Patho - Test 3

Secondary

-Elevation of pulmonary venous pressure (mitral valve disorders, left ventricular diastolic dysfunction) -Increased pulmonary blood flow (left to right shunts in congenital heart diseases, atrial or ventricular septal defects and patent ductus arteriosus) -Pulmonary vascular obstruction (pulmonary embolism) -Hypoxemia (advanced COPD or interstitial lung diseases) -Majority (type of pulmonary hypertension)

Postural

Small curve that corrects with bending. Corrected with passive and active exercises. (scoliosis)

Osteomalacia

Softening of bone in adults due to inadequate mineralization

Diuretics

Some increase loss of potassium, magnesium, and calcium (type of drug)

Hepatic Failure

Symptoms: -jaundice -ascites -fetor hepaticus (ammonia and ketones in breath) -hypoalbuminemia -hypoglycemia -palmar erythema -spider angiomata -testicular atrophy -balding -gynecomastia -bleeding disorders -hepatorenal syndrome -hepatic encephalopathy -muscle wasting -decreased movement -portal hypertension -renal dysfunction

Fractures

Symptoms: Pain, tenderness, swelling, loss of function, deformity of the affected part, abnormal mobility. X-ray confirms Dx

Diabetes

Symptoms: polyuria, polydipsia, polyphagia, weight loss, tiredness, lack of interest/concentration, numbness in hands/feet, blurred vision, frequent infections, slow-healing wounds

Sjogren's Syndrome

Systemic autoimmune disease that affects the entire body; dry mouth

Systemic Lupus Erythematosus (SLE)

Tx: •NSAIDS •Antimalarial drugs for rashes or musculoskeletal manifestations •High-dose corticosteroids for acute symptoms •Monoclonal Antibodies •Block B cell antibody production

Rheumatoid arthritis

Tx: •Rest and therapeutic exercise •Medications: NSAIDs, corticosteroids, antirheumatics, monoclonal antibodies •Surgery •OT: Splinting (anti-deformity positions), ADL retraining, joint protection strategies

Small cell lung cancer

Tx: Chemotherapy with or without radiation. Surgery is generally not recommended due to metastases (type of lung cancer)

Compartment syndrome

Tx: Relieve pressure (fasciotomy) (for a complication of fracture)

Non-small cell lung cancer

Tx: Surgery, radiation therapy and chemotherapy (type of lung cancer)

Diabetes/Metabolic Syndrome

Tx: meds (Metformin), surgery, diet/exercise* (2)

Rhinosinusitis

Tx: §Depends on the cause §Viral- self-limiting §Bacterial- antibiotics (reserved for severe cases) §Nasal polyps- may require surgery §Symptom management- intranasal corticosteroids or decongestants

Influenza

Tx: §Limit infection to upper respiratory tract §Early detection --> antiviral

Respiratory distress syndrome

Tx: §Mechanical ventilation and oxygen supplementation (may cause bronchopulmonary dysplasia and chronic respiratory insufficiency) §Surfactant

common cold

Tx: §Self-limited illness §Symptomatic treatment, bed rest, and antipyretic drugs §Antibiotics are not recommended

Osteomyelitis

Tx: •Identify causative organism •Treat organism (e.g., antibiotic) •Rest & pain management •Possible drainage

Tendonitis

Tx: •Rest •Occupational therapy &/or PT Bracing and exercise •Anti-inflammatory medications •Surgery in severe cases (tears)

24 weeks

Type II alveolar cells begin to develop and produce surfactant (stage of lung development)

Squamous cell carcinoma, Adenocarcinoma, Large cell carcinoma

Types of Non-small cell lung cancer (3)

•Angulation •Shortening •Rotation

Types of deformities of long bones in fractures (3)

Osteoprogenitor cells

Undifferentiated cells that differentiate into osteoblasts. Found in the periosteum, endosteum, and epiphyseal growth plate of growing bones. Stem cell

Chlamydia, Gonorrhea

Untreated ___ and ___: increased risk of Pelvic Inflammatory Disease in women

Saliva production, swallowing, esophageal motility and integrity, LES tone, ulcers

Upper GI problems (5)

Gonorrhea

Usually asymptomatic in women, symptomatic in men. Untreated can spread to bloodstream. Can lead to arthritis/joint pain/inflammation, multiple skin lesions

Antacids (long term use)

Vitamin B12 deficiency (type of drug)

Micronutrients

Vitamins, Minerals

Secretion`

Water, HCl, enzymes, some organic waste products (GI System process)

Absorption

Water, electrolytes, simple sugars, amino acids, fatty acids, vitamins, minerals (GI System process)

Retinopathy

Weakening of the blood vessels in the retina and the obstruction in the capillaries from very tiny blood clots. Higher risk for cataracts and glaucoma (diabetes complication)

Bone Homeostasis

Major influences on __ ________: •Mechanical stress •Calcium and phosphate levels •Cytokines •Hormones

Portal hypertension* (varices, splenomegaly, ascites, hepatic encephalopathy), jaundice

Manifestations of liver disease (2)

Systemic Lupus Erythematosus (SLE)

Manifestations: baldness, butterfly rash, oral ulcers, CNS symptoms, anemia/neutropenia, splenomegaly, osteoporosis, pleuritis, pericarditis, fingertip lesions, polyarthritis, pleural effusion, atelectasis (collapse)

Osteocytes

Mature bone cells, for maintenance of bone matrix. Play an active role in releasing calcium into the blood. Maintains bone tissue

Genu valgum

Medial malleoli do not touch when knees touch. •Common at age 3-4 •May require exercise, surgery as treatments if not resolved by 7 years old

BP (> 130/85mmHg); Blood glucose (insulin resistance, FBG ≥ 110mg/dL); Visceral (Waist: men > 40in; women >35in); Triglycerides (≥ 150mg/dL); HDL cholesterol (men <40mg/dL; women <50mg/dL)

Metabolic Syndrome Criteria (need 3 or more for Dx): -Increased ___ -High __ ____ -Excess ___ adiposity -High ___ -Low ___

insulin; apple

Metabolic Syndrome is a cluster of metabolic abnormalities related to ___ resistance. -Associated with high-risk overweight/obesity phenotype -___-shaped, central/visceral adiposity

Liver

Metabolizes, or breaks down, nutrients from food to produce energy when needed

Osteoarthritis

Risk factors: •Obesity •Injury when young •Advanced Age •Sex (male younger, female older) Treatment (symptom management): •Joint protection (exercise, rest, weight management) •Acetominophen or NSAIDs •Corticosteroid injections •Total joint replacement (severe cases)

Obesity

Weight that is higher than what is considered a healthy weight for a given height

•PT and/or OT •Return to daily activities •Structured exercise

What can a patient do to regain mass & function after immobilization? (3)

Metabolic bone disease

What happens when bone remodeling goes awry

Rheumatic disorders

What happens when inflammation goes awry

Compression fracture

Which bones are best at resisting?

