Final Review

Terms that end with "chromic" refer to:

"chromic" refers to hemoglobin content

Terms that end with "cytic" refer to:

"cytic" refers to cell size

multiple organ dysfunction syndrome

(MODS) progressive impairment of two or more organ systems resulting from an uncontrolled inflammatory response to a severe illness or injury.

2 major ways to have immune related injury to glomerulus...

*mecahnisms of injury (immune related) 1.) deposition of circulating soluble antigen-antibody complexes, often w/ complement fragments or 2.) formation of antibodies against the glomerular basement membrane also 3.) streptococcal release of neuramidase will damage glomerular membrane

What is Graves disease?

*most common cause of throtoxicosis cause: -Ab's stimulate TSH receptors (in thyroid galnd) to make excessive amounts of hormone Symptoms: - ↑T3 & T4 -diffuse thyroid enlargement (goiter) -pretibial myxedema (hyaluronic acid depostition in pretibial skin) -exophthalmus (protusion of eyeball due to inflammation)

kidney stone formation

*supersaturation of one or more salts -presence of a salt in a higher concntration than the volume able to dissolve the salt 0example: pouring salt in a bucket of water, it will eventualluy accumulate at the bottom) -stones: calcium oxalate or calcium phosphate (80%) *struvite stones (15% [UTI's]) *uric acid stones (5% [gout]) 5mm-50% chance of passage through urethra > 1cm- no way it will pass

primary pulmonary hypertension

- an idiopathic form of pulmonary artery hypertension & is characterized by pathologic changes in precapillary pulmonary arteries -usually hereditary component -diseases of the respiratory system & hypoxemia are more common causes of pulmonary hypertension

complicated hypertension

- leads to left ventricular hypertrophy (LVH), coronary artery disease (CAD), MI, sudden death) -Chronic hypertensive damage to the walls of systemic blood vessels, smooth muscle cells undergo hypertrophy (increase in volume) and hyperplasia ( increase in no. ) with fibrosis (dev of new tissue) of the tunica intima and media (innermost layer of vein)

evaluation of rheumatoid arthritis: 4 or more of the followin...

- morning joint stiffness lasting at leat 1 hour -arthritis of 3 or more joint areas -arthritis of the hand joints -symmetric arthritis -Rheumatoid nodules (in sub Q tissue over extensor surfaces: fingers & elbows) -abnormal amounts of serum rheumatoid factor -radiographic changes

Categories of diabetes mellitus

- type 1 -type 2 - other specific types - gestational diabetes

treatment of ↓ bone loss

- ↑ Ca intake to 1500mg/day w/ 800 IU vit D - ? estrogen/progesterone (breast cancer, DVT, heart disease complications)

Congential adrenal hyperplasia

- ↓ cortisol & aldosterone synthesis (at birth) → ↑ACTH → adrenal hyperplasia → ↑ androgens (which are also made in adrenal cortex -disorder of the adrenal cortex

Diabetic ketoacidosis

- ↓ glucose utilization in tissues → hepatic glucose production from cortisol, catecholamines, GH, glucagon (liver trying to produce glucose to fix the problem) along with: - ↑ fat & protein breakdown (since no glucose available to metabolize) → ↑ketones (from metabolism of FFA's) & mrabolic acidosis → coma

gastric ulcers

-1/4 common as duodenal ulcers -caused by NSAID's (↓ production of prostaglandins, which protect gastric lining), & H. polyri infection -primary defect is ↑ mucosal permeability to hydrogen ions (not ↑ acid secretion) -*main symptom is PAIN WITH EATING

large cell carcinoma

-10-15% of bronchogenic carcinomas -lost all evidence of differentiation; therefore referred to as undifferentiated

primary hypertension

-140/90 mmHg -also called essential or idiopathic hypertension -genetic (polygenic) & environmental factors (↑ Na intake, cigarette smoking, obesity, heavy alcohol consumption) -95% of people who have hypertension have primary hypertension risk factors: -family hisroty, advancing age, gender (men > than women before 55, women > then men after 55), black race, cigarette smoking/obesity, ↑ alcohol intake

hematoma formation

-1st stage in bone fracture healing -clot forms at damaged edges of bone

hypertension

-65% of americans have it - > than 60 years old -only 2/3 are adequately controlled

What is type 2 diabetes mellitus?

-90% of cases -non-insulin dependent -insulin resistance ↓ beta cell responsiveness (80% of patients) -***↑ resistance w/ obesity (+risk factor) - + genetic susceptibility - ↓ number of beta cells in pancreas

Neonatal hypothyroidism

-A.K.A cretinism -hypothyroidism in childhood -associated w/ mental deficiency

Crohn disease

-A.K.A granulomatous colitis, ileocolitis, or regional enteritis (rectum seldom involved) -idiopathic inflammatory disorder, affects any part of the digestive tract, from mouth to anus -difficult to differentiate from ulcerative colitis -similar risk factors & theories of causation as ulcerative colitis -causes "skip lesions" & granulomas -ulcerations can produce longitudial & transverse inflammatory fissures that extend into the lymphatics -ANEMIA may result from malabsorption of vitamin B12 &/or folic acid (absorbed in upper small intestine) -treatment is similar to ulcerative colitis surgical Rx: for fistulas, abscesses, obstruction, perforation

hypothyroidism

-An alteration of thyroid function -a glandular disorder resulting from insufficient production of thyroid hormones -the most common cause of thyroid dysfunction Primary hypothyroidism: -acute (bacterial)/ subacute (viral) thyroiditis -autoimmune thyroiditis (Hashimoto disease)- destruction of thyroid tissue by thyroid antibodies; ***most common cause of hypothyroidism in the US*** -postpartum thyroiditis (similar to Hashimoto)

dislocations of hip

-Anterior (rare): land on feet after falling -Posterior: auto accident- knee hits dashboard may disrupt circulation → necrosis of the joint → hip replacement (Bo Jackson) Rx: reduction

Primary hyperaldosteronism

-Conn disease -adenoma of adrenal gland -disorder of the adrenal cortex

obstructive jaundice

-Extrahepatic obstruction (common bile duct obstructed by gallstone or tumor so conjugated billirubin can't flow into duodenum → conjugated billirubin enters blood and secreted in urine [dark]) -Intrahepatic obstruction (cirrhosis → ↑ unconjugated & conjugated billirubin in blood due to disturbances in conjugation & excretion)

risk factors for kidney stones

-FLUID INTAKE, gender [male], race [white], geographic location [south], seasonal factors, diet (↑ protein, ↓ Ca, ↑ oxalate [tea], & occupation

What are the symptoms of hypothyroidism?

-MYXEDEMA (non-pitting, boggy edema around eyes and hands) -low BMR (basal metabolic rate) -cold intolerance -lethargy

treatment for rheumatoid arthritis

-Non surgical: rest, hot/cold packs, PT, non steroidal anti-inflammatory's, steroids (typically), gold salts -Surgical: synovectomy, joint replacement

renal cell carcinoma

-RCC: 80% of all Ca's -cancerous tumor of the kidney in adulthood -2X more prevalent in men -↑ smokers, African-americans 5 YR. SURVIVAL 50% (2% w/ metastasis)

What is hypopituitarism?

-Undersecretion of the ANTERIOR pituitary gland's hormones -Can range from the absence of pituitary hormones to the complete failure of hormonal functions. Can be caused by: -pituitary infarction -head trauma, infections, & tumors -panhypopituitarism

peptic ulcer disease

-a break or ulceraion in the protective mucosal lining of the lower esophagus, stomach, or duodenum -acute & chronic ulcers -superficial (erosions) -deep (true ulcers-penetrate muscularitis mucosa)

What does glomerular damage cause?

-a decreased glomerular basement membrane surface area -decreased glomerular blood flow leading to: -decreased glomerular hydrostatic pressure **ALL OF THE ABOVE CAUSES A DECREASE IN THE GFR (decreased filtrate)**

What is hyperpituitarism?

-a disease of the ANTERIOR pituitary -Excess of pituitary hormone secretion. -commonly caused by a benign slow-grwoing pituitary adenoma (causing ↑ secretion of one hormone)

What is Diabetes insipidus?

-a disease of the posterior pituitary -insufficiency of ADH -polyuria & polydipsia (thirsty) -partial or total inability to concentrate urine

inflammatory vs. noninflammatory joint disease: differentiated by...

-absence of synovial membrane inflammation -lack of systemic signs & symptoms -normal synovial fluid analysis

Type 1 diabetes mellitus

-absolute insulin deficiency -10% -demonstrates pancreatic atrophy & specific loss of beta cells (which make insulin) -AUTOIMMUNE destruction of beta cells , & Ab to insulin: macrophages, T- & B-lymphocytes, natural killer cells are present 2 types: -1A (80%)- B cell auto antibodies & antibodies to insulin -non immune type 1 (20%)- due to pancreatitis (& loss of beta cells) -diagnosis by 12 yr of age -genetic susceptibility -environmental factors (drugs/infection, esp. congenital rubella) -immunologically mediated destruction of beta cells

pericardial effusion

-accumulation of fluid in pericardial cavity symptoms: -hypotension -pulsus paradoxis ( ↓systolic BP 10 mmHg upon inspiration)

acute bronchitis

-acute infection or inflammation of the airways or bronchi -commonly follows a viral illness -causes similar symptoms to pneumonia but dies not demonstrate pulmonary consolidation & chest infiltrates

obstructive pulmonary disease

-airway obstruction that becomes WORSE with expiration -common signs & symptoms: dyspnea & wheezing -common OBSTRUCTIVE disorders: asthma, emphysema, chronic bronchitis

What is a Urinary Tract Infection?

-an inflammation of the urinary epithelium caused by bacteria -most common pathogen of UTI: E. Coli -virulence of uropathogens: host defense mechanisms important

treatment of osteomyelitis

-antibiotics -debridement -surgery -hyperbaric oxygen therapy -remove infected prosthesis

treatment for glomerulonephritis

-antibiotics (due to strep) -steroids (autoimmune disease) -anticoagulants

Coronary artery disease

-any vascular disorder that narrows or occludes the coronary arteries -atherosclerosis is the most common cause risk factors: -dyslipidemia-HDL/LDL cholesterol -hypertension -cigarette smoking -diabetes mellitus -obesity/sedentary lifestyle -advance age -male gender or femal gender after menopause -family history -markers of inflammation & thrombosis (C-reactive protein-a protein that indirectly measures plaque related infammation, fibrinogen, protein C, & plasminogen activator inhibitor non traditional risk factors: -hyperhomocysteinemia- a genetic lack of enzyme breaking down homocysteine -infection-chlamydia & helicobacter p. often present in atherosclerotic lesions

clinical stages of gout

-asymptomatic hyperuricemia -acute gouty arthritis -tophaceous gout (chronic stage)

Chronic glomerulonephrits

-autoimmune: Ag/Ab complexes or anti-GBM antibodies damage capillary wall -diabetes & lupus are secondary causes

Prerenal acute renal failure

-before the kidney -most common cause of ARF

renal adenomas

-benign tumor, can become malignant

acute respiratory distress syndrome

-biggest problem is alveoli capillary membrane thickens & hardens -fulminant form of respiratory failure characterized by acute lung inflammation & diffuse alveolocapillary injury -injury to the pulmonary capillary endothelium -inflammation & platelet activation -surfactant inactivation -atelectasis -development of hyaline membrane at alveolocapillary interface which impedes air exchange mortality: <60 yo=40%; >60yo=60% +

hepatic encephalopathy

-blood bypasses liver so ↑ ammonia levels (due to lack of filtering by liver) in blood which perfuse the brain causing reversible CNS alterations -central nervous system dysfunction resulting from liver disease; frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma

thrombus formation

-blood clot that remains attached to the vessel wall

What is nephritic sediment?

-blood, WBC's, & CASTS [cylindrical aggregates of particulate matter] -sediment of chronic glomerular disease has less stuff in the sediment

What does prolactin normally do?

-breast development during pregnancy -postpartum milk production -suppression of ovarian function in nursing mothers

lung cancer

-bronchogenic carcinomas -most common cause is cigarette smoking: heavy smokers have a 20 times greater chance of developing lung cancer than nonsmokers; smoking is related to cancers of the larynx, oral cavity, esophagus, & urinary bladder -most common cause of cancer deaths (30% of all deaths in US) -environmental or occupational risk factors also associated w/ lung cancer evaluation & treatment: TNM calassification; Tumor, Nodal involvement, Metastasis -surgery, chemotherapy, radiation therapy

secondary pneumothorax

-can be caused by chest trauma, -ie. stab wound or rib fracture, bullet- anything that tears the pleura

Acute pyelonephritis

-can occur after instrumentation -acute infection of the renal pelvis interstitium -vesicoureteral reflux & urinary obstruction most common underlying factors -E. coli, proteus, pseudomonas typical organisms

laryngeal cancer

-cancer of the larynx forms: -carcinoma of the true vocal cords (most common)-squamous cell CA -supraglottic -subglottic treatment: XRT/XRT & surgery

Chondrosarcoma

-cartilage forming -tumor of middle-aged & older adults -infiltrates trabeculae in spongy bone; frequent in the metaphyses or diaphysis of long bones -the tumor contains lobules of HYALINE CARTILAGE that expand & enlarge the bone -causes erosion of the cortex & can expand into the neighboring soft tissue

compression atelectasis

-caused by external pressure -Example=pneumothorax

Adrenal medulla hyperfunction

-caused by tumors derived from the chromaffin cells of the adrenal medulla -PHEOCHROMOCYTOMAS (rare) -secrete catecholamines on a continuous or episodic basis

virchow triad

-causes DVT -venous stasis, hypercoagulability, & injuries to the endothelial cells that line the vessels

Target cell failure

-cell surface receptor-associated disorders (water soluble hormones can't diffuse across a cell membrane [protein hormones & catecholamines]) * decrease in number of receptors * impaired receptor function * presence of antibodies against specific receptors * antibodies that mimic hormone action * unusual expression of receptor function (tumor cells w/ abnormal receptor activity) -Intracellular disorders (defects in post receptor signaling cascades, or inadequate synthesis of a 2nd messenger) -circulating inhibitors (Ab directed against a hormone making it inactive)

Evaluation & treatment of diseases of posterior pituitary

-check serum electrolytes, serum/urine osmolality -CAREFULLY give hypertonic saline (slowly > .9% normal saline

arteriosclerosis

-chronic disease of the arterial system -general term -abnormal thickening & hardening of the vessel walls -smooth muscle cells & collagen fibers migrate to the intima

Ulcerative collitis

-chronic inflammatory disease that causes ulceration of the colonic mucosa; sigmoid colon & rectum (20-40 yr old age group) suggested causes: infectious, immunologic (anticolon, antibodies), dietary, genetic- Jewish hereditary (supported by family studies & identical twin studies) symptoms: (intermittent) -diarrhea (10-20X's a day), bloody stools, cramping evaluation: UGI, LGI, colonoscopy w/ biopsy pathology: ulcers- abscess- necrosis Treatment: -broad spectrum antibiotics & steroids -immunosuppressive agents -surgery (resection of involved colon) AN INCREASED RISK OF COLON CANCER IS DEMONSTRATED

asthma

-chronic inflammatory disorder of the airways- IgE mediated -inflammation results from HYPERRESPONSIVENESS of the airways -can lead to obstruction & status asthmaticus (unrelieved , continued bronchoconstriction) symptoms: expiratory wheezing, dyspnea, tachypnea treatment: peak flow meters, oral corticosteroids, inhaled beta-agonists, & anti-inflammatories used to treat (antocholinergics often not recommended due to thickening of the bronchial secretions

inflammatory bowel diseases

-chronic relapsing inflammatory bowel disorders of unknown origin (Crohn disease, ulcerative colitis) Common to both: -genetics play a role as a risk factor -alterations of epithelial barrier functions (leaky) -altered immune reactions to intestinal mucosa -abnormal T cell responses (altered immunity)

stages of chronic renal failure

-chronic renal insufficiency- no symptoms, 25% renal function remains -chronic renal failure- systemic manifestations -end-stage renal failure- < 10% renal function left

fibromyalgia

-chronic widespread joint & muscle pain -vague symptoms: increased sensitivity to touch, absence of inflammation, fatigue, & sleep disturbances -*MOST EXPERTS FEEL IT IS A DECREASE IN PAIN TOLERANCE DUE TO FUNCTIONAL ABNORMALITIES OF THE CNS

What are the treatments for bone fractures?

-closed manipulation (most), traction (maintain reduction w/ force), open reduction (surgery) -internal (screws) and external fixation (bars)

polymyositis & dermatomyositis

-collectively described by the term myositis (inflammatory changes in the skeletal muscle) -viral, bacterial, & parasitic myositis: Staph Aureus infections; Trichinosis (Trichinella infection); Toxoplasmosis

Secondary hyperparathyroidism

-compensatory increase in PTH secretion secondary to a chronic disease (like renal failure/malabsorption of Ca) that causes chronic hypocalcemia -not making active Vit. D, therefore, not absorbing calcium -typically in the kidneys -autonomous (working on it's own) secretion of PTH can occur w/ parathyroid hyperplasia due to chronic renal failure (& no active Vit. D) (i.e. no feedback control)

What is Myositis Ossificans?

