Exam 2 Flashcards
Hormones secreted by the anterior pituitary
ACTH, thyroid stimulating hormone (TSH), LH, FSH, prolactin, growth hormone, and melanocyte stimulating hormone (MSH)
Hormones secreted by the posterior pituitary
Vasopressin (ADH), oxytocin
Disorder of too much ADH
SIADH
- Hyponatremic
- hyperosmolarity
- hypervolemia/ wt gain
Disorder of too little ADH
DI
- Polyuria, polydipsia
- UOP 8-12 L/day (norm 1-2)
- low urine specific gravity
- low urine osmolarity
- hypernatremia
Too much GH
Gigantism- kids and adolescents
Acromegaly- adulthood
Hypofunction of pituitary gland
- Panhypotituitarism (all hormones affected)
- ACTH deficiency- cortisol deficiency
- TSH deficiency-altered metabolism
- FSH and LH deficiency- lack of secondary sex characteristics
- GH deficiency- lack of growth in children
DM type 1
Polyuria, polydipsia, polyphagia
Weight loss, fatigue
-Pancreatic atrophy and loss of beta cell function, no longer producing insulin
DM type 2
Cells become insulin resistant
-fatigue, recurrent infections, visual changes, s/s of neuropathy
Signs of hypoglycemia
tachycardia, palpitations, diaphoresis, tremors, pallor, arousal anxiety
DKA
Polyuria, dehydration, kussmal respirations, sweet/fruity breath, glucose over 250, acidotic, urine ketones
-usually associated with type 1
HHS
- emergency
- precipitated by infections, noncompliance of meds, usually type 2 DM
- glycosuria, polyuria, dehydration, coma
- glucose over 600
Somogyi effect
hypoglycemia with rebound hyperglycemia
- usually type 1 and kids
- eat a high protein snack at night to prevent hypoglycemia
Dawn phenomenon
early morning glucose elevation without nocturnal hypoglycemia
-increase nighttime insulin dose to peak during the morning
Microvascular complications of DM
retinopathy, neuropathy, and nephropathy
Macrovascular complications of DM
CAD, CVA, PAD, infection
Hyperparathyroid
- increase in pth levels
- hypercalcemia, hyperphosphatemia, pathologic fractures
Hypoparathyroid
- decrease in pth levels
- hypocalcemia, hypophosphatemia, muscle spasms, chvostek’s sign (cheek), and trousseau sign (BP cuff)
Addison’s disease
adrenal insufficiency; low cortisol levels, elevated ACTH
-weakness, hyperpigmentation, vitiligo
Cushing’s
too much ACTH leads to excessive cortisol levels
-truncal (central) obesity, moon face, buffalo hump, na/h20 retention, glucose intolerance, purple striae, brown hyperpigmentation of skin
Thyrotoxicosis
hyperthyroidism
-low TSH and high T3 and T4
Grave’s disease
hyperthyroidism
-increased metabolic rate, tachycardia, heat intolerance, weight loss, insomnia, palpitations, diarrhea, goiter, exopthalmus
Thyrotoxic storm
rare and life threatening
- results from excessive stress, increased T3 and T4
- hyperthermia, tachycardia- esp atrial tachydysrhythmias, high output heart failure, delirium, nvd
Hypothyroidism
- primary is iodine deficiency (most common worldwide)
- autoimmune thyroiditis (most common in US)
- congenital
- thyroid carcinoma
- secondary hypothyroidism
Hypothyroidism (cont.)
- low basal metabolic rate, cold intolerance, lethargy, lower body temp, possible diastolic hypertension
- myexedema: non-pitting edema esp around eyes, hands, and feet, thickening of tongue
Myxedema coma
- emergency
- diminished LOC, hypothermia without shivering, tachypnea, hypotension, hypolgycemia, lactic acidosis, coma
Chromosomes
carries genetic information; 23 pairs of chromosomes
Genes
tells body how to make proteins; responsible for inherited characteristics
Allele
one of the possible forms of a gene (2 possible forms are dominant and recessive)
Codon
a set of three adjacent nucleotides or a triplet that constitutes the genetic code for a particular amino acid that is to be added to a polypeptide chain in the synthesis of a protein
Autosome
22 chromosome pairs in both males and females; not sex (X and Y)
Genotype
the set of genes in our DNA that is responsible for a particular trait
Phenotype
the physical characteristics of a trait
Hemizygous
males, having only one X chromosome, are said to be hemizygous for genes on this chromosome.
-females are homozygous because they have 2 X chromosomes
Transcription
the process of making an RNA copy of a DNA molecule
-gene splicing occurs (cleans it up to get ready for translation)
Translation
RNA is decoded in a ribosome (site of protein synthesis) to produce a specific amino acid chain, or polypeptide.
