Patho - Test 3
Secondary
-Elevation of pulmonary venous pressure (mitral valve disorders, left ventricular diastolic dysfunction) -Increased pulmonary blood flow (left to right shunts in congenital heart diseases, atrial or ventricular septal defects and patent ductus arteriosus) -Pulmonary vascular obstruction (pulmonary embolism) -Hypoxemia (advanced COPD or interstitial lung diseases) -Majority (type of pulmonary hypertension)
Postural
Small curve that corrects with bending. Corrected with passive and active exercises. (scoliosis)
Osteomalacia
Softening of bone in adults due to inadequate mineralization
Diuretics
Some increase loss of potassium, magnesium, and calcium (type of drug)
Hepatic Failure
Symptoms: -jaundice -ascites -fetor hepaticus (ammonia and ketones in breath) -hypoalbuminemia -hypoglycemia -palmar erythema -spider angiomata -testicular atrophy -balding -gynecomastia -bleeding disorders -hepatorenal syndrome -hepatic encephalopathy -muscle wasting -decreased movement -portal hypertension -renal dysfunction
Fractures
Symptoms: Pain, tenderness, swelling, loss of function, deformity of the affected part, abnormal mobility. X-ray confirms Dx
Diabetes
Symptoms: polyuria, polydipsia, polyphagia, weight loss, tiredness, lack of interest/concentration, numbness in hands/feet, blurred vision, frequent infections, slow-healing wounds
Sjogren's Syndrome
Systemic autoimmune disease that affects the entire body; dry mouth
Systemic Lupus Erythematosus (SLE)
Tx: •NSAIDS •Antimalarial drugs for rashes or musculoskeletal manifestations •High-dose corticosteroids for acute symptoms •Monoclonal Antibodies •Block B cell antibody production
Rheumatoid arthritis
Tx: •Rest and therapeutic exercise •Medications: NSAIDs, corticosteroids, antirheumatics, monoclonal antibodies •Surgery •OT: Splinting (anti-deformity positions), ADL retraining, joint protection strategies
Small cell lung cancer
Tx: Chemotherapy with or without radiation. Surgery is generally not recommended due to metastases (type of lung cancer)
Compartment syndrome
Tx: Relieve pressure (fasciotomy) (for a complication of fracture)
Non-small cell lung cancer
Tx: Surgery, radiation therapy and chemotherapy (type of lung cancer)
Diabetes/Metabolic Syndrome
Tx: meds (Metformin), surgery, diet/exercise* (2)
Rhinosinusitis
Tx: §Depends on the cause §Viral- self-limiting §Bacterial- antibiotics (reserved for severe cases) §Nasal polyps- may require surgery §Symptom management- intranasal corticosteroids or decongestants
Influenza
Tx: §Limit infection to upper respiratory tract §Early detection --> antiviral
Respiratory distress syndrome
Tx: §Mechanical ventilation and oxygen supplementation (may cause bronchopulmonary dysplasia and chronic respiratory insufficiency) §Surfactant
common cold
Tx: §Self-limited illness §Symptomatic treatment, bed rest, and antipyretic drugs §Antibiotics are not recommended
Osteomyelitis
Tx: •Identify causative organism •Treat organism (e.g., antibiotic) •Rest & pain management •Possible drainage
Tendonitis
Tx: •Rest •Occupational therapy &/or PT Bracing and exercise •Anti-inflammatory medications •Surgery in severe cases (tears)
24 weeks
Type II alveolar cells begin to develop and produce surfactant (stage of lung development)
Squamous cell carcinoma, Adenocarcinoma, Large cell carcinoma
Types of Non-small cell lung cancer (3)
•Angulation •Shortening •Rotation
Types of deformities of long bones in fractures (3)
Osteoprogenitor cells
Undifferentiated cells that differentiate into osteoblasts. Found in the periosteum, endosteum, and epiphyseal growth plate of growing bones. Stem cell
Chlamydia, Gonorrhea
Untreated ___ and ___: increased risk of Pelvic Inflammatory Disease in women
Saliva production, swallowing, esophageal motility and integrity, LES tone, ulcers
Upper GI problems (5)
Gonorrhea
Usually asymptomatic in women, symptomatic in men. Untreated can spread to bloodstream. Can lead to arthritis/joint pain/inflammation, multiple skin lesions
Antacids (long term use)
Vitamin B12 deficiency (type of drug)
Micronutrients
Vitamins, Minerals
Secretion`
Water, HCl, enzymes, some organic waste products (GI System process)
Absorption
Water, electrolytes, simple sugars, amino acids, fatty acids, vitamins, minerals (GI System process)
Retinopathy
Weakening of the blood vessels in the retina and the obstruction in the capillaries from very tiny blood clots. Higher risk for cataracts and glaucoma (diabetes complication)
Bone Homeostasis
Major influences on __ ________: •Mechanical stress •Calcium and phosphate levels •Cytokines •Hormones
Portal hypertension* (varices, splenomegaly, ascites, hepatic encephalopathy), jaundice
Manifestations of liver disease (2)
Systemic Lupus Erythematosus (SLE)
Manifestations: baldness, butterfly rash, oral ulcers, CNS symptoms, anemia/neutropenia, splenomegaly, osteoporosis, pleuritis, pericarditis, fingertip lesions, polyarthritis, pleural effusion, atelectasis (collapse)
Osteocytes
Mature bone cells, for maintenance of bone matrix. Play an active role in releasing calcium into the blood. Maintains bone tissue
Genu valgum
Medial malleoli do not touch when knees touch. •Common at age 3-4 •May require exercise, surgery as treatments if not resolved by 7 years old
BP (> 130/85mmHg); Blood glucose (insulin resistance, FBG ≥ 110mg/dL); Visceral (Waist: men > 40in; women >35in); Triglycerides (≥ 150mg/dL); HDL cholesterol (men <40mg/dL; women <50mg/dL)
Metabolic Syndrome Criteria (need 3 or more for Dx): -Increased ___ -High __ ____ -Excess ___ adiposity -High ___ -Low ___
insulin; apple
Metabolic Syndrome is a cluster of metabolic abnormalities related to ___ resistance. -Associated with high-risk overweight/obesity phenotype -___-shaped, central/visceral adiposity
Liver
Metabolizes, or breaks down, nutrients from food to produce energy when needed
Osteoarthritis
Risk factors: •Obesity •Injury when young •Advanced Age •Sex (male younger, female older) Treatment (symptom management): •Joint protection (exercise, rest, weight management) •Acetominophen or NSAIDs •Corticosteroid injections •Total joint replacement (severe cases)
Obesity
Weight that is higher than what is considered a healthy weight for a given height
•PT and/or OT •Return to daily activities •Structured exercise
What can a patient do to regain mass & function after immobilization? (3)
Metabolic bone disease
What happens when bone remodeling goes awry
Rheumatic disorders
What happens when inflammation goes awry
Compression fracture
Which bones are best at resisting?