-complication of local muscle injury -inflammation of muscular tissue w/ subsequent CALCIFICATION & ossification of the muscle -"rider's bone" in equestrians (adductor in thigh) -"drill bone" in infantry soldiers (pectoral m.) -thigh muscles in football players

treatment for acute renal failure

-correct fluid & electrolyte imbalances -treat infections -maintain nutrition - ? dialysis (temporary) mortality rate: 30%

What are the causes of Rhabdomyolysis?

-crush syndrome (most severe presentation) -compartment syndromes - local- (caused by limb ischemia, local trauma, excessive muscular activity, or heat stroke): (Volkmann) ischemia contracture- flexion contracture of fingers/wrist due to ischemia of forearm

signs & symptoms of pleural abnormalties

-decreased breath sounds -hyper-resonance/typanitic percussion -hypotension -tracheal deviation (tension pneumo)

Alterations of the hypothalamic-pituitary system

-decreased hypothalamic function: ↓GnRH, ↓TRH, ↓CRH, ↓PIF, ↓GHRH -Anterior pituitary (hypothalamus controls how pituitary is going to release): ↓FSH, ↓LH, ↓TSH, ↓ACTH, ↑Prolactin, ↓Growth Hormone

potential causes of osteoporosis

-decreased levels of estrogen (especially w/ women) and testosterone -decreased activity level (example: astronauts) -inadequate levels of vitamins D & C, or Mg (vit D increases absorption of calcium from intestines & kidney)

osteoarthrits (degenerative joint disease)

-degeneration & loss of articular cartilage, sclerosis of bone underneath cartilage, & formation of bone spurs (osteophytes) -also referred to as degenerative joint disease -incidence increase w/ age (>40 years old) -primary disease is idiopathic (don't know what causes it) -secondary disease due to ↑ stress on joints (athletes) is characterized by local areas of damage & loss of articular cartilage, new bone formation of joint margins, subchondrial bone changes (beneath articular cartilage), & variable degrees of mild synovitis & thickening of the joint capsule -erosion of cartilage is primary defect -"bone on bone" no articular cartilage -Bouchard= proximal -Heberden= distal -Varus deformity of knee (buckles out)

complications of intestinal obstruction

-dehydration -perforation -peritonitis

feminization

-development of female secondary sex characteristics due to estrogens -hypersecretion of estrogens

virilization

-development of male secondary sex characteristics due to androgens -hypersecretion of androgens

varicose veins

-dialated & filled w/ blood -a vein in which blood has pooled -distended, tortuous, palpable veins -caused by trauma or gradual venous distention due to prolonged standing, constricting garments & damaged valves risk factors: increase age, female, family history, obesity, pregnancy, phlebitis

Where is glomerulonephritis?

-diffuse -local -segmental (skip-lesions)

Varices

-dilated veins that cause massive bleeding) -lower esophagus, stomach, rectum

Hypersecretion of prolactin

-disease of the ANTERIOR pituitary -caused by prolactinomas ( * most common hormonally active pituitary tumor) -in females, increased levels of prolactin cause amenorrhea, galactorrhea (lacitn when not breast feeding), hirsutism, and osteopenia (↓ bone mineral density) -in males, increased levels of prolactin cause hypogonadism, erectile dysfunction, impaired libido, oligospermia, galactorrhea, & diminished ejaculate volume

What is acromegaly?

-disease of the ANTERIOR pituitary -hypersecretion of growth hormone during adulthood -↓ life expectancy (HEART DISEASE, colon & lung Ca's) -usually due to GH secreting pituitary adenoma

What is gigantism?

-disease of the ANTERIOR pituitary -hypersecretion of the GH in children & adolescents (prior to epiphyseal closure) -growth to 8-9 ft. tall

What are diseases of the posterior pituitary gland?

-diseases in this gland are rare -ADH (antidiuretic hormone which allows to retain water) is made in the hypothalamus and is stored in the posterior pituitary gland (reabsorption of water) -Syndrome of inappropriate antidiuretic hormone secretion (SIADH) [makes too much ADH]- the most common causes is ectopic tumor cell secretion *hypersecretion of ADH (small cell ca of lung) -brain injury or infection -The osmolarity goes way down →not so many dots -serum sodium goes↓ -urine concentration (serum urine) goes ↑

acute pericarditis

-disorder of the pericardium -90% due to virus, MI, uremia, meds symptoms: -severe chest pain -friction rub -ST segment elevation treatment: anit-inflammatories

isolated systolic hypertension

-elevations of systolic pressure are caused by increases in cardiac output, ↑total peripheral vascular resistance, or decreased arterial distensibility -founf in large % of people > 65 years old

thromboembolus

-embolus -part of a thrombus that breaks off & goes somewhere else -pulmonary embolism

raynaud disease

-epsodic VASOSPASM in arteires & arterioles of teh fingers, less commonly the toes -primary vasospastic disorder of unknown origin -affects young women -vasospastic attacks triggered by cold, emotion, cigarettes raynaud phenomenon: secondary to other systemic disease or conditions -collagen vascular disease (scleroderma), smoking, pulmonary hypertension, myxedema, & environmental factors (cold & prolonged exposure to vibrating machinery) treatment: -avoid cold, cigarettes -vasodilators (Ca+ channel blockers, angiotensin II receptor blockers

primary hyperparathyroidism

-excess secretion of PTH from one or more parathyroid glands (usually adenoma) w/ no feedback control: - ↑ osteoclastic activity (bone resorption, ↑ bone fractures) → ↑serum calcium - ↑ calcium, phosphorus in urine, & alkaline urine → kidney stones -mild insulin resistance occurs, causing ↑ insulin secretion

Cushing syndrome

-excessive level of cortisol -ACTH dependent (cushing disease) -ACTH independent (ectopic tumor secreting cortisol, or adrenal tumor secreting cortisol, or steroid medications) -***most common cause is side effects for taking anti-inflammatory steroid medications for asthma/rheumatoid arthritis

what causes elevated or depressed hormone levels?

-failure of feedback systems -dysfunction of an endocrine gland -secretory cells are unable to produce, obtain, or convert hormone precursors -the endocrine gland synthesizes or releases excessive amounts of hormone -increased hormone degradation or activation -ectopic (somewhere it shouldn't be) hormone release (ADH secreting lung tumor)

bronchiolitis obliterans

-fibrotic process that occludes airways & causes permanent scarring of the lungs

Fibrosarcoma

-firm, fibrous mass of collagen, malignant fibroblasts, & osteoclast-like cells -usually affects metaphysis of the femur or tibia -metastasis to the lungs is common

possible factors of fibromyalgia

-flu-like viral illness, chronic fatigue syndrome, HIV infection, Lyme disease, medications, physical or emotional trauma -scientific studies are unclear

ascites

-fluid in peritoneal cavity -back up of blood in intra-abdominal veins → ↑hydrostatic pressure → ascites

Hepatits A

-found in the feces, bile, & sera of infected individuals -usually transmitted by the fecal-oral route Risk factors: -crowded, unsanitary conditions -food & water contamination (restaurant) Prevention: -immune serum globulin -hep A vaccine Diagnosis: -positive antigen antibodies (anti- HAV) Treatment: -conservative

monitoring long term glucose regulation

-glucose eventually attatches to Hb molucules in blood (Hb A1C)[used to check if insulin levels are correct] -↑ glucose levels causes ↑ levels of Hb A1C (which can be measured)

What is gestational diabetes?

-glucose intolerance during pregnancy -requires aggressive therapy to protect fetus -important to monitor glucose levels

pulmonary hypertension

-has a mean pulmonary artery pressure 5-10 mm Hg above normal (above 20 mm Hg) -pulmonary artery pressure normally 25/10 classifications: -pulmonary arterial hypertension -pulmonary venous hypertension (due to CHF) -pulmonary hypertension due to respiratory disease or hypoxemia (which causes vasoconstriction) -pulmonary hypertension due to thrombotic or embolic disease -pulmonary hypertension due to diseases of the pulmonary vasculature

What are the clinical manifestations of hyperpituitarism?

-headache & fatique -visual changes -hyposecretion of neighboring anterior pituitary hormones due to pressure effects

exudative effusion

-high concentrations of white blood cells & plasma proteins -infection

treatment for kidney stones

-high fluid intake, decreasing dietary intake of stone-forming substances or -stone removal: endoscopy; laser lithotripsy

Chronic complications of diabetes mellitus

-hyperglycemia & nonenxymatic glycosylation (reversible attatchment of glucose to protein & lipids): w/ recurrent hyperglycemia glucose becomes permanently bound which causes tissue injury Microvascular disease -Retinopathy (retinal ischemia → neovascularization → retinal detatchment) → Rx w/ laser surgery -diabetic Nephropathy (most common cause of end stage renal disease) - microalbinuria → proteinuria (death in 10 years) Macrovascular disease -coronary artery disease -stroke (2X as common) -peripheral arterial disease (occlusion of arterioles) → amputation (Ron Santo) Diabetic neuropathies (nerve degeneration) Infection (due to neuropahty/poor WBC function/ ↓ blood supply)

What are the clinical manifestations of type 1 diabetes mellitus?

-hyperglycemia, glycosuria, breakdown of fats & proteins -polyuria, polydipsia, & polyphagia (-energy balance) -weight loss/fatigue -ketoacidosis

chronic bronchitis

-hypersecretion of mucous & chronic productive cough that lasts for at least 3 months of the year & for at least 2 consecutive years -inspired irritants increase mucous production & the size & number of mucous glands -caused primarily from cigarette smoke -mucous is thicker than normal -COPD treatment: bronchodilators (beta agonists & anticholinergics) expectorants, & chest physical therapy used to treat

What can chronic renal failure be a complication of?

-hypertension -diabetes mellitus -renal diseases: 1.) chronic glomerulonephritis (most common cause) 2.) chronic pyelonephritis (kidney infection) 3.) obstructive uropathies (prostatic hypertrophy)

Diagnosis of chronic glomerulonephritis

-hypertension -edema -urinalysis w/ protein -WBC's -RNC's -casts

symptoms of alterations in adrenal function

-hypertension (increased peripheral vascular resistance) -headache -hypermetabolism -sweating/palpitations/tachycardia

manifestations of ARDS

-hyperventilation -respiratory alkalosis -dyspnea & hypoxemia -metabolic acidosis -hypoventilaiton -respiratory acidosis -further hypoxemia -hypotension, decreased cardiac output, death

Acute complications of diabetes mellitus

-hypoglycemia (due to insulin reaction) → anxiety/tachycardia → coma -diabetic ketoacidosis -hyper-osmolar hyperglycemic non-ketotic syndrome (HHNKS)- ↑ serum osmotic pressure due to hyperglycemia ( >500) → severe dehydration [too much glucose; won't be acidiodic; constantly pee] -Somogyi effect- hypoglycemia followed by rebound hyperglycemia die to counter-regulatory hormones (epinephrine, GH, corticosteroids) that are released; usually occurs in middle of the night -Dawn phenomenon- early morning rise in blood glucose concentration (w/ no hypoglycemia at night) -due to nocturnal elevation of GH, cortisol, & catecholamines which mobilize glucose into the blood -Rx: re-adjust insulin doses

panhypopituitarism

-hypopituitarism -deficiency of all pituitary hormones -ACTH deficiency -TSH deficiency -FSH deficiency -GH deficiency (pituitary dwarf) - ↓ACTH potentially life threatening (need cortisol for metabolism): Symptoms= N&V, fatigue, weakness - ↓TSH: cold intolerance, dry skin, lethargy -↓FSH, LH: amenorrhea, atrophic vagina/uterus/breasts

pituitary infarction

-hypopituitarism -Sheehan syndrome (postpartum pituitary necroses) -hemorrhage -shock

Prediabetes

-impaired glucose tolerance (IGT): glucose > 140mg/dl & <200 mg/dl (due to diminished insulin secretion) OR -impaired fasting glucose (IFG): glucose >100 & < 126 (due to enhanced liver glucose output) -***both have significant risk of cardiovascular disease

What causes prerenal acute renal failure?

-impaired renal blood flow by: -massive dehydration -low blood pressure -massive bleeding -massive heart attack -GFR declines because of the decrease in filtration pressure/rate (DETERMINANTS OF FILTRATION PRESSURE: 25% of cardiac output goes to the kidneys -180 liters filtered through kidneys daily (120cc/min); a decrease in plasma filtration rate or pressure will decrease glomerular filtration rate (GFR)

acute respiratory failure

-inadequate gas exchange -PO2<50, -PCO2>50 -pH<7.25

chronic venous insufficiency

-inadequate venous return over al ong period due to varicose veins or valvular incompetence -venous stasis ulcers (complicated by infection) venous hypertension →circulatory stasis→tissue hypoxia→inflammatory reaction (in vessels & tissues)→ skin ulceration treatment: LEG ELEVATION, compression stockings, unna boot

What is acute cystitis?

-inflammation of the bladder

Rheumatoid arthritis

-inflammatory joint disease (2% of adults, female 3:1 ratio, 5% > 70 years old) -systemic AUTOIMMUNE damage to connective tissue, primarily in the joints (synovial membrane 1st to be involved; 1st thing that goes/gets damaged): antibodies against your own antibodies -similar symptoms to osteoarthrits -distal (small) joints most involved -presence of rheumatoid factors (RA or RF test); antibodies (IgG & IgM) against their own antibodies (draw blood to detect) -joint fluid presents w/ inflammatory exudate -"ulnar drift"

subendocardial infarction

-inner lining of the heart -occurs 1st since it is farther away from the blood supply -typically 1st

flail chest

-instability of a portion of the chest wall -paradoxical movement -broken ribs; part of chest wall doesn't expand the way it should -conditions caused by pulmonary disease or injury

Severity of urinary tract obstruction is based on...

-location -completeness -involvement of one or both upper urinary tracts -duration -cause: stricture/congenital; compression from tumor or inflammation; stone

Rhabdomyosarcoma

-malignant tumor of striated muscle -usually muscles of the tongue, neck, larynx, nasal cavity, axilla, vulva & heart -highly malignant w/ rapid metastasis -types: pleomorphic, emryonal, & alveolar

factors of osteomyelitis

-many small channels in bone inaccessable to body defenses -microcirculation of bone vulnerable to damage -limited capacity of osteoblasts to replace infected bone

neurogenic shock

-massive vasodilation due to parasympathetic - ↓sympathetic stimulation

Bone tumors

-may originate from bone cells, caritlage, fibrous tissue, marrow, or vascular tissue (osteogenic, chondrogenic, collagenic, & myelogenic) -fibroblast: bone cell cartilage; osteoblast (bone cell), chondroblast (cartilage cell), fibroblast (collagen producing cell) -Reticulum: Bone marrow

Gout

-metabolic disorder that disrupts the body's control of uric acid PRODUCTION or EXCRETION -gout manifestations high levels of uric acid in the blood & other body fluids -occurs when the uric acid concentration increases to high enough levels to crystallize -cyrstals deposit in connective tissues throughout the body -when these crystals occur in the synovial fluid, the inflammation is know as "gouty arthritis" - gout is related to purine (adenine & guanine) metabolism (URIC ACID is a breakdown product of purines) -affected patients can have accelerated purine synthesis, breakdown, or poor uric acid secretion in the kidneys -mechanics for crystal deposition: lower body temperatures, decreased albumin or glycosaminoglycan levels, changes in ion concentration and pH, & trauma (promotes uric acid crystal precipitation) -50% initial attacks in great toe (a condition known as PODOGRA) -RENAL STONES 1000X more prevalent in individuals w/ gout

callus formation

-mineralized new bone built up -osteoclasts destroy dead bone

lip cancer

-most common form: exophytic (squamous cell CA) -stages

duodenal ulcers

-most common in peptic ulcers (75%) -developmental factors: *helicobacter pylori infection-toxins & enzymes are released that promote inflammation & ulceration; hypersecretion of stomach acid & pepsin; use of NSAIDS; high gastrin levels (stimulate stomach pariteal cells to secrete HCL); acid production by cigarette smoking

manifestations of interstitial cystits

-most common in women 20-30 years old -bladder fullness, frequency, small urine volume, chronic pelvic pain

Osteosarcoma

-most common malignant bone tumor -****38% of bone tumors****** (usually end of long bone) -predominant in adolescents & young adults; occurs in seniors of they have a history of radiation therapy -contain masses of osteoid (abnormal cells): "streamers" noncalcified bone matrix & callus -located in the metaphyses of long bones: 50% occur around the knees -requires amputation

mitral valve prolapse syndrome (MVPS)

-most common valve disorder in U.S -more common in women -most common cause=myxomatous degeneration of leaflets most people are asymptomatic symptoms often due to arrythmias

contracture

-muscle fiber shortening w/out an action potential -caused by failure of the sarcoplasmic reticulum) calium pump) even w/ available ATP

What are the alterations of chronic renal failure?

