2850 Pathophysiology Exam Three Flashcards
What is the leading cause of lung cancer?
Cigarette smoking
What are additional causes of lung cancer?
Genetics
Asbesto exposure
What naturally occurring radioactive material causes 12% of all lung cancers?
Radon
How do smoke and environmental toxins damage the respiratory tract?
They paralyze the cilia, leading to carcinogen accumulation
Describe the disease process progression that happens when a respiratory tract lesion occurs
The lesion changes from hyperplasia to dysplasia (precancerous) to an invasive neoplasia (cancerous mass)
Why do lung cancer cells multiply rapidly and extensively?
Oncogene activation
Deactivation of tumor suppressor genes
Lack of cellular apoptosis
What are the two major categories of lung cancer?
Non small cell lung cancer and small cell lung cancer
What are the most common sites of metastasis of small cell lung cancer?
Hilar and mediastinal lymph nodes
How are lung cancers staged?
Stage 0-4
Stage 0 lung cancer
Small localized tumor (“in situ” tumor)
Stage one lung cancer
Large tumor
Stages 2-3 lung cancer
Tumor spread to lymph nodes
Stage 4 lung cancer
Metastasis has occurred
What are major presenting complaints in lung cancer?
Cough Hemoptysis Wheeze Strider Chest pain Dyspnea
What is a common paraneoplastic syndrome involving a lung tumor?
Tumor secretion of ACTH, which resembles melanocyte stimulating hormone, causing melanin release which makes the patient look very tan
What are the three ways that lymphomas are staged?
By grade, stage, and letter
Grade of lymphoma
Rate of growth, where a high grade is worse
Describe a high grade lymphoma
Rapid growth, very aggressive, much less curable and requires immediate intensive treatment
What does stage of lymphoma refer to?
Regions involved
What does letter of lymphoma refer to?
Symptoms and spread
Describe a stage IV lymphoma
Spread outside of lymph nodes and spleen to the organs (bone marrow, CNS)
What is often the first sign of lymphoma?
Painless enlarged lymph nodes (often in neck, under arm, or in the groin)
What are some other signs and symptoms of lymphoma?
Enlarged spleen or liver Night sweats Fever Chills Weight loss Pain/swelling from enlarged lymph nodes pressing on other things
What is the etiology of non-Hodgkins lymphoma?
Genetic influence (chromosomal translocations)
What cells are involved in non-Hodgkins lymphoma?
Lymphocytes (usually B cells)
What determines a tumor’s aggressiveness?
Pattern of growth and cell size
What infections may predispose a person to NHL?
EBV
HIV
hep C
H. Pylori (gastric ulcers)
What are some common causes of Hodgkin’s lymphoma?
EBV/other viruses
Carcinogens
genetic/immune mechanisms
What cell mutation is unique to Hodgkin’s lymphoma?
Reed-Sternberg cells
Describe Reed-Sternberg cells common to HL
Large malignant B cells with 2 nuclei
What are some common signs and symptoms of Hodgkin’s lymphoma?
Sore throat
Fever
Painless enlargement of lymph tissues/modes
What is Waldeyer’s ring?
Circular arrangement of lymphoid tissue in pharynx that is unique to Hodgkin’s lymphoma
What are the leading causes of chronic renal failure?
diabetes
Hypertension
Glomerulonephritis
Polycystic kidney disease
What is the normal GFR?
90-120 mL/min
Why are patients with stage 1 and 2 kidney disease usually asymptomatic?
Because functioning nephrons compensate for the damaged ones (we can function normally on 50% of our nephrons)
What alterations in lab values will be seen in patients with stage 3 kidney disease?
Decreased GFR
Increased BUN and creatinine
Decreased creatinine clearance
What characterizes stage 4 kidney disease?
GFR at 20% of normal
Nephrons are overwhelmed
Protein should be restricted
What characterizes stage 5/end stage kidney disease?
GFR at 5% of normal
Widespread uremia
Loss of ability to maintain BP and acid/base balance
What causes the systemic symptoms seen in CKD?
Accumulation of nitrogenous wastes
What do patients with CKD develop thrombocytopenia and anemia?
Platelets and RBCs lyse in a high nitrogen environment
What are the dangers of hypercalcemia in CKD?
Cardiac dysrhythmias and extreme muscle weakness
What happens when the kidneys cannot activate vitamin D?