Klinefelter syndrome
XXY genotype
Rhinovirus
most common cause of colds in persons aged 5 to 40 years
Irritable Bowel Syndrome
persistent/recurrent symptoms of abdominal pain, altered bowel function, flatulence, bloating, constipation or diarrhea, nausea, anorexia
Endometriosis
scarring of oviducts (fallopian tubes) prevents fertilization; Endometrial tissue outside uterine cavity and stimulates inflammatory response; "chocolate cysts;" most are mild cases Symptoms: dysmenorrhea, dyspareunia, infertility Tx: pain meds (NSAIDS), hormonal contraceptives, surgical removal, chemically-induced menopause
BMI (body mass index)
weight (kg)/[height (m)]2
Rhinosinusitis
§Acute - Facial pain, headache, purulent nasal drainage, decreased sense of smell, and fever §With maxillary sinus: pain with bending, unilateral maxillary pain, pain in teeth §Often difficult to distinguish from common cold and allergies
The common cold
§Acute, upper respiratory symptoms §Begins with a sore scratchy throat followed by rhinorrhea, nasal congestion, sneezing, and coughing
Rhinosinusitis
§Chronic - only symptoms may be nasal obstruction, a sense of fullness in ears, postnasal drip, hoarseness, chronic cough, and loss of taste/smell §Sinus pain is often absent, but may complain of a headache
Pneumonia
§Definition: inflammation of the parenchymal structures of the lung (bronchioles and alveoli) §Can be infectious and noninfectious
Rhinosinusitis
§Due to proximity, infection and inflammation can extend to cause cranial and orbital damage
Large cell carcinoma
§Large, polygonal cells, occur in the periphery of the lung
Adenocarcinoma
§Most common type of lung cancer found in women and nonsmokers §Originate in the bronchiolar or alveolar tissues, most located peripherally
Rhinosinusitis
§Most commonly due to obstruction of sinus drainage. Inflammation of the paranasal sinuses
Squamous cell carcinoma
§Most commonly found in men with smoking history §Tend to originate in the central bronchi (cells get coughed up increases chance of early detection)
Small cell lung cancer
§Small round to oval cells that grow in clusters §Presence of neurosecretory granules (may arise from neuroendocrine cells of the bronchial epithelium; responsible for paraneoplastic syndrome)
Respiratory Failure
•A condition in which the respiratory system fails in one or both of its gas exchange functions — oxygenation of mixed venous blood and elimination of carbon dioxide (PO2 < 60 mmHg, PCO2 > 45 mmHg, or both)
Cystic fibrosis
•Autosomal recessive genetic disorder in chloride transport proteins, CFTR ̶High concentrations of NaCl in the sweat ̶Less Na+ and water in respiratory mucus and in pancreatic secretions ºAccumulation of viscid mucus in the bronchi --> airway obstruction ºObstruction of pancreatic and biliary ducts
Bony callus formation
•Cartilage is ossified to form a bony callus •Formation of bone progresses toward the fracture site until a new bony sheath covers the callus •Fibrocartilage is converted to woven bone and gradually calcifies into mature bone
Pulmonary embolism
•Causes: -Thrombus (majority) -Air, fat, amniotic fluid
Bronchiectasis
•Clinical Manifestations: -Recurrent bronchopulmonary infection -Coughing, production of large amount of purulent sputum and hemoptysis -Marked dyspnea and cyanosis -Clubbing of fingers -Weight loss and anemia
Pulmonary embolism
•Clinical Manifestations: ̶Rapid and shallow breathing ̶Pleuritic pain, cough productive of blood-streaked sputum ̶Tachycardia ̶Pulmonary hypertension and right heart failure ̶Can be fatal
Sprain
•Common sites of injury: Ankle, knee (ACL), elbow
Strain
•Common sites of injury: Lower back, neck, hamstring
Compartment syndrome
•Compromises circulation and function •Screen for signs •Nerve and muscle death in 8 hrs (complication of fracture)
Remodeling
•Dead bone is removed by osteoclasts •Compact bone replaces spongy bone •Excess material is removed and compact bone is laid to reconstruct the shaft
Ligaments, Tendons
•Dense regular connective tissue •Inelastic collagen fibers •High tensile strength (2)
Woven bone (immature)
•Deposited rapidly •Temporary scaffolding for support •Low tensile strength •Found in developing fetus, areas surrounding tumors and infections and in fracture healing
Rhabdomyolysis
•Direct or indirect severe muscle injury (e.g., trauma, statins, excessive alcohol) •Complications: Acute renal failure, fatal heart rhythm disturbances, hypovolemic shock, disturbances of electrolyte balance, metabolic acidosis, hyperthermia, compartment syndrome
Ligaments, Tendons
•Disorganization of parallel fibers •Loosening of fibers attached to bone (↑osteoclastic activity) (effects of long-term immobilization on what structures)
Bronchial asthma
•Features: ̶Chronic recurring inflammation ̶Hyperreactive airways ̶Episodic, reversible bronchoconstriction persistent changes may occur, including mucus hypersecretion, injury to epithelial cells, smooth muscle hypertrophy, and blood vessel proliferation •Classification: ̶Extrinsic (atopic, a type I hypersensitivity response to an extrinsic antigen) ̶Intrinsic (nonatopic, non-immune mechanisms)
Fibrocartilaginous callus formation
•Granulation tissue called procallus is formed •Fibroblasts invade the procallus •Fibroblasts produce soft callus bridge that connects bone fragments
Collagen
•Increased degradation rate •Reduced mass (effects of long-term immobilization on what structure)
Tendonitis
•Inflammation of a tendon where it attaches to or contacts a bone •Causes: Repetitive motion/overuse •Symptoms: •Pain •Tenderness •Weakness
