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338 Cards in this Set
- Front
- Back
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What are the three factors that influence radiographic appearance? "Density
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thickness (depth)
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5. They are 2D images and are commonly used for the chest
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abdomen
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CT allows you to directly view the internal organs and internal architecture of the organs of the abdomen
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liver
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What are Hounsfield units
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windows and levels. "Hounsfield units are density values. Positive HU are more dense than water.
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anatomy than x-ray
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best for spatial resolution"
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What has the best tissue contrast? Spatial Contrast? "MRI has better inherent soft tissue contrast
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even without iv contrast.
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Iv contrast is sometimes indicated
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not always needed
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-good for evaluating for fluid filled structures like cysts
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biliary system
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Brain
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spinal cord
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Joints
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extremities
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Pelvis-genitourinary system -uterus
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ovaries
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- Allows detection of subtle differences in soft tissue density
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subtle microcalcifications"
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Medio-lateral Oblique “MLO” is an oblique sagittal view
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look at as though you are standing on the side of the patient. The superior breast extending into the axillary region is at the upper part of the film. A portion of the pectoralis major muscle is included on the film. MLO views are done to specifically include the axilla to look for enlarged axillary lymph nodes. Also
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Hyperechoic
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echogenic =white
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Gallbladder
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bladder
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- Scrotum
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testicles
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-Liver
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Kidneys
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Uterus
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ovaries
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“Live images”
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can evaluate motion
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Determine vascular patency & quantify blood flow
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measure velocities"
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This localizes to an organ or tissue of interest
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and will emit radiation
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A camera/detector moves around the patient and absorbs the emitted radiation
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and then transforms the information into an image.
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High Uptake is Hot
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The opposite is Cold or Photopenic"
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What are the key points of Nuclear Medicine? " Imaging based on tissue/organ function and physiology
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not primarily on anatomy
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Very specific uses and indications
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problem solving
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Fuzzy
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unclear images-easy to recognize!"
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What is The Burden of Cancer in the United States? "Cancer is one of the dominant causes of death in the United States
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accounting for almost a quarter of deaths. Second Leading cause behind heart disease
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In terms of numbers of deaths
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the dominant cancer sites in the U.S. are lung
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A. For most cancers
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incidence and mortality rates vary across the world. For some cancers (eg liver
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B. Migrants from low risk countries to high risk countries appear to have altered cancer risks compared to those who do not migrate. Within a few generations
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the migrant populations have cancer risks similar to others in the host country.
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C. There have been some dramatic changes in cancer incidence over time. For example
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as illustrated below
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D. Non-genetic risk factors have been identified for many cancers. Those that are causal offer the potential for cancer prevention. In the United Stated
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the most important cancer risk factor is tobacco use
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What are some of the non-genetic risk factors for cancer and what is their mechanism of carcinogenensis? " The mechanisms underlying some cancer risk factors are clear. In particular
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radiation and tobacco have been well-studied. Tobacco itself contains carcinogenic nitrosamines
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However
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for other risk factors
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1. Describe the genetic risk factors for cancer. " There are two types of genetic risk factors for cancer: 1) uncommon (or frankly rare) but highly penetrant genes
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and 2) relatively common polymorphisms which confer only a modest relative risk.
