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Gen Med Test 3 > Chapter 14: systemic disorders > Flashcards

Chapter 14: systemic disorders Flashcards

1
Q

Malignancies

A
  • cancer

- occurs when a cell mutates and no longer performed the function for which it was intended

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2
Q

non-hodgkin’s lymphoma

A
  • group of malignancies of the lymphoreticular system

- usually occurs around age 50

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3
Q

NHL signs and symptoms

A
  • nausea
  • vomiting
  • diarrhea
  • night sweats
  • unexplained weight loss
  • fatigue
  • fever
  • enlarged lymph nodes
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4
Q

NHL treatment and prognosis

A
  • radiation
  • chemo
  • combo
  • stage 1 = 81.1%
  • stage 2 = 70.5%
  • stage 3 = 58.5%
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5
Q

Hodgkins lymphoma

A
  • malignant disorder of lymphoreticular origin, different histologically from NHl because of the presence of reed-stenberg cells (giant cells)
  • peaks from 25-30 years old
  • common in Caucasians
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6
Q

Staging of hodgkins lymphoa

A
  1. limited to 1 lymph node region/organ
  2. two lymph node regions or organ + lymph node
  3. lymph nodes both above and below the diaphragm
  4. cancer cells in many portions of one or more organs and tissues
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7
Q

Hodgkins lymphoma s&s

A
  • enlarged lymph nodes
  • intense itching
  • intermittent fevers
  • night sweats
  • fatigue
  • weight loss
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8
Q

hodgkins lymphoma treatment and prognosis

A
  • radiation
  • chemo
  • stem cell transplantation
  • stage 1 = 90%
  • stage 2 = 90%
  • stage 3 = 80%
  • stage 4 = 65%
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9
Q

Leukemia

A
  • uncontrolled proliferation of white blood cells in the marrow
  • most common in children
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10
Q

Leukemia s&s

A
  • fatigue
  • loss of appetite
  • fever
  • enlarged lymph nodes
  • frequent nose bleeds
  • weight loss
  • enlarged liver & spleen
  • ecchymosis
  • petechiae
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11
Q

leukemia treatment, prog, surv

A
  • radiation
  • chemo
  • blood and platelet transfusions
  • bone marrow transplant
  • stem cell transplant
  • chronic = 84% (5 year)
  • acute = 85% (5 year)
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12
Q

Raynaud’s disorder

A
  • vasospasm of the arteries
  • hands, feet, nose, and ears
  • cold temps and emotional trauma
  • 3-5% of population
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13
Q

raynauds s&s, treatment

A
  • pallor
  • cyanosis
  • erythema
  • symptoms usually resolve over several minutes
  • avoid caffeine, tobacco
  • meds: calcium channel blockers
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14
Q

Systemic Lupus Erythematosus

A
  • chronic inflammatory autoimmune disorder
  • appears as discoid lupus erythematous which affects only the skin
  • systemic lupus which affects the entire body
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15
Q

DD for systemic lupus

A
  • rheumatoid arthritis
  • vasculitis
  • scleroderma
  • chronic active hepatitis
  • acute drug reactions
  • polyarteritis
  • drug-induced lupus
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16
Q

American rheumatism association diagnostic criteria

A
  • abnormal titer
  • butterfly rash
  • discoid rash
  • oral or nasopharyngeal ulcerations
  • photosensitivity
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17
Q

Incidence of lupus

A
  • primarily a disease of young women
  • peak incidence between ages 15-40
  • women more affected than men
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18
Q

risk factors for lupus

A
  • family
  • physical or mental stress
  • strep/viral infections
  • exposure to UV light
  • immunizations
  • pregnancy
  • certain drugs: oral contraceptives
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19
Q

Lupus: musculoskeletal

A
  • arthralgia
  • arthritis
  • fever
  • weight loss
  • fatigue
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20
Q