Calcium absorption from the GI tract decreases, leading to hypocalcemia, which can cause neuromuscular irritability, tetany, and seizures
Define renal osteodystrophy
Excessive PTH release due to hypocalcemia leads to bone demineralization and breakdown
Normal fasting blood glucose
70-100 mg/dL
Hypoglycemia blood glucose level
Less than 70 mg/dL
What blood glucose level indicates diabetes?
Fasting greater than or equal to 126 mg/dL on three separate screenings
What does insulin do after carbs are ingested in a meal?
Insulin makes cells permeable to glucose, causing rapid uptake, storage, and use
What does insulin do when the quantity of glucose entering the liver cells is more than can be stored as glycogen?
Insulin promotes the conversion of glucose into fatty acids, which are stored as adipose tissue
Hyperinsulinism
Body cells becoming insulin resistant, so pancreas tries to compensate by increasing insulin secretion
What happens if the pancreas secretes excessive insulin but the cells are not insulin resistant?
Severely low blood glucose can result
What are some additional roles of insulin in the body?
Inhibits use of fat for energy
Inhibits lipase action
Inhibits body protein breakdown
Promotes muscle building, fat storage, and glycogen formation
Enhances cellular permeability to amino acids
Where is glucagon secreted from?
Alpha cells of pancreatic islets
What does glucagon do?
Increases bloodstream glucose concentration by breaking down stored glycogen in the liver
Describe the regulation of glucagon secretion
Increased blood glucose inhibits glucagon
Decreased blood glucose causes it to be secreted
Type 1 diabetes
Deficient insulin due to autoimmune destruction of insulin secreting cells in pancreas
What do type one diabetics have autoantibodies to?
Islet cells, insulin, and enzymes involved in insulin production
What major processes cause type 2 diabetes?
Insulin resistance and pancreatic insulin deficiency
What happens when the pancreas becomes exhausted and cannot secrete sufficient insulin?
Blood glucose levels continuously climb
What is a major contributing factor to the development of T2DM?
Obesity
Why does obesity contribute to T2DM?
Fat cells are insulin resistant, so the body is overall more insulin resistant
What are risk factors for the development of T2DM?
Age Obesity Lack of physical activity HTN Pregnancy Hyperlipidemia
What are classic presenting symptoms of type 1 diabetes?
Polyuria
Polyphagia
Polydipsia
Why does polyuria happen in type 1 diabetes?
Excess glucose ends up in the urine, which draws more water in and results in more urine
Additional clinical manifestations of type 1 diabetes
Visual disturbances Fatigue Inability to concentrate Malaise/fatigue Weakness
What is often the presenting sign in type 1 diabetes?
Chronic UTI caused by candida infection
Classic symptoms of T2DM?
Polyuria
Polyphagia
Polydipsia
Why is DKA not typically a presenting feature of T2DM?
Because some insulin is present still
Goiter
Enlargement of the thyroid gland, with or without signs of thyroid dysfunction
What causes a goiter?
Excessive release of TSH from the pituitary gland
Why is sufficient iodine intake important?
Iodine is necessary for TH synthesis
What is the most common cause of hypothyroidism?
Primary hypothyroidism: no production of T3 and T4
Hypothyroidism risk factors
Age over 50 Female Caucasian Postpartum Radiation to neck Certain drugs
What is the most common risk factor for hypothyroidism?
Hashimoto’s thyroiditis, which is an autoimmune disorder
What are skin changes seen in hypothyroidism?
Hypercarotinemia (yellow orange skin due to carotene buildup)
What causes a puffy face in hypothyroidism?
Accumulation of sodium and water
What voice changes could be seen in hypothyroidism?
Hoarse voice
What metabolic changes occur in hypothyroidism?
Decreased LDL receptors, causing increased cholesterol and triglycerides
Decreased hematopoiesis, causing anemia
Decreased kidney function, causing risk for med toxicity
What are constitutional symptoms of hypothyroidism?
Cold intolerance Weight gain Lethargy Fatigue Muscle cramps Constipation Decreased fertility Hair loss Brittle nails
Myxedema
Severe adult hypothyroidism
What are some signs and symptoms of hypothyroidism in the elderly?
Disorientation, depression, and pseudo dementia
Hyperthyroidism
Excessive secretion of T3 and T4
What is the most common cause of hyperthyroidism?
Graves’ disease (autoimmune thyroid stimulation)
Subacute thyroiditis
Inflammation of the thyroid that causes excess hormone secretion
Plummer disease
Thyroid contains autonomously hyper functioning nodules
What is a toxic adenoma?
Single hyperfunctioning thyroid tumor
Jodbasedow syndrome
Iodine induced (excess) thyrotoxicosis
What effect does hyperthyroidism have on metabolic activity?
