Creighton ABSN Spring 2020 Patho exam 3

Which cancer makes up 40% of lung cancers and 85% pancreatic cancers, prevalent in prostate cancer

adenocarcinoma

breast cancer is usually

adenocarcinoma

CML is found mostly in

adults

Risk populations for mobility

age ethnicity SES race chronic pain congenital defects neuro disorders strokes head injury some meds

What are the risk factors for pain

age critically ill pt

sarcopenia

age related loss of skeletal muscle

Survival rate for HL depends on

age, gender, stage, and other variables

recessive

allele whose effects are hidden

dominant

allele whose effects are observable

Most common contact dermatitis

allergic contact dermatitis

fissure

an opening; a groove; a split

Effects of a core temp under 30.8C

apnea, coma, coagulation defects, cardiac dysrhythmia, cardiac arrest

Classical HL

appears to be derived from a B cell in the germinal center that has not undergone successful immunoglobulin gene rearrangement and would normally be induced to undergo apoptosis

The upper and lower levels of the thermoeffector threshold zone ___________ fixed

are not

ABCDE mole assessment

asymmetry, border, color, diameter, evolution

Cancer pain occurs where?

at main site of distant lesion from spreading

cellular changes of aging

atrophy, dec. function, loss of cells (apoptosis)

Tay sachs

autosomal recessive 80% jewish ancestry 4-6 month onset exaggerated startle, seizures, developmental repression, dementia, blindness

major types of carcinoma

basal squamous renal cell invasive ductal

greenstick fracture

bending and incomplete break of a bone; most often seen in children

diagnosis of sarcoma

biopsy, CT scan, ultrasound, bone scan

Diagnosis for leukemia

blood test; exam of bone marrow

When does the thermoeffector responses occur

body is beyond thermoneutral zone

comminuted fracture

bone breaks into many fragments

displaced fracture

bone ends are out of normal alignment

open fracture

bone fracture that breaks through the skin

spiral fracture

bone has been twisted apart

complete fracture

bone is broken all the way through

CM of leukemia

bone marrow depression fatigue (anemia) bleeding fever bleeding in gums, skin , mucous membranes, GI tract anorexia, wasting of muscle, taste sensitivity to sour & sweet Liver, spleen, lymph node HA, vomit, pailledema

TX for chronic leukemia

bone marrow transplantation, biologic response modifiers and combo with chemo

Where are the interpretive centers located in the brain?

brain stem, midbrain, diencephalon and cerebral cortex

_________________ is the most common cancer diagnosed in women in the US (>200,000 cases/yr)

breast cancer

impacted fracture

broken bone ends are forced into each other

closed fracture

broken bone with no open wound

nonshivering heat production=

brown adipose tissue uncoupled mitochondria protein

lipid and carb accumulation injury

can be all over but usually in spleen,liver, and CNS neurologic dysfunction

diseases related to free radicals

cancer cardiac myopathy DM RA

Lung cancer is the leading cause of _______________ in the US among men and women

cancer death

Stage 0

cancer in situ

malignant cells lack a ____________ and grown to invade nearby ________________, lymphatics and ______________________ structures

capsule blood vessels surrounding

Mendelian traits

caused by a single gene

central neuropathic pain

caused by lesion or dysfunction of brain or spinal cord

Homeostasis

cell ability to maintain steady state

autophagy

cell eats itself (canablism)

Aneuploidy

cell has three copies of 1 chromosome

Water accumulation injury

cell swelling; shift of extracellular water reversible, early sign of all cell injury

exfoliative cytology

cells shed from the surface

fat necrosis

cellular dissolution caused by powerful enzymes (lipases) that occur in the breast and pancreas

where is the cognitive evaluative system mediated?

cerebral cortex

Most common effected lymph chains effected in non-HL

cervical, axillary, inguinal, and femoral

What body functions depend on stable and optimal temp?

chemical enzymatic immune

What stimuli do nociceptors react to?

chemical, thermal, mechanical

TX of multiple myeloma

chemo radiation therapy marrow transplant poor prognosis

HL stage I, II, III, IV TX

chemo & radiation either combined or alone

Huntington's disease AKA

chorea

The three phases of chronic leukemia

chronic (2- 5 yrs) accelerated (6-18 months; primary symptoms) terminal blast phase (3-6 months)

Elevated levels of lactic dehydrogenase (LDH) and uric acid are common in what?

chronic leukemia

What is fibromyalgia?

chronic musculoskeletal syndrome lasting longer than 3 months (widespread muscle pain and tenderness)