Lupus: cutaneous and membranous lesions

A
  • butterfly rash (malar)
  • discoid lesions: red, raised, scaling
  • peripheral vasculitis
  • splinter hemorrhages
  • leg ulcers
  • raynauds
  • painful mouth ulcers
  • permanent hair loss from discoid lesions
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21
Q

Lupus: medical management

A
  • NSAIDS
  • antimalarial drugs
  • corticosteroids
  • immunosuppressive drugs
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22
Q

Lupus: mortality

A
  • reasonable good prognosis if respond well to Rx

- if not they suffer from other infections

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23
Q

Fibromyalgia

A
  • chronic widespread musculoskeletal pain syndrome with multiple tender points
  • fatigue, headaches, numbness common
  • women aged 20-50 years
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24
Q

Fibromyalgia clinical findings

A
  • chronic aching pain and stiffness
  • neck shoulders low back and hips
  • sleep disorders
  • subjective numbness
  • IBS
  • minor exertion aggravates pain and increases fatigue
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25
Q

DD for Fibromyalgia

A
  • not in people over 50
  • not if fever/weight loss
  • must rule out arthritis, SLE, CFS
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26
Q

Treatment for Fibromyalgia

A
  • patient education
  • support
  • stress managent
  • psychotherapy
  • analgesics, antidepressants
27
Q

Exercise for Fibromyalgia

A
  • conditioning and aerobic
  • aquatic therapy
  • short exercise sessions
  • reaching a goal of 30 minutes of continuous exercise may take weeks or months
  • susceptible to over use
28
Q

Rheumatoid arthritis

A
  • chronic inflammatory disorder of unknown cause that is typified by polyarticular, symmetrical joint involvement as well as characteristic extra-articular involvement
  • shows up in 1% of the population
  • 3rd to 4th decade, genetic
  • joint lesions
29
Q

RA etiology

A
  • not really known
  • could be infectious
  • earliest inflammatory changes involve inflammation and occlusion of small subsynovial blood vessels, suggesting agent is carried into the joint
30
Q

RA infections agent

A
  • virus like particles are often found in synovial biopsies

- polyarthritis occurs with several bacterial and viral illnesses

31
Q

RA Epstein-Barr virus

A
  • defect in their ability to regulate B cells infected with EBV
  • may aggravate the disease
32
Q

RA synovial cell interactions

A

macrophage - t cell interaction is central to the amplification of the immune response

  • b cells are factories for production of rheumatoid factor
  • t cells produce cytokines that stimulate production of fibroblast-like lining
  • macrophages stimulate endothelial cells to produce capillaries
33
Q

RA synovial fluid phase

A
  • neutrophil is the predominant cell in the synovial fluid

- releases free radicals and hydrolytic enzymes that destroy cartilage

34
Q

RA chronic proliferations

A
  • panes accumulates at the margin of the synovial membrane-cartilage border
35
Q

RA joint destructions

A
  • unpredictable

- swan neck deformity

36
Q

RA clinical features

A
  • symmetrical, bilateral joint involvement
  • MCP, PIP and wrist joints
  • DIP spared
  • Palmar flexor tendonitis
  • rotator cuff tendinitis
  • alanto-axial ligament involvement
37
Q

RA extra-articular involvement

A
  • 20 to 25% of patients
  • firm subcutaneous masses found in areas of repetitive trauma
  • may appear in the lungs
38
Q

RA diagnosis

A
  • prolonged morning stiffness. weight loss
  • MCP, PIP wrist pain and swelling
  • soft tissue swelling
  • RA nodules in extensor prominences
39
Q

American RA criteria for RA

A
  • morning stiffness for at least 1 hour and present for 6 months
  • swelling of three or more joints for at least 6 months
  • radiographic evidence
  • nodules
40
Q

DD for RA

A
  • non articular disorders (fibro)
  • osteoarthritis
  • hemochromatosis
41
Q

RA therapy

A
  • pt education
  • protect joints, strengthen weakened muscles
  • ADL things
42
Q

