Pathophysiology quiz 1

Which term is used to describe an objectively identifiable aberration of the disease?

A sign is an objectively identifiable aberration (deviates from normal) of the disease. A syndrome is a collection of different signs and symptoms that occur together. A symptom is a subjective feeling. The clinical manifestations of some diseases may change significantly over time, resulting in a completely different clinical presentation at different stages (periods in time).

Absorption

Absorption- Mvmt from site of administration into blood stream for distribution to the tissues.

The increase in a normal adaptive response to the decreased availability of oxygen at high altitudes is referred to as

Acclimatization is the normal adaptive response to the decreased availability of oxygen at a high altitude. Circadian rhythm and diurnal variation are terms that refer to factors that are similar depending on the time of day.

Tertiary/Treatment

Administering colace for constipation.

What general factors affect the expression of disease in a particular person?

Age, gender, genetic and ethnic background, socioeconomic factors and lifestyle considerations, and geographic location may affect the expression of disease in a particular individual

Which statement is true about the normal biological variations related to age?

Aging does usually result in diminished thirst perception. Adults have slower heart rates than infants. The elderly have fewer sweat glands. The elderly have diminished temperature sensations.

How does allostatic overload contribute to the development of disease?

Allostatic overload reflects maladaptation or damage that occurs to the body's tissues and organs due to an allostatic response that is excessive or ineffectively regulated. When homeostasis can no longer be attained and protective mechanisms are weakened, dysregulation of the mechanisms and mediators involved in the stress response can increase the risks of developing certain diseases

Acute and chronic clinical course

An acute condition has relatively severe manifestations but runs a short course measured in hours, days, or a few weeks. A chronic condition lasts for months to years. Sometimes chronic disease processes begin with an acute phase and become prolonged when the body's defenses are insufficient to overcome the causative agent or stressor. In other cases, chronic conditions develop insidiously and never have an acute phase.

Exacerbation and remission

An exacerbation is a relatively sudden increase in the severity of a disease or any of its signs and symptoms. A remission is an abatement (the ending, reduction, or lessening of something) or decline in severity of the signs and symptoms of a disease. If a remission is permanent (sometimes defined as longer than 5 years), the person is said to be cured.

Coping

Behavioral adaptive response.

Adaptation

Biophysical process of change.

COPD

Chronic obstructive pulmonary disease. Treatment with steroid prednisone which can cause Iatrogenic Cushing's disease.

Clinical manifestations

Clinical manifestations are observed signs of disease. S/Sx signs and symptoms.

Syndrome

Combination of both signs and symptoms. Condition or disorder. When the etiology of a particular set of signs and symptoms has not yet been determined, the disorder may be termed a syndrome. AIDS acquired immunodeficiency syndrome. A syndrome is a set of symptoms or conditions that occur together and suggest the presence of a certain disease or an increased chance of developing the disease. A disease is the actual diagnosed impairment of health or a condition of abnormal functioning.

Convalescence

Convalescence is the stage of recovery after a disease, injury, or surgical operation.

Cushing's disease

Cushing's disease excess hormone or steroid. Adrenal gland producing too much hormone. Swollen face "moon face".

Pandemic

Disease spreads from country to country.

Acute clinical course

During the stage of manifest illness, or the acute phase, the disease reaches its full intensity, and signs and symptoms attain their greatest severity.

Endorphins, Enkephalins, Cytokines

Endogenous opioids (body's natural pain relievers)

How are etiology and pathogenesis used to predict clinical manifestations and response to therapy?

Etiology is the study of the causal factors that provoke a particular disease or injury. Pathogenesis is a description of how etiologic factors are thought to alter physiologic function and lead to the development of clinical manifestations that are observed in a particular disorder or disease. An understanding of the etiology, pathogenesis and clinical manifestations of a particular disorder may suggest that certain treatments could be helpful

Quiz 1

Example how stress complex works. Homeostasis allostasis sequela using example of stroke patient who develops pulmonary pneumonia. Bioavailability. 19/22 86%

Iatrogenic perforated colon

Gastrointestinal GI bleeding treatment with colonoscopy examination with risk of perforation of colon with fiber optic cable.

GAS

General Adaptation Syndrome (Selye). Hypothalamus senses a stressful stimulus. Stimulation of sympathetic nervous system and adrenal medulla. Hypothalamus releases corticotropin-releasing hormone. Anterior pituitary releases adrenocorticotropic hormone. Adrenal cortex releases glucocorticoids.

Effects of stress responses are influenced by what?

Genetics, culture, prior susceptibilities.

What is the relationship between homeostasis and allostasis?

