Patho 2- final exam study guide

Hypertensive heart disease is a compensatory response to:

A compensatory response to increased afterload (the force the heart muscle must pump against in order to eject blood). Left ventricle hypertrophies.

What is ALS and what does it lead to

A progressive neurodegenerative disorder characterized by a loss of upper and lower motor neurons. Eventually results in respiratory failure (or a pneumonia that can set in) Symptoms: painless muscle weakness & atrophy

What is acute glomerulonephritis & cause

A renal disorder in which an immunological mechanism triggers inflammation that damages the membranes god the glomerulus. - Damage is caused by antibodies that are commonly activated by strep bacteria. - Antibodies combine with antigen & deposit as immune complexes within the kidney that are normally eliminated in the circulation. In glomerulonephritis, the immune complexes accumulate & cause inflammation and membrane damage.

What does long-term HTN lead to:

heart failure

Main purpose of foam cells (which start out as macrophages)

* Engulf & digest LDL which accumulate & create plaque Also, can transmit cholesterol back to blood stream.

Primary cause of chronic renal failure (which usually progresses to ESRD)?

**DM & HTN. Also, related to polycystic kidney disease & glomerulonephritis

Guillain-Barre syndrome & clinical symptoms

- An acute peripheral neuropathy that leads to progressive limb weakness over the course of several days up to 4 weeks. - post infectious disease Clinical symptoms: 1. progressive, usually symmetric muscle weakness accompanied by absent or depresses deep tendon reflexes. 2. Paresthresias and numbness usually first symptoms 3. Motor and sensory, distal to proximal, starting in limbs and moving upwards

Predisposing factors of ischemic stroke (obstruction blocks blood flow to brain)

- Arterial fibrillation - Carotid stenosis - Cerebral arteriosclerosis

What causes peripheral edema, where does it accumulate, and what are some complications ?

- Cause by a build-up of hydrostatic pressure within the capillary beds. - Accumulates in the sacral region (if supine) and in lower legs (when in depended position). - can lead to ulcers in sacral area Edema in feet and lower legs also happens in RVF.

polycystic ovary syndrome- cause & risk factors

- Leading cause of infertility. - Autosomal dominant genetic disorder - Involves a dysfunctional hypothalamic-pituitary-overy axis. - Can be part of metabolic syndrome Risk factors: - Obesity (38%) - dyslipidemia - DM - HTN - endometrial carcinoma (can result in a cancer)

What causes an increased risk for stroke?

- Plaque that calcifies over time, fissures easily, and a piece breaks off. - It travels to an arterial site where it can obstruct blood flow. - This is an embolism that then can cause a stroke.

Alcohol withdrawal symptoms

- Shakes approximately 12-24 hours after last drink - tremors cause by over excitation of CNS - tachycardia - diaphoresis - anorexia - insomnia After 24-72 hours, may have seizure After 3-5 days may have delirium tremens (disorientation, fever, visual hallunacions) medical emergency & must be hospitalized

Absence seizures (petit mal)

- brief sudden laps of consciousness for 5-30 sec > looks like staring into space - more common in kids than adults - Typical (briefly loses awareness of surroundings) & atypical (has muscle spasms with loss of awareness)

What is MS?

- chronic neurological disorder that affects the brain & spinal cord - A demyelinating disorder that results in inflammation & damage to the myelin and other cells within the CNS. - characterized by remissions and exacerbations

Tonic-clinic seizures (grand mal)

- commonly vocalizes loudly b/f the seizure and loses consciousness - rhythmic jerking movements & stiffening of muscles that can last up to 5 min. - One that lasts up to 30 min or a series of 3 is a medical emergency and called status epilepticus

Clinical presentation of PUD

- duodenal ulcers in epigastric - abdominal pain (intense, burning, gnawing slightly relieved by food & strong enough to wake person up) - episodes occur 2-3 hours after eating

Facts about Major Depressive Disorder

- highest life-time prevalence of any psychiatric disorder 17% - women twice as more than men b/c of hormones, childbirth, & psychosocial reasons - mean onset 40 although found throughout lifespan (half dx b/t 20-50) ** suicide major complication

UC

1- only affects large intestine (rectum continually upward into colon) 2- only affects upper layers of intestinal wall (mucosa & submucosa) 3- pseudopolyps seen on exam 4- no fistula/anal fissure 5- predisposes to colon cancer

What causes atherosclerosis (plaque buildup in arterial walls)?