DNA
Cytosine (C), thymine (T), adenine (A), guanine (G)
A to T, C to G
RNA
Cytosine (C), uracil (U), adenine (A), guanine (G)
A to U, C to G
Mutation
any inherited alteration of genetic material
Mutagens
are agents, such as radiation and chemicals, that increase the frequency of mutations
Autosomal recessive inheritance
two copies of an abnormal gene must be present in order for the disease or trait to develop
Turner syndrome
females only have one X chromosome
- absence of ovaries
- short stature
- webbing of the neck
- widely spaced nipples
Klinefelter syndrome
Individuals with at least one Y and two X chromosomes
- male appearance, gynecomastia, small testes, sparse body hair
- treat with testosterone
- likelihood of disorder increases with mother’s age
Down syndrome
Trisomy 21
- mental challenges, low nasal bridge, epicathal folds, protruding tongue, flat/low set ears, poor muscle tone
- increased risk for congenital heart disease, respiratory infections, and leukemia
Genetics of common diseases
CAD, htn, DM
Alzheimer disease
produces amyloid plaques and neurofibrillary tangles
-risk doubles if you have a first-degree relative
Alcoholism
risk is 3-5x higher in the individual with an alcoholic parent
-adoption studies- studies show it runs in genes rather than caregiver/environment
Schizophrenia
recurrence risk among offspring of one affected parent is 10x higher than the gen population
Bipolar affective disorder
also called manic depressive disorder
- risk rises 5-10% in an individual who has an affected first-degree relative as compared to normal, which is 0.5%
- genes that affect serotonin, dopamine, and noradrenaline systems have been implicated
Dominance and recessiveness
If two alleles are found together, then the allele that is observable is dominant and the one whose effects are hidden is recessive
Carrier
Has a disease allele but is phenotypically normal; can pass disease to offspring
Autosomal aneuploidy
Aneuploidy is a somatic cell that does not contain a multiple of 23 chromosomes.
- Trisomy: cell contains 3 copies of one chromosome
- Monosomy: presence of only 1 copy of any chromosome (is often fatal)
Deletions
chromosome breakage or loss of DNA
-ex: cri du chat syndrome; “cry of the cat”-low birth weight, mentally challenged, and microcephaly
Duplications
excess genetic material; usually have less serious complications
Inversion
chromosomal rearrangement in which a chromosome segment is inverted
-ABCDEFG becomes ABEDCFG
Translocation
the interchange of genetic material between nonhomologous chromosomes
Fragile sites
chromosome develops breaks and gaps when the cells are cultured in a folate-deficient medium
Congenital malformations
congenital diseases present at birth; having other disorders along with the congenital disease is common
Concordant traits
both members of a twin pair share a trait;
more genetic
Discordant traits
A twin pair does not share a trait;
more environmental
Polygenic trait s
effects of multiple genes cause the variations in traits
-focus is on the genes- usually many (poly) genes
Multifactoral traits
environmental factors cause the variations in traits
Quantitative traits
are measured on a continuous numeric scale
follows a normal bell curve for distribution
Incidence Rate
the number of new cases of a disease reported during a specific period (typically 1 year) divided by the number of individuals in the population
Prevalence Rate
the proportion of the population affected by a disease at a specific point in time; varies from population to population
Epigenetics
are chemical modifications of DNA sequences that alter the expression of genes, resulting in disease and phenotypic variations
DNA methylation
makes part of the gene silent or inactive
Genomic imprinting
the process of gene silencing, in which genes are predictably silenced, depending on which parent transmits them
Prader-Willi
inherited from dad
- abnormal pairs of the long arm of chromosome 15
- short stature, hypotonia, small hands/feet, obesity, mild mental retardation, hypogonadism
Angleman syndrome
Same deletion of pairs from long arm of chromosome 15 as prader willi, but angleman is inherited from mom*
-severe mental retardation, seizures, ataxic gait
Beckwith-Weidemann syndrome
overgrowth condition accompanied by an increased predisposition to cancer
- large for gestational age, neonatal hypoglycemia, large tongue
- uniparent disomy, affecting chromosome 11
Russel-silver syndrome
undergrowth condition
-growth retardation, proportionate short stature, leg length discrepancy, small/triangular shaped face
Layers of epidermis (from outermost to innermost)
- stratum corneum
- stratum lucidum
- stratum granulosm
- stratum spinosum
- stratum basale
Langerhans cell
- migrate from epidermis to bone marrow
- immune defense against environmental triggers
- present antigens to T cells
Merkel cells
- touch receptors on epidermis
- identifies stress occurring on skin
Keratinocytes
- produce keratin
- promotes hydration of skin
what is the dermis composed of?
elastin
collagen
reticulum
gel-like ground substance connective tissue
Layers of the dermis
Papillary- hair follicles, sebaceous and sweat glands, blood/lymph vessels, mast cells (release histamine), macrophages
Reticular- histocytes and fibroblasts that help with wound healing
Eccrine sweat glands
- in dermis
- thermoregulators through evaporation
- palms, soles, forehead
Apocrine sweat glands
- stink!