Homeostasis is a state of equilibrium, of balance within the organism, whereas allostasis is the overall process of adaptive change necessary to maintain survival and well-being. Thus, allostasis is a process that supports homeostasis; the organism's overall stability is accomplished through change

Homeostasis and Allostasis

Homeostasis- "similar", stable, symptoms are in balance at an ideal "set point". Allostasis- "variable", adaptation to re-establish homeostasis. Can create new normal- allostatic state.

When the cause of a disease is due to unintended or unwanted medical treatment, the term to describe this is

Iatrogenic means that the cause was medical intervention. Genotype refers to the genetic inheritance for a condition. Idiopathic is when the cause of the condition is unknown. Ecogenetics is a struggle between genetic makeup and environment.

Bioequivalence

If two medicines are bioexuivalent there is no clinically significant difference in their bioavailability.

Allostatic overload

Inadequate adaptation.

Parenteral route

Intravenous (fastest delivery into the blood circulation). Intramuscular, subcutaneous (under skin), intradermal, intraarterial, intrathecal, intraarticular.

Stages of clinical course

Latent period- dormant period. Prodromal period-initial signs/symptoms of disease. Subclinical stage- very mild symptoms, E.g. walking pneumonia. Acute-short limiting episode. Chronic-ongoing comes back. Exacerbation-intense episode. Remission-undetectable, suppressed e.g. cancer 5yr marker. Convalescence-recuperate. Sequela-pathological condition as a result from a disease.

Chronic clinical illness.

Longterm disease that lasts more than 6 months.

What are the key features of Selye's General Adaptation Syndrome?

Nonspecific physiologic responses to stress incorporate three systemic stages: alarm, resistance, and exhaustion. The alarm stage (fight-or-flight response) begins when the hypothalamus senses a need to activate the general adaptation syndrome (GAS) in response to a stimulus, a stressor placing the balance of homeostasis at risk. The hypothalamus then mediates the activation of the sympathetic nervous system, which in turn stimulates the adrenal medulla to release catecholamines into the system. The release of corticotropic-releasing hormone (CRH) from the hypothalamus stimulates the anterior pituitary to release ACTH. ACTH subsequently causes the adrenal cortex to release glucocorticoids, specifically cortisol. In the resistance stage, the sympathetic nervous system and adrenal medulla and cortex are working at full force. If the stressor is adequately addressed or resolved, the organism returns to its steady-state with all of the mechanisms activated by the alarm stage returning to their baseline level of functioning. Exhaustion occurs when the body is no longer able to bring about a return to homeostasis, which can lead to maladaptation, development of pathology, and death

How are normal and abnormal physiologic parameters defined?

Normal physiologic parameters are defined by measuring a particular variable in the general population, and determining the standard deviation. A normal range is suggested as the mean ±2 standard deviations. Measurements outside of the normal range are considered to be abnormal

First-pass metabolism

P.O. and rectal administration because they go through portal vein to liver for metabolism. Bypass first pass is Intramuscular and sublingual.

Pathogenesis

Pathogenesis (is the evolution of a disease) is a description of how etiologic factors alter physiologic function and development of clinical manifestations which are observed in desease.

What is pathophysiology?

Pathophysiology is the study of abnormalities in physiologic functioning of living beings and seeks to reveal physiologic responses of organisms to disruptions in its internal or external environment

The study of specific characteristics and functions of a living organism and its parts is called

Physiology is the study of the mechanical, physical, and biochemical functions of living organisms. Psychiatry is a branch of medicine dealing with mental illness. Homeostasis is a dynamic steady state. Pathophysiology refers to the disorder or breakdown of the human body's function.

convalescence

Recovery/ recuperation

Pharmacodynamics

"Action". The study of what the drug does to the body. Mechanism of drug actions in living tissues. drug receptor relationships.

Pharmacoeconomics

"Cost-benefit analysis".

Pharmaceutics

"Form". The science of dosage form design. Dosage form determines the rate of drug dissolution (dissolve and absorb in GI tract). Enteric protected form stomach. Extended-release tablets and capsules release drug molecules in the patient's GI tract over a prolonged period of time. This ultimately prolongs drug absorption as well as duration of action. Don't crush enteric, extended release.

Pharmacokinetics

"Movement". The study of drug distribution among various body compartments after a drug has entered the body until all metabolites leave body. Drug's time of onset of action, time to peak effect, and duration of action. Phases: absorption, distribution, metabolism, and excretion. Distribution- blood stream. Metabolism- break down. Excretion-

Pharmacognosy

"Plant and animal sources". The study of natural (vs synthetic) drug sources (i.e., plant, animals, minerals). Insulin from pigs. Premarin- pregnant mare urine.