Klinefelter syndrome

XXY genotype

Rhinovirus

most common cause of colds in persons aged 5 to 40 years

Irritable Bowel Syndrome

persistent/recurrent symptoms of abdominal pain, altered bowel function, flatulence, bloating, constipation or diarrhea, nausea, anorexia

Endometriosis

scarring of oviducts (fallopian tubes) prevents fertilization; Endometrial tissue outside uterine cavity and stimulates inflammatory response; "chocolate cysts;" most are mild cases Symptoms: dysmenorrhea, dyspareunia, infertility Tx: pain meds (NSAIDS), hormonal contraceptives, surgical removal, chemically-induced menopause

BMI (body mass index)

weight (kg)/[height (m)]2

Rhinosinusitis

§Acute - Facial pain, headache, purulent nasal drainage, decreased sense of smell, and fever §With maxillary sinus: pain with bending, unilateral maxillary pain, pain in teeth §Often difficult to distinguish from common cold and allergies

The common cold

§Acute, upper respiratory symptoms §Begins with a sore scratchy throat followed by rhinorrhea, nasal congestion, sneezing, and coughing

Rhinosinusitis

§Chronic - only symptoms may be nasal obstruction, a sense of fullness in ears, postnasal drip, hoarseness, chronic cough, and loss of taste/smell §Sinus pain is often absent, but may complain of a headache

Pneumonia

§Definition: inflammation of the parenchymal structures of the lung (bronchioles and alveoli) §Can be infectious and noninfectious

Rhinosinusitis

§Due to proximity, infection and inflammation can extend to cause cranial and orbital damage

Large cell carcinoma

§Large, polygonal cells, occur in the periphery of the lung

Adenocarcinoma

§Most common type of lung cancer found in women and nonsmokers §Originate in the bronchiolar or alveolar tissues, most located peripherally

Rhinosinusitis

§Most commonly due to obstruction of sinus drainage. Inflammation of the paranasal sinuses

Squamous cell carcinoma

§Most commonly found in men with smoking history §Tend to originate in the central bronchi (cells get coughed up increases chance of early detection)

Small cell lung cancer

§Small round to oval cells that grow in clusters §Presence of neurosecretory granules (may arise from neuroendocrine cells of the bronchial epithelium; responsible for paraneoplastic syndrome)

Respiratory Failure

•A condition in which the respiratory system fails in one or both of its gas exchange functions — oxygenation of mixed venous blood and elimination of carbon dioxide (PO2 < 60 mmHg, PCO2 > 45 mmHg, or both)

Cystic fibrosis

•Autosomal recessive genetic disorder in chloride transport proteins, CFTR ̶High concentrations of NaCl in the sweat ̶Less Na+ and water in respiratory mucus and in pancreatic secretions ºAccumulation of viscid mucus in the bronchi --> airway obstruction ºObstruction of pancreatic and biliary ducts

Bony callus formation

•Cartilage is ossified to form a bony callus •Formation of bone progresses toward the fracture site until a new bony sheath covers the callus •Fibrocartilage is converted to woven bone and gradually calcifies into mature bone

Pulmonary embolism

•Causes: -Thrombus (majority) -Air, fat, amniotic fluid

Bronchiectasis

•Clinical Manifestations: -Recurrent bronchopulmonary infection -Coughing, production of large amount of purulent sputum and hemoptysis -Marked dyspnea and cyanosis -Clubbing of fingers -Weight loss and anemia

Pulmonary embolism

•Clinical Manifestations: ̶Rapid and shallow breathing ̶Pleuritic pain, cough productive of blood-streaked sputum ̶Tachycardia ̶Pulmonary hypertension and right heart failure ̶Can be fatal

Sprain

•Common sites of injury: Ankle, knee (ACL), elbow

Strain

•Common sites of injury: Lower back, neck, hamstring

Compartment syndrome

•Compromises circulation and function •Screen for signs •Nerve and muscle death in 8 hrs (complication of fracture)

Remodeling

•Dead bone is removed by osteoclasts •Compact bone replaces spongy bone •Excess material is removed and compact bone is laid to reconstruct the shaft

Ligaments, Tendons

•Dense regular connective tissue •Inelastic collagen fibers •High tensile strength (2)

Woven bone (immature)

•Deposited rapidly •Temporary scaffolding for support •Low tensile strength •Found in developing fetus, areas surrounding tumors and infections and in fracture healing

Rhabdomyolysis

•Direct or indirect severe muscle injury (e.g., trauma, statins, excessive alcohol) •Complications: Acute renal failure, fatal heart rhythm disturbances, hypovolemic shock, disturbances of electrolyte balance, metabolic acidosis, hyperthermia, compartment syndrome

Ligaments, Tendons

•Disorganization of parallel fibers •Loosening of fibers attached to bone (↑osteoclastic activity) (effects of long-term immobilization on what structures)

Bronchial asthma

•Features: ̶Chronic recurring inflammation ̶Hyperreactive airways ̶Episodic, reversible bronchoconstriction persistent changes may occur, including mucus hypersecretion, injury to epithelial cells, smooth muscle hypertrophy, and blood vessel proliferation •Classification: ̶Extrinsic (atopic, a type I hypersensitivity response to an extrinsic antigen) ̶Intrinsic (nonatopic, non-immune mechanisms)

