Exam 1: Chapters 1-6 Flashcards
The study of functional changes in the body caused by injury, disorder, or disease is called what?
Pathophysiology
A disease is a _______ _________ of cells, tissues, organs, or organ systems
Functional impairment
Pathogenesis encompasses the point at which disease process begins to when?
The point when the disease presents itself
a disease-causing microorganism is what?
A pathogen
When a disease has an unknown cause, it is called what?
Idiopathic
When a disease is caused inadvertently by medical treatment, this is known as what?
Iatrogenic
These types of diseases are caused by an infection received in a healthcare environment
Nosocomial
What is the difference between incidence and prevalence?
- Incidence is the rate** **of new cases of a disease occurring in a specific population over a particular period of time.
- Prevalence the number of cases of a disease in a specific population at a particular timepoint or over a specified period of time.
A dramatic increase in disease incidence in a POPULATION is called what?
Epidemic
When epidemic spreads across continents, it is known as what?
Pandemic
A disease outbreak that is consistently present, but limited to within a certain area is known as what?
Endemic
How are Nosocomial disease prevented?
appropriate hand hygiene and infection control measures
The presenting signs and symptoms of the disease are known as what?
Clinical manifestations
Subjective data reported by the ill individual are known as what?
Symptoms
“At your health screening, you describe the following: achiness, lethargy, and vague abdominal discomfort. These are categorized as what?”
systemic manifestations
Identify the difference between a signs and symptoms.
- Signs are the observable or measurable expression: manifestations that can be seen or measured by the healthcare professional: 99 degree fever, blisters, rash, etc.
- Symptoms are self-reported by the patient, subjective manifestations: fatigue, tingling, discomfort, etc.
___ Encompasses when the disease process first starts to the point when the disease presents itself
Pathogenesis
What is the difference between morbidity and mortality?
- morbidity is the negative outcome with disease complications that can impact the quality of life
- motility = death
The decrease in size of a cell is considered what?
Atrophy
When a cell increases in size, this is known as what?
Hypertrophy
When the number of cells increase, this can be labeled as what?
Hyperplasia
When a cell changes from one type to another, this is considered what?
Metaplasia
When a cell changes in size, shape, arranged, uniformity, and structure, it is labeled as what?
Dysplasia
What Am I:
Reduction is size of the cells in the cerebrum of the brain, resulting in reduction in brain tissue itself.
Cerebral Atrophy
In brief terms, why does cerebral atrophy occur?
(Pathophysiology)
Loss of neuron function / neural death leads to atrophy
- As atrophy occurs, distance between neurons increases, making communication between other neurons more difficult
- Decreased stimulation leads to further atrophy
What are some causes of cerebral atrophy?
- Decreased stimulation resulting from reduction in physical and intellectual activities
- Low levels of Vitamin B
- Mechanical injury – TBI
- Loss of neurons and neurotransmitter production in one region, resulting in atrophy elsewhere (communication issues)
- Reduced oxygen and nutrient delivery
What are some clinical manifestations of cerebral atrophy?
- Can be localized to certain region in the brain
- Can be global and affect entire brain
- Clinical manifestations depend on what part of the brain is impacted
- Ex: Cognitive impairment from frontal and temporal lobes. Atrophy in basal ganglia results in movement impairment
Atrophy in what region is associated with Alzheimers?
Hippocampus and cerebral cortex (frontal and temporal lobes)
- Condition affecting memory and comprehension → REMEMBER: cognitive impairment associated w/ frontal and temporal atrophy
Movement disorders are associated with atrophy where? Why is this important?
- Basal ganglia
- Region responsible for production of dopamine (required for motor function)
The clinical manifestations associated with cerebral atrophy depends on what?
- The degree of atrophy
- The location of atrophy
Which condition am I?
- Occurs because of neuronal insult during a critical time in brain development
- Manifestations vary but many involve motor skills, coordination, balance, and seizure activity
Cerebral palsy
Cellular atrophy results in:
a. Increase in tissue volume due to increase in cell number
b. Increase in tissue volume due to increase in cell size
c. Decrease in tissue volume due to decrease in cell size
d. No change in tissue volume
Cellular atrophy results in:
C. Decrease in tissue volume due to decrease in cell size
Why is early diagnosis critical with cerebral atrophy?