1- oxidizing free radicals 2- shearing force of high BP 3- high circulating glucose levels 4- elevated levels of LDL

S/S of peritonitis (3 of 4)

1. Abdominal pain (with movement so patient wants to be still) 2. Abdominal rigidity (like board) aka involuntary guarding 3. Rebound tenderness 4. electrolyte imbalances due to fluid shift (preset with severe hypotension or shock)- tachycardia, clammy skin, decreased or absent bowel sounds, oliguria 5. fever if infection

Risk factors of altered renal function (including acute tubular necrosis)

1. Long-term DM & HTN 2. Exposure to nephrotoxic agents (meds) 3. Strep infection 4. Major surgeries (which can reduce renal blood flow & lead to injury) 5. Acute MI or heart failure

S/S of ectopic pregnancy

1. Pain 2. Amenorrhea 3. Vaginal bleeding If ruptured: 1. Lower abdominal pain 2. Bleeding into abdomen 3. Referred shoulder pain from bleeding in abdomen

Causes of dysphasia & major risk

1. Structural abnormalities such as diverticula, stricture, webs, & rings cause mechanical problems of swallowing. Food becomes obstructed. 2. Damage to cranial nerves IX, X, or XII that become dysfunctional b/c of stroke, degenerative neurological diseases, and trauma Aspiration and aspiration pneumonia- esophagus lies posterior to trachea, creating this risk. Food or fluid enters trachea instead and lodge in sterile environment of resp system leading to aspiration pneumonia. Greatest risk for aspiration pneumonia: - hx of stroke - trauma to upper spinal cord - brain injury - someone who receives internal feedings Symptoms: drooling, frequent coughing while eating, pain when eating

What causes septic shock?

1. Toxins and inflammatory mediators cause widespread arterial vasodilation 2. Capillary permeability is increased (makes sense since they are dilated) with plasma entering tissues. 3. Inflammatory mediators also activate coagulation pathway, which leads to micro thrombi. Initiation of coagulation cascade. And inhibits activation of protein C, naturally occurring anticoagulant. Can also leas to coagulopathy, inability to clot.

Cushing's triad and clinical manifestations

1. bradycardia 2. HTN (with wide pulse pressure) 3. erratic respiratory rate ....caused by rising intracranial pressure that affects the brain stem

Consequences of increased intra-abdominal pressure:

1. compression fo inferior vena cava reduces cardiac output 2. Renal perfusion is reduced increasing likelihood of acute tubular necrosis 3. Barrier b/t bowel wall & bowel content breaks down. Diffusion of microbes and toxins into blood stream leading to sepsis, shock, MODS 4. Decreased ventilation as increased pressure pushes up the diaphragm and compresses base of lungs. 5. Increased intrathoracic pressure is transmitted upward towards jugular veins. Increased intracranial pressure causing decreases LOC

Clinical presentatomi of PTSD

1. flashbacks 2. insomnia 3. hyperarousal & hyper vigilance Can lead to socially inappropriate behavior and legal problems Can be chronic and be associated with dysfunctions of : - nervous system - hypothalamus-pituitary-adrinal axis - cardiovascular, metabolic, and immune systems

s/s of benign prostatic hyperplasia

1. frequent urination 2. urgency 3. hesitancy 4. straining to urinate 5. weak stream 6. retention of urine in bladder 7. dribbling

Organs damaged by HTN

1. heart 2. brain 3. retina 4. kidneys 5. peripheral arteries

Clinical presentation of upper GI bleed

1. hematemesis (bloody vomit, bright red streaks or coffee grinds) Bright red is current 2. melena (bloody stool that looks black) 3. occult blood (blood not visible in feces) If slow GI bleed: -Fatigue & lethargy. May or may not have pain. Sudden/massive UGIB: - rapid onset of anxiety, dizziness, weakness, SOB, change in mental status, tachycardia, skin pale and clammy

How long can ischemia last before it causes irreversible damage to the heart?

