, E. coli, appendicitis, obstruction, volvulus, intussusception, peritonitis
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fx of duodenum, jejunum, and ileum
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neutralization of acid, action of enzymes, absorb food elements, mixing, propulsion
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fx of colon
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water absorption, storage
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describe intestinal immunology
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contents of lumen are sampled/regulated by immune system, prior sensitization allows immediate response (bad bacteria and food allergy)
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what is celiac disease and its basis?
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genetic basis; gluten sensitivity, immune response to gluten breakdown products - remove it from diet
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affects of celiac disease
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dammage to villi in upper GI tract, decreased absorption and enzyme production, malnutrition, affects Fe uptake
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lactose intolerance is NOT an
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allergy
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what is the mechanism of food allergies
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antigen recognition by mast cells due to prior specific antibody production; gut is initial target, then systemic
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how does infection occur in GI and how is it fixed
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bacteria/virus avoids gastric sterilization and colonizes, imbalance in natural flora, secretes toxins; restored by host immune system, other microbes, drugs
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appendicitis - cause, symptoms, resolution
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blockage, inflammation, infection, swelling, necrosis; RLQ pain; resolution or peritonitis
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what happens w/ inadequate inflow and outflow of blood to intestine
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in - hypoxia, ischemia; out - edema
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mechanical obstruction - intussusception (describe, symptoms, leads to)
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intestine invaginates in on itself; pain, vomiting, diarrhea, jelly stool; perfusion, ischemia, necrosis
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mechanical obstruction - volvulus (describe, caused by)
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twist in loop of gut; failure of mesentery to retain organization, congenital predisposition
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mechanical obstruction - adhesions (describe, caused by, leads to)
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connection of adjacent intestinal segments; healed or ongoing inflammation, surgery; leads to restriction of mvmt or dilation
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strangulation associated w/
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herniation of the abdominal muscle; loop of intestine can protrude, obstruction
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congenital obstruction - atresia
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failure in development, blind end of intestine
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congenital obstruction - aganglionosis (hirschprung's) - describe, leads to, tx
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non-propulsive region causing fx obstruction in infant, neurons don't develop; distended colon, toxicity; surgical excision
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what is ileus, its origin, caused by, leads to
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paralysis of intestine; neuro origin; follows surgery, trauma, disease; fine if spontaneous reversal after hrs, bacterial overgrowth, damage, peritonitis, sepsis, bacteremia, shock, mortality
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what is the peritoneum - structures
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parietal, visceral peritoneum, mesentery and omentum; participates in inflam, thin, highly vascular, highly innervated membrane
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what does the omentum do during inflammation
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loose sheet, mobilizes to sites of inflam. attaches to outside; adhesions, fibrosis
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what is peritonitis, symptoms
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inflam of peritoneal cavity, perforation = chemical irritation (bile), bacteria; guarding, fluid in peritoneal cavity, ileus, systemic infection
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what are some functional pathologies of the esophagus
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dysphagia, stenosis, stricturing, atresia, somatic disease, achalasia
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what is atresia
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discontinuous intestinal tube formation; failure in development
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what is GERD and what can cause it
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gastro-esophageal reflux disease, acid reflux into lower esophagus causing inflam; lax LES, excessive acid production, hiatal hernia
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2 kinds of esophageal cancer and causes
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adenocarcinoma - GERD, obesity; squamous cell carcinoma - tobacco, alcohol, diet, H.pylori
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what are some diagnostic tests for GI
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endoscopy, colonoscopy, sigmoidoscopy, ERCP, manometry, pH monitoring, questionnaire
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what are different kinds of blood found in stool, what do they mean
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fresh - local source, black/tarry - upper GI sources, cryptic - chemically detected
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how is GI cancer approached
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detect, remove, resection, chemo/radiation to prevent growth, detect metastases
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what causes hemorrhoids, symptoms, tx
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venous pressure expands perianal rectal veins, incontinence, constipation; inflam, pain; banding, cautery, surgery
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haustra
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contractions of circular smooth muscle forming ring-like constrictions
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diverticulosis, caused by
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small out-pocketings of colonic wall; low-fibre, constipation
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diverticulitis, cause, symptom
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diverticula become inflamed; unknown, small seeds?; pain, mild/severe
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symptoms of IBS
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pain, constipation, diarrhea
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what are the Rome criteria
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abdominal pain released w/ defecation, change in frequency and consistency; two or more of the following: altered freq./form, mucous stool, bloating
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crohn's - location and characteristics
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mouth - anus, mostly ileus, full thickness of gut wall; lesions, cobblestoning, inflammation, thickened bowel wall, abscess, adhesions, fistulae, stricturing
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ulcerative colitis - symptoms, leads to
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pain, bleeding, diarrhea, fever, anemia, weight loss; mucosal ulcers in colon/rectum
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location and tx of UC
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only colon; resection