Spongy bone
•Inner bone •Light weight, lattice like pattern •Compressive (force absorption) •Functional Unit: Trabeculae
Sprain
•Involves ligaments or joint capsule •Due to abnormal or excessive movement of a joint •Symptoms: Pain, rapid swelling, discoloration, and limited function
Lamellar bone (mature)
•Made of cylindrical osteons or Haversian systems •Concentric lamellae of bone matrix surround a central Haversian canal •Tiny weight-bearing pillars
Cystic fibrosis
•Manifestations in lung function ̶Chronic bronchiolitis and bronchitis ̶Bronchiectasis Chronic infection
Atelectasis
•Manifestations: -Decreased chest expansion and breath sounds on affected side -Intercostal retraction during inspiration -Signs of respiratory distress: tachypnea, tachycardia, dyspnea, cyanosis, signs of hypoxemia
Pleural effusion
•Manifestations: -Vary with the cause -A decrease in lung expansion on the affected side -dullness or flatness to percussion, diminished breath sounds -Dyspnea, hypoxemia, pleuritic pain
Disorders of Ventilation and Gas Exchange
•Obstructive Lung diseases •Restrictive lung diseases •Pulmonary Vascular Disorders •ARDS/Respiratory Failure
Resorption
•Organic and inorganic components are removed, creating a tunnel-like space in the osteon •Soluble factors (e.g. OPG) released aid in the recruitment of osteoblasts to the site ("reversal") (bone remodeling stage)
Compact bone
•Outer shell •Densely packed, calcified extracellular matrix (more rigid) •Functional Unit: Osteon
Systemic Lupus Erythematosus (SLE)
•Primarily seen in young females (15-40 years) •Incidence higher in some families
Gout
•Primary: Cause unknown or metabolic error; hyperuricemia •Secondary: Due to underlying disorder
RANKL
•Produced by osteoblasts •Binds to RANK receptor and promotes activation of osteoclasts
Muscle
•Reduced protein synthesis •Increased protein breakdown (↓ muscle mass) (effects of long-term immobilization on what structure)
Osteopenia
•Reduction in bone mass •Term used to describe lack of bone mass on x-ray (not a diagnosis)
Pneumothorax
•Results in partial or complete collapse of the affected lung -Spontaneous: an air-filled bleb on the lung ruptures oPrimary: occurs in otherwise healthy persons oSecondary: occurs in persons with underlying lung disease Traumatic: air enters through chest injuries
Strain
•Stretching or partial tear in a muscle or muscle-tendon unit •Inflammatory response and fibrous tissue replacement at the site •Symptoms: Pain, stiffness, swelling, and local tenderness
Formation
•Successive lamellae are deposited, and the canal attains relative proportions of original osteon •When they receive a signal, osteoblasts release RANKL (induces osteoclast activity) (bone remodeling stage)
Rheumatoid arthritis
•Systemic, chronic autoimmune disease •Peak incidence between 40 and 50 years •Genetic predisposition (HLA type) + immunological trigger
Marasmus
•Undernourishment characterized as energy deficit and reduction in all nutrients •Loss of muscle and fat stores •Diarrhea is common •Children - growth failure •Disordered Eating and Eating Disorders •Associated with Female Athlete Triad •now using term Relative Energy Deficiency in Sports (RED - S) Occurs in male and female athletes
Scoliosis
•Uneven shoulders or iliac crest •Prominent scapula on convex side of curve •Asymmetry of thoracic cage (cardinal signs of __)
Crohn's disease
Does not characteristically predispose to cancer
Chylothorax
Effusion of lymph in the thoracic cavity (type of pleural effusion)
Disorders of lung inflation
Conditions that obstruct the airways, cause lung compression, or produce lung collapse
Osteoporosis
Tx: •Exercise (weight-bearing) •Calcium, vitamin D •Medications (e.g., bisphosphonates)
Gout
Elevated serum uric acid •Overproduction or excessive breakdown of purines (adenine and guanine) •Decreased uric acid excretion
Emphysema (COPD)
Enlargement of air spaces and destruction of lung tissue; barrel chest
Osteoporosis
Risk Factors: Personal Characteristics -Advanced age -Females -Ethnicity (white or Asian) -Small bone structure/low body weight -Postmenopausal -Family history Lifestyle (modifiable) -Sedentary -Calcium/Vitamin D deficiency -Malnutrition -Smoking -Excessive alcohol intake -Excessive caffeine intake (*) -Medications
Lung cancer, COPD
Risk factor: cigarette smoking (2)
Acquired atelectasis
In adults; Commonly caused by airway obstruction and lung compression (mucous plug, pneumothorax or pleural effusion)
equilibrium
In normal bone, the remodeling cycle of resorption and formation is at __
Genu varum
Outward bowing of knees (>1 in.) when medial malleoli are touching. May require bracing after 2 years old
Appendicitis
Pain localizes in lower right quadrant
Osteomalacia
Risk factors: •Elderly (deficient diets & malabsorption) •Long-term anticonvulsant or diauretic treatment (metabolic bone disease)
Developmental Hip Dysplasia
Congenital disorder •Screening: Ortolani test (Flex/abduct hips; Should be equal, produce no click) •Tx: Pavlik harness. Results from underdeveloped hip socket
Ligaments
Connect bone to bone
Tendons
Connect muscle to bone
Bone (osseous tissue)
Connective tissue that provides: •Support/protection •Levers for muscle •Mineral storage
Osteopenia
Contributions to ____: Endocrine disorders •Hypogonadism •Menopause •Hypercortisolemia •Hyperthyroidism •Hyperparathyroidism Multifactorial issues •Pregnancy •Type 1 diabetes •HIV/AIDS •Anorexia •Relative Energy Deficiency in Sport (RED-S) Nutritional disorders -Renal failure -Chronic liver disease -Alcohol abuse -Calcium deficiency -Vitamin D deficiency -Malabsorption -Inflammatory bowel disease
