Ptha 1321 - Human Diseases: A Systemic Approach - Zelman Book And Miele Lecture - Exam 5

Front 1

Describe the structure of bone ***

Back 1

Fibrous connective tissue, impregnated with mineral salts

- Connective tissue gives bone its toughness/elasticity
- Mineral salts give bone is hardness/rigidity

Front 2

Bone shapes ***

Back 2

- long
- short
- flat
- irregular
(- sesamoid)

Front 3

What is periosteum? ***

Back 3

tough fibrous outer membranous covering of a bone

Front 4

Characteristics of periosteum ***

Back 4

- Highly vascular (blood supply to bone)

- Inner lining of periosteum contains osteoblasts (cells responsible for growth and repair of bone)

Front 5

What is compact bone? ***

Back 5

a.k.a. cortical bone

outer bone layer laid down in concentric circles

Front 6

What is spongy bone? ***

Back 6

a.k.a. cancellous bone

inner bone layer; porous appearance

Front 7

Characteristics of spongy bone ***

Back 7

- thin calcified plates (trabeculae) laid down in response to stress
(this is why exercise is important to bones!)

- primarily at ends of long bones and in flat bones

- contains spaces filled with red marrow (for RBC formation)

Front 8

Components of (long) bone ***

Back 8

- medullary cavity
- diaphysis
- epiphysis
- metaphysis

Front 9

What is the medullary cavity? ***

Back 9

- central cavity of long bone

- filled with yellow marrow (fat) in adults (this is what can cause embolism with a fracture)

Front 10

What is the diaphysis? ***

Back 10

the shaft of the long bone

Front 11

What is the epiphysis? ***

Back 11

the expanded ends of the long bone

Front 12

What is the metaphysis? ***

Back 12

the epiphyseal growth plate

- a disc of cartilage between diaphysis and epiphysis in children

- new bone forms here

- when growth stops, cartilage disappears and ossification occurs

Front 13

How may bones become infected? ***

Back 13

Infectious agents can enter the bone through
- open fractures
- from bloodstream
- from adjacent infected tissue

Front 14

What is osteomyelitis? ***

Back 14

inflammation of bone (medullary cavity and spongy bone)
- local and systemic infection
- most common in children and adolescents
- long bones affected (femur, humerus, tibia)

Front 15

How does osteomyelitis form? ***

Back 15

- infectious pyogenic organism (staph) from bloodstream/open wound enters bones
- abscess forms
- pus fills cavity
- local inflammatory response (heat swelling, pain)
- vessels in area are compressed due to edema
- bone tissue ischemia, then necrosis
- separation of necrotic bone from healthy bone (sequestrum)
- blood clots from infectious tissue travel to other bone sites and form new bone abscesses

Front 16

What are the systemic effects of and treatment for osteomyelitis? ***

Back 16

- systemic effects: fever/chills, elevated WBC level

- tx: massive (IV) antibiotics, NWB, surgery to necrotic bone

Front 17

Characteristics of tuberculosis of bone ***

Back 17

- while TB is primarily a lung disease, it can spread to other structures
- infectious tubercules from lungs travel via bloodstream to bone
- iInfectious clumps form on bone, cavities develop in bone, bone tissue is destroyed

- commonly affects: ends of long bones, cartilage in joints

Front 18

Sequelae of tuberculosis of bone ***

Back 18

- arthritis of joints
- destruction of growth plates
- Pott’s disease (vertebral column of children); results in spinal deformity, possible nerve impingements

Front 19

Treatment for tuberculosis of bone ***

Back 19

- TB antibiotics
- surgery to correct deformities

Front 20

How does Vitamin D deficiency affect bones? ***

Back 20

- Vitamin D is necessary for absorption of calcium and phosphorus into system

- lack of Vitamin D results in soft bones that bend easily:
---- Rickets (children)
---- Osteomalacia (adults)
---- genu varum (bowed legs)
---- genu valgus (knock knees)
---- also spinal curvature, delayed teething, and muscle flabbiness

Front 21

How do deficiencies in blood levels of calcium and phosphorus affect bones? ***

Back 21

result in soft, deformed bone

Vitamin D is needed for these minerals to be absorbed into the system

Front 22

What is the treatment for Vitamin D (and calcium/phosphorous) deficiency? ***

Back 22

- sunshine
- supplements
- fortified milk
- cod liver oil

Front 23

What is osteitis fibrous cystica? ***

Back 23

- caused by hyperactivity of parathyroid

- excessive production of parathyroid hormones pulls calcium from bones (increases activity of osteoclasts)

- cysts and nodules form in bones, which decalcify and become porous

- results in bone deformities, spontaneous fractures, calcium in vessels, kidney stones, depressed nervous system

Front 24

Treatment for osteitis fibrous cystica ***

Back 24

- drug therapy
- removal of parathyroid tumor
- surgery to correct deformity

Front 25

What is Paget's disease? ***

Back 25

- softening of the bone
- causes remodeling and overproduction of soft “immature” bones
- etiology unknown; possibly genetic

- results in enlarged bones (primarily skull, pelvis, vertebrae)
- also frequent fractures and bony deformities

Front 26

Treatment for Paget's disease? ***

Back 26

- if mild, none
- if severe: NSAIDS, diet, drugs to prevent bone loss

Front 27

What is osteoporosis? ***

Back 27

- increased porosity of bone
- leads to reduction in bone mass
- skeletal system becomes fragile (primarily vertebral bones, pelvis, femur, radius)

- traebecular/spongy bone affected mostly, but compact bone too
- occurs most frequently in white females > 50 yrs.

Front 28

Causes of osteoporosis ***

Back 28

- possibly heredity
- females with small bone mass
- aging process with decreased estrogen post-menopause

- immobilization/disuse atrophy
- calcium-poor diet (particularly in teen years when bone is developing)
- lack of exercise

Front 29

Complications of osteoporosis ***

Back 29

- compression fractures of vertebral bodies (causing pain, spinal nerve pressure)
- fractures of weight bearing bones (hips, pelvis) radius (wrist)
- curvature of spine (kyphosis)
- decreased height

Front 30

Treatment for osteoporosis ***

Back 30

- exercise
- estrogen therapy
- calcium-rich diet
- surgery for fractures

Front 31

What are the two most common deformities of the spinal column? ***

Back 31

- scoliosis
- kyphosis

Front 32

Name four types of bone neoplasms ***

Back 32

- osteoma
- giant cell tumors
- osteogenic sarcoma
- secondary tumors

Front 33

What is osteoma? ***

Back 33

- benign growth
- usually develops at end of long bone
- can affect joints

Front 34

What are giant cell tumors? ***

Back 34

- benign or malignant
- removed surgically

Front 35

What is osteogenic sarcoma? ***

Back 35

- primarily malignant
- most common in children (long bones, knee)
- can develop from Paget's disease
- treated with chemotherapy or amputation