Specificity theory of pain does not account for

chronic, cognitive or emotional pain

purpura

circumscribed area of blood greater than 0.5cm in diameter

petechiae

circumscribed area of blood less than 0.5cm

Evaluation of breast cancer

clinical breast examination, mammography, ultrasound, thermography, MRI, percutaneous needle aspiration, biopsy or minimally invasive biopsy, hormone receptor assays and gene expression profiling

frailty

clinical syndrome in elderly vulnerable to falls, functional decline, disability, disease and death

gas necrosis

clostridium caused gangrene

Peripheral thermoreceptors are mostly _________ sensitive and located __________________

cold; beneath skin

Most common type of adenocarcinoma

colon

Screenings for colon cancer

colonoscopy & blood test

necrosis

common type of cell death cell swelling and organelle breakdown

gentoype

composition of genes at a given locus

Modes of transfer for heat into environment

conduction convection radiation evaporation

pain perception

conscious awareness of pain

Processes ________________ heat or __________ it from regions

conserve; transfer

metastaic calcification

consists of mineral deposits that occur in undamaged normal tissue

Heat is _________________ produced

continuously

sweating =

cooling via evaporation on skin

thermoreceptors monitor _______temp

core

Genetic cancer is a malfunction of

creation of oncogene tumor suppression gene caretaker genes aging mechanism

squamous cell carcinoma

crusty, may bleed, scaly red patches, open sores, growth w/ a middle depression, warts

symptoms of newborn heat loss

crying, restlessness, skin cool acrocyanosis

North europeans

cystic fibrosis

DNA

cytosine thymine adenine guanine

Bad complications of compartment syndrome

dec. blood flow nerve and muscle damage cycle of cont. inc. pressure in limb ischemia

atrophy

dec. in cell size

DNA fragmentation

dec. protein synthesis

Metastasis (cancer)

defining characteristic contributes to pain invasion/local spread is prereq

Parkinson disease

degeneration of the basal ganglia = loss of dopamine- producing neurons ; inc. cholinergic activity

tertiary intention wound

delayed closure, contaminated wound

Specificity theory of pain is also known as

descartes

pattern theory

describes the role of impulse intensity and repattering of the CNS

Massage, acupuncture or intense cold or heat are examples of:

diffuse noxious inhibitory control

what CMs characterize fibromyalgia?

diffuse pain fatigue inc. sensitivity touch absence of inflammation sleep isn't good anxiety/depression

Causes of bone breaks

direct indirect compression torsion pathologic condition

Cancer pain can arise from a variety of _________ & ____________ mechanisms

direct; indirect

malignant neoplasm

disease of the cell characterized by abnormal function, growth and dissemination of affected cells alters in cell cycle that lead to poor differentiation and longer than normal lifespan programmed to spread, invade and destroy normal tissue

mod-severe force fracture

displaced impacted

metastasis=

distant

incidence of multiple myeloma has

doubled in the past 2 decades

how to protect infant from heat loss

drying quickly skin to skin contact radiant warmer increase muscle activity

peripheral neuropathic pain

due to trauma or disease on 1 or more peripheral nerves

Advance prostate cancer symptoms are

dull, deep pain or stiffness in the pelvis, lower back, ribs, or upper thighs wt loss swelling of the lower limbs

Thermoregulation at risk population

elderly lean body mass poor CV health paralysis impaired cognition impaired communication

Free radical

electrically uncharged atom or group that has unpaired electrons

radiant heat loss

electromagnetic energy exchange

CM of multiple myeloma

elevated Ca in blood, renal failure, anemia, and bone lesions - proteinuria (90%) - suppression of humoral immune system

vesicle

elevated, circumscribed, superficial, not into dermis; filled with serous fluid; less than 1 cm in diameter

papule

elevated, firm, circumscribed area less than 1 cm in diameter

nodule

elevated, firm, deep in dermis, 1-2 cm

plaque

elevated, firm, rough, top surface larger than 1 cm

Wheal

elevated, irregular-shaped area of cutaneous edema; solid, transient, variable diameter

Tumor

elevated, solid lesion, more than 2 cm, abnormal mass of tissue

pustule

elevated, superficial lesion; similar to a vesicle but filled with purulent fluid

A Fever is

elevation of the body's temp that is the effect of febrile illness and response to potentially harmful antigens

tumor suppressor genes

encode proteins that in their normal state negatively regulate proliferation (must be inactivated for cancer to happen)

stable (expanding) cells

endocrine, kidney, liver, smooth muscle

abnorm cell substance

endogenous (abnorm metabolism) or exogenous ( infectious agent or mineral

What are neuropeptides that inhibit the transmission of pain impulses in the spinal cord and brain?

endorphins

granulocytopenia

entire granulocyte count very low neutrophils reduced (<500/mm3)

chemical thermogenesis occurs as a result of ___________- inc. metabolic rate

epinephrine

renewing cells (labile)

epithelial, mucous membranes, GI bone marrow

contact dermatitis CM

erythema, swelling, pruritus, vesicular lesions

adenocarcinoma is commonly found in the _______________

esophagus

hormonal hyperplasia

estrogen dependent (uterus and breasts)

normal cell substances are

excess water, proteins, lipids, and carbs

Hypertrophic scar

excessive collagen does not extend border

Glycogen accumulation

excessive vacuolation of cytoplasm

Causes of heat stroke

exertion environmental heat impaired body function to let out heat

Stage III

extensive local/regional spread

TNM system is used to determine

extent

partial trisomy

extra portion of a chromosome in each cell

asphyxial injuries

failure of cell to receive or use O2

endogenous opioids are

family of morphine like neuropeptides; block pain messages in spinal cord, brain and periphery

Division of cancerous cells is _______________, ______________, & ______________ than normal cells

faster, more, immoral

non motor effects of parkinsons

fatigue, disturbed sleep, olfactory dysfunction, pain, ortho-hypotension, pee retention, constipation, drooling, disphoresis, dementia, psychosis, hallucination D/A

phantom sensations

feelings other than pain in missing body part

Risk factors for breast cancer

female age history BRCA 1/2 gene high breast density atypical hyperplasia high dose radiation no full term babies late age at 1st baby no breast feeding high alcohol smoking BC hormone TX inactive obesity