Because there is limited ability to restore function that has been lost by the time the diagnosis is made
Once neuron death has occurred, it cannot be reversed. WANT TO PREVENT FURTHER DEATH INSTEAD.
What is the goal with cerebral atrophy diagnosis?
To determine the underlying cause of atrophy to initiate appropriate treatment early.
Why can atrophy be difficult to identify early?
The signs are slow and subtle
- May be observed by others rather than the affected individual first
What are some ways to determine atrophy?
(Diagnostic testing)
- Physical assessment for neurologic deficits
- Brain imaging MRI, PET, SPECT, CT to determine location and severity of atrophy
Treatment for cerebral atrophy is targeted towards what?
Prevention or slowly of continued atrophy
What are some treatment options for cerebral atrophy?
- There is no cure: neurons cannot replicate
- Treatment is individualized based on specific diagnosis and type of atrophy → goal is to maximize function and minimizing atrophy
- PT, OT, SPEECH CRITICAL FOR PROMOTION OF OPTIMAL FUNCTION
- PHARM OPTIONS MAY HAVE W/ NEUROLOGICAL SIGNAL TRANSMISSIONS
I am a condition cellular hyperplasia. What am I?
Acromegaly
What is the cause of Acromegaly
- Secretion of excessive growth hormone
- Increase in insulin-like growth factor 1 (IGF-1)
What condition results in exaggerated skeletal and organ growth after epiphyseal plate closure
Acromegaly
What are some clinical manifestations of Acromegaly
- Soft tissue swelling: difficult getting rings on/off
- Altered facial features: prominent jaw, brow, nasal bone
- Pain, numbness in hands
- Voice deepening
- Skin changes: course hair growth, body odor, skin tags, oily appearance, sweating
- Breast discharge, impotence, menstrual cycle changes
Why is Acromegaly difficult to diagnose?
- Due to slow and insidious onset of clinical manifestations
How is Acromegaly diagnosed?
- Confirmed w/ elevated IGF-1
- Measurement of growth hormone
- Imaging to determine if pituitary adenoma is present
- Glucose tolerance test
What are some treatments for Acromegaly?
Drug Therapy
Radiation therapy
Surgical removal adenoma
What is treatment designed to do for Acromegaly?
Reduce overproduction of IGF-1 and growth hormone
What are the drug classes used in Acromegaly treatment?
- Somatostatin analogs
- Dopamine agonists
- Growth factor antagonist
Acromegaly drug therapy: Somatostatin analogs
- First choice
- inhibits growth hormone secretion and reduction in the pituitary adenoma size
Acromegaly drug therapy: Dopamine agonists
- second choice: less effective
- reduce the hormone growth hormone and subsequent IGF-1 secretion
Acromegaly drug therapy: Growth hormone antagonist
binds to the growth hormone receptor
What are some non pharmacological treatment options for Acromegaly?
- radiation therapy to promote death in growth hormone hypersecreting cells
- Surgical: removal of tumor (adenoma) causing hypersecretion of growth hormone
What size does the adenoma have to be for surgery to be an option in Acromegaly?
less than 40 ng/mL
Cardiac Hypertrophy can be described as…
Heart muscle becomes thickened due to excessive workload and functional demand
What is the cause of Cardiac Hypertrophy?
- Primary hypertrophic cardiomyopathy: know specific cause, often result of inherited genetic autosomal-dominant trait
- Secondary hypertrophy: often caused by underlying condition that causes an increase in ventricle workload
Cardiac Hypertrophy that occurs in the right ventricle is due to
increased pressure in the pulmonary circulation
Cardiac Hypertrophy that occurs in the left ventricle is due to
increased pressure in the systemic circulation (i.e, HTN)
How does Cardiac Hypertrophy affect pumping and filling of the heart?