Pharmacotherapeutics

"Treatment and effectiveness". The clinical use of drugs to prevent and treat diseases. Defines principles of drug actions-the cellular processes that change in response to the presence of drug molecules. Drugs are organized into pharmacologic classes.

Etiology

"cause of the disease" etiology is the cause or reason for a phenomenon and identifies casual factors. When the link between an etiologic factor and development of a disease is less than certain, but the probability is increased when the factor is present, it is termed a risk factor. The mechanism of disease development is called pathogenesis. The functional consequences of these changes are the clinical manifestations.

Phases of drug activity

*image* Dose of formulated drug. Administration. Pharmaceutical phase I: Disintegration of dosage from; dissolution of drug in body. Drug available for absorption. Pharmacokinetic phase II: absorption, distribution, metabolism, excretion. Drug available for acton. Pharmacodynamic phase III: Drug-receptor interaction. Effect.

Remission

5 yr remission with cancer is considered a cure.

Bioavailability

A measurement of the extent of a therapeutically active medicine that reaches the systemic circulation and is there fore available at the site of action.

Sequela

A pathological condition resulting from a disease. Occasionally a disease produces a subsequent pathologic condition called a sequela (plural: sequelae). Diabetes-Glaucoma/blindness, heart disease,

What factors affect the stress response?

Response to a stressor depends upon its magnitude and the meaning that the stressor has for an individual. Stressors may be perceived as more or less stressful. Perception depends on genetic constitution, past experiences and conditioning, and cultural influences. The type of stressor also affects the stress response; they may be physical, chemical, biological, sociocultural, or psychological. The developmental stage of life and effects of other previous or concurrent stressors all contribute to the stress response

Normality

Statistical normality- estimate of diseases in a normal population, based on a bell-shaped curve. Reliability- Test's ability to give the same results in repeated measurements. Validity- degree to which a measurement reflects the true value of what it intends to measure. Predictive value- extent to which a test can differentiate between presence or absence of a person's condition.

S/Sx and Symptoms

Symptoms are subjective. Signs are objective, measured e.g. weight, temperature. The subjective feelings of an abnormality in the body are termed symptoms. By definition, symptoms are subjective and can only be reported by the affected individual to an observer.

Restoration of effective function is the goal of which level of prevention?

Tertiary prevention (appropriate in the stage of advanced disease or disability) includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning. Primary prevention is prevention of disease by altering susceptibility or reducing exposure for susceptible individuals. Clinical is a stage referred to in early disease prevention (secondary). Secondary prevention is the early detection, screening, and management of the disease.

Enteral route

The drug is absorbed into the systemic circulation through the oral or gastric mucosa or the small intestine. Oral, rectal. Sublingual, Buccal are oral but bypass first pass.

Which organ shrinks with age?

The gums shrink with age. The heart enlarges with age. The prostate enlarges with age. Sweat glands become fewer in number with age

Latent period

The interval between exposure of a tissue to an injurious agent and the first appearance of signs and symptoms may be called a latent period or, in the case of infectious diseases, an incubation period. Sometimes during the course of a disease, the signs and symptoms may become mild or even disappear for a time. This interval may be called a silent period or latent period

What kinds of information about disease can be gained through understanding concepts of epidemiology?

The occurrence, incidence, prevalence, transmission, and distribution of diseases in large groups of people or populations are established through epidemiology, which are essential for effective prevention strategies and treatment

How do the sympathetic nervous system and neuroendocrine system respond to stress?

The primary role of the sympathetic nervous system is appraisal of a stressful stimulus and release of norepinephrine. Norepinephrine released from sympathetic nerve endings increases heart rate and contractility, constricts blood vessels, enhances blood flow to skeletal muscle, reduces gastrointestinal motility and secretion, and dilates the pupils. Stress simultaneously stimulates sympathetic activation of the adrenal medulla to release epinephrine. The actions of epinephrine are similar to those of norepinephrine and are particularly important for increasing cardiac performance and the release of glucose from the liver. Stimulation of the sympathetic nervous system activates the renin-angiotensin-aldosterone system, with aldosterone promoting volume expansion and increasing blood pressure. The actions of the HPA axis may synergize or antagonize the effects of the catecholamines. Catecholamines facilitate the release of adrenocorticotropic hormone (ACTH), which acts to maintain the function of the HPA axis and the release of cortisol. Cortisol, from the adrenal cortex, has widespread effects on numerous tissues that are both synergistic and antagonistic with catecholamines, and has an anti-inflammatory role

Signs and symptoms of a disease first occur during the

The prodromal period, or prodrome, refers to the appearance of the first signs and symptoms indicating the onset of a disease. During the acute phase, the disease reaches its full intensity, and signs and symptoms attain their greatest severity. If the disease has a latent period, the signs and symptoms may become mild or even disappear for a time. A number of diseases have a subclinical stage, during which the patient functions normally, although the disease processes are well established.

