Final Review
Terms that end with "chromic" refer to:
"chromic" refers to hemoglobin content
Terms that end with "cytic" refer to:
"cytic" refers to cell size
multiple organ dysfunction syndrome
(MODS) progressive impairment of two or more organ systems resulting from an uncontrolled inflammatory response to a severe illness or injury.
2 major ways to have immune related injury to glomerulus...
*mecahnisms of injury (immune related) 1.) deposition of circulating soluble antigen-antibody complexes, often w/ complement fragments or 2.) formation of antibodies against the glomerular basement membrane also 3.) streptococcal release of neuramidase will damage glomerular membrane
What is Graves disease?
*most common cause of throtoxicosis cause: -Ab's stimulate TSH receptors (in thyroid galnd) to make excessive amounts of hormone Symptoms: - ↑T3 & T4 -diffuse thyroid enlargement (goiter) -pretibial myxedema (hyaluronic acid depostition in pretibial skin) -exophthalmus (protusion of eyeball due to inflammation)
kidney stone formation
*supersaturation of one or more salts -presence of a salt in a higher concntration than the volume able to dissolve the salt 0example: pouring salt in a bucket of water, it will eventualluy accumulate at the bottom) -stones: calcium oxalate or calcium phosphate (80%) *struvite stones (15% [UTI's]) *uric acid stones (5% [gout]) 5mm-50% chance of passage through urethra > 1cm- no way it will pass
primary pulmonary hypertension
- an idiopathic form of pulmonary artery hypertension & is characterized by pathologic changes in precapillary pulmonary arteries -usually hereditary component -diseases of the respiratory system & hypoxemia are more common causes of pulmonary hypertension
complicated hypertension
- leads to left ventricular hypertrophy (LVH), coronary artery disease (CAD), MI, sudden death) -Chronic hypertensive damage to the walls of systemic blood vessels, smooth muscle cells undergo hypertrophy (increase in volume) and hyperplasia ( increase in no. ) with fibrosis (dev of new tissue) of the tunica intima and media (innermost layer of vein)
evaluation of rheumatoid arthritis: 4 or more of the followin...
- morning joint stiffness lasting at leat 1 hour -arthritis of 3 or more joint areas -arthritis of the hand joints -symmetric arthritis -Rheumatoid nodules (in sub Q tissue over extensor surfaces: fingers & elbows) -abnormal amounts of serum rheumatoid factor -radiographic changes
Categories of diabetes mellitus
- type 1 -type 2 - other specific types - gestational diabetes
treatment of ↓ bone loss
- ↑ Ca intake to 1500mg/day w/ 800 IU vit D - ? estrogen/progesterone (breast cancer, DVT, heart disease complications)
Congential adrenal hyperplasia
- ↓ cortisol & aldosterone synthesis (at birth) → ↑ACTH → adrenal hyperplasia → ↑ androgens (which are also made in adrenal cortex -disorder of the adrenal cortex
Diabetic ketoacidosis
- ↓ glucose utilization in tissues → hepatic glucose production from cortisol, catecholamines, GH, glucagon (liver trying to produce glucose to fix the problem) along with: - ↑ fat & protein breakdown (since no glucose available to metabolize) → ↑ketones (from metabolism of FFA's) & mrabolic acidosis → coma
gastric ulcers
-1/4 common as duodenal ulcers -caused by NSAID's (↓ production of prostaglandins, which protect gastric lining), & H. polyri infection -primary defect is ↑ mucosal permeability to hydrogen ions (not ↑ acid secretion) -*main symptom is PAIN WITH EATING
large cell carcinoma
-10-15% of bronchogenic carcinomas -lost all evidence of differentiation; therefore referred to as undifferentiated
primary hypertension
-140/90 mmHg -also called essential or idiopathic hypertension -genetic (polygenic) & environmental factors (↑ Na intake, cigarette smoking, obesity, heavy alcohol consumption) -95% of people who have hypertension have primary hypertension risk factors: -family hisroty, advancing age, gender (men > than women before 55, women > then men after 55), black race, cigarette smoking/obesity, ↑ alcohol intake
hematoma formation
-1st stage in bone fracture healing -clot forms at damaged edges of bone
hypertension
-65% of americans have it - > than 60 years old -only 2/3 are adequately controlled
What is type 2 diabetes mellitus?
-90% of cases -non-insulin dependent -insulin resistance ↓ beta cell responsiveness (80% of patients) -***↑ resistance w/ obesity (+risk factor) - + genetic susceptibility - ↓ number of beta cells in pancreas
Neonatal hypothyroidism
-A.K.A cretinism -hypothyroidism in childhood -associated w/ mental deficiency
Crohn disease
-A.K.A granulomatous colitis, ileocolitis, or regional enteritis (rectum seldom involved) -idiopathic inflammatory disorder, affects any part of the digestive tract, from mouth to anus -difficult to differentiate from ulcerative colitis -similar risk factors & theories of causation as ulcerative colitis -causes "skip lesions" & granulomas -ulcerations can produce longitudial & transverse inflammatory fissures that extend into the lymphatics -ANEMIA may result from malabsorption of vitamin B12 &/or folic acid (absorbed in upper small intestine) -treatment is similar to ulcerative colitis surgical Rx: for fistulas, abscesses, obstruction, perforation
hypothyroidism
-An alteration of thyroid function -a glandular disorder resulting from insufficient production of thyroid hormones -the most common cause of thyroid dysfunction Primary hypothyroidism: -acute (bacterial)/ subacute (viral) thyroiditis -autoimmune thyroiditis (Hashimoto disease)- destruction of thyroid tissue by thyroid antibodies; ***most common cause of hypothyroidism in the US*** -postpartum thyroiditis (similar to Hashimoto)
dislocations of hip
-Anterior (rare): land on feet after falling -Posterior: auto accident- knee hits dashboard may disrupt circulation → necrosis of the joint → hip replacement (Bo Jackson) Rx: reduction
Primary hyperaldosteronism
-Conn disease -adenoma of adrenal gland -disorder of the adrenal cortex
obstructive jaundice
-Extrahepatic obstruction (common bile duct obstructed by gallstone or tumor so conjugated billirubin can't flow into duodenum → conjugated billirubin enters blood and secreted in urine [dark]) -Intrahepatic obstruction (cirrhosis → ↑ unconjugated & conjugated billirubin in blood due to disturbances in conjugation & excretion)
risk factors for kidney stones
-FLUID INTAKE, gender [male], race [white], geographic location [south], seasonal factors, diet (↑ protein, ↓ Ca, ↑ oxalate [tea], & occupation
What are the symptoms of hypothyroidism?
-MYXEDEMA (non-pitting, boggy edema around eyes and hands) -low BMR (basal metabolic rate) -cold intolerance -lethargy
treatment for rheumatoid arthritis
-Non surgical: rest, hot/cold packs, PT, non steroidal anti-inflammatory's, steroids (typically), gold salts -Surgical: synovectomy, joint replacement
renal cell carcinoma
-RCC: 80% of all Ca's -cancerous tumor of the kidney in adulthood -2X more prevalent in men -↑ smokers, African-americans 5 YR. SURVIVAL 50% (2% w/ metastasis)
What is hypopituitarism?
-Undersecretion of the ANTERIOR pituitary gland's hormones -Can range from the absence of pituitary hormones to the complete failure of hormonal functions. Can be caused by: -pituitary infarction -head trauma, infections, & tumors -panhypopituitarism
peptic ulcer disease
-a break or ulceraion in the protective mucosal lining of the lower esophagus, stomach, or duodenum -acute & chronic ulcers -superficial (erosions) -deep (true ulcers-penetrate muscularitis mucosa)
What does glomerular damage cause?
-a decreased glomerular basement membrane surface area -decreased glomerular blood flow leading to: -decreased glomerular hydrostatic pressure **ALL OF THE ABOVE CAUSES A DECREASE IN THE GFR (decreased filtrate)**
What is hyperpituitarism?
-a disease of the ANTERIOR pituitary -Excess of pituitary hormone secretion. -commonly caused by a benign slow-grwoing pituitary adenoma (causing ↑ secretion of one hormone)
What is Diabetes insipidus?
-a disease of the posterior pituitary -insufficiency of ADH -polyuria & polydipsia (thirsty) -partial or total inability to concentrate urine
inflammatory vs. noninflammatory joint disease: differentiated by...
-absence of synovial membrane inflammation -lack of systemic signs & symptoms -normal synovial fluid analysis
Type 1 diabetes mellitus
-absolute insulin deficiency -10% -demonstrates pancreatic atrophy & specific loss of beta cells (which make insulin) -AUTOIMMUNE destruction of beta cells , & Ab to insulin: macrophages, T- & B-lymphocytes, natural killer cells are present 2 types: -1A (80%)- B cell auto antibodies & antibodies to insulin -non immune type 1 (20%)- due to pancreatitis (& loss of beta cells) -diagnosis by 12 yr of age -genetic susceptibility -environmental factors (drugs/infection, esp. congenital rubella) -immunologically mediated destruction of beta cells
pericardial effusion
-accumulation of fluid in pericardial cavity symptoms: -hypotension -pulsus paradoxis ( ↓systolic BP 10 mmHg upon inspiration)
acute bronchitis
-acute infection or inflammation of the airways or bronchi -commonly follows a viral illness -causes similar symptoms to pneumonia but dies not demonstrate pulmonary consolidation & chest infiltrates
obstructive pulmonary disease
-airway obstruction that becomes WORSE with expiration -common signs & symptoms: dyspnea & wheezing -common OBSTRUCTIVE disorders: asthma, emphysema, chronic bronchitis
What is a Urinary Tract Infection?
-an inflammation of the urinary epithelium caused by bacteria -most common pathogen of UTI: E. Coli -virulence of uropathogens: host defense mechanisms important
treatment of osteomyelitis
-antibiotics -debridement -surgery -hyperbaric oxygen therapy -remove infected prosthesis
treatment for glomerulonephritis
-antibiotics (due to strep) -steroids (autoimmune disease) -anticoagulants
Coronary artery disease
-any vascular disorder that narrows or occludes the coronary arteries -atherosclerosis is the most common cause risk factors: -dyslipidemia-HDL/LDL cholesterol -hypertension -cigarette smoking -diabetes mellitus -obesity/sedentary lifestyle -advance age -male gender or femal gender after menopause -family history -markers of inflammation & thrombosis (C-reactive protein-a protein that indirectly measures plaque related infammation, fibrinogen, protein C, & plasminogen activator inhibitor non traditional risk factors: -hyperhomocysteinemia- a genetic lack of enzyme breaking down homocysteine -infection-chlamydia & helicobacter p. often present in atherosclerotic lesions
clinical stages of gout
-asymptomatic hyperuricemia -acute gouty arthritis -tophaceous gout (chronic stage)
Chronic glomerulonephrits
-autoimmune: Ag/Ab complexes or anti-GBM antibodies damage capillary wall -diabetes & lupus are secondary causes
Prerenal acute renal failure
-before the kidney -most common cause of ARF
renal adenomas
-benign tumor, can become malignant
acute respiratory distress syndrome
-biggest problem is alveoli capillary membrane thickens & hardens -fulminant form of respiratory failure characterized by acute lung inflammation & diffuse alveolocapillary injury -injury to the pulmonary capillary endothelium -inflammation & platelet activation -surfactant inactivation -atelectasis -development of hyaline membrane at alveolocapillary interface which impedes air exchange mortality: <60 yo=40%; >60yo=60% +
hepatic encephalopathy
-blood bypasses liver so ↑ ammonia levels (due to lack of filtering by liver) in blood which perfuse the brain causing reversible CNS alterations -central nervous system dysfunction resulting from liver disease; frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma
thrombus formation
-blood clot that remains attached to the vessel wall
What is nephritic sediment?
-blood, WBC's, & CASTS [cylindrical aggregates of particulate matter] -sediment of chronic glomerular disease has less stuff in the sediment
What does prolactin normally do?
-breast development during pregnancy -postpartum milk production -suppression of ovarian function in nursing mothers
lung cancer
-bronchogenic carcinomas -most common cause is cigarette smoking: heavy smokers have a 20 times greater chance of developing lung cancer than nonsmokers; smoking is related to cancers of the larynx, oral cavity, esophagus, & urinary bladder -most common cause of cancer deaths (30% of all deaths in US) -environmental or occupational risk factors also associated w/ lung cancer evaluation & treatment: TNM calassification; Tumor, Nodal involvement, Metastasis -surgery, chemotherapy, radiation therapy
secondary pneumothorax
-can be caused by chest trauma, -ie. stab wound or rib fracture, bullet- anything that tears the pleura
Acute pyelonephritis
-can occur after instrumentation -acute infection of the renal pelvis interstitium -vesicoureteral reflux & urinary obstruction most common underlying factors -E. coli, proteus, pseudomonas typical organisms
laryngeal cancer
-cancer of the larynx forms: -carcinoma of the true vocal cords (most common)-squamous cell CA -supraglottic -subglottic treatment: XRT/XRT & surgery
Chondrosarcoma
-cartilage forming -tumor of middle-aged & older adults -infiltrates trabeculae in spongy bone; frequent in the metaphyses or diaphysis of long bones -the tumor contains lobules of HYALINE CARTILAGE that expand & enlarge the bone -causes erosion of the cortex & can expand into the neighboring soft tissue
compression atelectasis
-caused by external pressure -Example=pneumothorax
Adrenal medulla hyperfunction
-caused by tumors derived from the chromaffin cells of the adrenal medulla -PHEOCHROMOCYTOMAS (rare) -secrete catecholamines on a continuous or episodic basis
virchow triad
-causes DVT -venous stasis, hypercoagulability, & injuries to the endothelial cells that line the vessels
Target cell failure
-cell surface receptor-associated disorders (water soluble hormones can't diffuse across a cell membrane [protein hormones & catecholamines]) * decrease in number of receptors * impaired receptor function * presence of antibodies against specific receptors * antibodies that mimic hormone action * unusual expression of receptor function (tumor cells w/ abnormal receptor activity) -Intracellular disorders (defects in post receptor signaling cascades, or inadequate synthesis of a 2nd messenger) -circulating inhibitors (Ab directed against a hormone making it inactive)
Evaluation & treatment of diseases of posterior pituitary
-check serum electrolytes, serum/urine osmolality -CAREFULLY give hypertonic saline (slowly > .9% normal saline
arteriosclerosis
-chronic disease of the arterial system -general term -abnormal thickening & hardening of the vessel walls -smooth muscle cells & collagen fibers migrate to the intima
Ulcerative collitis
-chronic inflammatory disease that causes ulceration of the colonic mucosa; sigmoid colon & rectum (20-40 yr old age group) suggested causes: infectious, immunologic (anticolon, antibodies), dietary, genetic- Jewish hereditary (supported by family studies & identical twin studies) symptoms: (intermittent) -diarrhea (10-20X's a day), bloody stools, cramping evaluation: UGI, LGI, colonoscopy w/ biopsy pathology: ulcers- abscess- necrosis Treatment: -broad spectrum antibiotics & steroids -immunosuppressive agents -surgery (resection of involved colon) AN INCREASED RISK OF COLON CANCER IS DEMONSTRATED
asthma
-chronic inflammatory disorder of the airways- IgE mediated -inflammation results from HYPERRESPONSIVENESS of the airways -can lead to obstruction & status asthmaticus (unrelieved , continued bronchoconstriction) symptoms: expiratory wheezing, dyspnea, tachypnea treatment: peak flow meters, oral corticosteroids, inhaled beta-agonists, & anti-inflammatories used to treat (antocholinergics often not recommended due to thickening of the bronchial secretions
inflammatory bowel diseases
-chronic relapsing inflammatory bowel disorders of unknown origin (Crohn disease, ulcerative colitis) Common to both: -genetics play a role as a risk factor -alterations of epithelial barrier functions (leaky) -altered immune reactions to intestinal mucosa -abnormal T cell responses (altered immunity)
stages of chronic renal failure
-chronic renal insufficiency- no symptoms, 25% renal function remains -chronic renal failure- systemic manifestations -end-stage renal failure- < 10% renal function left
fibromyalgia
-chronic widespread joint & muscle pain -vague symptoms: increased sensitivity to touch, absence of inflammation, fatigue, & sleep disturbances -*MOST EXPERTS FEEL IT IS A DECREASE IN PAIN TOLERANCE DUE TO FUNCTIONAL ABNORMALITIES OF THE CNS
What are the treatments for bone fractures?
-closed manipulation (most), traction (maintain reduction w/ force), open reduction (surgery) -internal (screws) and external fixation (bars)
polymyositis & dermatomyositis
-collectively described by the term myositis (inflammatory changes in the skeletal muscle) -viral, bacterial, & parasitic myositis: Staph Aureus infections; Trichinosis (Trichinella infection); Toxoplasmosis
Secondary hyperparathyroidism
-compensatory increase in PTH secretion secondary to a chronic disease (like renal failure/malabsorption of Ca) that causes chronic hypocalcemia -not making active Vit. D, therefore, not absorbing calcium -typically in the kidneys -autonomous (working on it's own) secretion of PTH can occur w/ parathyroid hyperplasia due to chronic renal failure (& no active Vit. D) (i.e. no feedback control)
What is Myositis Ossificans?