RA pharmacologic therapy

A
  • NSAIDs
  • corticosteroids
  • immune pathway blockers
43
Q

RA mortality

A
  • reasonably good if respond to Rx
44
Q

Chronic Fatigue Syndrome

A
  • usually accompanied by other musculoskeletal problems

- associated with Epstein-barr virus

45
Q

Diabetes Mellitus

A
  • diabetes = siphon - term used by ancient greeks to describe the large urinary volume excreted
  • Mellitus = sweet - distinguish this urine from the people with diabetes insidious
46
Q

Diabetes: pancreas

A
  • exocrine component

- enzymes flow into ducts eventually into main pancreatic duct which empties into duodenum

47
Q

Diabetes pancreas & endocrine

A
  • endocrine component
  • islets of langerhans = cells within exocrine tissue that secrete insulin, glucagon and somatostatin
  • hormones released directly into blood
48
Q

Diabetes explanation

A
  • hyperglycemia: chronic increase in blood glucose levels

- relative deficiency in insulin from reduced insulin secretion or reduced insulin action or both

49
Q

Type 1 diabetes

A
  • juvenile-onset diabetes or insulin-dependent diabetes

- characterized by a complete or almost complete lack of insulin production

50
Q

Type 2 diabetes

A
  • formerly known as adult-onset diabetes or non-insulin dependent
  • resistance to insulin in the presence of normal, or slightly increased level of plasma insulin
51
Q

Diabetes prevalance

A
  • USA = 8.3% of pop, adults = type 2

- world wide = 2.8% of population, 4.4% expected by 2030

52
Q

Diabetes complications

A
  • 6th leading cause of death/disability in USA
  • end-stage renal disease (ESRD)
  • amputation
  • heart disease
  • blindness
  • pregnancy complications
53
Q

Type 1 Diabetes Etiology

A
  • usually appears before age 20
  • usually caused by autoimmune destruction of pancreatic beta cells, leading to a failure to produce insulin
  • onset is rapid
  • no cure
  • dietary manipulation, exogenous insulin
  • polyuria
  • weight loss
  • polyphagia
54
Q

Type 2 diabetes etiology

A
  • mostly in adults
  • non caucasian and elderly populations are disproportionately affected
  • insulin resistance: tissue don’t respond to insulin
  • obesity
  • onset is slow
  • treatment is weight loss, exercise, diet and oral hypoglycemic drugs
55
Q

Type 2 Dm risk factors

A
  • age
  • men
  • GI
  • fam hx
  • sedentary lifestyle
  • obese
56
Q

Diabetes diagnosis

A
  • fasting = > 126 mg/dl
  • oral = >200 mg/dl
  • casual = > 200mg/dl
57
Q

Fasting blood glucose test (FBG)

A
  • gold standard

- hyperglycemia on at least 2 occasions typically means diabetes

58
Q

Oral glucose tolerance test

A
  • fast
  • blood glucose measured 5 times over 3 hours
  • glucola drink
59
Q

Diabetic ketoacidosis

A
  • increase plasma glucose = glucose and ketones are lost in urine
  • increased nutrient concentration in kidney tubules leads to osmotic diuresis = decreased plasma volume and decreased blood pressure
  • increase ketone production results in blood acidosis = coma and death
60
Q

Insulin therapy

A
  • goals are to achieve normoglycemia
  • delay or prevent late vascular complications
  • type 1 = insulin for life
  • type 2 = insulin use is reserved for those who actually need it
61
Q

Thyroid gland disorders

A
  • endocrine gland

- responsible for synthesis of thyroxine and triiodothyronine

62
Q

Hyperthyroidism

A
  • hyper metabolic state that is caused by the excess production of thyroid hormones from gland
  • grave’s disease
  • autoimmune caused by diffuse toxic goiter/enlargement of gland
63
Q

Hypothyroidism

A
  • thyroid hormone deficiency
  • more prevalent in women
  • usually hashimoto’s thyroiditis
  • most frequent cause of goiter

Gen Med Test 3 (5 decks)

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