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what factors do CD and UC have in common
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inappropriate activation of mucosal immune system; genetic factors are involved but not the only cause; possible environmental factors - smoking, luminal flora
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components of long bone
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epiphysis, metaphysis, diaphysis, periosteum, endosteum
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periosteum fx
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surrounds bone, entrance of blood vessels
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endosteum fx
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lines medullary cavity, bone marrow, site of hematopoiesis
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2 types of bone
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spongy (cancellous, trabecular), compact (cortical)
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bone components
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haversian system (osteon), matrix rings (lamellae), haversian canals, osteocytes in lacunae
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bones are composed of
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collagen (matrix), hydroxyapatite
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osteoblasts fx
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Ca deposition, increase alkaline phosphatase
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osteoclasts fx
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Ca resorption
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how is bone formed
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chondrocytes produce cartilage, becomes calcified, osteoblasts invade, occurs at epiphyseal plates
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what are the classifications of bone trauma
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complete/incomplete, open/closed, # of fracture lines (segmented, comminuted), direction of fracture (transverse, spiral, oblique)
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how else can bone be damaged
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impacted, pathological (tumour), stress, depressed
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2 special types of bone fracture
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colles - wrist puts force against immovable object (bone moves instead); potts - same w/ ankle
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signs/symptoms of fractures
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swelling, loss of fx, deformity, crepitus, pain, early numbness
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what happens after the fracture
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bleeding/hematoma, granulation tissue, procallus, bony callus, remodelling
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what affects healing of fractures
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degree of damage, inflam, blood supply, approximation, immobilization, foreign material, systemic factors (diabetes, glucocorticoids, nutrition)
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healing complications w/ fractures
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muscle spasm, infection, ischemia, compartment syndrome, nerves/vessels compressed, fat emboli, non-union
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joints - synarthroses, ex.
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immovable, fibrous tissue; skull
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joints - amphiarthroses, ex.
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slightly movable, hyaline cartilage; pubic symphysis, tibia/fibula
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joints - diarthroses
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freely movable, synovial
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parts of a synovial joint
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articular surface (hyaline cartilage), synovial membrane, synovial fluid (glycoproteins), bursa
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tendons, tears are called
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join muscle w/ bone; strain
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ligament, tear called
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join bones; sprains, poor blood supply
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what is a partial dislocation
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subluxation
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what is a total separation of tendon/ligament from bone
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avulsion
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example of a repetitive strain
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carpal tunnel syndrome
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3 different spinal abnormalities
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kyphosis, lordosis, scoliosis
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2 different kinds of scoliosis
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structural - idiopathic, congenital, degenerative; functional - muscular dystrophy, cerebral palsy, trauma
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what contributes to rheumatoid arthritis
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genetics, autoimmune - rheumatoid factor
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synovitis
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inflam of synovial membrane
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pannus
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abnormal layer of fibrovascular tissue or granulation tissue
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ankylosis
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joint fixation, abnormal stiffness/rigidity of bone/joint
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signs of RA
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small joints first, disuse - muscle atrophy, pain, swelling, shortening of muscles around joint, subluxation, boutonniere deformity, ulnar drift
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difference b/t juvenile and adult RA
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acute onset, large joints, no RF, anti-nuclear antibodies found (autoimmune), rash, fever, enlarged spleen, iris inflam.
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how does gout occur
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uric acid crystals in synovial fluids b/c of excess purine breakdown and poor elimination
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whats a tophi
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big nodule on the joint
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tx for gout
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diet, alopurinol, colchicine, increase fluid, uring pH
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what is ankylosing spondylitis, what happens w/ it
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fusing of vertebral joints; sacroiliac joints first, rigid back, kyphosis
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what happens w/ osteoarthritis
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bone and joint disease, degenerative, bone spurs, mechanical stress at articular cartilage, narrowed joint, local inflam, non-systemic
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signs of osteoarthritis
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pain, ltd mobility, heberden/bouchard nodes, crepitus
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tx for osteoarthritis
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rest, glucocorticoids, analgesics, NSAIDs, joint replacement
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what are rickets and osteomalacia
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rickets - in children; insufficient bone mineralization, Vit D deficiency; malabsorption, renal disease
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what is osteoporosis
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decreased bone density, matrix and mineralization
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primary osteoporosis happens to...
