patho exam #3

risk factors for cholelithiasis:

"fat, female, and forty" 1. obesity 2. female 3. middle age 4. oral contraceptive use 5. rapid weight loss 6. Native American ancestry (60-70%!!) 7. genetic predisposition 8. gallbladder, pancreas, or ileal disease

what did Kawasaki's disease used to be called?

"mucocutaneous lymph node syndrome"

what are some other names for kidney stones? risk factors?

"nephrolithiasis, renal calculi, urinary stones" - age: > 50 years of age - female: men > women - race: caucasians - fluids: don't consume enough fluids - diet: excessive vitamin D & calcium ingestion, vitamin A deficiency - exercise: don't exercise regularly - *GENETICS!* *living in warmer environments increases risk of kidney stones (more likely to be dehydrated!)

what is the process of atherosclerotic plaque formation?

*Begins with some sort of injury (toxin, free radical, etc.)!!* 1. endothelial damage & acute inflammation 2. cellular proliferation 3. MACROPHAGE migration and adherence 4. LDL oxidation (macrophages engulf LDL cholesterol to form FOAM CELLS) 5. fatty streak formation 6. fibrous plaque (covering over the fatty streak to wall it off) 7. complicated plaque (pieces that can break off)

what is flail chest?

*chest wall disorder: EMERGENCY that needs to be dealt with!* - INSTABILITY of a portion of the chest wall - changes the anatomy of the lung tissue with every breath

diagnosis and criteria for Kawasaki's disease:

*diagnosis is based on a FEVER of >5 days and 4 of the 5 following criteria*: 1. Conjunctivitis 2. Rash on trunk and genitals 3. Erythema on palms of hands & soles of feet 4. Adenopathy-- swollen lymph nodes often unilateral 5. Mucosal involvement: red, cracked, dry lips and swollen red tongue ("strawberry tongue")

what are the manifestations and criteria for constipation?

*need 2+ for 3 or more months! *all are about 25% of the time - STRAINING with defecation - HARD stools - sensation of INCOMPLETE EMPTYING - MANUAL MANEUVERS to facilitate stool evacuation (i.e. impacted) - LESS THAN 3 bowel movements per WEEK!

examples of acute coronary syndromes:

- "unstable angina": TRANSIENT ischemia, get A LOT of chest pain (that blood supply is NOT consistent!); result of REVERSIBLE myocardial ischemia - "myocardial infarction": SUSTAINED ischemia ("heart attack"), leads to myocardial remodeling, inflammation, & necrosis

risk factors for acute kidney injury?

- *older adults hospitalized in an ICU (highest risk!)* - hospitalization - peripheral artery disease, hypertension, heart failure - diabetes - preexisting kidney disease or transplant - recent surgery - liver disease

what is the incidence of congenital heart defects (CHD)?

- 1%. or 40,000 births/year - 25% of these are CRITICAL heart defects *leading cause of death in INFANCY after prematurity

about ________________ people in the U.S. have peripheral artery disease (most are what age?)

- 8.5 million - >40 years old

end-stage renal disease is characterized by a GFR of ____________________, ___________________, and ________________________. what is the classic marker/end result?

- <15 mL/min - oliguria (maybe anuria eventually) - increased BUN and creatinine levels *UREMIA = abnormally high waste products in the blood!*

manifestations of tetralogy of fallot:

- ACUTE cyanosis at birth or GRADUAL cyanosis over first year of life - ACUTE episodes of cyanosis & hypoxia ("TET SPELLS") - difficulty feeding, poor growth

what factors affect the prevalence of hypertension?

- AGE: older age - GENDER: affects more males, then more females after menopause (~ 55 y.o.) - RACE: african americans - LIFESTYLE - HEREDITY

what are some clinical manifestations of patent ductus arteriosus?

- ASYMPTOMATIC - dyspnea, fatigue, poor feeding *continuous, MACHINERY-LIKE murmur in both systole and diastole!*

symptoms of vesicoureteral reflux?

- ASYMPTOMATIC! - unexplained fevers, poor growth & development, irritability, feeding problems

peptic ulcer disease results in a ________________ or _________________ in the ________________________ (where does it usually occur?)

- BREAK, ULCERATION, protective mucosal lining - usually in the stomach or proximal duodenum (sometimes the esophagus)

what are the laboratory values with acute glomerulonephritis?

- BUN: increases (normal = 8-21 mg/dL) - Creatinine: increases (normal = 0.7-1.2 mg/dL)

what is inflammatory bowel disease? what causes it?

- CHRONIC, RELAPSING inflammatory bowel disorders - genetics, environmental factors, alterations of epithelial barrier functions, altered immune reactions to intestinal flora

what are the early & late symptoms of hepatic encephalopathy?

- EARLY: subtle changes in personality, memory loss, irritability, disinhibition, lethargy, sleep disturbances - LATE: confusion, disorientation to time and space, flapping tremor of the hands ("asterixis"), slow speech, bradykinesia, stupor, convulsions, coma

clinical manifestations of bladder tumors?

- GROSS, painless hematuria - flank pain

what does vesicoureteral reflux lead to? who does it mostly affect?

- INFECTION! (especially pyelonephritis in CHILDREN!) --> often bacteria is hanging out in the urinary bladder - girls > boys by a ratio of 10:1

what is a urinary tract infection? what parts of the urinary tract can it affect?