-complication of local muscle injury -inflammation of muscular tissue w/ subsequent CALCIFICATION & ossification of the muscle -"rider's bone" in equestrians (adductor in thigh) -"drill bone" in infantry soldiers (pectoral m.) -thigh muscles in football players
treatment for acute renal failure
-correct fluid & electrolyte imbalances -treat infections -maintain nutrition - ? dialysis (temporary) mortality rate: 30%
What are the causes of Rhabdomyolysis?
-crush syndrome (most severe presentation) -compartment syndromes - local- (caused by limb ischemia, local trauma, excessive muscular activity, or heat stroke): (Volkmann) ischemia contracture- flexion contracture of fingers/wrist due to ischemia of forearm
signs & symptoms of pleural abnormalties
-decreased breath sounds -hyper-resonance/typanitic percussion -hypotension -tracheal deviation (tension pneumo)
Alterations of the hypothalamic-pituitary system
-decreased hypothalamic function: ↓GnRH, ↓TRH, ↓CRH, ↓PIF, ↓GHRH -Anterior pituitary (hypothalamus controls how pituitary is going to release): ↓FSH, ↓LH, ↓TSH, ↓ACTH, ↑Prolactin, ↓Growth Hormone
potential causes of osteoporosis
-decreased levels of estrogen (especially w/ women) and testosterone -decreased activity level (example: astronauts) -inadequate levels of vitamins D & C, or Mg (vit D increases absorption of calcium from intestines & kidney)
osteoarthrits (degenerative joint disease)
-degeneration & loss of articular cartilage, sclerosis of bone underneath cartilage, & formation of bone spurs (osteophytes) -also referred to as degenerative joint disease -incidence increase w/ age (>40 years old) -primary disease is idiopathic (don't know what causes it) -secondary disease due to ↑ stress on joints (athletes) is characterized by local areas of damage & loss of articular cartilage, new bone formation of joint margins, subchondrial bone changes (beneath articular cartilage), & variable degrees of mild synovitis & thickening of the joint capsule -erosion of cartilage is primary defect -"bone on bone" no articular cartilage -Bouchard= proximal -Heberden= distal -Varus deformity of knee (buckles out)
complications of intestinal obstruction
-dehydration -perforation -peritonitis
feminization
-development of female secondary sex characteristics due to estrogens -hypersecretion of estrogens
virilization
-development of male secondary sex characteristics due to androgens -hypersecretion of androgens
varicose veins
-dialated & filled w/ blood -a vein in which blood has pooled -distended, tortuous, palpable veins -caused by trauma or gradual venous distention due to prolonged standing, constricting garments & damaged valves risk factors: increase age, female, family history, obesity, pregnancy, phlebitis
Where is glomerulonephritis?
-diffuse -local -segmental (skip-lesions)
Varices
-dilated veins that cause massive bleeding) -lower esophagus, stomach, rectum
Hypersecretion of prolactin
-disease of the ANTERIOR pituitary -caused by prolactinomas ( * most common hormonally active pituitary tumor) -in females, increased levels of prolactin cause amenorrhea, galactorrhea (lacitn when not breast feeding), hirsutism, and osteopenia (↓ bone mineral density) -in males, increased levels of prolactin cause hypogonadism, erectile dysfunction, impaired libido, oligospermia, galactorrhea, & diminished ejaculate volume
What is acromegaly?
-disease of the ANTERIOR pituitary -hypersecretion of growth hormone during adulthood -↓ life expectancy (HEART DISEASE, colon & lung Ca's) -usually due to GH secreting pituitary adenoma
What is gigantism?
-disease of the ANTERIOR pituitary -hypersecretion of the GH in children & adolescents (prior to epiphyseal closure) -growth to 8-9 ft. tall
What are diseases of the posterior pituitary gland?
-diseases in this gland are rare -ADH (antidiuretic hormone which allows to retain water) is made in the hypothalamus and is stored in the posterior pituitary gland (reabsorption of water) -Syndrome of inappropriate antidiuretic hormone secretion (SIADH) [makes too much ADH]- the most common causes is ectopic tumor cell secretion *hypersecretion of ADH (small cell ca of lung) -brain injury or infection -The osmolarity goes way down →not so many dots -serum sodium goes↓ -urine concentration (serum urine) goes ↑
acute pericarditis
-disorder of the pericardium -90% due to virus, MI, uremia, meds symptoms: -severe chest pain -friction rub -ST segment elevation treatment: anit-inflammatories
isolated systolic hypertension
-elevations of systolic pressure are caused by increases in cardiac output, ↑total peripheral vascular resistance, or decreased arterial distensibility -founf in large % of people > 65 years old
thromboembolus
-embolus -part of a thrombus that breaks off & goes somewhere else -pulmonary embolism
raynaud disease
-epsodic VASOSPASM in arteires & arterioles of teh fingers, less commonly the toes -primary vasospastic disorder of unknown origin -affects young women -vasospastic attacks triggered by cold, emotion, cigarettes raynaud phenomenon: secondary to other systemic disease or conditions -collagen vascular disease (scleroderma), smoking, pulmonary hypertension, myxedema, & environmental factors (cold & prolonged exposure to vibrating machinery) treatment: -avoid cold, cigarettes -vasodilators (Ca+ channel blockers, angiotensin II receptor blockers
primary hyperparathyroidism
-excess secretion of PTH from one or more parathyroid glands (usually adenoma) w/ no feedback control: - ↑ osteoclastic activity (bone resorption, ↑ bone fractures) → ↑serum calcium - ↑ calcium, phosphorus in urine, & alkaline urine → kidney stones -mild insulin resistance occurs, causing ↑ insulin secretion
Cushing syndrome
-excessive level of cortisol -ACTH dependent (cushing disease) -ACTH independent (ectopic tumor secreting cortisol, or adrenal tumor secreting cortisol, or steroid medications) -***most common cause is side effects for taking anti-inflammatory steroid medications for asthma/rheumatoid arthritis
what causes elevated or depressed hormone levels?
-failure of feedback systems -dysfunction of an endocrine gland -secretory cells are unable to produce, obtain, or convert hormone precursors -the endocrine gland synthesizes or releases excessive amounts of hormone -increased hormone degradation or activation -ectopic (somewhere it shouldn't be) hormone release (ADH secreting lung tumor)
bronchiolitis obliterans
-fibrotic process that occludes airways & causes permanent scarring of the lungs
Fibrosarcoma
-firm, fibrous mass of collagen, malignant fibroblasts, & osteoclast-like cells -usually affects metaphysis of the femur or tibia -metastasis to the lungs is common
possible factors of fibromyalgia
-flu-like viral illness, chronic fatigue syndrome, HIV infection, Lyme disease, medications, physical or emotional trauma -scientific studies are unclear
ascites
-fluid in peritoneal cavity -back up of blood in intra-abdominal veins → ↑hydrostatic pressure → ascites
Hepatits A
-found in the feces, bile, & sera of infected individuals -usually transmitted by the fecal-oral route Risk factors: -crowded, unsanitary conditions -food & water contamination (restaurant) Prevention: -immune serum globulin -hep A vaccine Diagnosis: -positive antigen antibodies (anti- HAV) Treatment: -conservative
monitoring long term glucose regulation
-glucose eventually attatches to Hb molucules in blood (Hb A1C)[used to check if insulin levels are correct] -↑ glucose levels causes ↑ levels of Hb A1C (which can be measured)
What is gestational diabetes?
-glucose intolerance during pregnancy -requires aggressive therapy to protect fetus -important to monitor glucose levels
pulmonary hypertension
-has a mean pulmonary artery pressure 5-10 mm Hg above normal (above 20 mm Hg) -pulmonary artery pressure normally 25/10 classifications: -pulmonary arterial hypertension -pulmonary venous hypertension (due to CHF) -pulmonary hypertension due to respiratory disease or hypoxemia (which causes vasoconstriction) -pulmonary hypertension due to thrombotic or embolic disease -pulmonary hypertension due to diseases of the pulmonary vasculature
What are the clinical manifestations of hyperpituitarism?
-headache & fatique -visual changes -hyposecretion of neighboring anterior pituitary hormones due to pressure effects
exudative effusion
-high concentrations of white blood cells & plasma proteins -infection
treatment for kidney stones
-high fluid intake, decreasing dietary intake of stone-forming substances or -stone removal: endoscopy; laser lithotripsy
Chronic complications of diabetes mellitus
-hyperglycemia & nonenxymatic glycosylation (reversible attatchment of glucose to protein & lipids): w/ recurrent hyperglycemia glucose becomes permanently bound which causes tissue injury Microvascular disease -Retinopathy (retinal ischemia → neovascularization → retinal detatchment) → Rx w/ laser surgery -diabetic Nephropathy (most common cause of end stage renal disease) - microalbinuria → proteinuria (death in 10 years) Macrovascular disease -coronary artery disease -stroke (2X as common) -peripheral arterial disease (occlusion of arterioles) → amputation (Ron Santo) Diabetic neuropathies (nerve degeneration) Infection (due to neuropahty/poor WBC function/ ↓ blood supply)
What are the clinical manifestations of type 1 diabetes mellitus?
-hyperglycemia, glycosuria, breakdown of fats & proteins -polyuria, polydipsia, & polyphagia (-energy balance) -weight loss/fatigue -ketoacidosis
chronic bronchitis
-hypersecretion of mucous & chronic productive cough that lasts for at least 3 months of the year & for at least 2 consecutive years -inspired irritants increase mucous production & the size & number of mucous glands -caused primarily from cigarette smoke -mucous is thicker than normal -COPD treatment: bronchodilators (beta agonists & anticholinergics) expectorants, & chest physical therapy used to treat
What can chronic renal failure be a complication of?
-hypertension -diabetes mellitus -renal diseases: 1.) chronic glomerulonephritis (most common cause) 2.) chronic pyelonephritis (kidney infection) 3.) obstructive uropathies (prostatic hypertrophy)
Diagnosis of chronic glomerulonephritis
-hypertension -edema -urinalysis w/ protein -WBC's -RNC's -casts
symptoms of alterations in adrenal function
-hypertension (increased peripheral vascular resistance) -headache -hypermetabolism -sweating/palpitations/tachycardia
manifestations of ARDS
-hyperventilation -respiratory alkalosis -dyspnea & hypoxemia -metabolic acidosis -hypoventilaiton -respiratory acidosis -further hypoxemia -hypotension, decreased cardiac output, death
Acute complications of diabetes mellitus
-hypoglycemia (due to insulin reaction) → anxiety/tachycardia → coma -diabetic ketoacidosis -hyper-osmolar hyperglycemic non-ketotic syndrome (HHNKS)- ↑ serum osmotic pressure due to hyperglycemia ( >500) → severe dehydration [too much glucose; won't be acidiodic; constantly pee] -Somogyi effect- hypoglycemia followed by rebound hyperglycemia die to counter-regulatory hormones (epinephrine, GH, corticosteroids) that are released; usually occurs in middle of the night -Dawn phenomenon- early morning rise in blood glucose concentration (w/ no hypoglycemia at night) -due to nocturnal elevation of GH, cortisol, & catecholamines which mobilize glucose into the blood -Rx: re-adjust insulin doses
panhypopituitarism
-hypopituitarism -deficiency of all pituitary hormones -ACTH deficiency -TSH deficiency -FSH deficiency -GH deficiency (pituitary dwarf) - ↓ACTH potentially life threatening (need cortisol for metabolism): Symptoms= N&V, fatigue, weakness - ↓TSH: cold intolerance, dry skin, lethargy -↓FSH, LH: amenorrhea, atrophic vagina/uterus/breasts
pituitary infarction
-hypopituitarism -Sheehan syndrome (postpartum pituitary necroses) -hemorrhage -shock
Prediabetes
-impaired glucose tolerance (IGT): glucose > 140mg/dl & <200 mg/dl (due to diminished insulin secretion) OR -impaired fasting glucose (IFG): glucose >100 & < 126 (due to enhanced liver glucose output) -***both have significant risk of cardiovascular disease
What causes prerenal acute renal failure?
-impaired renal blood flow by: -massive dehydration -low blood pressure -massive bleeding -massive heart attack -GFR declines because of the decrease in filtration pressure/rate (DETERMINANTS OF FILTRATION PRESSURE: 25% of cardiac output goes to the kidneys -180 liters filtered through kidneys daily (120cc/min); a decrease in plasma filtration rate or pressure will decrease glomerular filtration rate (GFR)
acute respiratory failure
-inadequate gas exchange -PO2<50, -PCO2>50 -pH<7.25
chronic venous insufficiency
-inadequate venous return over al ong period due to varicose veins or valvular incompetence -venous stasis ulcers (complicated by infection) venous hypertension →circulatory stasis→tissue hypoxia→inflammatory reaction (in vessels & tissues)→ skin ulceration treatment: LEG ELEVATION, compression stockings, unna boot
What is acute cystitis?
-inflammation of the bladder
Rheumatoid arthritis
-inflammatory joint disease (2% of adults, female 3:1 ratio, 5% > 70 years old) -systemic AUTOIMMUNE damage to connective tissue, primarily in the joints (synovial membrane 1st to be involved; 1st thing that goes/gets damaged): antibodies against your own antibodies -similar symptoms to osteoarthrits -distal (small) joints most involved -presence of rheumatoid factors (RA or RF test); antibodies (IgG & IgM) against their own antibodies (draw blood to detect) -joint fluid presents w/ inflammatory exudate -"ulnar drift"
subendocardial infarction
-inner lining of the heart -occurs 1st since it is farther away from the blood supply -typically 1st
flail chest
-instability of a portion of the chest wall -paradoxical movement -broken ribs; part of chest wall doesn't expand the way it should -conditions caused by pulmonary disease or injury
Severity of urinary tract obstruction is based on...
-location -completeness -involvement of one or both upper urinary tracts -duration -cause: stricture/congenital; compression from tumor or inflammation; stone
Rhabdomyosarcoma
-malignant tumor of striated muscle -usually muscles of the tongue, neck, larynx, nasal cavity, axilla, vulva & heart -highly malignant w/ rapid metastasis -types: pleomorphic, emryonal, & alveolar
factors of osteomyelitis
-many small channels in bone inaccessable to body defenses -microcirculation of bone vulnerable to damage -limited capacity of osteoblasts to replace infected bone
neurogenic shock
-massive vasodilation due to parasympathetic - ↓sympathetic stimulation
Bone tumors
-may originate from bone cells, caritlage, fibrous tissue, marrow, or vascular tissue (osteogenic, chondrogenic, collagenic, & myelogenic) -fibroblast: bone cell cartilage; osteoblast (bone cell), chondroblast (cartilage cell), fibroblast (collagen producing cell) -Reticulum: Bone marrow
Gout
-metabolic disorder that disrupts the body's control of uric acid PRODUCTION or EXCRETION -gout manifestations high levels of uric acid in the blood & other body fluids -occurs when the uric acid concentration increases to high enough levels to crystallize -cyrstals deposit in connective tissues throughout the body -when these crystals occur in the synovial fluid, the inflammation is know as "gouty arthritis" - gout is related to purine (adenine & guanine) metabolism (URIC ACID is a breakdown product of purines) -affected patients can have accelerated purine synthesis, breakdown, or poor uric acid secretion in the kidneys -mechanics for crystal deposition: lower body temperatures, decreased albumin or glycosaminoglycan levels, changes in ion concentration and pH, & trauma (promotes uric acid crystal precipitation) -50% initial attacks in great toe (a condition known as PODOGRA) -RENAL STONES 1000X more prevalent in individuals w/ gout
callus formation
-mineralized new bone built up -osteoclasts destroy dead bone
lip cancer
-most common form: exophytic (squamous cell CA) -stages
duodenal ulcers
-most common in peptic ulcers (75%) -developmental factors: *helicobacter pylori infection-toxins & enzymes are released that promote inflammation & ulceration; hypersecretion of stomach acid & pepsin; use of NSAIDS; high gastrin levels (stimulate stomach pariteal cells to secrete HCL); acid production by cigarette smoking
manifestations of interstitial cystits
-most common in women 20-30 years old -bladder fullness, frequency, small urine volume, chronic pelvic pain
Osteosarcoma
-most common malignant bone tumor -****38% of bone tumors****** (usually end of long bone) -predominant in adolescents & young adults; occurs in seniors of they have a history of radiation therapy -contain masses of osteoid (abnormal cells): "streamers" noncalcified bone matrix & callus -located in the metaphyses of long bones: 50% occur around the knees -requires amputation
mitral valve prolapse syndrome (MVPS)
-most common valve disorder in U.S -more common in women -most common cause=myxomatous degeneration of leaflets most people are asymptomatic symptoms often due to arrythmias
contracture
-muscle fiber shortening w/out an action potential -caused by failure of the sarcoplasmic reticulum) calium pump) even w/ available ATP
What are the alterations of chronic renal failure?