-musculoskeletal -cardiovascular & pulmonary -hematologic -immune -neurologic -gastrointestinal (alteration in protein, carbohydrate, & lipid metabolism) -endocrine & reproduction -integumentary

Stress-induced muscle tension

-neck stiffness, back pain, clenching teeth, hand grip, & headache -associated w/ chronic anxiety

detrusor areflexia

-neurogenic bladder -atonic, flaccid bladder due to distension of bladder (BPH) or peripheral nerve lesion

treatment for interstitial cystits

-no single treatment effective (? steroids); symptoms relief

deep venous thrombosis

-obstruction of venous flow leading to increased venous pressure & stasis→ venous thrombosis causative agents: (virchow's triad) -venous stasis venous endothelial damage -hypercoagulable states treatment: anticoagulant; treatment to prevent pulmonary embolism; prescriptions: heparin/low molecular weight heparin (lovenox)/coumadin/plavix (oral) -IVC filter=filter put in inferior vena cava below the renal vein; used to catch clot prevention: -early ambulation -pneumatic devices/compression stockings -prophylactic anticoagulation

pulmonary embolism

-occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble -pulmonary emboli commonly arise from the deep veins in the thigh (90%) -increases V/Q

spontaneous pneumothorax

-occurs unexpectedly -caused by spontaneous rupture of blebs (blister-like formations) on the visceral pleura

manifestations of acute cystits

-often assymptomatic -frequency, dysuria, urgency, & lower abdominal &/or suprapubic pain , hematuria

phases of acute renal failure

-oliguria phase (1-3 weeks): don't make much urine -diuretic phase (variable): make way too much urine (worry about dehydration) -recovery phase (3-12 months)

clinical manifestations of osteoporosis

-pain -bone deformity -fractures

manifestations of osteoarthritis

-pain -stiffness -enlargement of the joint -tenderness -limited motion -deformity

aspiration

-passage of fluid & solid particles into the lungs -"going down the wrong tube"

Cheyne-stokes respirations

-periods of deep & shallow breathing followed by apnea of 15-20 seconds -due to CO2 concentration -due to neurological injury -doesn't have to be permanent

chronic pyelonephritis

-persistant or recurring episodes of acute pyelobephritis that leads to scarring -risk of chronic pyelonephritis increases in individuals w/ renal infections & some type of obstructive pathologic condition (prostatic hypertrophy)

Evaluation & treatment of ARDS

-physical examination, blood gases, & radiologic examination -supportive therapy w/ ventilation & prevention of infection -surfactant to improve compliance

tension pneumothorax

-pleural rupture site acts as a one-way valve letting air enter on inspiration but preventing air escape on expiration -the pressure pushes important structures to the left/right -absolute surgical emergency

pleural inflammation

-pleuritis (pleurisy) -can be viral, bacterial, or allergic

osteoporosis

-porous bone -poorly mineralized bone -bone density (peaks at 35 years old), then resorption → formation (osteoclasts begin to do more work than osteoblasts) -Remember: quantity & QUALITY (decrease) -demonstrated by reduced bone mass/density (DEXA scan) & is an imbalance between bone resorption & formation -* bone histology is usually normal but it lacks structural integrity -by age 50: 55% of people have osteoporosis or ↓ bone mass -by age 90: 17% males, 32% females have hp fracture -Women: complete loss of trabeculae -Men: form more bone on outer surface -Kyphosis

postrenal acute renal failure

-post kidney -develops due to obstruction -occurs w/ urinary tract obstruction that affect the kidneys bilaterally (↑ prostate, bilateral ureteral obstruction, bladder neck obstruction)

Hemolytic jaundice

-prehepatic jaundice -excessive hemolysis of red blood cells or absorption of a hematoma → ↑ unconjugated billirubin in blood (liver can't conjugate fast enough)

Adrenocortical hypofunction

-primary adrenal insufficinecy (ADDISON DISEASE) -rare -autoimmune mechanics that destroy adrenal cortical cells -secondary hypocortisolism- low/absent ACTH caused by exogenous glucocorticosteroids or cortisol secreting tumors (negative feedback)

superior vena cava syndrome

-progressive occlusion of the superior vena cava that leads to venous distention & edema of upper extremities & head -concologic emergency: 75% due to local lung carcinoma treatment: -treat the cancer (surgery/chemo/XRT) -venous bypass surgery

Evaluation of hyperthyroidism

-radioactive iodine is used in differential diagnosis of hyperthyroidism -If there is a low uptake of iodine: thyroiditis Normal or elevated uptake (indicate): -Graves disease -Toxic multinodular goiter -toxic adenoma

malignant hypertension

-rapidly progressive hypertension -diastolic pressure is usually >140 mmHg→ cerebral edema→ coma→ death

Thyroid cancer

-rare (though most common endocrine Ca) -euthyroid state (normal T3, T4 levels)

disuse atrophy

-reduction in the normal size of muscle cells as a result of prolonged inactivity: bed rest, trauma, casting, or nerve damage

Clinical manifestations of diseases of posterior pituitary

-related to enhanced renal water retention →hyponatremia & hypoosmolality

absorption atelectasis

-removal of air from obstructed or hypoventilated alveoli or from inhalation of concentrated oxygen -most common -w/ open pore of Kohn (little openings between the walls of the alveoli); commonly seen postoperatively; deep breath in then cough to pop the mucous plug out

manifestations of kidney stones

-renal colic: hematuria, flank pain → groin (obstruction in pelvis/prox ureter) -lower abdominal pain (mid ureter) -dysuria (lower ureter)

Hepatitis C

-responsible for most cases of post-transfusion hepatitis -also implicated in infections related to IV drug use -*50-80% of hepatitis C cases result in chronic hepatitis (20% OF THESE DEVELOP CIRRHOSIS)

Diagnosis of diseases of posterior pituitary

-serum hypoosmolality, hyponatremia, urine hyperosmolarity, normal adrenal & thyroid function must exist

non-small cell lung cancer

-squamous cell carcinoma (30% in hilum) -adenocarcinoma-tumor arising from the gland; 35-40% of all bronchogenic carcinomas (40% in periphery)

evaluation of kidney stones

-stone & urine analysis -intravenous pyelogram (IVP) or kidney, ureter, bladder x-ray (KUB) -spiral abdominal CT ***most common - MRI***

myocardial infarction

-sudden & extended obstruction of the myocardial blood supply; complete blockage -cellular injury -cellular death -structural & functional changes: myocardial stunning- temporary loss of contractile function of surrounding muscle for hours/days hibernating myocardium-cardian muscle adapts to ischemia; can completely recover after revascularization ex. coronary bypass grafting or coronary angioplasty myocardial remodeling- myocyte hypertrophery & loss of contractile function distant to the area of ischemia resulting in ↓ ejection fraction due to cytokines, angiotension II, catecholamines etc. repair: -strudy scar tissue forms w/ in 6 weeks

Treatment for renal cell carcinoma

-surgical removal - +/- chemo/XRT

Secondary hyperaldosteronism

-sustained renin release due to ↓ blood volume (dehydration) or renal artery stenosis (↓ flow & pressure) -disorder of the adrenal crotex

false aneurysms

-tear in intima & media, not adventia -involves 2 of the 3 layers -saccular aneurysms -dissecting aneurysms

dislocation fracture

-temporary displacement of 2 bones -loss of contact between articular cartilage

what is chronic renal failure?

-the irreversible loss of renal function that affects nearly all organ systems (months → years) -proteinuria & uremia (the syndrome caused by accumulation of nitrogenous waste products from protein metabolism) -↓ creatinine & urea clearance (elevation in blood BUN & creatinine)= AZOTEMIA -fluid & electrolyte balance *sodium & water balance (Na & h2O retained → edema) * ↑ phosphate & ↓ calcium (lack of active vit D) * ↑ potassium ( ↑ serum K+ because it's not secreted in urine) * acid-base balance (metabolic acidosis - loss of HCO3, retention of H+) -fluid & electrolyte balance continued: *sodium & water balance (Na & H2O retained, causing peripheral edema) * increased serum phosphate, decreased Ca+ * Potasium balance: increased serum K+ (K+ not secreted) * acid-base balance (metabolic acidosis - loss of HCO3, retention of H+)

what is the treatment for thyroid cancer?

-thyroidectomy (recommended for a healthy person who can tolerate the surgery) (a complication of this surgery= hypoparathyroidism) -TSH suppressants -radioactive iodine -XRT

Hepatitis B

-transmitted through contact w/ infected blood, body fluids, or contaminated needles -maternal transmission can occur if the mother is infected during the 3rd trimester -vaccine prevents transmission & development prevention: -vaccine -immune serum globulin given early in exposure diagnosis: -serum antigens (HBsAG, HBcAG) treatment: -conservative -chronic disease- antivirals; interferon alpha

small cell carcinoma

-tumors central in origin -constitutes for 20% -strongest correlation w/ cigarette smoking -worst prognosis; 6-12 month survival time

diagnosis of acute cystits

-urinalysis, culture & sensitivity

Colon cancer

-usually arise from adenomatous polyps (discovered during colonoscopy) -once malignant cells transverse muscularis mucosa they become invasive & highly malignant (Adenocarcinomas) -greater size (more than 1.5 cm)= increased malignant potential pathology: -moderatly differentiated adenocarcinoma -slow grwoing symptoms: -depends on location, size, type -ascending colon: polypoid; rarely obstruct lumen; cause melena (black, tarry stools) -descending colon: elevated, button-like lesion; circumferential (will obstruct); ulcerating; *BRB stools Rectal CA: -up tp 15 cm from anal opening -can spread through rectal wall Evaluation: -family history -check for anemia (blood in stool; hemoccult test) -barium enema (BE), colonoscopy → remove polyps if found -check for metastases (liver) Dukes Classification (A, B, C, D) -A: to bowel wall -B: through blood wall -C: lymph nodes positive -D: distant metastases Treatment: -radiation, then surgical excision -chemotherapy for distant metastases

secondary hypertension

-usually renal disease -caused by a sytemic disease process that reaises perpheral vascular resistance or cardiac output (renal vascular disease, adrenocortical tumors, adrenomedullary tumors, [pheochromocytoma], drugs

symptoms of intestinal obstruction

-vomiting -abdominal pain -significant abdominal distension (tympany to percussion, hyperactive bowel sounds)

Stages of infection

1) colonization, 2) invasion, 3) multiplication, 4) spread

Mechanisms of local spread

1. Cellular proliferation or multiplication. (mitotic rate vs. cellular death rate. 2. Angiogenesis and perhaps lyphogenesis. (Increased pressure) 3. Digestion of capsules and other structural barriers. (release of lytic enzymes) 4. Changes in cell-to-cell adhesion (loss of fibronectin making cancer cells slippery). 5. Increased motility of individual tumor cells.

Anemias will fall into one of these 4 categories:

1. Impaired erythrocyte poduction / 2. Blood loss / 3. Erythrocyte destruction / 4. Combination of the above

Phases of tumor spread

1. Transformation 2. Growth 3. Local Invasion 4. Distant Metastesis

intestinal obstructions

1. hernia 2. intussusception (usually in the colon (folds)) 3. volvulus- twist 4. adhesions- #1 cause is surgery

treatment of intestinal obstruction

1. long tube decompression (75% success rate for surgical adhesions) (miller-abbot tube) 2. surgery

pathogenesis of pulmonary embolism

1. venous stasis; vessel injury; hypercoagulability 2. thrombus formation 3. dislodgement of portion of thrombus 4. occlusion of part of pulmonary circulation 5. hypoxic vasoconstriction; decreased surfactant; release of neurohumoral & inflammatory responses; pulmonary edema; atelectosis 6. tachypnea; dyspnea; chest pain; increased dead space; V/Q imbalances; decreased PaCO2; pulmonary infarction; pulmonary hypertension; decreased cardiac output; systemic hypotension; shock

What are the treatments for compartment syndrome?

1.) Fasciotomy (of anterior & posterior compartments) to relieve pressure 2.) "flush" kidneys w/ diuretics (build up of myoglobin)

prevention of osteoporosis

1.) adequate intake of Ca/Vit D 2.) weight bearing exercise 3.) no tobacco/alcohol 4.) avoidance of glucocorticoids

stress (microfracture)

2 types: fatigue & insufficiency (new activity vs. fatigue fracture in abnormal bone)

clonal selection

2nd phase of immune response; initiated by antigen; process which involves complex interaction among cells; final products are plasma cells that produce antibodies and memory B and T cells

Death by suffocation can occur within minutes when ambien oxyten drops below:

5%

A concussion is defined as temporary axonal disturbance with loss of consciousness lasting less than:

6 hours.

obstruction sequelae

7 days: fibrosis of distal nephron 14 days: both proximal & distal nephron 28 days: damage to glomerulus (inability to concentrate urine & conserve Na+ & bicarb → dehydration → metabolic acidosis) 60 days: partial kidney recovery

Adenocarcinoma

A cancer that arises from ductal or glandular epithelium. Ex. a malignant tumor arising from breast glandular tissue is called mammary adenocarcinoma.

Cachexia

A condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with diseases such as advanced cancer. Includes anorexia, early satiety, weight loss, altered lipid carb metabolism, asthenia (tingling), taste alterations, etc.

Injury to the endoplasmic reticulum due to hypoxic injury results in:

A decrease in protein synthesis - (Because of the lack of ATP, the sodium/potassium pump fails allowing sodium and water to enter the cell freely causing dilation of the ER. Dilation of the ER results in detachment of ribosomes from rough ER, reducing protein synthesis.)

production of lactate

A direct result of anaerobic metabolism during hypoxic cell injury

Chromosome amplification

A genetic abnormality that turns on oncogenes. They are the result of duplication of a small piece of a chromosome over and over again. Results in increased expression of oncogenes and in some cases, drug resistant genes.

Tumor

A growth of tissue caused the uncontrolled replication of cells.

parietal pain

A localized, intense pain that arises from the parietal peritoneum, the lining of the abdominal cavity. Example: late appendicitis

Radon

A natural radioactive gas derived from the radioactive decay of uranium that is ubiquitous in rock and soil. Can cause lung cancers. Small cell carcinoma occurs in miners.

postobstructive diuresis

A period of brisk urine production when urinary tract obstruction is relieved. 10 liters of urine is excreted within a 24 hr period.

Local spread

A prerequiste for metastasis and the first step in the metastic process. In its earliest stages it is a function of direct tumor extension.

Clonal Proliferation or Clonal Expansion

A result of mutations. A cell will acquire chracteristics that will allow it to have an advantage over neighboring cells. The more proliferation there is, the higher risk of cancer.

What is Thrombotic thrombocytopenic purpura (TTP)?

A thrombotic micro-angiopathy: platelets aggregate, form microthrombi, and cause occlusion of arterioles and capillaries / Chronic relapsing TTP / Acute idiopathic TTP

Describe the p53 gene.

A tumor suppressor gene that 1)attempts to repair DNA damages or 2) stops the cell cycle, or 3)initiates apoptosis. Defects in this gene may be inherited or are caused by exposure to carcinogens. Loss of this gene may facilitate angiogenesis and resistence to apoptosis.

what are the steps in callus formation?

A.) hematoma formation B.) organization of hematoma C.) invasion of osteoblasts, deposition of calcium D.) callus formation E.) remodeling

Gastroesophageal reflux

A.K.A GER or GERD is the reflux of chyme from the stomach into the esophagus if GER causes inflammation of the esophagus, it is called reflux esophagitis a normal functioning lower esophageal sphincter (LES) maintains a zone of high pressure to prevent chyme reflux conditions that increase abdominal pressure can contribute to GER (coughing, lifting, bending, lying flat): LES pressure is overcome

More on DIC:

Activating the fibrinolytic system / fibrin degradation product (FDP) / D-dimer levels increase / High mortality rate / Treatment remove the stimulus: restore hemostasis, maintain organ viability, replace deficient coagulation factors

Cushing ulcer

Acute gastric ulcer associated with CNS injury severe head trauma or brain surgery

Physical findings of HL?

Adenophathy / mediastinal mass / splenomegaly / and abdominal mass

How does obesity correlate with cancer?

Adipose tissue releases free fatty acids. Free fatty acids give rise to insulin resistance and cause chronic hyperinsulemia. Correlates with colon, breast, endometrial, and pancreatic cancers.

Angiogenic Factors

Advanced cancers are able to secrete factors that will stimulate new blood vessel growth. Ex. Vascular endothelial growth factor.

What are the effects of Vitamin B12 deficiency?

