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