-musculoskeletal -cardiovascular & pulmonary -hematologic -immune -neurologic -gastrointestinal (alteration in protein, carbohydrate, & lipid metabolism) -endocrine & reproduction -integumentary
Stress-induced muscle tension
-neck stiffness, back pain, clenching teeth, hand grip, & headache -associated w/ chronic anxiety
detrusor areflexia
-neurogenic bladder -atonic, flaccid bladder due to distension of bladder (BPH) or peripheral nerve lesion
treatment for interstitial cystits
-no single treatment effective (? steroids); symptoms relief
deep venous thrombosis
-obstruction of venous flow leading to increased venous pressure & stasis→ venous thrombosis causative agents: (virchow's triad) -venous stasis venous endothelial damage -hypercoagulable states treatment: anticoagulant; treatment to prevent pulmonary embolism; prescriptions: heparin/low molecular weight heparin (lovenox)/coumadin/plavix (oral) -IVC filter=filter put in inferior vena cava below the renal vein; used to catch clot prevention: -early ambulation -pneumatic devices/compression stockings -prophylactic anticoagulation
pulmonary embolism
-occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble -pulmonary emboli commonly arise from the deep veins in the thigh (90%) -increases V/Q
spontaneous pneumothorax
-occurs unexpectedly -caused by spontaneous rupture of blebs (blister-like formations) on the visceral pleura
manifestations of acute cystits
-often assymptomatic -frequency, dysuria, urgency, & lower abdominal &/or suprapubic pain , hematuria
phases of acute renal failure
-oliguria phase (1-3 weeks): don't make much urine -diuretic phase (variable): make way too much urine (worry about dehydration) -recovery phase (3-12 months)
clinical manifestations of osteoporosis
-pain -bone deformity -fractures
manifestations of osteoarthritis
-pain -stiffness -enlargement of the joint -tenderness -limited motion -deformity
aspiration
-passage of fluid & solid particles into the lungs -"going down the wrong tube"
Cheyne-stokes respirations
-periods of deep & shallow breathing followed by apnea of 15-20 seconds -due to CO2 concentration -due to neurological injury -doesn't have to be permanent
chronic pyelonephritis
-persistant or recurring episodes of acute pyelobephritis that leads to scarring -risk of chronic pyelonephritis increases in individuals w/ renal infections & some type of obstructive pathologic condition (prostatic hypertrophy)
Evaluation & treatment of ARDS
-physical examination, blood gases, & radiologic examination -supportive therapy w/ ventilation & prevention of infection -surfactant to improve compliance
tension pneumothorax
-pleural rupture site acts as a one-way valve letting air enter on inspiration but preventing air escape on expiration -the pressure pushes important structures to the left/right -absolute surgical emergency
pleural inflammation
-pleuritis (pleurisy) -can be viral, bacterial, or allergic
osteoporosis
-porous bone -poorly mineralized bone -bone density (peaks at 35 years old), then resorption → formation (osteoclasts begin to do more work than osteoblasts) -Remember: quantity & QUALITY (decrease) -demonstrated by reduced bone mass/density (DEXA scan) & is an imbalance between bone resorption & formation -* bone histology is usually normal but it lacks structural integrity -by age 50: 55% of people have osteoporosis or ↓ bone mass -by age 90: 17% males, 32% females have hp fracture -Women: complete loss of trabeculae -Men: form more bone on outer surface -Kyphosis
postrenal acute renal failure
-post kidney -develops due to obstruction -occurs w/ urinary tract obstruction that affect the kidneys bilaterally (↑ prostate, bilateral ureteral obstruction, bladder neck obstruction)
Hemolytic jaundice
-prehepatic jaundice -excessive hemolysis of red blood cells or absorption of a hematoma → ↑ unconjugated billirubin in blood (liver can't conjugate fast enough)
Adrenocortical hypofunction
-primary adrenal insufficinecy (ADDISON DISEASE) -rare -autoimmune mechanics that destroy adrenal cortical cells -secondary hypocortisolism- low/absent ACTH caused by exogenous glucocorticosteroids or cortisol secreting tumors (negative feedback)
superior vena cava syndrome
-progressive occlusion of the superior vena cava that leads to venous distention & edema of upper extremities & head -concologic emergency: 75% due to local lung carcinoma treatment: -treat the cancer (surgery/chemo/XRT) -venous bypass surgery
Evaluation of hyperthyroidism
-radioactive iodine is used in differential diagnosis of hyperthyroidism -If there is a low uptake of iodine: thyroiditis Normal or elevated uptake (indicate): -Graves disease -Toxic multinodular goiter -toxic adenoma
malignant hypertension
-rapidly progressive hypertension -diastolic pressure is usually >140 mmHg→ cerebral edema→ coma→ death
Thyroid cancer
-rare (though most common endocrine Ca) -euthyroid state (normal T3, T4 levels)
disuse atrophy
-reduction in the normal size of muscle cells as a result of prolonged inactivity: bed rest, trauma, casting, or nerve damage
Clinical manifestations of diseases of posterior pituitary
-related to enhanced renal water retention →hyponatremia & hypoosmolality
absorption atelectasis
-removal of air from obstructed or hypoventilated alveoli or from inhalation of concentrated oxygen -most common -w/ open pore of Kohn (little openings between the walls of the alveoli); commonly seen postoperatively; deep breath in then cough to pop the mucous plug out
manifestations of kidney stones
-renal colic: hematuria, flank pain → groin (obstruction in pelvis/prox ureter) -lower abdominal pain (mid ureter) -dysuria (lower ureter)
Hepatitis C
-responsible for most cases of post-transfusion hepatitis -also implicated in infections related to IV drug use -*50-80% of hepatitis C cases result in chronic hepatitis (20% OF THESE DEVELOP CIRRHOSIS)
Diagnosis of diseases of posterior pituitary
-serum hypoosmolality, hyponatremia, urine hyperosmolarity, normal adrenal & thyroid function must exist
non-small cell lung cancer
-squamous cell carcinoma (30% in hilum) -adenocarcinoma-tumor arising from the gland; 35-40% of all bronchogenic carcinomas (40% in periphery)
evaluation of kidney stones
-stone & urine analysis -intravenous pyelogram (IVP) or kidney, ureter, bladder x-ray (KUB) -spiral abdominal CT ***most common - MRI***
myocardial infarction
-sudden & extended obstruction of the myocardial blood supply; complete blockage -cellular injury -cellular death -structural & functional changes: myocardial stunning- temporary loss of contractile function of surrounding muscle for hours/days hibernating myocardium-cardian muscle adapts to ischemia; can completely recover after revascularization ex. coronary bypass grafting or coronary angioplasty myocardial remodeling- myocyte hypertrophery & loss of contractile function distant to the area of ischemia resulting in ↓ ejection fraction due to cytokines, angiotension II, catecholamines etc. repair: -strudy scar tissue forms w/ in 6 weeks
Treatment for renal cell carcinoma
-surgical removal - +/- chemo/XRT
Secondary hyperaldosteronism
-sustained renin release due to ↓ blood volume (dehydration) or renal artery stenosis (↓ flow & pressure) -disorder of the adrenal crotex
false aneurysms
-tear in intima & media, not adventia -involves 2 of the 3 layers -saccular aneurysms -dissecting aneurysms
dislocation fracture
-temporary displacement of 2 bones -loss of contact between articular cartilage
what is chronic renal failure?
-the irreversible loss of renal function that affects nearly all organ systems (months → years) -proteinuria & uremia (the syndrome caused by accumulation of nitrogenous waste products from protein metabolism) -↓ creatinine & urea clearance (elevation in blood BUN & creatinine)= AZOTEMIA -fluid & electrolyte balance *sodium & water balance (Na & h2O retained → edema) * ↑ phosphate & ↓ calcium (lack of active vit D) * ↑ potassium ( ↑ serum K+ because it's not secreted in urine) * acid-base balance (metabolic acidosis - loss of HCO3, retention of H+) -fluid & electrolyte balance continued: *sodium & water balance (Na & H2O retained, causing peripheral edema) * increased serum phosphate, decreased Ca+ * Potasium balance: increased serum K+ (K+ not secreted) * acid-base balance (metabolic acidosis - loss of HCO3, retention of H+)
what is the treatment for thyroid cancer?
-thyroidectomy (recommended for a healthy person who can tolerate the surgery) (a complication of this surgery= hypoparathyroidism) -TSH suppressants -radioactive iodine -XRT
Hepatitis B
-transmitted through contact w/ infected blood, body fluids, or contaminated needles -maternal transmission can occur if the mother is infected during the 3rd trimester -vaccine prevents transmission & development prevention: -vaccine -immune serum globulin given early in exposure diagnosis: -serum antigens (HBsAG, HBcAG) treatment: -conservative -chronic disease- antivirals; interferon alpha
small cell carcinoma
-tumors central in origin -constitutes for 20% -strongest correlation w/ cigarette smoking -worst prognosis; 6-12 month survival time
diagnosis of acute cystits
-urinalysis, culture & sensitivity
Colon cancer
-usually arise from adenomatous polyps (discovered during colonoscopy) -once malignant cells transverse muscularis mucosa they become invasive & highly malignant (Adenocarcinomas) -greater size (more than 1.5 cm)= increased malignant potential pathology: -moderatly differentiated adenocarcinoma -slow grwoing symptoms: -depends on location, size, type -ascending colon: polypoid; rarely obstruct lumen; cause melena (black, tarry stools) -descending colon: elevated, button-like lesion; circumferential (will obstruct); ulcerating; *BRB stools Rectal CA: -up tp 15 cm from anal opening -can spread through rectal wall Evaluation: -family history -check for anemia (blood in stool; hemoccult test) -barium enema (BE), colonoscopy → remove polyps if found -check for metastases (liver) Dukes Classification (A, B, C, D) -A: to bowel wall -B: through blood wall -C: lymph nodes positive -D: distant metastases Treatment: -radiation, then surgical excision -chemotherapy for distant metastases
secondary hypertension
-usually renal disease -caused by a sytemic disease process that reaises perpheral vascular resistance or cardiac output (renal vascular disease, adrenocortical tumors, adrenomedullary tumors, [pheochromocytoma], drugs
symptoms of intestinal obstruction
-vomiting -abdominal pain -significant abdominal distension (tympany to percussion, hyperactive bowel sounds)
Stages of infection
1) colonization, 2) invasion, 3) multiplication, 4) spread
Mechanisms of local spread
1. Cellular proliferation or multiplication. (mitotic rate vs. cellular death rate. 2. Angiogenesis and perhaps lyphogenesis. (Increased pressure) 3. Digestion of capsules and other structural barriers. (release of lytic enzymes) 4. Changes in cell-to-cell adhesion (loss of fibronectin making cancer cells slippery). 5. Increased motility of individual tumor cells.
Anemias will fall into one of these 4 categories:
1. Impaired erythrocyte poduction / 2. Blood loss / 3. Erythrocyte destruction / 4. Combination of the above
Phases of tumor spread
1. Transformation 2. Growth 3. Local Invasion 4. Distant Metastesis
intestinal obstructions
1. hernia 2. intussusception (usually in the colon (folds)) 3. volvulus- twist 4. adhesions- #1 cause is surgery
treatment of intestinal obstruction
1. long tube decompression (75% success rate for surgical adhesions) (miller-abbot tube) 2. surgery
pathogenesis of pulmonary embolism
1. venous stasis; vessel injury; hypercoagulability 2. thrombus formation 3. dislodgement of portion of thrombus 4. occlusion of part of pulmonary circulation 5. hypoxic vasoconstriction; decreased surfactant; release of neurohumoral & inflammatory responses; pulmonary edema; atelectosis 6. tachypnea; dyspnea; chest pain; increased dead space; V/Q imbalances; decreased PaCO2; pulmonary infarction; pulmonary hypertension; decreased cardiac output; systemic hypotension; shock
What are the treatments for compartment syndrome?
1.) Fasciotomy (of anterior & posterior compartments) to relieve pressure 2.) "flush" kidneys w/ diuretics (build up of myoglobin)
prevention of osteoporosis
1.) adequate intake of Ca/Vit D 2.) weight bearing exercise 3.) no tobacco/alcohol 4.) avoidance of glucocorticoids
stress (microfracture)
2 types: fatigue & insufficiency (new activity vs. fatigue fracture in abnormal bone)
clonal selection
2nd phase of immune response; initiated by antigen; process which involves complex interaction among cells; final products are plasma cells that produce antibodies and memory B and T cells
Death by suffocation can occur within minutes when ambien oxyten drops below:
5%
A concussion is defined as temporary axonal disturbance with loss of consciousness lasting less than:
6 hours.
obstruction sequelae
7 days: fibrosis of distal nephron 14 days: both proximal & distal nephron 28 days: damage to glomerulus (inability to concentrate urine & conserve Na+ & bicarb → dehydration → metabolic acidosis) 60 days: partial kidney recovery
Adenocarcinoma
A cancer that arises from ductal or glandular epithelium. Ex. a malignant tumor arising from breast glandular tissue is called mammary adenocarcinoma.
Cachexia
A condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with diseases such as advanced cancer. Includes anorexia, early satiety, weight loss, altered lipid carb metabolism, asthenia (tingling), taste alterations, etc.
Injury to the endoplasmic reticulum due to hypoxic injury results in:
A decrease in protein synthesis - (Because of the lack of ATP, the sodium/potassium pump fails allowing sodium and water to enter the cell freely causing dilation of the ER. Dilation of the ER results in detachment of ribosomes from rough ER, reducing protein synthesis.)
production of lactate
A direct result of anaerobic metabolism during hypoxic cell injury
Chromosome amplification
A genetic abnormality that turns on oncogenes. They are the result of duplication of a small piece of a chromosome over and over again. Results in increased expression of oncogenes and in some cases, drug resistant genes.
Tumor
A growth of tissue caused the uncontrolled replication of cells.
parietal pain
A localized, intense pain that arises from the parietal peritoneum, the lining of the abdominal cavity. Example: late appendicitis
Radon
A natural radioactive gas derived from the radioactive decay of uranium that is ubiquitous in rock and soil. Can cause lung cancers. Small cell carcinoma occurs in miners.
postobstructive diuresis
A period of brisk urine production when urinary tract obstruction is relieved. 10 liters of urine is excreted within a 24 hr period.
Local spread
A prerequiste for metastasis and the first step in the metastic process. In its earliest stages it is a function of direct tumor extension.
Clonal Proliferation or Clonal Expansion
A result of mutations. A cell will acquire chracteristics that will allow it to have an advantage over neighboring cells. The more proliferation there is, the higher risk of cancer.
What is Thrombotic thrombocytopenic purpura (TTP)?
A thrombotic micro-angiopathy: platelets aggregate, form microthrombi, and cause occlusion of arterioles and capillaries / Chronic relapsing TTP / Acute idiopathic TTP
Describe the p53 gene.
A tumor suppressor gene that 1)attempts to repair DNA damages or 2) stops the cell cycle, or 3)initiates apoptosis. Defects in this gene may be inherited or are caused by exposure to carcinogens. Loss of this gene may facilitate angiogenesis and resistence to apoptosis.
what are the steps in callus formation?
A.) hematoma formation B.) organization of hematoma C.) invasion of osteoblasts, deposition of calcium D.) callus formation E.) remodeling
Gastroesophageal reflux
A.K.A GER or GERD is the reflux of chyme from the stomach into the esophagus if GER causes inflammation of the esophagus, it is called reflux esophagitis a normal functioning lower esophageal sphincter (LES) maintains a zone of high pressure to prevent chyme reflux conditions that increase abdominal pressure can contribute to GER (coughing, lifting, bending, lying flat): LES pressure is overcome
More on DIC:
Activating the fibrinolytic system / fibrin degradation product (FDP) / D-dimer levels increase / High mortality rate / Treatment remove the stimulus: restore hemostasis, maintain organ viability, replace deficient coagulation factors
Cushing ulcer
Acute gastric ulcer associated with CNS injury severe head trauma or brain surgery
Physical findings of HL?
Adenophathy / mediastinal mass / splenomegaly / and abdominal mass
How does obesity correlate with cancer?
Adipose tissue releases free fatty acids. Free fatty acids give rise to insulin resistance and cause chronic hyperinsulemia. Correlates with colon, breast, endometrial, and pancreatic cancers.
Angiogenic Factors
Advanced cancers are able to secrete factors that will stimulate new blood vessel growth. Ex. Vascular endothelial growth factor.
What are the effects of Vitamin B12 deficiency?