Fibrocartilaginous callus formation

•Granulation tissue called procallus is formed •Fibroblasts invade the procallus •Fibroblasts produce soft callus bridge that connects bone fragments

Collagen

•Increased degradation rate •Reduced mass (effects of long-term immobilization on what structure)

Tendonitis

•Inflammation of a tendon where it attaches to or contacts a bone •Causes: Repetitive motion/overuse •Symptoms: •Pain •Tenderness •Weakness

Spongy bone

•Inner bone •Light weight, lattice like pattern •Compressive (force absorption) •Functional Unit: Trabeculae

Sprain

•Involves ligaments or joint capsule •Due to abnormal or excessive movement of a joint •Symptoms: Pain, rapid swelling, discoloration, and limited function

Lamellar bone (mature)

•Made of cylindrical osteons or Haversian systems •Concentric lamellae of bone matrix surround a central Haversian canal •Tiny weight-bearing pillars

Cystic fibrosis

•Manifestations in lung function ̶Chronic bronchiolitis and bronchitis ̶Bronchiectasis Chronic infection

Atelectasis

•Manifestations: -Decreased chest expansion and breath sounds on affected side -Intercostal retraction during inspiration -Signs of respiratory distress: tachypnea, tachycardia, dyspnea, cyanosis, signs of hypoxemia

Pleural effusion

•Manifestations: -Vary with the cause -A decrease in lung expansion on the affected side -dullness or flatness to percussion, diminished breath sounds -Dyspnea, hypoxemia, pleuritic pain

Disorders of Ventilation and Gas Exchange

•Obstructive Lung diseases •Restrictive lung diseases •Pulmonary Vascular Disorders •ARDS/Respiratory Failure

Resorption

•Organic and inorganic components are removed, creating a tunnel-like space in the osteon •Soluble factors (e.g. OPG) released aid in the recruitment of osteoblasts to the site ("reversal") (bone remodeling stage)

Compact bone

•Outer shell •Densely packed, calcified extracellular matrix (more rigid) •Functional Unit: Osteon

Systemic Lupus Erythematosus (SLE)

•Primarily seen in young females (15-40 years) •Incidence higher in some families

Gout

•Primary: Cause unknown or metabolic error; hyperuricemia •Secondary: Due to underlying disorder

RANKL

•Produced by osteoblasts •Binds to RANK receptor and promotes activation of osteoclasts

Muscle

•Reduced protein synthesis •Increased protein breakdown (↓ muscle mass) (effects of long-term immobilization on what structure)

Osteopenia

•Reduction in bone mass •Term used to describe lack of bone mass on x-ray (not a diagnosis)

Pneumothorax

•Results in partial or complete collapse of the affected lung -Spontaneous: an air-filled bleb on the lung ruptures oPrimary: occurs in otherwise healthy persons oSecondary: occurs in persons with underlying lung disease Traumatic: air enters through chest injuries

Strain

•Stretching or partial tear in a muscle or muscle-tendon unit •Inflammatory response and fibrous tissue replacement at the site •Symptoms: Pain, stiffness, swelling, and local tenderness

Formation

•Successive lamellae are deposited, and the canal attains relative proportions of original osteon •When they receive a signal, osteoblasts release RANKL (induces osteoclast activity) (bone remodeling stage)

Rheumatoid arthritis

•Systemic, chronic autoimmune disease •Peak incidence between 40 and 50 years •Genetic predisposition (HLA type) + immunological trigger

Marasmus

•Undernourishment characterized as energy deficit and reduction in all nutrients •Loss of muscle and fat stores •Diarrhea is common •Children - growth failure •Disordered Eating and Eating Disorders •Associated with Female Athlete Triad •now using term Relative Energy Deficiency in Sports (RED - S) Occurs in male and female athletes

Scoliosis

•Uneven shoulders or iliac crest •Prominent scapula on convex side of curve •Asymmetry of thoracic cage (cardinal signs of __)

Crohn's disease

Does not characteristically predispose to cancer

Chylothorax

Effusion of lymph in the thoracic cavity (type of pleural effusion)

Disorders of lung inflation

Conditions that obstruct the airways, cause lung compression, or produce lung collapse

Osteoporosis

Tx: •Exercise (weight-bearing) •Calcium, vitamin D •Medications (e.g., bisphosphonates)

Gout

Elevated serum uric acid •Overproduction or excessive breakdown of purines (adenine and guanine) •Decreased uric acid excretion

Emphysema (COPD)

Enlargement of air spaces and destruction of lung tissue; barrel chest

Osteoporosis

Risk Factors: Personal Characteristics -Advanced age -Females -Ethnicity (white or Asian) -Small bone structure/low body weight -Postmenopausal -Family history Lifestyle (modifiable) -Sedentary -Calcium/Vitamin D deficiency -Malnutrition -Smoking -Excessive alcohol intake -Excessive caffeine intake (*) -Medications

Lung cancer, COPD

Risk factor: cigarette smoking (2)

Acquired atelectasis

In adults; Commonly caused by airway obstruction and lung compression (mucous plug, pneumothorax or pleural effusion)

equilibrium

In normal bone, the remodeling cycle of resorption and formation is at __

Genu varum

Outward bowing of knees (>1 in.) when medial malleoli are touching. May require bracing after 2 years old

Appendicitis

Pain localizes in lower right quadrant

Osteomalacia

Risk factors: •Elderly (deficient diets & malabsorption) •Long-term anticonvulsant or diauretic treatment (metabolic bone disease)

Developmental Hip Dysplasia

Congenital disorder •Screening: Ortolani test (Flex/abduct hips; Should be equal, produce no click) •Tx: Pavlik harness. Results from underdeveloped hip socket

Ligaments

Connect bone to bone

Tendons

Connect muscle to bone

Bone (osseous tissue)

Connective tissue that provides: •Support/protection •Levers for muscle •Mineral storage

Osteopenia

Contributions to ____: Endocrine disorders •Hypogonadism •Menopause •Hypercortisolemia •Hyperthyroidism •Hyperparathyroidism Multifactorial issues •Pregnancy •Type 1 diabetes •HIV/AIDS •Anorexia •Relative Energy Deficiency in Sport (RED-S) Nutritional disorders -Renal failure -Chronic liver disease -Alcohol abuse -Calcium deficiency -Vitamin D deficiency -Malabsorption -Inflammatory bowel disease