- INFLAMMATION of the URINARY EPITHELIUM usually caused by bacteria from GUT FLORA - Bladder (cystitis), kidney (pyelonephritis), ureter, urethra

what is status asthmaticus?

- MEDICAL EMERGENCY! - extreme asthma exacerbation

what are some characteristic physical findings of infective endocarditis?

- Osler nodes = painful, reddened nodules on pads of fingers & toes - Janeway lesions = non-painful, hemorrhagic lesions of hands and feet

manifestations of cystic fibrosis in the GI tract?

- PANCREATIC insufficiency - STEATORRHEA (fat in the stool) - ABDOMINAL DISTENSION

what is pericardial effusion? tamponade?

- PERICARDIAL EFFUSION: exudate comes from neutrophils as a result of inflammation (accumulates in double-layered sac) - TAMPONADE: pressure exerted by the pericardial effusion will inhibit ventricular filling (this decreases cardiac output!)

what is acute liver failure?

- RARE! - severe IMPAIRMENT or NECROSIS of liver cells without preexisting liver disease or cirrhosis

what is nephroblastoma? how many kids are diagnosed per year? what's the peak age for diagnosis? what group has the highest incidence?

- RARE, embryonal tumor of the kidney - 500 children diagnosed per year - peak age: 2-3 years old - girls of AFRICAN descent

what are some signs and symptoms of kidney stones?

- RENAL COLIC (pain; smooth muscle of ureter is spasming!) - dull, aching flank pain - dull, aching suprapubic pain - acute, severe, intermittent pain of the flank or abdomen - N/V - pallor - cool, clammy skin

what causes nephroblastoma to develop?

- SPORADIC (*most common*): no known genetic predisposition - INHERITED (*most rare*): autosomal DOMINANT pattern *has been linked to mutation of tumor suppressor genes!

TRANSIENT myocardial ischemia can lead to what?

- STABLE ANGINA = chest pain, not actually causing long-lasting damage - PRINZMETAL ANGINA = not as lethal, less predictable (get randomly!)

tension pneumothorax leads to __________________ and often happens after _______________ or __________________

- TRACHEAL DEVIATION - open pneumothorax, spontaneous pneumothorax

true vs. false aneurysm:

- TRUE: weakening of ALL 3 layers of vessel wall/cardiac chamber - FALSE: extravascular hematoma that communicates with the intravascular space

upper vs. lower gastrointestinal bleeding:

- UPPER: esophagus, stomach, or duodenum - LOWER: jejunum, ileum, colon, or rectum

assessment for kidney stones:

- URINALYSIS: blood, protein, bacteria - 24 HOUR URINE or ANALYSIS OF STONE THAT PASSES - KUB (kidneys, ureter, bladder), IVP (intravenous pyelogram), U/S (ultrasound), CT scan, cystoscopy

what is cystitis?

- UTI of the bladder - ~50% of women will get at some point in their life!

what is pyelonephritis?

- UTI of the kidneys ("UPPER UTI") - 30% of women who experience cystitis will progress on to pyelonephritis

what is Kawasaki's disease? who does it primarily affect?

- VASCULITIS of medium-sized vessels (acute coronary artery vasculitis) - 80%: children <5 years old - RARE: children <3 months - highest risk for heart sequelae: 3 months-1 year

what causes hemolytic uremic syndrome?

- a BACTERIAL or VIRAL illness (animals, contaminated meats/veggies, etc.) - UPPER RESPIRATORY INFECTION or GASTROINTESTINAL ILLNESS precedes the syndrome by 1-2 WEEKS! - most cases are associated with BLOODY DIARRHEA from a strain of E. coli (that produces Shiga toxin!)

cholecystitis is almost always caused by what?

- a GALLSTONE lodged in the CYSTIC DUCT - pain is similar to that caused by gallstones

what are some risk factors for infective endocarditis?

- acquired valvular problem - ventricular septal defect (increases turbulence of blood) - long-term IV access - IV drug users (don't use aseptic technique!)

glomerulonephritis can ultimately result in what?

- acute renal failure - hypertension (retaining water) - edema - renal failure - scarring of the kidneys

risk factors for UTI?

- age - gender (female!!!) - neurogenic bladder (NS prevents them from fully emptying bladder) - chronic diseases - prostate hypertrophy - instrumentation (e.g. cystoscopy, catheterization) - impaired immune system other risk factors!

Hirschsprung disease is characterized by _________________________, leading to ___________________________

- an absence of PARASYMPATHETIC NS intrinsic ganglion cells - impaired fecal movements

what is a urinary tract obstruction? what can it cause? how is it categorized?

- an interference with the flow of urine at ANY SITE along the urinary tract - can cause HYDRONEPHROSIS (build up of pressure in the kidneys) - categorized into UPPER & LOWER

symptoms of gastritis?

- anorexia - fullness - N/V - epigastric pain

what vessel is most susceptible to aneurysm? what can the results of this be?

- aorta, especially abdominal - can lead to aortic DISSECTION or RUPTURE!

what is the difference between arteriosclerosis and atherosclerosis?

- arteriosclerosis: abnormal thickening & hardening of the tunica intima of the ARTERIAL system - atherosclerosis: form of arteriosclerosis, involves foam cells & fatty streaks (we know the cause!) *Atherosclerosis is the #1 reason for arteriosclerosis!*

complications of patent ductus arteriosus?