Prodromal period

The prodromal period, or prodrome, refers to the appearance of the first signs and symptoms indicating the onset of a disease. Prodromal symptoms often are nonspecific, such as headache, malaise, anorexia, and nausea.

Epidemiology

The study of patterns of disease involving populations. Endemic disease- within a region. Epidemic disease- outbreak of communal disease. pandemic disease- widespread, plane travel.

Distribution

The transport of a drug by the bloodstream to its site of action. High affinity = less available. Low affinity=more available. Areas of rapid distribution include the heart, liver, kidneys, and brain. Areas of slower distribution include muscle, skin, and fat.

Treatment (surgical or Rx)

The understanding of etiology, pathogenesis, and clinical manifestations suggest or imply treatment.

Iatrogenic pneumothorax

Treatment of inserting chest tube can cause the lung to collapsed or deflate. Iatrogenic pneumothorax.

Compare and contrast men and women hemoglobin level, creatine level, calcium level, and snoring

Women generally have lower hemoglobin levels than men. Women have higher calcium levels than men. Women have higher creatinine levels than men. Men tend to snore more than women.

treatment/ tertiary

administer colace for constipation

acute

condition less than 6 mo

sequela

consequence of treatment. opiod causes constipation.

Adrenocortical steroids

cortisol and aldosterone. critical to maintenance of homeostasis. May synergize or antagonize effect of catecholamines.

asthma attach

exacerbation

risk factor

high risk but can't directly prove

Generic name

nonproprietary name, given by US adopted names council.

Catecholamines

norepinephrine and epinephrine play an integral role in allostasis. Sympathico-adrenal system response mediates the flight-or-flight reponse.

Drug absorption p.0.

oral disintegration, buccal tables, and oral soluble wafers. Liquids, elixiers (alcohol, nightquil), syrups. suspension solutions (shake, powder in syrup). Powders Capsules Tablets (pill) Enteric-coated tablets (slow)

epidemic

out break of disease

Distress

perceived inability to cope with a stressor.

Trade name

proprietary name, the drug has a registerd trademark, manufacturer patent name.

Iatrogenic

reates to illness caused by medical examination or treatment (medication).

mamogram

secondary

BP 120/80

sign

Topical route

skin (includes transdermal patches), eyes, ears, nose, lungs (inhalation), rectum, vagina. Topical application delivers a uniform amount of drug over a longer period, but the effects of the drug are usually slower in their onset and more prolonged in their duration of action as compared to oral or parenteral administration. All except rectal avoid first pass.

risk factor

smoking

Pandemic

spread of disease from one country to another.

epidemiology

study of pattern of disease

Subclinical stage

subclinical stage, during which the patient functions normally, although the disease processes are well established.

subclinical

symptoms are very mild

Pharmacology

the study or science of drugs

iatrogenic

unintened

Idiopathic

when the cause is unknown. E.g. cancer.

Adaptation, coping, and illness

• Adaptation, or allostasis, is a network of biopsychosocial processes of responding to a stressor with the goal of re-establishing homeostasis. Coping mechanisms are usually seen as behavioral adaptations to stress but are often used interchangeably with adaptation. • The wear-and-tear effect of adaptation on the body and mind is the allostatic load. It occurs as mediators produced by the stress response systems accumulate and contribute to tissue damage over time. Allostatic load reflects the cumulative costs of adaptation. • A number of disorders are thought to be related to excessive stress or inappropriate stress responses—allostatic overload. These are a result of the dysregulation and excessive use of the mechanisms and mediators involved in the stress response.

Homeostasis and allostasis

• Contemporary concepts of homeostasis have a long history, reaching back to the ancient Greeks. • Homeostasis is a state of equilibrium, of balance within the organism. • Homeostatic responses refer to systems whose purpose is specifically to normalize selected physiologic variables. • Allostasis is the overall process of adaptive change necessary to maintain survival and well-being. • Allostasis may involve altering multiple physiologic variables in order to match the resources of the body to environmental demands. It helps the body achieve homeostasis.