Gout
Crystal-induced inflammatory disorder; primary manifestations in joints/kidneys
•Whole body •Lumbar* •Femur* •Wrist*
DXA imaging options: (4)
Neuropathy
Damage to nerves in the body (diabetes complication)
spurs, collagen, eroded
Damaged joint cartilage tries to heal itself in OA: creating osteophytes or ___; cartilage contains more water, less ___; cartilage becomes weak, rough, ____
Cholestyramine
Decrease absorption of fat soluble vitamins as well as vitamin B12, folic acid and calcium (type of drug)
Systemic Lupus Erythematosus (SLE)
Defective elimination of self-reactive B cells and increase in antibody production, causing tissue damage
Vitamin D
Deficiency in ___ can cause: Adults: Increased fractures, muscle weakness, bone loss (can contribute to osteoporosis, osteomalacia). Children: growth delay, soft bones, Rickets
Calcium
Deficiency in ___ can cause: Adults: osteoporosis, osteomalacia. Children: soft bones, Rickets
Iodine
Deficiency in ___ can cause: goiter
Vitamin B12
Deficiency in ___ can cause: megaloblastic anemia
Osteoporosis
Deficiency of calcium, Vitamin D
Neural tube defects
Deficiency of folic acid
Anemia
Deficiency of iron, Vitamin B12, folate
Kwashiorkor
Deficiency of protein, seen in alcoholics; edema, hair changes, apathy, anemia, muscle wasting, dermatoses, fatty liver
BeriBeri
Deficiency of thiamin (alcoholics)
Vitamin A
Deficiency of this nutrient can lead to congenital anomalies in pregnancy, night blindness
Folate
Deficiency of this nutrient can lead to megaloblastic anemia/congenital anomalies in pregnancy
Malunion
Deformity or angulation on x-ray. Inadequate reduction. Misalignment of fracture at time of immobilization.
Bronchiectasis
Destruction of the smooth muscle and elastic supporting tissue of the bronchi and bronchioles, and dilation of these structures. Obstruction and chronic persistent infection and inflammation (bacterial pneumonia following a viral infection, tuberculosis)
Osteoclasts
"Bone-chewing" cells responsible for resorption (removal of bone mineral and organic matrix
Osteoprotegerin (OPG)
"Decoy" receptor to block RANKL activity to ensure balance
Hypoxemic respiratory failure
(Failure of the gas exchange) oMismatching of ventilation and perfusion oImpaired diffusion (hypoxemia but not hypercapnia): Interstitial lung disease, ARDS, Pulmonary edema, Pneumonia
Hypercapnic/hypoxemic respiratory failure
(Hypoventilation or ventilatory failure): depression of the respiratory center, diseases of respiratory nerves or muscles, thoracic cage disorders
nephropathy
Diabetic ___ is the leading cause of end-stage renal disease (ESRD)
Metabolic bone disease
Disorders of bone metabolism (bone remodeling) result in structural changes to the skeleton. These changes include decreased bone mass and diminished bone strength. (Osteopenia, Osteoporosis, Osteomalacia, Paget's disease)
Disorders of the Pleura, Atelectasis
Disorders of lung inflation (2)
Bone fractures
Disruption in the continuity of a bone •Causes: High compression, tension, shearing, bending, or torsion forces
Diverticular disease
Diverticula protruding through GI tract; diverticulitis occurs w/ inflammation & bacterial release into wall; need fiber
Left lower quadrant
Diverticular manifests w/ pain or tenderness in which quadrant?
Pellagra
4-Ds (dementia, diarrhea, dermatitis, and death) (deficiency of Niacin)
Hypoxia
A decrease in tissue oxygenation
Achalasia
A failure of smooth muscle fibers to relax, which can cause a sphincter to remain closed and fail to open when needed.
Hypoxemia
A reduction in the partial pressure of oxygen (PO2) of the arterial blood; PO2 < 60 mm Hg
Wolff's Law
A tissue adapts to the level of stress imposed upon it (Strengthening and weakening, depending on level of stress)
Hematogenous Osteomyelitis
A: Infection reaches bone B: Purulent exudate collects as infection spreads, shearing off perforating arteries C: Bone necrosis; necrotic bone separates from live bone to form devascularized fragments, called sequestra
Primary
Abnormal proliferation and contraction of vascular smooth muscle, marked intimal fibrosis (type of pulmonary hypertension)
Hyperglycemia
Abnormally high circulating glucose. Characterized by: 1.Polyphagia-frequent hunger, pronounced hunger 2.Polydipsia-frequent thirst, excessive thirst 3.Polyuria-frequent urination
Hypoglycemia
Abnormally low circulating glucose. Symptoms: -Increased heart rate -Trembling -Nervousness -Sweating -Anxiety -Can cause coma and death
Osteomyelitis
Acute or chronic infection of the bone and marrow
Antihypertensives
Affect body levels of potassium, calcium and zinc (type of drug)
Crohn's disease
Affects GI tract with skip lesions; healthy tissue interrupted by areas of diseased tissue (IBD)
Crohn's disease
Affects anywhere in the GI tract; mouth to anus (IBD)
Ulcerative colitis
Affects from rectum continually upward into colon (IBD)
Peripheral neuropathy
Affects nerves in the toes, feet, legs, hand, and arms (Tingling, burning, deep pain, weakness, light-headed, fast heart beat)
Autonomic neuropathy
Affects nerves that help regulate digestive, bowel, bladder, heart, and sexual function (Digestive problems, bladder infections and incontinence, sexual problems)
Crohn's disease
Affects the whole thickness of the intestinal wall (transmural) (IBD)
Pleural effusion
An abnormal collection of fluid in the Pleural Cavity; excess fluid formation, decreased removal by the lymphatics
Atelectasis
An incomplete expansion of a lung or portion of a lung.
