Exam II Flashcards
0
Q
What does cardiac muscle rely on for muscle contraction?
A
Relies heavily on entrance of extracellular calcium for muscle contraction
1
Q
What does skeletal muscle rely on for energy?
A
ATP is important for muscle contraction and relaxation
2
Q
What are characteristics of smooth muscle?
A
Found in arteries, GI tract
Controlled by autonomic nervous system
Able to undergo cell proliferation (regenerate)
3
Q
What factors go into strength?
A
A factor of the number of motor units recruited and their firing frequency
4
Q
Slow oxidative fibers make up what type of muscles?
A
Endurance and postural muscles
5
Q
Fast glycolytic muscles are for?
A
More anaerobic activities and fatigue quick
6
Q
What is the process of skeletal muscle contraction?
A
- Contraction initiated by increase in intracellular calcium
- Actin and myosin filaments slide over each other
- cross-bridges activated by ATP
- ATP also necessary to break linkage of myosin and actin
7
Q
The process of smooth muscle contraction
A
- Filaments are not in parallel, but cross obliquely
- Actin attached to dense bodies
- Contraction initiated by increase in intracellular calcium
- Anatomy of smooth muscle allows larger tension range; can contract even when organ distended
8
Q
What are some age-related muscle changes?
A
- Sarcopenia: age-related decreases in strength
- Gender differences:
- Males: peaks in the 2nd & 3rd decade remains for 45-50
- Females: lose earlier - Age: accounts for only 30% of changes
9
Q
UAE strength is maintained __________ than LE strength.
A
More
10
Q
Changes in motor fibers & motor units over time
A
- Decline in the number and size of muscle fibers
- Decreased motor unit firing rates
- 1% loss of motor units per year starting after the 20s
- Loss in fast twitch muscle fibers
11
Q
Changes in structural muscles
A
- increased connective and fat tissue within muscle (don’t contract)
- increased membrane thickness–> decreased nutrient delivery
- decreased protein synthesis
12
Q
Characteristics of connective tissue
A
- most abundant tissue in the body
- connects, binds, supports tissue
- consists of cells & extracellular matrix
- 2 main types
- connective tissue proper
- special
13
Q
Characteristics of Connective Tissue Proper: loose
A
- soft and pliable: secretes extracellular matrix
- Example: Fibroblasts- produce collagen, elastin, and reticular fibers
14
Q
Characteristics of Connective Tissue Proper: reticular
A
Provides internal scaffold for soft organs, capillaries, nerves, and muscles
15
Q
Characteristics of Connective Tissue Proper: Dense
A
- Attaches structures, provides strength
- Found in tendons & ligaments
16
Q
Characteristics of Specialized Connective Tissue types
A
- Bone
- Cartilage
- Hematopoietic & lymphatic tissues
- Blood cells
- Adipose tissue
17
Q
Characteristics of Connective Tissue Extracellular Matrix
A
- Supportive matrix
- 3 types of fibers
- collagen
- elastin
- reticular fibers
18
Q
Characteristics of Collagen
A
Tough; serves as structural framework for skin, ligaments, & tendons
19
Q
Characteristics of Elastin
A
Stretchable; found in tissues that must deform & return to original shape (example: arteries)
20
Q
Characteristics of Reticular fibers
A
Thin, flexible network in organs that need to change form or volume
Example: bladder, uterus
21
Q
Characteristics of Collagen Class Type I
A
Thick bundles common in the body
Form mature scars, tendons, and bones
22
Q
Characteristics of Collagen Class Type II
A
Thin supporting tissue
Forms cartilagenous tissue
23
Q
Characteristics of Collagen Class Type III
A
Thin elastic tissue
More prevalent in infants –> turns into type I
Contributes to wound healing & fresh scars
24
Characteristics of Collagen Class Type IV
Forms basement membrane
Where cells attach
25
What type of collagen is articular collagen and what are some examples?
Type II
Examples: joint surfaces, bone apophyses, epipheseal plates, costal cartilage, fetal skeleton
26
What type of collagen is fibrocartilage collagen and what are some examples?
Type I
Examples: tendon insertion, ligament insertion, meniscus, disk
27
What type of collagen is elastic collagen and what are some examples?