- scalp, axilla, genitalia, face, abd
Hypodermis
- deep, fatty layer of skin
- adipocytes and connective tissue
- veins and arteries run through this layer
Staging pressure ulcers
- nonblanchable
- partial; epidermis and/or dermis
- full thickness: subcutaneous
- full thickness; muscle, bone
atopic dermatitis
*eczema
severe pruritus- hallmark sign
eczematoid appearance with redness, edema, and scaling
where does atopic dermatitis appear in infants?
scaly red lesions appear on face, scalp, trunk, extensor surfaces of arms/legs
where does atopic dermatitis appear in children and adults?
neck, AC and popliteal fossa, hands, feet
chronic eczema
- thick, leathery, hyperpigmented skin
- lichenification
stasis dermatitis occurs as a result of?
venous stasis
edema
vascular trauma
stasis dermatitis sequence of events
edema erythema pruritus scaling petechiae hyperpigmentation ulcerations
seborrheic dermatitis involves what areas of the body?
is it constant or intermittent?
-chronic skin inflammation involving: scalp eyebrows eyelids nasolabial folds axillae chest back
-periods of remission/exacerbation
seborrheic dermatitis in infants
“cradle cap”
psoriasis
- T cell autoimmune mediated skin disease
- cells do not have time to mature or keratinize
- systemic: arthritis and CV disease
Lichen planus
- benign self limiting inflammatory disorder
- more prevalent during spring/fall
- may be linked to Hep C
manifestations of Lichen Planus
- nonscaling flat papular violet-colored lesion
- pruritus on wrists, ankles, lower legs, and ginitals
- oral=white lacy rings
acne vulgaris
- inflammatory disease of pilosebaceous follicles
- hypertrophy of sebaceous glands and telangiectasia
acne rosacea
chronic immune mediated skin inflammation
easily exacerbated
acne rosacea manifestations
- telangiectasia
- rhinophyma (bulbous nose)
folliculitis
infection of hair follicles
S. aureus
pustules with erythema
furuncle
*boil
inflammation from preceding folliculitis
follicular wall into surrounding dermis
S. aureus, MRSA
carbuncle
collection of infected hair follicles
abscess can develop
erythematous, painful, drainage
cellulitis definition, cause?
infection in dermis/subcutaneous
staphylococcus or GBS, MRSA
erysipelas definition, cause?
superficial cellulitis
acute infection of upper dermis
streptococcus pyrogenes
face, ears, lower legs
tinea cruris
jock itch
inner and upper surface of thighs
scaling vesicular patches, defined border
tinea manus
hand
dry, scaly, erythematous OR moist vesicular lesions
clusters, intense itching
HSV 1
infected saliva
cold sores/fever blisters
HSV 2
genital infections
skin to skin contact during viral shedding
mother to neonate; high mortality
varicella and herpes zoster
what kind of virus?
where does infection occur?
DNA virus
infection occurs within keratinocytes
contact, airborne precautions
verrucae
cause?
transmission?
*warts
caused by HPV
transmitted by touch
manifestations of verrucae
rough, grayish surface
condylomate acuminata
venereal warts
sexually transmitted, highly contagious
oncogenic HPV primary cause of cervical cancer
condylomate acuminata
veneral warts- very contagious
sexually transmitted
cauliflower like lesions
kwashiorkor
protein deficient
1-4 years of age weaned from breast milk to high starch
can have leaky guy, inflammation, store fat in liver, pancreatic atrophy
marasmus
deficient in all nutrients (protein, carbs)
younger than 1 year old
stunned growth, muscle/fat wasting, anemia, diarrhea, dermatosis, low Hgb
gastrin
“stimulates secretion of gastric juice”
enhances relaxation of stomach
enhance peristalsis of stomach
cholecystokinin
stimulates digestion of fat and protein
D cells
somatostatin- inhibitory
decreases release of glucagon/insulin
slows gastric motility/perstalsis
Kupffer cells
phagocytic cells
central to innate immunity
stellate cells
remove foreign substances from blood
trap bacteria
pit cells
natural killer cells
interferon y- tumor defense
what stimulates pepsin?
what inactivates it?
acetylcholine stimulates
alkaline environment of duodenum inactivates
what is saliva composed of?