Affects nervous system / Myelin degeration: loss of fibers in spinal cord: parestthesia and gait disturbances / Effectiveness of therapy: Reticulocyte count
The postmortem decrease in body temperature is called:
Algor Mortis.
Which of the following problems are likely to occur following a severe focal brain injury?
All of the above A) Cerebral edema B) Subdural hematoma C) Contrecoup injury
Spinal shock involves loss of:
All of the above : A) skeletal motor function. B) peripheral sensory function. C) autonomic function.
An extreme laceration is called:
An avulsion.
Telomerase
An enzyme that catalyzes the lengthening of telomeres. The enzyme includes a molecule of RNA that serves as a template for new telomere segments.
Human T cell leukemia-lymphoma virus (HTLV)
An oncogenic retrovirus linked to the development of adult T cell leukemia and lymphoma (ATLL). Inherited vertically (by children from infected parents) and horizontally (breast-feeding, sexual intercourse, etc.
Metaplasia involves the replacement of normal cells by:
Another type of cell. (Ex: Replacement of normal columnar ciliated epithelial cells of the bronchial lining by stratisfied squamous epithelial cells. The new cells do not secrete mucus or have cilia, causing loss of protection.)
Vitamin E, Vitamin C, and beta-carotene are molecules in food that act as:
Antioxidants. (Inactivate free radicals)
Cancer
Any malignant growth or tumor caused by abnormal and uncontrolled cell division.
The process by which cells program themselves to die is called:
Apoptosis.
The risk factor that contributes to mesothelioma
Asbestos
What is Goodpasture syndrome?
Autoantibodies against alveolar and glomerular basement membrane proteins -rapidly progressing glomerulonephritis
Lysosomal rupture during hypoxic injury leads to:
Autodigestion of cells. (lysosomal rupture is caused by cellular swelling.)
The process of cellular self-digestion following local cell death is called:
Autolysis.
Which type of genetic disorder is Tay-Sachs?
Autosomal recessive.
What is the most common type of non-hodgkin lymphoma in children / It is caused by a B-cell tumor that causes a very fast-growing tumor of the jaw and facial bones / Lasly Epstein-Barr virus is found in nasophryngeal secretions of patients?
BURKITT LYMPHOMA
evaluation of GER
Barium swallow manometric studies-measures the pressure in the esophagus pH studies-easures the pH in lower esophogus endoscopy
Ultra violet radiation causes what type of cancer?
Basal cell carcinoma. At risk are light-skinned, fair haired, blue-eyed people. The majority of damage happens in our teen years.
Tumor marker
Biologic markers. Substances found on tumor plasma membranes or in blood, spinal fluid, or urine. Can be use to 1.) screen and identify individuals at high risk for cancer, 2.) help diagnose the specific type of tumor for individuals with clinical manifestations relalting to cancer, as in adrenal tumors, and 3.) follow the clinical course of cancer.
Clinical s/s demonstrate wide variobility in DIC:
Bleeding from venipuncture sites / bleeding from arterial lines / purpura, petechiae, and hematomas / symmetric cyanosis of the fingers and toes
Liquefactive necrosis typically occurs after severe hypoxic inury to which organ?
Brain. (Results from Ischemic injury to neurons and glial cells in the brain because the central nervous system contains little connective tissue.)
torus fracture
Buckling of the cortex of a long bone from trauma (usually radius or ulna)
thromboangititis obliterans
Buerger's disease is aka -occurs mainly in young men who smoke -inflammatory disease of PERIPHERAL arteries resulting in the formation of nonatherosclerotic lesions (autoimmune) -obliterates the small & medium -sized arteries -causes pain, tenderness & hair loss in the affected areas -symptoms are caused by slow, sluggish blood flow -often red skin (rubor) -can often lead to gangerous lesions treatment: -quit cigarettes -vasodilators -sypathecotmy-cuts off epinephrine & noreepinephrine
pneumothorax
COLLAPSED LUNG
Which molecule is likely to accumulate in any dead or dying tissue?
Calcium. (Calcium pump fails due to mitochondrial injury. Calcium accumulates in cytoplasm contributing to irreversible cell injury and death.)
Pathogenic Calcification:
Can be dystrophic or metastatic. Dystrophic calcification occurs in dying and dead tissues. Metastatic calcification consists of mineral deposits that occur in undamaged normal tissues as a result of hypercalcemia.
Carcinogen
Cancer causing agents
Autocrine stimulation
Cancers acquire the ability to secrete and respond to their own growth factors.
Sarcoma
Cancers arising from connective tissues. Ex. Malignant cancers of skeletal muscle are termed rhabdomyosarcomas.
Carcinoma
Cancers arising in epithelial tissue.
Leukemia
Cancers of blood-forming cells.
Lymphoma
Cancers of the lymphatic tissue.
Why is carbon monoxide exposure a life-threatening condition?
Carbon monoxide binds to hemoglobin and prevents normal oxygen transport to tissues.
A type of necrosis that results from tuberculosis and is a combination of liquefactive and coagulative necroses is:
Caseous Necrosis. (Dead cells disintegrate, but the debris is not completely digested by the hydrolases. Tissues resemble clumped cheese in that they are soft and granular. A granulomatous inflammatory wall encloses areas of caseous necrosis.)
Metaplasia occurs in response to:
Cell injury from noxious stimuli - generated by cytokines and growth factors in cells environment. (Noxious stimuli is any thermal, mechanical, or chemical substance that causes injury.)
Accepted theories of aging consist of:
Cellular aging results from wear and tear over the course of a lifetime. Degeneration of extracellular materials such as collagen contributes to aging. Genetic mechanisms of aging are programmed in a cell's DNA.
abnormal sputum
Change in color, odor, consistency, and amount of sputum -
What are the characteristic of these Megaloblastic anemias?
Characterized by defective DNA synthesis due to deficiencies in Vitamin B12 or Folate (Folic Acid) / The Ribonucleic acid or RNA processes are normal: results in unequal growth or nucleus and cytoplasm
What is the characteristic of Microcytic-Hypochromic Anemias?
Characterized by red cells that are abnormally small and contain reduced amounts of hemoglobin
The population group most vulnerable to lead poisoning is:
Children are most vulnerable to lead poisoning because they absorb lead through the intestines more rapidly than adults.
Bystander effects
Chromosomal abberations and mutations that exist in not only the clonal progeny of the irraiated cells, but also in other cells (nonclonal) that were not directly radiated.
NHL are differentiated by Etiology / Unique Features / Response to Therapies. What are NHL linked to?
Chromosome translocations / Viral and bacterial infections / Environmental agents / Immunodeficiencies / Autoimmune disorders
Who is at risk for Iron Deficiency Anemia?
Chronic Poverty / Women of childbearing age / Children / Children living in developing countries with poor diet and chronic parasitic infections / Women with menorrhagia
What cellular process occurs during apoptosis?
Cleavage of key cellular protens. (Apoptosis results in the rapid killing of a cell through nuclear shrinkage and the activation of proteases that neatly cleave key cellular proteins.)
A type of necrosis that occurs primarily in the kidneys, heart and adrenal glands is:
Coagulative Necrosis. (Commonly results from hypoxia caused by severe ischemia or hypoxia caused by chemical injury, especially if ingestion of mercuric acid. Coagulation is caused by protein denaturation, which causes the albumin to change from a gelatinous, transparent state to a firm, opaque state.
The presence of the tumor marker CEA (Carcinoembryonic antigen) indicates what cancers?
Colon, liver, pancreas, lung, breast, ovarian.
What is Disseminated Intravascular Coagulation (DIC)
Complex, acquired disorder / DIC is the result of increased protease activity in the blood caused by unregulated release of thrombin / endothelial damage / TF starts the coagulation cascade / amount of activated thrombin exceeds the body's antithrombins and the thrombin does not remain localized
pectus excavatum
Congenital deformity of the bony thorax in which the sternum is bent inward.
Type of injury that results in bleeding in the skin or underlying tissues.
Contusion.
Clinical manifestations of Myeloma?
Cortical and medullary bone loss / skeletal pain / recurring infections / renal failure / anemia
hypoxemia
DECREASED OXYGEN IN THE BLOOD
evaluation of osteoporosis
DEXA scan (dual energy x-ray absorptiometry) -30% of bone tissue already lost when 1st detected by regular x-ray
Free radicals directly injury cells by the following mechanisms:
DNA Fragmentation: Causing decreased protein synthesis. Lipid Peroxidation: Destruction of polyunsaturated lipids. Mitochondrial Damage: causing liberation of calcium into cytosol and attacking critical proteins that affect ion pumps and transport mechanisms.
Why is the RAA (Renin-Angiotensin Aldosterone) system activated?
Decrease blood flow detected by the kidneys activates the RAA, causing salt and water retention in an attempt to increase blood volume
What are the primary factors contributing to oncosis from hypoxic injury?
Decrease in ATP production and sodium movement into the cell.
A decrease in cerebral perfusion pressure (CPP) is related to which of the following physiological changes?
Decrease in arterial blood pressure
Cellular atrophy involves:
Decrease in cell size. *Most common in skeletal muscle, heart, secondary sex organs, and the brain.
Tissue ischemia and a decrease in mitochondrial oxygenation result in:
Decreased ATP production.
What pathologic mechanisms happen in Anemia of Chronic Inflammation?
Decreased Erythrocyte life span / Ineffective bone marrow response to Erythropoietin / Altered Iron metabolism
A reduction in the total number of erythrocytes in the circulating blood or in the quality or quantity of hemoglobin. What is this?
Definition of ANEMIA
dyspnea
Difficulty breathing -subjective sensation of uncomfortable breathing
What is Idiopathic (immune) thrombocytopenic purpura (ITP)?
Diffuse hemorrhage into skin tissues / Not enough normal platelets to plug damaged vessels / IgG antibody that targets platelet glycoproteins (autoimmune response) / antibody-coated platelets are sequestered and removed fr circulation / one of the most common childhood bleeding disorders
LOCAL LYMPHADENOPATHY?
Drainage of an inflammatory lesion located near the enlarged node
During hypoxia what happens to the vessels, HR, RR and RAA?
During HYPOXIA due to anemia, less RBC creates less volume of blood, so fluid will flow in the blood to compensate, causing VASODILATION. More fluids in the blood system causes increase HR, need for oxygen causes inrease RR, release of O2 from Hgb, and the Renin-Angiotensin Aldosterone system or RAA is activated.
Chronic infection of the cervix by the Human Papillomavirus results in cervical:
Dysplasia. (Abnormal changes in size, shape, and organization of mature cells.)
What is often the first sign of HL?
Enlarged Lymph Nodes
What is LYMPHADENOPHATHY?
Enlarged lymph nodes that become palpable and tender
Phase 1 activation enzymes
Enzymes that activate xenobiotics.
A collection of blood between the inner surface of the skull and the dura usually caused by a torn artery and almost always associated with a skull fracture.
Epidural Hematoma
Hormonal hyperplasia occurs chiefly in:
Estrogen dependant organs, such as the breast and uterus. (Ex: after ovulation, estrogen stimulates the endometrium to grow and thicken in preparation for implantation. If pregnancy occurs, hormonal hyperplasia, as well as hypertrophy, enable the uterus to enlarge.)
In the pathophysiology of cerebral infarction, the release of which substance is associated with neuron hyperpolarization and seizure activity?
Excitotoxins
inhalation disorders
Exposure to toxic gases, smoke, ammonia, chlorine,causes inflammation
What type of megaloblastic anemia is caused by a vitamin required for RNA and DNA synthesis in the erythrocyte / a defiiency more common than PA / causes simila sns than PA except for neurological symptoms / and occurs in alcoholics and malnourished?
FOLATE (FOLIC ACID) deficiency anemia
What would falling PSA levels after treatment for prostate cancer indicate?
Falling PSA levels would indicate that the treatment is working.
Which molecule accumulates in liver cells as a result of alcohol abuse?
Fat (lipids).
Even though the symptoms of anemia are variable. What are the classic symptoms of ANEMIA?
Fatigue / Weakness / Dyspnea / Pallor
What are the clinical manifestation of LEUKEMIAS?
Fatigue / anemia / bleeding cos decreased in platelets / Fever cos of infection / Anorexia, weight loss / CNS involvement / Splenomegaly, hepatomegaly / Joint and bone pain r/t leuckemic cell profiferation
S/S of Infectious Mononucleosis?
Fever / sore throat / swollen cervical lymph nodes / increased lymphocyte count / atypical (activated) lymphocytes / serious complications are infrequent <5% / >50% lymphocytes and at least 10% atypical lymphocytes
S/S of HL?
Fever / weight loss / night sweats / pruritus
Xenobiotics
Foreign compounds that are not part of our core metabolism. These include toxic, mutagenic, and carcinogenci compounds. Can be counteracted by detoxification enzymes and antioxidant systems.
The process of cellular atrophy is accomplished through which process?
Formation of autophagic vacuoles. Autophagic vacuoles are membrane-bound vesicles within the cell that contain cellular debris nad hydrolytic enzymes. The level of hydrolytic enzymes rises rapidly in atrophy. The enzymes are isolated in autophagic vacuoles to prevent uncontrolled cellular destruction. Thus, the vacuoles form as needed to protect uninjured organelles from the injured organelles and are eventually taken up and destroyed by lysosomes.
An increase in granulocytes (neutrophils, eosinophils, or basophils)?
GRANULOCYTOSIS
What is NON-HODKIN LYMPHOMA (NHL)?
Generic term for a diverse group of lymphomas
Caretaker gene
Genes that are responsible for maintenance of genomic activity. They encode proteins that are involved in repairing damaged DNA. Mutations can be caused by UV rays.
Tumor suppressor genes
Genes which code for proteins that suppress tumor formation by applying brakes on cell proliferation. (mutation that creates a deficiency would contribute to carcinogenesis). Both of the cell's two genes must be defective to lead to abnormal cell division. Inactivation occurs by loss of function, mutation, and LOH.
Malignant tumors
Grow more rapidly then benign tumors. have specific microscopic alterations which include loss of differentiation, absense of normal tissue organization, lack of a capsule, invasion into blood vessels, lymphatics, and surrounding structures, and distant spread (metastasis).
Tattooing and stippling occurs with which injury?
Gunshot wounds.
What is a bacteria that infects more than half of the world's population?
H. Pylori. It is a common cause of gastric infection and is implicated in peptic ulcer disease, gastric lymphomas, and gastric carcinomas.
This type of anemia is caused by Accelerated destruction of RBCs?
HEMOLYTIC ANEMIA
What type of lymphomas is characterized by the presence of Reed-Sternberg (RS) cells?
HODGKIN LYMPHOMA
All of the following signs are associated with diffuse axonal injury except:
Headache
Symptoms of autonomic hyperreflexia include the following:
Headache and blurred vision
Yellow-brown pigment derived from hemoglobin is called:
Hemosiderin. (Causes the color changing in the blood reflect caused by excesses of iron.)
Treatment for TTP?
Heparin / IgG antibodies / Derease in platelets
What are some of the viruses that are implicated in cancers?
Hepatitis B & C (liver cancer). Epstein Barr Virus-EBV (Bcell lymphoma). Kaposi Sarcoma Herpesvirus- KSHV (side effect of HIV/AIDS). Human papillomavirus-HPV (Cervical cancers). Human T cell leukemia-lymphoma virus-HTLV (Tcell leukemia and lymphoma) These all can be passed on either vertically or horizontally.
In strangulation injuries, airway injury is caused by a fracture in which bone?
Hyoid.
Causes of Thrombocytopenia?
Hypersplenism / autoimmune disease / hypothermia, and viral or bacterial infections that cause disseminated intravascular coagulation (DIC)
In response to an increased workload, such as that caused by high blood pressure, myocardial cells in the left ventricle will adapt through which process:
Hypertrophy. (Physiologic hypertrophy)
The major mechanism of injury in drowning is:
Hypoxemia. (Low blood 02 levels)
How dangerou is IM and what is it caused by?
IM is acute, selft limiting infection / Commonly caused by the Epstein-Barr virus (EBV) 85% of the time / and caused 15% of the time by CMV
What is and what is another name for INFECTIOUS MONONUCLEOSIS (IM) and why?
IM is an acute infection of B lymphocytes (B cells) with Epstein-Barr virus (EBV) / Transmission of EBV is usually through saliva from close personal contact hence the term: Kissing Disease
This type of Anemia is the most common type of anemia worlwide / It occurs in underdeveloped as well as developed countries / and it is estimated that 1/5 world population is affected. What kind of anemia is this?
IRON DEFICIENCY ANEMIA
What is Heparin-Induced Thrombocytopenia (HIT)?
Immune-mediated, adverse drug reaction / Caused by IgG antibodies ag Heparin / Cause platelet aggregation and thrombin activation
What are alterations of platelet functions?