Gout

Crystal-induced inflammatory disorder; primary manifestations in joints/kidneys

•Whole body •Lumbar* •Femur* •Wrist*

DXA imaging options: (4)

Neuropathy

Damage to nerves in the body (diabetes complication)

spurs, collagen, eroded

Damaged joint cartilage tries to heal itself in OA: creating osteophytes or ___; cartilage contains more water, less ___; cartilage becomes weak, rough, ____

Cholestyramine

Decrease absorption of fat soluble vitamins as well as vitamin B12, folic acid and calcium (type of drug)

Systemic Lupus Erythematosus (SLE)

Defective elimination of self-reactive B cells and increase in antibody production, causing tissue damage

Vitamin D

Deficiency in ___ can cause: Adults: Increased fractures, muscle weakness, bone loss (can contribute to osteoporosis, osteomalacia). Children: growth delay, soft bones, Rickets

Calcium

Deficiency in ___ can cause: Adults: osteoporosis, osteomalacia. Children: soft bones, Rickets

Iodine

Deficiency in ___ can cause: goiter

Vitamin B12

Deficiency in ___ can cause: megaloblastic anemia

Osteoporosis

Deficiency of calcium, Vitamin D

Neural tube defects

Deficiency of folic acid

Anemia

Deficiency of iron, Vitamin B12, folate

Kwashiorkor

Deficiency of protein, seen in alcoholics; edema, hair changes, apathy, anemia, muscle wasting, dermatoses, fatty liver

BeriBeri

Deficiency of thiamin (alcoholics)

Vitamin A

Deficiency of this nutrient can lead to congenital anomalies in pregnancy, night blindness

Folate

Deficiency of this nutrient can lead to megaloblastic anemia/congenital anomalies in pregnancy

Malunion

Deformity or angulation on x-ray. Inadequate reduction. Misalignment of fracture at time of immobilization.

Bronchiectasis

Destruction of the smooth muscle and elastic supporting tissue of the bronchi and bronchioles, and dilation of these structures. Obstruction and chronic persistent infection and inflammation (bacterial pneumonia following a viral infection, tuberculosis)

Osteoclasts

"Bone-chewing" cells responsible for resorption (removal of bone mineral and organic matrix

Osteoprotegerin (OPG)

"Decoy" receptor to block RANKL activity to ensure balance

Hypoxemic respiratory failure

(Failure of the gas exchange) oMismatching of ventilation and perfusion oImpaired diffusion (hypoxemia but not hypercapnia): Interstitial lung disease, ARDS, Pulmonary edema, Pneumonia

Hypercapnic/hypoxemic respiratory failure

(Hypoventilation or ventilatory failure): depression of the respiratory center, diseases of respiratory nerves or muscles, thoracic cage disorders

nephropathy

Diabetic ___ is the leading cause of end-stage renal disease (ESRD)

Metabolic bone disease

Disorders of bone metabolism (bone remodeling) result in structural changes to the skeleton. These changes include decreased bone mass and diminished bone strength. (Osteopenia, Osteoporosis, Osteomalacia, Paget's disease)

Disorders of the Pleura, Atelectasis

Disorders of lung inflation (2)

Bone fractures

Disruption in the continuity of a bone •Causes: High compression, tension, shearing, bending, or torsion forces

Diverticular disease

Diverticula protruding through GI tract; diverticulitis occurs w/ inflammation & bacterial release into wall; need fiber

Left lower quadrant

Diverticular manifests w/ pain or tenderness in which quadrant?

Pellagra

4-Ds (dementia, diarrhea, dermatitis, and death) (deficiency of Niacin)

Hypoxia

A decrease in tissue oxygenation

Achalasia

A failure of smooth muscle fibers to relax, which can cause a sphincter to remain closed and fail to open when needed.

Hypoxemia

A reduction in the partial pressure of oxygen (PO2) of the arterial blood; PO2 < 60 mm Hg

Wolff's Law

A tissue adapts to the level of stress imposed upon it (Strengthening and weakening, depending on level of stress)

Hematogenous Osteomyelitis

A: Infection reaches bone B: Purulent exudate collects as infection spreads, shearing off perforating arteries C: Bone necrosis; necrotic bone separates from live bone to form devascularized fragments, called sequestra

Primary

Abnormal proliferation and contraction of vascular smooth muscle, marked intimal fibrosis (type of pulmonary hypertension)

Hyperglycemia

Abnormally high circulating glucose. Characterized by: 1.Polyphagia-frequent hunger, pronounced hunger 2.Polydipsia-frequent thirst, excessive thirst 3.Polyuria-frequent urination

Hypoglycemia

Abnormally low circulating glucose. Symptoms: -Increased heart rate -Trembling -Nervousness -Sweating -Anxiety -Can cause coma and death

Osteomyelitis

Acute or chronic infection of the bone and marrow

Antihypertensives

Affect body levels of potassium, calcium and zinc (type of drug)

Crohn's disease

Affects GI tract with skip lesions; healthy tissue interrupted by areas of diseased tissue (IBD)

Crohn's disease

Affects anywhere in the GI tract; mouth to anus (IBD)

Ulcerative colitis

Affects from rectum continually upward into colon (IBD)

Peripheral neuropathy

Affects nerves in the toes, feet, legs, hand, and arms (Tingling, burning, deep pain, weakness, light-headed, fast heart beat)

Autonomic neuropathy

Affects nerves that help regulate digestive, bowel, bladder, heart, and sexual function (Digestive problems, bladder infections and incontinence, sexual problems)

Crohn's disease

Affects the whole thickness of the intestinal wall (transmural) (IBD)

Pleural effusion

An abnormal collection of fluid in the Pleural Cavity; excess fluid formation, decreased removal by the lymphatics

Atelectasis

An incomplete expansion of a lung or portion of a lung.