- bacterial endocarditis (makes sense! abnormal opening for turbulent blood flow) - pulmonary hypertension later in life

describe more about melena stools. what are some reasons for this?

- black, tarry, foul-smelling stools - when there's A LOT of blood in the stool but it's traveled through most of the GI system (upper GI bleed) - other reasons for this: iron supplements (but not foul smelling), black berries, pepto bismol

what is patent ductus arteriosus? what kind of shunt is it?

- blood flows from the AORTA --> pulmonary artery to be returned to the lungs (this is supposed to functionally close after birth) - left-->right shunt (ACYANOTIC!)

what are possible causes of acute post-streptococcal glomerulonephritis?

- can begin 7-10 DAYS after a Group A Beta Hemolytic Streptococci infection of the throat - up to 6 WEEKS after a skin infection such as impetigo - also bacterial endocarditis, varicella, or hepatitis B & C

pathophysiology of hepatic encephalopathy:

- cells in the nervous system are vulnerable to NEUROTOXINS absorbed from the GI tract - because of liver dysfunction, these neurotoxins circulate to the brain

what is a tension pneumothorax?

- collapsed lung (*biggest emergency!!*) - outside air puts pressure on the lungs; everything is shifted over (also puts pressure on the HEART!)

symptoms of ulcerative colitis?

- diarrhea (10-20/day!!!) - urgency (when they've got to go they've got to go!) - bloody stools - cramping

manifestations of systolic heart failure:

- dyspnea - orthopnea - cough or frothy sputum - fatigue - decreased urine output - edema - pulmonary edema - hypotension/hypertension *S3 Gallop!*

manifestations of acute respiratory distress syndrome?

- dyspnea & hypoxemia despite supplemental oxygen - hyperventilation & respiratory alkalosis - decreased tissue perfusion, metabolic acidosis, organ dysfunction - increased WOB, decreased tidal volume, hypoventilation - hypercapnia & respiratory acidosis

what is pulmonary edema? pulmonary edema is often the result of ________________

- excess water in the lungs - left-sided heart failure

what is tricuspid atresia? what type of shunt?

- failure of the tricuspid valve to develop - NO communication between the right atrium & right ventricle - right-to-left (cyanotic) shunt (decreased pulmonary blood flow)

MINOR manifestations of acute rheumatic fever:

- fever - tachycardia - arthalgias - elevated CSR and C-reactive protein level - other associated symptoms: abdominal pain, nosebleeds, weakness/fatigue, weight loss

clinical manifestations of pyelonephritis:

- fever & chills - CVA tenderness - DYSURIA - urinary frequency - BACKACHE possible - N/V

pathophysiology of cirrhosis?

- hepatocytes SWELL & FIBROSE (causing liver enlargement) - as fibrosis spreads, the liver shrinks! - lobules are covered with fibrous connective tissue and get filled with FAT

what are some complications of cirrhosis?

- hepatomegaly - splenomegaly - esophageal varices - ascites - hepatic encephalopathy - portal hypertension!*

with CF, chronic inflammation leads to...

- hyperplasia of goblet cells - bronchiectasis (abnormal dilation of bronchi) - pneumonia - hypoxia - fibrosis, etc.

what are some common causes of acute glomerulonephritis?

- immunologic abnormalities** - ischemia - free radicals - drugs - toxins - vascular disorders - systemic diseases (diabetes, SLE)

how is hypertension different in children than adults?

- in adults, hypertension is mainly primary - in children, hypertension is mainly secondary (caused by something else, e.g. renal disease or coarctation of the aorta) children are also commonly ASYMPTOMATIC

what is heart failure?

- inadequate CARDIAC OUTPUT (inadequate to meet the metabolic demands of the body!) *single most common cause for hospitalization for individuals over the age of 65! (U.S.)

destruction of the basement membrane in glomerulonephritis leads to:

- increased capillary permeability, cell proliferation, and leakage of protein and red blood cells into the urine - decreased GFR

what is the pathophysiology of hemolytic uremic syndrome?

- infection triggers inflammatory cascade (platelet aggregation, fibrin clot formation) - endothelial injury to the GLOMERULAR ARTERIOLES! - become swollen & occluded with platelets and fibrin clots (platelets get used up!) - RBCs are damaged as they pass through!!

what is a heart valve disease with vegetation called? what are some agents that cause this?

- infective endocarditis - bacteria, viruses, fungi, rickettsiae, parasites

what is glomerulonephritis?

- inflammation of the glomerulus - EPITHELIAL layer of the glomerular capillary membrane is disturbed or altered

what is the MAIN things that occurs with chronic bronchitis?

- inspired irritants increase MUCUS PRODUCTION & the SIZE and NUMBER of mucus glands - the mucus is THICKER than normal!

what happens to the other kidney during obstruction? what about when the obstruction's relieved?

- it takes over (hypertrophies) - DIURESIS (can have 10 L of urine per day)

causes of upper urinary tract obstructions?

- kidney stones - tumor in the kidney - strictures (narrowing) in the ureters - other tumors pressing on the ureters or ureter-bladder junction

what organs/systems are affected by cystic fibrosis?