Normal Barr bodies

female= 1 bar body male = none

Fibromyalgia effects most ___________ and the peak age is ____________

females (80-90%) 30-50

Trisomy X

females have 3 or more X instead of 2

What influences thermoeffector threshold zone?

fever acclimatization systemic physiologic processes

telangiectasia

fine, irregular, red lines produced by capillary dilation

Macule

flat (freckle) less than cm

infectious mononucleosis symptoms

flu like (HA, malaise, joint pain) splenic rupture

A fever requires supportive_________,______________, and ____________. Cooling pt is ______________

fluids kcal O2 counter productive

heat produced is affected by

food consumption physical activity hormone levels

convective heat gain

forced air movement to restore heat to skin

protein alterations

fragmenting the polypeptide chains

symptoms of prostate cancer

frequency of peeing difficulty starting /stopping pee leaking pee when cough blood in pee inability to pee standing

efferent pathways send pain signals

from the brain to tissue receptors

Meiosis

generation of daughter cells that are different from eachother and parent cell

What causes/triggers a migraine?

genetic disorder dietary hormone change environment inc.stress sleeping

primary sites for gout

great toe, knees, ankles, and knuckles

Sickle Cell Disease

group of disorders that cause abnormal hemoglobin S w/in RBC: half moon shaped RBCs autosomal recessive homozygous form (severe)

Non-HL from T cell and NK cell neoplasms

group that includes lymphomas that originate form either T or NK cells

Scale

heaped up, keratinized cells, flaky skin, irregular, thick or thin, dry or oily

________flows from warmer to cooler areas

heat

vasoconstriction=

heat conservation

vasodilation =

heat loss

radiant heat gain

heat transfer to body from light

Duchenne Muscular Dystrophy

hemizygous X linked Males (1/3500) dystrophin gene mutation = poorly anchored muscle fibers that tear themselves apart under repeat stress of contraction; free Ca enter muscle cell = cell death/necrosis muscle weakness, difficulty walking and large calves ( cant walk by 8-13)

Sickle Cell Thalassemia

heterozygous kid gets both abnorm hemoglobin from 1 parent

heat stroke symptoms

high core temp absence of sweating rapid pulse rate confusion agitation coma

spina bifida complications

hydrocephalus seizure risk functional implications

Other bad changes from hyperthermia are

hypotenison tachycardia dec. CO = dec. perfusion coagulation

Coagulative necrosis

hypoxia caused by severe ischemia/hypoxia caused by chemical kidney, heart, and adrenal glands

diagnosis for lung cancer

imaging sputum cytology tissue sample

phantom pain can occur

immediately or months later

After pain is transmitted to the A-delta fibers and C-fibers what occurs?

impulse travels into the dorsal horn and spinal cord

Severe damage caused by free radicals

lipid peroxidation protein alteration DNA fragmentation Mitochondrial damage

Non- HL usually begins as ______________ or _______________ lymphadenopathy (similar to HL)

localized or generalized

polymorphic

locus that has 2 or more alleles that each occur w/ an appreciable frequency

limitations of gene therapy

logistics (when, how, how completely) viral vector for insertion not possible for genetic defects that express in all somatic cells

rev. cell injury

loss of ATP, caused by injurious stimuli like chemical agent, lack of O2, free radicals, physical and mechanical agents

anaplasia

loss of differentiation of cells

ulcer

loss of epidermis and dermis concaved various sizes

Sarcopenia

loss of muscle mass and strength

erosion

loss of part of epidermis, depressed, moist, glistening , follows rupture or blister or bulla

Deconditioned

loss of physical fitness

Differentiation in cancer cells is __________ compared to normal cells

lost

What is sciatica?

low back pain along lumbar nerve root

TX of non-HL

low-dose chemo followed by autologous stem cell transplantation

risk factors of gout

male, high alcohol, red meat, fructose intake

Hemizygous X linked disease

males always effected because the Y chromosome can not balance out

X-linked recessive effects more

males than females

Skin Cancer

melanoma, basal, squamous 40-50% of fair skin will have 1 type if they live to 65 cured if found early

meningocele

meninges only

CM of downs syndrome

mental disability low nasal bridge epicanthal folds protruding tongue poor muscle tone

Stage IV

metastasis

Where does the paleospinothalamic tract carry information to?

midbrain

Colon cancer

more than 200,000 case/yr most often begins as small noncancerous (benign) clumps of cells called adenomatous polyps (these polyps can then develop into colon cancer)

multiple myeloma involves_________chromosomal translocations

most

Osteoarthritis

most common form wear and tear on joints breaks down cartilage M: OA in hip, knees,Spine F: OA in hip, knees, hands risk w/ repeat jobs, obesity, med condition

neutrophilia

most numerous of granulocytes

CLL and AML are the ____________common type of leukemia in _______________

most; adults

diploid

mother and father each donate 1 chromosome per pair (23 pairs =46 chromosomes)