30 min

There are 4 mechanisms for TBI. One is...

Acceleration-deceleration - When skull stops abruptly (as in car accident). Brain continues to move forward, rotating within the skull and causes shearing of brain tissue against the skull's rough interior edges. - Bounces of skull and moves in opposite direction of first impact and strikes skull on opposite side- referred to as COUP-CONTRECOUP injury. Whiplash. Causes: - Stretching and shearing of neural axons, resulting in diffuse axonal injuries.

What is the most common cause of acute kidney injury (AKI)?

Acute tubular necrosis (when ischemia & hypoxia damage renal tubules)

Progressive stage of shock

All available blood is conserved for heart and brain. Begins to show signs of MODS Organs begin to fail

What can patients experience before a seizure? How does it manifest?

An aura Manifests: 1. perception of strange light 2. unpleasant smell 3. confusing thoughts or experiences

What is the primary cause of pulmonary edema?

An increase of hydrostatic pressure in the capillary bed of the lungs usually caused by *left ventricular heart failure*. Weakened left ventricle can't eject all of blood within the chamber causing blood to accumulate in the left ventricle. As a result, hydrostatic pressure builds backwards into left atrium, pulmonary veins, and eventually pulmonary capillaries. High hydrostatic pressure within capillaries causes fluid form blood to diffuse into interstitial tissue.

What is TB?

An infection cause by bacteria- Mycobacterium tuberculosis. Usually found in lungs (also adrenal gland, vertebrae, lymph nodes) and can spread with thin the bloodstream & cause multi-system disease.

Lactic acid shock is a result of:

Anaeorobic metabolism b/c liver is unable to convert lactic acid back to sugar compounds.

Parkinson's Disease is associated with....

Associated with progressive loss of dopamine-producing cells in the substantial migration within the basal ganglia of the midbrain.

Diagnosis of Major Depressive Disorder

At least 5 of the following for min of 2 weeks: 1. sad mood most of day, nearly every day 2. decreased interest n pleasurable activities (anhedonia) 3. weight loss to gain 4. daily insomnia or hypersomnia 5. psychomotor retardation or agitation 6. fatigue/loss of energy 7. feelings of worthlessness 8. inappropriate guilt 9. diminished levels of concentration and decisiveness 10. recurrent suicidal thoughts & plan

Brain death (may want to read p. 799)

Brain death is the reversible end of all brain activity. Occurs: when ICP is not lowered and the brain tissue is compresses & forced downward in the skull. Brain tissue becomes herniated or displaced to another region of the brain. Most common type: transtenrotial herniation (aka uncal herniation)- part of the temporal lobe (uncus) is forced through the tectorial notch (opening in the sheet of tissue b/t temporal lobe & cerebellum). Brain tissue compression results in death to tissue. If herniation compresses vital centers of brainstem, death happens. Vital centers control: HR, RR, BP, and LOC

Causes & risk factors of ectopic pregnancy

Causes: - Slow oven transport (from decreased Fallopian tube mobility or distorted structure) - Past infection & scaring in fallopian tube Risk factors: - Pelvic inflammatory disease - Abortion - Tubal ligation - Previous ectopic pregnancy - DES - infertility (& use of fertility drugs) - Progestin-only oral contraceptive) - Morning after pill

Chlamydia is caused by which bacteria (which means can be treated & cured with meds)?

Chlamydia trachomatis

Blood transfusions contain __________________ which binds with _________________.

Citrate, calcium Therefore, treatment with multiple blood transfusions requires calcium supplementation. Citrate is used in transfusion as anticoagulant b/c binds with calcium which is necessary for clotting.

Transfusions of RBCs and crystalloids don't contain what?

Clotting factors. Therefore, coagulation factors must be administered.