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Many of the genes associated with these familial cancer syndromes encode proteins that perform fundamental cellular functions. There is a considerable amount to be learned about these genes. For example
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although the genes are all highly penetrant for cancer in at least one organ
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Genetic variation in metabolic or signaling pathways has the potential to affect cancer risk. Polymorphisms in some of the relevant genes are surprisingly common
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but their impact on cancer risk has not yet been completely defined. In some cases it is thought that the polymorphisms increase cancer risk through an increased susceptibility to known risk factors. "
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Chronic Inflammation: Oxidative Stress
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Tissue Proliferation
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Any forms
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Cigarettes
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Not a mutagen or animal carcinogen. Acetaldehyde is...1st metabolite of alcohol. At many sites it acts with tobacco: Oropharynx
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larynx and esophagus. Liver (Cirrhosis)
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Risk Factors
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Chemotherapy and hormones. NSAIDS are protective of GI tract cancers
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Tend to be organ specific
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Tend to be viruses. Caused by inflammation or a viral induced genetic change. Liver = HBV
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Red Processed Meat is bad
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well done meat has some carcinogens
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Obesity: Metabolic Effect
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Endometrium
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Highly Penetrant Genes: BRCA
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FAP
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5. Carcinoma-in-situ" " 1. Hyperplasia: An increase in cell number (eg: prostate
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endometrium
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2. Metaplasia: Replacement of one normal cell type with another normal cell type (eg: squamous metaplasia of glandular epithelium in lung
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cervix)
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a. Non neoplastic
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disorganized proliferation (potentially reversible) of cells within the epithelium
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b. Disorganized growth with cellular pleomorphism
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abnormal mitoses and nuclear hyperchromasia
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c. Degrees of dysplasia: mild
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moderate and severe
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a. Dysplasia (all degrees) involving specific sites – cervix (CIN)
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vulva (VIN)
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a. Non-reversible dysplastic change
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involving the entire epithelial thickness
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b. No invasion into the underlying tissue
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therefore no risk of metastasis"
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Define Cancer
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neoplasia
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2. Neoplasia: An abnormal growth of cells
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characterized by autonomous cell proliferation. The process of neoplastic growth results in a “neoplasm” which may be benign or malignant.
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4. Carcinoma: A malignant neoplasm of epithelial cell origin (eg; squamous
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glandular
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5. Sarcoma: A malignant neoplasm of mesenchymal cell origin (e.g. from connective tissue
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bone
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f. Some may undergo malignant transformation
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as discussed in the section on carcinogenesis
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d. Capable of metastasizing (via blood
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lymphatics
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a. Germ cell tumors (ectoderm
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endoderm
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Describe grading and staging of neoplasms. " A. Grade: Provided by the pathologist
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indicates degree of differentiation of the tumor (cytology and architecture)
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e.g.: bladder transitional cell carcinoma has grades I-IV
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breast adenocarcinoma has grades I-III)
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1. Grade I - Well differentiated tumors (usually “low grade”
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grows more slowly)
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3. Grades III or IV - Poorly differentiated tumors (generally
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""high grade""
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B. Stage: Provided by the clinician
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based on information provided by the pathologist (as compared with pure clinical staging that is based on physical exam and radiological imaging studies only)
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1. TNM staging: Based on the degree of local growth (Tumor size)
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presence or absence of metastasis to regional lymph Nodes
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3. More or less precise staging systems are defined for each major type of tumor. Your goal should be to understand the general basis for staging and its clinical use
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and to learn the rules for staging a specific neoplasm when you work with it regularly.
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NOTE: Pathologic diagnoses are rendered in words and numbers (grades and stages). The words can be ambiguous because classifications can vary in different medical centers
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or in different countries. Clinicians should talk to the pathologists in their medical centers to make sure they are interpreting the information on a pathology report in the same way."
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What are the different types of diagnostic techniques? "A. Clinical examination and imaging (X-rays
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CT scan
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D. Histologic examination
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routine:
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H. Molecular diagnostics (Gregory Tsongalis PhD
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DHMC):
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Real time PCR
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reverse PCR
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Malnutrition contributes to disease outcome: including Length of Hospital Stay
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morbidity
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What are the general ideas about macromolecule intake? "Macronutrients are important for calories...Carbs
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Proteins
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Quality: Proteins
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fats
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Carbs: diabetes
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heart disease
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Proteins: Kwashiorkor
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renal disease
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Fat: heart disease
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diabetes
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The mean of the RDA is the Estimate Average Requirement
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this is the mean value that the average guy should get. RDA is two standard deviations above the EAR
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AI
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adequate intake is the level that is probably neccessary but this is without sufficient data to establish a RDA.
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Tolerable Upper Intake Level
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UL
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not prescriptions
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plans
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asserting wishes
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for naming individuals to speak for you
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What Are some things to know about CPR? "Success is restoration of rythum and pulse
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survival
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Factors for success: Traumatic
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witnessed
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What matters most to a patient that they get from a doctor? " Honesty
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Willingness
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What is palliative care? "Interdisciplinary approach to care for people with life threatening illnesses which addresses physical
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emotional
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Does Hospice care extend life? Yes
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on average 29 days
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What about dosing? "Fractioning is very important
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Chronic inflammaition is associated with what cancer? "Chronic Inflammation: Oxidative Stress
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Tissue Proliferation
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Tobacco is associated with cancer how? "Any forms
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Cigarettes
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Most potent are combustion products PAH
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Poly Aromatic Hydrocarbons
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Lung
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Larynx
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All parts of the urinary tract
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pancreas...Myeloid Leukemia? Colorectal?"