Affects nervous system / Myelin degeration: loss of fibers in spinal cord: parestthesia and gait disturbances / Effectiveness of therapy: Reticulocyte count

The postmortem decrease in body temperature is called:

Algor Mortis.

Which of the following problems are likely to occur following a severe focal brain injury?

All of the above A) Cerebral edema B) Subdural hematoma C) Contrecoup injury

Spinal shock involves loss of:

All of the above : A) skeletal motor function. B) peripheral sensory function. C) autonomic function.

An extreme laceration is called:

An avulsion.

Telomerase

An enzyme that catalyzes the lengthening of telomeres. The enzyme includes a molecule of RNA that serves as a template for new telomere segments.

Human T cell leukemia-lymphoma virus (HTLV)

An oncogenic retrovirus linked to the development of adult T cell leukemia and lymphoma (ATLL). Inherited vertically (by children from infected parents) and horizontally (breast-feeding, sexual intercourse, etc.

Metaplasia involves the replacement of normal cells by:

Another type of cell. (Ex: Replacement of normal columnar ciliated epithelial cells of the bronchial lining by stratisfied squamous epithelial cells. The new cells do not secrete mucus or have cilia, causing loss of protection.)

Vitamin E, Vitamin C, and beta-carotene are molecules in food that act as:

Antioxidants. (Inactivate free radicals)

Cancer

Any malignant growth or tumor caused by abnormal and uncontrolled cell division.

The process by which cells program themselves to die is called:

Apoptosis.

The risk factor that contributes to mesothelioma

Asbestos

What is Goodpasture syndrome?

Autoantibodies against alveolar and glomerular basement membrane proteins -rapidly progressing glomerulonephritis

Lysosomal rupture during hypoxic injury leads to:

Autodigestion of cells. (lysosomal rupture is caused by cellular swelling.)

The process of cellular self-digestion following local cell death is called:

Autolysis.

Which type of genetic disorder is Tay-Sachs?

Autosomal recessive.

What is the most common type of non-hodgkin lymphoma in children / It is caused by a B-cell tumor that causes a very fast-growing tumor of the jaw and facial bones / Lasly Epstein-Barr virus is found in nasophryngeal secretions of patients?

BURKITT LYMPHOMA

evaluation of GER

Barium swallow manometric studies-measures the pressure in the esophagus pH studies-easures the pH in lower esophogus endoscopy

Ultra violet radiation causes what type of cancer?

Basal cell carcinoma. At risk are light-skinned, fair haired, blue-eyed people. The majority of damage happens in our teen years.

Tumor marker

Biologic markers. Substances found on tumor plasma membranes or in blood, spinal fluid, or urine. Can be use to 1.) screen and identify individuals at high risk for cancer, 2.) help diagnose the specific type of tumor for individuals with clinical manifestations relalting to cancer, as in adrenal tumors, and 3.) follow the clinical course of cancer.

Clinical s/s demonstrate wide variobility in DIC:

Bleeding from venipuncture sites / bleeding from arterial lines / purpura, petechiae, and hematomas / symmetric cyanosis of the fingers and toes

Liquefactive necrosis typically occurs after severe hypoxic inury to which organ?

Brain. (Results from Ischemic injury to neurons and glial cells in the brain because the central nervous system contains little connective tissue.)

torus fracture

Buckling of the cortex of a long bone from trauma (usually radius or ulna)

thromboangititis obliterans

Buerger's disease is aka -occurs mainly in young men who smoke -inflammatory disease of PERIPHERAL arteries resulting in the formation of nonatherosclerotic lesions (autoimmune) -obliterates the small & medium -sized arteries -causes pain, tenderness & hair loss in the affected areas -symptoms are caused by slow, sluggish blood flow -often red skin (rubor) -can often lead to gangerous lesions treatment: -quit cigarettes -vasodilators -sypathecotmy-cuts off epinephrine & noreepinephrine

pneumothorax

COLLAPSED LUNG

Which molecule is likely to accumulate in any dead or dying tissue?

Calcium. (Calcium pump fails due to mitochondrial injury. Calcium accumulates in cytoplasm contributing to irreversible cell injury and death.)

Pathogenic Calcification:

Can be dystrophic or metastatic. Dystrophic calcification occurs in dying and dead tissues. Metastatic calcification consists of mineral deposits that occur in undamaged normal tissues as a result of hypercalcemia.

Carcinogen

Cancer causing agents

Autocrine stimulation

Cancers acquire the ability to secrete and respond to their own growth factors.

Sarcoma

Cancers arising from connective tissues. Ex. Malignant cancers of skeletal muscle are termed rhabdomyosarcomas.

Carcinoma

Cancers arising in epithelial tissue.

Leukemia

Cancers of blood-forming cells.

Lymphoma

Cancers of the lymphatic tissue.

Why is carbon monoxide exposure a life-threatening condition?

Carbon monoxide binds to hemoglobin and prevents normal oxygen transport to tissues.

A type of necrosis that results from tuberculosis and is a combination of liquefactive and coagulative necroses is:

Caseous Necrosis. (Dead cells disintegrate, but the debris is not completely digested by the hydrolases. Tissues resemble clumped cheese in that they are soft and granular. A granulomatous inflammatory wall encloses areas of caseous necrosis.)

Metaplasia occurs in response to:

Cell injury from noxious stimuli - generated by cytokines and growth factors in cells environment. (Noxious stimuli is any thermal, mechanical, or chemical substance that causes injury.)

Accepted theories of aging consist of:

Cellular aging results from wear and tear over the course of a lifetime. Degeneration of extracellular materials such as collagen contributes to aging. Genetic mechanisms of aging are programmed in a cell's DNA.

abnormal sputum

Change in color, odor, consistency, and amount of sputum -

What are the characteristic of these Megaloblastic anemias?

Characterized by defective DNA synthesis due to deficiencies in Vitamin B12 or Folate (Folic Acid) / The Ribonucleic acid or RNA processes are normal: results in unequal growth or nucleus and cytoplasm

What is the characteristic of Microcytic-Hypochromic Anemias?

Characterized by red cells that are abnormally small and contain reduced amounts of hemoglobin

The population group most vulnerable to lead poisoning is:

Children are most vulnerable to lead poisoning because they absorb lead through the intestines more rapidly than adults.

Bystander effects

Chromosomal abberations and mutations that exist in not only the clonal progeny of the irraiated cells, but also in other cells (nonclonal) that were not directly radiated.

NHL are differentiated by Etiology / Unique Features / Response to Therapies. What are NHL linked to?

Chromosome translocations / Viral and bacterial infections / Environmental agents / Immunodeficiencies / Autoimmune disorders

Who is at risk for Iron Deficiency Anemia?

Chronic Poverty / Women of childbearing age / Children / Children living in developing countries with poor diet and chronic parasitic infections / Women with menorrhagia

What cellular process occurs during apoptosis?

Cleavage of key cellular protens. (Apoptosis results in the rapid killing of a cell through nuclear shrinkage and the activation of proteases that neatly cleave key cellular proteins.)

A type of necrosis that occurs primarily in the kidneys, heart and adrenal glands is:

Coagulative Necrosis. (Commonly results from hypoxia caused by severe ischemia or hypoxia caused by chemical injury, especially if ingestion of mercuric acid. Coagulation is caused by protein denaturation, which causes the albumin to change from a gelatinous, transparent state to a firm, opaque state.

The presence of the tumor marker CEA (Carcinoembryonic antigen) indicates what cancers?

Colon, liver, pancreas, lung, breast, ovarian.

What is Disseminated Intravascular Coagulation (DIC)

Complex, acquired disorder / DIC is the result of increased protease activity in the blood caused by unregulated release of thrombin / endothelial damage / TF starts the coagulation cascade / amount of activated thrombin exceeds the body's antithrombins and the thrombin does not remain localized

pectus excavatum

Congenital deformity of the bony thorax in which the sternum is bent inward.

Type of injury that results in bleeding in the skin or underlying tissues.

Contusion.

Clinical manifestations of Myeloma?

Cortical and medullary bone loss / skeletal pain / recurring infections / renal failure / anemia

hypoxemia

DECREASED OXYGEN IN THE BLOOD

evaluation of osteoporosis

DEXA scan (dual energy x-ray absorptiometry) -30% of bone tissue already lost when 1st detected by regular x-ray

Free radicals directly injury cells by the following mechanisms:

DNA Fragmentation: Causing decreased protein synthesis. Lipid Peroxidation: Destruction of polyunsaturated lipids. Mitochondrial Damage: causing liberation of calcium into cytosol and attacking critical proteins that affect ion pumps and transport mechanisms.

Why is the RAA (Renin-Angiotensin Aldosterone) system activated?

Decrease blood flow detected by the kidneys activates the RAA, causing salt and water retention in an attempt to increase blood volume

What are the primary factors contributing to oncosis from hypoxic injury?

Decrease in ATP production and sodium movement into the cell.

A decrease in cerebral perfusion pressure (CPP) is related to which of the following physiological changes?

Decrease in arterial blood pressure

Cellular atrophy involves:

Decrease in cell size. *Most common in skeletal muscle, heart, secondary sex organs, and the brain.

Tissue ischemia and a decrease in mitochondrial oxygenation result in:

Decreased ATP production.

What pathologic mechanisms happen in Anemia of Chronic Inflammation?

Decreased Erythrocyte life span / Ineffective bone marrow response to Erythropoietin / Altered Iron metabolism

A reduction in the total number of erythrocytes in the circulating blood or in the quality or quantity of hemoglobin. What is this?

Definition of ANEMIA

dyspnea

Difficulty breathing -subjective sensation of uncomfortable breathing

What is Idiopathic (immune) thrombocytopenic purpura (ITP)?

Diffuse hemorrhage into skin tissues / Not enough normal platelets to plug damaged vessels / IgG antibody that targets platelet glycoproteins (autoimmune response) / antibody-coated platelets are sequestered and removed fr circulation / one of the most common childhood bleeding disorders

LOCAL LYMPHADENOPATHY?

Drainage of an inflammatory lesion located near the enlarged node

During hypoxia what happens to the vessels, HR, RR and RAA?

During HYPOXIA due to anemia, less RBC creates less volume of blood, so fluid will flow in the blood to compensate, causing VASODILATION. More fluids in the blood system causes increase HR, need for oxygen causes inrease RR, release of O2 from Hgb, and the Renin-Angiotensin Aldosterone system or RAA is activated.

Chronic infection of the cervix by the Human Papillomavirus results in cervical:

Dysplasia. (Abnormal changes in size, shape, and organization of mature cells.)

What is often the first sign of HL?

Enlarged Lymph Nodes

What is LYMPHADENOPHATHY?

Enlarged lymph nodes that become palpable and tender

Phase 1 activation enzymes

Enzymes that activate xenobiotics.

A collection of blood between the inner surface of the skull and the dura usually caused by a torn artery and almost always associated with a skull fracture.

Epidural Hematoma

Hormonal hyperplasia occurs chiefly in:

Estrogen dependant organs, such as the breast and uterus. (Ex: after ovulation, estrogen stimulates the endometrium to grow and thicken in preparation for implantation. If pregnancy occurs, hormonal hyperplasia, as well as hypertrophy, enable the uterus to enlarge.)

In the pathophysiology of cerebral infarction, the release of which substance is associated with neuron hyperpolarization and seizure activity?

Excitotoxins

inhalation disorders

Exposure to toxic gases, smoke, ammonia, chlorine,causes inflammation

What type of megaloblastic anemia is caused by a vitamin required for RNA and DNA synthesis in the erythrocyte / a defiiency more common than PA / causes simila sns than PA except for neurological symptoms / and occurs in alcoholics and malnourished?

FOLATE (FOLIC ACID) deficiency anemia

What would falling PSA levels after treatment for prostate cancer indicate?

Falling PSA levels would indicate that the treatment is working.

Which molecule accumulates in liver cells as a result of alcohol abuse?

Fat (lipids).

Even though the symptoms of anemia are variable. What are the classic symptoms of ANEMIA?

Fatigue / Weakness / Dyspnea / Pallor

What are the clinical manifestation of LEUKEMIAS?

Fatigue / anemia / bleeding cos decreased in platelets / Fever cos of infection / Anorexia, weight loss / CNS involvement / Splenomegaly, hepatomegaly / Joint and bone pain r/t leuckemic cell profiferation

S/S of Infectious Mononucleosis?

Fever / sore throat / swollen cervical lymph nodes / increased lymphocyte count / atypical (activated) lymphocytes / serious complications are infrequent <5% / >50% lymphocytes and at least 10% atypical lymphocytes

S/S of HL?

Fever / weight loss / night sweats / pruritus

Xenobiotics

Foreign compounds that are not part of our core metabolism. These include toxic, mutagenic, and carcinogenci compounds. Can be counteracted by detoxification enzymes and antioxidant systems.

The process of cellular atrophy is accomplished through which process?

Formation of autophagic vacuoles. Autophagic vacuoles are membrane-bound vesicles within the cell that contain cellular debris nad hydrolytic enzymes. The level of hydrolytic enzymes rises rapidly in atrophy. The enzymes are isolated in autophagic vacuoles to prevent uncontrolled cellular destruction. Thus, the vacuoles form as needed to protect uninjured organelles from the injured organelles and are eventually taken up and destroyed by lysosomes.

An increase in granulocytes (neutrophils, eosinophils, or basophils)?

GRANULOCYTOSIS

What is NON-HODKIN LYMPHOMA (NHL)?

Generic term for a diverse group of lymphomas

Caretaker gene

Genes that are responsible for maintenance of genomic activity. They encode proteins that are involved in repairing damaged DNA. Mutations can be caused by UV rays.

Tumor suppressor genes

Genes which code for proteins that suppress tumor formation by applying brakes on cell proliferation. (mutation that creates a deficiency would contribute to carcinogenesis). Both of the cell's two genes must be defective to lead to abnormal cell division. Inactivation occurs by loss of function, mutation, and LOH.

Malignant tumors

Grow more rapidly then benign tumors. have specific microscopic alterations which include loss of differentiation, absense of normal tissue organization, lack of a capsule, invasion into blood vessels, lymphatics, and surrounding structures, and distant spread (metastasis).

Tattooing and stippling occurs with which injury?

Gunshot wounds.

What is a bacteria that infects more than half of the world's population?

H. Pylori. It is a common cause of gastric infection and is implicated in peptic ulcer disease, gastric lymphomas, and gastric carcinomas.

This type of anemia is caused by Accelerated destruction of RBCs?

HEMOLYTIC ANEMIA

What type of lymphomas is characterized by the presence of Reed-Sternberg (RS) cells?

HODGKIN LYMPHOMA

All of the following signs are associated with diffuse axonal injury except:

Headache

Symptoms of autonomic hyperreflexia include the following:

Headache and blurred vision

Yellow-brown pigment derived from hemoglobin is called:

Hemosiderin. (Causes the color changing in the blood reflect caused by excesses of iron.)

Treatment for TTP?

Heparin / IgG antibodies / Derease in platelets

What are some of the viruses that are implicated in cancers?

Hepatitis B & C (liver cancer). Epstein Barr Virus-EBV (Bcell lymphoma). Kaposi Sarcoma Herpesvirus- KSHV (side effect of HIV/AIDS). Human papillomavirus-HPV (Cervical cancers). Human T cell leukemia-lymphoma virus-HTLV (Tcell leukemia and lymphoma) These all can be passed on either vertically or horizontally.

In strangulation injuries, airway injury is caused by a fracture in which bone?

Hyoid.

Causes of Thrombocytopenia?

Hypersplenism / autoimmune disease / hypothermia, and viral or bacterial infections that cause disseminated intravascular coagulation (DIC)

In response to an increased workload, such as that caused by high blood pressure, myocardial cells in the left ventricle will adapt through which process:

Hypertrophy. (Physiologic hypertrophy)

The major mechanism of injury in drowning is:

Hypoxemia. (Low blood 02 levels)

How dangerou is IM and what is it caused by?

IM is acute, selft limiting infection / Commonly caused by the Epstein-Barr virus (EBV) 85% of the time / and caused 15% of the time by CMV

What is and what is another name for INFECTIOUS MONONUCLEOSIS (IM) and why?

IM is an acute infection of B lymphocytes (B cells) with Epstein-Barr virus (EBV) / Transmission of EBV is usually through saliva from close personal contact hence the term: Kissing Disease

This type of Anemia is the most common type of anemia worlwide / It occurs in underdeveloped as well as developed countries / and it is estimated that 1/5 world population is affected. What kind of anemia is this?

IRON DEFICIENCY ANEMIA

What is Heparin-Induced Thrombocytopenia (HIT)?

Immune-mediated, adverse drug reaction / Caused by IgG antibodies ag Heparin / Cause platelet aggregation and thrombin activation

What are alterations of platelet functions?

