Clinical Manifestations of Disease Flashcards
Homeostasis
The purposeful maintenance of a stable internal environment maintained by coordinated physiological processes that oppose change
Pathophysiology Definition
Pathology: study of the structure and functional changes in cells, tissues, and organs caused by disease
Physiology: the branch of biology that deals with the normal functions of living organisms and their parts; study of pathology
Disease State
any deviation from or interruption of the normal structure or function of a part, organ, or system of the body manifested by aa characteristic set of symptoms or signs
Disease:
- does not allow body to function normally
- can affect individual organs or an entire body system
- acute or chronic
2018 ACC/AHA guidelines for blood pressure
normal: <120/<80
elevated: 120-129/<80
Stage 1 HTN: 130-139/80-89
Stage 2 HTN: 140 +/90 +
What is the #1 reason for office visits?
Hypertension; 55 yo normotensive person has up to 90% lifetime risk of developing HTN
leading contributor to death (MI, stroke..)
Pathogenesis
sequence of cellular events from time of initial contact until presentation of disease
clinical manifestations
signs and symptoms
Etiology of disease
cause of the disease, can be:
biologic, physical forces, chemical agents, genetics, nutrition
infectious disease transmitted by:
microorganism and is contagious; can be bacterial, viral, fungal, parasitic
non infectious disease can be:
genetic or hereditary
congenital like cerebral palsy (happened in utero or at birth)
environmental
not contagious, not caused by microorganism
pathogens
microorganisms which can cause disease; not all cause disease
yeast-promotes normal bacteria in the colon
microflora on skin is normal
how to pathogens make us sick?
bacteria produce toxins that cause cell death
viruses use our cells to reproduce and cause cell death
fungi grow and produce toxins
parasites live and grow in our body destroying tissue
diagnostic process includes:
history taking of symptoms and the physical exam of signs
cephalgia
headaches
brain tissue itself ___ pain receptors, but meninges are _____ sensitive
lacks, pain
primary classification of headaches
migraine, tension-type, cluster and chronic daily headache
secondary headaches
based on:
tumor, sinus, medication overuse or withdrawal, cerviogenic(whiplash), infection, trauma, bleed
based on etiology not symptoms!
Bilateral headaches include:
tension-type headache: non throbbing headache “band around head” can be caused by stress, squinting, sun, clenching jaw
sinus headaches which are secondary headaches
unilateral presenting headaches:
migraine: throbbing, with or without aura, nausea and visual changes
cluster: severe headache attacks and typical autonomic symptoms like flushed face, stiffness
chronic daily headache can be diagnosed with what frequency:
15 or more days a month for longer than three months
can encompass multiple headache syndromes
ask all patients with headache this question:
is this the worst headache of your life?
red flag- worried about subarachnoid hemmorge
other red flags with headaches:
fever, sudden onset, absence of similar headaches in past, worsening pattern, change in mental status or LOC
danger signs on exam of headache:
neck stiffness and meningismus(resistance to passive neck flexion)
paipillodema
focal neurological signs suggesting intracranial mass lesion, increase in intracranial pressure
subjective fever vs objective fever
feel hot and red vs pt took actual temp at home and it is high
temp ranges: normal and fever
body temp fluctuation
normal is 97-99.5 or 36-37.5
fever indicated at 100.4 or 38
temp normally is higher at night
how does a fever affect basal metabolic rate?
for every 1C above baseline, BMR increases 7% and oxygen consumption increases 13%
exogenous pyrogen
derived from outside the host
eg. gram - endotoxins and gram + exotoxins
endogenous pyrogen
aka pyrogenic cytokines
ex) IL-6, IL-1
these induce prostaglandin release causing an increase in the thermostatic set point
play a role in both infectious and non-infectious cause of fever
can see fever in multiple differential diagnoses :
infectious disease, skin inflammations, immunological diseases like lupus, Kawasaki disease, inflammatory bowel diseases, tissue destruction as in surgery, infection, rhabdomylosis, incompatible blood products, cancers, metabolic disorders, thrombosis-embolic processes, can also be of unknown origin
what to think with kids with fever but no obvious source?
urinary tract infection
cough can be classified by:
duration-acute, subacute, chronic (greater than 8 weeks)
character-productive, wet or dry
quality
timing
most common differential diagnosis of cough in infections?
common cold
can have unexplained cough in ?
gastroesophageal reflux
8% of pts using this drug develop cough?
ACE inhibitors (angiotensin converting enzyme inhibitors) used to treat HTN cough is common side effect with increasing doses
diagnostic approach to cough:
cbc, h pylori if h/o gerd, sed rate for inflammation, cxr, spirometry
edema is :
palpable swelling produced by expansion of interstitial fluid volume
pathophysiology of edema :
alteration in capillary hemodynamics that favors the movement of fluid from the vascular space into the interstitum
-retention of dietary or iv administered sodium and water by the kidneys
differentail diagnoses of edema:
heart failure, cirrhosis, nephrotic syndrome, renal failure, meds like calcium channel blockers, lymphedema, venous stasis disease
grading edema levels:
1+=2mm
2+=4mm
3+=6mm
4+=8mm
what should we be thinking about with acute onset unexplained unilateral leg edema??
Deep vein thrombosis
consider hx long drive or flight, tobacco use esp in females over age 35 and birth control use, recent surgery
check with ultrasounf
weight loss defined as:
loss of 5% body weight over 6-12 months
cachexia?
weakness and wasting of the body due to severe chronic illness; losing muscle mass
differential diagnoses of vague neurological complaints:
syncope, dizziness (is the room spinning or are you spinning), numbness or tingling
always ask pt to elaborate on what they mean
syncope clinical definiton?
clinical syndrome defined as transient loss of consciousness
true syncope:
results from abrupt drop of systemic bp
typically brief duration
spontaneously self limited
differential diagnoses of tru syncope:
reflex syncope-see blood/scared
orthostatic syncope
cardiac arrhythmias
structural cardiopulmonary disease
causes of transient loc that is not true syncope:
seizures -wake up confused?, sleep disturbances, accidental falls, psych conditons
dizziness
dizziness is a ____ , not a ______!
nonspecific term used by pts to describe symptoms
symptom, not a diagnosis
pts will interchange lightheadedness for dizziness
most common diagnosis with dizziness?
number 1 cause: peripheral vestibular dysfunction-40%
- pre syncope or disequilibrium-25%
- psych disorder
- central brainstem vestibular lesion
- unknown in 10% of pts
sensory loss is categorized as:
hypoesthesia, anesthesia, hypalgesia, analgesia
hypoesthesia:
diminished ability to perceive pain, temp, touch or vibration
anesthesia:
complete inability to perceive pain, temp, touch or vibration
hypalgesia:
decreased sensitivity to painful stimuli
analgesia:
complete insensitivity to painful stimuli
numbness/tingling differential diagnoses:
mononeuropathy-carpal tunnel distal sensory polyneuropathy(glove and stocking)-as in diabetes, etoh, vit definciencies, hiv spinal cord lesions brain stem lesions thalamic lesions sensory cortex lesions
goal of sensory exam is to:
localize the lesion
three main processes of inflammation:
arterioles dilate
capillaries become permeable
neutrophils and some macrophages migrate out of the capillaries and venules and move into interstitial spaces
5 cardinal signs of inflammation:
pain redness immobility swelling heat PRISH
what to think with unilateral swelling?
long drive, tobacco use and on BC..think DVT
consider cellulitis
what to think with bilateral inflammation?
rhabdomyolysis
immune disorders