- lungs - digestive tract - reproductive organs (affects PROTEINS on the surfaces of certain epithelial cells)

manifestations of ventricular septal defect:

- may be ASYMPTOMATIC - dyspnea - tachypnea *loud, harsh PANSYSTOLIC MURMUR and SYSTOLIC THRILL* - can contribute to pulmonary hypertension (Eisenmenger syndrome)

clinical manifestations of Hirschsprung disease?

- mild to severe constipation - diarrhea - enterocolitis (inflammation of GI tract), sepsis, death

what are duodenal ulcers? developmental factors? where does pain occur?

- most common of the peptic ulcers! - helicobacter pylori infection, use of NSAIDs - INTERMITTENT pain in the EPIGASTRIC area

what is acute pericarditis?

- outside layer of the heart (pericardium) is INFECTED & INFLAMED - may see temporary changes in the ECG - auscultation: "friction rub" - can cause POSITIONAL chest pain (pain is worse when lying down, unusual for angina)

what is intermittent claudication? what is it associated with?

- pain with exercise that resolves with rest - peripheral artery disease

hypoventilation & hyperventilation are both signs of ____________________. what do they mean in relation to carbon dioxide?

- pulmonary disease - hypoventilation: hypercapnia (high levels of CO2) - hyperventilation: hypocapnia (low levels of CO2)

ARDS can ultimately lead to ________________________

- respiratory failure - decreased C.O. - hypotension - death

clinical manifestations of nephrotic syndrome:

- severe proteinuria - hypoalbuminemia (means the blood has low PR) - edema - hyperlipidemia (lots of fat in the blood!) - periorbital edema!!**

what is post-thrombotic syndrome? what percentage of people diagnosed with DVT have long-term complications knows as post-thrombotic syndrome?

- swelling, pain, discoloration, and scaling in the affected limb - 50%

what is acute rheumatic fever?

- systemic, inflammatory disease - caused by a delayed IR to PHARYNGEAL infection by group A beta-hemolytic streptococci - FEBRILE illness: inflammation of the joints, skin, nervous system, and heart (children b/w 5 & 15) - rheumatic heart disease (25-34 years old)

what is vesicoureteral reflux?

- the BACKWARD flow of urine from the bladder to the ureters and up to the kidney - this PREVENTS the urinary bladder from emptying completely!!

ulcerative colitis is a ____________ inflammatory disease that causes ______________________. what part of the colon does it affect? what is it characterized by?

- ulceration of the COLONIC MUCOSA - begins in the SIGMOID COLON & the RECTUM! (may extend proximally to the entire colon) - intermittent periods of REMISSION & EXACERBATION

subtypes of inflammatory bowel disease?

- ulcerative colitis - Crohn disease

evaluation methods of bladder tumors?

- urinalysis to rule out infection - urine cytology (looking at cells to determine what they are) - cystoscopy with tissue biopsy - staging: TNM system

what are the ventilation & perfusion abnormalities involved in the lungs?

- ventilation: atelectasis - perfusion: problem with the capillaries

how are nephrotic syndromes diagnosed?

1. 24-hour urine collection (protein >3.5 grams) 2. serum albumin <3 g/dL 3. fat droplets in the urine 4. hyperlipidemia (cholesterol, phospholipids, triglycerides) 5. renal biopsy for confirmation!

with acute glomerulonephritis, we will mainly look at what two things?

1. BUN 2. creatinine

what are the names of specific stress-related mucosal disease?

1. CURLING ulcers: BURN injury 2. CUSHING ulcers: severe BRAIN trauma or surgery

what is the body's response to urinary tract obstruction?

1. DILATION - ureter ("hydroureter") - renal pelvis, calyces, parenchyma ("hydronephrosis") - URETEROHYDRONEPHROSIS! 2. WITHIN 7 DAYS: - tubulointerstitial FIBROSIS - apoptosis 3. IRREVERSIBLE RENAL DAMAGE - approx. 4 weeks 4. IMPAIRED ABILITY TO CONCENTRATE URINE - increased urine volume - decreased GFR 5. IMPAIRED ABILITY TO REABSORB BICARBONATE - metabolic acidosis 6. IMPAIRED ABILITY TO EXCRETE AMMONIA - alteration in mental status 7. COMPENSATORY HYPERTROPHY (of opp. kidney)

causes of ARDS?

1. DIRECT LUNG INJURY (pneumonia, aspiration, near drowning, smoke inhalation) 2. SYSTEMIC INSULT (sepsis, multiple trauma)

3 phases of acute respiratory distress syndrome?

1. EXUDATIVE (within 72 hours of initial insult): interstitial edema, fluid enters the alveolar space, blood cannot be oxygenated 2. PROLIFERATIVE (4-21 days after initial insult): type II pneumocystis, fibroblasts, myofibroblasts 3. FIBROTIC (14-21 days after initial insult): remodeling & fibrosis of lung tissue

causes of prerenal acute kidney injury?

1. HYPOVOLEMIA 2. RENAL HYPOPERFUSION 3. SYSTEMIC VASODILATION 4. AFFERENT ARTERIAL VASOCONSTRICTION 5. DECREASED ARTERIAL BLOOD VOLUME

what are the different types of GI bleeding?