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At many sites it acts with tobacco: Oropharynx
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larynx and esophagus
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Liver (Cirrhosis)
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breast (hormones)"
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How is diet related to cancer? "Red Processed Meat is bad
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well done meat has some carcinogens
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Liver = HBV
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HCV
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Endometrium
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Post Menopausal Breast
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Adipose tissue is not inert: it is hormonally active
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Estrogens Adipokines
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What are primary
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secondary
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Screening appears to help people live longer
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but they may not have more survival time
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What is length time bias? "Screening works best when the cancer develops slowly
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they are more likely to find slow growing tumors. Screening therefore usually finds tumors with a better prognosis.
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1/7000
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new cases. Probability of a newborn developing cancer by 20= 1/300
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Incidence and survival of various types if cancer in kids affected by age
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race
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Mortality in childhood cancers has reduced
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this has been an effective screening "
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What are the mechanisms of Tumorogenesis? "Gain of function
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Oncogenes
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Mutations
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increased function
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Increased expression
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activation
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by translocation – IgG-myc Burkitt’s lymphoma
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amplification
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myc. Neuroblastoma
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Mutation
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inactivating
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Deletions
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loss of gene or chromosome"
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• Cytopenias: RBC (pallor
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fatigue
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• Infiltration: Bone pain
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lymphadenopathy
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• Immunophenotype (flow cytometry)
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cytogenetics
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• Age (1-10 yrs Low Risk
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<1yr & >10yrs High Risk)
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• WBC (<50 Low Risk
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>50 High Risk)
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• Immunophenotype
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karyotype
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• Prognostic factors less clear
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overall prognosis significantly worse
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• 40% Hodgkin’s Disease
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HD
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• 60% Non-Hodgkin’s Lymphoma
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NHL (Lymphoblastic
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• Adenopathy
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SVC syndrome
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• Staging studies: Bone marrow aspirate & biopsies
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gallium scan
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(I: one site
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II: limited to one side of diaphragm
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NHL: Chemotherapy
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Intrathecal therapy
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HD: Low stage 90%
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Advanced stage 80%
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NHL: Low stage 95+%
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Advanced stage 80%"
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• Astrocytoma (Cerebellar
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Cerebral)
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• Misc: Optic glioma
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pineoblastoma
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• Headache
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vomiting
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Combined modality: Surgery
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Radiation
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• Astrocytoma: Low grade: 90%
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High grade <30%
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• Medulloblastoma: Good risk 70-80%
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Poor risk 40-50%
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• Ependymoma: Low grade
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resectable 80%
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• Brain Stem Glioma: Resectable (rare) 50%
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Unresectable (common) <10%"
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• Imaging (MRI
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CT)
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• Age (<1yr good
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>1yr poor)
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• Stage (Limited stage excellent
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advanced stage very poor)
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• N-myc oncogene copy number (1 good
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>1 poor)
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• DNA Index (>1.16 good
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<1.16 poor)
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Intermediate Risk: Surgical resection (upfront or delayed)
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chemo
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High Risk: Intensive chemo
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surgery
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• Tumor may arise anywhere in the body
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typically occur in three regions
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• Tissue for morphology
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inununohistochemistry
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• Histology: Embryonal (good)
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Alveolar (poor)
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• May have hematuria
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flank pain
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• Stage (I: Limited
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II: Local extension
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Stage I & II: Surgical resection
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adjuvant chemotherapy
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Stage III & IV: Surgical resection (upfront or delayed)
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chemo
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Stage V (Bilateral): Bilateral partial nephrectomies
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then treat per highest stage
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Favorable histology: Stage I: 95%
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II: 90%
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Anaplastic histology: Stage I: 90%
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II-IV: 50-60%"
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What are the most common type of drug used is? The Most Common type of drug used is DNA dammaging agents
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but in the recent past
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What are some strategies in cancer chemotherapy? " A. By varying the route of delivery of a chemotherapeutic agent
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differential effects
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B. Combination chemotherapy involves the combination of several agents to get greater cell kill than with single agents
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often with decreased side effects.