Hypercapnia
An increase in the carbon dioxide (PCO2) content of the arterial blood; PCO2 >50 mm Hg
Crohn's disease
Anal fistula and anal fissure formation (IBD)
Osteonecrosis
Aseptic destruction of a segment of bone due to an interruption in blood flow
Metabolic syndrome
Associated with hyperglycemia, hyperinsulinemia, dyslipidemia and hypertension (cluster)
18.5; 18.5-24.9; 25-29.9; 30+
BMI Categories: Underweight = <__ Normal weight = ____-___ Overweight = __-___ Obesity = ___
Bony callus formation
Begins 3 to 4 weeks after injury and continues for months later (bone healing process)
Irritable Bowel Syndrome
Believed to result from dysregulation of intestinal motor and sensory functions modulated through the CNS; often in response to physical or psychological stress. Dx based on 3 months' symptoms of discomfort, relieved by defecation. Tx focuses on stress management.
hematoma
Blood vessels in the bone and surrounding tissues bleed into and around the fragments forming a __ in fracture healing. Fibrin meshwork forms and seals the fracture site (initiates healing process)
Hemothorax
Bloody (type of pleural effusion)
Type 1 diabetes
Body does not produce insulin; commonly diagnosed in children/young adults
vascularized
Bone is well ___
Osteoblasts
Bone-building cells that synthesize and secrete the organic matrix of bone. Participate in calcification of the organic matrix.
compact, spongy
Bones contain both __ and ___ bone in different proportions
Genu varum
Bowlegs
Scurvy
Bruising, swollen and/or bleeding gums, weakness, fatigue, rash, coiled hair, failure to thrive, irritability, muscle weakness, or weight loss (deficiency of VitC)
avascular
Cartilage is ___
Syphilis
Causative bacteria; can infect fetus during pregnancy; more common in men
Secondary Tuberculosis
Cause: reinfection/reactivation.Clinical manifestations: signs of chronic pneumonia (low-grade fever, night sweats, easy fatiguability, anorexia and weight loss), "Consumption": Eventually fatal if untreated
Respiratory Distress Syndrome
Cause: §Immature lung structures §Lack of surfactant - infants are not strong enough to inflate their alveoli §Protein-rich fluid leaks into the alveoli - further blocks oxygen uptake
Nutritional disorders
Caused by a deficiency or excess of one or more nutrients that alters the structure and/or function of cells, tissues, and organs to cause disease. Most are chronic not acute
DKA
Causes of ___: Infection, injury, a serious illness, surgery, or non-compliance to insulin therapy. Life-threatening condition! -More often in T1D -Younger, female -Mortality 2-5% -Usually develops rapidly <24h -Polydypsia, Polyuria --> Volume depletion --> hypotension, increased HR
Improper and/or inadequate food intake, Obesity and/or surgical procedures designed to treat obesity, Food Faddism, Deficient supply of food, Medications, Certain medical conditions, Emotional factors, Metabolic abnormalities, Poor dietary habits, Inadequate absorption of food, Poverty, natural disasters, political problems, lack of knowledge, war, pandemics (epidemics) - food insecurity
Causes/risk factors for suboptimal nutrition (11)
Osteopenia
Causes: •Decrease in bone formation •Inadequate bone mineralization •Excessive bone resorption
Paget's disease
Characterized by: •Focal areas of excessive osteoclast-mediated bone resorption •Disorganized osteoblast-mediated bone repair •Disorganized, thickened, but soft bones (metabolic bone disease)
Respiratory Distress
Chest wall retraction, nasal flaring, stridor, grunting, wheezing (manifestations of __)
Systemic Lupus Erythematosus (SLE)
Chronic autoimmune disease that can affect any organ system •"The great imitator" •Widespread inflammation and tissue damage •Joints, skin, brain, lungs, kidneys, blood vessels •Blood test: anti-nuclear Ab (ANA)
Inflammatory bowel disease
Chronic incurable diseases that can occur at any age but are more prevalent in the young adult. Activate inflammatory cells, causing tissue damage.
4; Morning; 3; Symmetric; nodules; anti-CCP
Classification of Rheumatoid arthritis (Criteria include __ or more of the following): 1.____ stiffness for 1+ hours, present for 6+ weeks 2.Simultaneous swelling of ___+ joints for 6 + weeks 3.Swelling of wrist, metacarpophalangeal, or proximal interphalangeal joints for 6+ weeks 4._____ joint swelling for 6+ weeks 5.Rheumatoid _____ 6.Serum rheumatoid factor (RF) and ____ 7.Radiographic changes on hand or wrist
Transudative effusion
Clear fluid, hydrothorax (type of pleural effusion)
Lung cancer
Clinical Manifestations: -Fatigue, unintentional weight loss, decreased appetite -Chronic cough, SOB, and wheezing §Effects of local spread and metastasis -Invasion of the mediastinum oDull, intermittent, and poorly localized retrosternal pain oHoarseness - involvement of the recurrent laryngeal nerve oDifficulty in swallowing - compression of the esophagus oSuperior vena cava syndrome due to compression -Pleural effusion -Metastases (brain, bone and liver) §Paraneoplastic syndrome
Respiratory distress syndrome
Clinical Manifestations: Central cyanosis, difficulty breathing, grunting
Influenza
Clinical Manifestations: §Upper Respiratory Infection §Abrupt onset fever/chills, malaise, muscle aching, headache, profuse watery nasal discharge, nonproductive cough, sore throat §Viral Pneumonia §Rapid progression of fever, tachypnea, cyanosis, and hypotension. Can cause hypoxemia and death within a few days §Secondary Bacterial Infection Sinusitis, otitis media, bronchitis, and bacterial pneumonia
Rheumatoid arthritis
Clinical manifestation: •Usually symmetrical and polyarticular •Joint pain and stiffness •Subluxation of joints & spindle-shaped appearance •Progressive joint destruction •Misalignment of bone •Swelling and thickening •Limitation of movement
Crohn's disease
Cobblestoning seen on examination of the colon (IBD)
Abdominal pain, nausea & vomiting, diarrhea, GI bleeding, obstructive jaundice
Common GI symptoms (5)
Obstructive airway disorders
Conditions that limit expiratory airflow. ̶Bronchial asthma ̶Chronic Obstructive Pulmonary Diseases (COPD) (Chronic bronchitis, Emphysema) ̶Bronchiectasis (due to necrotizing infections) ̶Cystic fibrosis
Nonunion
Failure of bone to heal before bone repair. Motion at fracture site. Pain on weight bearing. Inadequate reduction. Severe trauma. Bone fragment separation. Soft tissue between fragments. Infection. Extensive loss of bone. Inadequate circulation. Malignancy. Bone necrosis. Noncompliance with restrictions.