Front 36

What are secondary tumors? ***

Back 36

- cancer that has metastasized (generally from lung or breast)
- very painful in bone
- easily fractures ribs, sternum, skull (highly vascular bones)

Front 37

What is a fracture and what are some causes? ***

Back 37

- disruption of the continuity of bone

caused by
- trauma excessive stress on bone
- fatigue - repeated stress on bone (stress fracture)
- pathology - disease process (TB, CA, osteoporosis)

Front 38

Name ten types of fractures ***

Back 38

- open (compound)
- closed (simple)

- avulsion
- comminuted
- compression
- depressed
- greenstick
- impacted
- multiple
- spiral

Front 39

Open fracture ***

Back 39

a.k.a. compound fracture

- fractured bone pierces skin

can result in
- infection (osteomyelitis)
- contamination
- soft tissue damage

Front 40

Closed fracture ***

Back 40

a.k.a. simple fracture

- no communication with external
- skin not pierced

Front 41

Impacted fracture ***

Back 41

- one fractured end is forced into the other end

- commonly due to falls
- also common in hip fractures

Front 42

Greenstick fracture ***

Back 42

bone fractures on one side, but bends on the other

common in children because their bones have more organic matrix and are more flexible

Front 43

Comminuted fracture ***

Back 43

fracture with splintered, fragmented, bony pieces

common in those with brittle bones, such as osteogenesis imperfecta

Front 44

Multiple fracture ***

Back 44

more than one segment of bone fractures

Front 45

Avulsion fracture ***

Back 45

occurs when a fracture of bone tears away from the main bone due to external force or trauma

Front 46

Compression fracture

Back 46

bone is crushed

common in patients with osteoporosis

Front 47

Depressed fracture

Back 47

broken bone is pressed inward

common in skull fractures

Front 48

Spiral fracture

Back 48

jagged break due to twisting force on bone

common fracture in sports injuries

Front 49

What are the five stages of fracture healing? ***

Back 49

- hematoma - blood seeps out and surrounds fx’s surfaces

- granulation - hematoma invaded by tiny capillaries; tissue becomes soft and rubbery

- callus - osteoblasts (repair cells for bone from periosteum) enter site of repair and lay irregular trabeculae of bone; new blood vessels grow into tissue; osteoclasts reabsorb necrotic bone

- consolidation - osteoblasts organized, callus transformed into mature bone

- remodeling - union is complete; newly formed bone forms a “collar” that is stronger, thicker, and denser than the original bone

Front 50

What are four types of treatment for fractures? ***

Back 50

- closed reduction
- open reduction internal fixation
- external fixation
- mechanical traction

Front 51

What is the primary goal of fracture treatment? ***

Back 51

reduction of fracture

realignment of bone

Front 52

What is closed reduction of a fracture? ***

Back 52

- manual manipulation
- realignment of bone from outside
- no surgery
- cast to immobilize while healing

Front 53

What is open reduction and internal fixation (ORIF) of a fracture? ***

Back 53

surgery performed
- fracture site and wound cleaned out, and
- fracture fixed with pins, plates, screws, etc., or
- prosthesis (TKA, etc.)

Front 54

What is external fixation of a fracture? ***

Back 54

- percutaneous pins/wires connected to a rigid external frame

- allows 3-plane correction of a deformity

Front 55

What is mechanical traction of a fracture? ***

Back 55

- fracture is immobilized in a traction unit
- especially with long bones of the lower extremities
- until healed or ORIF

(think of the old cartoons with the casted leg elevated in a sling)

Front 56

What are some possible complications of a fracture? ***

Back 56

- TBI (skull fracture)
- SCI (vertebral fracture)

- damage to surrounding organs (muscles, vessels, organs)
- embolism (fat, blood clot, air) can become pulmonary embolism
- infection, especially with compound fracture or ORIF

- delayed union, or non-union, due to poor vascular supply
- bone shortening
- issues due to immobilization (pneumonia, decubitus ulcers)

- avascular necrosis - death of bone tissue due to lack of blood supply
---- can lead to tiny breaks in the bone and eventual bone collapse
---- most often affects head of femur, causing hip pain
---- can affect other bones as well

Front 57

What is a joint? ***

Back 57

the articulation of two or more bones

Front 58

Structure of a joint ***

Back 58

- articulation of two or more bones

- articulating surfaces covered with hyaline cartilage

- often cartilaginous discs/menisci present between bones to
----- serve as shock absorbers/distributors
----- accommodate movement (vertebrae, knee)

Front 59

What is a sprain? ***

Back 59

- tearing or stretching of ligaments surrounding joint (Grade I-III)

- can rupture blood vessels of surrounding tissue; joint intact

- once torn, it’s torn because the tissue is avascular

- also easier to re-sprain b/c it is stretched and remains stretched

Front 60

Signs and symptoms of a sprain ***

Back 60

- inflammation
- edema
- ecchymosis (blood from somewhere superior)
- pain
- LOM

Front 61

What is dislocation/subluxation of a joint? ***

Back 61

- bone displaced from joint (shoulder, finger, patella)
- secondary to excessive force or poorly formed joint
- soft tissue damage

- edema
- pain
- deformity
- LOM

- may be congenital: displaced bone in joint due to improperly formed joint in newborn; usually hip

Front 62

What is arthritis? ***

Back 62

inflammation of a joint or joints resulting in pain, swelling, and stiffness

Front 63

What is rheumatoid arthritis? ***

Back 63

- progressive, chronic, systemic inflammatory disease of the joints

- inflammation of synovial membrane with membrane thickening (pannus)

- spreads to joint space and results in erosion of articulating surfaces due to inflammatory phase (inflammation continuous)

- scar tissue forms
- joint ankyloses (fuses); can be severely crippling
- results in no joint motion
- subcutaneous nodules in areas of increased mechanical pressure often occur (usually in MCPs)
- affects multiple bilateral joints
- periods of exacerbation/remission

Front 64

Cause of and treatment for rheumatoid arthritis ***

Back 64

cause:
- possible tissue hypersensitivity secondary to autoimmune reactions
- possible genetic factor

treatment:
- no cure
- treat symptoms with anti-inflammatories, prednisone (steroids)
- exercise (do not overstretch pt)
- possible surgery

Front 65

What is juvenile RA? ***

Back 65

- RA with onset prior to age 16
- can be severe and crippling by young adulthood

Front 66

What is the most common form of arthritis? ***

Back 66

osteoarthritis

Front 67

What is osteoarthritis? ***

Back 67

- deterioration of articulating cartilage resulting in exposure of underlying bone

- causes new bone formation (hypertrophy)
- osteophytes (spurs) develop

- often affects only one joint; usually a weight bearing joint (hip, knee, vertebra)

- affects sexes equally

Front 68

Cause of and treatment for osteoarthritis ***

Back 68

- cause unknown
- associated with injured/overworked joints
- aging worsens with increased weight