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postmenopausal, senile
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secondary osteoporosis happens w/
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Cushings - too many glucocorticoids; malabsorption of calcium, protein, vit D
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risk factors for osteoporosis
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age, postmeno, decreased mobility, diet, vit d/calcium;protein, smoking, caffeine, drugs, glucocorticoids/antacids/chemo
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osteoporosis symptoms
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cancellous bone lost faster than cortical, compression fractures - vertebral, femoral, neck, kyphosis
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tx for osteoporosis
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supplement calcium and vit d, bisphosphonates, exercise, estrogen, calcitonin, strontium ranelate
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muscle cramp, caused by
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pain from spasm, lactic acid build up, reduced blood flow - ischemic pain, not enough oxygen or blood flow to remove agents
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what is tetany caused by
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hypocalcemia - increased Na permeability, potential to get waaay too much contraction (vit D deficiency, alkalosis - proteins bind Ca, low PTH - take Ca out of bone)
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what is trousseaus sign
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flexion of wrist exacerbated by cutting of blood flow
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cause of muscular dystrophy
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genetic - defective dystrophin which attaches actin and myosin to cell membrane for contraction
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duchennes muscular dystrophy
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early onset, rapid progression, x-linked recessive (males)
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myotonic muscular dystrophy
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delayed relaxation, autosomal dominant, slow progression
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what are other characteristics of muscular dystrophy
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increased creatine kinase, muscle replaced by fat/connective tissue, cardiomyopathy, gower's maneuver (climb up self), vertebral deformities - scoliosis
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describe fibromyalgia syndrome
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pain/stiffness in muscles/tendons, 18 trigger points, may accompany IBS, no obvi inflam, aggravated by sleep deprivation, stress, fatigue
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cause of fibromyalgia and tx
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increased sensitivity to substance P?; NSAIDs, SSRIs
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what provides protection for the brain
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skull, meninges (dura mater, arachnoid, pia mater), CSF, blood-brain barrier
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what is the fx of the front of the brain
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personality, intellect
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fx of the side of the brain
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sensory, speech, auditory, memory, mvmt
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fx of back of brain
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vision
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fx of cerebellum
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balance, equilibrium, coordination
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left hemisphere fx
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usually dominant, language, logic
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right hemisphere fx
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creativiy, emotion, spatial relationships
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basal nuclei/ganglia fx
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control/coordinate skeletal muscle activity, mostly automatic things
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limbic system fx
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emotion and feelings regulation
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diencephalon is made up of what, what are their fxs
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thalamus - relay incoming sensory impulses; hypothalamus - homeostasis, body temp, food/water intake, stress, libido
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parts and fx of brainstem
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pons - afferent/efferent fibres, cranial nerves; medulla oblongata - resp/cardio fx, cough, swallow, vomit; reticular activating system - arousal
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fx of cranial nerves
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take in sensory info, send out efferent info, sensory, motor, or mix
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what are supratentorial lesions
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in cerebral hemispheres, discrete loss of specific fx
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what are infratentorial lesions
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brain stem, widespread impairment - cardiovascular or cardiorespiratory
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what would you lose fx of w/ a right/left side lesion
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L - logic, analytical skills, communication; R - music/art, behavioural problems
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signs of stroke
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weakness in arm, hand, leg, numbness on one side, dimness/loss of vision, difficulty speaking, inability to understand speech, dizziness, loss of balance, headache
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damage to optic nerve, chiasm and tract lead to
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nerve - loss of vision in one eye, chiasm - blindness, tract - visual field deficits
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brocas aphasia
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lose ability to speak/write
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wernicke's aphasia
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inability to read, understand language
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global aphasia
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combo of broca and wernicke
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seizures/convulsions are caused/preceded by
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excessive discharge of anatomical pockets of neurons; hypoxia, bleeding, inflam, sensory stimulus
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early signs of increased ICP
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decreased loc, headache, vomiting, papilledema - bulging of retina b/c nerve fibres are being poked through
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cushings reflex
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attempt to maintain blood supply to brain, vasoconstriction increases BP, baroreceptors slow heart, circulation improves - relax, ICP increases again
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visual signs of ICP
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affects size and response of pupils, same side pupil becomes fixed and dilated
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describe benign brain tumours
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normally well-defined borders, can still be life-threatening b/c of pressure
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describe malignant brain tumours
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borders are harder to define, project into local tissue
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stroke - thrombosis