Delayed union
Failure of fracture to heal within predicted time. Large displaced fracture. Inadequate immobilization. Large hematoma or infection at fracture site. Excessive loss of bone. Inadequate circulation.
Cirrhosis
Final, common end-stage for a variety of chronic liver diseases
Osteoporosis
First manifestation: Sudden fractures •Vertebral compression fracture •Fracture of vertebra(e), hip, pelvis, humerus
Structural
Fixed deformity •Congenital (vertebral development) •Neuromuscular (cerebral palsy, DMD) •Idiopathic- majority (scoliosis)
Dairy
Food group that provides calcium, potassium, vitamin D, vitamin B12, and protein
Grains
Food group that provides dietary fiber, several B vitamins (thiamin, riboflavin, niacin, and folate), and minerals (iron, magnesium, and selenium)
Vegetables
Food group that provides many nutrients, including potassium, dietary fiber, folate (folic acid), vitamin A, and vitamin C
Fruits
Food group that provides potassium, dietary fiber, vitamin C, and folate (folic acid)
Protein
Food group that provides protein, B vitamins (niacin, thiamin, riboflavin, and B6), vitamin E, vitamin B12, iron, zinc, and magnesium
Vomiting
Forceful oral expulsion of gastric contents, basic physiologic response to rid the GI tract of noxious materials
Transverse (across straight), Oblique (diagonal), Spiral
Fracture line directions (3)
Chronic Pancreatitis
Gallstones aren't involved. Most due to chronic alcoholism. Dense scar tissue, dilated ducts, gritty calcification. Could render pt diabetic
Paget's disease
Genetic and environmental influences: •Mutations in RANK pathways •Viral origin debated (metabolic bone disease)
Uric acid
Gout Tx: ____ ____ management (Low-purine diet, medications [e.g., xanthine oxidase inhibitors])
Liver
Helps your body fight infection by removing bacteria from the blood
Frank hematemesis
Hemorrhage above the stomach (vomiting blood)
Anemia
Hemorrhage can lead to
Fecal occult blood
Hemorrhage in the intestine with blood mixing into stools (not apparent blood in feces)
Melena
Hemorrhage into intestines with large volumes of blood (dark, tarry feces)
Coffee-ground vomitus
Hemorrhage into the stomach with partial digestion of blood
Dual-energy X-ray absorptiometry (DXA or DEXA)
How to Dx Osteoporosis
Infection, bleeding
Immediate concern w/ an open fracture? (2)
Protein pump inhibitors (used to treat GERD)
Increase risk of hypocalcemia and hypomagnesemia (type of drug)
Bone
Increased bone resorption (↓ bone mass) (effects of long-term immobilization on what structure)
Chronic bronchitis (COPD)
Increased mucus production, obstruction of small airways, and a chronic productive cough
Compartment syndrome
Increased pressure within limited space (complication of fracture)
Chlostridium difficile (C. Diff)
Infection in intestines. Causes severe diarrhea
Hemorrhage
Inflammation and damage to the bowel wall
Rheumatic Disorders
Inflammatory disorders, often autoimmune, that cause degenerative musculoskeletal tissue changes.
Motility
Ingestion, swallowing, peristalsis, elimination (GI System: process)
Croup
Inspiratory stridor, hoarseness and a barking cough; usually occurs at night; relieved by exposure to cold or moist air; common in childhood
Type 2 diabetes
Insulin-resistance
Functional Hypothalamic Amenorrhea (FHA)
Interruption of GnRH secretion with stress/excess exercise/extreme weight loss
Cirrhosis
Irreversible inflammatory disease; decreased hepatic function due to fibrosis; alcoholic, biliary, postnecrotic
Pulmonary hypertension
Is defined by a mean pulmonary artery pressure ≥25 mm Hg at rest, measured during right heart catheterization
Osteoporosis
Joint disease of severely decreased bone mass. Increased susceptibility to fractures.
Nephropathy
Kidney glomeruli become damaged and leak protein into the urine. Over time, this can lead to kidney failure. Protein in the urine is an important marker of kidney damage. (diabetes complication)
Genu valgum
Knock-knees
Scoliosis
Lateral curvature of the spine in the upright position.
Sprain
Ligament issue
perpendicular
Ligaments and tendons are bad at resisting forces that occur ___ to fiber direction
blood supply
Ligaments and tendons have a limited __ __
Hepatitis C
Liver disease transmitted via blood
Paget's disease
Local excessive resorption and unpatterned mineralization
Hyaline
Location: b/w tips of ribs and bones of sternum; cover bone surfaces at synovial joints; support larynx, trachea, bronchi; part of nasal septum Function: provides stiff but somewhat flexible support; reduces friction b/w bony surfaces (cartilage)
Elastic
Locations: auricle of external ear; epiglottis; auditory tube; cuneiform cartilages of larynx Functions: provides support; tolerates distortion w/o damage and returns to original shape (cartilage)
Fibrous
Locations: pads w/i knee joint; b/w pubic bones of pelvis; intervertebral discs Functions: resists compression; prevents bone-bone contact; limits relative mvmt (cartilage)
Anorexia
Loss of appetite, alone or with nausea & vomiting, caused by many drugs and disease states, also associated with emotional states
Magnesium
Low levels of this nutrient seen in type 2 diabetes, metabolic syndrome, heart disease, and osteoporosis. Main symptoms severe deficiency: abnormal heart rhythm, muscle cramps, restless leg syndrome, fatigue, and migraines
Respiratory syncytial virus (RSV) and Parainfluenza viruses
Most common and severe in children less than 3 years (2)
Chlamydia
Most common bacterial STI; cases are asymptomatic in men & women
Type 2
Most common form of diabetes
Klinefelter syndrome
Most common genetic cause of hypogonadism
Colon (sigmoid)
Most common site for diverticular disease
Hyperosmolar Hyperglycemic State (HHS)
Most often in T2D, underlying infection, older individuals. •Circulating glucose > 600mg/dl •Serum osmolality > 320mosm/L •Dehydration up to 9L •Alterations in consciousness •Life-threatening condition! •Mortality 5-20%(acute complication of diabetes)
Osteoarthritis
Most prevalent degenerative joint disease; leading cause of physical disability
Strain
Muscle/tendon issue
Ulcerative colitis
No fistula or anal fissure formation (IBD)
Cardiovascular disease
No. 1 causes of death and disability among people with Type 2 Diabetes. Diabetes with Hypertension doubles the risk. Associated with low HDL and high triglycerides.