Accelerates it (energy expenditure and heat production increase)
What are typical presenting symptoms of hyperthyroidism?
Nervousness
Insomnia
Heat sensitivity
Weight loss
Graves ophthalmopathy
Deposits of lymphocytes and sugars that push eyes forward and cause periorbital edema and eye bulging
Thyrotoxic crisis
Also known as a thyroid storm, it is an intense, overwhelming release of thyroid hormones that excessively stimulate the metabolism
What can precipitate a thyrotoxic crisis?
Surgery, trauma, or infection
Symptoms of thyrotoxic crisis?
High fever Tachycardia N/V Tremulousness Agitation Psychosis
Most common causes of cirrhosis of the liver
Hepatitis C
Alcoholic liver disease
Non-alcoholic fatty liver disease
What effect does cirrhosis have on stellate cells?
It causes the cells to produce abundant amounts of collagenous tissue, disrupting hepatocyte function
What are the consequences of increased resistance within the portal vein?
Backup of pressure into vessels and organs that drain into portal system
Caput medusa
Dilated, visible superficial veins around the umbilicus due to portal hypertension
What are some results of increased venous pressure in the GI system due to portal hypertension?
Splenomegaly
Esophageal varices
Rectal varices
Ascites
What are other consequences of cirrhosis of the liver?
Decreased detox ability Decreased bile and albumin synthesis Hyperbilirubinemia Bleeding Encephalopathy Osteoporosis Anemia
Symptoms of severe liver dysfunction
Jaundice
Steatorrhea
Dark urine
Symptoms of portal hypertension
Ascites and hematemesis (due to esophageal varices)
Dermatological manifestations of cirrhosis
Jaundice
Spider angiomas
Palmar erythema
Finger clubbing
Why does pruritus often develop in patients with cirrhosis?
Accumulation of bile salts in the bloodstream
What are the two types of strokes?
Ischemic and hemorrhagic
Which kind of stroke makes up the majority?
Ischemic (80% of strokes)
Ischemic stroke: pathophysiology
Obstruction in cerebral blood flow is is caused by a thrombus or embolus
Which arteries are most commonly affected with ischemic strokes?
Internal carotid or middle cerebral arteries
What are the three top reasons why thrombi form and cause ischemic strokes?
Atrial fibrillation
Carotid stenosis
Cerebral arteriosclerosis
How does a-fib lead to clot formation?
Stasis of blood in the left atrium of the heart allows for clot formation, which can then travel to the brain
What percentage of strokes are hemorrhagic?
15%
What is a hemorrhagic stroke?
Cerebral artery ruptures and can no longer bring blood to the brain
What are the three major predisposing factors to hemorrhagic strokes?
Hypertension
Oral anticoagulation
Cerebral aneurysm
What are some non-modifiable stroke risk factors?
Age (over 65) Gender (men) Family history Ethnicity (AA, NA, Hispanic) Sickle cell disease Previous stroke or TIA
What are some modifiable stroke risk factors?
Arteriosclerosis Hyperlipidemia Diabetes Alcohol abuse/smoking Obesity/inactivity Oral contraceptive use
What is a TIA?
Transient ischemic attack
Has many similar signs and symptoms to a stroke, but less severe
TIA can signal what?
An impending stroke in 20-25% of cases
FAST acronym
Signs and symptoms of stroke
Face drooping
Arm weakness
Speech difficulty
Time to call 911
What are primary signs and symptoms of stroke?
Neurological deficits on one side of the body Slurred speech Gag reflex loss Facial droop Disorientation/confusion Aphasia Vision or sensation loss
Expressive aphasia
Patient can understand but not speak
Receptive aphasia
Patient can speak but not understand language
With stroke assessment, what should the nurse ask?
When the symptoms first began
Parkinson’s: etiology
Unknown in 85-90% of cases
Familial in about 10% of cases
Parkinson’s: pathophysiology
Progressive loss of dopamine producing cells in the substantia nigra
What does the loss of dopamine producing cells in Parkinson’s cause?
Imbalance between dopamine and acetylcholine. Too much unopposed ACh causes tremors and spastic movements
At what point of substantia nigra deterioration does Parkinson’s become evident?
50-80% deteriorated
Risk factors for Parkinson’s?
Genetics/gene mutations Advanced age Chemical exposure/pesticides Chronic antipsychotic use Being male Viral infection Street drugs with meperidine analog Repeated head trauma or disease
What is the triad of classic Parkinson’s symptoms?