1. OCCULT bleeding: blood is NOT visible, but testing shows blood in the stool 2. HEMATOCHEZIA: bright RED stools (lower GI tract) 3. MELENA: BLACK, TARRY, FOUL-SMELLING stools (upper GI tract)

what are some causes of secondary hypertension?

1. RENAL ARTERY STENOSIS (triggers RAAS) 2. PHEOCHROMOCYTOMA (excess N.E.)

portal hypertension can lead to...

1. VARICES (mostly esophageal) 2. SPLENOMEGALY 3. VOMITING OF BLOOD (from bleeding esophageal varices)* = most common clinical manifestation!

what are some causes of cirrhosis?

1. alcohol abuse 2. gallstones that obstruct bile flow in the gallbladder 3. cystic fibrosis (can cause mucus plugs to form in the bile duct) 4. chronic hepatitis (particularly HCV) 5. long-term exposure to toxic material 6. storage disorders like hemochromatosis (iron!)

pathophysiology of lung cancer:

1. begins with CHRONIC IRRITATION from sources like smoking or another environmental factor 2. leads to METAPLASIA 3. loss of CILIATED cells 4. more irritants & inflammation! 5. cellular DYSPLASIA (pre-cancerous cells) 6. carcinoma in situ (localized) 7. lung cancer!!

MAJOR manifestations of acute rheumatic fever:

1. carditis & chest pain (pancarditis: can involve any layer of the heart, mitral valve is frequently affected, usually associated with a systolic murmur, can have pericardial effusion) 2. migratory polyarthritis 3. erythema marginatum 4. subcutaneous nodules: bones/tendons ("Aschoff bodies") 5. Sydenham chorea (rapid, involuntary movements)

what are the 2 types of chronic gastritis?

1. chronic FUNDAL gastritis (type A, immune), less common (more associated with the development of gastric cancer!) 2. chronic ANTRAL gastritis (type B, non immune), more common

what are the different types of atelectasis?

1. compression atelectasis 2. obstructive (absorption) atelectasis 3. surfactant impairment (adhesive) atelectasis

manifestations of asthma?

1. cough 2. expiratory wheeze 3. SOB, tachypnea 4. nasal flaring 5. use of accessory muscles 6. exercise intolerance

what is the pathogenesis of infective endocarditis?

1. damaged (prepared) endocardium 2. blood-borne microorganism adherence 3. proliferation of the microorganism ("vegetations")

risk factors for atherosclerosis?

1. diabetes 2. smoking 3. hyperlipidemia/dyslipidemia (interchangeable!) 4. hypertension 5. autoimmunity

causes of hepatitis?

1. direct attack of a virus 2. cell-mediated immune response

classic findings of infective endocarditis:

1. fever 2. new or changed CARDIAC MURMUR (esp. if vegetations are on valves!) 3. petechial lesions of the SKIN, CONJUNCTIVA, & ORAL MUCOSA

what are the components of fetal circulation?

1. foramen ovale 2. ductus arteriosus 3. ductus venosus

what are the different types of aneurysms?

1. fusiform, circumferential (looks like an inner tube) --> true 2. fusiform, saccular (means it's just on 1 side) --> true 3. dissecting, saccular --> true 4. false

what are the 2 major symptoms of severe glomerulonephritis?

1. microscopic hematuria (with RBC casts) 2. proteinuria exceeding 3-5 g/day with ALBUMIN (macroalbuminmemia) as the major protein (microscopic too!)

what are the types of pneumothorax?

1. open pneumothorax 2. tension pneumothorax 3. spontaneous pneumothorax 4. secondary pneumothorax

primary symptoms of ARDS?

1. pulmonary edema 2. atelectasis 3. severely impaired gas exchange ("pulmonary shunt")

treatment of kidney stones:

1. reduce the size of the stone, allow it to pass (high fluid intake, decrease dietary intake of stone-forming substances, stone removal) 2. extracorporeal shock wave lithotripsy (ESWL): if it's > 6 or 7 mm, under general anesthesia

what are the acquired cardiovascular disorders in children? which one is the most common?

1. rheumatic heart disease 2. *kawasaki's disease* 3. hypertension

risk factors for the development of bladder cancer?

1. smoking 2. exposure to METABOLITES of ANILINE DYES (used when we treat leather, also in woodworking) 3. women who take large amounts of PHENACETIN (in certain types of hair dye) 4. "Uroepithelial schistosomiasis" infection

peptic ulcers can be ___________ or __________. what are the differences between these 2 types?

1. superficial (erosions) 2. true (extend through the muscularis mucosae with DAMAGE TO BLOOD VESSELS!)

risk factors for COPD:

1. tobacco smoke 2. occupational dusts & chemicals 3. air pollution 4. any factor affecting LUNG GROWTH during gestation & childhood

primary/essential hypertension is a blood pressure consistently above ______________ for average adults. what defines it as primary?

140/90 - NOT caused by any underlying conditions or medications - if left untreated for a long period of time, it can damage the ARTERIAL WALLS as a result of increased vasoconstriction

which percentage of people with pulmonary embolism die without any prior symptoms?

25%

_____________ of children with Kawasaki's disease will develop cardiac complications ___________

25%, if untreated

cholelithiasis pain often occurs when in relation to a fatty meal?