- no cure
- treat symptoms with analgesics, NSAIDS, corticosteroid injections
- decrease WBing on joint, lose weight,
- possible surgery

Front 69

What is the structure of skeletal muscle? ***

Back 69

- consists of bundles of muscle cells (fibers)

- muscle fibers consist of myofibrils which contain actin and myosin

- myofibrils comprise contractile units called sarcomeres

- the number of muscle fibers present in a muscle is fixed
- any increase in size of muscle is brought about by hypertrophy of each individual fiber
(increased mitochondria, increased myofibrils)

Front 70

What is a motor unit, and how does it function? ***

Back 70

- motor unit = all the muscle fibers innervated by one motor neuron and its axon

- stimulation of motor unit occurs at neuromuscular junction

- requires release of Ach from presnynaptic junction

- excess Ach cleaned up by (acetyl)cholinesterase enzyme

Front 71

What is tendinitis/tendonitis and how is it treated? ***

Back 71

inflammation of tendon due to
- trauma
- repeated microtrauma (sports)
- postural malalignment

- can result in scarring, calcium deposits laid down

treatment:
- immobilization
- NSAIDs
- steroidal injections
- PT

Front 72

What is a strain? ***

Back 72

- damage to muscle tissue

mild; without loss of continuity of fibers
severe:
- partial or complete tear of muscle
- loss of continuity of muscle fibers

Front 73

What is a cramp? ***

Back 73

painful, involuntary muscle contraction due to
- electrolyte imbalance or
- muscle fatigue

decreased blood flow leads to ischemia, which sets off reflex contraction

muscle soreness due to:
1) microtears of muscle or CT
2) edema due to accumulation of metabolic wastes
(need acetylcholinesterase to clear wastes out; this is
why DOMS is helped by doing a couple of pushups)

Front 74

What is compartmental syndrome? ***

Back 74

- condition which develops when there is increased pressure in an enclosed and limited anatomical space resulting in compression of muscles, nerves, vessels

- extremities (esp LE) are susceptible to compartmental syndrome because muscles, nerves, blood vessels, and bone are surrounded by non-expanding fascial sheaths

- any condition that increases the contents of the compartment (usually inflammation, edema) puts patient at risk for neuromuscular damage due to ischemia

- check distal muscles, pulse, sudden onset of foot drop

- can cause permanent damage if not treated

Front 75

Causes of and treatment for compartmental syndrome? ***

Back 75

causes:
- burns
- intensive use of muscles
- bites
- capillary filtration

treatement - fasciotomy

Front 76

What is Muscular Dystrophy? ***

Back 76

- a group of uncommon inherited conditions in which there is progressive degeneration and destruction of muscle fibers

- cell defect which interferes with protein metabolism necessary for providing energy for muscle contraction

- muscles necrose and are replaced by connective tissue and fat

- different types of dystrophies (9 in all), all have muscle wasting in common

Front 77

What is Duchenne's Muscular Dystrophy? ***

Back 77

- sex-linked recessive gene carried by mother
- affects males exclusively

- diagnosed by 2-3 years (Gower’s sign)
- affects proximal muscles (shoulder/pelvic girdles)

- wheelchair-bound by 8-10 years after diagnosis
- death usually by 20 years due to cardiac/respiratory complications

Front 78

What is myasthenia gravis? ***

Back 78

- disorder of the neuromuscular junction; but nerve and muscle are intact

- autoimmune disease
- antibodies produced which cover many of the Ach receptors at motor end plate on post-synaptic membrane
- results in decreased stimulation of muscle tissue; weakness

- females > males 20-40 years
- can be life threatening if respiratory muscle involvement

Front 79

Treatment for myasthenia gravis ***

Back 79

treatment:

- cholinesterase-inhibiting drugs (Ach stays in cleft longer an has more a chance to bind onto available receptor site)

- plasmaphereis – blood removed, plasma which contains antibodies is skimmed off, blood elements returned

Front 80

What is rhabdomyosarcoma and how is it treated? ***

Back 80

- rare, malignant cancer of skeletal muscle

- highly malignant, metastasizes early

- poor prognosis

- treatment: aggressive chemotherapy, surgery to remove cancerous muscle tissue

Front 81

What is myositis (heterotropic) ossificans? ***

Back 81

a.k.a. heterotropic ossification

- an extra-osseous, non neoplastic growth of new bone

- occurs most commonly in the second and third decade in the arms and thighs of patients who have experienced some sort of trauma

- quadriceps and brachialis are the most affected

Front 82

What causes myositits (heterotropic) ossificans? ***

Back 82

- not applying R.I.C.E.M. (rest, ice, compression, elevation, and motion) immediately after injury.

- having intensive physical therapy or massage too soon after injury

- returning too soon to training after injury

Front 83

What are the signs and symptoms of myositis ossificans? ***

Back 83

- restricted range of motion
- pain in the muscle with movement
- (palpable) hard lump in the muscle
- x-ray showing bone growth

Front 84

Treatment of myositis ossificans ***

Back 84

- rest from activity
- usually will resolve itself in time
- may require surgical excision of calcified tissue
- also prone to reoccur

Front 85

What is Osgood Schlatters disease? ***

Back 85

- common cause of knee pain in children and young athletes

- tibial tuberosity becomes inflamed, painful and swollen

Front 86

Cause of Osgood Schlatters disease ***

Back 86

- patellar tendon inserts at the tibial tuberosity and through overuse can tug away at the bone causing inflammation

- most often in children involved with running and jumping activities

- with repeated trauma, new bone grows back during the healing
- causes a bony lump which is often felt at the tibial tuberosity.

Front 87

Signs and symptoms of and treatment for Osgood Schlatter's disease ***

Back 87

- tenderness and pain on the tibial tuberosity during and after exercise.

- pain when contracting the quadriceps against resistance or when contracting the muscles with the leg straight

treatment
- rest from activity
- ice after sports activity
- knee brace or support

Front 88

Structure of skin ***

Back 88

Skin consists of two primary layers:
- epidermis (outer layer) and
- dermis (deeper layer) with an
- underlying subcutaneous layer of fat

Front 89

What is the epidermis? ***

Back 89

- multi-layered
- consists of squamous (layered) epithelium
- contains free nerve endings
- no blood vessels

- keratinocytes (water-proofing cells)
- melanocytes (skin pigments)

Front 90

What is the dermis? ***

Back 90

- underlies epidermis

- has nerve endings
- has special sensory receptors

- rich vascular bed

- hair follicles (epithelial beds)
- sweat glands
- sebaceous glands

Front 91

What is the subcutaneous fat layer? ***

Back 91

- underlies dermis
- connects dermis to underlying fascia
- provides food reserve and insulation
- sweat glands
- sebaceous glands

Front 92

Name 10 types of skin lesion ***

Back 92

- bulla
- fissure
- macule
- nodule
- papule
- pustule
- scales
- ulcer
- vesicle
- wheal

Front 93

What is a macule? ***

Back 93

a discolored spot of skin that is neither elevated above nor depressed below the surrounding skin surface

Front 94

What is a papule? ***

Back 94

a solid, red, elevated skin lesion

Front 95

What is a nodule? ***

Back 95

a solid, hardened, elevated skin lesion

Front 96

What is a vesicle? ***

Back 96

a small (generally less than 0.5 cm) fluid-filled blister

Front 97

What is a bulla? ***

Back 97

a large (generally greater than 0.5 cm) fluid-filled blister

Front 98

What is a pustule? ***

Back 98

a circumscribed, raised skin lesion filled with pus

Front 99

What is a wheal? ***

Back 99

a generally round, transient elevation of skin, white in center, with pale red edges

often accompanied by itching

Front 100

What are scales? ***

Back 100

thin, dry dead tissue shed from upper layers of skin

Front 101

What is a fissure? ***

Back 101

a crack like a sore or ulcer

Front 102

What is an ulcer?