Bradykinesia
Resting tremor
Muscle rigidity
What is bradykinesia?
Slowed movements, often seen first in distal muscles of arms and legs with Parkinson’s
What is often the first sign of Parkinson’s?
Resting tremor
What is “pill rolling”?
Appearance of resting tremor in the hands (looks like rolling a pill in the fingers). Disappears with purposeful movement
What are “cogwheel” movements?
Movements caused by rigid muscles
What are other signs and symptoms of Parkinson’s?
Akinesia Postural imbalance Facial masking Swallowing issues Decreased fine motor skills Constipation Hypotension Urinary/bladder/sexual dysfunction Depression Fatigue Shuffling/propulsive gait Sleep issues
What are some diagnostic tests for Parkinson’s?
Clinical assessment for manifestations
PET scan
Initiating dopamine treatment and watching for improvement
What is epilepsy?
A predisposition to seizures with no known cause
What is a seizure
Abnormal, disorderly discharge of neurons that interferes with cognition, consciousness, movement, etc
What is required for diagnosis of epilepsy?
2 or more unprovoked seizures within 24 hours
What kind of seizures are NOT epilepsy?
Febrile seizures
Seizures caused by substance withdrawal
What sort of issue is present in the CNS to allow a seizure to occur?
A sodium potassium pump problem, which creates a decreased threshold for neuron excitability
What is a focal seizure?
A very localized/pinpoint seizure
What are the two types of focal seizures?
Simple (only one hemisphere involved, no loss of consciousness)
Complex (altered LOC, both hemispheres involved)
How will focal seizures often manifest?
Motor, sensory, autonomic, or psychic symptoms without condition impairment
May have sense of deja vu, heart racing, flushing, amnesia before or after, automatisms
Generalized seizures
Can be many different types, but they arise in one hemisphere and then spread to both hemispheres
Absence seizures
5-30 seconds of lapse of consciousness/staring into space
Tonic-clonic seizures
Also called grand mal seizures
Includes loss of consciousness, rhythmic jerking and periods of muscle stiffness, can last for up to 5 minutes
Characterized by ictal cry before tonic-clinic phase
What is status epilecticus?
Tonic clonic seizures that don’t stop for 30 minutes or more
Clonic seizure
Loss of consciousness and rhythmic jerking
Tonic seizure
20-30 seconds or more of stiffened muscles
Atonic seizure
Muscle tone loss, patient will often fall
Myoclonic seizure
Brief jerking or stiffening of extremities, can be symmetrical or asymmetrical
What are some risks factors for epilepsy?
Being a young child Head trauma Stroke Autism or Down syndrome Dementia Prenatal injury Genetics/family history Cerebral palsy
What may precede a seizure?
An aura
What can the patient experience after a seizure?
Drowsiness Confusion Hypertension Headache Amnesia
What are some risk factors for seizures (not necessarily epilepsy?
Brain tumors Cerebrovascular disease Trauma Infection Substance abuse or withdrawal
What is cerebral palsy?
Group of permanent disorders of development of posture and movement. Attributed to disturbances in developing fetal or infant brain
What is cerebral palsy usually caused by?
Hypoxia issues in the brain (either in utero or early in childhood)
What is the most common type of cerebral palsy?
Spastic (70-80% of cases)
How does spastic cerebral palsy manifest?
Can affect one half of body, or top or bottom of body. Muscles are constantly tensed
What are the two forms of non-spastic/extrapyramidal CP?
Dyskinetic and ataxic
What is mixed CP?
Both spastic and non-spastic CP
What are typical manifestations of CP?
Delayed developmental milestones (rolling, sitting, crawling) Delayed gross motor development Abnormal motor performance Abnormal postures Reflex abnormalities Seizures Cognitive impairment
What kind of reflex abnormalities are seen with CP?
Persistent early infancy reflexes (rooting, Moro)
Obligatory tonic neck reflex
What are some risk factors for CP?
Preterm birth of extremely low birth weight and very low birth weight infants Bacterial meningitis Múltiples in one birth Male children AA children
What are some diagnostic tests for CP?
Neuro exam Caregiver history Neuroimaging Assessment tools in first two years of life Metabolic and genetic testing
Cause of glaucoma
Increased intraocular pressure
What are some risk factors for glaucoma development?
Age over 40 African American ethnicity Genetics Diabetes Hypertension Certain medications Use of contact lenses Past eye problems
What kind of drugs can increase glaucoma risk?
Anticholinergics Sympathomimetics Antidepressants Cocaine Sulfonamides
Which kind of glaucoma has a slow progressive onset?