•B cell cancer characterized by the proliferation of malignant plasma cells that infiltrate the bone marrow and aggregate into tumor masses throughout the skeletal system

multiple myeloma

rigor mortis

muscle stiffening

The greatest amount of body heat is produced by _______________ and metabolic activity in the ____________

muscles; liver

onocogenes

mutant gene in non-mutant stage direct synthesis of proteins that positively regulate (accelerate proliferation)

Thermoneutral zone

needs no regulatory changes in heat production or loss dynamic balance

What are the two tracks of pain impulse ascension

neospinothalamic paleosinothalamic

1st line Promoters of abnormal cell

nicotine alcohol nitrates UV/radiation oncogenix viruses hormones H. pylori

There are ______ early warning signs of early prostate cancer

no

if the core temp. is within set range then _____ compensatory process is needed

no

TX of prostate cancer

nonspecific from watchful waiting to surgical options

disjunction

normal separation of chromosomes during cell division

incomplete fracture

not broken all the way through

somatic cell mutation (cancer)

not inherited present after birth later in life multifactorial and polygenic

Turner's syndrome

not intellectual but some spatial and math impairment females (75% from mom) 1/5000 short, webbing of neck, wide nipples, coarctation of aorta gymnests

fine needle aspiration

obtains dissociated cells for cytologic study; does not preserve tissue structure

Minor Force Fractures

occult patho/stress greenstick

Sex influenced defects

occur more often in 1 sex compared to the other EX: male pattern baldness

oblique fracture

occurs at an angle across the bone

Klinefelter syndrome

occurs in males 50% develop breasts 1/1000 high pitch voice sterile, small testes sparse body hair

transverse fracture

occurs straight across the bone

oxidative stress

occurs when excessive reactive O2 species overwhelm endogenous antioxidant system

When do symptoms of prostate cancer occur

once tumor causes swelling or cancer to spread beyond prostate

Huntington's disease

onset 25 to 45 Autosomal dom. rare, hereditary, degenerative hyperkinetic disorder (basal ganglia and cerebral cortex) both mom and/or dad involuntary fragmentary movement (cog. deficits, loss of working memory, dec. capacity to plan, organize and sequence)

CM of carcinoma

open sore, red patch, pink growth, shiny bumps or scars

What does the activation of nociceptors do?

opens the Ca and Na channels which creates electrical impulses to A-delta fibers and C fibers

What receptor type in the plasma membrane do endorphins attach to?

opiate

karyotype

ordered display of chromosomes

Visceral pain

organs, abs, bones non-localized

leukemia risk factors

other disease, cigarette smoke exposure

Compartment syndrome 5 P's

pain pallor pulselessness paresis paresthesia

neuropathic pain

pain caused by primary lesion or problem in nerve system that lead to long term changes in pain pathway and processing of stimuli

referred pain

pain felt in a area different from actual source area

Gate control theory

pain impulse is let in and out based on a balance of impulses conducted to the spinal cord

phantom pain

pain in an amputated limb after stump is already healed

CM of breast cancer

painless lump palpable nodes in armpit dimpling bone pain

symptoms of sarcoma

painless lump that causes pain as it grows; trouble breathing; swelling; limp

Which tract is responsible for the reflex response to pain (changes autonomic function)?

paleospinothalamic

linear fracture

parallel to long axis of the bone

Neuromodulators

pathways that mediate info about painful stimuli throughout the nervous system

neuromatrix theory

patterns of nerve impulses drawn from various inputs like: genetic, psychologic and cognitive experiences

Incomplete Penetrance

people w/ disease causing genotype may not exhibit all the visible manifestations (phenotype)

core needle biopsy

performed with direct vision or guided with CT

Hypothermia can cause

peripheral tissue ischemia due to vasoconstriction to try to keep heat in and coagulation if the temp below 28 C then ice crystals form in cell and cause rupture

Core temperature above 41.2 C result in

permanent neural damage, coma, death

Neuromatrix theory covers what hard to explain type of pain

phantom limb pain (pain from lack of input)

What are some of the genetic translocations that are observed in leukemic cells

philadelphia chromosome (between 9 and 22) 95% of those w/ CML 30% of adults w/ALL

wilms tumor diagnosis

physical, blood and urine test, imaging

malignant cells are _____________ and marked ______________ of size and shape

pleomorphic variability

irrev. cell injury

point of no return vacuolization fo mitochondria & Ca move into cell

many of the patterns of disease are ______________ or __________________

polygenic ; multifactorial

locus

position along a chromosome a gene occupies

Heat stroke

potentially life threatening result overstressed thermoreg center with a core temp above 41.2 C

Dystrophic calcification

predisposes arteries to severe narrowing and thrombosis

Leukemia clasification

predominant cell of origin degree of differentiation before became malignant

Protein accumulation

primarily in epithelial cells of renal convoluted tubule and antibody forming plasma cells of immune systems

heat exhaustion causes

profuse sweating, vasodilation, dehydration, dec. plasma volume, hypotension, dec. CO, and tachycardia

Apoptosis

programmed cell death (AKA cell suicide) normal and pathological

inhibitory neuromodulators

progressive buildup of repeated stimulation of neurons which can result in pathologic changes in the CNS

