Damjanov Chapter 2 Flashcards
Both _____ and ______ fatigue can be
mental; psychological; relieved by rest!!
Most common form of fatigue?
- Psychogenic
- Organic
- Undetermined
For muscular fatigue, list steps of why you have this problem?
- Muscles depleted of fuel in form of nutrients and energy-rich compounds like creatine phosphate or adenosine triphosphate
- Lactic acid accumulates and internal milieu acidifies, inhibiting actin-myosin interaction and muscle cell contraction
- Increased [phosphorus] concentration in cytosol affects Ca release from internal stores, preventing action on contractile fibers
Psychogenic fatigue is not
relieved by rest
Anxiety states, depression, and sleep disorders could
cause fatigue
Pharm causes of fatigue include
sleeping pills, tranquilizers, some antihypertensive drugs; also recreational drug abuse
Neuromuscular disorders like what can cause
Parkinson’s, MS, myasthenia gravis, muscular dystrophy;
fatigue with muscle weakness!!
Weight loss can result from
- insufficient intake of food
- malabsorption of nutrients
- loss of metabolites and nutrients (vomiting, diarrhea, diabetes)
- increased demand for nutrients and calories (infancy, childhood, pregnancy, chronic infetions, burns, malignant tumors, hyperthyroid)
In starvation, how does the body respond?
- Reduce energy expenditure (fat tissue lost first)
- Liver and intestines reduced in weight
- Weight of heart, skeletal muscles, kidneys reduced, and skin atrophic
- BRAIN INTACT and intellect NOT AFFECTED
- HR, RR slow, muscles weak, gonads make less sex hormones
Typical presentation of someone with cachexia?
- Weakness, weight loss in someone with cancer or something like TB or AIDS
- Muscle wasting (tired, weak, can’t work)
- BMR increased (proteins, carbs, fats metabolized)
- Increased BUN, creatinine
- Anemia, hypoalbuminemia
- Reduced glucose utilization, increased gluconeogenesis (hyperglycemia and insulin resistance)
- Increased free FA’s
Cachexia in cancer patients can be due to?
- Obstruction of GI tract (think stomach, esophagus carcinoma; also carcinoma of head of pancreas)
- Anorexia
- Early satiety (hyperglycemia, too much protein and aa’s)
- Increased energy expenditure
- Cytokines released in response to tumor growth (anorexia, hypermetabolism, muscle proteolysis, apoptosis)
- Therapy (chemo)
For body temp, skin receptors respond to what, and central receptors respond to what?
external temperatures; temperature of the blood
Resetting of thermostat in times of fever is due to
action of cytokines released from activated macrophages, and lesser extent, activated T lymphocytes; think interleukins (IL-1, IL-6), TNF, and IFN;
endogenous pyrogens act on endothelial cells of OVLT, which make prostaglandin PGE2 and diffuses to adjacent hypothalamus and raises set point for thermoreg;
leads to vasoconstriction of dermal vessels, cessation of sweating, and shivering of muscles
Afebrile infections can often occur in middle-aged adults with
CHF or chronic renal insufficiency
Fever related to noninfectious disease can be due to
- endogenous pyrogens from inflamm cells infiltrating various organs, after tissue necrosis after infarction, gout, drug reaction
- think endothelial cells or fixed macrophages like Kupffer cells, glial cells, dermal Langerhan cells
- Tumor cells
High temps can help cause
increased HR and RR, BMR; sweating and chills; headache, convulsions
Heat stroke can cause
high fever, but NO SWEATING (a failure of central thermoregulation)
Nociceptors can be classified as; they include
thermal, mechanical, chemical, or polymodal nociceptors;
fast, myelinated mechanical Adelta fibers and slow unmyelinated polymodal C fibers
Peripheral sensitization is
associated with hyperalgesia, an increased feeling of pain and a reduced threshold to pain
Endorphins can
bind to opioid receptors on sensory neurons, modifying the perception of pain
Nociceptive pain
originates in skin and subcutaneous tissue and corresponds to innervation of anatomic dermatomes and is called somatic pain (sharp, prickling, severe)
Parietal pain
originates from parietal peritoneum or pleura; can be localized or diffuse (appendicitis vs. peritonitis respectively)
Visceral pain
pain originating from nerve endings in internal organs
Neuropathic pain and examples?