Hypercapnia

An increase in the carbon dioxide (PCO2) content of the arterial blood; PCO2 >50 mm Hg

Crohn's disease

Anal fistula and anal fissure formation (IBD)

Osteonecrosis

Aseptic destruction of a segment of bone due to an interruption in blood flow

Metabolic syndrome

Associated with hyperglycemia, hyperinsulinemia, dyslipidemia and hypertension (cluster)

18.5; 18.5-24.9; 25-29.9; 30+

BMI Categories: Underweight = <__ Normal weight = ____-___ Overweight = __-___ Obesity = ___

Bony callus formation

Begins 3 to 4 weeks after injury and continues for months later (bone healing process)

Irritable Bowel Syndrome

Believed to result from dysregulation of intestinal motor and sensory functions modulated through the CNS; often in response to physical or psychological stress. Dx based on 3 months' symptoms of discomfort, relieved by defecation. Tx focuses on stress management.

hematoma

Blood vessels in the bone and surrounding tissues bleed into and around the fragments forming a __ in fracture healing. Fibrin meshwork forms and seals the fracture site (initiates healing process)

Hemothorax

Bloody (type of pleural effusion)

Type 1 diabetes

Body does not produce insulin; commonly diagnosed in children/young adults

vascularized

Bone is well ___

Osteoblasts

Bone-building cells that synthesize and secrete the organic matrix of bone. Participate in calcification of the organic matrix.

compact, spongy

Bones contain both __ and ___ bone in different proportions

Genu varum

Bowlegs

Scurvy

Bruising, swollen and/or bleeding gums, weakness, fatigue, rash, coiled hair, failure to thrive, irritability, muscle weakness, or weight loss (deficiency of VitC)

avascular

Cartilage is ___

Syphilis

Causative bacteria; can infect fetus during pregnancy; more common in men

Secondary Tuberculosis

Cause: reinfection/reactivation.Clinical manifestations: signs of chronic pneumonia (low-grade fever, night sweats, easy fatiguability, anorexia and weight loss), "Consumption": Eventually fatal if untreated

Respiratory Distress Syndrome

Cause: §Immature lung structures §Lack of surfactant - infants are not strong enough to inflate their alveoli §Protein-rich fluid leaks into the alveoli - further blocks oxygen uptake

Nutritional disorders

Caused by a deficiency or excess of one or more nutrients that alters the structure and/or function of cells, tissues, and organs to cause disease. Most are chronic not acute

DKA

Causes of ___: Infection, injury, a serious illness, surgery, or non-compliance to insulin therapy. Life-threatening condition! -More often in T1D -Younger, female -Mortality 2-5% -Usually develops rapidly <24h -Polydypsia, Polyuria --> Volume depletion --> hypotension, increased HR

Improper and/or inadequate food intake, Obesity and/or surgical procedures designed to treat obesity, Food Faddism, Deficient supply of food, Medications, Certain medical conditions, Emotional factors, Metabolic abnormalities, Poor dietary habits, Inadequate absorption of food, Poverty, natural disasters, political problems, lack of knowledge, war, pandemics (epidemics) - food insecurity

Causes/risk factors for suboptimal nutrition (11)

Osteopenia

Causes: •Decrease in bone formation •Inadequate bone mineralization •Excessive bone resorption

Paget's disease

Characterized by: •Focal areas of excessive osteoclast-mediated bone resorption •Disorganized osteoblast-mediated bone repair •Disorganized, thickened, but soft bones (metabolic bone disease)

Respiratory Distress

Chest wall retraction, nasal flaring, stridor, grunting, wheezing (manifestations of __)

Systemic Lupus Erythematosus (SLE)

Chronic autoimmune disease that can affect any organ system •"The great imitator" •Widespread inflammation and tissue damage •Joints, skin, brain, lungs, kidneys, blood vessels •Blood test: anti-nuclear Ab (ANA)

Inflammatory bowel disease

Chronic incurable diseases that can occur at any age but are more prevalent in the young adult. Activate inflammatory cells, causing tissue damage.

4; Morning; 3; Symmetric; nodules; anti-CCP

Classification of Rheumatoid arthritis (Criteria include __ or more of the following): 1.____ stiffness for 1+ hours, present for 6+ weeks 2.Simultaneous swelling of ___+ joints for 6 + weeks 3.Swelling of wrist, metacarpophalangeal, or proximal interphalangeal joints for 6+ weeks 4._____ joint swelling for 6+ weeks 5.Rheumatoid _____ 6.Serum rheumatoid factor (RF) and ____ 7.Radiographic changes on hand or wrist

Transudative effusion

Clear fluid, hydrothorax (type of pleural effusion)

Lung cancer

Clinical Manifestations: -Fatigue, unintentional weight loss, decreased appetite -Chronic cough, SOB, and wheezing §Effects of local spread and metastasis -Invasion of the mediastinum oDull, intermittent, and poorly localized retrosternal pain oHoarseness - involvement of the recurrent laryngeal nerve oDifficulty in swallowing - compression of the esophagus oSuperior vena cava syndrome due to compression -Pleural effusion -Metastases (brain, bone and liver) §Paraneoplastic syndrome

Respiratory distress syndrome

Clinical Manifestations: Central cyanosis, difficulty breathing, grunting

Influenza

Clinical Manifestations: §Upper Respiratory Infection §Abrupt onset fever/chills, malaise, muscle aching, headache, profuse watery nasal discharge, nonproductive cough, sore throat §Viral Pneumonia §Rapid progression of fever, tachypnea, cyanosis, and hypotension. Can cause hypoxemia and death within a few days §Secondary Bacterial Infection Sinusitis, otitis media, bronchitis, and bacterial pneumonia

Rheumatoid arthritis

Clinical manifestation: •Usually symmetrical and polyarticular •Joint pain and stiffness •Subluxation of joints & spindle-shaped appearance •Progressive joint destruction •Misalignment of bone •Swelling and thickening •Limitation of movement

Crohn's disease

Cobblestoning seen on examination of the colon (IBD)

Abdominal pain, nausea & vomiting, diarrhea, GI bleeding, obstructive jaundice

Common GI symptoms (5)

Obstructive airway disorders

Conditions that limit expiratory airflow. ̶Bronchial asthma ̶Chronic Obstructive Pulmonary Diseases (COPD) (Chronic bronchitis, Emphysema) ̶Bronchiectasis (due to necrotizing infections) ̶Cystic fibrosis

Nonunion

Failure of bone to heal before bone repair. Motion at fracture site. Pain on weight bearing. Inadequate reduction. Severe trauma. Bone fragment separation. Soft tissue between fragments. Infection. Extensive loss of bone. Inadequate circulation. Malignancy. Bone necrosis. Noncompliance with restrictions.