Back 102

an erosion or eating away of tissue

Front 103

What are infectious skin diseases? ***

Back 103

those that result from
- bacteria
- virus
- fungus
- parasite

Front 104

What is impetigo and how is it treated? ***

Back 104

- bacterial infection
- most often seen in children
- caused by strep or staph
- oozing vesicles that crust over

- treated with antibiotics

Front 105

What is an abscess and how is it treated? ***

Back 105

- a.k.a. carbuncle
- cluster of boils (furuncles)
- caused by staph infection

- involve imbedded hair follicles and subcutaneous tissue

- treated with antibiotics
- occasionally irrigation and drainage (I&D)

Front 106

What is herpes simplex I and how is it treated? ***

Back 106

- painful vesicles which form scabs
- cycles of dormancy/activity
- recur with stress, sunburn, reduced immunity

- treated with topical analgesics

Front 107

What is herpes zoster (shingles)? ***

Back 107

- reactivation of chicken pox
- eruptions of painful water blisters along nerves affected by virus
- usually on trunk or face
- unilateral

Front 108

What are warts? Name three types. ***

Back 108

- virus causes proliferation of keratinocytes and hypertrophy of epidermis

- verucca vulgaris (elevated, seen in children)
- plantar (grow inward on soles of feet, painful)
- genital (can be sexually transmitted)

Front 109

Name two fungal diseases and their treatment ***

Back 109

- ringworm - red, ring-shaped pruritis (actually a fungus, not a worm)
- athlete's foot - fissures, pruritis

- treated with antifungal medications and good hygiene

Front 110

Name two parasitic infections and their treatment ***

Back 110

- pediculosis - skin infestation with lice
- scabies - skin infestation with mites

- treated with medication and good hygiene

Front 111

Name two hypersensitivity disorders and their symptoms ***

Back 111

- urticaria (hives) - allergic reaction, wheals, pruritus

- eczema (dermatitis) - delayed allergic response to substance which has contacted skin (e.g., poison ivy, dyes, perfumes, soaps)
erythema, vesicles, bulla, pruritus

Front 112

Name four types of neoplastic skin diseases ***

Back 112

- nevus
- basal cell carcinoma
- squamous cell carcinoma
- malignant melanoma

Front 113

What is a nevus? ***

Back 113

- benign neoplastic growth of melanocytes
- can become malignant

Front 114

What is a basal cell carcinoma and how is it treated? ***

Back 114

- slow-growing skin cancer
- caused by overexposure to the sun
- non-metastasizing

- treated with radiation and surgery

Front 115

What is squamous cell carcinoma and how is it treated? ***

Back 115

- fast-growing skin cancer
- caused by overexposure to the sun
- metastasizing

- treated with radiation and surgery

Front 116

What are malignant melanomas? ***

Back 116

- arise from melanocytes
- highly malignant
- can develop from nevi

Front 117

Name six metabolic skin disorders? ***

Back 117

- acne - caused by hyperactive sebaceous glands

- chronic dandruff - caused by hyperactive sebaceous glands

- sebaceous cysts - from blocked sebaceous glands
---- large nodules form; contain bacteria and pus; tend to reoccur

- pilonidal cysts - gluteal crease near rectum
---- treated with I&D, removal of glands

- seborrheic keratosis (senile warts) - raised horny lesions
---- excessive production of keratinocytes; occur with aging

- psoriasis - chronic disease, possibly with genetic factor
---- patches of red skin lesions covered with silvery scales
---- non-infectious
---- exacerbations/remissions

Front 118

What are decubitus ulcers? ***

Back 118

- localized area of ischemic necrosis and ulceration

- develops primarily over bony prominences that have been subjected to
---- prolonged pressure
---- shearing forces
---- friction
---- moisture

Front 119

Describe a first stage decubitus ulcer ***

Back 119

- epidermis is intact

- skin is red, does not resolve after 20-30 minutes

- usually resolves with pressure relief

Front 120

Describe a second stage decubitus ulcer ***

Back 120

- superficial breakdown in epidermis

- redness, edema, induration (dented in), occasional blistering

- usually resolves with pressure relief

Front 121

Describe a third stage decubitus ulcer ***

Back 121

- necrosis into dermis and subcutaneous fat layer

- eschar (leathery, dark, dead skin) present

- drainage from wound, infection

- PT wound care intervention, debridement (must remove old/dead skin before new skin can proliferate)

Front 122

Describe a fourth stage decubitus ulcer ***

Back 122

- ulceration beyond fat layer into muscle and bone

- eschar (leathery, dark, dead skin), drainage, and infection

- if bone is exposed - osteomyelitis, bone destruction

- often requires surgical debridement, skin/muscle flaps, osteotomy

Front 123

Are decubitus ulcers typically painful? ***

Back 123

no, especially early on

this is why they go undiagnosed

you can test skin blanching to detect

Front 124

What types of patients are most susceptible to decubitus ulcer? ***

Back 124

- debilitated (cancer, pneumonia)
- malnourished (cancer)
- immobilizaed (fractures, coma, paralysis)
- lack of sensation/mentation (SCI, CVA, TBI)
- edematous body parts (esp. due to burns)

Front 125

Where are the most common sites of decubitus ulcers? ***

Back 125

- occiput
- scapula
- spinous processes (usually thoracic)
- elbow
- sacrum
- ischial tuberosity
- greater trochanter (side-lying)
- iliac crest
- malleoli (side-lying)
- heels

Front 126

What are some means of preventing decubitus ulcers? ***

Back 126

- position, position, position!!
- care in transfer (watch shearing with sheet)
- decrease weight bearing
- types of mattresses can make a difference
- clean sheets
- flat sheets (get wrinkles out before putting pt in)
- dry sheets

Air splints
Sheepskin (??)