Migraines are treated

prophylactic and acute abortive

Acute pain

protective function of the body that alerts the pt of bad conditions hurting their homeostasis ie why you stop touching the hot stove

human genome project

provides basis for correcting heritable disorders

adenocarcinoma

starts in gland that line the inside of the organ; occurs when grow out of control

Impaired physical mobility

state in which a person has a limitation in physical movement but is not immobile

___________ cells in bone marrow perform less efficiently, predisposing older persons to acute and chronic illnesses

stem

Pharmacogenomics

study of how an individual's genetic make up affects the body's response to drugs

what is an example of an excitatory neuromodular

substance P & histamine

excitatory neuromodulars

substance that sensitize the nociceptors in the PNS

tumor markers

substances produced by both benign and malignant cells located on/in actual cell, blood, spinal fluid or urine include hormones, enzymes, genes, antigens, and antibodies

somatic mutation

successive generation of that cell

Causes of asphyxial injuries

suffocation strangulation chemical drowning

somatic pain

superficial, well localized, skin

symptoms of osteosarcoma

swelling or lumps around bones or ends of bones; bone or joint pain/soreness; broken bone from non-normal event

adenocarcinoma is diagnosed via

symptom analysis, screening (colonoscopy) and diagnostics (imaging, biopsy)

evaluation for multiple myeloma

symptomology radiographic lab studies bone marrow biopsy - qty measures of immunoglobulins

ashkenazi jewish

tay sachs

mediterranean

thalassemia

Autosomes

the 22 homologous pairs in males and females last pair if homologous =girl nonhomologus= boy

A break in the bone happens because

the inc energy is beyond what the bone can tolerate

Translocation

the interchanging of material between nonhomologous chromosomes chromosomes break and segment join abnormal involve more than 1 gene

Normothermia is

the state in which body temp is within 'normal' range

Genomics

the study of all of the genes in the human genome including their interactions with each other and the environment

What is the hypothalamus considered to be?

the thermostat of the body

Gene therapy

the treatment of human disease by adding exogenous wild-type genes to correct the defective function of mutations

Pain is defined as:

the unpleasant sensory and emotional experience associated w/ actual or potential tissue damage supported by the client's expression of the experience

Specificity theory of pain:

there are specific receps. in body that project to brain pain intensity related to amount of tissue injury

triploidy

three times the sets of chromosomes 69

the ______________ of liability must be crossed before the disease is expressed

threshold

What are the CMs of a migraine?

throbbing 1-side HA N/V light and sound sensitivity aura

CM of sciatica

tingling, numbness and weakness in various places of leg and foot

Pain transduction begins when

tissue is damaged by exposure to chemical, mechanical or thermal noxious stimuli

Afferent pathways send pain stimuli

to the brain from tissue receptors

Anoxia

total lack of O2 (sudden obstruction) infarction reversible if O2 restored

sensory nerves do what?

transmit stimuli from pain receptors into dorsal horn of the spinal cord

directional fractures

transverse oblique linear spiral

CM of parkinsons disease

tremor (pill rolling, resting) rigidity cogwheeling bradykinesia postural instability

stage I

tumor limited to tissue of origin

success of non- HL TX depends on

type, stage, cell type, involved organs, age, severity of body's reaction

The cause of phantom pain is?

unknown

survival of nodular lymphoma ranges

up to 15 years

nondisjunction

usually aneuploidy caused failure of homo chromo or sister chromatid to split during meiosis or mitosis

evaporative heat loss

vaporization of liquid on skin

Diaper Dermatitis

vary from mild erythema to erythematous papular lesions

What areas of the brain get afferent stimulation that causes efferent pathways from the brain to send pain signals to the affected tissue?

ventromedial medulla and periaqueductal gray matter in the midbrain (inhibits afferent signals to dorsal horn)

bones commonly involved in multiple myeloma

vertebrae, ribs, skull, pelvis, femur, clavicle, scapula

Loss of height in the elderly is due to ?

vertebral disks degnerate tendons shrink and harden

Autosomal dominant

very rare <than 1 in 500 1 allele for observable effect 50% of recurrence M/F affected = no generations skipped

bulla

vesicle larger than 1 cm in diameter

How do newborns produce heat

via nonshivering method of burning brown fat

Central _________-sensitive thermoreceptors are most common then central _____________- sensitive receptors

warm; cold

respiration contributes to heat loss by

warmer air being exhaled

Conductive heat loss

warmer skin to colder surface

conductive heat gain

warmer surface to skin

shivering =

warming effect; involuntary motor activity aerobic contraction

multifactorial inheritance

when environmental factors influence the expression of the trait height and IQ

somatic death

whole person dead

Vacuolation

within cytoplasm and swelling of lysosomes & marked mitochondrial swelling if no O2 restored

Primary intention wounds

wounds that heal under conditions of minimal tissue loss -paper cut & surgery incision

Secondary intention wound

wounds that require a great deal more tissue replacement ex: deep open wound & pressure ulcer

diagnosis of osteosarcoma

xray CT MRI bone scans

BMR is higher in

younger pt

infectious mononucleosis

•Acute infection of B lymphocytes (B cells) with Epstein Barr virus adult 15-35 45/10,000 transmission via saliva (or other secretions)

leukemia

•Clonal malignant disorder of the blood and blood-forming organs

Malignant lymphoma

•Diverse group of neoplasms that develop from the proliferation of malignant lymphocytes in the lymphatic system hodgkin & non-hodgkin

compartment syndrome

•Increased pressure w/in the muscle compartment causing compression on vessels & nerves