Primary open angle glaucoma
Pathophysiology of primary open angle glaucoma
Structural changes to the ciliary muscle cause it to not relax, leading to obstruction of the canal of Schlemm. This causes high IOP, leading to optic nerve damage and vision loss
Does sympathetic or parasympathetic stimulation cause contraction of the ciliary muscle?
Sympathetic
What kind of glaucoma is sudden onset?
Acute angle closure glaucoma
Acute angle closure glaucoma accounts for what percent of glaucoma cases?
Around 10%
What is acute angle closure glaucoma?
Sudden onset of ciliary muscle relaxation and canal obstruction, leading to loss of peripheral or central vision
What determines the outcome/treatment success of acute angle closure glaucoma?
Duration of problems
What are manifestations of either form of glaucoma?
Eye redness Blood vessel redness in sclera Vision loss Thickened, less transparent eyes Blurry vision
What are cataracts?
Excessive growth of epithelial layers of the eye lens. It’s one of the most common causes of blindness in the US
What are the two types of cataracts?
Congenital cataracts
Senile cataracts
What are risk factors/causes of congenital cataracts?
Prenatal infections/complications
Genetic abnormalities
What are some risk factors/causes for senile cataracts?
Age over 40 Smoking Obesity Diabetes Kidney disorders Musculoskeletal disorders Trauma Long term steroid use UV light exposure
Pathophysiology of cataracts
Excess epithelial layers develop on the lens and the eye also loses some ability to degenerate old cells.
Water solubility of lens also decreases, making it less flexible
Free radical damage cause accumulation of protein fiber damage, causing eye cloudiness
Cataracts: manifestations
Gradual loss of vision Blurry vision Cloudy eyes Halos around bright objects Sensitivity to glare Nearsightedness (myopia)
What are autism spectrum disorders?
Complex neuro developmental disorders that can manifest in many different ways
What are some risk factors for the development of autism?
Maternal/paternal age over 40 Fetal distress Boys (4x more than girls) Family history Fragile X syndrome Very preterm babies
Pathophysiology of autism
Unkown
What are some social manifestations of autism?
Less social interest
Lack of eye contact
Inability to recognize non-verbal cues
What are some communication manifestations of autism?
Absent or delayed speech
Failure to respond to name
What are some behavioral/cognitive manifestations of autism?
Resisting physical touch Persistence of primitive reflexes Fixation on details Extreme sensitivity to stimuli Unusual repetitive behavior Cognitive impairment Activities that cause self-harm Very specific food preferences
What are some physical manifestations/problems associated with autism?
Epileptic seizures
Severe constipation
What is dementia?
Decline of reasoning, memory, judgement, and other cognitive functions
What are the two types of dementia?
Alzheimer’s and multi-infarct (vascular) dementia
What are some risk factors for Alzheimer’s?
Advanced age Being female Family history Smoking Hypertension CAD High cholesterol Inactivity
What neuronal changes are seen in Alzheimer’s?
Accumulation of neurofibrillary tangles (due to tau protein changes)
Accumulation of amyloid plaques
What is caused by neurofibrillary tangles and amyloid plaques in Alzheimer’s?
Neuron transport system collapses, resulting in poor neuron communication and gradual neuron destruction
Why is a deficiency of ACh significant in Alzheimer’s?
It plays a role in memory and behavior
What are some preventative behaviors/actions against Alzheimer’s?
Mentally and socially stimulating activity
High levels of formal education
Stimulating job
Mentally challenging leisure activities
Risk factors for vascular dementia
Vascular disease Smoking Hypertension CAD High cholesterol Diabetes Inactivity
Which type of dementia is irreversible?
Vascular/multi-infarct
What are the four types of vascular dementia?
Multi-infarct (several small strokes)
Single infarct (one large stroke)
Hemorrhagic lesions
Mixed dementia (vascular + Alzheimer’s)
What are hemorrhagic lesions often caused by?
Diffuse cerebrovascular disease or focal lesions
What are some manifestations of dementia?
Amnesia Language/reasoning/personality changes Disorientation Short-term memory loss Mood swings Anxiety Apathy
Anomia
Forgetting names
Apraxia
Difficulty performing familiar tasks
Agnóstica
Forgetting the purpose of objects
Why do dementia patients often develop anxiety?
Because they know something isn’t right and that they’re forgetting things
What is sundowning?
A common manifestation of dementia in which patients become confused, disoriented, moody, and even combative late in the day and into the night. Can be a serious safety concern