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C. Differentiation therapy involves a whole different paradigm in treating malignancy. Instead of trying to “kill” tumor cells
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the aim is to cause them to differentiate from malignant cells into cells more like their normal
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Describe the clonal evolution of cancer "Cancers start from a single cell and are therefore termed ""clonal"". As they grow
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certain cells within the tumor acquire mutations so that they and their progeny may have significant characteristics which differ from the majority of tumor cells. These characteristics may include faster growth rate
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What about the cell cycle and cancer chemotherapy? " All cells go through the typical cell cycle at some point in their development. This process is highly regulated. In cancer cells the process becomes dysregulated. Because many anti-cancer drugs target cells at different points in the cell cycle while others are able to kill cells at any point in the cycle
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chemotherapy drugs are often classified by the following scheme:
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1. Cycle-specific agents kill cells that are actively cycling (i.e.
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alkylating agents).
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2. Cycle-nonspecific agents kill non-cycling cells (i.e.
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steroids and some antimetabolites).
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What is the Log Kill Hypothesis? In vitro experiments show that
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for many combinations of drugs and tumor cells
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Tell me about Apoptosis and Cancer Chemotherapy "In the past
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medical students were taught that chemotherapeutic drugs preferentially kill rapidly dividing cells. For example
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The p53 protein
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a tumor suppressor
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Linkage Analysis "Based on the fact that chromosomal recombination (crossing over) happens over generations
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with a frequency proportional to the distance between two loci.
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[There are ~30 cross-overs in the human genome per cell
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Caveats to genetic linkage analysis "A negative result
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in the absence of a known positive mutation in the family
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Referral to research studies around the country is important
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both for the individual and the advancement of knowledge.
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A negative result
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when the mutation in the family is known
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Occasionally
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instead of the expected loss of heterozygosity at informative loci
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functional assays
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once developed
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What are some problems in genetic testing? "Probabalistic
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not diagnostic
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Tell me all about Spinal Cord Compression in Cancer Patients "2nd most common neurologic complication of malignancy
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occurs in 5% of malignancies
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lymphoma
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prostate
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80-90 will still walk if walking before
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not many will regain function
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Weakness
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sensory loss
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Radiation is the mainstay
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steroids given for acute symptom relief
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Most common in Breast
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myeloma
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Dehydrated
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anorexic
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Labs indicated elevated corrected calcium
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BUN/Cr is high; EKG: Brady
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Tell me about tumor lysis syndrome and cancer patients "Result of treatment with chemo. Most common in chemo sensitive tumors: Acute lymphocytic leukemia
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Acute Myelogenous leukemia
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Prevention: IV Hydration
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Alkalinization
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Hyperkalemia: Manifested by EKG: PR Prolonged
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QRS widening (treat with Kayexelate
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Hyperphosphatemia: Consequences for calcium
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interacts and can precipitate (PO4 x Ca > 55)
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Hypocalcemia: Tetany
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cardiac arrythmias
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Tell me about neutropenic Fever and Cancer Patients? "Result of treatment with chemo. Most common in chemo sensitive tumors: Acute lymphocytic leukemia
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Acute Myelogenous leukemia
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Prevention: IV Hydration
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Alkalinization
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Hyperkalemia: Manifested by EKG: PR Prolonged
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QRS widening (treat with Kayexelate
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Hyperphosphatemia: Consequences for calcium
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interacts and can precipitate (PO4 x Ca > 55)
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Hypocalcemia: Tetany
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cardiac arrythmias
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What are some other emergencies in cancer patients? Other: Uric Acid Nephropathy
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Hyponatremia
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Diagnosis
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prior treatments
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What is a good protocol to follow when giving bad news? " Setting Make sure the setting is supportive. Be seated at eye level
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ensure privacy
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Perception Elicit the patient’s perception of the problem. Listen to the words they choose
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and the level of their understanding.
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Invitation Get their invitation to disclose information. Make sure they are receptive to receiving the information
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and get a sense of the depth of specifics they would like to hear now.
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Knowledge Convey the information
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periodically assessing whether they are acquiring the knowledge. Expect some degree of cognitive dysfunction. Avoid medical jargon.