- Not able to pump as well due to rigidity of the ventricles, leading to “pump failure”
- Muscle becomes less effective @ contracting despite increased size, impacting pumping ability
- Increased muscle doesn’t allow as much blood in
How does left sided Cardiac Hypertrophy impact the rest of the body?
Left ventricle responsible for pumping blood from lungs → providing oxygen rich blood to body
What are some clinical manifestations of Cardiac Hypertrophy
- Variable in its expression: some develop signs, others do not
- Symptoms of pump failure: SOB, chest pain, syncope
- Irregular heart rate and rhythm,
How is Cardiac Hypertrophy diagnosed?
- Genetic testing (primary hypertrophic)
- Routine screenings to determine HTN, exercise tolerance, presence of ventricular arrhythmia
- EKG: evaluate electrical activity of the heart
- Ultrasound: measures ventricles, heart valves, blood vessels
- Exercise stress testing
What is normally heard during cardiac contraction w/ Cardiac Hypertrophy?
Heart murmur
What are some treatments for Cardiac Hypertrophy?
- Strategies: target symptom relieve and prevent sudden death
- Antihypertensives (ARBs drug of choice followed by ACE)
- Surgery to reduce left ventricular mass or repair heart valve
- Activity restrictions may be required
What are the medications used with Cardiac Hypertrophy
- ARBs - “tan”
- ACE - Benazepril, Lisinopril
When does cervical metaplasia occur?
When there is an external issue with the cervix that causes damage to the squamous epithelial cells
- Infection
- Irritation
- Trauma
When does cervical dysplasia occur?
- When there is abnormal cell growth that happens during breakdown of existing cell tissues
- Internal issue
What are the clinical manifestations of cervical metaplasia and dysplasia?
There are no signs
What increases your risk for cervical metaplasia and dysplasia
- Early onset sexual activity
- Multiple (more than 3) sexual partners
- Exposure to HPV
- Smoking
What are some lab and diagnostic tests associated w/ cervical metaplasia and dysplasia
- Routine screening (PAP) smears help identify characteristics of cells
- Colposcopy: visually see cervix with use of speculum
How often should you get PAP smear?
Initial screening begins at 21, every 3 years after that until 30, then 5 years until 65
What are some treatment options for cervical metaplasia and dysplasia?
- Cryosurgery: cold therapy destroys the mildly dysplastic cells
- Liquid nitrogen: used for the dysplastic cells on the exocervix
- CO2 laser ablation: directing a laser toward the cervical lesion vaporizing tissue
- Ablation
Dyspnea is a frequent complaint that may indicate either an underlying ______ or _____ condition
Cardiovascular or Pulmonary
Cool, pale, and painful extremities may indicate the presence of a ____ or _____
clot or peripheral vascular disease
Blood pressure and heart rate will do what with smoking?
Increase
What are some laboratory studies that may indicate markers of CVD?
- Decreased HLD
- Increase LDL
What is our body’s first line of defense?
- Skin
- Eyes: lashes
- Tears
What is our body’s second line of defense?
- Inflammatory mechanisms activated
- Vasodilation & capillary permeability
- Phagocytes move in to engulf and destroy
What is our body’s third line of defense?
- Immune response
- Immune cells recognize and destroy harmful substance
What are the 3 main goals of inflammation?
- Increase blood flow to site (vascular response)
- Increase healing cells at site (cellular response)
- Remove injured tissue and prepare for tissue repair and healing
What are the 5 cardinal signs of inflammation?
heat, incapacitation (loss of function), pain, edema, redness
What are some Systemic manifestations of inflammation?
fever
increased circulating leukocytes (leukocytosis= elevated WBC) and plasma proteins (C-Reactive Proteins)
What is the treatment of inflammation?
Reduce blood flow (elevate, ice)
Decrease swelling (compression, rest)
Block the action of chemical mediators
Decrease pain
What are the 3 stages of wound healing?