Increased bleeding time in the presence of a normal platelet count / platelet function disorders result from platelet membrane glycoprotein (von Willebrand factor deficiencies) / Manifestations / Disorders can be congenital or acquired
Stomatitis
Inflammation of the mucous membrane of the mouth. Can be caused by chemo and radiation.
Which of the following is not a type of subdural hematoma?
Intracerebral
What diseases are Mircocytic-Hypochromic Anemias related to?
Iron metabolism / Porphyrin and heme synthesis / Globin synthesis
The most common cause of hypoxic injury is:
Ischemia
What kind of s/s can be expected from Hemolytic Anemia?
Jaundice occurs when liver cannot keep up with heme destruction by conjugating and excreting biliburin
Which intervertebral disks are most likely to be herniated?
L4-S1
An uncontrolled proliferation of malignant leukocytes, causing an overcrowding of bone marrow and decreased production and function of normal hematopoietic cells, what is that?
LEUKEMIA
Lead poisoning affects nervous system function by which mechanism?
Lead interferes with neurotransmitter release (and blocks normal neuron function.)
What is LEUKOCYTOSIS?
Leukocytosis is higher than normal leukocyte count. Such as in inflammation, surgery... can be normal or abnormal
What is LEUKOPENIA?
Leukopenia is lower than normal leukocyte count. Less than 1000/mm3 = risk for infection / unlike leukocytosis, leukipenia is never normal
Tay-Sachs Disease results in the accumulation of:
Lipids in the nerve cells of the brain.
Examples of benign tumors
Lipoma- fatty tumor Gliosis- intercranial Leiomyoma- uterine (smooth muscle) Chondroma- cartilage
Examples of malignant tumors
Liposarcoma- fat Glioma- intercranial Leiomyosarcoma- Uterine (smooth muscle) Chondrosarcoma- cartilage
Which organs are affected by Gaucher Disease?
Liver, Spleen, Bone Marrow, lungs, and brain. (Gaucher disease is caused by the accumulation of a fatty substance called glucocerebroside in the spleen, liver, and bone marrow.)
Which organ is most frequently affected by ethanol injury?
Liver. (Alcohol directly affects the cells in the liver and the brain)
Discoloration of dependant parts of the body following death is called:
Livor Mortis.
pulmonary abscess
Localized area of pus formation in the lungs
Loss of heterozygosity (LOH)
Loss of a region on one chromosome that corresponds to a mutated region on the other chromosome; loss of the same loci on both chromosome inactivates the affected gene.
Alopecia
Loss of hair.
Fetal exposure to alcohol during pregnancy can result in:
Low birth weight, mental retardation, death.
What is LYMPHOCYTOPENIA?
Lymphocytopenia is seen neoplasias / immune deficiencies / drug destruction / viral destruction
What is LYMPHOCYTOSIS?
Lymphocytosis is seen in acute VIRAL infections, particularly those caused by Epstein-Barr virus (EBV)
This disease is characterized by Neoplastic proliferation of plasma cells / Tumor may be solitary or multifocal / Malignant Plasma Cells?
MYELOMA
What is the othe name for MACROCYTIC-NORMOCHROMIC Anemias and what does that mean?
Macrocytic-Normochromic Anemias are called MEGALOBLASTIC Anemias / They are unusually large stem cells that mature into large erythrocytes and the hemoglobin content is normal.
What are MALIGNANT LYMPHOMAS?
Malignant transformation & proliferation of lymphocytes and their precursors in lymphoid tissues / 2 major categories: 1. Hodgkin lymphoma / 2. Non-Hodgkin lymphomas
What is the significance of capillary beds and metastasis?
Metastasis often occurs in the first capillary bed that the circulating cells encounter.
Diagnostic test and treatment of IM
Monospot qualitative test for heterophilic antibodies / Treatment: symptomatic
Dissemination
Movement of cancerous cells in the blood or through the lymphs.
Oncogene
Mutant genes that in their normal nonmutant state direct synthesis of proteins that positively regulate (accelerate) proliferation. They have a dominant effect because only one of the cell's two copies has mutated. This leads to unregulated growth.
A condition associated with a reduction in circulation neutrophils and exist clinically when the neutrophils count is less than 2000/mm3?
NEUTROPENIA
acute tubular necrosis
Name the most common type or cause. • Acute renal failure in the United States what causes....? -ischemia of tubules due to bleeding, sepsis, burns. nephrontoxins (x-ray dye, aminoglycoside antibiotics like gentamycin) -Dx: oliguria/ ↑ BUN, ↑ creatinine
What are the causes of diabetes insipidus?
Neurogenic: -insufficient amounts of ADH (due to lesion of hypothalamus) Nephrogenic: -inadequate response of renal tubules to ADH Psychogenic (primary polydipsia): -chronic ingestion of large quantities of fluid
Angiogenesis
New blood vessel growth. Occurs in the embryo and fetal development, and tumor growth.
Neoplasm
New tumor growth that can be benign or malignant.
GENERAL LYMPHADENOPATHY?
Occurs in the presence of malignant or nonmalignant disease
malunion
Occurs when the fracture heals in a position that does not resemble the original anatomical form of the bone and alters the mechanical function of the bone.
Alcohol increases risks for what types of cancers?
Oral cavity, pharynx, hypopharynx, larynx, liver, and esophageal cancers. Alcohol alters the mucosal integrity of the GI tract.
MULTIPLE MYELOMA causes increased?
Osteoclastic bone destruction
What are Myeloproliferative RBC Disorders?
Overproduction of cells, as well as a deficiency
What causes Pernicious Anemia?
PA is caused by VITAMIN B12 deficiencies due to the absense of INTRINSIC FACTOR (IF), an enzyme required for gastric absorption of vitamin B12.
What is the most common type of Megaloblastic Anemia?
PERNICIOUS ANEMIA or PA / Pernicious means highly injurous or destructive and once fatal
How is PA treated?
Parenteral or high oral doses of Vitamin B12
Manifestations of Idiopathic (immune) thrombocytopenic purpura (ITP)?
Petechiae and purpura, progressing to major hemorrhage
What is POLYCYTHEMIA?
Polycythemia is an excessive red cell production
What is CHRONIC LEUKEMIA?
Predominant cell is mature but does not function normally
Organ Tropism
Preferential growth of cancerous cells in certain organs. The right cancer "seed" and the right "soil" or tissue.
Carcinoma in Situ (CIS)
Preinvasive epithelial tumors of glandular or squamous cell origin. Can be found in cervix, skin, oral cavity, esophagus, and bronchus. A pap smear can pick up CIS in the cervix.
What is ACUTE LEUKEMIA?
Presence of undifferentiated or immature cells, usually blast cells
What is PRIMARY POLYCYTHEMIA?
Primary (absolute) Polycythemia is seen in POLYCYTHEMIA VERA: genetic abnormality of stem cells in the bone marrow
Apoptosis
Programmed cell death.
Causes of Neutropenia?
Prolonged severe infections when production of granulocytes cannot keep up with demand / Decreased production / Reduced survival / Abnormal neutrophil distribution and sequestration
A 55 year old man goes in for a routine exam. A routine blood test indicates high levels of PSA (prostate specific antigen) in the blood. What could this indicate?
Prostate cancer. PSA is a tumor marker for this condtion.
Adaptive cellular mechanisms function to:
Protect cells from injury
Telomere
Protective cap made of DNA that is found on the ends of a chromosome. They shorten after each cell division cycle and need to be restored by telomerase. When non-germ cells begin to proliferate abnormally, their telomere caps become shorter with each cell division.
The process of muscle hypertrophy involves an increase in:
Protein synthesis. (Increase protein in cellular componet, not an increase in cellular fluid).
empyema
Pus in the pleural cavity -infected pleural effusion
3 factors causing free radical injury are:
Radiation injury, tissue reperfusion following ischemia, and enzymatic metabolism of chemicals.
What are the physiologic maninestation of Anemia?
Reduced OXYGEN carrying capacity
Restoration of oxygen to oxygen-deprived tissues results in:
Referfusion injury -- Radicals (hydroxy, superoxide, hydrogen peroxide) further membrane damage and mitochondrial calcium overload.
What is RELATIVE POLYCYTHEMIA?
Relative Polycythemia results from DEHYDRATION / fluid loss results in relative increases of red cell counts and Hgb and Hct values, and resolves with fluid administration
When demand for neutrophils exceeds supply, immature neutrophils are released from bone marrow. Premature release of immature cells is known as?
SHIFT TO THE LEFT or LEUKEMOID REACTION
When the shift to the left is corrected, it is called a?
SHIFT TO THE RIGHT
This type of anemia is not because of a loss of iron but because or INEFFICIENT IRON UPTAKE?
SIDEROBLASTIC ANEMIAS (SAs) / Inefficient iron uptake results in abnormal hemoglobin synthesis / is characterized by ringed sideroblasts in bone marrow / and mimics iron deficiency anemia
What is SECONDARY POLYCYTHEMIA?
Secondary (absolute) Polycythemia is an increase in erythropoietin as a normal response to chronic HYPOXIA or an inappropriate response to erythropoietin secreting tumors
When does Anemia of Chronic Inflammation usu occurs?
Seen in AIDS, rheumatoid arthritis, lupus erythematosus, hepatitis, renal failure, and malignancies
Due to lack of nerve stimulation, an individual with damage to the spinal cord may experience atrophy to which organ?
Skeletal Muscles
What is the biggest risk factor for cancer?
Smoking. Smoking has a multipotent carcinogenic mixture. It has been linked to cancers of the lung, lower urinary tract, aerodigestive tract (rectal and anal), liver, cervical, kidney, pancreas, as well as myeloid leukemia.
Which of the following vertebral disorders involves a structural defect (often hereditary) that causes forward displacement of affected vertebra?
Spondylosis
Know Cancer Staging.
Stage 1- Cancer is confined to the organ of origin. (Local spread) Stage 2- Cancer is locally invasive. Stage 3- Cancer has spread to regional structures such as lymph nodes. Stage 4- Cancer has spread to distant sites, such as liver cancer spreading to the lungs, or prostate cancer spreading to the bones.
A collection of blood between the inner surface of the dura mater and the surface of the brain, resulting in the shearing of small veins that bridge the subdural space is called:
Subdural Hematoma.
Biologic Response Modifiers (BRM's)
Substances produced by normal cells that block tumor growth or stimulate the immune system to fight cancer.
A decrease in the number of circulation platelets?
THROMBOCYTOPENIA / Platelet count <100,000/mm3 / <50,000/mm3: hemorrhage from minor trauma / <15,000: spontaneous bleeding / <10,000/mm3: severe bleeding that can be fatal esp in GI, internal bleeding
A woman is admitted to the ER. Blood and urine tests indicate raised levels of catecholamines (epinephrine and related compounds). What cancer could this be an indication of and why?
The cancer could be Pheochromocytoma (cancer of the adrenal medulla). The presence of increased amounts of epinephrine is a tumor marker for this condition.
What is the goal of chemotherapy?
The goal is to eliminate enough cancer cells so that the body's defense can eradicate any remaining cancer cells. CURATIVE!!!
What is the most common mode of spread in metastasis?
The lymphatic system. Example: Colorectal cancer will spread to the liver through the mesentaric lymphatics.
Point mutation
The most common cause of genetic lesions in cancer. Usually seen in pancreatic and colorectal cancers. They are changes in one or a few nucleotide base pairs. A point mutation is ras converts it from a regulated proto-oncogene to an unregulated oncogene, accelerating cellular proliferation.
What are the typical symptoms of pernicious anemia?
The sns of PA are those of classic anemias: Weakness / Fatigue / Paresthesias of feet and fingers / Difficulty walking / Loss of appetite...
Metastasis
The spread of cancer cells from the site of the original tumor to distant organs and tissues throughout the body.
What symptoms set PA apart?
The symptoms that set PA apart are neurologic manifestation because of nerve demyelination / beefy red tongue (atrophic glossitis) / icterus (flapping tremor of hands) / and splenic enlargement
Proto-oncogene
These are the regulators of normal cell process; growth promoting; mutations activate them to function as oncogenes (tumor producing genes). They are normal.
What anemia class do those disease belong to: APLASTIC ANEMIA / HEMOLYTIC ANEMIA / SICKLE CELL ANEMIA
They are Normocytic-Normochromic Anemias: characterized by erythrocytes that are normal in size and hemoglobin content but insufficient in numbers.
Benign tumors
They are not called cancers. They are well-emcapsulated, well differentiated, retain normal tissue structure, and do not invade the capsule, nor do they spread to regional lymph nodes or distant location.
Characteristics of Malignant tumors
They grow rapidly. They are anaplastic (without form) and have a high mitotic index (High mobility). They are poorly differentiated; does not look like the tissue from which it arose. They are not encapsulated. They invade local structures and tissues. They spread distantly through the bloodstream and the lymphatics. THESE WILL BE ON THE TEST!!!
Charactersitics of Benign tumors
They grow slowly. They are microscopically well-differentiated with a low mitotic index (Low mobility). They are well-differentiated; looks like the tissue from which it arose. They have a well-defined capsule. They are not invasive. They do not metastasize. THESE WILL BE ON THE TEST!!
Chromosome instability
This increases in malignant cells. Results in a high rate of chromosome loss.
Describe the Rb gene
This is a tumor suppressor gene (retinoblastoma gene). It is responsible for pRB protein. If a mutation causes lack of this protein, the cell will be constantly in the "on" position. Mutations in this gene have been ID'd in a number of cancers including bone, bladder, some lung, and some breast cancers.
Autonomy
This refers to the cancer cell's independence from normal cellular controls.
venous stasis ulcer
This type of ulcer is due to poor venous circulation (veins back up to the heart). Affects lower extremities. There are changes in skin texture, turgor & color. Starts as small open area around or above ankle. Slow healing.
What is Essential (primary) THROMBOCYTHEMIA?
ThromboCYTHemia is characterized by platelet counts >400,000/mm3 / myeloproliferative disorder of platelet precursor cells / microvasculature thrombosis occurs / splenomegaly
Laboratory findings of HL?
Thrombocytosis / leukocytosis / eosinophilia / elevated ESR / and elevated alkaline phosphatase
In compensatory hyperplasia, growth factors stimulate cell division in response to:
Tissue loss. (compensatory hyperplasia is an adaptive mechanism that enables certain organs to regenerate.)
MALTomas
Tumors that arise mucous associated lymphoid tissues. H. Pylori is the main culprit.
Adjuvant therapy
Used after the primary treatments (surgery) have been completed to decrease the chance that a cancer will recur. Ex. A melanoma is removed and then chemo or radiation follows.
Pleomorphic
Variable size and shape. Example; anaplastic cells are of variable size and shape.
What are alterations of coagulation?
Vitamin K deficiency / Vitamin K is necessary for synthesis and regulation of prothrombin / TPN & antibiotics therapy destroy gut flora / liver disease causes a broad range of hemostasis disorders
Widespread thromboses leads to (related to DIC):
Widespread ischemia / Infarction / Organ hypoperfusion
Anaplasia
Without form. It is recognized by a marked increase in nuclear size, with evidence of ongoing proliferation such as mitotic figures. The increased amount of anaplasiac cells we see, is related to increased malignancy.
Are benign tumors removed?