Front 127

What types of agents can cause burns? ***

Back 127

- thermal
- chemical
- electrical
- radiation (x-ray, UV)

Front 128

Describe a thermal burn ***

Back 128

- temperature over 111 degrees
- liquids (water, oil, molten metal)
- flame (fire, flash burns)
- hot objects

Front 129

Describe a chemical burn ***

Back 129

- can continue for long periods of time

- requires immediate washing with copious amounts of water

Front 130

What is cellulitis? ***

Back 130

- spreading skin infection caused by streptococci
- follows other skin damage
- red, swollen skin surrounding lesion
- streaks, spreads rapidly
- fever, chills, pain
- may be life-threatening if it spreads to the lymph system or bloodstream

Front 131

What is the clinical importance of burn depth determination? ***

Back 131

- wound care
- excision and grafting
- outcome

Front 132

What is a superficial burn (first-degree)? ***

Back 132

- outer epidermal layer, no dermal involvement

- painful (nerve endings)
(e.g., sunburn - no blisters, dry and red, will peel)

- healing 2-5 days, usually not treated by healthcare team

Front 133

What is a partial-thickness (second-degree) burn? ***

Back 133

- burn into the dermal layer
- epidermis completely destroyed
- painful
since the dermal layer is not completely destroyed, there are still sweat glands and hair follicles
- epithelial beds generate new skin growth

Front 134

What is a superficial partial thickness burn? ***

Back 134

- burn into dermis
- blisters
- extremely painful
- healing in 1-3 weeks

Front 135

What is a deep partial thickness burn? ***

Back 135

- severe damage to entire dermis
- bleeding
- moist, weeping
- edema
- blanches, mottles
- painful
- healing in 3-5 weeks
- extensive burns usually seen by healthcare team for wound care (change dressing, prevent infection)

Front 136

Upon what does the healing of a partial-thickness burn depend? ***

Back 136

- prevention of infection
- scarring

Front 137

What is a full-thickness (third-degree) burn? ***

Back 137

- all of epidermis, dermis destroyed
- damage to underlying subcutaneous fat layer/muscle
- thick eschar, dry and leathery, brown, black, or red
- tissue does not blanch (needs to be excised)

- anesthetized because nerve endings destroyed
- epithelial beds destroyed (no skin buds)
- tissue regeneration only from wound edges
- usually requires skin grafts
- healing time usually takes months, scarring

Front 138

Describe electrical burns ***

Back 138

- complete destruction of all tissues from epithelium to bone

- entrance wound (charred and depressed) and
- exit wound (explosive edges)

- may require amputation of extremity
- often a lot of internal soft tissue/organ damage
- difficult to assess

Front 139

What is the Rule of Nines? ***

Back 139

- size of wound expressed as percentage of total body surface area (TBSA) burned

- Rule of Nines is rapid calculation for determination of %TBSA burned

- divides body into multiples of 9 (head = 9%, leg = 18%)

- calculations differ from infant-child body to adult body

Front 140

What is the Lund-Browder method for assessing burns? ***

Back 140

- more accurate way to assess TBSA burned

- measures the extent of area burned based on percentage of total surface area affected

- uses a table that divides the body based on areas as well as age

Front 141

When area of body burned is greater than 70%, ... ***

Back 141

more than half of victims die

Front 142

What is mental illness? ***

Back 142

a group of psychiatric disorders characterized by severe disturbances in
- thought
- mood
- behavior

Front 143

What is psychiatry? ****

Back 143

medical specialty that diagnoses and prescribes medical treatment for mental illness
(can write a prescription)

Front 144

What is psychology? ***

Back 144

studies normal and abnormal behavior and applies counseling to treat mental illness
(no prescriptions)

Front 145

What is the incidence of mental illness in the US? ***

Back 145

1 in 4

Front 146

What are some warning signs of mental illness? ***

Back 146

- aggression
- changes in eating or sleeping habits
- confusion
- decline in school or work performance
- depression
- euphoria alternating with depression
- excessive fear
- frequent complaints of physical illnesses (somaticizing)
- hearing voices
- substance abuse
- thoughts of suicide
- withdrawal from family and friends

Front 147

How many psychiatric diagnoses exist for adults and children? ***

Back 147

over 200

Front 148

What is the DSM-IV? ***

Back 148

Diagnostic and Statistical Manual of Mental Disorders (IV)

Front 149

How is the DSM-IV used? ***

Back 149

- internationally to classify, assess, and guide treatment for mental illness

- disorders are categorized according to groups of symptoms or diagnostic criteria

- disorders are assigned 5 axes that address adaptive issues and contribute to primary diagnoses

- all disorders require evidence of impairment in academic achievement, occupational performance, or social relationships

Front 150

How are the five axes of psychiatric disorders used? ***

Back 150

they guide documentation and are used like a SOAP note

- Axis 1: primary diagnosis (clinical disorders and other conditions that may be a focus of clinical attention)

- Axis 2: primary diagnosis (personality disorders, mental retardation, learning disabilities)—hardest to treat

- Axis 3: general medical conditions (may not be mental, e.g., TKA, these will be what we see)

- Axis 4: psychological and environmental problems

- Axis 5: global assessment of functioning

Front 151

How are psychiatric records protected? ***

Back 151

even more stringently than medical records

Front 152

What are some potential biological causes of mental illness? ***

Back 152

- genes/heredity
- brain size
- altered neural connections from trauma
- degenerative processes
- neurotransmitter malfunction

Front 153

How may neurotransmitters cause mental illness? ***

Back 153

- inadequate regulation
- excess neurotransmitter
- burned out receptor sites due to substance abuse, prolonged depression/sadness

Front 154

What is the function of dopamine? ***

Back 154

regulates
- mood
- behavior
- thought processes
- heart rate
- blood pressure
- appetite/satiety

Front 155

What mental illnesses are associated with inadequate regulation of dopamine? ***

Back 155

- schizophrenia
- depression
- ADHD
- bipolar disorder
- eating disorders
- autism
- Tourette’s syndrome

Front 156

What mental illnesses are associated with inadequate regulation of norepinephrine? ***

Back 156

- depression
- anxiety disorders
- ADHD
- bipolar disorder

Front 157

What is the function of norepinephrine? ***

Back 157

regulates
- mood
- anxiety
- vigilance
- arousal
- heart rate
- blood pressure

Front 158

What is the function of serotonin? ***

Back 158

regulates
- perception of pain
- feeding
- sleep-wake cycle
- motor activity
- sexual behavior
- body temperature

Front 159

What mental illnesses are associated with inadequate regulation of serotonin? ***

Back 159

- depression
- aggression
- suicidality
- bipolar disorder
- eating disorders

Front 160

What is the function of acetylcholine? ***

Back 160

regulates
- learning
- memory
- muscle tone

Front 161

What mental illnesses are associated with inadequate regulation of acetylcholine? ***

Back 161

- Alzheimer’s disease
- Parkinson’s disease
- Huntington’s Chorea
- Tourette’s syndrome