30 minutes after

__________ of Americans have some form of hypertension

33%

bladder tumors consist of __________ of all malignant tumors (________________ new each year!) & primarily affect _______________________

4.5%, 80,000+, men over the age of 60

patients reaching _______ are at a higher risk for developing DVT

45

the pericardial sac can fill up with about _________ before the heart is affected

50-100 mL (can go in with needles to withdraw fluid = pericardiocentesis)

acute respiratory distress syndrome usually develops with _______________ of initial insult

7 DAYS

with vesicoureteral reflux, there's a ____________ chance in children if their parents were affected, a ___________ in siblings of affected child

70%, 50%

_________ of people recover from hemolytic uremic syndrome with no ___________________

90%, chronic issues

what is the normal GFR of the kidneys?

90-120 mL/min

______________ of individual with hypertension have primary hypertension

92-95%

if the kidney stone is ____________, there's a _________ chance of it passing through the ureters

<5 mm, 50%

end-stage renal failure is characterized by _______________ nephron loss

>90% (only ~10% proper nephron function!!)

what is hemolytic uremic syndrome?

ACUTE disorder characterized by: - HEMOLYTIC ANEMIA - THROMBOCYTOPENIA - ACUTE RENAL FAILURE

what are the acyanotic (left to right) vs. cyanotic (right to left) congenital heart defects?

ACYANOTIC: - INCREASED pulmonary blood flow: patent ductus arteriosus (PDA), ventricular septal defect (VSD), atrial septal defect (ASD) - OBSTRUCTED blood flow: coarctation of the aorta, aortic & pulmonary stenosis CYANOTIC: - DECREASED pulmonary blood flow: tetralogy of fallot, tricuspid atresia - MIXING DEFECTS (mixing desaturated & saturated blood): transposition of the great vessels

what ethnic group is at higher risk for DVT?

African Americans

nephritic vs. nephrotic syndromes:

BOTH consequences of glomerular damage: - NEPHRITIC syndrome: RBCs ARE able to pass through the pores in the podocytes within the kidneys (proteinuria & hematuria) - NEPHROTIC syndrome: podocytes of affected kidneys have small pores; protein passes through but not RBCs (proteinuria)

who does acute post-streptococcal glomerulonephritis most commonly affect? when does it come on?

CHILDREN, suddenly

chronic liver diseases in children can progress to what?

CIRRHOSIS (infrequent!)

what are the stages of chronic kidney disease?

CKD stage 1: REDUCED RENAL RESERVE (GFR >90 mL/min = normal) CKD stage 2: MILD DISEASE (GFR 60-89 mL/min) CKD stage 3: MODERATE DISEASE (GFR 30-59 mL/min) CKD stage 4: SEVERE DISEASE (15-29 mL/min) CKD stage 5: END-STAGE RENAL DISEASE (GFR <15 mL/min)

an aneurysm is a local __________ or ____________ of a ___________ or _____________

DILATION, OUTPOUCHING, vessel wall, cardiac chamber

what is the main cause of UTIs?

E. coli (85%!!)

what is the screening method for Kawasaki's disease? when?

ECHOCARDIOGRAPHY - at diagnosis - at 2 weeks after onset of illness - at 6-8 weeks after onset of illness

anytime you hear about kidney problems, you will almost always see ____________

EDEMA!

_______________ of children who have acute post-streptococcal glomerulonephritis are ___________________

HALF, asymptomatic (~1% of children progress to chronic kidney disease)

acute rheumatic fever is a type ________ hypersensitivity

II

what is constipation?

INFREQUENT or DIFFICULT defecation - primary condition - secondary condition (*more common*): diet, medications, various disorders, aging

with stress-related mucosal disease, _____________ ulcers occur within hours of...

ISCHEMIC - hemorrhage - multi-system trauma (fight-or-flight) - severe burns - heart failure - sepsis

how is acute rheumatic fever diagnosed?

JONES CRITERIA: - 2 major and/or - 1 major and 2 minor

in ulcerative colitis, lesions are usually on the _________ side of the colon

LEFT

what is the #1 primary cause of portal hypertension?

LIVER CIRRHOSIS!!

what is the leading cause of cancer death?

LUNG CANCER (more than total breast, prostate, and colon cancer-related deaths combined!)

cystic fibrosis leads to ________________ of _____________, _____________, _____________, and __________________________

MALDIGESTION --> proteins, carbohydrates, fats, fat-soluble vitamins

what is the most common cause of acute kidney injury?

PRERENAL - caused by impaired renal blood flow (GFR declines)

what are the types of nephrotic syndrome?

PRIMARY: unknown cause (affects more boys; 2-3 years old) SECONDARY: consequences of nephrotoxic drugs!!) - drugs or toxins (NSAIDs) - infections/malignancies/vascular disorders - systemic diseases (DM and SLE)

what is diastolic heart failure? symptoms?

PULMONARY CONGESTION despite normal stroke volume and cardiac output - dyspnea on exertion - fatigue - pulmonary edema - pleural effusions! *S4 Gallop!*

what is a complication of DVT?

PULMONARY EMBOLISM! (clot that has dislodged from the initial site of injury and traveled to the vessels in the lungs)

what is projectile vomiting?