Concepts of normality in health and disease

• Determining whether clinical findings are normal, abnormal, or normal variation is an essential but often difficult process in evaluating for the presence or absence of disease. • Normal ranges for laboratory tests are typically defined as the mean ±2 standard deviations; thus 5% of the normal population may fall outside the normal range despite the absence of disease. Laboratory tests must be evaluated in concert with clinical information. • The predictive value of a clinical test is the extent to which it can differentiate between presence and absence of disease in an individual. Tests with high sensitivity and specificity generally have better predictive value. • Variations in physiologic processes may be a result of factors other than disease or illness. Age, gender, genetic and ethnic background, geographic area, and time of day may influence various physiologic parameters. • Trends and changes in a particular individual are more reliable than single observations.

Patterns of disease in population

• Epidemiology is the study of patterns of disease in human populations. • Diseases may be endemic (regularly found among particular people or in a certain area), epidemic (a widespread occurrence of an infectious disease in a community at a particular time), or pandemic (prevalent over a whole country or the world) depending upon location and the number of people affected. • Aggregate factors such as age, ethnicity, gender, lifestyle, socioeconomic status, and geographic location are epidemiologic variables that influence the occurrence and transmission of disease in populations. • Understanding the epidemiologic aspects of a disease is essential for effective prevention and treatment.

Neurohormonal Mediators of stress and adaptation

• Modern views of allostatic maintenance of homeostasis in the face of stress are primarily derived from an understanding of negative feedback, as well as the roles of the sympathetic nervous system and the glucocorticoid cortisol. • The primary role of the sympathetic nervous system is appraisal of a stressful stimulus and release of norepinephrine. Norepinephrine released from sympathetic nerve endings increases heart rate and contractility, constricts blood vessels to decrease blood flow to less essential tissues and organs and raise blood pressure, reduces gastrointestinal motility and gastric acid secretion, dilates the pupils, and inhibits insulin secretion. • Stress simultaneously stimulates sympathetic activation of the adrenal medulla to release epinephrine. Epinephrine's actions are similar to those of norepinephrine and are particularly important for increasing cardiac performance (increased heart rate, contractility, and cardiac output), promoting the release of glucose from the liver, and enhancing bronchodilation. • Cortisol, from the adrenal cortex, has widespread effects on numerous tissues that are both synergistic and antagonistic with catecholamines, and has an anti-inflammatory role. • Aldosterone promotes fluid volume expansion and increases blood pressure. • Endorphins and enkephalins are released by the central nervous system (CNS) in response to painful stressors, leading to decreased perception of pain and increased sedation and euphoria. Immune cells in the periphery also contribute to pain modulation. • Understanding the role of the immune system in response to stressors is rapidly expanding. Immune cells respond to the hormones released by the HPA axis and sympathetic nervous system. They also release cytokines that in turn affect the functioning of these stress systems. • Sex hormones and differential release of growth hormone, prolactin, and oxytocin produce mediating effects on the stress response that may differ between genders.

Framework for pathophysiology

• Pathophysiology includes four interrelated topics: etiology, pathogenesis, clinical manifestations, and treatment implications. • Etiology refers to study of the proposed cause or causes of a particular disease process. Etiology is a complex notion, because most diseases are multifactorial, resulting from interplay between genetic constitution and environmental influences. • Pathogenesis refers to the proposed mechanisms whereby an etiologic stimulus leads to typically observed clinical manifestations. Pathogenesis describes the direct effects of the initiating event, as well as the usual physiologic responses and compensatory mechanisms. • Clinical manifestations describe the signs and symptoms that typically accompany a particular pathophysiologic process. Manifestations may vary depending on the stage of the disorder, individual variation, and acuity or chronicity. • An understanding of the etiology, pathogenesis, and clinical consequences of a particular disorder may imply that certain treatments could be helpful.

Stress as a concept

• Stress is a real or perceived threat to the balance of homeostasis. The stress response is meant to restore balance. • Selye's theory of a GAS reflects the view of a nonspecific physiologic response to stress. It incorporates three stages reflecting the changes in the body's systemic response: alarm, resistance, and exhaustion. • Stressors are agents or conditions capable of producing stress. • The body's response to stressors is meant to be helpful, at least initially, in terms of mobilizing resources to help manage stressors. • Response to a stressor depends on its magnitude and the meaning that the stressor has for an individual. Stressors may be perceived as more or less stressful. Perception depends on genetic constitution, gender, past experiences and conditioning, and cultural influences. Stressors may be external or internal. They may be physical, chemical, biological, sociocultural, or psychological. • Individuals may be more vulnerable to the effects of stressors at certain times. The developmental stage of life and the effects of other previous or concurrent stressors all contribute to the stress response. • Risk factors are conditions or situations that increase the likelihood of encountering or experiencing a stressor.