Increased bleeding time in the presence of a normal platelet count / platelet function disorders result from platelet membrane glycoprotein (von Willebrand factor deficiencies) / Manifestations / Disorders can be congenital or acquired

Stomatitis

Inflammation of the mucous membrane of the mouth. Can be caused by chemo and radiation.

Which of the following is not a type of subdural hematoma?

Intracerebral

What diseases are Mircocytic-Hypochromic Anemias related to?

Iron metabolism / Porphyrin and heme synthesis / Globin synthesis

The most common cause of hypoxic injury is:

Ischemia

What kind of s/s can be expected from Hemolytic Anemia?

Jaundice occurs when liver cannot keep up with heme destruction by conjugating and excreting biliburin

Which intervertebral disks are most likely to be herniated?

L4-S1

An uncontrolled proliferation of malignant leukocytes, causing an overcrowding of bone marrow and decreased production and function of normal hematopoietic cells, what is that?

LEUKEMIA

Lead poisoning affects nervous system function by which mechanism?

Lead interferes with neurotransmitter release (and blocks normal neuron function.)

What is LEUKOCYTOSIS?

Leukocytosis is higher than normal leukocyte count. Such as in inflammation, surgery... can be normal or abnormal

What is LEUKOPENIA?

Leukopenia is lower than normal leukocyte count. Less than 1000/mm3 = risk for infection / unlike leukocytosis, leukipenia is never normal

Tay-Sachs Disease results in the accumulation of:

Lipids in the nerve cells of the brain.

Examples of benign tumors

Lipoma- fatty tumor Gliosis- intercranial Leiomyoma- uterine (smooth muscle) Chondroma- cartilage

Examples of malignant tumors

Liposarcoma- fat Glioma- intercranial Leiomyosarcoma- Uterine (smooth muscle) Chondrosarcoma- cartilage

Which organs are affected by Gaucher Disease?

Liver, Spleen, Bone Marrow, lungs, and brain. (Gaucher disease is caused by the accumulation of a fatty substance called glucocerebroside in the spleen, liver, and bone marrow.)

Which organ is most frequently affected by ethanol injury?

Liver. (Alcohol directly affects the cells in the liver and the brain)

Discoloration of dependant parts of the body following death is called:

Livor Mortis.

pulmonary abscess

Localized area of pus formation in the lungs

Loss of heterozygosity (LOH)

Loss of a region on one chromosome that corresponds to a mutated region on the other chromosome; loss of the same loci on both chromosome inactivates the affected gene.

Alopecia

Loss of hair.

Fetal exposure to alcohol during pregnancy can result in:

Low birth weight, mental retardation, death.

What is LYMPHOCYTOPENIA?

Lymphocytopenia is seen neoplasias / immune deficiencies / drug destruction / viral destruction

What is LYMPHOCYTOSIS?

Lymphocytosis is seen in acute VIRAL infections, particularly those caused by Epstein-Barr virus (EBV)

This disease is characterized by Neoplastic proliferation of plasma cells / Tumor may be solitary or multifocal / Malignant Plasma Cells?

MYELOMA

What is the othe name for MACROCYTIC-NORMOCHROMIC Anemias and what does that mean?

Macrocytic-Normochromic Anemias are called MEGALOBLASTIC Anemias / They are unusually large stem cells that mature into large erythrocytes and the hemoglobin content is normal.

What are MALIGNANT LYMPHOMAS?

Malignant transformation & proliferation of lymphocytes and their precursors in lymphoid tissues / 2 major categories: 1. Hodgkin lymphoma / 2. Non-Hodgkin lymphomas

What is the significance of capillary beds and metastasis?

Metastasis often occurs in the first capillary bed that the circulating cells encounter.

Diagnostic test and treatment of IM

Monospot qualitative test for heterophilic antibodies / Treatment: symptomatic

Dissemination

Movement of cancerous cells in the blood or through the lymphs.

Oncogene

Mutant genes that in their normal nonmutant state direct synthesis of proteins that positively regulate (accelerate) proliferation. They have a dominant effect because only one of the cell's two copies has mutated. This leads to unregulated growth.

A condition associated with a reduction in circulation neutrophils and exist clinically when the neutrophils count is less than 2000/mm3?

NEUTROPENIA

acute tubular necrosis

Name the most common type or cause. • Acute renal failure in the United States what causes....? -ischemia of tubules due to bleeding, sepsis, burns. nephrontoxins (x-ray dye, aminoglycoside antibiotics like gentamycin) -Dx: oliguria/ ↑ BUN, ↑ creatinine

What are the causes of diabetes insipidus?

Neurogenic: -insufficient amounts of ADH (due to lesion of hypothalamus) Nephrogenic: -inadequate response of renal tubules to ADH Psychogenic (primary polydipsia): -chronic ingestion of large quantities of fluid

Angiogenesis

New blood vessel growth. Occurs in the embryo and fetal development, and tumor growth.

Neoplasm

New tumor growth that can be benign or malignant.

GENERAL LYMPHADENOPATHY?

Occurs in the presence of malignant or nonmalignant disease

malunion

Occurs when the fracture heals in a position that does not resemble the original anatomical form of the bone and alters the mechanical function of the bone.

Alcohol increases risks for what types of cancers?

Oral cavity, pharynx, hypopharynx, larynx, liver, and esophageal cancers. Alcohol alters the mucosal integrity of the GI tract.

MULTIPLE MYELOMA causes increased?

Osteoclastic bone destruction

What are Myeloproliferative RBC Disorders?

Overproduction of cells, as well as a deficiency

What causes Pernicious Anemia?

PA is caused by VITAMIN B12 deficiencies due to the absense of INTRINSIC FACTOR (IF), an enzyme required for gastric absorption of vitamin B12.

What is the most common type of Megaloblastic Anemia?

PERNICIOUS ANEMIA or PA / Pernicious means highly injurous or destructive and once fatal

How is PA treated?

Parenteral or high oral doses of Vitamin B12

Manifestations of Idiopathic (immune) thrombocytopenic purpura (ITP)?

Petechiae and purpura, progressing to major hemorrhage

What is POLYCYTHEMIA?

Polycythemia is an excessive red cell production

What is CHRONIC LEUKEMIA?

Predominant cell is mature but does not function normally

Organ Tropism

Preferential growth of cancerous cells in certain organs. The right cancer "seed" and the right "soil" or tissue.

Carcinoma in Situ (CIS)

Preinvasive epithelial tumors of glandular or squamous cell origin. Can be found in cervix, skin, oral cavity, esophagus, and bronchus. A pap smear can pick up CIS in the cervix.

What is ACUTE LEUKEMIA?

Presence of undifferentiated or immature cells, usually blast cells

What is PRIMARY POLYCYTHEMIA?

Primary (absolute) Polycythemia is seen in POLYCYTHEMIA VERA: genetic abnormality of stem cells in the bone marrow

Apoptosis

Programmed cell death.

Causes of Neutropenia?

Prolonged severe infections when production of granulocytes cannot keep up with demand / Decreased production / Reduced survival / Abnormal neutrophil distribution and sequestration

A 55 year old man goes in for a routine exam. A routine blood test indicates high levels of PSA (prostate specific antigen) in the blood. What could this indicate?

Prostate cancer. PSA is a tumor marker for this condtion.

Adaptive cellular mechanisms function to:

Protect cells from injury

Telomere

Protective cap made of DNA that is found on the ends of a chromosome. They shorten after each cell division cycle and need to be restored by telomerase. When non-germ cells begin to proliferate abnormally, their telomere caps become shorter with each cell division.

The process of muscle hypertrophy involves an increase in:

Protein synthesis. (Increase protein in cellular componet, not an increase in cellular fluid).

empyema

Pus in the pleural cavity -infected pleural effusion

3 factors causing free radical injury are:

Radiation injury, tissue reperfusion following ischemia, and enzymatic metabolism of chemicals.

What are the physiologic maninestation of Anemia?

Reduced OXYGEN carrying capacity

Restoration of oxygen to oxygen-deprived tissues results in:

Referfusion injury -- Radicals (hydroxy, superoxide, hydrogen peroxide) further membrane damage and mitochondrial calcium overload.

What is RELATIVE POLYCYTHEMIA?

Relative Polycythemia results from DEHYDRATION / fluid loss results in relative increases of red cell counts and Hgb and Hct values, and resolves with fluid administration

When demand for neutrophils exceeds supply, immature neutrophils are released from bone marrow. Premature release of immature cells is known as?

SHIFT TO THE LEFT or LEUKEMOID REACTION

When the shift to the left is corrected, it is called a?

SHIFT TO THE RIGHT

This type of anemia is not because of a loss of iron but because or INEFFICIENT IRON UPTAKE?

SIDEROBLASTIC ANEMIAS (SAs) / Inefficient iron uptake results in abnormal hemoglobin synthesis / is characterized by ringed sideroblasts in bone marrow / and mimics iron deficiency anemia

What is SECONDARY POLYCYTHEMIA?

Secondary (absolute) Polycythemia is an increase in erythropoietin as a normal response to chronic HYPOXIA or an inappropriate response to erythropoietin secreting tumors

When does Anemia of Chronic Inflammation usu occurs?

Seen in AIDS, rheumatoid arthritis, lupus erythematosus, hepatitis, renal failure, and malignancies

Due to lack of nerve stimulation, an individual with damage to the spinal cord may experience atrophy to which organ?

Skeletal Muscles

What is the biggest risk factor for cancer?

Smoking. Smoking has a multipotent carcinogenic mixture. It has been linked to cancers of the lung, lower urinary tract, aerodigestive tract (rectal and anal), liver, cervical, kidney, pancreas, as well as myeloid leukemia.

Which of the following vertebral disorders involves a structural defect (often hereditary) that causes forward displacement of affected vertebra?

Spondylosis

Know Cancer Staging.

Stage 1- Cancer is confined to the organ of origin. (Local spread) Stage 2- Cancer is locally invasive. Stage 3- Cancer has spread to regional structures such as lymph nodes. Stage 4- Cancer has spread to distant sites, such as liver cancer spreading to the lungs, or prostate cancer spreading to the bones.

A collection of blood between the inner surface of the dura mater and the surface of the brain, resulting in the shearing of small veins that bridge the subdural space is called:

Subdural Hematoma.

Biologic Response Modifiers (BRM's)

Substances produced by normal cells that block tumor growth or stimulate the immune system to fight cancer.

A decrease in the number of circulation platelets?

THROMBOCYTOPENIA / Platelet count <100,000/mm3 / <50,000/mm3: hemorrhage from minor trauma / <15,000: spontaneous bleeding / <10,000/mm3: severe bleeding that can be fatal esp in GI, internal bleeding

A woman is admitted to the ER. Blood and urine tests indicate raised levels of catecholamines (epinephrine and related compounds). What cancer could this be an indication of and why?

The cancer could be Pheochromocytoma (cancer of the adrenal medulla). The presence of increased amounts of epinephrine is a tumor marker for this condition.

What is the goal of chemotherapy?

The goal is to eliminate enough cancer cells so that the body's defense can eradicate any remaining cancer cells. CURATIVE!!!

What is the most common mode of spread in metastasis?

The lymphatic system. Example: Colorectal cancer will spread to the liver through the mesentaric lymphatics.

Point mutation

The most common cause of genetic lesions in cancer. Usually seen in pancreatic and colorectal cancers. They are changes in one or a few nucleotide base pairs. A point mutation is ras converts it from a regulated proto-oncogene to an unregulated oncogene, accelerating cellular proliferation.

What are the typical symptoms of pernicious anemia?

The sns of PA are those of classic anemias: Weakness / Fatigue / Paresthesias of feet and fingers / Difficulty walking / Loss of appetite...

Metastasis

The spread of cancer cells from the site of the original tumor to distant organs and tissues throughout the body.

What symptoms set PA apart?

The symptoms that set PA apart are neurologic manifestation because of nerve demyelination / beefy red tongue (atrophic glossitis) / icterus (flapping tremor of hands) / and splenic enlargement

Proto-oncogene

These are the regulators of normal cell process; growth promoting; mutations activate them to function as oncogenes (tumor producing genes). They are normal.

What anemia class do those disease belong to: APLASTIC ANEMIA / HEMOLYTIC ANEMIA / SICKLE CELL ANEMIA

They are Normocytic-Normochromic Anemias: characterized by erythrocytes that are normal in size and hemoglobin content but insufficient in numbers.

Benign tumors

They are not called cancers. They are well-emcapsulated, well differentiated, retain normal tissue structure, and do not invade the capsule, nor do they spread to regional lymph nodes or distant location.

Characteristics of Malignant tumors

They grow rapidly. They are anaplastic (without form) and have a high mitotic index (High mobility). They are poorly differentiated; does not look like the tissue from which it arose. They are not encapsulated. They invade local structures and tissues. They spread distantly through the bloodstream and the lymphatics. THESE WILL BE ON THE TEST!!!

Charactersitics of Benign tumors

They grow slowly. They are microscopically well-differentiated with a low mitotic index (Low mobility). They are well-differentiated; looks like the tissue from which it arose. They have a well-defined capsule. They are not invasive. They do not metastasize. THESE WILL BE ON THE TEST!!

Chromosome instability

This increases in malignant cells. Results in a high rate of chromosome loss.

Describe the Rb gene

This is a tumor suppressor gene (retinoblastoma gene). It is responsible for pRB protein. If a mutation causes lack of this protein, the cell will be constantly in the "on" position. Mutations in this gene have been ID'd in a number of cancers including bone, bladder, some lung, and some breast cancers.

Autonomy

This refers to the cancer cell's independence from normal cellular controls.

venous stasis ulcer

This type of ulcer is due to poor venous circulation (veins back up to the heart). Affects lower extremities. There are changes in skin texture, turgor & color. Starts as small open area around or above ankle. Slow healing.

What is Essential (primary) THROMBOCYTHEMIA?

ThromboCYTHemia is characterized by platelet counts >400,000/mm3 / myeloproliferative disorder of platelet precursor cells / microvasculature thrombosis occurs / splenomegaly

Laboratory findings of HL?

Thrombocytosis / leukocytosis / eosinophilia / elevated ESR / and elevated alkaline phosphatase

In compensatory hyperplasia, growth factors stimulate cell division in response to:

Tissue loss. (compensatory hyperplasia is an adaptive mechanism that enables certain organs to regenerate.)

MALTomas

Tumors that arise mucous associated lymphoid tissues. H. Pylori is the main culprit.

Adjuvant therapy

Used after the primary treatments (surgery) have been completed to decrease the chance that a cancer will recur. Ex. A melanoma is removed and then chemo or radiation follows.

Pleomorphic

Variable size and shape. Example; anaplastic cells are of variable size and shape.

What are alterations of coagulation?

Vitamin K deficiency / Vitamin K is necessary for synthesis and regulation of prothrombin / TPN & antibiotics therapy destroy gut flora / liver disease causes a broad range of hemostasis disorders

Widespread thromboses leads to (related to DIC):

Widespread ischemia / Infarction / Organ hypoperfusion

Anaplasia

Without form. It is recognized by a marked increase in nuclear size, with evidence of ongoing proliferation such as mitotic figures. The increased amount of anaplasiac cells we see, is related to increased malignancy.

Are benign tumors removed?