How is hep A transmitted

Contaminated food or water or contracted from person to person by unsanitary conditions

Dementia vs Delirium

Dementia- decline of reasoning, memory, judgment, and other cognitive functions Delirium- transient, usually reversible, cause of cerebral dysfunction 1. dementia- gradual onset delirium- sudden onset 2. dementia- progressive delirium- fluctuating course 3. dementia- months to years in duration delirium- days in duration 4. dementia- consciousness: alert delirium- consciousness: altered level, impaired attention 5. dementia- not reversible delirium- fully reversible with treatment

Left sided heart failure causes what?

Diminished perfusion of the kidneys which stimulates the secretion of renin from the nephron which initiates the cycling of RAAS.

Clinical manifestations of ICP (intracranial pressure)

Early signs: heading (caused by direct compression of brain tissue), vomiting (caused by compression of vomiting center in medulla), decreasing LOC (level of consciousness caused by compression of reticular activating system) - altered response of pupil to light & altered size- caused by pressure on 3rd cranial nerve (oculomotor) causes by an uncal herniation - If ICP continues to rise and there is significant pressure on brainstem, Cushing's Triad occurs

Gummas

Granulomas made of macrophages, plasma cells, & T-cells during latent stage of syphilis

cystocele

Hernia of the urinary bladder into the vaginal canal.

Reasons for AKI (acute kidney injury)

In sepsis, shock, and MODS caused by hypotension, the kidney has to conserve water and maximally concentrate urine. Hyperkalemia Hyponatrium

______________________ builds within the vascular beds of the GI system producing ____________, ______________, ______________ and eventually _______________.

Increased venous pressure builds within the vascular beds of the GI system producing: splenomegaly esophageal varices rectal varices and eventually ascites.

Patho of osteoarthritis. What causes inflammation?

Inflammation occurs as: cytokines various inflammatory mediators metalloproteases are released into joint and degrade cartilage.

Treatment for ectopic pregnancy

Laparoscopic surgery followed by methotrexate to eliminate residual pregnancy tissue.

Gohn's

Lesion (called a tubercle which is a granulomatous accumulation of WBCs, bacilli, and fibrotic tissue) in TB. When calcified, called a Renke complex.

Etiology of NAFLD

Metabolic syndrome related to: - hyperlipidemia - insulin resistance - obesity - Other: DM, protein malnutrition, HTN, sleep apnea, various drugs

Transient Ischemic Attack (TIA) & causes

Minor stroke; where neurological function is regained quickly (several minutes to hours) - most commonly resolve within an hour Causes: - embolus. In TIAs, the body's fibrinolytic system dissolves the occlusion and the focal deficits disappear in fewer than 24 hours

Criteria Systemic inflammatory responce syndrome (SIRS) criteria

Must have 2 of any 4 signs: - Tachycardia (HR greater than 90/min) - Tachypnea (resp rate greater than 20/min) - hyper or hypothermia (temp greater than 100.4 or lower than 96.8) - leukocytosis (greater than 12,000) or leukopenia (less than 4,000) or greater than 10% immature forms

Natriuresis & what do the heart and brain release & why?

Natural diuresis by the heart and the brain. Heart releases ANP (atrial natriuretic peptide) and brain releases BNP. Response to excess water in blood stream. Helps to regulate BP.

Gonorrhea is caused by which bacteria

Neisseria gonorrhoeae

neurogentic shock

Occurs when SCI (spinal cord injury) is above T6 b/c sympathetic nerves are affected. SNS dysfunction prevents the tachycardia & peripheral vasoconstriction that should normally counteract hemorrhagic shock. Therefore, imp to suspect hemorrhagic shock even when tachycardia is absent. T6 or above causes: hypotension & bradycardia C4 and above: respiration ability

What is ventilation-perfusion mismatching and what is the most common cause?