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Summary Provide a summary
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to include a specific plan of further discussion
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Common ‘errors’ include initiating such a discussion in a setting that is rushed and/or lacking in privacy. Also
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feeling the need to talk so as to fill up uncomfortable periods of silence doesn’t allow some patients to formulate and express their main concerns. Perhaps most importantly
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3. Keep in mind the differences between tolerance
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physical dependence
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4. In the setting of chronic pain
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a regular schedule of administration of analgesics is superior to a ""prn"" schedule
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b. tolerance may mean increasing doses
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despite stable disease (patients sometimes equate a need for a higher dose with tumor progression)
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e. don't wait for constipation
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institute a preventive bowel regimen
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g. think twice before administering naloxone to a patient on narcotics for pain
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and if the patient is comatose
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How are adjuvants used in pain managment? "a. Tricyclics
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e.g. amitriptyline; may potentiate opiate analgesia; perhaps particularly suited for neuropathic pain/dysesthesias
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b. Antihistamines
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e.g. Vistaril (hydroxyzine); particularly for the anxious or nauseated patient
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c. Anticonvulsants
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e.g. carbamazepine -- consider using for brief lancinating pain in neuralgia syndromes
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d. Steroids
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e.g.
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3. dorsal rhizotomy (cutting sensory roots) - motor fibers spared
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but proprioception is lost (though microsurgery may improve on this)
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What are some considerations about nausea/anorexia and cancer patients? "Alleviate hunger
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reduce anxiety
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Appetite Stimulants
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Steroids (Megestrol)
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Could be from drugs
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GI probs
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Treat underlying causes
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anti-emetics
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What care plans are in place for fatigue for cancer patients? " 1. An exceedingly common symptom in advanced cancer patients. Also reported in patients free of disease
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typically within the first year of diagnosis and treatment
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2. Important to assess and treat the potential contribution of treatable components
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such as anemia
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What treatment factors are of important note for dyspnea and cancer patients? "1. Work-up/evaluation: history
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exam
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2. Management: deal with underlying causes. For instance
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thoracentesis/pleurodesis if a pleural effusion is the cause
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3. Useful medications: opioids
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anti-anxiety meds (if anxiety is present)."
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What are treatment considerations for cancer patients with delirium? " 1. Features: restlessness
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irritability
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Athletes are constantly looking for performance improvement
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and diet and dietary supplements are a common variable they try to manipulate in this effort.
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Vitamin D has been suggested to have a role in athletic performance
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especially in the winter months.
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Generally
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RDA suggested intake of vitamins and minerals are adequate."
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What do we need to know about carbohydrates and athletes? "Preferred fuel source for muscles is glucose
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then muscle and liver glycogen.
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Low glycemic index best for normal diet situations
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and precompetition.
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What do we need to know about proteins and athletes? "Protein needs in the athlete do not exceed that provided in the average American diet
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which is already higher in protein than most people require.
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Endurance exercise still burns glycogen first
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fat burned after 60 mins when those stores are gone.
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High fat (Zone
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40-30-30
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Water with food vs sports drinks – depends on convenience
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palatability
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Larger volumes absorbed more quickly
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so athletes should drink more
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Overhydration with plain water can be dangerous
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however
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Marathons and other long distance events offer more sports drinks
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educate regarding not over hydrating."
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Tell me about sports bars and gels and stuff? "Big business
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and expensive per calorie.
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Convenient
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no spoilage or waste.
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Advertised as protein containing
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or having special carbohydrates.
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Probably better to choose other cheaper foods instead
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except for convenience factor.
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Don't have to chew gels
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they must be consumed with water"
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What is the importance of supplementation? "Very big business
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unregulated by FDA.
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|
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Ephedra – stimulant
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example of substance banned successfully by FDA due to causing harm.
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|
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Creatine – probably does boost performance
|
but only for short duration high intensity events. By combining with phosphate to become a donor for the resynthesis of ATP
|
|
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Androstenedione/DHEA – testosterone precursor
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banned.