Hepatitis A
Occurs in unclean conditions; transmitted via fecal matter; highly contagious viral liver infection; jaundice, nausea, abdominal pain
Diabetic Ketoacidosis (Acute)
Occurs when the body cannot use glucose as fuel and uses fat instead. The breakdown of fat produces ketones. At high levels, ketones are poisonous.
Secondary atelectasis
Of the infants; Respiratory distress syndrome, Airway obstruction due to aspiration (amniotic fluid, blood)
Primary atelectasis
Of the newborn; the lung has never been inflated
Pancreatitis
Often caused by alcohol use; caused by injury/damage to pancreatic cells
Exudative effusion
Often contains inflammatory cells (type of pleural effusion)
Sinus headache
Often worse with bending over, coughing, sneezing
Respiratory distress syndrome
One of the most common causes of respiratory disease in premature infants
Congenital clubfoot
One of the most common pediatric orthopedic conditions •Treated by manipulation, casting, surgery
Ulcerative colitis
Only affects the large intestine (IBD)
Ulcerative colitis
Only affects upper layers of intestinal wall (mucosa and submucosa)(IBD)
Mouth, salivary glands, pharynx, esophagus, stomach, liver, gallbladder, pancreas, small intestine, large intestine, rectum, anus
Organs of the digestive system (12)
Deformities
Osteomalacia results in: •Bone pain & tenderness •Fractures •____* (gravity, muscle weakness, bone softening)
Vitamin D; Phosphate
Osteomalacia two main causes: (1)Insufficient calcium absorption from the intestine or _____ deficiency (most common) (2)____ deficiency due to increased renal losses or decreased intestinal absorption
1
Osteopenia: Measured as Bone Mineral Density > __ standard deviation below young adult reference population
height, kyphosis
Osteoporosis signs: Wedging & collapse of vertebrae •Loss of ____ in the vertebral column •_____: Dowager hump
2.5
Osteoporosis: Bone density > __ SD below young adult reference population
65; 60, 64
Osteoporosis: DXA is recommended for: •All people ___ years and older •Women __ to __ years with increased fracture risk
spongy
Osteoporosis: loss of ____ bone
Digestion
Physical (chewing & grinding), Chemical (digestive enzymes) (GI System: process)
Anorexia, nausea, vomiting
Physiologic responses common to many GI disorders (3)
Primary
Positive skin test; alveolar macrophages ingest bacteria but can't kill them (type of TB)
Ulcerative colitis
Predisposes to colon cancer (IBD)
Gout
Presents as: (1)Acute gouty arthritis (2)Tophi- accumulation of crystalline deposits in articular surfaces, bones, soft tissue, and cartilage (3)Gouty nephropathy or renal impairment (4)Uric acid kidney stones Most commonly affects men
Liver
Prevents shortages of nutrients by storing vitamins, minerals, and sugar
Insulin
Primary stimulus is glucose. ___ allows your body to use glucose from carbohydrates in the foods we eat for energy. The liver can make glucose (gluconeogenesis) in times of need (like fasting). Inhibits the breakdown of fat (lipolysis)
Liver
Produces bile, a compound needed to digest fat and to absorb vitamins A, D, E, and K
Liver
Produces most of the substances that regulate blood clotting
Liver
Produces most proteins needed by the body
Macronutrients
Protein, Fat, Carbohydrate
Ulcerative colitis
Pseudopolyps seen on examination of the colon (IBD)
Empyema
Purulent (type of pleural effusion)
Osteomyelitis
Pyogenic - Staphylococcus aureus is most common cause •Hematogenous- Originates with infectious organisms that reach the bone through the bloodstream. Symptoms: •Bacteremia (chills, fever, malaise) •Bone lesion (pain, reduced motion)
Gastroparesis
Reduced vagal nerve conduction. Reduced smooth muscle activity. Compromised myoelectric activity
Joints
Reduction of range of motion (↑ stiffness)(effects of long-term immobilization on what structure)
Tuberculosis
Remains one of the deadliest diseases in the world (Latest stats by WHO: 13th leading cause of death) Transmission: Droplet inhalation (cough/sneeze/talking)
Liver
Removes potentially toxic byproducts of certain medications
Klinefelter syndrome
Result of meiotic non-disjunction; often diagnosed as adult
the common cold
Rhinoviruses, Respiratory syncytial virus and Parainfluenza viruses, Coronaviruses and adenoviruses
Osteonecrosis
Symptoms: •Depend on location & severity •Pain with activity (can progress to pain at rest) Treatment: •Short-term immobilization or limited weight-bearing •Exercises •NSAIDs •Advanced: total joint replacement
Considered
Scoliosis Tx: Curves 20-30º
Bracing
Scoliosis Tx: Curves 30-40º
Surgery
Scoliosis Tx: Curves 40+º
Paget's disease
Second most common metabolic bone disease after osteoporosis •Often asymptomatic (~70%) •~3% of US population •~10% of people 80+ yrs
Greenstick
Seen in children, partial break in bone continuity (fracture)
Pneumonia
Setting: Hospital/nosocomial or Community. Type of agent: typical or atypical. Distribution: lobar, patchy
Osteonecrosis
Sites with poor collateral circulation (e.g., femoral head) are most commonly affected
Rhabdomyolysis
Symptoms: •Excessive muscle pain, muscle weakness •Dark red or brown urine Tx: IV fluids, nutrients, mobilization
Osteoarthritis
Symptoms: •Joint pain, stiffness, instability •Limited movement •Deformity Joint disease is irreversible
Kidney failure
Symptoms: -swelling in the feet and ankles, -itching, -fatigue, -headache, -weight loss, -vomiting, -pale skin color
Syphilis
Stages of this STI symptoms: localized sore -> systemic illness -> infection but no symptoms; infection may remain silent for up to ~2 yrs -> severe medical problems