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gradual narrowing of arteries, deprive neuro tissue of blood
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stroke - embolism
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rapid blockage, clot (blood or plaque), often from a systemic source
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stroke - aneurism
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hemorrhage, blood vessel burst, rupture cerebral artery
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what is the most devastating kind of stroke, why
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hemorragic, blood is more toxic to neuro tissue, pressure, starve tissue
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describe necrotic core and apoptotic penumbra
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necrotic core - cell death by lack of blood or toxin; apoptotic penumbra - programmed cell death, lack of O2
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tx of stroke
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avoid it, stop bleed (surgery), unblock vessel, rescue penumbra (cold), rehab
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meningitis, symptoms, tx
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bacterial infection of meninges; headache, back pain, rigidity, vomiting, irritability; aggressive antimicrobial therapy, and anti-inflam
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brain abscess, tx
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localized infection of CNS, usually infiltration of bacteria from periphery - surgically drain, anti-microbial therapy
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encephalitis, symptoms
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infection of connective tissue, glia of brain or spinal cord; flu then neuro
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rabies
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virus from bite, travels along peripheral nerve to CNS; inflam, necrosis, SLOW
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tetanus
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soil, rusty nails, bacteria, sloooow
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poliomyelitis
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attacks motor neurons, very transmittable
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3 infection-related syndromes
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reyes - associated w/ ASA from aspirin, gullian-barre - assoc. w/ viral infect, shingles - chicken pox
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what is a contusion
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blow to the head, bruising of brain tissue, ruptures blood vessels, swelling/hemorrhage
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different types of fractures
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linear, compound (multiple, fragments), depressed, basilar (base of skull)
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what is primary brain injury
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direct effect of insult; kill/disconnect neurons, damage glial cells and blood vessels
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what is secondary brain injury
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consequences of primary insult; cerebral edema, hemorrhage, vasospasm, infection, ischemia
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spinal cord injury, most common where
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fracture or dislocation of vertebra which compresses, stretches, or tears spinal cord; neck and back (flexible)
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autonomic dysreflexia
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stimulus (pain, distended bladder), enters spinal cord, activates sympathetic ganglion chain, vasoconstrict - BP up, brain is cut off so it can't stop it
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hydrocephalus, two types
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accumulation of CSF, compress brain and blood vessels; communicating and noncommunicating
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spinal bifida, dx, factors
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neural tube deficits; dx by amniocentesis; gestational diabetes, vit A or folate deficiency
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cerebral palsy
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motor impairment caused by brain damage in perinatal period, malformed by mechanical, hypoxia, hemorrhage, hypoglycemia etc.
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3 types of cerebral palsy
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spastic - affects motor cortex, doesn't mediate reflexes in spinal cord, rigid; dyskinetic - motor control in basal ganglia, lose fine motor control; ataxic - spinal cord, lose coordination/balance
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epilepsy
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uncontrolled, excessive neuronal discharge in brain - sudden spontaneous depolarization of neurons
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two types of seizures
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absence seizure (petit mal) - zone out; tonic-colonic (grand mal) - generalized seizure
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main symptoms of parkinson's
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tremor, rigidity, bradykinesia, instability
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cause of parkinson's
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gradual loss of striatal neurons involved in mvmt control, lose coordinated dopamine release
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tx for parkinson's
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L-dopa; MAO-B and COMT inhibitors; anticholinergics; fetal dopamine transplants; brain stimulation
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multiple sclerosis
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progressive demyelination of neurons of brain, spinal cord, cranial nerves, interferes w/ impulse conduction, plaques develop
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amyotropic lateral sclerosis
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muscle wasting and hardening of the lateral corticospinal tracts; flaccid paralysis
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myasthenia gravis
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autoimmune disorder; skeletal muscle weakness, starts w/ face and ocular muscles, later arm and trunk, swallowing, breathing
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huntington's disease
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inherited, late onset, progressive brain atrophy, degeneration of GABAergic neurons of basal ganglia and frontal cortex
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dementia
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progressive cortical atrophy, loss of memory, personality changes; alzheimers, mad cow, AIDS
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progression of alzheimers
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starts w/ entorhinal cortex, hippocampus (mild memory loss), cortex (developing symptoms)
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tx for alzheimers
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none really effective, slow cognitive decay, inhibit formation of amyloid plaques
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schizophrenia
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too much dopamine, delusions, flat affect, decreased speech
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unipolar depression
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major depression
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bipolar depression
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alternating periods of depression and mania
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tx for depression
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tricyclic antidepressants - block NT reuptake, SSRIs, MAO inhibitors, electroconvulsive therapy
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