Yes. An example is colon polyps. These may be benign, but they could turn cancerous later.

chemotactic factors

a biochemical substance that facilitates chemotaxis

cyanosis

a bluish discoloration of the skin and mucous membranes -decrease in oxygen in tissues

What is a fracture?

a break in the continuity of a bone -↑ incidence in males 15-24, greater than 65 classifications: -complete or incomplete (open or closed) -comminuted (multiple bone & fragments) -linear (parallel to long axis of bone) -oblique -spiral (wrapping around bone) -transverse (90 degrees to long axis)

bone fractures

a broken bone can cause damage to the surrounding tissue, the periosteum (which is a vascular membrane covering bones) and the blood vessels in the cortex & marrow

aneurysm

a cardiovascular disease characterized by a sac-like widening of an artery resulting from weakening of the artery wall complications: -HEMORRHAGE (when they rupture) -OCCLUSION of a supplying artery to an organ treatment: -surgery (synthetic graft replacement) -percutaneous grafts

endothelial cells

a cell of endothelial layer that lines heart, blood, lymph vessels and the lung cavity;

mast cells

a cell of the connective tissue that produces substances that cause activation of the inflammatory responses, vasoconstriction, and muscle contraction

Hyperaldosteronism

a condition caused by over-production of aldosterone -disorder of the adrenal cortex Symptoms: -hypertension (heart disease), hypokalemia Rx: -surgically removed adrenal adenoma for Conn disease

nephrotic syndrome

a condition in which very high levels of protein are lost in the urine and abnormally low levels of protein are present in the blood -excretion of 3.5g or more of protein in the urine per day -the protein excretion is caused by glomerular injury: ↑ capillary permeability; ↓ negative ionic charge findings: -liver goes into overdrive to try & make albumin & tends to make more lipid -hypoalbuminemia, edema, hyperlipidemia (↑ synthesis of lipids in hyperactive liver). & lipiduria, & vitamin D deficiency (loss of serum transport proteins & vitamin D activation by kidney)

metabolic acidosis

a decrease in pH caused by an increase in noncarbonic acids or a decrease in bicarbonate; headache, lethargy, anorexia, nausea, vomiting, diarrhea, and abdominal discomfort

respiratory acidosis

a decrease in ventilation in relation to the metabolic production of carbon dioxide by an increase in carbonic acid; headache, blurred vision, apprehension, breathlessness, restlessness, lethargy, disorientation, muscle twitching, tremors, convulsions, and coma

toxigenicity

a factor important in determining a pathogen's virulence, such as production of soluble toxins or endotoxin

platelet activating factor

a mast cell-derived substance that increases vascular permeability, leukocyte adhesion to endothelial cells, and platelet activation

prostaglandins

a mast cell-derived substance that increases vascular permeability, muscle contraction, neutrophil chemotaxis, induces pain, and potentially inhibits some aspects of inflammation

renin-angiotensin system

a mechanism by which sodium and water levels are regulated in the body, including the release of renin, conversion of angiotensinogen into angiotensin I, conversion of angiotensin II, and the release of aldosterone and its actions on the kidney that increase water and sodium reabsorption--increasing systemic blood pressure and restoring renal perfusion

aldosterone

a mineralocorticoid that is synthesized and secreted by the adrenal cortex and regulates sodium and potassium balance by altering reabsorption in the kidney

greenstick fracture

a partial fracture of a bone (usually in children) -fracture of 1 side of cortex & spongy bone splinters

myocardial ischemia

a partial obstruction of blood flow in the coronary arteries that reduces blood flow to the myocardium - ↓flow or O2 content of coronary blood (50-65% of O2 normally extracted from coronary arteries-continually requiring O2 to pump & work -stabile angina-chest pain caused by myocardial ischemia; if you sit & rest, it goes away -prinzmetal angina-chest pain due to coronary vasospasm; due to sympathetic system -silent ischemia-more common in women; no symptoms

atrial natriuretic peptide (ANP) or factor

a protein hormone that is synthesized and released from the atria in response to high sodium concentration, high extracellular fluid volume, or high blood volume; it promotes sodium secretion and causes vasodilation in the circulatory system

septic shock

a serious condition that occurs when an overwhelming bacterial infection affects the body

Major histocompatibility complex (MHC)

a set of recognition molecules used to identify whether a donor and recipient tissues possess antigens that make them compatible; also referred to as human leukocyte antigens (HLAs)

rheumatic fever

a severe disease chiefly of children and characterized by painful inflammation of the joints and frequently damage to the heart valves -diffuse, inflammatory disease caused by a delayed immune response to infection by the group A beta-hemolytic strep -febrile illness-inflammation of the joints, skin, nervous system & heart -if left untreated, rheumatic fever causes rheumatic heart disease (damage to mitral/aortic valves -carditis-inflammation of endocardium -polyarthritis-migrating inflammation of the joints -chorea-CNS disorder -erythema marginatum-truncal rash

normal bacterial flora

a spectrum of nonpathogenic bacteria which resides on the body's surfaces

atherosclerosis

a stage of arteriosclerosis involving fatty deposits (atheromas) inside the arterial walls -form of arteriosclerosis -thickening & hardening is caused by accumulaiton of liped-laden macrophages in the arterial wall -plaque development progression: inflammation of endothelium -cellular proliferation -macrophage migration; monocyte in the blood -LDL oxidation (foam cell formation) -fatty streak -fibrous plaque -complicated plaque Foam cells→ LDL oxidized the engulfed by macrophage

volatile

a substance such as carbonic acid (CO2 gas) that can evaporate rapidly--body acids

buffer

a substance that can absorb excess acids or bases without causing a significant change in pH

nonvolatile

a substance that does not have a vapor form and can be eliminated by the kidney

What is a muscle strain?

a sudden, forced motion causing the muscle to become stretched beyond its normal capacity -local muscle damage -muscle strains can also involve the tendons -6 weeks healing time

alkalosis

a systemic decrease in hydrogen ion concentration; an acid base imbalance characterized by elevated pH

The most common cause of a transient ischemic attack (TIA) is obstruction of a cerebral artery by:

a thrombus.

pathogenicity

ability of an agent to produce disease; success depends on its speed of reproduction, extent of tissue damage, and production of toxins

immunogenicity

ability of pathogens to induce an immune response

infectivity (infection)

ability of the pathogen to invade and multiply in the individual

pneumothorax

abnormal presence of air in the pleural cavity resulting in the collapse of the lung

clubbing

abnormal widening and thickening of the ends of the fingers and toes associated with chronic oxygen deficiency

clubbing

abnormal widening and thickening of the ends of the fingers and toes associated with chronic oxygen deficiency -associated with hypoxemia

Portal hypertension

abnormally high blood pressure in the portal venous system caused by resistance to portal blood flow -in the liver 3 Types: -prehepatic (obstruction/constriction of portal vein or tributaries) -intrahepatic (cirrhosis- most common cause of portal hypertension) -posthepatic (hepatic vein thrombosis, inferior vena cava obstruction, or right heart failure causing back-up)

conditions caused by pulmonary disease or injury

abscess formation & cavitation -consolidation; pneumonia -abscess -cavitation; pneumonia, TB

What is Uremia?

accumulation in the blood of nitrogen-bearing waste products (urea) that are usually excreted in the urine -systemic manifestations caused by decline in renal function

hemothorax

accumulation of blood in the pleural cavity (the space between the lungs and the walls of the chest)

tamponade

accumulation of fluid compressing heart → death

endotoxins

activate the inflammatory response and produce fever; contained in the cell walls of gram negative bacteria and are released during lysis, or destruction of the bacteria

angiotensin II

active hormone that is formed from the cleavage of angiotensin I by angiotensin-converting enzyme; stimulates aldosterone secretion and vasoconstriction

manifestations of osteomyelitis

acute & chronic inflammation (intermittent), fever, pain, necrotic bone (can be very insidious) -bone infection is so bad since not a good blood supply

cough

acute cough-resolves within 2-3 weeks of onset chronic cough- longer than 3 weeks

what is tendinitis?

acute inflammation of a tendon due to new activity -resolves w/ rest, ice, & anti-inflammatories

stress ulcers

acute ulcers caused by severe illness, systemic traumas, burn, neural injury presentation: bleeding treatment: propylasis w/ antacids & proton pump inhibitors (prilosec, prevacid)

compensation

adjustment of acid or base content by removal or addition in response to changes in pH; for example a decrease in pH is accompanied by an increase in carbon dioxide removal by the lungs, causing pH to increase

In individuals with spinal cord injuries, autonomic hyperreflexia occurs:

after spinal shock is resolved.

Type I hypersensitivity: IgE mediated

against environmental antigens (allergens); IgE binds to Fc receptors on surface of mast cells; histamine release

An individual who is unable to visually recognize and identify objects because of injury to the sensory cortex has:

agnosia.

A major risk factor for the development of a chronic subdural hematoma is:

alcoholism.

extracellular fluid (ECF)

all the fluid outside the cells and is divided into smaller compartments-interstitial fluid and intravascular fluid; other ECF compartments include: lymph and transcellular fluids-synovial, intestinal, and cerebrospinal fluid, sweat, urine, and pleural, peritoneal, pericardial, and intraocular fluids; about 1/3 of all TBW

Liver and germ cells secrete what protein?

alpha Fetoprotein. This is a tumor marker for hepatic and germ cell cancers.

hypersensitivity

altered immunologic response to an antigen that results in disease or damage to the host: autoimmunity, allergy, alloimmunity

immunogens

an antigen that will induce an immune response resulting in the production of antibodies or functional T-cells

renin

an enzym secreted by the juxtaglomerular cells of the kidney that is released in response to decreased blood pressure in the kidney and sympathetic nerve stimulation, and decreased blood volume

angiotensin I

an inactive polypeptide; inactive product of the cleavage of angiotensinogen by renin

metabolic alkalosis

an increase in pH caused by an increase in bicarbonate ions secondary to an increase in metabolic acid loss; weakness, muscle cramps, hyperactive reflexes, tetany, shallow and slow respirations, confusion, convulsions, and atrial tachycardida

What is urinary tract obstruction?

an interference w/ the flow of urine at any site along the urinary tract.

What can cause urinary tract obstruction?

anatomic or functional defect obstructive uropathy most common (anatomic)

treatment of GER

antacids (maalox, tums, rolaids) H2 receptor blockers (tagament, pepcid, zantac) proton pump inhibitors (prilosec, prevacid) anti-reflux surgery is the last resort

Risk factors for stroke syndromes include all of the following except:

anticoagulant medications.

Type III hypersensitivity: Immune complex-mediated

antigen body complexes are formed in the circulation and are later deposited in vessel walls or extravascular tissues (too small to be removed by mononuclear phagocytes); not organ specific, but specific to certain tissues throughout the entire body ----(mediated by antibody)--autoimmune: lupus

paratope

antigenic binding site

epitope

antigenic determinant; recognizing part on an antigenic molecule

haptens

antigens that are too small to be immunogens by themselves but become immunogenic after combining with larger molecules that function as carriers for the hapten

allergens

antigens that induce an allergic response

treatment for acute cystitis

antimicrobial therapy (3-7 days), increased fluid intake, avoidance of bladder irritants, & urinary analgesics (pyridium) = orange urine

dislocation & subluxation fractures

are associated with fractures, muscle imbalance (weight lifters), rheumatoid arthritis, or other forms of joint instability - < 20 years old -shoulder, elbow, wrist, hip, knee

T-lymphocytes

attach antigen directly; during clonal selection these cells differentiate into effector T-cells, such as cytotoxic T-cell--also develop into memory cells

melena

black tarry stools

Bladder tumors

bladder lining made up of transitional cells transitional cell Ca: -gross, painless hematuria -males > 60 year old -1% of all cancers

antihistamines

block binding of histamine to histamine receptors on target cells

pulmonary embolism

blockage of the pulmonary artery by foreign matter or by a blood clot

intravascular fluid

blood plasma

bowing fracture

bone in pairs: 1 breaks, other bends

evaluation of osteomyelitis

bone scan, CT, MRI (most common)

what is the second stage of bone fracture healing?

bone tissue destruction triggers an inflammatory response (fractured ends of bone decalcify)

hematochezia

bright red blood in stools

Curling ulcer

burn injury, Acute gastric ulcer associated with severe burns

kidney stones

calculi (urinary stones) -massess of crystals, protein, or other substances that form w/in & may obstruct the urinary tract -classified accroding to teh minerals comprising the stones (Ca+, Ph+, oxalate, uric acid) -prevalence: 5% women; 12% men 80% between 20-50 years old

memory cells

capable of remembering the antigen and responding more rapidly and efficiently if the associated pathogen invades again

shock

cardiovascular system fails to perfuse the tissues adequatly -impaired oxygen use -impaired glucose use -cells not using oxygen→ anaerobic glycolysis

superantigens

cause fever, low blood pressure and potentially shock; produce an excessive production of cytokines

AIDS

caused by a retrovirus which depletes the body's Th cells--CD4 cells; genetic information in retrovirus is in the form of RNA; contains reverse transcriptase to convert RNA into double-stranded DNA

water excess

caused by compulsive water drinking (psychogenic); acute renal failure, severe congestive heart failure and cirrhosis paired with IV infusion of 5% dextrose in water; decreased urine formation; confusion, convulsions, weakness, nausea, muscle twitching, headache, and weight gain

pure sodium deficits

caused by extrarenal losses, such as vomiting, diarrhea, gastrointestinal suctioning, and burns, or renal loss from the use of diuretics

serum sickness

caused by formation of immune complexes in the blood and their subsequent generalized deposition in target tissues; symptoms: fever, enlarged lymph nodes, rash, and pain at sites of inflammation--can be caused by repeated intravenous admin of drugs

Arthus reaction

caused by repeated local exposure to an antigen that reacts with preformed antibody and forms immune complexes in the walls of the local blood vessel; symptoms: typical inflammatory reaction, increased vascular permeability, and accumulation of neutrophils, edema, hemorrhage, clotting, and tissue damage

cytotoxic T-cells

cells that kill targets directly; destroy cancer cells or cells infected with virus; perforin, granzymes, or direct receptor interactions

antigen presenting cells (APCs)

cells that phagocytose, break up, and present antigenic fragments on the cell surface; these cells interact with Th cells to induce B cell to mature into plasma cells or T cells to mature into effector T cells

necrosis

cellular death caused by severe cell swelling and the breakdown of organelles

atopic

certain individuals that are genetically predisposed to develop allergies

agglutination (direct antibody function)

clumping insoluble particles that are in suspension

visceral pain

comes from an abdominal organ; poorly localized, diffuse and vague Example: early appendicitis

inflammatory joint disease

commonly called arthritis (inflammation of a joint) -characterized by inflammatory damage or destruction in the synovial membrane or articular cartilage & by systemic signs of inflammation (fever, leukocytois, malaise, anorexia, & hyperfibrinogenemia) -infectious or noninfectious causes (typically non infectious)

What is an avulsion?

complete separation of a tendon or ligament from its bony attachment site

endotoxic shock

complication of sepsis and can be fatal to the individual

scare tissue

composed primarily of collagen that fills in the lesion and restores strength but cannot carry out the physiologic functions of destroyed tissue

intracellular fluid (ICF)

comprises all the fluid within the cells; about 2/3 of TBW

chest wall restriction

compromised chest wall, deformation, immbolization and or obesity. -condition caused by pulmonary disease or injury

Primary Immune Deficiencies

congenital, nonsurvivable; most are the result of a single gene defect: 1) B-lymphocyte deficiencies 2) T-lymphocyte deficiencies 3) combined T and B cell deficiencies 4) complement defects 5) phagocyte defects

complement system

consists of a large number of proteins that together constitute about 10% of the total circulating serum protein

sublaxtion fracture

contact between articular surfaces is only partially lost

hemorrhagic exudate

contains blood, indicates bleeding

hemoptysis

coughing up blood from the respiratory tract

tumor necrosis factor alpha

cytokine, secreted by macrophages in response to recognition of foreign materials by toll-like receptors

interleukins

cytokine; produced by macrophages and lymphocytes in response to their recognition of a pathogen or stimulation by other products of inflammation

exotoxins

damage the plasma membranes of host cells or can inactivate enzymes critical to protein synthesis; enzymes released during growth, causing specific responses

Thyrotoxic storm

dangerous worsening of hyperthyroid state, death in 48 hours -due to excessive stress, infection symptoms: -hyperthermia -tachycardia -N&V -high output heart failure Treatment: -propylthiouricil (blocks TH synthesis)

B-lymphocyte deficiencies

defective development of B cells in central lymphoid organ (bone marrow); defect in class switch; results are lower levels of immunoglobulins (hypogammaglobulinemia) or occasionally totally or nearly absent immunoglobulins (agammaglobulinemia)

combination B and T deficiencies

defective development, defects in cooperation- B, T, and APCs, large variety of defects that affect the function of B or T cells

complement deficiencies

defective production of one early component of the complement system; defective production of the membrane attack complex

T-lymphocyte deficiencies

defects in the development and function of t-lymphocytes; contributes to failure to thrive, oral infections, chronic diarrhea, pneumonia, and skin rashes; DiGeorge syndrome:lack or partial lack of thymus

phagocytic deficiencies

defects in the production of neutrophils; defects in bacterial killing

Osteomalacia (rickets in kids)

deficiency of Vitamin D lowers the absorption of calcium from the intestine -inadequate or delayed mineralization -bone formation progresses to osteoid formation but calcification does not occur; the result is soft bones -pain, bone fractures, vertebral collapse, bone malformation

hypoxia

deficient amount of oxygen in tissue cells

hypoventilation

deficient movement of air in and out of the lungs causing hypercapnia -too little breathing -increase PaCO2

allergy

deleterious effects of hypersensitivity to environmental (exogenous) antigens--exaggerated response

glomerular disorders

demonstrates a sudden or gradual insidious onset of hypertension, edema, & an elevated blood urea nitrogen (BUN) & plasma creatinine -decreased glomerular filtration rate: elevated plasma creatinine (reduced creatinine clearance, i.e. not as much filtrate formed), & ↑ urea So: serum BUN & creatinine elevated -increased glomerular capillary permeability & loss of negative ionic charge barrier result in passage of PLASMA PROTEINS into the urine (membrane has a negative charge; pushes protein also has a negative charge) -resulting hypoalbuminemia encourages plasma fluid to move into the interstitial spaces i.e. peripheral edema (less dots in blood (less pulling force) → fluid moves out into tissues)

dehydration

describes water deficit but also is commonly used to indicate both sodium loss and water loss (isotonic and isoosmolar dehydratioin)

hyponatremia

develops when serum sodium concentration fall below 135 mEq/L; sodium deficits usually cause hypoosmolality with movement of water into cells; sodium loss, inadequate sodium intake, or dilution of the body's sodium level by water excess; lethargy, confusion, apprehension, depressed reflexes, seizures, and coma,