SPONTANEOUS vomiting that does NOT follow nausea or retching (e.g. from increased ICP, tumors, brain aneurysms, GI obstruction)

tumor staging of nephroblastoma:

STAGE I: tumor limited to the kidney STAGE II: tumor ascending beyond the kidney but can be totally resected STAGE III: residual non-hematogenous tumor confined to the abdomen STAGE IV: hematogenous metastases to organs (lungs, liver, bone, brain) STAGE V: bilateral disease (then staged for each kidney)

SYSTEMIC hypertension in children is defined as:

SYSTOLIC & DIASTOLIC blood pressure over 95th percentile for age, gender, and heigh on at least 3 occasions!!

what are the types of left-sided heart failure?

SYSTOLIC HF: - ejection fraction <40% DIASTOLIC HF: - ejection fraction is normal

what is the etiology of Kawasaki's disease?

UNKNOWN etiology (abnormal response to a bacteria or virus?? autoimmune component??)

are acute coronary syndromes stable or unstable?

UNSTABLE

what are the factors promoting deep vein thrombosis?

VIRCHOW'S TRIAD: 1. venous stasis (immobility: obesity, surgery, paralysis, extended travel) 2. venous endothelial damage (trauma, IV, chemical injury, inflammation) 3. hyper coagulable states (dehydration, SLE, cancer, increased platelets, pregnancy, etc.)

cystic fibrosis mostly affects people of...

Western European descent

what is another name for nephroblastoma? who does it affect?

Wilms tumor, kids!

what is acute kidney injury?

a SUDDEN decline in kidney function (decrease in GFR, oliguria, accumulation of nitrogenous waste products in the blood)

how is hypertension diagnosed?

a blood pressure above 140/90 on two different occasions separated by more than 24 hours!

chronic bronchitis occurs when there's...

a hyper-secretion of MUCUS and CHRONIC PRODUCTIVE COUGH that lasts for at least 3 months of the year and for at least 2 consecutive years

what is hepatic encephalopathy?

a neurologic syndrome of impaired BEHAVIORAL, COGNITIVE, and MOTOR function

what is ventricular septal defect? what type of shunt?

abnormal opening between the right and left ventricles - left-to-right shunt (acyanotic)

what is azotemia?

abnormally high levels of NITROGEN-CONTAINING compounds (BUN and creatinine) - the kidneys should normally remove these compounds!

what is the leading cause of acute liver failure in the U.S.?

acetaminophen overdose

pulmonary edema can also be a result of ______________________

acute respiratory distress syndrome (ARDS)

what disorder is associated with atelectasis?

acute respiratory distress syndrome (ARDS)

emphysema involves ___________ within the lungs due to _______________________________

air trapping, abnormal PERMANENT ENLARGEMENT of the gas-exchange airways

what is stress-related mucosal disease?

an ACUTE form of peptic ulcer disease that accompanies SEVERE ILLNESS or MAJOR TRAUMA!

asthma is usually triggered in response to ____________ and releases ____________________

an allergen or irritant (IgE antibodies react), mast cells (which release inflammatory mediators)

what is Acute Respiratory Distress Syndrome (ARDS)?

an often life-threatening condition causing LUNG INFLAMMATION & ALVEOLOCAPILLARY injury - requires ventilator support to survive it!

what is the most prevalent chronic disease in childhood? how many children are affected?

asthma! 8.3%

in cirrhosis, ___________________ become obstructed and cause __________________________

biliary channels, portal hypertension

what is a dissecting aneurysm?

blood is collecting BETWEEN the layers of the vessel wall or cardiac chamber - extremely life-threatening! can eventually rupture because all 3 layers don't have sufficient strength - releases HUGE amount of blood!

how are kidney stones classified? what are the most common ones?

by the MINERALS that make up the stone - CALCIUM STONES (70-80%): calcium phosphate*, calcium oxalate - STRUVITE STONES (15%): if urine is consistently alkaline; magnesium-ammonium-phosphate - URIC ACID STONES (7%): if urine is consistently acidic

what is clubbing?

changes to the nail as a result of chronic hypoxia (often associated with pulmonary disease, e.g. cystic fibrosis) - early, moderate, severe

cystic fibrosis results from defective _______________________ due to a gene mutation of ____________

chloride ion transport, CFTR

most common type of gallstone?

cholesterol (other examples: bilirubin, calcium, etc.)

what are 2 subsets of COPD?

chronic bronchitis and emphysema

what is atelectasis?

collapse of lung tissue (alveoli)

what is the main concern with occult bleeding?

colon cancer

what is orthostatic hypotension?

decrease in both SYSTOLIC and DIASTOLIC blood pressure upon standing (can get dizzy, light headed, etc.)

pain in the calf when the foot is ______________ is known as _____________

dorsiflexed, Homans' sign

what is the MAIN problem with cystic fibrosis?

dried-out mucus production that you can't clear from the airways! - neutrophils are chronically released (more mucus!)

common findings/symptoms of cholecystitis?

fever, leukocytosis, rebound tenderness, abdominal muscle guarding

during acute glomerulonephritis, immune complexes ___________________ and _________________________. this leads to what process?

form in the blood, deposit in the glomerular basement membrane. this leads to COMPLEMENT activation & destruction of the membrane

what is Hirschsprung disease?

functional OBSTRUCTION of the COLON

what is cholelithiasis?

gallstones! - gallbladder: stores bile, needed to digest FAT!