Yes. An example is colon polyps. These may be benign, but they could turn cancerous later.
chemotactic factors
a biochemical substance that facilitates chemotaxis
cyanosis
a bluish discoloration of the skin and mucous membranes -decrease in oxygen in tissues
What is a fracture?
a break in the continuity of a bone -↑ incidence in males 15-24, greater than 65 classifications: -complete or incomplete (open or closed) -comminuted (multiple bone & fragments) -linear (parallel to long axis of bone) -oblique -spiral (wrapping around bone) -transverse (90 degrees to long axis)
bone fractures
a broken bone can cause damage to the surrounding tissue, the periosteum (which is a vascular membrane covering bones) and the blood vessels in the cortex & marrow
aneurysm
a cardiovascular disease characterized by a sac-like widening of an artery resulting from weakening of the artery wall complications: -HEMORRHAGE (when they rupture) -OCCLUSION of a supplying artery to an organ treatment: -surgery (synthetic graft replacement) -percutaneous grafts
endothelial cells
a cell of endothelial layer that lines heart, blood, lymph vessels and the lung cavity;
mast cells
a cell of the connective tissue that produces substances that cause activation of the inflammatory responses, vasoconstriction, and muscle contraction
Hyperaldosteronism
a condition caused by over-production of aldosterone -disorder of the adrenal cortex Symptoms: -hypertension (heart disease), hypokalemia Rx: -surgically removed adrenal adenoma for Conn disease
nephrotic syndrome
a condition in which very high levels of protein are lost in the urine and abnormally low levels of protein are present in the blood -excretion of 3.5g or more of protein in the urine per day -the protein excretion is caused by glomerular injury: ↑ capillary permeability; ↓ negative ionic charge findings: -liver goes into overdrive to try & make albumin & tends to make more lipid -hypoalbuminemia, edema, hyperlipidemia (↑ synthesis of lipids in hyperactive liver). & lipiduria, & vitamin D deficiency (loss of serum transport proteins & vitamin D activation by kidney)
metabolic acidosis
a decrease in pH caused by an increase in noncarbonic acids or a decrease in bicarbonate; headache, lethargy, anorexia, nausea, vomiting, diarrhea, and abdominal discomfort
respiratory acidosis
a decrease in ventilation in relation to the metabolic production of carbon dioxide by an increase in carbonic acid; headache, blurred vision, apprehension, breathlessness, restlessness, lethargy, disorientation, muscle twitching, tremors, convulsions, and coma
toxigenicity
a factor important in determining a pathogen's virulence, such as production of soluble toxins or endotoxin
platelet activating factor
a mast cell-derived substance that increases vascular permeability, leukocyte adhesion to endothelial cells, and platelet activation
prostaglandins
a mast cell-derived substance that increases vascular permeability, muscle contraction, neutrophil chemotaxis, induces pain, and potentially inhibits some aspects of inflammation
renin-angiotensin system
a mechanism by which sodium and water levels are regulated in the body, including the release of renin, conversion of angiotensinogen into angiotensin I, conversion of angiotensin II, and the release of aldosterone and its actions on the kidney that increase water and sodium reabsorption--increasing systemic blood pressure and restoring renal perfusion
aldosterone
a mineralocorticoid that is synthesized and secreted by the adrenal cortex and regulates sodium and potassium balance by altering reabsorption in the kidney
greenstick fracture
a partial fracture of a bone (usually in children) -fracture of 1 side of cortex & spongy bone splinters
myocardial ischemia
a partial obstruction of blood flow in the coronary arteries that reduces blood flow to the myocardium - ↓flow or O2 content of coronary blood (50-65% of O2 normally extracted from coronary arteries-continually requiring O2 to pump & work -stabile angina-chest pain caused by myocardial ischemia; if you sit & rest, it goes away -prinzmetal angina-chest pain due to coronary vasospasm; due to sympathetic system -silent ischemia-more common in women; no symptoms
atrial natriuretic peptide (ANP) or factor
a protein hormone that is synthesized and released from the atria in response to high sodium concentration, high extracellular fluid volume, or high blood volume; it promotes sodium secretion and causes vasodilation in the circulatory system
septic shock
a serious condition that occurs when an overwhelming bacterial infection affects the body
Major histocompatibility complex (MHC)
a set of recognition molecules used to identify whether a donor and recipient tissues possess antigens that make them compatible; also referred to as human leukocyte antigens (HLAs)
rheumatic fever
a severe disease chiefly of children and characterized by painful inflammation of the joints and frequently damage to the heart valves -diffuse, inflammatory disease caused by a delayed immune response to infection by the group A beta-hemolytic strep -febrile illness-inflammation of the joints, skin, nervous system & heart -if left untreated, rheumatic fever causes rheumatic heart disease (damage to mitral/aortic valves -carditis-inflammation of endocardium -polyarthritis-migrating inflammation of the joints -chorea-CNS disorder -erythema marginatum-truncal rash
normal bacterial flora
a spectrum of nonpathogenic bacteria which resides on the body's surfaces
atherosclerosis
a stage of arteriosclerosis involving fatty deposits (atheromas) inside the arterial walls -form of arteriosclerosis -thickening & hardening is caused by accumulaiton of liped-laden macrophages in the arterial wall -plaque development progression: inflammation of endothelium -cellular proliferation -macrophage migration; monocyte in the blood -LDL oxidation (foam cell formation) -fatty streak -fibrous plaque -complicated plaque Foam cells→ LDL oxidized the engulfed by macrophage
volatile
a substance such as carbonic acid (CO2 gas) that can evaporate rapidly--body acids
buffer
a substance that can absorb excess acids or bases without causing a significant change in pH
nonvolatile
a substance that does not have a vapor form and can be eliminated by the kidney
What is a muscle strain?
a sudden, forced motion causing the muscle to become stretched beyond its normal capacity -local muscle damage -muscle strains can also involve the tendons -6 weeks healing time
alkalosis
a systemic decrease in hydrogen ion concentration; an acid base imbalance characterized by elevated pH
The most common cause of a transient ischemic attack (TIA) is obstruction of a cerebral artery by:
a thrombus.
pathogenicity
ability of an agent to produce disease; success depends on its speed of reproduction, extent of tissue damage, and production of toxins
immunogenicity
ability of pathogens to induce an immune response
infectivity (infection)
ability of the pathogen to invade and multiply in the individual
pneumothorax
abnormal presence of air in the pleural cavity resulting in the collapse of the lung
clubbing
abnormal widening and thickening of the ends of the fingers and toes associated with chronic oxygen deficiency
clubbing
abnormal widening and thickening of the ends of the fingers and toes associated with chronic oxygen deficiency -associated with hypoxemia
Portal hypertension
abnormally high blood pressure in the portal venous system caused by resistance to portal blood flow -in the liver 3 Types: -prehepatic (obstruction/constriction of portal vein or tributaries) -intrahepatic (cirrhosis- most common cause of portal hypertension) -posthepatic (hepatic vein thrombosis, inferior vena cava obstruction, or right heart failure causing back-up)
conditions caused by pulmonary disease or injury
abscess formation & cavitation -consolidation; pneumonia -abscess -cavitation; pneumonia, TB
What is Uremia?
accumulation in the blood of nitrogen-bearing waste products (urea) that are usually excreted in the urine -systemic manifestations caused by decline in renal function
hemothorax
accumulation of blood in the pleural cavity (the space between the lungs and the walls of the chest)
tamponade
accumulation of fluid compressing heart → death
endotoxins
activate the inflammatory response and produce fever; contained in the cell walls of gram negative bacteria and are released during lysis, or destruction of the bacteria
angiotensin II
active hormone that is formed from the cleavage of angiotensin I by angiotensin-converting enzyme; stimulates aldosterone secretion and vasoconstriction
manifestations of osteomyelitis
acute & chronic inflammation (intermittent), fever, pain, necrotic bone (can be very insidious) -bone infection is so bad since not a good blood supply
cough
acute cough-resolves within 2-3 weeks of onset chronic cough- longer than 3 weeks
what is tendinitis?
acute inflammation of a tendon due to new activity -resolves w/ rest, ice, & anti-inflammatories
stress ulcers
acute ulcers caused by severe illness, systemic traumas, burn, neural injury presentation: bleeding treatment: propylasis w/ antacids & proton pump inhibitors (prilosec, prevacid)
compensation
adjustment of acid or base content by removal or addition in response to changes in pH; for example a decrease in pH is accompanied by an increase in carbon dioxide removal by the lungs, causing pH to increase
In individuals with spinal cord injuries, autonomic hyperreflexia occurs:
after spinal shock is resolved.
Type I hypersensitivity: IgE mediated
against environmental antigens (allergens); IgE binds to Fc receptors on surface of mast cells; histamine release
An individual who is unable to visually recognize and identify objects because of injury to the sensory cortex has:
agnosia.
A major risk factor for the development of a chronic subdural hematoma is:
alcoholism.
extracellular fluid (ECF)
all the fluid outside the cells and is divided into smaller compartments-interstitial fluid and intravascular fluid; other ECF compartments include: lymph and transcellular fluids-synovial, intestinal, and cerebrospinal fluid, sweat, urine, and pleural, peritoneal, pericardial, and intraocular fluids; about 1/3 of all TBW
Liver and germ cells secrete what protein?
alpha Fetoprotein. This is a tumor marker for hepatic and germ cell cancers.
hypersensitivity
altered immunologic response to an antigen that results in disease or damage to the host: autoimmunity, allergy, alloimmunity
immunogens
an antigen that will induce an immune response resulting in the production of antibodies or functional T-cells
renin
an enzym secreted by the juxtaglomerular cells of the kidney that is released in response to decreased blood pressure in the kidney and sympathetic nerve stimulation, and decreased blood volume
angiotensin I
an inactive polypeptide; inactive product of the cleavage of angiotensinogen by renin
metabolic alkalosis
an increase in pH caused by an increase in bicarbonate ions secondary to an increase in metabolic acid loss; weakness, muscle cramps, hyperactive reflexes, tetany, shallow and slow respirations, confusion, convulsions, and atrial tachycardida
What is urinary tract obstruction?
an interference w/ the flow of urine at any site along the urinary tract.
What can cause urinary tract obstruction?
anatomic or functional defect obstructive uropathy most common (anatomic)
treatment of GER
antacids (maalox, tums, rolaids) H2 receptor blockers (tagament, pepcid, zantac) proton pump inhibitors (prilosec, prevacid) anti-reflux surgery is the last resort
Risk factors for stroke syndromes include all of the following except:
anticoagulant medications.
Type III hypersensitivity: Immune complex-mediated
antigen body complexes are formed in the circulation and are later deposited in vessel walls or extravascular tissues (too small to be removed by mononuclear phagocytes); not organ specific, but specific to certain tissues throughout the entire body ----(mediated by antibody)--autoimmune: lupus
paratope
antigenic binding site
epitope
antigenic determinant; recognizing part on an antigenic molecule
haptens
antigens that are too small to be immunogens by themselves but become immunogenic after combining with larger molecules that function as carriers for the hapten
allergens
antigens that induce an allergic response
treatment for acute cystitis
antimicrobial therapy (3-7 days), increased fluid intake, avoidance of bladder irritants, & urinary analgesics (pyridium) = orange urine
dislocation & subluxation fractures
are associated with fractures, muscle imbalance (weight lifters), rheumatoid arthritis, or other forms of joint instability - < 20 years old -shoulder, elbow, wrist, hip, knee
T-lymphocytes
attach antigen directly; during clonal selection these cells differentiate into effector T-cells, such as cytotoxic T-cell--also develop into memory cells
melena
black tarry stools
Bladder tumors
bladder lining made up of transitional cells transitional cell Ca: -gross, painless hematuria -males > 60 year old -1% of all cancers
antihistamines
block binding of histamine to histamine receptors on target cells
pulmonary embolism
blockage of the pulmonary artery by foreign matter or by a blood clot
intravascular fluid
blood plasma
bowing fracture
bone in pairs: 1 breaks, other bends
evaluation of osteomyelitis
bone scan, CT, MRI (most common)
what is the second stage of bone fracture healing?
bone tissue destruction triggers an inflammatory response (fractured ends of bone decalcify)
hematochezia
bright red blood in stools
Curling ulcer
burn injury, Acute gastric ulcer associated with severe burns
kidney stones
calculi (urinary stones) -massess of crystals, protein, or other substances that form w/in & may obstruct the urinary tract -classified accroding to teh minerals comprising the stones (Ca+, Ph+, oxalate, uric acid) -prevalence: 5% women; 12% men 80% between 20-50 years old
memory cells
capable of remembering the antigen and responding more rapidly and efficiently if the associated pathogen invades again
shock
cardiovascular system fails to perfuse the tissues adequatly -impaired oxygen use -impaired glucose use -cells not using oxygen→ anaerobic glycolysis
superantigens
cause fever, low blood pressure and potentially shock; produce an excessive production of cytokines
AIDS
caused by a retrovirus which depletes the body's Th cells--CD4 cells; genetic information in retrovirus is in the form of RNA; contains reverse transcriptase to convert RNA into double-stranded DNA
water excess
caused by compulsive water drinking (psychogenic); acute renal failure, severe congestive heart failure and cirrhosis paired with IV infusion of 5% dextrose in water; decreased urine formation; confusion, convulsions, weakness, nausea, muscle twitching, headache, and weight gain
pure sodium deficits
caused by extrarenal losses, such as vomiting, diarrhea, gastrointestinal suctioning, and burns, or renal loss from the use of diuretics
serum sickness
caused by formation of immune complexes in the blood and their subsequent generalized deposition in target tissues; symptoms: fever, enlarged lymph nodes, rash, and pain at sites of inflammation--can be caused by repeated intravenous admin of drugs
Arthus reaction
caused by repeated local exposure to an antigen that reacts with preformed antibody and forms immune complexes in the walls of the local blood vessel; symptoms: typical inflammatory reaction, increased vascular permeability, and accumulation of neutrophils, edema, hemorrhage, clotting, and tissue damage
cytotoxic T-cells
cells that kill targets directly; destroy cancer cells or cells infected with virus; perforin, granzymes, or direct receptor interactions
antigen presenting cells (APCs)
cells that phagocytose, break up, and present antigenic fragments on the cell surface; these cells interact with Th cells to induce B cell to mature into plasma cells or T cells to mature into effector T cells
necrosis
cellular death caused by severe cell swelling and the breakdown of organelles
atopic
certain individuals that are genetically predisposed to develop allergies
agglutination (direct antibody function)
clumping insoluble particles that are in suspension
visceral pain
comes from an abdominal organ; poorly localized, diffuse and vague Example: early appendicitis
inflammatory joint disease
commonly called arthritis (inflammation of a joint) -characterized by inflammatory damage or destruction in the synovial membrane or articular cartilage & by systemic signs of inflammation (fever, leukocytois, malaise, anorexia, & hyperfibrinogenemia) -infectious or noninfectious causes (typically non infectious)
What is an avulsion?
complete separation of a tendon or ligament from its bony attachment site
endotoxic shock
complication of sepsis and can be fatal to the individual
scare tissue
composed primarily of collagen that fills in the lesion and restores strength but cannot carry out the physiologic functions of destroyed tissue
intracellular fluid (ICF)
comprises all the fluid within the cells; about 2/3 of TBW
chest wall restriction
compromised chest wall, deformation, immbolization and or obesity. -condition caused by pulmonary disease or injury
Primary Immune Deficiencies
congenital, nonsurvivable; most are the result of a single gene defect: 1) B-lymphocyte deficiencies 2) T-lymphocyte deficiencies 3) combined T and B cell deficiencies 4) complement defects 5) phagocyte defects
complement system
consists of a large number of proteins that together constitute about 10% of the total circulating serum protein
sublaxtion fracture
contact between articular surfaces is only partially lost
hemorrhagic exudate
contains blood, indicates bleeding
hemoptysis
coughing up blood from the respiratory tract
tumor necrosis factor alpha
cytokine, secreted by macrophages in response to recognition of foreign materials by toll-like receptors
interleukins
cytokine; produced by macrophages and lymphocytes in response to their recognition of a pathogen or stimulation by other products of inflammation
exotoxins
damage the plasma membranes of host cells or can inactivate enzymes critical to protein synthesis; enzymes released during growth, causing specific responses
Thyrotoxic storm
dangerous worsening of hyperthyroid state, death in 48 hours -due to excessive stress, infection symptoms: -hyperthermia -tachycardia -N&V -high output heart failure Treatment: -propylthiouricil (blocks TH synthesis)
B-lymphocyte deficiencies
defective development of B cells in central lymphoid organ (bone marrow); defect in class switch; results are lower levels of immunoglobulins (hypogammaglobulinemia) or occasionally totally or nearly absent immunoglobulins (agammaglobulinemia)
combination B and T deficiencies
defective development, defects in cooperation- B, T, and APCs, large variety of defects that affect the function of B or T cells
complement deficiencies
defective production of one early component of the complement system; defective production of the membrane attack complex
T-lymphocyte deficiencies
defects in the development and function of t-lymphocytes; contributes to failure to thrive, oral infections, chronic diarrhea, pneumonia, and skin rashes; DiGeorge syndrome:lack or partial lack of thymus
phagocytic deficiencies
defects in the production of neutrophils; defects in bacterial killing
Osteomalacia (rickets in kids)
deficiency of Vitamin D lowers the absorption of calcium from the intestine -inadequate or delayed mineralization -bone formation progresses to osteoid formation but calcification does not occur; the result is soft bones -pain, bone fractures, vertebral collapse, bone malformation
hypoxia
deficient amount of oxygen in tissue cells
hypoventilation
deficient movement of air in and out of the lungs causing hypercapnia -too little breathing -increase PaCO2
allergy
deleterious effects of hypersensitivity to environmental (exogenous) antigens--exaggerated response
glomerular disorders
demonstrates a sudden or gradual insidious onset of hypertension, edema, & an elevated blood urea nitrogen (BUN) & plasma creatinine -decreased glomerular filtration rate: elevated plasma creatinine (reduced creatinine clearance, i.e. not as much filtrate formed), & ↑ urea So: serum BUN & creatinine elevated -increased glomerular capillary permeability & loss of negative ionic charge barrier result in passage of PLASMA PROTEINS into the urine (membrane has a negative charge; pushes protein also has a negative charge) -resulting hypoalbuminemia encourages plasma fluid to move into the interstitial spaces i.e. peripheral edema (less dots in blood (less pulling force) → fluid moves out into tissues)
dehydration
describes water deficit but also is commonly used to indicate both sodium loss and water loss (isotonic and isoosmolar dehydratioin)
hyponatremia
develops when serum sodium concentration fall below 135 mEq/L; sodium deficits usually cause hypoosmolality with movement of water into cells; sodium loss, inadequate sodium intake, or dilution of the body's sodium level by water excess; lethargy, confusion, apprehension, depressed reflexes, seizures, and coma,
Diabetes Mellitus
diabetes caused by a relative or absolute deficiency of insulin and characterized by polyuria -not a single disease, but a group of disorders w/ glucose intolerance in common -insulin needed for protein, fat, & carbohydrate metabolism -Dx: based on ↑ fasting glucose levels ( >126) or abnormal glucose tolerance testing ( >200)
dysphagia
difficulty swallowing due to mechanical obstruction or disorder of esophageal motility
mechanisms of action (infection)
direct damage of cells, interference with cellular metabolism, and rendering a cell dysfunctional because of accumulation of pathogenic substances and toxin production
chemotaxis
directional movement and attraction of microorganisms or phagocytes to substances released in the environment or tissues
glomerulopathies
disorders that directly affect the glomerulus
autoimmunity
disturbance in the immunologic tolerance of self-antigens
regional osteoporosis
disuse or immobilization of limb
occult bleeding
do not know the source of where it is coming from
opportunisitc microorganisms
e. coli, yeast--overgrowth of normal flora
hyperkalemia
elevation of ECF potassium above 5.5 mEq/L; mild: increased neuromuscular irritability-restlessness, intestinal cramping, and diarrhea; severe: muscle weakness, loss of muscle tone, and paralysis; decreased cardiac conduction and more rapid repolarization of heart muscle; narrow and taller T wave, and shortened QT interval
diapedesis
emigration of cells through the endothelial junctions
The most common neurologic disorder observed in individuals with AIDS is:
encephalopathy.