Diabetes Mellitus

diabetes caused by a relative or absolute deficiency of insulin and characterized by polyuria -not a single disease, but a group of disorders w/ glucose intolerance in common -insulin needed for protein, fat, & carbohydrate metabolism -Dx: based on ↑ fasting glucose levels ( >126) or abnormal glucose tolerance testing ( >200)

dysphagia

difficulty swallowing due to mechanical obstruction or disorder of esophageal motility

mechanisms of action (infection)

direct damage of cells, interference with cellular metabolism, and rendering a cell dysfunctional because of accumulation of pathogenic substances and toxin production

chemotaxis

directional movement and attraction of microorganisms or phagocytes to substances released in the environment or tissues

glomerulopathies

disorders that directly affect the glomerulus

autoimmunity

disturbance in the immunologic tolerance of self-antigens

regional osteoporosis

disuse or immobilization of limb

occult bleeding

do not know the source of where it is coming from

opportunisitc microorganisms

e. coli, yeast--overgrowth of normal flora

hyperkalemia

elevation of ECF potassium above 5.5 mEq/L; mild: increased neuromuscular irritability-restlessness, intestinal cramping, and diarrhea; severe: muscle weakness, loss of muscle tone, and paralysis; decreased cardiac conduction and more rapid repolarization of heart muscle; narrow and taller T wave, and shortened QT interval

diapedesis

emigration of cells through the endothelial junctions

The most common neurologic disorder observed in individuals with AIDS is:

encephalopathy.

nonunion

ends of bone does not grow together

splenomegaly

enlarged spleen which can bleed

hydronephrosis

enlargement of renal pelvis & calyces

cor pulmonale

enlargement of the right ventricle of the heart due to disease of the lungs or of the pulmonary blood vessels -secondary to pulmonary hypertension -pulmonary hypertension creates chronic pressure in the right ventricle w/ eventual right ventricular failure

self-antigen

even though foreign, does not normally elicit an immune response

remodeling

excess callus resorbed & trabecular bone laid down Remember: bone (like liver) will form new bone not scar tissue when healing

pulmonary edema

excess water in the lungs -most common cause=heart not working; left ventricular dysfunction -injury to capillary end -infection: ex. pneumonia

hyperthyroidism

excessive activity of the thyroid gland -Thyrotoxicosis (condition resulting from ↑ thyroid hormones) common causes: -graves disease -toxic multinodular goiter (many hyperfunctioning nodules) -solitary toxic adenoma (1 hyperfunctioning nodule in thyroid gland)

pulmonary fibrosis

excessive amount of fibrous or connective tissue in the lung

Pathologic Hyperplasia is the abnormal proliferation of normal cells, usually in response to:

excessive hormonal stimulation or growth factors on target cells.( Ex: Pathologic endometrial hyperplasia, which causes excessive menstrual bleeding, is under the influence of regular growth-inhibition controls. If these controls fail, hyperplastic endometrial cells can undergo a malignant transformation.)

hypercapnia

excessive level of carbon dioxide in the blood -caused by hypoventilation

hyperventilation

excessive movement of air in and out of the lungs causing hypocapnia -decrease PaCO2

What is hyperparathyroidism?

excessive secretion of parathyroid hormone resulting in abnormally high levels of calcium in the blood DX: -6 month history of symptoms associated w/ hypercalcemia RX: -surgical removal of adenoma or abnormal hyperplastic glands: 3 & 3/4 glands removed

lymphocytes

extremely specific, each cell recognizes only one specific antigen: B-lymphocytes, T-lymphocytes

interstitial hydrostatic pressure

facilitates the inward movement of water from the interstitial space into the capillary

capillary hydrostatic pressure (blood pressure)

facilitates the outward movement of water from the capillary to the interstitial space

interferon

family of cytokines that protect against viral infections

referred pain

felt at a distance from an organ; well localized in skin or deeper tissue away from the organ Example: diaphragmatic irritation felt in shoulder

orthopnea

form of dyspnea in which the person can breathe comfortably only when standing or sitting erect -dyspnea only when the person is laying down

IgA

found predominantly in the blood and body secretions; secretory immunoglobulin; primary role is to prevent the attachment of pathogens through mucosal membranes (GI, pulmonary and GU)

pathologic fracture

fracture caused by diseased or weakened bone

transchondral fracture

fragmentation and separation of a portion of the articular cartilage that covers the end of a bone at a joint

Intracerebral hemorrhages most frequently occur in the:

frontal and temporal lobes.

Polymyositis

generalized muscle inflammation

clotting system

group of plasma proteins that, when activated sequentially, form a fibrinous meshwork at an injured or inflamed site

manifestations of GER

heartburn, regurgitation of chyme, and upper abdominal pain w/ in 1 hour of eating cough because it regurgitates down into the trachea asthma because the regurgitation goes into the lungs causing bronchial constriction

eosinophils

help regulate the inflammatory response, phagocyte

Helper T-lymphocytes (Th cells)

help the antigen driven maturation of B and T cells; APCs usually present antigen to these cells; facilitate response between APCs and immunocompetent lymphocytes

latrogenic osteoporosis

heparin, glucocorticoids

urticaria

hives, a dermal manifestation of allergic reactions, characterized by white fluid filled blisters (wheals) surrounded by areas of redness (flares)-usually accompanied by itching

Excess cerebrospinal fluid (CSF) accumulation in the ventricles or subarachnoid space is a condition called:

hydrocephalus

cushing disease

hypercortisolism (moon face), some symptoms mimic diabetes mellitus and results from ADH excess -disorder of the adrenal cortex -excessive anterior pituitary secretion of ATCH 9tumor/hyperplasia) ***most common complication of cushing disease is cushing syndrome

water deficits

hyperosmolar or hypertonic dehydration; thirst, dry skin and mucous membranes; elevated temperature, weight loss, and concentrated urine; skin turgor may be normal or decreased; hypvolemia: tachycardia, weak pulses, and postural hypotension

monocyte

immature form of WBC (macrophage) in the blood

humoral immunity

immune protection afforded by the presence of antibodies in the blood: fluid immunity, circulating antibody (IgG, IgM, etc)

Cell-mediated immunity

immune protection by the ability of cytotoxic T-cells to lyse target cells that contain receptors

alloimmunity

immune reaction to tissues of another individual-transfusions, transplants

adaptive immunity

immunity acquired from vaccines or prior infection; third line of defense; acquired or specific immunity--third line of defense

antibodies

immunoglobulins, produced by plasma cells MADGE: characterized by antigenic, structural, and functional differences; produced by mature B cell (plasma cells) in response to a challenge by an antigen

The development of sensory and motor symptoms in multiple sclerosis is caused by:

immunologic and inflammatory demyelination of central nervous system neurons.

Vital to the management of individuals with spinal cord trauma is preventing long-term complications. All of the following are potential complications of spinal cord trauma except:

immunosuppression.

What can happen if bone fracture is not treated properly?

improper reduction or lack of immobilization: need to keep bone from moving or nonunion occurs

In subarachnoid hemorrhage (SAH), blood accumulates:

in the cerebrospinal fluid (CSF) between the brain and skull.

neutralization (direct antibody function)

inactivation or blocking the binding o antigen to receptors

hypoparathyroidism

inadequate secretion of parathyroid hormone resulting in abnormally low levels of calcium in the blood -abnormally low PTH levels -usually caused by a parathyroid damage in thyroid durgery -hyperphosphatemia ( ↑ phosphate reabsorption by renal tubules) symptoms: -hypocalcemia → ↓ nerve & muscle thresholds → muscle spasms → hyper-reflexia, tonic-clonic convulsions Dx: -low serum calcium, high serum phosphorus w/ absence of renal disease Rx: -immediate parenteral calcium; active form of vitamin D & oral Ca for maintenance

All of the following problems are complications of subarachnoid hemorrhage (SAH) except:

increased cerebral blood flow.

detrusor hyperreflexia

increased contractile activity of the detrusor muscle of the bladder, resulting in urinary incontinence -bladder empties automatically when full -due to stroke, brain tumors, dementia: causes urinary leakage & incontinence (CNS lesion)

malignant bone tumors

increased nuclear/cytoplasmic ratio, irregular borders, excess chromatin, a prominent nucleolus, & in an increase in the mitotic rate

what is bursitis?

inflammation of a bursa (small sacs filled with synovial fluid located between tendons & muscles) -skin over bone, skin over muscle, & muscle & tendon over bone -caused by repeated trauma -septic bursitis is caused by a wound infection

What is epicondylitis?

inflammation of a tendon where it attaches to a bone in the elbow

What is acute poststreptoccal glomerulonephritis?

inflammation of the glomerli 10 days after strep infection -commonly affect kids

What is glomerulonephritis?

inflammation of the glomeruli of the kidney -***immunologic abnormalities (most common) -drugs & toxins -vascular disorders -systemic diseases -viral causes -***most common cause of end-stage renal failure***

What is pyelonephritis?

inflammation of the kidney and its pelvis caused by bacterial infection

bronchiolitis

inflammation of the membranes lining the bronchioles -inflammatory obstruction of the small airways -most common in children -occurs in adults w/ chronic bronchitis, associated w/ a viral infection, or with inhalation of toxic gases

gastritis

inflammatory disorder of the gastric mucosa in which surface epithelium is eroded acute gastritis: ASA, NSAID's, alcohol, steroids, spices, etc. chronic gastritis: -chronic fundal gastritis (Type A): proximal 1/3 of stomach & body, also called atrophic gastritis-risk of carcinoma, perniculous anemia chronic antral gastritis (Type B): in antrum, 4X as prevalent as fundal gastritis

ankylosing spondylitis (rheumatoid arthritis of backbone)

inflammatory joint disease of the spine or sacroiliac joints causing stiffness & fusion of the joints -systemic, auto-immune inflammatory disease (not antibodies against antibodies) -primary proposed site is the ENTHESIS: site where ligaments, tendons, & the joint capsule are inserted into the bone -cause unknown, but there is a strong association w/ HLA-B27 antigen -begins with the inflammation of fibrocaritlage, particularly in the vertebrae & sacroiliac joint -inflammatory cells infiltrate & erode fibrocartilage -as repair begins, the scar tissue ossifies & calcifies; the joint eventually fuses -early symptoms: low back pain, stiffness, pain, & restricted motion -patient demonstrates loss of normal lumbar curvature -spine is straight up & down

pneumoconiosis

inhalation of dust particles -silica -asbestos -coal (black lung disease)

allergic alveolitis

inhalation of organic dusts that give a diffuse allergic (type III immune complex) reaction in the alveoli and bronchioles -extrinsic allergic alveolitis (hypersensitivity pneumonitis)

surface coats

inhibit phagocytosis, surface receptors to bind host cells, and toxins

primary response (immune response to antigen)

initial exposure; latent period or lag phase while B-cell differentiation is occurring; after 5-7 days IgM can be detected, and IgG response equal or slightly less after IgM

fibrin

insoluble protein; produced by coagulation cascade, main substance

kinin system

interacts closely with the coagulation system, final product of the kinin system is bradykinin--pain; causes dilation of blood vessels, pain, smooth muscle contraction, vascular permeability, and leukocyte chemotaxis

Most forms of focal brain injury or diffuse axonal injury are associated with increased:

intracranial pressure.

procallus formation

invasion by osteoblasts, calcium deposition

The tonic phase of an epileptic seizure is characterized by:

involuntary muscle contraction and loss of consciousness.

true aneurysms

involve all three layers of the arterial wall; weakening of the wall -fusiform aneurysms-involving entire circumference of artery -saccular aneurysms-localized weakness of arterial wall (side somewhere)

transmural infarction

involves the complete wall

What is Rhabdomyolysis?

is a life-threatening complication of severe muscle trauma w/muscle cell necrosis: myoglobinemia → myoglobinuria → KIDNEY TOXICITY

osteomyelitis (inflammation of the bone)

is most often caused by a staph infection -most common cause is open wound (exogenous); also can be from a blood bourne (endogenous) infection (skin, ear, dental, sinus infection)

treatment for disuse atrophy

isometric movements & passive lengthening exercises

isotonic fluid loss

isotonic dehydration; causes contraction of the ECF volume with weight loss, dryness of skin and mucous membranes, decreased urine output, and symptoms of hypovolemia--rapid heart rate, flattened neck veins, and normal or decreased blood pressure

IgM

largest of the immunoglobulins; first antibody produced during the initial or primary response to an antigen; synthesized during fetal life and its synthesis may be increased as a response to infection in utero.

tennis elbow

lateral epicondylitis

valvular regurgitation

leaking of blood backward through a valve that does not close tightly. -aortic regurgitation -mitral regurgitation -tricuspid regurgitation

IgE

least concentrated of Ig in the circulation; mediator of many specialized common allergic responses; defender against parasites

What is a myxedema coma?

life-threatening form of hypothyroidism -medical emergency - ↓ level of consciousness w/ severe hypothyroidism -hypothermia/hypotension/hypoglycemia -can lead to a coma & eventually death if not fixed

active immunity

long lived, antibodies or T-cells produced after either a natural exposure to an antigen or after immunization

achalasia

loss of esophageal peristalsis & failure of lower esophageal sphincter (LES) to relax so food gets stuck at distal esophagus due to loss of neurons in wall of esophagus (bird's beak sign)

orthostatic hypotension

low blood pressure occurring in some people when they stand up -decrease in both systolic & diastolic blood pressure upon standing -lack of normal blood pressure compensation in response to gravitational changes on the circulation→ dizziness→ syncope -acute orthostatic hypotension-usually volume depletion (elderly) -chronic orthostatic hypotension-endocrine/neurologic disorders

hypovolemic shock

low blood volume - ↓ intravascular volume by 15%

IgD

low concentration in the blood, located primarily on the surface of developing B-lymphocytes and mainly an antigen receptor on the surface of early B-cells

chylothorax

lymph fluid in pleural space

natural killer cells (NK)

lymphoid cells, but lack antigen specific receptors

secretory (mucosal) immune system

lymphoid tissues that protect external surfaces the body; antibodies present in tears, sweat, saliva, mucus, and breast milk--IgA

chloride (Cl-)

major anion in the ECF, and provides electroneutrality; particularly in relation to sodium; concentration tends to vary inversely with bicarbonate (HCO3-) the other major anion

potassium

major intracellular electrolyte and is essential for normal cellular functions; ECF concentration: 3.5-5.0 mEq/L; maintained by sodium-potassium adenosine triphosphate active transport system; required for glycogen and glucose deposition in liver and skeletal muscle cells, maintains the resting membrane potential; mainly regulated by the kidney

opsonization (indirect antibody function)

make more susceptible to phagocytosis

precipitation (direct antibody function)

making a soluble antigen into an insoluble precipitate

what is nephrotic sediment?

massive amounts of PROTEIN [& lipids] in the urine

macrophage

mature monocyte in the tissues

postoperative respiratory failure

may be characterized by: -atelectasis -pneumonia -pulmonary edema -pulmonary emboli prevention: -frequent turning, deep breathing, early ambulation, air humidification, incentive spirometry

golfer's elbow

medial epicondylitis

Type IV hypersensitivity: cell mediated

mediated by T-lymphocytes--direct killing by Tc or recruitment of phagocytic cells by Th1 cells, does not involve antibody; acute graft rejection, skin test for TB--extreme memory involved

Symptoms of bacterial meningitis can include all of the following except:

mild frontal headache.

desensitization

minute quantities of the allergen to which the person is sensitive are injected in increasing doses over a prolonged period, may reduce the severity of the allergic reaction in the treated individual

cytokines

molecule produced by cells of the acquired immune system that mediates interactions between cells to kill bacteria; active during inflammatory response

opsonins

molecules that coat bacteria and increase their susceptibility to being eaten and killed by inflammatory cells, such as neutrophils and macrophages

anaphylatoxins

molecules that induce rapid degranulation of mast cells, thus increasing inflammation

secondary response

more rapid caused by the presence of memory cells that do not have to differentiate; larger amounts of antibody are produced; IgM is produced in similar quantities to the primary response, but IgG is produced in considerably greater numbers

IgG

most abundant class (80-85%) in the blood, transported across placenta (major Ig in fetus and newborn); accounts for most of the protective activity against infections

isotonic fluid excess

most commonly the result of excessive administration of intravenous fluids, hypersecretion of aldosterone, or the effects of drugs such as cortisone (which causes renal reabsorption of sodium and water); as plasma volume expands, hypervolemia develops with weight gain leading to decreased hematocrit and decreased plasma protein concentration; neck veins may be distended, blood pressure increases, edema

Amyotrophic lateral sclerosis (ALS) is caused by the degeneration of:

motor neurons in the spinal cord and peripheral nerves.

net filtration

movement of fluid back and forth across the capillary wall; best described as Starling's forces

shunting

moving oxygenated blood into vital areas and bypassing less vital areas -ventilation-perfusion abnormalities

antigenic variation

mutation-antigenic drift recombination-antigenic shift gene switching

In terms of risk factors, cerebral vascular accidents (strokes) are most similar to:

myocardial infarctions.