Gout is

•Localized metabolic inflammation of joints from excess serum uric acid and is triggered by stress or trauma - Overproduction of uric acid causes crystallization of synovial fluid in joint

Mobility

•Purposeful physical movement, including gross simple movements, fine complex movements and coordination

-Rhabdomyolysis

•Rapid breakdown of muscle causing release of intracellular myoglobin (when excreted in urine can cause acute tubular necrosis & dark brown urine)

Fat Emboli

•Release of a fat globule following long bone fracture (femur) that travels to heart & lung causing dyspnea, tachycardia, & chest pain (pulmonary embolism)

Contact dermatitis

•The allergen comes in contact with the skin, binds to a carrier protein to form a sensitizing antigen; Langerhans cells process the antigen and carry it to T cells, which become sensitized to the antigen

Non-HL from B-cell neoplasms

•group that consists of a variety of lymphomas including myelomas that originate from B cells at various stages of differentiation

lymphocytosis

•seen most commonly in acute viral infections (particularly in Epstein-Barr)

X inactivation

1 X chromosome in the somatic cells of females is permanently inactivated

haploid

1 member for each chromosome pair for a total of 23 chromosomes

debridement

*Cleaning up the dissolved clots, microorganisms, erythrocytes, and dead tissue cells

healing of the wound includes

*Filling in the wound *Sealing the wound (epithelialization) *Shrinking the wound (contraction)

Hodgkin lymphoma

- Progression from one group of lymph nodes to another, the development of systemic symptoms and the presence of Reed-Sternberg cells

histologic grading

- degree of differentiation - Grade I to IV

Lymphocytopenia

-Abnormalities of lymphocyte production associated with neoplasias and immune deficiencies -Destruction by drugs, viruses or radiation -No known cause

CAUTION stands for

-Change in BM/pee habit - A sore that wont heal - unusual bleeding/discharge -Thickening or lump Indigestion/dysphagia - Obvious change in wart/mole - nagging cough/hoarseness

Phase III: Remodeling and Maturation

-Continuation of cellular differentiation -Scar tissue formation & tissue remodeling -Scar remodeling for up to 2 years

Tx of diaper dermatitis

-Frequent diaper changes to keep area clean and dry -Frequent exposure of perineal area to air -Topical antifungal medications -Short-term topical steroids -Barrier creams or pastes

Phase 1: Inflammatory Phase

-Hemostasis -Platelet adhesion, platelet activation, platelet plug -Fibrin clot formation -Recruitment of phagocytic cells and wound debridement

multiple hit theory

-Self sufficiency in growth signals -Insensitivity to antigrowth signals -Evading apoptosis -Limitless replicative potential -Sustained angiogenesis -Tissue invasion and metastasis ALL CANCERS MUST ACQUIRE IN 6 AREAS

Types of breast cancer

-adenocarcinoma -ductal carcinoma in situ -inflammatory breast cancer - invasive lobular carcinoma -male breast cancer - paget's disease of the breast

Phase II: Proliferative Phase

-angiogenesis (O2 to bed) & granulation -Beefy red granular appearance-Pink means lack of 02 -Fibroblasts form collagen -Contraction of the wound -Epithelialization

Euploid cells

-cells with a multiple of the normal number haploid and diploid

Symptoms of colon cancer

-change in BM -rectal bleeds/blood in stool -bowel fullness -weakness/fatigue -unexplained wt loss

Factors that can causes hyperthermia are

-injury to hypothalamus -genetic abnorm -environment - exert rhabdomyolysis

Factors hurt wound healing

-lifestyle -environment -nutrition -inadequate hydration - mobility loss -inadequate perfusion lack of skin integrity

contractures

-permanent muscle & tendon shortening due to fibrotic changes from muscle spasm or weakness

Types of physiologic thermoeffector responses

-sweating -shivering -nonshivering heat production -vasoconstriction -vasodilation

polyploid

-when a euploid cell has more than the diploid number of chromosomes

Phases of wound healing

1. inflammatory phase 2. proliferative phase 3. maturation phase

Body temperature is only allowed to vary by how many degrees before the body intervenes?

1.5 C

CM of HL

1/3 have fever, night sweats, itchy skin -pericardial friction rub -pericardial effusion -engorgement of neck veins

Malignancy Stages (Old Theory)

1: initiation 2: promotion 3: progression

Klinefelter

2 X and 1Y in each cell

Heterozygous

2 alleles are not identical

homozygous

2 alleles are the same

mitosis

2 genetic identical daughter cells from 1 parent cell

Lung cancer affects more than ____________ americans yearly

200,000

homologous chromosomes

22 of the 23 chromosome pairs, the 2 members of each pair are virtually identical

survival rates range from ____ for AML to ______ for CLL

23%; 74%

incidences of HL _____/100,000 males and ______/100,000 females; greater in whites than blacks

3 2.6

There are ___________ cases of prostate cancer in the US yearly

3 million

moderate hypothermia

30 to 34 C

mild hypothermia

34C to 36 C

Thermoeffector threshold zone's acceptable core temp

36 - 38.5 C

Tetraploidy

4 pairs of chromosomes 92

Turner's syndrome AKA

45, X

Klinefelter syndrome AKA

47, XXY

Muscle loss begins around age?