Occurs when air cannot flow into an alveolus or blood flow around an alveolus is altered. Most common cause is a PE. The clot prevents blood flow to the alveolus and gas exchange can't take place.

cerebral arteriosclerosis related to ischemic stroke

Plaque in the cerebral artery can cause: 1- the blood vessel diameter to decrease (lessens blood flow to tissue) 2- thrombi when plaque breaks off and lodges in an arteriole and obstructs blood flow. Causes ischemia & infarction of brain tissue

Clinical presentation of syphilis

Primary stage *highly infectious - skin lesions called chancre (2-10 weeks after sexual contact, often unnoticed b/c painless) - As heals, enters T. palladium bacteria enters blood stream enlarged inguinal lymph nodes Secondary stage *highly infectious - rash in body, palms, soles of feet Latent stage - 1/3 heal spontaneously, 1/3 remain asymptomatic, 1/3 progress - granulomas (called gummas that consist of macrophages, plasma cells, & T-cells) form in organs Tertiary stage: - neurological & cardiovascular complications

What is the serious side effect of a DVT?

Pulmonary embolism- clot can travel within the venous system and enter lungs where it becomes a PE

What can occur in compartment syndrome?

S/S: edema pallor paresthesias (pins & needles) weak distal pulses/ or pulselessness tissue ischemia necrosis functional impairment rhabdomyolysis (breakdown of skeletal muscle tissue) nephron tubule dysfunction due to breakdown of products- renal failure & death Surgery immediately

S/S of ARDS (acute respiratory distress syndrome)

SOB at rest, breathing fast (tachypnia), anxious. Despite how much oxygen given, still low saturation. May have fever or hypothermia.

How is TB spread?

Spread when the bacterial is inhaled from another person's cough or sneeze and droplets pass down the airway, eventually settling in the bronchial tree. TB organism is aerobic & prefers area of the lung with high O2 levels (apex).

Initial stage of shock

Sudden drop in tissue perfusion. - SNS (triggers tachycardia as compensatory measure) and RAAS system (increased blood volume & stimulates vasoconstriction) are triggered. But these don't work and BP isn't normalized. Patient anxious, pale, extremities cold and clammy

Which cells are involved in the patho of asthma?

T helper lymphocytes. - Th1 cells- stimulated by microbes and allergen and assist B cells transform into plasma cells that produce IgE. - Th2 cells- attract mast cells, eosinophils, & basophils which promote inflammation. IgE binds to mast cells & provokes their degranulation, which releases histamine ** The degranulation of mast cells releases histamine. Histamine contributes to bronchospasm & inflammation.

Ischemic penumbra

The perimeter around the core ischemic area. Rapid repercussion of this area is critical b/c, if left untreated, the penumbra will succumb to ischemia and infarction.

Risk factors for stroke

Think ABC's! Look at risk fact, can address HTN which is directly related to circulatory system. Tie pieces together - high BP - high cholesterol - heart disease - diabestes - obesity - previous strike or transient ischemic attack (TIA) - sickle cell - smoking - alcohol - physical inactivity - oral contraceptives- estrogen increases susceptibility to clotting - age and gender- increases with age. Men more than women & men 65 & older - race & ethnicity- AA, hispanics, native Americans

Compartment syndrome occurs when ________________ pressure exceeds _________________ pressure in a _________________ anatomical space.

Tissue, perfusion, closed Pressure greater than 30

cryptorchidism

Undescended testicles, testicles remain within abdomen - affects 2-9% of all newborns - 1-3% of boys at 3 months She said seen in infants and young adults More common in premature boys

Which STD is the silent STD?

chlamydia Also most common

Fresh, frozen plasma contains....

coagulation factors and should be part of DIC plan.

What precautions are necessary in TB?

droplet

Alzheimer's disease and changes

progressive, neurological degenerative disease of the brain characterized by significant changes to brain tissue. Changes: - accumulation of neurofibrillary tangles - senile plaques (aka beta-amyloid plaque) - cerebrocortical atrophy

Hypovolemic shock

shock resulting from blood or fluid loss Example: hexmoorrhage, diarrhea (in kids), vomiting, ascites, burns

septic shock

state of severe sepsis with persistent life-threatening hypotension that is refractory (unmanageable) to fluid replacement and vasopressors.

PTDS can cause...

suicidal or homicidal actions

Syphilis is caused by which bacteria

treponema pallidum

Neurogenic shock

type of shock where SNS is disrupted by spinal cord injury Tachycardia is expected compensatory response in shock. However bradycardia occurs in this shock b/c shut-in if SNS and unopposed influence of PSNS.