How to diagnosis for thyroid cancer?

needle aspiration of thyroid nodule

Pathologic hyperplasia can lead to:

neoplasia (cancer), dysplasia, metaplasia.

baroreceptors

nerve endings that are sensitive to changes in volume and pressure-stimulate the release of ADH from the pituitary gland; found in the aorta, pulmonary arteries, and carotid sinus

Starling's forces

net filtration=forces favoring-forces opposing filtration forces favoring filtration=capillary hydrostatic pressure and interstitial oncotic pressure forces opposing=capillary oncotic pressure and interstitial hydrostatic pressure

What is functional obstruction of lower urinary tract obstruction?

neurogenic bladder (bladder dysfunction to nerve dysfunction) or atonic [flaccid-can't contract] bladder

chemotactic factors of the mast cell

neutrophil chemotactic factor, eosinophil chemotactic factor of anaphylaxis

what is interstitial cystits?

nonbacterial cystitis

mutual relationship

normal flora; relationship can be breached by injury; normal flora can leave normal sites and cause infection elsewhere

causes of intestinal obstruction

obstruction due to surgical adgesions (small intestine); carcinoma, intussusception & volvulus (large intestine)

embolism

occlusion of a blood vessel by an embolus (a loose clot or air bubble or other particle) -can be something other than blood -bolus of matter that is circulated in the bloodstream -dislodged thrombus, air bubble, amniotic fluid, aggregate of fat, bacteria, cancer cells, or a foreign substance

dilutional hyponatremia

occur when the proportion of TBW to total body sodium is excessive; weight gain, edema, ascites, and jugular vein distention

hyperchloremia

occurs clinically when there is too much sodium or too little bicarbonate; more than normal amounts of chloride can be expected with hypernatremia or metabolic acidosis

clonal diversity

occurs in specialized lymphoid organs (Thymus-T cells, and bone marrow- B cells); 1st phase of immune response; antigen recognition, and lymphocyte specificity

syndrome of inappropriate secretion of ADH (SIADH)

occurs when factors other than hyperosmolality or hypovolemia stimulate the secretion of ADH-caused by decreased renal excretion of water

lymphedema

occurs when lymphatic channels are blocked or surgically removed, proteins and fluid accumulate in the interstitial space

hypernatremia

occurs when serum sodium levels exceed 147 mEq/L; may be caused by an acute gain in sodium or a net loss of water--intracellular dehydration; thirst, fever, dry mucous membranes, restlessness as a result of water loss; CNS: muscle twitching and hyperflexia; convulsions

correction

occurs when the values for both components of the buffer pair (carbonic acid and bicarbonate) return to normal levels

respiratory alkalosis

occurs when there is alveolar hyperventilation and excessive reduction in plasma carbon dioxide levels (hypocapnia); dizziness, confusion, tingling of extremeties, convulsions and coma

Granulocyotis is also called neutophilia because neutrophils are the most numerous of the granulocytes. NEUTROPHILIA is seen in the early stages of?

of INFECTION or INFLAMMATION and is established when the absolute count exceeds 7500/mm3

carbonic acid-bicarbonate buffer

operates in both the lung and the kidney and is major extracellular buffer; the lungs decrease carbonic acid by blowing off carbon dioxide and leaving water, and the kidneys can reabsorb bicarbonate or regenerate new bicarbonate from carbon dioxide and water; 20:1 ratio maintained

clusters of differentiation (CD)

originally used to describe proteins found on the surface of lymphocytes, now it is a labeling system used to identify a family of proteins on many cells: CD4, CD8, CD 16 cells

interstitial oncotic pressure

osmotically attracts water from the capillary into the interstitial space

capillary oncotic pressure

osmotically attracts water from the interstitial space back into the capillary

compensatory hypertrophy

other kidney ↑ in size of glomeruli -obligatory growth (due to growth hormone)

Autonomic hyperreflexia is often caused by:

pain stimulation below the level of the spinal cord lesion.

What is tendinosis?

painful degradation of collagen fibers due to repeated trauma

An individual with paralysis of the lower extremities has:

paraplegia.

margination

pavementing; adherence of leukocytes to endothelial cells

chemokines

peptides that primarily induce leukocyte chemotaxis

bronchiectasis

persistent abnormal dilation of the bronchi

debridement

phagocytic clean up o the site of injury by removal of fibrin clots after dissolution by fibrinolytic enzymes and removal of microorganisms, erythrocytes, and dead tissue cells

Dermatomyositis

polymyositis accompanied w/ skin lesions

hypokalemia

potassium deficiency; develops when serum potassium concentration falls below 3.5 mEq/L; neuromuscular excitability decreases, causing skeletal muscle weakness, smooth muscle atony, and cardiac dysrhythmias; amplitude of T wave decreases and amplitude of U wave increases, and ST segment is depressed; QRS complex can be prolonged in severe cases

virulence

potency of a pathogen measure in terms of the number of microorganisms or micrograms of toxin required to kill a host

sodiumd

predominantly extracellular cation

How to diagnose glomerulonephritis?

presentation: -membranous=thickening of wall w/ immune depostis -sclerotic= glomerular scarring from previous glomerular injury

granulocytes

primary circulatory WBC; many enzyme containing granules in the cytoplasm; includes neutrophils, eosinophils, and basophils

phagocytosis

process by which a cell ingests and disposes of foreign material steps: 1) adherence, 2) engulfment, 3) phagosome formation, 4) fusion of phagosome with lysosomal granules, 5) destruction of target

class switch

process that results in the change in antibody production from IgM to IgG during primary immune response; under control of Th2 cytokines

B-lymphocytes

produce antibodies that enter the blood and react with antigen, during clonal selection these cells can differentiate into active antibody cells (plasma cells)--also develop into memory cells

delayed union

prolongation of expected healing time for a fracture: 8-9 months

natriuretic hormones

promote urinary excretion of sodium and water and decreases blood pressure; 3rd factor in sodium regulation; after increased glomerular filtration rate and aldosterone (overcomes the sodium retaining action of aldosterone)--reduces blood pressure

innate resistance

protection from or resistance to infection by nonimmune mechanisms such as natural, physical, mechanical and biochemical barriers; natural or native immunity--first line of defense

antimicrobial peptide

protein released by epithelial cells that is toxic to some bacteria, fungi, and viruses and is capable of activating cells involved in innate and acquired immunity

Exopthalmus

protruding eyes; assoc with hyperthyroidism/grave's disease 2 types: -functional abnormality due to hyperactivity of autonomic nervous system (eye lid & eye globe lag) -infilitrative changes: edema of ocular muscles, paralysis of ocular muslces, damage to retina & optic nerve - IRREVERSIBLE CHANGES

purulent exudate

pus; indicates a bacterial infection; cysts or abcesses

hypertrophic scar

raised but remains within the original boundaries of the wound, tend to regress over time

keloid

raised scar that extends beyond the original boundaries of a wound, and invades surrounding tissue and is likely to recur after surgical removal

MHC class II

react with CD4 T-helper (Th) cells and present exogenous antigens from digested extracellular pathogens; found on B-cells, APCs, and some epithelial cells

MHC class I

react with CD8 T-cytotoxic (Tc) cells; present endogenous antigens, found on all nucleated cells and platelets

T regulatory cells

regulate the immune response to avoid attacking "self"; type of T-helper cell; can suppress immune response

intrarenal acute renal failure

renal failure in the kidney due to tubular necrosis

repair

replacement of destroyed tissue with scar tissue

Tuberculosis

respiratory tract infection -myocobacterium tuberculosis -acid-fast bacillus (AFB) -airborne transmission -tubercle formation -caseous necrosis (cottage cheese like due to enzymes) -positive tuberculin skin test (PPD) -positive sputum C&S -CXR

crystalline fragment (Fc receptors)

responsible for most of the the biologic functions of antibodies;

Diffuse axonal injury results from:

rotational acceleration forces.

inflammatory response

second line of defense; activated to protect the body from further injury, prevent infection of the injured tissue and promote healing; a rapid activation of biochemical and cellular mechanisms that are actively nonspecific, with similar responses being initiated against a wide variety of causes of tissue damage

secondary deficiencies

secondary to disease or other physiologic alterations; acquired deficiencies: stress, dietary insufficiencies, malignancies, physical trauma, medical treatments, infections, AIDS

anaphylactic shock

severe allergic reaction

cardiogenic shock

shock caused by cardiac arrest - ↓cardiac output despite normal volume

Pneumonia

signs & symptoms: due to consolidation of an area of lung -dullness to percussion Auscultation: -inspiratory crackles (rales) -egophony -whispered pectoriloqy (whispered sounds [99] louder than normal Dx: -CBC (increase WBC's) -CXR (will show area of consolodation) - +sputum gram stain/C&S -productive cough (viral cough often non-productive) treatment: -antibiotics -pulmonary hygiene

A severe focal injury to the temporal region of the skull can rupture the middle meningeal artery, resulting in an epidural hemorrhage. In this type of intracranial hemorrhage, the bleeding occurs between the dura mater and the:

skull.

leukotrienes

slow-reacting substances of anaphylaxis; sulfur containing lipids that produce histamine-like effects: smooth muscle contraction and increased vascular permeability

histamine

small weight molecule with potent effects on many other cells, particularly those that control the circulation; vasoactive amine; causes temporary rapid constriction of smooth muscle and dilation of postcapillary venules, which results in increased blood flow into microcirculation

Type II hypersensitivity: Tissue specific

specific tissue is the target of an immune response; blood cells are often affected; generally against a specific cell or tissue--transfusion reactions, Goodpasture syndrome, autoimmune anemias; five mechanisms---mediated by antibody

Immediately following a spinal cord injury, spinal reflexes below the level of the lesion are disrupted because of:

spinal cord swelling

volume-sensitive receptors

stimulate release of ADH from pituitary gland; located in the right and left atria and thoracic vessles

osmoreceptors

stimulated by increased osmolality causing thirst and the signaling of the pituitary to release ADH

paraesophageal hiatal hernia

stomach slides upwards through a defect next to the normal diaphragmatic opening (twisting of the stomach); potential surgical emergency due to torsion

sliding hiatal hernia

stomach slides upwards through esphogeal opening in the diaphragm (often asymptomatic)

The most common source of life-threatening meningitis is:

streptococcus pneumoniae.

antigen

substances considered foreign or "non-self", on infectious agent, non infectious substances of the environment-drugs, vaccines, transfusions; a molecule that can react with antibodies or antigen receptors on B and T cells

paroxysmal nocturnal dyspnea

sudden awakening from sleeping with shortness of breath -PND

Treatment for hyperpituitarism?

surgery/XRT

What is the treatment for a support structure injury?

suture together (min 8 weeks healing)

acidosis

systemic increase in hydrogen ion concentration; an acid-base imbalance characterized by a reduction in arterial blood pH

Viral hepatitis

systemic viral disease that primarily affects the liver -Hep A (HAV)- formally known as infectious hepatitis -Hep B (HBV)- formally known as serum hepatitis -Hep C - D, E, & G Sequence: -incubation phase (30-180 days) -prodromal (pre-icetric) phase -icetric phase (2-6 weeks) -recovery phase (resolution or jaundice) Chronic passive hepatitis: -persistent virus after acute infection Chronic active hepatitis: -persistent liver cell damage after acute infection Fulminant hepatitis (B&C) -results from impairment or necrosis of hepatocytes Prevention for A & B: -give immune globulin before or during incubation phase

What is a sprain?

tear or injury to a ligament

what is a strain?

tear or injury to a tendon -1st (least severe, 2nd, 3rd degree (most severe)

passive immunity

temporary because donor's antibodies are eventually destroyed; preformed antibodies or T-lymphocytes are transferred from a donor to a recipient

ileus

temporary loss of intestinal motility due to inflammation or more commonly postoperative abdominal surgery

buffering

the action of buffers minimizing the change in pH of a solution in response to the addition of acids or bases; most important plasma buffer systems are carbonic acid-bicarbonate and the protein hemoglobin; phosphate and protein are the most important intracellular buffers

hydroureter

the distention of the ureter with urine that cannot flow because the ureter is blocked -proximal to obstruction

edema

the excessive accumulation of fluid within the interstitial spaces; the forces favoring fluid movement from the capillaries or lymphatic channels into the tissues are increased capillary hydrostatic pressure, lowered plasma oncotic pressure, increased capillary membrane permeability, and lymphatic channel obstruction

What is the most common cause of alterations of the hypothalamic-pituitary system?

the interruption of the pituitary stalk die to destructive lesions, traumatic head injury, or surgical transection

Quality (osteoporosis)

the microarchitecture of bone -crystal size & shape -brittleness -integrity of trabecular network -ability to repair tiny cracks (don't get repaired)

toxic myopathies

the most common cause of toxic myopathy is ALCOHOL ABUSE -acute attack of muscle weakness, pain, & swelling -chronic weakness in a drinker of long duration -necrosis of individual muscle fibers -disturbance of energy turnover, gene dysregulation, & initiation of apoptosis

anaphylaxis

the most rapid immediate hypersensitivity reaction; is an explosive reaction that occurs within minutes of re-exposure to the antigen and can lead to cardiovascular shock

valvular stenosis

the narrowing or constriction of a valve. -aortic stenosis -mitral stenosis

alkalemia

the pH of arterial blood is greater than 7.4

acidemia

the pH of arterial blood is less than 7.4

neutrophils

the predominant cell needed to kill bacteria in the early stages of inflammation, phagocyte

septicemia

the presence of bacteria in the blood and is caused by a failure of the body's defense mechanisms; usually caused by proliferation of gram negative bacteria and fungi

degranulation

the release of contents of mast cell granules

interstitial fluid

the space between cells and outside the blood vessels

total body water (TBW)

the sum of fluids within all body compartments; about 60% of body weight; expressed as a % of body weight in kilograms

arterial thrombi

these usually adheree to the wall of cardiac chambers or the aorta

fibrinous exudate

thick, clotted exudate; indicates more advanced inflammation; fluid in lungs--pneumonia

acute coronary syndromes

transient ischemia-comes & goes (stable coronary plaque) -unstable angina-leads to MI in 20% of people; get the pain, sit & rest but pain does not go away -myocardial infarction-irreversible muscle death

The displacement of the temporal lobe into the tentorial notch resulting in brain stem compression is know as a(n):

uncal herniation.

What are the manifestations of bone fractures?

unnatural alignments, swelling, muscle spasm, tenderness, pain, impaired sensation, & possible muscle spasms

clinical manifestations of gastrointestinal dysfunction

upper gastrointestinal bleeding: bright red or "coffee ground" due to breakdown by stomach acids -bleeding gastritis -bleeding peptic ulcers -bleeding esophageal varices (dilated varicose veins in distal esophagus) - mallory-weis tear at esophagogastric (EG) junction due to vomiting lower gastrointestinal bleeding: below the ligament of Treitz (bleeding from the jejunum, ileum, colon, or rectum)-due to polyps, cancer, hemorrhoids (can be "tarry" or bright red)

Absorption of folate occurs in the?

upper small intestine and is not dependent on any othe facilitating factor / treatment for folate deficiency anemia requires daily oral admistration of folate

hypochloremia

usually the result of hyponatremia or elevated bicarbonate concentration, as in metabolic alkalosis; develops with vomiting and loss of hydrochloric acid

venous thrombi

vein blood clot

The main source of bleeding in subdural hematomas is:

venous

kussmaul respirations

very deep and rapid respirations -increase in tidal volume -increase in respiration rate -labored breathing, no expiratory pause -seen with extreme exercise, metabolic acidosis

Encephalitis is usually caused by:

viral infection.

hematemesis

vomiting blood

serous exudate

water exudate which indicates early inflammation; fluid in a blister

transudative effusion

watery -low content of cells

resolution

when repaired tissue is close to normal if damage is minor, no complications occur, and destroyed tissues are capable of regeneration

contracture

when wound contraction is excessive resulting in deformity--burns

dehiscence

wound pulls apart at the suture line--5-12 days after suturing; usually leads to wound infection

primary intention

wounds that heal under conditions of minimal tissue loss; papercut, sutured surgical wound

secondary intention

wounds that require a great deal more tissue replacement so that epithelialization, scar formation, and contraction take longer; open wound--pressure ulcer

Jaundice

yellow pigmentation of skin secondary to hyperbillirubinemia

postmenopausal osteoporosis

↓ estrogen/androgen -age-related bone loss begins in 40's