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|
|
Vitamins and minerals "No evidence that taking a regular multiple vitamin is a bad idea
|
but >100% USRDA is questionable
|
|
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Athletes should not try to lose weight with a high fat (Atkins
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South Beach) diet.
|
|
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Eat a meal 4 hours before
|
snack during event.
|
|
|
manifests itself after a sustained period of inadequate intake
|
which impairs normal physiologic function
|
|
|
Increased losses
|
nutrient requirements
|
|
|
actual weight/ideal body weight...80-90 is mild
|
70-79 moderate
|
|
|
BMI is used weight(kg)/height^2(m^2)
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< 18.5
|
|
|
Limited in scope for age
|
muscle mass
|
|
|
Non-hospitalized people were used to generate the table. Also
|
body fat is not evenly distributed"
|
|
|
What are some different anthopometric testing methods? "BMI is used weight(kg)/height^2(m^2)
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< 18.5
|
|
|
Limited in scope for age
|
muscle mass
|
|
|
Non-hospitalized people were used to generate the table. Also
|
body fat is not evenly distributed"
|
|
|
What is the Resting Metabolic Rate? Energy of a person that is conscious and laying down
|
non-exerting in ambient conditions. It represents about 70% of the total need for calories in a day.
|
|
|
Tell me about calories "Calories
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Calories
|
|
|
To loose one pound
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decrease 3500 kcal...500 cal per day for a week
|
|
|
For a tee incrase of 2%
|
5 lbs per year
|
|
|
Wasting of muscle and fat mass < 60% of standard
|
edema is abscence
|
|
|
Poverty or neglect
|
emergencies
|
|
|
underweight
|
pitting edema
|
|
|
Poverty or neglect
|
grain based diets
|
|
|
causes premature birth
|
Low Birth Weight
|
|
|
Nutritionally appropriate
|
immunologic protection
|
|
|
40-50% of calories
|
lipase with the fat so the baby can use it.
|
|
|
mostly lactose
|
amylase to digest the starch
|
|
|
Secretory IgA
|
Lactoferrin
|
|
|
Decreased postpardum bleeding
|
less menstraul loss
|
|
|
adolescent girls
|
no effects seen on attention"
|
|
|
What about infant and child nutrition? "watch the growth curves
|
they should stay near the growth curve that they are born on
|
|
|
weight drops off first
|
height next
|
|
|
Nutrient poor foods
|
low fiber intake
|
|
|
high in fat
|
low in fiber
|
|
|
What are the different nutritional needs for an elderly patient? "Decreased LBM/Energy needs
|
Oral Health
|
|
|
Prevalence of Malnutrition: Home 3-11%
|
Nursing Homes. 20%
|
|
|
Constipation because of motility and fiber decrease due to the inability to eat well. B-12
|
osteoperosis
|
|
|
Decrease in muscle
|
bone density
|
|
|
Decreased caloric needs
|
increase Vit D
|
|
|
Vitamin B1 deficiency? "· Function: Thiamine diphosphate serves as a cofactor for a number of enzymes involved in carbohydrate and amino acid catabolism
|
neurotransmitter formation
|
|
|
· Signs and symptoms: weakness
|
sore
|
|
|
· Food sources: liver
|
brewer’s yeast
|
|
|
· Risk factors for deficiency: jaundiced newborns undergoing phototherapy (“bili lights”)
|
alcoholism
|
|
|
Vitamin B3 Deficiency? "· Signs and symptoms: the triad of dermatitis
|
diarrhea and dementia: “the three Ds.”
|
|
|
· Dermatitis: pruritic
|
pigmented
|
|
|
· Dementia: patchy demyelinization and degenerative changes in the CNS result in depression
|
delusions
|
|
|
· Untreated
|
mortality is high (40-75%). Death is sometimes called “the fourth D” of pellagra.
|
|
|
· Function: >200 enzymes are dependent on NAD/NADP. Involved in DNA processing
|
fatty acid and steroid hormone synthesis
|
|
|
· Food sources: meat
|
fish
|
|
|
· Risk factors for pellagra: niacin-poor diet
|
alcoholism
|
|
|
· Functions: hydroxylation of proline and lysine residues during the synthesis of collagen
|
synthesis of neurotransmitters and steroid hormones
|
|
|
· Food sources: citrus fruit
|
berries
|
|
|
· Risk factors: alcoholism
|
poor diet (e.g. patients with mental illness
|
|
|
Tell me about Vitamin A and nutrition? "· Function: role in vision--present in the retinal cells (rods and cones)
|
cellular differentiation
|
|
|
· Signs and symptoms: night blindness
|
conjunctival changes (Bitot’s spots)
|
|
|
· Preformed vitamin A (retinyl esters): liver
|
eggs
|
|
|
· Provitamin A carotenoids (e.g. beta-carotene): green leafy vegetables
|
orange and red fruits and vegetables.