Type III
Examples: Trachea, Earlobe, ligamentum flavum
28
What type of collagen is Fibroelastic collagen and what are some examples?
Type II
Example: Meniscus
29
What is tendon structure and function?
- connect muscle to bone
- dense bands of fibrous connective tissue
- cross bridges (strength)
- bundles parallel to tendon axis (stretch)
- surrounded by sheath (lubricate)
- handle large unidirectional forces; provide strong flexible support
30
What are tenocytes?
Collagen producing cells that constitute tendons
31
What is the Tendon Healing Sequence?
1. Hemostasis & inflammation (3 days typically)
2. Proliferation: within 2 weeks immobilization --> random deposition of collagen
3. Maturation/Remodeling: begins 3 weeks; immature Type III collagen to Type I & fibers re-align
- collagen diameter is smaller (reducing tensile strength)
32
A healed tendon is __________.
Remarkably different from normal
33
Surgery precautions for tendons
- Main concern post-op is protect healing tissues
- Max muscle forces avoided until at least 8 weeks post-op
- Significant weakness persists
34
What is ligament structure and function?
- Bone to bone
- Dense bands of fibrous connective tissue
- Long sheets or short thick strips
- Bundles of collagen fibrils are parallel to long axis of ligament
- Cross linkages
- Crimping (allows to stress & move out of line)
35
Ligaments are ________ organs.
Sensory
36
Ligament healing is variable depending on.....
The injury and involved tissue
Example: ACLs tend not to heal well
37
Ligament healing sequence
1. Hemostasis & inflammation
2. Proliferation
3. Maturation/Remodeling (months to years)
End result: a ligament that is morphologically & biomechanically inferior
-leads to ligamentous laxity
38
What is disk structure and function?
- Functions to withstand pressure & tension
- 3 zones
- Outer annulus fibrosis: type I & concentric rings
- Fibrocartilaginous inner annular fibrosis (Type II)
- Visco-elastic nucleus pulposis (Type II & water)
39
Disk changes across the lifespan: Newborn
- Annulus well vascularized
- With weight-bearing, vascularization changes & by age 5, only outer annulus is vascularized (thus healing only occurs in annulus)
40
Disk changes across lifespan: adult --> aging nucleus
- decreased proteoglycan content
- water binding ability decreases
- less able to accommodate compressive loads
41
Disk changes across the lifespan: Annulus
- composition changes to Type I collagen
| - Thick & disorganized fibers lessen metabolite transfer
42
Disk disease progression
Nucleus less able to absorb water --> dehydration --> nucleus thick & fibrous --> fissures form in annulus --> disk begins to collapse --> reduced load bearing capacity --> altered passage of nutrients & wastes
43
Risk factors for herniation
- Early morning (during the night no weight bearing so taller & more water in nucleus)
- Lifting of heavy loads
- Torsional stress
- Strenuous exercise
- Smoking
- Genetics
44
Characteristics of intervertebral disk healing
- evidence exists that the healing of the outer annulus can occur
- due to increased cell density & blood supply (metabolite transport)
- can adapt its strength to mechanical demands
- reduces pain & inflammation & increases function
45
Elements of bone
- Bone matrix
- Bone cells
- Osteoblasts
- Osteocytes
- Osteoclasts
46
What do osteoblasts?
Build bone
47
What are osteocytes?
Bone cells that affect blasts and clasts
48
What are osteoclasts function?
Destroy bone
49
Does a traumatic fracture occur?
Sudden impact
50
How does a stress or fatigue fracture occur?
- Due to rhythmic, repeated, microtrauma
| - Partial (called a "reaction") or complete (called a "fracture")
51
How does an insufficiency fracture occur?
Due to normal stress on weak bone or bone with insufficient elasticity
52
How does a pathological fracture occur?
In bone affected by neoplasm or other disease
53
Diagnosis of fracture with radiographs can miss?
- May not detect stress reaction
| - 35% of sacral fractures undetected
54
What is a CT good for in diagnosing a fracture?
- May be better for sacral fractures
| - Good for pathological fractures
55
What are MRIs good for and what's a con for diagnosing a fracture?
- Can detect stress injuries
| - but are expensive
56
What is the rule about films and diagnosing a fracture?