Front 162

What is the function of Gamma aminobutyric acid (GABA)? ***

Back 162

interacts with a wide range of neurotransmitters to enhance inhibition

Front 163

What mental illnesses are associated with inadequate regulation of Gamma aminobutyric acid (GABA)? ***

Back 163

- anxiety disorders
- alcoholism
- Tourette’s syndrome
- sleep disorders

Front 164

List two disruptive behavior disorders and their common characterization. ***

Back 164

- conduct disorder

- oppositional defiant disorder

they are characterized by willful disobedience

Front 165

Attributes of disruptive behavior disorders ***

Back 165

- affects males > females
- affects children most often

- defiance of authority, fighting, school failure, destruction of property are common behaviors

- often from broken or violent home situations
- associated with harsh physical punishment
- often parents may have antisocial disorder or be substance abusers

- often (nearly always) overlaps with other psychiatric disorders

Front 166

What is attention deficit hyperactivity disorder (ADHD) and what is its typical treatment? ***

Back 166

neurobiological condition

prominent symptoms of
- inattention and/or
- hyperactivity/impulsivity

affects boys > girls; often persists into adulthood

treatment - stimulants and behavioral therapy

Front 167

What are the three subtypes of ADHD? ***

Back 167

- predominantly inattentive - spacey, socially withdrawn, fewer conduct and behavior problems

- predominately hyperactive - impulsive, runs around and fidgets, difficulty engaging in quiet activities, interrupts others, blurts out answers

- combined - characteristics of both

Front 168

What is mental retardation? ***

Back 168

- low intelligence
- deficits in social and language skills

- results from
---- psychosocial factors
---- biological factors or
---- combination of the two

- often unknown etiology

Front 169

What is autistic disorder and what causes it? ***

Back 169

characterized by deficits in
- reciprocal language/language development
- social interaction

- repetitive stereotyped behaviors (posturing, hand flapping, self-injurious behavior, abnormal eating or drinking patterns)
- limited eye contact
- speech may be echo-like, and illogical

- may not appear until after 3 years of age

causes may include
- illness that affects CNS: rubella, seizures, encephalitis, toxins.

Front 170

What are tic disorders and how are they treated? ***

Back 170

- tic: sudden, rapid, involuntary movement or vocalization that may be temporarily suppressed by subconscious effort

- exacerbated by stress, anxiety, boredom, fatigue
- typically decreases when subject is concentrating on enjoyable task

- affects boys > girls

- transient tics require no medical treatment
- complicated tic disorders require titrated medication therapy

Front 171

What is dementia? List three types and their characteristics. ***

Back 171

dementia - degenerative syndrome with deficits in memory, language in mood

- Alzheimer's disease - most common form; develops gradually after age 60

- Vascular dementia - more abrupt onset, caused by physical insults from HTN, DM, CVA as well as poor nutrition and possibly chronic alcoholism

- Parkinson's disease - degenerative neurological movement disorder; dementia in late stages

Front 172

Progression of Alzheimer's disease ***

Back 172

early signs - short-term memory loss

advanced disease - psychosis, aggression, profound personality changes

- severe disease - judgment lost, personal care neglected, physical illnesses may lead to death

- degeneration of neurons and plaque formation on and around neurons

- acetycholine is neurotransmitter most affected

Front 173

Two most common risk factors for Alzheimer's and current treatment methods ***

Back 173

risk factors
- advanced age
- family history

treatment
- medication to slow progression and treat comorbid conditions (e.g., depression, antianxiety medications)

Front 174

Characteristics of substance abuse disorders and treatment for them ***

Back 174

- substance abuse is a conscious choice
- includes alcohol and drug addiction

- social problem with extensive emotional and economic consequences

warning signs of disorders include
- continued use in spite of medical, social, economic, and legal consequences

core symptoms of dependency include:
- compulsive use,
- physical and psychological cravings,
- tolerance, and
- withdrawal (may be unable to function without substance)

treatment: rehab centers, 12 step programs, counseling

Front 175

What is schizophrenia? ***

Back 175

a complex, characterized by
- loss of contact with reality,
- severe disturbances in social functioning,
- bizarre thoughts

- changes in affect or emotional state
- patient may have no regard for ADLs
- onset usually late teenage years, or adulthood

Front 176

How does schizophrenia present? ***

Back 176

Presentation:
- withdraws from society, increasing concern for abstract and eccentric ideas
- may be only episodic,
- depression, anxiety, suspiciousness, difficulty concentrating, restlessness early signs
- hallucinations, delusions:
---- persecutory (watched, followed, plotted against)
---- grandiose (special powers, influence or wealth)
---- somatic (belief that something is rotting inside their body)

Front 177

Affectation of schizophrenia ***

Back 177

Affects
- “feeling tone”, outward expression of emotion
- schizophrenic affect may be unstable and shift rapidly
- may be flattened, devoid of emotional expression
- motor disturbances:
---- may be catatonic, rigid, disorganized or
---- range from “zombie-like” to wild and aggressive
conduct may be blunted having no relationship to social signals

Front 178

Cause of and treatment for schizophrenia? ***

Back 178

causes:
- neurobiological,
- family influences,
- social and environmental attributes

treatment:
- most serious known psychiatic illness,
- suicide rate 10%,
- lower life expectancy
- medications influencing dopamine

Front 179

What are mood disorders? Name two. ***

Back 179

- characterized by marked periods of sadness and euphoria

- mood disorders are debilitating and result in vocational failure, social withdrawal, and dysfunctional relationships

two mood disorders
- major depression
- bipolar disorder

Front 180

Characteristics of major depression ***

Back 180

- heredity is predisposing factor
- occurs at any age
- women two times more often than men
- common in the elderly

- feelings of hopelessness, sadness, and despair

major depressive disorder consists of at least one episode of serious mood depression followed by a number of changes in behavior
- loss of interest or pleasure,
- feelings of guilt, worthlessness, anxiety and shame
- unexplained weight loss or gain,
- disturbed sleep,
- poor eye contact,
- monosyllabic speech

Front 181

Subcategories of major depression ***

Back 181

Seasonal Affective Disorder: due to decreased sunlight exposure

Postpartum Depression: usually 2 to 6 weeks postpartum, persistent care of newborn, sleep disturbances, social stresses and hormonal changes

Premenstrual dysmorphic disorder: Chronic depression or dysthymia if symptoms persist more than 2 years; cyclic depressive symptoms may occur for some women.