Osteoarthritis
Stems from loss of cartilage in synovial joints; leads to joint space narrowing on x-ray
Nausea
Stimulation of medullary vomiting center. Often precedes vomiting & accompanied by autonomic responses such as salivation & vasoconstriction, pallor, sweating, and tachycardia
GERD (gastroesophageal reflux disease)
Stomach contents enter esophagus; most common esophageal disease
26-30 weeks
Sufficient amounts of surfactant are available to prevent alveolar collapse (stage of lung development)
25-28 weeks
Sufficient terminal sacs are present to permit survival (stage of lung development)
Klinefelter syndrome
Symptoms of syndrome: Smaller testes, Diminished facial/chest hair, Gynecomastia: breast enlargement in males, Feminine adipose distribution pattern, Low muscle mass, muscle weakness, Tall stature, Low libido, Infertility, may have delayed speech/language development
DKA
Symptoms: Central (headache, sleepiness, confusion, loss of consciousness, coma) Muscular (seizures, weakness) Intestinal (diarrhea) Respiratory (SOB, coughing) Heart (arrhythmia, increased HR) Gastric (nausea, vomiting)
Paget's disease
Symptoms: •Bone pain, abnormal bone curvatures, brain compression, impaired motor function, deafness, atrophy of the optic nerve •Tumors and tumor like conditions
8th year of life
The adult complement of alveoli is present (a full-term infant has only 1/6 of the adult number of alveoli) (stage of lung development)
Hyperosmolar Hyperglycemic State (HHS) (Acute)
The condition is characterized by: ◦Hyperglycemia: glucose transport into cells is limited due to insulin resistance ◦Hyperosmolarity: as glucose is filtered and excreted, additional fluid is lost, concentrating plasma ◦Dehydration: increased fluid loss in urine (polyuria) ◦Without significant ketoacidosis
ulcers; amputation
The most serious consequences of neuropathy occur in the legs and feet and pose a risk for ___ and, in unusually severe cases, ____. (diabetes complication)
Pneumothorax
The presence of air in the pleural cavity
marasmus, disordered eating and/or eating disorders, cachexia, starvation, anorexia
Too little energy leads to (5)
Dehydration
Too little water leads to
Obesity
Too much energy leads to
Water intoxication or overhydration causes hyponatremia
Too much water leads to
Human Papilloma Virus (HPV)
Transmission is skin-skin contact; most people are asymptomatic; certain types cause cervical cancer, genital warts
Common cold
Transmission: Hands/fingers/contaminated surfaces are the greatest source of spread - more than coughing and sneezing
Influenza
Transmission: §Droplet inhalation (Cough, Sneeze)
Hepatitis B
Transmitted via bodily fluid; abdominal fluid, vomiting, yellowing of skin/eyes
Klinefelter syndrome
Treatment: testosterone replacement therapy, fertility Tx
Reduction (reset), Immobilization, Preserve/restore function
Tx for fractures (3)
Rest, ice, compression, and elevation (RICE). (•The affected area may be immobilized until pain/swelling is reduced •Early diagnosis, treatment, and rehabilitation are essential in preventing weakening of injured area due to immobilization)
Tx for strains/sprains (4)
Paget's disease
Tx: •Anti-inflammatory agents •Bone resorption inhibitors •Bisphosphonates •Calcium/Vitamin D
Jaw osteonecrosis
__ _______ risk increases w/ biphosphonate therapy (given for osteoporosis)
Callus, weight-bearing
__ formed by end of 2nd or 3rd week, not strong enough for ___ (bone healing)
30
__% of adults have metabolic syndrome
Osteopenia
___ is present in: •Osteoporosis •Osteomalacia •Malignancies such as multiple myeloma •Endocrine disorders such as hyperparathyroidism and hyperthyroidism
Osteoclastic
___ resorption of existing bone in bone remodeling
Paracrine
___ system balances resorption and formation in bone remodeling
70
___% of population is overweight or obese (BMI)
Osteoblasts
____ begin to deposit organic matrix (osteoid) on the wall of the osteon canal in bone remodeling
Metabolic syndrome
________ leads to increased risk of coronary heart disease, atherosclerosis, Type 2 diabetes, heart attack, kidney disease, stroke, nonalcoholic fatty liver disease
Dysphagia
difficulty swallowing; lack of coordination between contraction and relaxation; choking, coughing, or gagging, reflux; heartburn
Turner's Syndrome
dysfunctional ovarian development; 45,X genotype (missing/partially missing X chromosome); common cause of spontaneous abortion Mild, wide range of symptoms: short stature, broad chest w/ widely-spaced nipples, underdeveloped breasts, short/webbed neck, low hairline, low set ears, dysfunctional ovarian development (infertility), common congenital heart defects Tx: growth hormone to increase height (childhood), estrogen treatment to initiate puberty, fertility treatment
Celiac disease
gluten-sensitive enteropathy; immune disease with gluten intolerance
Polycystic ovarian syndrome (PCOS)
hormonal disruption of menstrual cycle; One of the most common endocrine disorders in females of reproductive age Diagnosis requires presence of 2 of the following: polycystic ovaries (excessive # o follicles in ovaries, cysts), infrequent menstrual cycles/amenorrhea, hyperandrogenism (elevated levels of androgens or clinical signs of high androgen level)
Celiac disease
infants: diarrhea, abdominal distention, & malnutrition. Older children: anemia, short stature, dental enamel defects, & constipation. Adults: diarrhea, abdominal pain, discomfort
Crohn's Disease, ulcerative colitis
inflammatory bowel diseases (2)