Always need 2 views
57
7 elements for complete radiograph evaluation of a fracture?
- Anatomic site & extent of fracture
- Type of fracture
- Alignment of fracture
- Direction of fracture
- Presence of associated abnormalities
- Special types of fracture
58
Characteristics of Stage 1 of Bone healing?
- Hematoma development and inflammation
- Brings fibroblasts, growth factors, & cytokines to the area
-By the end of week 1 phagocytic cells have removed initial hematoma & fibrosis is beginning
59
Characteristics of Stage 2 bone healing?
- Reparative phase
- soft callus forms around week 2
- osteoclasts clear necrotic bone
- bone growth factors facilitate repair
- hard callus replaces soft callus
- completed in 6-12 weeks
60
Characteristics of Stage 3 bone healing
- remodeling phase
- bone union achieved
- immature disorganized bone is remodeled into mature bone, adding stability
- excessive bony callus resorbed
- bone remodels in response to stress
- months to years
61
Factors that impact bone healing
- Age (kids 4-6 weeks, teens 6-8 weeks, adults 10-18 weeks)
- Bone involved
- Fracture site and type
- Treatment required
- Soft tissue injury
- Nutritional status (calcium & vitamin D)
- Co-morbid conditions
62
Characteristics of the inflammatory process
- a non-specific response
- immune reactions
- injury
- ischemic
- localized protective response serves to destroy, dilute, or wall off both the injurious agent & the injured tissue
63
What are the types of inflammation
Acute & chronic
Local & systemic
64
What are the cardinal signs of acute inflammation
- Rubor (redness)
- Tumor (swelling)
- Calor (heat)
- Dolar (pain)
65
What are secondary signs of acute inflammation
- loss of function
| - fever may occur (systemic sign)
66
There _______ be inflammation without healing, but there _______ be healing without inflammation.
Can
Can't
67
What is acute inflammation and what is it's aim?
- Early (almost immediate) reaction of local tissue to injury
- Aim: remove injurious agent & limit tissue damage
68
What happens in the vascular stage of acute inflammation
Changes in the blood vessels occur
69
What happens in the cellular stage of acute inflammation
Movement of WBCs into the area
70
What is step 1 of the vascular stage of acute inflammation
Rapid vasoconstriction (reduces immediate blood loss)
71
What is step 2 of the vascular stage of acute inflammation
Rapid vasodilation (increased blood flow causes increased heat & swelling)
72
What is step 3 of the vascular stage of acute inflammation
Vessel becomes more permeable
- Loss of proteins with fluid outflow (exudate)
- Produces swelling (edema) in tissue
- Serves to dilute offending agent
73
What is step 4 of the vascular stage of acute inflammation
Flow stagnates, clotting of blood occurs (aids in confining spread of bacteria)
74
What is step 1 of the cellular stage of acute inflammation
Margination & adhesion (mediators cause WBC to accumulate along vessel endothelium)
75
What is step 2 of the cellular stage of acute inflammation
Emigration (WBCs squeeze out of the vessel)
76
What is step 3 of the cellular stage of acute inflammation
Chemotaxis
| -WBCs are guided to the site of inflammation by cytokines, bacterial & cellular debris, & complement fragments
77
What is step 4 of the cellular stage of acute inflammation
Activation & Phagocytosis
| -WBCs engulf & destroy pathogens
78
What is the job of neutrophils in the cellular stage of acute inflammation
- Cause phagocytosis within 90 min & generate toxins to destroy pathogens (especially bacteria)
- Key to fighting infection
79
What is the job of eosinophils in the cellular stage of acute inflammation
Generate toxins to destroy pathogen (especially parasites) & mediate allergic reactions
80
What is the job of basophils in the cellular stage of acute inflammation
Produce allergic reactions
81
What is the job of monocytes in the cellular stage of acute inflammation
Engulf larger pathogens; predominate cell type 24 hours after injury
AKA phagocytes
82
What is the role of chemical mediators in acute inflammation
- Derived from plasma & cells
- Responsible for vascular & leukocyte response
- Numerous effects on blood vessels, inflammatory cells, & other cells
- Vasoconstrict
- Vasodilate
- Modulate vascular permeability
- Contribute to chemotaxis
83
What are characteristics of cell-derived mediator histamine in acute inflammation