50

perspiration accounts for __________ml of waer loss daily

600

Irritant contact dermatitis

80% non-immunologic inflammation chemical irritation similar to allergic contact tx: remove stimulus

about ______ of all ALL arise from the b cell line and ______ from T cell

85%; 15%

Osteosarcoma

<20,000/year common in kids and teen boys -ends of long bones - error in DNA or coding

Severe hypothermia

<30C

nicotine causes _______

>30%

DNA pairs

A-T G-C

Down syndrome

AKA trisomy 21 most well known aneuploidy 1/800 babies inc risk with mom >35

Four types of leukemia

Acute lymphocytic (ALL), acute myelogenous (AML), chronic lymphocytic (CLL) chronic myelogenous (CML)

Risk factors for fracture

Age bone disease poor nutrition lifestyle habit

RNA pairs

U+A C+G

Static (permanent) cells

CNS, skeletal muscle, myocardium

benign neoplasm

Cells arise from normal differentiated cells keep normal cell appearance and function can mitosis but not metastasis

lipid peroxidation

Destruction polyunsaturated fats

allele

Different forms of a gene at a particular locus

Free radicals are triggered by

UV light &radiation reduction of O2 to H2O

Cyst

Elevated, circumscribed, encapsulated lesion; in dermis or subcutaneous layer; filled with liquid or semisolid material

Stage III pressure ulcer

Full-thickness skin loss involving damage or loss of subcutaneous tissue (not through deeper tissues such as fascia)

Stage IV pressure ulcer

Full-thickness skin loss with damage to muscle, bone, or supporting structures

Hypothermia

accidental or therapeutic decrease in body temp <36.2C

The second step in pain transduction is

activation of nociceptors

Sensory - discriminative system

ID the presence, character, location, and intensity of pain

tx for leukemia

Main = chemo blood transfusions antibx, fungals and virals

stump pain

acute nociceptive pain at amputation site

compensatory hyperplasia

adaptive mech that allows certain organs to regenerate

Somatic pain is also associated with the CM

N/V and shock

Migraines might also be accompanied with

N/V, irritability, constipation, diarrhea, photophobia

Prolonged sweating due to hyperthermia can lead to

Na loss and dehydration

Stage I pressure ulcer

Non-blanching erythema (redness) of intact skin

Stage II pressure ulcer

Partial-thickness skin loss involving epidermis or dermis (blister)

excoriation

linear, hollowed out, crusted area, loss of epidermis

CM of lung cancer

SOB coughing up blood pain fluid in chest

Tx for fibromyalgia

SSRI, anticonvulsant, antidepressants, opioids PT, exercise cognitive-behavioral therapy acupuncture, biofeedback, chiropractic, massage

Types of lung cancer

Small cell and non-small cell

Neural tube defects

Spina Bifida meningocele myelomeningocele anencephaly encephalocele causes of gene and environment

TNM stands for

T=tumor N=nodal involvement M= metastasis

caseous necrosis

TB pulmonary infection, tissue soft and granular like cheese

myelomeningocele

spinal cord and meninges

RNA

Uracil cytosine adenine guanine

A migraine is described as

a HA that begins in temporal region one sided after vascular changes of cranial arteries

occult fracture

a bone fracture that cannot be detected by X-ray until several weeks after the injury ('occult' means 'hidden')

patch

a flat, nonpalpable, irregular shaped greater than 1 cm in diameter.

stress fracture

a small crack in the bone that often develops from chronic, excessive impact

Wilms tumor symptoms

ab mass (palpable) ab swelling ab pain

metastasis

ability to spread far beyond the tissue of origin

Dysplasia (atypical hyperplasia)

abnorm change in size, shape, and organization of mature cells

Contractures

abnorm exaggeration of wound contraction red. mobility shrinking deform wound

Carcinoma in situ

abnormal cells that stay in the cells of origin and do not spread

pathologic hyperplasia

abnormal division of a normal cell; response to hormone stimuli or growth factor target

Hyperthermia is

abnormally high temp leads to body changes including CV collapse and damage to NS >37.6C

Peripheral warm sensors are located

in dermia

impaired bed mobility

inability to change positions in bed independently

Barr bodies

inactivated X chromosomes are observable in many interphase cells as highly condensed intranuclear chromatin bodies

Labs for Gout

inc erythrocyte sedimentation & C- Reactive protein

mutagens

inc. frequency of mutations

hypertrophy

inc. in cell size

hyperplasia

inc. in number of cells from inc. division

Granulocytosis

increase in granulocytes

Growth in cancerous cells is at a _______________then normal cells

increased rate

carrier

individual who has a disease gene but it phenotypically normal

Cognitive- evaluative system

individual's learned behavior from experience of pain and modulate perception of pain how you adjust pain grading in front of a super attractive person vs your mom

Affective- motivational system

individuals conditioned avoidance behavior and emotional response to pain learned from bad experiences like a bad vaccine

2nd line Promoters of abnormal cells

inflammation dec. immunity chemo diet (low fiber; high fat) obesity inactivity depression sex practices