Delayed union

Failure of fracture to heal within predicted time. Large displaced fracture. Inadequate immobilization. Large hematoma or infection at fracture site. Excessive loss of bone. Inadequate circulation.

Cirrhosis

Final, common end-stage for a variety of chronic liver diseases

Osteoporosis

First manifestation: Sudden fractures •Vertebral compression fracture •Fracture of vertebra(e), hip, pelvis, humerus

Structural

Fixed deformity •Congenital (vertebral development) •Neuromuscular (cerebral palsy, DMD) •Idiopathic- majority (scoliosis)

Dairy

Food group that provides calcium, potassium, vitamin D, vitamin B12, and protein

Grains

Food group that provides dietary fiber, several B vitamins (thiamin, riboflavin, niacin, and folate), and minerals (iron, magnesium, and selenium)

Vegetables

Food group that provides many nutrients, including potassium, dietary fiber, folate (folic acid), vitamin A, and vitamin C

Fruits

Food group that provides potassium, dietary fiber, vitamin C, and folate (folic acid)

Protein

Food group that provides protein, B vitamins (niacin, thiamin, riboflavin, and B6), vitamin E, vitamin B12, iron, zinc, and magnesium

Vomiting

Forceful oral expulsion of gastric contents, basic physiologic response to rid the GI tract of noxious materials

Transverse (across straight), Oblique (diagonal), Spiral

Fracture line directions (3)

Chronic Pancreatitis

Gallstones aren't involved. Most due to chronic alcoholism. Dense scar tissue, dilated ducts, gritty calcification. Could render pt diabetic

Paget's disease

Genetic and environmental influences: •Mutations in RANK pathways •Viral origin debated (metabolic bone disease)

Uric acid

Gout Tx: ____ ____ management (Low-purine diet, medications [e.g., xanthine oxidase inhibitors])

Liver

Helps your body fight infection by removing bacteria from the blood

Frank hematemesis

Hemorrhage above the stomach (vomiting blood)

Anemia

Hemorrhage can lead to

Fecal occult blood

Hemorrhage in the intestine with blood mixing into stools (not apparent blood in feces)

Melena

Hemorrhage into intestines with large volumes of blood (dark, tarry feces)

Coffee-ground vomitus

Hemorrhage into the stomach with partial digestion of blood

Dual-energy X-ray absorptiometry (DXA or DEXA)

How to Dx Osteoporosis

Infection, bleeding

Immediate concern w/ an open fracture? (2)

Protein pump inhibitors (used to treat GERD)

Increase risk of hypocalcemia and hypomagnesemia (type of drug)

Bone

Increased bone resorption (↓ bone mass) (effects of long-term immobilization on what structure)

Chronic bronchitis (COPD)

Increased mucus production, obstruction of small airways, and a chronic productive cough

Compartment syndrome

Increased pressure within limited space (complication of fracture)

Chlostridium difficile (C. Diff)

Infection in intestines. Causes severe diarrhea

Hemorrhage

Inflammation and damage to the bowel wall

Rheumatic Disorders

Inflammatory disorders, often autoimmune, that cause degenerative musculoskeletal tissue changes.

Motility

Ingestion, swallowing, peristalsis, elimination (GI System: process)

Croup

Inspiratory stridor, hoarseness and a barking cough; usually occurs at night; relieved by exposure to cold or moist air; common in childhood

Type 2 diabetes

Insulin-resistance

Functional Hypothalamic Amenorrhea (FHA)

Interruption of GnRH secretion with stress/excess exercise/extreme weight loss

Cirrhosis

Irreversible inflammatory disease; decreased hepatic function due to fibrosis; alcoholic, biliary, postnecrotic

Pulmonary hypertension

Is defined by a mean pulmonary artery pressure ≥25 mm Hg at rest, measured during right heart catheterization

Osteoporosis

Joint disease of severely decreased bone mass. Increased susceptibility to fractures.

Nephropathy

Kidney glomeruli become damaged and leak protein into the urine. Over time, this can lead to kidney failure. Protein in the urine is an important marker of kidney damage. (diabetes complication)

Genu valgum

Knock-knees

Scoliosis

Lateral curvature of the spine in the upright position.

Sprain

Ligament issue

perpendicular

Ligaments and tendons are bad at resisting forces that occur ___ to fiber direction

blood supply

Ligaments and tendons have a limited __ __

Hepatitis C

Liver disease transmitted via blood

Paget's disease

Local excessive resorption and unpatterned mineralization

Hyaline

Location: b/w tips of ribs and bones of sternum; cover bone surfaces at synovial joints; support larynx, trachea, bronchi; part of nasal septum Function: provides stiff but somewhat flexible support; reduces friction b/w bony surfaces (cartilage)

Elastic

Locations: auricle of external ear; epiglottis; auditory tube; cuneiform cartilages of larynx Functions: provides support; tolerates distortion w/o damage and returns to original shape (cartilage)

Fibrous

Locations: pads w/i knee joint; b/w pubic bones of pelvis; intervertebral discs Functions: resists compression; prevents bone-bone contact; limits relative mvmt (cartilage)

Anorexia

Loss of appetite, alone or with nausea & vomiting, caused by many drugs and disease states, also associated with emotional states

Magnesium

Low levels of this nutrient seen in type 2 diabetes, metabolic syndrome, heart disease, and osteoporosis. Main symptoms severe deficiency: abnormal heart rhythm, muscle cramps, restless leg syndrome, fatigue, and migraines

Respiratory syncytial virus (RSV) and Parainfluenza viruses

Most common and severe in children less than 3 years (2)

Chlamydia

Most common bacterial STI; cases are asymptomatic in men & women

Type 2

Most common form of diabetes

Klinefelter syndrome

Most common genetic cause of hypogonadism

Colon (sigmoid)

Most common site for diverticular disease

Hyperosmolar Hyperglycemic State (HHS)

Most often in T2D, underlying infection, older individuals. •Circulating glucose > 600mg/dl •Serum osmolality > 320mosm/L •Dehydration up to 9L •Alterations in consciousness •Life-threatening condition! •Mortality 5-20%(acute complication of diabetes)

Osteoarthritis

Most prevalent degenerative joint disease; leading cause of physical disability

Strain

Muscle/tendon issue

Ulcerative colitis

No fistula or anal fissure formation (IBD)

Cardiovascular disease

No. 1 causes of death and disability among people with Type 2 Diabetes. Diabetes with Hypertension doubles the risk. Associated with low HDL and high triglycerides.