Front 182

Treatment for major depression ***

Back 182

- antidepressants
- counseling

common comorbid diseases
- thyroid disease
- chronic heart disease
- cancer
- HIV infection
should be treated as well

Front 183

Characteristics and treatment of bipolar disorder ***

Back 183

a.k.a. manic-depressive illness:

- unusual shifts in mood from depression to mania
- affects more than 2 million American adults
- typically develops in late adolescence or early adulthood

treatment: mood stabilizers (Lithium), individual and family counseling

Front 184

Characteristics of anxiety disorders ***

Back 184

- include a number of disorders with primary feature being abnormal or inappropriate anxiety that interferes with ADLs

- anxiety is normal in response to danger. “fight or flight”
- at onset of stressful event HR, respiratory rate, blood pressure, and muscle tension increase in order for us to respond quickly

- symptoms of anxiety are problematic if they occur without known cause or disproportionately to stimulus.

Front 185

Name five types of anxiety disorders ***

Back 185

- panic disorder
- generalized anxiety disorder
- phobias
- obsessive compulsive disorder
- post-traumatic stress disorder

Front 186

Characteristics of panic disorder ***

Back 186

- panic attack is sudden onset of fear and terror

accompanied by
- physical signs in vital organs,
- SOB,
- palpitations,
- chest pains

- symptoms peak within 10 mins.and usually subside within 30-60 mins.
- worry about having a panic attack can lead to anxiety disorder
- may seek ER care

Front 187

Characteristics of generalized anxiety disorder ***

Back 187

- severe persistent worries, out of proportion to circumstances
- common worries related to work, money, health, safety are difficult to control
- restlessness, fatigue, muscle tension, impaired concentration, and disturbed sleep
- may be misdiagnosed as depression

Front 188

Characteristics of phobic disorders ***

Back 188

- most common type of anxiety disorder

- irrational fear of something
- some, such as fear of the dark, large animals, begin in childhood and disappear with age

- may be accompanied with hyperventilation, rapid breathing
- facing fear may bring on panic attack

Front 189

What is social phobia? ***

Back 189

- excessive worry and self-consciousness in everyday social situations
- fear of being humiliated to the point that it interferes with ordinary activities
- physical symptoms include blushing, profuse sweating, nausea, and difficulty talking.

Front 190

What is obsessive-compulsive disorder? ***

Back 190

- obsessions lead to rituals to prevent or get rid of obsessive stimulus

- rituals are patterns of irrational behaviors, or compulsions that provide temporary relief from the anxiety

- patients are often aware of irrational compulsions but cannot stop behavior

Front 191

What is post-traumatic stress disorder? ***

Back 191

- exposure to an intense traumatic event or encounters with rape, child abuse, war or other violence

- victims develop persistent frightening thoughts and memories months or years after event

- repeatedly relive experience through nightmares and flashbacks

- avoid reminders of event, startle or frighten easily, may feel detached and numb
- may lose interest in things previously enjoyed, avoid affection, and become irritable or aggressive

Front 192

How are anxiety disorders treated? ***

Back 192

- medication
- psychotherapy

Front 193

What are personality disorders? ***

Back 193

- persistent, inflexible patterns of behavior that affect interpersonal relationships

- appear in adolescence or early adulthood

- remain stable throughout a person’s lifetime

Front 194

What are the three categories of personality disorders? ***

Back 194

Described in DSM-IV in three categories:
- Cluster A: Paranoid and Schizoid
- Cluster B: Antisocial, Borderline, Histrionic, and Narcissistic
- Cluster C: Avoidant, Dependent, and Obsessive- Compulsive

Front 195

What is a Cluster A personality disorder? ***

Back 195

paranoid personality:
- indifferent, suspicious, and hostile
- shallow relationships due to tendency to mistrust acts of kindness

schizoid personality:
- appear cold and isolated
- introverted, self-absorbed, and withdrawn
- often deal with fears through superstitions, magical thinking, and unusual beliefs

Front 196

What is a Cluster B personality disorder? ***

Back 196

antisocial personality:
- callous disregard for others and
- manipulation of people for personal gratification

borderline personality:
- often occurs in women deprived of care in childhood
- moods are unstable and characterized by crisis and anger alternating with depression

histrionic personality:
- theatrical and exaggerate their emotions

narcissistic personality:
- exaggerated self-image and tendency to think little of others
- expects others to admire their grandiosity and feel entitled to having needs met

Front 197

What is a Cluster C personality disorder? ***

Back 197

avoidant personality:
- appear shy and timid
- fear relationships, although have strong desire to feel accepted
- hypersensitive to criticism and rejection

dependent personality:
- extremely poor self-image
- appoint others to make significant decisions our of fear of expressing themselves or offending others
- extended illness may bring out a dependent personality in adults

obsessive-compulsive personality:
- dependable
- meticulous, orderly and intolerant of mistakes
- often high achievers
- attend to details, but never finish the task at hand
- avoid new situations and relationships because they cannot be methodically controlled

Front 198

What is the treatment for personality disorders? ***

Back 198

- most people with personality disorders see no need for treatment
- individual, family and group therapy is necessary to point out consequences of behavior

- often secondary medical and psychiatric illnesses force persons with PD to seek treatment

- rigid thoughts and behavior often complicate treatment, and compliance is an issue
- tend to frustrate health care providers

- medication is helpful to relieve anxiety, depression, and psychosis

Front 199

Characteristics of suicide risk ***

Back 199

- most often associated with mental illness
- irrational self-directed acts of aggression
- seems an alternative when all is viewed as hopeless with no solutions to problems

those at risk:
- substance abusers,
- those with family history of suicide,
- those with history of sexual abuse,
- those making previous suicide attempts,
- those with history of impulsive, aggressive behavior

- suicidal behavior most often occurs when people experience major losses and stressful events (e.g., divorce, loss of a job, incarceration, and chronic illness)

Front 200

Warning signs of suicide ***

Back 200

- withdrawal
- talk of death
- giving away cherished possessions

- sudden shift in mood (severely depressed person may suddenly appear better)

- schizophrenic may progressively develop delusions about death

Front 201

What is stress? ***

Back 201

how a person reacts to what happens to them

Front 202

What is eustress? ***

Back 202

stress that invigorates

Front 203

What is the difference between distress and eustress? ***

Back 203

- the individual's reaction
- the meaning they attach to stress
- how they cope with stress

Front 204

Distress arises when... ***

Back 204

imposed demands are perceived to exceed one's ability to cope

(again, it's all about perceptions)

Front 205

What is the alarm reaction? ***

Back 205

the body's response to stress

under stress, the body requires more
- glucose and
- oxygen
for extra energy

- hypothalamus regulates internal functioning of body to
- control homeostasis and
- direct proper responses during stressful situations

hypothalamus does this through regulation of ANS and endocrine system

Front 206

How does the ANS function during stress? ***

Back 206

hypothalamus stimulates SNS

SNS releases epinephrine
- vasoconstriction of skin and GI
- increased BP
- vasodilation of heart, brain, respiratory tract
- increased respiratory, venous return, cardiac output
- stimulation of liver to release glucose

= more oxygen and glucose for "fight or flight"