nonunion
ends of bone does not grow together
splenomegaly
enlarged spleen which can bleed
hydronephrosis
enlargement of renal pelvis & calyces
cor pulmonale
enlargement of the right ventricle of the heart due to disease of the lungs or of the pulmonary blood vessels -secondary to pulmonary hypertension -pulmonary hypertension creates chronic pressure in the right ventricle w/ eventual right ventricular failure
self-antigen
even though foreign, does not normally elicit an immune response
remodeling
excess callus resorbed & trabecular bone laid down Remember: bone (like liver) will form new bone not scar tissue when healing
pulmonary edema
excess water in the lungs -most common cause=heart not working; left ventricular dysfunction -injury to capillary end -infection: ex. pneumonia
hyperthyroidism
excessive activity of the thyroid gland -Thyrotoxicosis (condition resulting from ↑ thyroid hormones) common causes: -graves disease -toxic multinodular goiter (many hyperfunctioning nodules) -solitary toxic adenoma (1 hyperfunctioning nodule in thyroid gland)
pulmonary fibrosis
excessive amount of fibrous or connective tissue in the lung
Pathologic Hyperplasia is the abnormal proliferation of normal cells, usually in response to:
excessive hormonal stimulation or growth factors on target cells.( Ex: Pathologic endometrial hyperplasia, which causes excessive menstrual bleeding, is under the influence of regular growth-inhibition controls. If these controls fail, hyperplastic endometrial cells can undergo a malignant transformation.)
hypercapnia
excessive level of carbon dioxide in the blood -caused by hypoventilation
hyperventilation
excessive movement of air in and out of the lungs causing hypocapnia -decrease PaCO2
What is hyperparathyroidism?
excessive secretion of parathyroid hormone resulting in abnormally high levels of calcium in the blood DX: -6 month history of symptoms associated w/ hypercalcemia RX: -surgical removal of adenoma or abnormal hyperplastic glands: 3 & 3/4 glands removed
lymphocytes
extremely specific, each cell recognizes only one specific antigen: B-lymphocytes, T-lymphocytes
interstitial hydrostatic pressure
facilitates the inward movement of water from the interstitial space into the capillary
capillary hydrostatic pressure (blood pressure)
facilitates the outward movement of water from the capillary to the interstitial space
interferon
family of cytokines that protect against viral infections
referred pain
felt at a distance from an organ; well localized in skin or deeper tissue away from the organ Example: diaphragmatic irritation felt in shoulder
orthopnea
form of dyspnea in which the person can breathe comfortably only when standing or sitting erect -dyspnea only when the person is laying down
IgA
found predominantly in the blood and body secretions; secretory immunoglobulin; primary role is to prevent the attachment of pathogens through mucosal membranes (GI, pulmonary and GU)
pathologic fracture
fracture caused by diseased or weakened bone
transchondral fracture
fragmentation and separation of a portion of the articular cartilage that covers the end of a bone at a joint
Intracerebral hemorrhages most frequently occur in the:
frontal and temporal lobes.
Polymyositis
generalized muscle inflammation
clotting system
group of plasma proteins that, when activated sequentially, form a fibrinous meshwork at an injured or inflamed site
manifestations of GER
heartburn, regurgitation of chyme, and upper abdominal pain w/ in 1 hour of eating cough because it regurgitates down into the trachea asthma because the regurgitation goes into the lungs causing bronchial constriction
eosinophils
help regulate the inflammatory response, phagocyte
Helper T-lymphocytes (Th cells)
help the antigen driven maturation of B and T cells; APCs usually present antigen to these cells; facilitate response between APCs and immunocompetent lymphocytes
latrogenic osteoporosis
heparin, glucocorticoids
urticaria
hives, a dermal manifestation of allergic reactions, characterized by white fluid filled blisters (wheals) surrounded by areas of redness (flares)-usually accompanied by itching
Excess cerebrospinal fluid (CSF) accumulation in the ventricles or subarachnoid space is a condition called:
hydrocephalus
cushing disease
hypercortisolism (moon face), some symptoms mimic diabetes mellitus and results from ADH excess -disorder of the adrenal cortex -excessive anterior pituitary secretion of ATCH 9tumor/hyperplasia) ***most common complication of cushing disease is cushing syndrome
water deficits
hyperosmolar or hypertonic dehydration; thirst, dry skin and mucous membranes; elevated temperature, weight loss, and concentrated urine; skin turgor may be normal or decreased; hypvolemia: tachycardia, weak pulses, and postural hypotension
monocyte
immature form of WBC (macrophage) in the blood
humoral immunity
immune protection afforded by the presence of antibodies in the blood: fluid immunity, circulating antibody (IgG, IgM, etc)
Cell-mediated immunity
immune protection by the ability of cytotoxic T-cells to lyse target cells that contain receptors
alloimmunity
immune reaction to tissues of another individual-transfusions, transplants
adaptive immunity
immunity acquired from vaccines or prior infection; third line of defense; acquired or specific immunity--third line of defense
antibodies
immunoglobulins, produced by plasma cells MADGE: characterized by antigenic, structural, and functional differences; produced by mature B cell (plasma cells) in response to a challenge by an antigen
The development of sensory and motor symptoms in multiple sclerosis is caused by:
immunologic and inflammatory demyelination of central nervous system neurons.
Vital to the management of individuals with spinal cord trauma is preventing long-term complications. All of the following are potential complications of spinal cord trauma except:
immunosuppression.
What can happen if bone fracture is not treated properly?
improper reduction or lack of immobilization: need to keep bone from moving or nonunion occurs
In subarachnoid hemorrhage (SAH), blood accumulates:
in the cerebrospinal fluid (CSF) between the brain and skull.
neutralization (direct antibody function)
inactivation or blocking the binding o antigen to receptors
hypoparathyroidism
inadequate secretion of parathyroid hormone resulting in abnormally low levels of calcium in the blood -abnormally low PTH levels -usually caused by a parathyroid damage in thyroid durgery -hyperphosphatemia ( ↑ phosphate reabsorption by renal tubules) symptoms: -hypocalcemia → ↓ nerve & muscle thresholds → muscle spasms → hyper-reflexia, tonic-clonic convulsions Dx: -low serum calcium, high serum phosphorus w/ absence of renal disease Rx: -immediate parenteral calcium; active form of vitamin D & oral Ca for maintenance
All of the following problems are complications of subarachnoid hemorrhage (SAH) except:
increased cerebral blood flow.
detrusor hyperreflexia
increased contractile activity of the detrusor muscle of the bladder, resulting in urinary incontinence -bladder empties automatically when full -due to stroke, brain tumors, dementia: causes urinary leakage & incontinence (CNS lesion)
malignant bone tumors
increased nuclear/cytoplasmic ratio, irregular borders, excess chromatin, a prominent nucleolus, & in an increase in the mitotic rate
what is bursitis?
inflammation of a bursa (small sacs filled with synovial fluid located between tendons & muscles) -skin over bone, skin over muscle, & muscle & tendon over bone -caused by repeated trauma -septic bursitis is caused by a wound infection
What is epicondylitis?
inflammation of a tendon where it attaches to a bone in the elbow
What is acute poststreptoccal glomerulonephritis?
inflammation of the glomerli 10 days after strep infection -commonly affect kids
What is glomerulonephritis?
inflammation of the glomeruli of the kidney -***immunologic abnormalities (most common) -drugs & toxins -vascular disorders -systemic diseases -viral causes -***most common cause of end-stage renal failure***
What is pyelonephritis?
inflammation of the kidney and its pelvis caused by bacterial infection
bronchiolitis
inflammation of the membranes lining the bronchioles -inflammatory obstruction of the small airways -most common in children -occurs in adults w/ chronic bronchitis, associated w/ a viral infection, or with inhalation of toxic gases
gastritis
inflammatory disorder of the gastric mucosa in which surface epithelium is eroded acute gastritis: ASA, NSAID's, alcohol, steroids, spices, etc. chronic gastritis: -chronic fundal gastritis (Type A): proximal 1/3 of stomach & body, also called atrophic gastritis-risk of carcinoma, perniculous anemia chronic antral gastritis (Type B): in antrum, 4X as prevalent as fundal gastritis
ankylosing spondylitis (rheumatoid arthritis of backbone)
inflammatory joint disease of the spine or sacroiliac joints causing stiffness & fusion of the joints -systemic, auto-immune inflammatory disease (not antibodies against antibodies) -primary proposed site is the ENTHESIS: site where ligaments, tendons, & the joint capsule are inserted into the bone -cause unknown, but there is a strong association w/ HLA-B27 antigen -begins with the inflammation of fibrocaritlage, particularly in the vertebrae & sacroiliac joint -inflammatory cells infiltrate & erode fibrocartilage -as repair begins, the scar tissue ossifies & calcifies; the joint eventually fuses -early symptoms: low back pain, stiffness, pain, & restricted motion -patient demonstrates loss of normal lumbar curvature -spine is straight up & down
pneumoconiosis
inhalation of dust particles -silica -asbestos -coal (black lung disease)
allergic alveolitis
inhalation of organic dusts that give a diffuse allergic (type III immune complex) reaction in the alveoli and bronchioles -extrinsic allergic alveolitis (hypersensitivity pneumonitis)
surface coats
inhibit phagocytosis, surface receptors to bind host cells, and toxins
primary response (immune response to antigen)
initial exposure; latent period or lag phase while B-cell differentiation is occurring; after 5-7 days IgM can be detected, and IgG response equal or slightly less after IgM
fibrin
insoluble protein; produced by coagulation cascade, main substance
kinin system
interacts closely with the coagulation system, final product of the kinin system is bradykinin--pain; causes dilation of blood vessels, pain, smooth muscle contraction, vascular permeability, and leukocyte chemotaxis
Most forms of focal brain injury or diffuse axonal injury are associated with increased:
intracranial pressure.
procallus formation
invasion by osteoblasts, calcium deposition
The tonic phase of an epileptic seizure is characterized by:
involuntary muscle contraction and loss of consciousness.
true aneurysms
involve all three layers of the arterial wall; weakening of the wall -fusiform aneurysms-involving entire circumference of artery -saccular aneurysms-localized weakness of arterial wall (side somewhere)
transmural infarction
involves the complete wall
What is Rhabdomyolysis?
is a life-threatening complication of severe muscle trauma w/muscle cell necrosis: myoglobinemia → myoglobinuria → KIDNEY TOXICITY
osteomyelitis (inflammation of the bone)
is most often caused by a staph infection -most common cause is open wound (exogenous); also can be from a blood bourne (endogenous) infection (skin, ear, dental, sinus infection)
treatment for disuse atrophy
isometric movements & passive lengthening exercises
isotonic fluid loss
isotonic dehydration; causes contraction of the ECF volume with weight loss, dryness of skin and mucous membranes, decreased urine output, and symptoms of hypovolemia--rapid heart rate, flattened neck veins, and normal or decreased blood pressure
IgM
largest of the immunoglobulins; first antibody produced during the initial or primary response to an antigen; synthesized during fetal life and its synthesis may be increased as a response to infection in utero.
tennis elbow
lateral epicondylitis
valvular regurgitation
leaking of blood backward through a valve that does not close tightly. -aortic regurgitation -mitral regurgitation -tricuspid regurgitation
IgE
least concentrated of Ig in the circulation; mediator of many specialized common allergic responses; defender against parasites
What is a myxedema coma?
life-threatening form of hypothyroidism -medical emergency - ↓ level of consciousness w/ severe hypothyroidism -hypothermia/hypotension/hypoglycemia -can lead to a coma & eventually death if not fixed
active immunity
long lived, antibodies or T-cells produced after either a natural exposure to an antigen or after immunization
achalasia
loss of esophageal peristalsis & failure of lower esophageal sphincter (LES) to relax so food gets stuck at distal esophagus due to loss of neurons in wall of esophagus (bird's beak sign)
orthostatic hypotension
low blood pressure occurring in some people when they stand up -decrease in both systolic & diastolic blood pressure upon standing -lack of normal blood pressure compensation in response to gravitational changes on the circulation→ dizziness→ syncope -acute orthostatic hypotension-usually volume depletion (elderly) -chronic orthostatic hypotension-endocrine/neurologic disorders
hypovolemic shock
low blood volume - ↓ intravascular volume by 15%
IgD
low concentration in the blood, located primarily on the surface of developing B-lymphocytes and mainly an antigen receptor on the surface of early B-cells
chylothorax
lymph fluid in pleural space
natural killer cells (NK)
lymphoid cells, but lack antigen specific receptors
secretory (mucosal) immune system
lymphoid tissues that protect external surfaces the body; antibodies present in tears, sweat, saliva, mucus, and breast milk--IgA
chloride (Cl-)
major anion in the ECF, and provides electroneutrality; particularly in relation to sodium; concentration tends to vary inversely with bicarbonate (HCO3-) the other major anion
potassium
major intracellular electrolyte and is essential for normal cellular functions; ECF concentration: 3.5-5.0 mEq/L; maintained by sodium-potassium adenosine triphosphate active transport system; required for glycogen and glucose deposition in liver and skeletal muscle cells, maintains the resting membrane potential; mainly regulated by the kidney
opsonization (indirect antibody function)
make more susceptible to phagocytosis
precipitation (direct antibody function)
making a soluble antigen into an insoluble precipitate
what is nephrotic sediment?
massive amounts of PROTEIN [& lipids] in the urine
macrophage
mature monocyte in the tissues
postoperative respiratory failure
may be characterized by: -atelectasis -pneumonia -pulmonary edema -pulmonary emboli prevention: -frequent turning, deep breathing, early ambulation, air humidification, incentive spirometry
golfer's elbow
medial epicondylitis
Type IV hypersensitivity: cell mediated
mediated by T-lymphocytes--direct killing by Tc or recruitment of phagocytic cells by Th1 cells, does not involve antibody; acute graft rejection, skin test for TB--extreme memory involved
Symptoms of bacterial meningitis can include all of the following except:
mild frontal headache.
desensitization
minute quantities of the allergen to which the person is sensitive are injected in increasing doses over a prolonged period, may reduce the severity of the allergic reaction in the treated individual
cytokines
molecule produced by cells of the acquired immune system that mediates interactions between cells to kill bacteria; active during inflammatory response
opsonins
molecules that coat bacteria and increase their susceptibility to being eaten and killed by inflammatory cells, such as neutrophils and macrophages
anaphylatoxins
molecules that induce rapid degranulation of mast cells, thus increasing inflammation
secondary response
more rapid caused by the presence of memory cells that do not have to differentiate; larger amounts of antibody are produced; IgM is produced in similar quantities to the primary response, but IgG is produced in considerably greater numbers
IgG
most abundant class (80-85%) in the blood, transported across placenta (major Ig in fetus and newborn); accounts for most of the protective activity against infections
isotonic fluid excess
most commonly the result of excessive administration of intravenous fluids, hypersecretion of aldosterone, or the effects of drugs such as cortisone (which causes renal reabsorption of sodium and water); as plasma volume expands, hypervolemia develops with weight gain leading to decreased hematocrit and decreased plasma protein concentration; neck veins may be distended, blood pressure increases, edema
Amyotrophic lateral sclerosis (ALS) is caused by the degeneration of:
motor neurons in the spinal cord and peripheral nerves.
net filtration
movement of fluid back and forth across the capillary wall; best described as Starling's forces
shunting
moving oxygenated blood into vital areas and bypassing less vital areas -ventilation-perfusion abnormalities
antigenic variation
mutation-antigenic drift recombination-antigenic shift gene switching
In terms of risk factors, cerebral vascular accidents (strokes) are most similar to:
myocardial infarctions.