_______________ in acute post-streptococcal glomerulonephritis leads to _______________________

glomerular BLOCKAGE; decreased GFR (oliguria in severe cases, edema, hypertension, azotemia, fever/chills, pallor)

what is the most common cause of chronic and end-stage renal failure?

glomerulonephritis

what type of bacteria is most responsible for peptic ulcer diseases (duodenal, gastric, stress-related mucosal disease)?

helicobacter pylori

what is the most common cause of renal failure in children?

hemolytic uremic syndrome (most often occurs in people <4 years old!)

what is portal hypertension?

high blood pressure in the hepatic portal vein (carries ~1 L of blood supply to the liver every minute)

what is secondary hypertension?

high blood pressure that results from another disease (e.g. renal or endocrine disease) - treat by managing UNDERLYING CONDITION!

air trapping associated with emphysema causes what?

hyper expansion of the chest (barrel-chested)

_________________ and ______________ are the main causes of chronic kidney disease

hypertension, diabetes

chronic systolic heart failure leads to _____________, whereas acute systolic heart failure leads to _________________

hypertension, hypotension

atherosclerosis results in _____________, _____________, and ____________________

inadequate perfusion, ischemia, necrosis

__________________ in acute post-streptococcal glomerulonephritis leads to _________________________

increased permeability; hematuria & proteinuria

what is cholecystitis?

inflammation of the gallbladder OR cystic duct (what connects the gallbladder to the common bile duct)

what is chronic gastritis?

inflammatory disorder of the GASTRIC MUCOSA in the stomach

with emphysema, it is easier to ________ than to ___________

inhale, exhale

acute myocardial infarctions lead to cellular ________ & __________

injury, death

what will happen to the right ventricle in cor pulmonale?

it will ENLARGE (has to work harder to get blood to the lungs), possibly FAIL

where do upper urinary tract obstructions take place?

kidneys or ureters

what is cirrhosis?

late-stage scarring of the liver

how is constipation treated?

managing the underlying disease (really difficult to do! hard to change diet or meds)

________________, ______________, and ________________ women are most likely to get UTIs

menopausal, pregnant, sexually active

what are the typical features of cystic fibrosis?

mucus plugging*, chronic inflammation, and chronic infection of the SMALL AIRWAYS

what is the most common of the renal cancers?

nephroblastoma

chronic bronchitis is an example of what kind of respiratory disorder?

obstructive

asthma is a(n) ______________ respiratory disease that causes ___________, _____________, and _________________

obstructive; inflammation, bronchoconstriction, mucosal edema (bronchial hyperactivity & airflow obstruction!)

cholelithiasis can lead to what symptoms?

often ASYMPTOMATIC or VAGUE! - EPIGASTIRC & RIGHT HYPOCHONDRIUM pain - intolerance to fatty foods!!

duodenal ulcers are a type of _______________________

peptic ulcer disease

what happens if a complicated plaque breaks off?

platelets can attach to the new site of injury and form a CLOT

what is cor pulmonale?

pulmonary hypertension creates chronic pressure overload in the RIGHT ventricle (what leads to right-sided heart failure)

cystic fibrosis is an autosomal ____________ inherited disease of the ________________ that occurs on chromosome _____

recessive, lower respiratory tract, 7

how is duodenal peptic ulcer pain relieved?

relieved rapidly by ingestion of FOOD or ANTACIDS (will feel pain again 2-3 hours after eating!)

with nephrotic syndrome, you see ________________, but the symptoms are ___________ than nephritic syndrome

severe proteinuria, worse

______________ accounts for up to __________ of all lung cancer cases. smokers with ___________ have even greater risk

smoking, 90% COPD

onset of symptoms begins around what stage?

stage 2

renal insufficiency begins around what stage?

stage 3 and 4

what is tetralogy of fallot? what kind of shunt is it?

syndrome represented by FOUR defects: 1. ventricular septal defect (VSD) 2. overriding aorta that straddles the VSD 3. pulmonary valve stenosis 4. right ventricle hypertrophy - right-to-left (cyanotic) shunt (decreases pulmonary blood flow)

what is transient myocardial ischemia?

temporary deprivation of coronary blood supply

what is vomiting? what are two different types?

the FORCEFUL emptying of the stomach and intestinal contents through the mouth - RETCHING: nonproductive vomiting - PROJECTILE VOMITING

why do we see periorbital edema with nephrotic syndrome?

there's not enough albumin to hold the water in the blood

what happens to the alveolar walls with emphysema?

they are destroyed WITHOUT obvious fibrosis (loss of elastic recoil)

what is the goal of asthma therapy?

to achieve long-term control

acute glomerulonephritis is a _______________ hypersensitivity reaction

type III (immune complex-mediated reaction) antigen-antibody complexes found in blood get caught up in the glomerulus)

what is stenosis? what would mitral stenosis be?

valve that is very STIFF (difficulty opening up!) - bicuspid/mitral valve in the LV has difficulty opening up

what is the most common congenital heart defect?

ventricular septal defect

what is another reason for UTIs besides the introduction of bacteria?

vesicoureteral reflux

in __________ of cases, acute rheumatic fever can progress to _______________________ if it is _______________

~10%, rheumatic heart disease, not properly treated

____________ after a urinary tract obstruction, we will see ________________. why?

~4 weeks, irreversible damage to the nephrons - the tubules become FIBROTIC as collagen gets laid down there (can't function the way they're supposed to)