Front 207

How does the endocrine system (hormones) function during stress? ***

Back 207

hypothalamus stimulates pituitary gland through release of hormones

pituitary gland stimulates:
- adrenal cortex to release corticosteroids--inflammatory response, increased blood glucose
- thyroid gland releases thyroxine--Increased cellular activity (increased energy, body heat)

Front 208

What happens due to corticosteroid presence in the body for long periods of time? ***

Back 208

- an excess of anti-inflammatory hormones produced during stress can cause the spread of an infection by weakening the body’s barricade around the infectious organism

- steroids suppress the immune reaction reaction against microorganisms, reducing the patient’s response to infection

Front 209

Name some stress-related diseases ***

Back 209

gastrointestinal:
- diarrhea/constipation
- vomiting, eating disorders
- GI ulcers, ulcerative colitis, Crohn’s disease

cardiovascular:
- elevated BP secondary to vasoconstriction of peripheral vessels
- increase of adrenal cortex

sexual function:
- decreased libido, sexual function, impotence

respiratory:
- common cold
- asthma

skin:
- fever blisters
- eczema
- psoriasis

Front 210

What factors influence wellness? ***

Back 210

- genetic make-up, family medical history, body size and shape

- family environment, loved ones and friendships

- psychological characteristics: positive self image, ability to manage stress

- external physical environment: food, water, air, work setting, residential setting

- lifestyle: proper diet; regular exercise; avoidance of smoking, alcohol and drug abuse

- unresolved negative emotions: emotional stress, tension, anger

Front 211

What are the components of a well-balanced diet? ***

Back 211

High-fiber low-fat diet: research suggests a high fiber, low-fat diet lowers the risk of colon and rectal cancer and leads to lower fatty deposits in arteries

Recommended daily requirement of fiber = 20 to 30 grams of fiber per day
met by eating:
5 servings of fresh or cooked fruit or vegetables
2 slices of whole wheat bread
Peas and beans (legumes) – rich in protein, fiber, and virtually no fat

Vitamins: may relate to cancer protection
Beta carotene: contained in deep yellow and dark green vegetables: carrots, spinach, sweet potatoes, winter squash, and tomatoes

Antioxidants:
Vit C: oranges, grapefruit, strawberries, baked potatoes, and broccoli
Vit E: vegetable oils, leafy greens, and whole grains

Bone density: Vit D needed for absorption of calcium and phosphorus from the GI tract
Vit D – fortified milk and sunlight

Formation of red blood cells: Vit B 12 and folic acid
Sources: lean meat, eggs, dairy products, breakfast cereals

Front 212

How do cholesterol and triglycerides influence health? ***

Back 212

cholesterol: does not dissolve in blood, carried on lipoproteins

Total blood cholesterol includes the following:
- LDL: low-density lipoprotein = bad cholesterol (deposits on vascular walls)
- HDL: high-density lipoprotein = good cholesterol (prevents deposits, carries substances away from arteries and to liver) 1/3 to 1/4 of total cholesterol

Triglycerides: form of fat made in body (from carbohydrates)
- levels can generally be reduced with weight reduction, increased exercise, decreased alcohol intake

L(p)a cholesterol: genetic variation of LDL. High levels associated with vascular disease

Front 213

How does aerobic exercise influence health? ***

Back 213

regular aerobic exercise improves the body’s ability to utilize oxygen which is necessary to burn calories for the production of energy

aerobic exercise: target heart rate should be maintained for 20 to 30 minutes at least 3 times per week to attain aerobic benefits

Target heart rate = 220 – your age x .70 (moderate intensity)
220 - your age x .90 = (high intensity)

Front 214

Reforms in the treatment of the mentally ill started after the French Revolution with an Austrian physician named:

Back 214

Franz Mesmer

Front 215

Psychiatric diagnoses are categorized in a book named the:

Back 215

DSM

Front 216

Which neurotransmitter is implicated in schizophrenia, depression, and ADHD?

Back 216

dopamine

Front 217

Which of the following regarding ADHD is false?
a. ADHD is limited to children
b. ADHD is a neurobiological disorder
c. ADHD is more common in males than in females
d. There are three subtypes of ADHD

Back 217

a. ADHD is limited to children

Front 218

Medications that replace ________ are effective in improving memory in persons with Alzheimer's disease.

Back 218

acetylcholine

Front 219

A false belief that one is being watched or punished is also known as a _______ delusion.

Back 219

persecutory

Front 220

Binge eating followed by purging behavior such as self-induced vomiting most commonly occurs in:

Back 220

bulimia nervosa

Front 221

Periods of intense mania and depression that last for several weeks is also known as _______.

Back 221

bipolar I

Front 222

Adults with bipolar illness may be treated with all of the following types of medications except _______.
a. sedatives
b. antidepressant medications
c. stimulant medications
d. antipsychotic medications

Back 222

c. stimulant medications

Front 223

Anxious, irrational thoughts and images are also called _______.

Back 223

obsessions

Front 224

Bones are soft in rickets due to a ____ deficiency.

Back 224

Vitamin D

Front 225

Osteomalacia affects (bones/joints) of young (children/adults).

Back 225

bones of adults

Front 226

Carpal tunnel syndrome is caused by damage to the _______.

Back 226

median nerve

Front 227

Biopsy in addition to electromyography is a diagnostic test for __________

Back 227

Duchenne's MD

Front 228

________ is the most common form of arthritis.

Back 228

osteoarthritis

Front 229

Ankylosis and immobility results in severe _______.

Back 229

rheumatoid arthritis

Front 230

Colchicine and corticosteroids are used to treat acute cases of _______.

Back 230

gout

Front 231

Which of these is NOT due to calcium deficiency?
a. osteoporosis
b. osteomalacia
c. osteogenic sarcoma
d. rickets

Back 231

c. osteogenic sarcoma

Front 232

Which of these is a type of autoimmune disorder?
a. rhabdomyosarcoma
b. Duchenne's MD
c. myasthenia gravis
d. osteitis fibrosa cystica

Back 232

c. myasthenia gravis

Front 233

Streptococci and staphylococci are associated with
a. Pott's disease
b. tuberculosis
c. osteomyelitis
d. osteoporosis

Back 233

c. osteomyelitis

Front 234

Bacterial infections on the skin may be caused by ________.

Back 234

staphylococci

Front 235

A discolored spot of the skin is a _________.

Back 235

macule

Front 236

A sac filled with a fluid or semifluid material is a _____.

Back 236

cyst

Front 237

The outermost layer of the skin is the ________.

Back 237

epidermis

Front 238

In pallor, the skin appears _______.

Back 238

white

Front 239

The ________ lies under the dermis and connects the skin to underlying structures.

Back 239

subcutaneous tissue

Front 240

Solid elevated areas of the skin are called ________.

Back 240

papule

Front 241

Folliculitis is an inflammation of _________.

Back 241

hair follicles

Front 242

Pediculosis is a ________ infection.

Back 242

parasitic

Front 243

________ is the oily fluid that is released through the hair follicles.

Back 243

sebum