How to diagnosis for thyroid cancer?
needle aspiration of thyroid nodule
Pathologic hyperplasia can lead to:
neoplasia (cancer), dysplasia, metaplasia.
baroreceptors
nerve endings that are sensitive to changes in volume and pressure-stimulate the release of ADH from the pituitary gland; found in the aorta, pulmonary arteries, and carotid sinus
Starling's forces
net filtration=forces favoring-forces opposing filtration forces favoring filtration=capillary hydrostatic pressure and interstitial oncotic pressure forces opposing=capillary oncotic pressure and interstitial hydrostatic pressure
What is functional obstruction of lower urinary tract obstruction?
neurogenic bladder (bladder dysfunction to nerve dysfunction) or atonic [flaccid-can't contract] bladder
chemotactic factors of the mast cell
neutrophil chemotactic factor, eosinophil chemotactic factor of anaphylaxis
what is interstitial cystits?
nonbacterial cystitis
mutual relationship
normal flora; relationship can be breached by injury; normal flora can leave normal sites and cause infection elsewhere
causes of intestinal obstruction
obstruction due to surgical adgesions (small intestine); carcinoma, intussusception & volvulus (large intestine)
embolism
occlusion of a blood vessel by an embolus (a loose clot or air bubble or other particle) -can be something other than blood -bolus of matter that is circulated in the bloodstream -dislodged thrombus, air bubble, amniotic fluid, aggregate of fat, bacteria, cancer cells, or a foreign substance
dilutional hyponatremia
occur when the proportion of TBW to total body sodium is excessive; weight gain, edema, ascites, and jugular vein distention
hyperchloremia
occurs clinically when there is too much sodium or too little bicarbonate; more than normal amounts of chloride can be expected with hypernatremia or metabolic acidosis
clonal diversity
occurs in specialized lymphoid organs (Thymus-T cells, and bone marrow- B cells); 1st phase of immune response; antigen recognition, and lymphocyte specificity
syndrome of inappropriate secretion of ADH (SIADH)
occurs when factors other than hyperosmolality or hypovolemia stimulate the secretion of ADH-caused by decreased renal excretion of water
lymphedema
occurs when lymphatic channels are blocked or surgically removed, proteins and fluid accumulate in the interstitial space
hypernatremia
occurs when serum sodium levels exceed 147 mEq/L; may be caused by an acute gain in sodium or a net loss of water--intracellular dehydration; thirst, fever, dry mucous membranes, restlessness as a result of water loss; CNS: muscle twitching and hyperflexia; convulsions
correction
occurs when the values for both components of the buffer pair (carbonic acid and bicarbonate) return to normal levels
respiratory alkalosis
occurs when there is alveolar hyperventilation and excessive reduction in plasma carbon dioxide levels (hypocapnia); dizziness, confusion, tingling of extremeties, convulsions and coma
Granulocyotis is also called neutophilia because neutrophils are the most numerous of the granulocytes. NEUTROPHILIA is seen in the early stages of?
of INFECTION or INFLAMMATION and is established when the absolute count exceeds 7500/mm3
carbonic acid-bicarbonate buffer
operates in both the lung and the kidney and is major extracellular buffer; the lungs decrease carbonic acid by blowing off carbon dioxide and leaving water, and the kidneys can reabsorb bicarbonate or regenerate new bicarbonate from carbon dioxide and water; 20:1 ratio maintained
clusters of differentiation (CD)
originally used to describe proteins found on the surface of lymphocytes, now it is a labeling system used to identify a family of proteins on many cells: CD4, CD8, CD 16 cells
interstitial oncotic pressure
osmotically attracts water from the capillary into the interstitial space
capillary oncotic pressure
osmotically attracts water from the interstitial space back into the capillary
compensatory hypertrophy
other kidney ↑ in size of glomeruli -obligatory growth (due to growth hormone)
Autonomic hyperreflexia is often caused by:
pain stimulation below the level of the spinal cord lesion.
What is tendinosis?
painful degradation of collagen fibers due to repeated trauma
An individual with paralysis of the lower extremities has:
paraplegia.
margination
pavementing; adherence of leukocytes to endothelial cells
chemokines
peptides that primarily induce leukocyte chemotaxis
bronchiectasis
persistent abnormal dilation of the bronchi
debridement
phagocytic clean up o the site of injury by removal of fibrin clots after dissolution by fibrinolytic enzymes and removal of microorganisms, erythrocytes, and dead tissue cells
Dermatomyositis
polymyositis accompanied w/ skin lesions
hypokalemia
potassium deficiency; develops when serum potassium concentration falls below 3.5 mEq/L; neuromuscular excitability decreases, causing skeletal muscle weakness, smooth muscle atony, and cardiac dysrhythmias; amplitude of T wave decreases and amplitude of U wave increases, and ST segment is depressed; QRS complex can be prolonged in severe cases
virulence
potency of a pathogen measure in terms of the number of microorganisms or micrograms of toxin required to kill a host
sodiumd
predominantly extracellular cation
How to diagnose glomerulonephritis?
presentation: -membranous=thickening of wall w/ immune depostis -sclerotic= glomerular scarring from previous glomerular injury
granulocytes
primary circulatory WBC; many enzyme containing granules in the cytoplasm; includes neutrophils, eosinophils, and basophils
phagocytosis
process by which a cell ingests and disposes of foreign material steps: 1) adherence, 2) engulfment, 3) phagosome formation, 4) fusion of phagosome with lysosomal granules, 5) destruction of target
class switch
process that results in the change in antibody production from IgM to IgG during primary immune response; under control of Th2 cytokines
B-lymphocytes
produce antibodies that enter the blood and react with antigen, during clonal selection these cells can differentiate into active antibody cells (plasma cells)--also develop into memory cells
delayed union
prolongation of expected healing time for a fracture: 8-9 months
natriuretic hormones
promote urinary excretion of sodium and water and decreases blood pressure; 3rd factor in sodium regulation; after increased glomerular filtration rate and aldosterone (overcomes the sodium retaining action of aldosterone)--reduces blood pressure
innate resistance
protection from or resistance to infection by nonimmune mechanisms such as natural, physical, mechanical and biochemical barriers; natural or native immunity--first line of defense
antimicrobial peptide
protein released by epithelial cells that is toxic to some bacteria, fungi, and viruses and is capable of activating cells involved in innate and acquired immunity
Exopthalmus
protruding eyes; assoc with hyperthyroidism/grave's disease 2 types: -functional abnormality due to hyperactivity of autonomic nervous system (eye lid & eye globe lag) -infilitrative changes: edema of ocular muscles, paralysis of ocular muslces, damage to retina & optic nerve - IRREVERSIBLE CHANGES
purulent exudate
pus; indicates a bacterial infection; cysts or abcesses
hypertrophic scar
raised but remains within the original boundaries of the wound, tend to regress over time
keloid
raised scar that extends beyond the original boundaries of a wound, and invades surrounding tissue and is likely to recur after surgical removal
MHC class II
react with CD4 T-helper (Th) cells and present exogenous antigens from digested extracellular pathogens; found on B-cells, APCs, and some epithelial cells
MHC class I
react with CD8 T-cytotoxic (Tc) cells; present endogenous antigens, found on all nucleated cells and platelets
T regulatory cells
regulate the immune response to avoid attacking "self"; type of T-helper cell; can suppress immune response
intrarenal acute renal failure
renal failure in the kidney due to tubular necrosis
repair
replacement of destroyed tissue with scar tissue
Tuberculosis
respiratory tract infection -myocobacterium tuberculosis -acid-fast bacillus (AFB) -airborne transmission -tubercle formation -caseous necrosis (cottage cheese like due to enzymes) -positive tuberculin skin test (PPD) -positive sputum C&S -CXR
crystalline fragment (Fc receptors)
responsible for most of the the biologic functions of antibodies;
Diffuse axonal injury results from:
rotational acceleration forces.
inflammatory response
second line of defense; activated to protect the body from further injury, prevent infection of the injured tissue and promote healing; a rapid activation of biochemical and cellular mechanisms that are actively nonspecific, with similar responses being initiated against a wide variety of causes of tissue damage
secondary deficiencies
secondary to disease or other physiologic alterations; acquired deficiencies: stress, dietary insufficiencies, malignancies, physical trauma, medical treatments, infections, AIDS
anaphylactic shock
severe allergic reaction
cardiogenic shock
shock caused by cardiac arrest - ↓cardiac output despite normal volume
Pneumonia
signs & symptoms: due to consolidation of an area of lung -dullness to percussion Auscultation: -inspiratory crackles (rales) -egophony -whispered pectoriloqy (whispered sounds [99] louder than normal Dx: -CBC (increase WBC's) -CXR (will show area of consolodation) - +sputum gram stain/C&S -productive cough (viral cough often non-productive) treatment: -antibiotics -pulmonary hygiene
A severe focal injury to the temporal region of the skull can rupture the middle meningeal artery, resulting in an epidural hemorrhage. In this type of intracranial hemorrhage, the bleeding occurs between the dura mater and the:
skull.
leukotrienes
slow-reacting substances of anaphylaxis; sulfur containing lipids that produce histamine-like effects: smooth muscle contraction and increased vascular permeability
histamine
small weight molecule with potent effects on many other cells, particularly those that control the circulation; vasoactive amine; causes temporary rapid constriction of smooth muscle and dilation of postcapillary venules, which results in increased blood flow into microcirculation
Type II hypersensitivity: Tissue specific
specific tissue is the target of an immune response; blood cells are often affected; generally against a specific cell or tissue--transfusion reactions, Goodpasture syndrome, autoimmune anemias; five mechanisms---mediated by antibody
Immediately following a spinal cord injury, spinal reflexes below the level of the lesion are disrupted because of:
spinal cord swelling
volume-sensitive receptors
stimulate release of ADH from pituitary gland; located in the right and left atria and thoracic vessles
osmoreceptors
stimulated by increased osmolality causing thirst and the signaling of the pituitary to release ADH
paraesophageal hiatal hernia
stomach slides upwards through a defect next to the normal diaphragmatic opening (twisting of the stomach); potential surgical emergency due to torsion
sliding hiatal hernia
stomach slides upwards through esphogeal opening in the diaphragm (often asymptomatic)
The most common source of life-threatening meningitis is:
streptococcus pneumoniae.
antigen
substances considered foreign or "non-self", on infectious agent, non infectious substances of the environment-drugs, vaccines, transfusions; a molecule that can react with antibodies or antigen receptors on B and T cells
paroxysmal nocturnal dyspnea
sudden awakening from sleeping with shortness of breath -PND
Treatment for hyperpituitarism?
surgery/XRT
What is the treatment for a support structure injury?
suture together (min 8 weeks healing)
acidosis
systemic increase in hydrogen ion concentration; an acid-base imbalance characterized by a reduction in arterial blood pH
Viral hepatitis
systemic viral disease that primarily affects the liver -Hep A (HAV)- formally known as infectious hepatitis -Hep B (HBV)- formally known as serum hepatitis -Hep C - D, E, & G Sequence: -incubation phase (30-180 days) -prodromal (pre-icetric) phase -icetric phase (2-6 weeks) -recovery phase (resolution or jaundice) Chronic passive hepatitis: -persistent virus after acute infection Chronic active hepatitis: -persistent liver cell damage after acute infection Fulminant hepatitis (B&C) -results from impairment or necrosis of hepatocytes Prevention for A & B: -give immune globulin before or during incubation phase
What is a sprain?
tear or injury to a ligament
what is a strain?
tear or injury to a tendon -1st (least severe, 2nd, 3rd degree (most severe)
passive immunity
temporary because donor's antibodies are eventually destroyed; preformed antibodies or T-lymphocytes are transferred from a donor to a recipient
ileus
temporary loss of intestinal motility due to inflammation or more commonly postoperative abdominal surgery
buffering
the action of buffers minimizing the change in pH of a solution in response to the addition of acids or bases; most important plasma buffer systems are carbonic acid-bicarbonate and the protein hemoglobin; phosphate and protein are the most important intracellular buffers
hydroureter
the distention of the ureter with urine that cannot flow because the ureter is blocked -proximal to obstruction
edema
the excessive accumulation of fluid within the interstitial spaces; the forces favoring fluid movement from the capillaries or lymphatic channels into the tissues are increased capillary hydrostatic pressure, lowered plasma oncotic pressure, increased capillary membrane permeability, and lymphatic channel obstruction
What is the most common cause of alterations of the hypothalamic-pituitary system?
the interruption of the pituitary stalk die to destructive lesions, traumatic head injury, or surgical transection
Quality (osteoporosis)
the microarchitecture of bone -crystal size & shape -brittleness -integrity of trabecular network -ability to repair tiny cracks (don't get repaired)
toxic myopathies
the most common cause of toxic myopathy is ALCOHOL ABUSE -acute attack of muscle weakness, pain, & swelling -chronic weakness in a drinker of long duration -necrosis of individual muscle fibers -disturbance of energy turnover, gene dysregulation, & initiation of apoptosis
anaphylaxis
the most rapid immediate hypersensitivity reaction; is an explosive reaction that occurs within minutes of re-exposure to the antigen and can lead to cardiovascular shock
valvular stenosis
the narrowing or constriction of a valve. -aortic stenosis -mitral stenosis
alkalemia
the pH of arterial blood is greater than 7.4
acidemia
the pH of arterial blood is less than 7.4
neutrophils
the predominant cell needed to kill bacteria in the early stages of inflammation, phagocyte
septicemia
the presence of bacteria in the blood and is caused by a failure of the body's defense mechanisms; usually caused by proliferation of gram negative bacteria and fungi
degranulation
the release of contents of mast cell granules
interstitial fluid
the space between cells and outside the blood vessels
total body water (TBW)
the sum of fluids within all body compartments; about 60% of body weight; expressed as a % of body weight in kilograms
arterial thrombi
these usually adheree to the wall of cardiac chambers or the aorta
fibrinous exudate
thick, clotted exudate; indicates more advanced inflammation; fluid in lungs--pneumonia
acute coronary syndromes
transient ischemia-comes & goes (stable coronary plaque) -unstable angina-leads to MI in 20% of people; get the pain, sit & rest but pain does not go away -myocardial infarction-irreversible muscle death
The displacement of the temporal lobe into the tentorial notch resulting in brain stem compression is know as a(n):
uncal herniation.
What are the manifestations of bone fractures?
unnatural alignments, swelling, muscle spasm, tenderness, pain, impaired sensation, & possible muscle spasms
clinical manifestations of gastrointestinal dysfunction
upper gastrointestinal bleeding: bright red or "coffee ground" due to breakdown by stomach acids -bleeding gastritis -bleeding peptic ulcers -bleeding esophageal varices (dilated varicose veins in distal esophagus) - mallory-weis tear at esophagogastric (EG) junction due to vomiting lower gastrointestinal bleeding: below the ligament of Treitz (bleeding from the jejunum, ileum, colon, or rectum)-due to polyps, cancer, hemorrhoids (can be "tarry" or bright red)
Absorption of folate occurs in the?
upper small intestine and is not dependent on any othe facilitating factor / treatment for folate deficiency anemia requires daily oral admistration of folate
hypochloremia
usually the result of hyponatremia or elevated bicarbonate concentration, as in metabolic alkalosis; develops with vomiting and loss of hydrochloric acid
venous thrombi
vein blood clot
The main source of bleeding in subdural hematomas is:
venous
kussmaul respirations
very deep and rapid respirations -increase in tidal volume -increase in respiration rate -labored breathing, no expiratory pause -seen with extreme exercise, metabolic acidosis
Encephalitis is usually caused by:
viral infection.
hematemesis
vomiting blood
serous exudate
water exudate which indicates early inflammation; fluid in a blister
transudative effusion
watery -low content of cells
resolution
when repaired tissue is close to normal if damage is minor, no complications occur, and destroyed tissues are capable of regeneration
contracture
when wound contraction is excessive resulting in deformity--burns
dehiscence
wound pulls apart at the suture line--5-12 days after suturing; usually leads to wound infection
primary intention
wounds that heal under conditions of minimal tissue loss; papercut, sutured surgical wound
secondary intention
wounds that require a great deal more tissue replacement so that epithelialization, scar formation, and contraction take longer; open wound--pressure ulcer
Jaundice
yellow pigmentation of skin secondary to hyperbillirubinemia
postmenopausal osteoporosis
↓ estrogen/androgen -age-related bone loss begins in 40's