Three phases of bone healing

inflammatory> reparative>remodeling

Metabolic activity includes

ingestion, BMR, and metabolism of food

Descending inhibitory pathways

inhibit afferent (to the brain) pain signals at dorsal horns

Diffuse noxious inhibitory control

inhibitory system that involves spinal-medullary-spinal pathway

Calcium accumulation

injured and dead tissue

Fragile X syndrome

intellectual disability 1/4000 (M) 1/8000 (F) Females dont always express but carriers males always express because only 1 X

cellular accumulations

intracellular accumulation of abnormal amounts of various substances and the resultant metabolic disturbances

Physiologic thermoeffector responses are ________________ responses to heat & cold that ____________ or _______________ heat

involuntary conserve transfer

germ-cell mutation

involves fertilization all somatic cells and 1/2 of germ cells have mutation

Keloid

irregular shape, beyond borders excessive collagen common in african americans

initiation stage

irreversible mutation of a gene that may lead to a malignant transformation

pain modulaton

is many different mechanisms that inc. or dec. the sending of pain signals in the nervous system

liquafactive necrosis

ischemic injury to neurons and glial cells in brain; cells digested by themselves

Hypoxia

lack of O2 common cell injury dec. air O2, loss hemoglobin, dec. RBC, disease of resp and CV system

Chronic pain:

lasts more than 12 wks, well beyond expected normal healing time

Where does the neospinothalamic tract carry information to?

lateral thalamus & cortex

ALL Leukemia is ____________ common type overall but ___________common in kids

least; most

In kids under the age of 15 _________________ accounts for more deaths than any other cancer

leukemia

mitochondrial damage

liberation of Ca into the cytosol

Stage II

limited local spread

Sex limited defects are

limited to only one sex so basically a female cant have a testicular defect

livor mortis

purple discolor after death

visceral pain is described as

radiating

What type of pain does A-delta fibers transmit?

rapid, sharp, localized pain (withdrawal reflex & pain modulation)

Sarcoma

rare cancer of connective tissues (bones, muscles, tendons,etc)

Wilms tumor

rare kidney cancer kids (3-4 year old) AKA nephroblastoma

Autosomal recessive

rare; 1 in 2500 births M & F affected = marriage between relatives seen in siblings but not parents 1/4 effected offspring

ischemia

reduced blood supply (most common), rev if O2 restored cause: arteriosclerosis thrombosis

algo mortis

reduced body temp after dead

neutropenia

reduction in circulating neutrophils (<2000/mm3)

Gangrenous necrosis

refer to death of tissue from a severe hypoxic injury

incisional biopsy

removal of a selected portion of a lesion

convective heat loss

removal of heat from skin due to breeze from air

excisional biopsy

removal of tissue and a margin of normal tissue

promotion stage

required for malignancy - the promoting agent simulates the growth and division of a cell

poikilothermia

result from low body temp below 30.8

phenotype

result of genotype and environment; actual appearance

Heat exhaustion

results from prolonged high core or environmental temp

reperfusion injury

results from the generation of highly reactive intermediates WBC effected rev. by antioxidant TX

where mediates the affective motivational system?

reticular formation, limbic system, and brain stem

where does pain perception occur?

reticular/limbic systems & cerebral cortex

metaplasia

rev. replacement of 1 mature cell type by another

Adaptation

rev. structural of functional response to both normal, adverse, and pathologic conditions

lichenification

rough, thickened epidermis secondary to persistent rubbing, itching, or skin irritation

Prevention for breast cancer

screening moderate alcohol exercise limit hormone tx healthy weight diet

Epithelialization

sealing the wound

local invasion/extension

seeing

telescoping

sensation that missing part of limb is gradually approaching limb stump

What are examples of inhibitory neuromodulators

seratonin and noephinephrine

progression stage

series of change that lead to undifferentiated cell; increased growth rate of the tumor, increased invasiveness, and metastasis

atopic dermatitis

severe form of eczema etiology unknown onset infancy; develops by age 5 itching, eruption of red, weeping, crusting patch on the skin

Pathological causes of apoptosis

severe injury misfold proteins infection obstruction in tissue ducts

Somatic pain is described as

sharp, dull, aching, throbbing

contraction

shrinking the wound

African Americans

sickle cell & thalassemia

Sickle cell pain occurs due to

sickled erythrocytes plugging blood vessels, inc. the viscosity of blood

Turner

single X (not XX or YX)

disuse atrophy

skeletal muscle shrinks do to not using

Peripheral thermoreceptors are located in

skin, oral, and urogenitial mucosa

What type of pain does C fibers transmit?

slow, dull, aching, burning

Symptoms of chronic leukemia

slowly and insidiously splenomegaly extreme fatigue wt loss night sweats low grade fever liver enlargement

Nociceptors are

small unmyelinated and/or lightly myelinated nerve endings of afferent neurons in nearly all tissue

Risk factors for lung cancer

smoking (1st and 2nd hand) radon gas asbestos history

Types of sarcoma

soft tissue bone (osteosarcoma)

sporadic cancer is from

somatic cell mutation

What is the sensory discriminative system controlled by?

somatosensory cortex

polygenic traits

some traits results that are produced from several genes acting together

gametes

sperm and egg