water with mucous sodium bicarb potassium chloride salivary amylase
has IgA
acute liver failure patho
hepatocytes become edematous, patchy areas of necrosis and inflammatory cell infiltrates disrupt the parenchyma
*hepatic necrosis irreversible
acute liver failure s/s
anorexia, N/V, abd. pain, progressive jaundice
consequences of portal HTN
varices
splenomegaly
hepatopulmonary syndrome
MCC of ascites
cirrhosis
hepatitis
autoimmune or viral inflammation of the liver
phases of hepatitis
Prodromal: 2 weeks post exposure to jaundice
Icteric: jaundice phase
Recovery: when jaundice resolves
manifestations of cirrhosis
nausea, anorexia, fever, abd pain, jaundice
cirrhosis patho
- irreversible inflammatory fibrotic disease that disrupts liver function
- biliary channels blocked, causes portal HTN
biliary cirrhosis
- begins in bile canaliculi and ducts
- primary: autoimmune- T lymphocyte mediated
- secondary: obstruction
black pigmented cholelithiasis
form in gallbladder
chronic liver and hemolytic disease
brown pigmented cholelithiasis
bacterial infection in bile ducts
bili stasis or bili parasites EW!
manifestations of cholecystitis
inflamed gallbladder
- fever, leukocytosis, rebound tender, abd guarding
pancreatitis patho
- damage to pancreatic cells and ducts that causes a leakage of pancreatic enzymes into pancreatic tissues
- the enzymes can leak into blood and cause injury to blood vessels and other organs
chronic pancreatitis patho and manifestations
- destroyed acinar cells and islets of Langerhans
- pancreatic parenchyma destroyed
- s/s: may have continuous or intermittent abd pain
intussusception
- telescoping or invagination of one part of the intestine to another
- MCC: ileum into cecum
intussusception s/s
- abd pain
- vomiting soon after pain
- “currant jelly” stools (dark and gelatinous)
- infants: sausage shaped mass, colicky, flexes knees
Hirschsprung disease
- obstruction of colon
- failure of neural crest cells to migrate to GI tract: “skipped segments”
Hirschsprung disease manifestations
delayed meconium, poor feeding, poor weight gain, abd distention
lower airways: pulmonary anatomy
trachea** who knew?!
bronchi
bronchioles
carina
ridge where trachea divides into R and L bronchi
hila
where R and L bronchi enters lungs
blood and lymph vessels
goblet cells
produce mucous
surfactant
lipoprotein that coats the inner surface of the alveolus
decreases surface tension which prevents collapse
left shift oxyhgb dissociation curve
- Hgb increased affinity for O2
- alkalosis
- hypothermia
- hypocapnia (hyperventilation)
right shift oxyhgb dissociation curve
- Hgb decreased affinity for O2
- acidosis
- hyperthermia
- hypercapnia (hypoventilation)
emphysema patho
- abnormal permanent enlargement of the gas exchange airways
- destruction of alveolar walls without obvious fibrosis
- loss of elastic recoil
primary emphysema?
secondary?
primary- deficiency of a1- antitrypsin
secondary- cigs, air pollution, childhood resp. infections
emphysema manifestations
- thin
- dyspnea on exertion (may progress)
- little cough, little sputum
- tachypnea w prolonged expiration
- barrel chest
- tripod position
Laryngotracheobronchitis
who?
when?
*croup
6 mo-3 years old
late autumn/winter
causes of Laryngotracheobronchitis
commonly caused by a virus
- parainfluenza
- influenza A
- RSV
manifestations of Laryngotracheobronchitis
usually after episode of rhinorrhea sore throat fever seal like barking cough hoarse voice inspiratory stridor
pulmonary edema patho?
MCC?
- excess water in the lung from disturbances of capillary hydrostatic pressure, capillary oncotic pressure, or capillary permeability
- MCC- L heart fail
early asthmatic response
IgE causes mast cells to degranulate, releasing a large # of inflammatory mediators
- vasodilation
- increased cap. permeability
- bronchial smooth muscle contraction
- mucosal edema
ARDS patho and manifestations
alveoli fill with fluid
- massive pulmonary inflammation
- increased cap. permeability
- pulmonary edema
- shunting
- V/Q mismatching
- hypoxemia
manifestations of atelectasis
dyspnea
cough
fever
leukocytosis
posterior pituitary- ADH
ADH
- controls plasma osmolality (ADH released when increased)
- causes water reabsorption in the kidneys
too much ADH
SIADH hyponatremia hypoosmolality urine hyperosmolality hypervolemia
too little ADH
DI (neuro, nephro, dipsogenic)
- inability of kidney to increase permeability to water
- 3 P’s
- inability to concentrate urine