Hepatitis A

Occurs in unclean conditions; transmitted via fecal matter; highly contagious viral liver infection; jaundice, nausea, abdominal pain

Diabetic Ketoacidosis (Acute)

Occurs when the body cannot use glucose as fuel and uses fat instead. The breakdown of fat produces ketones. At high levels, ketones are poisonous.

Secondary atelectasis

Of the infants; Respiratory distress syndrome, Airway obstruction due to aspiration (amniotic fluid, blood)

Primary atelectasis

Of the newborn; the lung has never been inflated

Pancreatitis

Often caused by alcohol use; caused by injury/damage to pancreatic cells

Exudative effusion

Often contains inflammatory cells (type of pleural effusion)

Sinus headache

Often worse with bending over, coughing, sneezing

Respiratory distress syndrome

One of the most common causes of respiratory disease in premature infants

Congenital clubfoot

One of the most common pediatric orthopedic conditions •Treated by manipulation, casting, surgery

Ulcerative colitis

Only affects the large intestine (IBD)

Ulcerative colitis

Only affects upper layers of intestinal wall (mucosa and submucosa)(IBD)

Mouth, salivary glands, pharynx, esophagus, stomach, liver, gallbladder, pancreas, small intestine, large intestine, rectum, anus

Organs of the digestive system (12)

Deformities

Osteomalacia results in: •Bone pain & tenderness •Fractures •____* (gravity, muscle weakness, bone softening)

Vitamin D; Phosphate

Osteomalacia two main causes: (1)Insufficient calcium absorption from the intestine or _____ deficiency (most common) (2)____ deficiency due to increased renal losses or decreased intestinal absorption

1

Osteopenia: Measured as Bone Mineral Density > __ standard deviation below young adult reference population

height, kyphosis

Osteoporosis signs: Wedging & collapse of vertebrae •Loss of ____ in the vertebral column •_____: Dowager hump

2.5

Osteoporosis: Bone density > __ SD below young adult reference population

65; 60, 64

Osteoporosis: DXA is recommended for: •All people ___ years and older •Women __ to __ years with increased fracture risk

spongy

Osteoporosis: loss of ____ bone

Digestion

Physical (chewing & grinding), Chemical (digestive enzymes) (GI System: process)

Anorexia, nausea, vomiting

Physiologic responses common to many GI disorders (3)

Primary

Positive skin test; alveolar macrophages ingest bacteria but can't kill them (type of TB)

Ulcerative colitis

Predisposes to colon cancer (IBD)

Gout

Presents as: (1)Acute gouty arthritis (2)Tophi- accumulation of crystalline deposits in articular surfaces, bones, soft tissue, and cartilage (3)Gouty nephropathy or renal impairment (4)Uric acid kidney stones Most commonly affects men

Liver

Prevents shortages of nutrients by storing vitamins, minerals, and sugar

Insulin

Primary stimulus is glucose. ___ allows your body to use glucose from carbohydrates in the foods we eat for energy. The liver can make glucose (gluconeogenesis) in times of need (like fasting). Inhibits the breakdown of fat (lipolysis)

Liver

Produces bile, a compound needed to digest fat and to absorb vitamins A, D, E, and K

Liver

Produces most of the substances that regulate blood clotting

Liver

Produces most proteins needed by the body

Macronutrients

Protein, Fat, Carbohydrate

Ulcerative colitis

Pseudopolyps seen on examination of the colon (IBD)

Empyema

Purulent (type of pleural effusion)

Osteomyelitis

Pyogenic - Staphylococcus aureus is most common cause •Hematogenous- Originates with infectious organisms that reach the bone through the bloodstream. Symptoms: •Bacteremia (chills, fever, malaise) •Bone lesion (pain, reduced motion)

Gastroparesis

Reduced vagal nerve conduction. Reduced smooth muscle activity. Compromised myoelectric activity

Joints

Reduction of range of motion (↑ stiffness)(effects of long-term immobilization on what structure)

Tuberculosis

Remains one of the deadliest diseases in the world (Latest stats by WHO: 13th leading cause of death) Transmission: Droplet inhalation (cough/sneeze/talking)

Liver

Removes potentially toxic byproducts of certain medications

Klinefelter syndrome

Result of meiotic non-disjunction; often diagnosed as adult

the common cold

Rhinoviruses, Respiratory syncytial virus and Parainfluenza viruses, Coronaviruses and adenoviruses

Osteonecrosis

Symptoms: •Depend on location & severity •Pain with activity (can progress to pain at rest) Treatment: •Short-term immobilization or limited weight-bearing •Exercises •NSAIDs •Advanced: total joint replacement

Considered

Scoliosis Tx: Curves 20-30º

Bracing

Scoliosis Tx: Curves 30-40º

Surgery

Scoliosis Tx: Curves 40+º

Paget's disease

Second most common metabolic bone disease after osteoporosis •Often asymptomatic (~70%) •~3% of US population •~10% of people 80+ yrs

Greenstick

Seen in children, partial break in bone continuity (fracture)

Pneumonia

Setting: Hospital/nosocomial or Community. Type of agent: typical or atypical. Distribution: lobar, patchy

Osteonecrosis

Sites with poor collateral circulation (e.g., femoral head) are most commonly affected