- Back pain due to compression of spinal nerves from herniated disc
- Herpes simplex neuropathy involving facial nerve
- Pain due to SCI;
injury to peripheral sensory nerves or nerves in spinal cord and brain
Migraine with aura is associated with
premonitory aura or prodrome of neurologic symptoms; think bright spot in center of visual field that flickers and changes color; also pins and needles in fingers and tingling in area of nose, mouth, and lips (digitolingual paresthesia)
Migraine pain can be precipitated by
alcohol, MSG, estrogen, etc.; premenstrual period, exposure to bright light, changes in weather
Distribution of headache for tension:
bilateral, tightness, “headband distribution”;
tenderness over temporalis muscle
Distribution of cluster headaches
severe unilateral periorbital or temporal lancinating pain (occur more often on awakening)
For secondary headaches, how can you get this extracranially and intracranially?
E: muscle spasm, contraction of arteries, temporal arteritis, inflammation of mucosa of nasal sinuses;
I: dura at base of brain, arteries, venous sinuses and major veins, and CN V, VII, IX, X
Low back pain can come about from
psychogenic factors (depression, stress, anxiety), ligamentous sprain (deep structures of back), fibromuscular pain, sciatica (herniation of intervertebral disc
Chest pain can come about from
- dermal pain (herpes zoster)
- myalgia
- ostalgia (periosteum of ribs and vertebrae)
- Posterior root pain (compression of nerves due to deformities of thorax)
- Pleural pain (irritating parietal pleura)
- Esophageal pain (heartburn)
- Cardiac pain
- Pericardial pain
Abdo pain could come from
- visceral pain (vague, poorly localized)
- parietal (visceral can become parietal if parietal peritoneum is involved!!)
- Referred pain
- Metabolic or toxic pain (porphyria or diabetic acidosis)
- Neurogenic pain (think tabes dorsalis)
- psychogenic pain
UMN weakness can cause
hemiplegia, dysarthria/dysphonia, dysphagia, spasticity
Tics are a feature of
Tourette’s syndrome, an AD disease affecting usually males (think complex motor tics of face, like blinking, frowning, sniffing; and phonic tics, like throat-clearing, grunting, barking)
Flapping of hands in e.g. a postural tremor is known as
asterixis, a common sign of end-stage liver disease
Chorea could be combined with
athetosis, slow writhing movements involving entire extremity
Syncope is a
transient sudden loss of consciousness with loss of postural tone, then spontaneous recovery; caused by CEREBRAL ISCHEMIA
Cardiac syncope could be due to
aortic stenosis!! also hypertrophic cardiomyopathy, malfunctioning cardiac prostheses, thromboemboli; think FAINTING
Vasomotor syncope is
related to increased vagal tone and inadequate sympathetic regulation of peripheral circulation; think SWALLOWING, carotid sinus syncope, micturition syncope
Orthostatic hypotension are
idiopathic, maybe seen in diabetes mellitus patients, those with adrenergic blockers, also anaphylactic drug reaction
Coma only develops if
both hemispheres of brain are affected
Metabolic and toxic causes of coma are
see in end-stage renal or hepatic failure, metabolic diseases like diabetes, acid-base imbalance
Stages of coma:
- diffuse cerebral cortical depression (respiration fine, maybe hyperventilation; pupils midposition and normally reactive, extraocular reflexes are intact; extremities hypo/hypertonic)
- Diffuse deep-hemispheric depression: hyperventilation, alkalosis, or maybe Cheyne-Stokes respiration; pupils same as earlier; extremities are diffusely hypertonic, decorticate response
- Thalamic impairment: Cheyne-Stokes breathing, hyperventilation; pupils small, reactive to light; eyes in abducted position; decerebrate response to noxious stimuli
- Pontine impairment: breathing irregular with apnea; pupils UNREACTIVE and midposition or narrow; could have complete ophthalmoplegia; could see flaccid quadriplegia and no decerebrate or decortication
- Medullary impairment: breathing irregular depth and pattern (ataxic); pupils dilated and unreactive; ophthalmoplegia complete; flaccid quadriplegia
Macule: large macules are
patches
Large papules are
plaques