- Inflammatory
- Proliferative
- Maturation
Stages of Wound Healing: Inflammatory
- Immediate, 2-5 days
- Bleeding stops, clots begins
- Formation of a scab
Stages of Wound Healing: Proliferative
- 5 to 3 weeks
- New granulation tissue forms
- Wound edges pull together
Stages of Wound Healing: Maturation
- 3 weeks to 2 years
- Collagen forms, strengthens wound
- Only 80% as strong as original tissue
What condition am I?
“Inflammation of the lining of the paranasal sinuses lasting 4-12 weeks”
Acute sinusitis
- Acute lasts 4-8weeks
- Subacute lasts 8-12 weeks
When does recurrent acute sinusitis occur?
When the patient has had up to four episodes per year, with sinus inflammation completely resolving between episodes
What can cause acute sinusitis?
- When ostia and outfow of mucus are blocked
- Impaired clearance of the mucus by protective cilia or altered mucus quality or quantity
What is the role of the ostia in the sinus?
Provide outflow of drainage and prevent backflow and contamination of sinuses
What is the primary etiology of acute sinusitis?
Viral infections transmitted via respiratory droplets:
- rhinovirus
- adenovirus
- coronavirus
- Influenza A and B
What are some clinical manifestations of acute sinusitis?
- Facial pain over sinus regions of face increasing w/ straining or bending down
- Fever
- Nasal congestion and/or excessive nasal discharge
- Persistant cough
- Fatigue
What are some diagnostic criteria for acute sinusitis?
- Physical examination: have clinical manifestation
- General inflammatory labs: WBC, CRP, ESR
- Sinus radiographs when dx is in question (will reveal opaque, mucus filled thickened sinus)
An acute sinusitis follows a what many times?
Upper respiratory infection
What are some treatments for acute sinusitis?
It can resolve on its own
Pharmacologic
- Antibiotics for 10 to 14 days
- Antihistamines
- Decongestants
- Nasal sprays → oxymetazoline hydrochloride-
Surgical
- If antibiotic treatment is unsuccessful and continues to have thick purulent drainage
Acute sinusitis treatment: oxymetazoline hydrochloride
- Nasal spray
- Helps w/ vasoconstriction
- Only use for 5 days, can cause rebound congestion
What condition am I
“Persistent low-grade inflammation the paranasal sinuses lasting over 12 weeks with or without flares .”
Chronic sinusitis
What is the pathophys of Chronic sinusitis
Multifactorial
- Environmental: persistent infection/allergens
- Genetics: Metabolic abnormalities or immune deficiencies
How do the multifactorial triggers result in chronic sinusitis?
(environmental - infections, allergens, genetics; immune, metabolic issues)
- Disrupt mucociliary clearance and result in mucus stagnation → creates environment conducive to bacterial growth and chronic inflammation
What are some clinical manifestations of chronic sinusitis?
- Nasal congestion
- Nasal discharge
- Sore throat
- Foul breath, unpleasant taste
- Low-grade fever
- Chronic cough
- Hyposmia: reduced ability to smell
- Facial fullness, discomfort, headache
What is the diagnostic criteria
Persistence of obstructed and mucus-filled sinuses over 12 weeks or longer
Two of the following must be present
- Anterior or posterior mucopurulent drainage
- Nasal obstruction
- Facial pain, pressure fullness
- Hyposmia
Confirmed by the presence of mucosal thickening, changes to the surrounding bone, and changes in the air fluid levels by a CT scan
What are some treatment options for chronic sinusitis
GOAL: reduce mucosal swelling, promote sinus drainage, clear infections
Pharmacologic
- Glucocorticoids- oral or topical through a nasal spray
- Antibiotics
Nonpharamcologic
- Nasal saline irrigation
- If ineffective, consider surgical internvention*
All burns cause an acute _____ response
Inflammatory
Burns: Superficial partial-thicknes
- known as first degree
- Damage to epidermis
- Mild sunburn
- Does not result in necrosis or scaring
- Healing occurs in about a week
Burns: Deep partial-thickness
- Known as second degree
- Damage epidermis and penetrate the dermis layer
- Scalding with hot liquids, chemical burn
- Blisters present
- Healing occurs in 2 to 4 weeks