Rhabdomyolysis

Symptoms: •Excessive muscle pain, muscle weakness •Dark red or brown urine Tx: IV fluids, nutrients, mobilization

Osteoarthritis

Symptoms: •Joint pain, stiffness, instability •Limited movement •Deformity Joint disease is irreversible

Kidney failure

Symptoms: -swelling in the feet and ankles, -itching, -fatigue, -headache, -weight loss, -vomiting, -pale skin color

Syphilis

Stages of this STI symptoms: localized sore -> systemic illness -> infection but no symptoms; infection may remain silent for up to ~2 yrs -> severe medical problems

Osteoarthritis

Stems from loss of cartilage in synovial joints; leads to joint space narrowing on x-ray

Nausea

Stimulation of medullary vomiting center. Often precedes vomiting & accompanied by autonomic responses such as salivation & vasoconstriction, pallor, sweating, and tachycardia

GERD (gastroesophageal reflux disease)

Stomach contents enter esophagus; most common esophageal disease

26-30 weeks

Sufficient amounts of surfactant are available to prevent alveolar collapse (stage of lung development)

25-28 weeks

Sufficient terminal sacs are present to permit survival (stage of lung development)

Klinefelter syndrome

Symptoms of syndrome: Smaller testes, Diminished facial/chest hair, Gynecomastia: breast enlargement in males, Feminine adipose distribution pattern, Low muscle mass, muscle weakness, Tall stature, Low libido, Infertility, may have delayed speech/language development

DKA

Symptoms: Central (headache, sleepiness, confusion, loss of consciousness, coma) Muscular (seizures, weakness) Intestinal (diarrhea) Respiratory (SOB, coughing) Heart (arrhythmia, increased HR) Gastric (nausea, vomiting)

Paget's disease

Symptoms: •Bone pain, abnormal bone curvatures, brain compression, impaired motor function, deafness, atrophy of the optic nerve •Tumors and tumor like conditions

8th year of life

The adult complement of alveoli is present (a full-term infant has only 1/6 of the adult number of alveoli) (stage of lung development)

Hyperosmolar Hyperglycemic State (HHS) (Acute)

The condition is characterized by: ◦Hyperglycemia: glucose transport into cells is limited due to insulin resistance ◦Hyperosmolarity: as glucose is filtered and excreted, additional fluid is lost, concentrating plasma ◦Dehydration: increased fluid loss in urine (polyuria) ◦Without significant ketoacidosis

ulcers; amputation

The most serious consequences of neuropathy occur in the legs and feet and pose a risk for ___ and, in unusually severe cases, ____. (diabetes complication)

Pneumothorax

The presence of air in the pleural cavity

marasmus, disordered eating and/or eating disorders, cachexia, starvation, anorexia

Too little energy leads to (5)

Dehydration

Too little water leads to

Obesity

Too much energy leads to

Water intoxication or overhydration causes hyponatremia

Too much water leads to

Human Papilloma Virus (HPV)

Transmission is skin-skin contact; most people are asymptomatic; certain types cause cervical cancer, genital warts

Common cold

Transmission: Hands/fingers/contaminated surfaces are the greatest source of spread - more than coughing and sneezing

Influenza

Transmission: §Droplet inhalation (Cough, Sneeze)

Hepatitis B

Transmitted via bodily fluid; abdominal fluid, vomiting, yellowing of skin/eyes

Klinefelter syndrome

Treatment: testosterone replacement therapy, fertility Tx

Reduction (reset), Immobilization, Preserve/restore function

Tx for fractures (3)

Rest, ice, compression, and elevation (RICE). (•The affected area may be immobilized until pain/swelling is reduced •Early diagnosis, treatment, and rehabilitation are essential in preventing weakening of injured area due to immobilization)

Tx for strains/sprains (4)

Paget's disease

Tx: •Anti-inflammatory agents •Bone resorption inhibitors •Bisphosphonates •Calcium/Vitamin D

Jaw osteonecrosis

__ _______ risk increases w/ biphosphonate therapy (given for osteoporosis)

Callus, weight-bearing

__ formed by end of 2nd or 3rd week, not strong enough for ___ (bone healing)

30

__% of adults have metabolic syndrome

Osteopenia

___ is present in: •Osteoporosis •Osteomalacia •Malignancies such as multiple myeloma •Endocrine disorders such as hyperparathyroidism and hyperthyroidism

Osteoclastic

___ resorption of existing bone in bone remodeling

Paracrine

___ system balances resorption and formation in bone remodeling

70

___% of population is overweight or obese (BMI)

Osteoblasts

____ begin to deposit organic matrix (osteoid) on the wall of the osteon canal in bone remodeling

Metabolic syndrome

________ leads to increased risk of coronary heart disease, atherosclerosis, Type 2 diabetes, heart attack, kidney disease, stroke, nonalcoholic fatty liver disease

Dysphagia

difficulty swallowing; lack of coordination between contraction and relaxation; choking, coughing, or gagging, reflux; heartburn

Turner's Syndrome

dysfunctional ovarian development; 45,X genotype (missing/partially missing X chromosome); common cause of spontaneous abortion Mild, wide range of symptoms: short stature, broad chest w/ widely-spaced nipples, underdeveloped breasts, short/webbed neck, low hairline, low set ears, dysfunctional ovarian development (infertility), common congenital heart defects Tx: growth hormone to increase height (childhood), estrogen treatment to initiate puberty, fertility treatment

Celiac disease

gluten-sensitive enteropathy; immune disease with gluten intolerance

Polycystic ovarian syndrome (PCOS)

hormonal disruption of menstrual cycle; One of the most common endocrine disorders in females of reproductive age Diagnosis requires presence of 2 of the following: polycystic ovaries (excessive # o follicles in ovaries, cysts), infrequent menstrual cycles/amenorrhea, hyperandrogenism (elevated levels of androgens or clinical signs of high androgen level)

Celiac disease

infants: diarrhea, abdominal distention, & malnutrition. Older children: anemia, short stature, dental enamel defects, & constipation. Adults: diarrhea, abdominal pain, discomfort

Crohn's Disease, ulcerative colitis

inflammatory bowel diseases (2)