|
|
|
· Risk factors for deficiency: poverty (poor diet)
|
prematurity
|
|
|
· In the developing world
|
vitamin A deficiency is the leading cause of blindness in children.
|
|
|
· 100 and 140 million children are vitamin A deficient
|
and 250
|
|
|
· Function: regulation of calcium and phosphorus metabolism in bone
|
intestine and kidney. Vitamin D receptor is present in many cells; vitamin D affects gene transcription and appears to have a role in cellular proliferation/differentiation
|
|
|
· Signs and symptoms: bony abnormalities (rickets in children
|
osteomalacia in adults)
|
|
|
· Food sources: fatty fish (e.g. salmon
|
tuna and mackerel)
|
|
|
· Risk factors for deficiency: Aging
|
dark skin
|
|
|
What are the concerns of Iodine intake? "· Function: component of thyroid hormones (T3 and T4) which regulate a variety of processes
|
including:
|
|
|
· Congenital hypothyroidism (in fetuses of affected mothers): mental retardation (formerly called “cretinism”)
|
blunting of IQ
|
|
|
It has clinical and business aims
|
linked processes
|
|
|
Microsystems are concerned first with the care and flow of the patient’s need
|
not with the flow of money"
|
|
|
What are some interprofessional concerns? "Basic building block: primary
|
secondary
|
|
|
Clinical policy-in-use: where science
|
written guidance for care becomes practice
|
|
|
Access
|
flow—patient observable variables—about care are all managed—or not—here.
|
|
|
Work dissatisfiers such as schedules
|
logistics of rooms
|
|
|
Give the branches one of the following areas: People
|
Processes
|
|
|
Cannot only identify with one of the faces
|
some dismiss the value of the other two."
|
|
|
Systemic
|
regular
|
|
|
Unnatural
|
Selective in effect
|
|
|
Does not mean bad
|
can be a move in the right direction."
|
|
|
accuracy
|
availability and cost of the test
|
|
|
Risk of genetic testing are psycological
|
social and financial
|
|
|
Newborn Screening: Shortly after birth to look for inborn errors of metabolism and hearing loss
|
opportunity to begin treatment early
|
|
|
Pharmacogenetic testing: predictive testing that will likely play a role in the clinical practice of the future
|
tests for gene variants that predict a person's response to a drug
|
|
|
What is the bottom line for genetic testing? Genetic testing can be costly
|
it is complex
|
|
|
a. Background disease
|
may be progressive
|
|
|
8% increased risk of cancer per 1 Sv of radiation (1 Sv =100 rem
|
1 mrem = Sv^-5)"
|
|
|
· Fatal in 1:75
|
000 doses
|
|
|
· Additives
|
latex
|
|
|
How are children's fractures different? "If the bone is from a young animal that's still growing
|
there should be a cartilaginous growth plate at one or both ends.
|
|
|
Endochondral Osssification
|
Children have a thick periosteum that offers more stability from fractures.
|
|
|
Children have uncalcified cartilage in their growth plates
|
failure to recognize a growth plate injury can cause growth arrest/deformity"
|
|
|
· Type II - A fracture through the growth plate and the metaphysis
|
sparing the epiphysis
|
|
|
· Type III - A fracture through growth plate and epiphysis
|
sparing the metaphysis
|
|
|
· Type IV - A fracture through all three elements of the bone
|
the growth plate
|
|
|
o GI enzymes
|
bile salts and bacterial growth differ
|
|
|
o Rarely used (except for Vit K
|
some antibiotics)
|
|
|
home safety
|
car seat
|
|
|
Home Safety
|
diet-juices
|
|
|
Intellectual readiness; follow directions
|
communicate need
|
|
|
Physical Readiness
|
walk
|
|
|
Need: Time and patience
|
potty
|
|
|
20 minutes after meals
|
rewards
|
|
|
Physical
|
Sexual
|
|
|
Physical Exam
|
detailed and conspicuous
|