- From mast cells; also in basophils & platelets
- Cause vasodilation & increase permeability
- One of the 1st mediators of inflammatory response
84
What are characteristics of cell-derived mediator arachidonic acid metabolites in acute inflammation
- Found in cell membrane phospholipids
- Synthesizes prostaglandins via cyclooxygenase (COX) enzyme
- Corticosteroids & NSAIDS block arachidonic acid production
86
What are characteristics of cell-derived mediator platelet activating factor in acute inflammation
- Induces platelet activity
| - Activates cells (including endothelial cells & leukocytes
87
What are characteristics of plasma-derived mediator coagulation/fibrolytic system in acute inflammation
aids in blood clotting
88
What are characteristics of cell-derived mediator cytokines in acute inflammation
- Many kinds exist and have a number of inflammatory effects
- IL-1
- Contributes to fever
- Alters blood chemistry, including increasing coagulation factors
- Increases number of neutrophils
89
What are characteristics of plasma-derived mediator kinin enzymatics in acute inflammation
- Causes increased capillary permeability
| - Cause pain
90
What are characteristics of plasma-derived mediator proteins in the complement system in acute inflammation
- Cause vasodilation and capillary permeability
- Promote leukocyte activation, adhesion, & chemotaxis
- Augment phagocytosis
91
What is RICE or PRICE Treatment?
```
Protection
Rest
Ice
Compression
Elevation
```
92
What is the etiology of chronic inflammation?
- Repeated acute microtrauma & overuse
- Persistence of the offending agent (asbestos, surgical suture)
- repeated bouts of the acute inflammation
- Recurrent infections
- Low-grade responses that fail to evoke an acute response
93
What are the 3 phases of tissue healing?
- Inflammatory
- Proliferative
- Remodeling & maturation
94
What is the purpose of the Inflammatory phase of tissue healing?
Sets the stage for healing
95
What is the purpose of the Proliferative phase of tissue healing?
Fill in the wound gaps
96
What is the purpose of the Remodeling & Maturation phase of tissue healing?
Restore tissue properties
97
What is the purpose of the Inflammatory phase of wound healing?
- Begins: instantaneously with cell injury
- Prepares wound for healing
- Hemostasis (vasoconstriction; blood clotting through platelet activation & aggregation)
- Vasodilation (increases vascular permeability)
- Migration of phagocytic cells
- Macrophages also release growth factors that stimulate growth, etc.
- Ends: 10 days post-injury
- MOST activity completed by 72 hours
98
What is a manifestation of local inflammation?
Production of exudate (fluids, plasma proteins, cellular debris)
Examples: serous, hemorrhagic, fibrinous, & purulent exudate
99
What is Serous Exudate?
watery fluids low in protein content due to plasma entering inflammatory site (manifestation of local inflammation)
100
What is hemorrhagic exudate?
Leakage of RBC (manifestation of local inflammation)
101
What is fibrinous exudate?
Large amounts of fibrinogen & form a thick, sticky mesh work like a blood clot (manifestation of local inflammation)
102
What is purulent exudate?
Pus composed of degraded WBC, proteins, & tissue debris (manifestation of local inflammation)
103
What are characteristics of tissue repair?
- Overlaps the inflammatory process
- Attempt to maintain/regain normal tissue structure & function
- 2 forms
- Regeneration
- Replacement
104
What is the purpose of regeneration tissue repair?
injured cells are replaced with same type of cells with no evidence of previous injury
105
What is the purpose of replacement tissue repair?
injured cells replaced with connective tissue (scar)
106
Characteristic of regeneration of Labile cells and examples?
- Constant state of renewal
| - Examples: cells lining GI tract, blood cells, basement membrane of skin
107
Characteristic of regeneration of Permanent cells and examples?
- Unable to divide & reproduce
- Examples: Neurons & Cardiac cells
- Replaced with fibrous scar tissue
108
Characteristic of regeneration of Stable cells and examples?
- renewed slowly; capable of renewal after tissue loss
| - Example: liver cells
109
The Proliferation & migration flow chart
Endothelial cells proliferate --> Establish vascular network --> Form new capillaries --> Granulation tissue formed --> Cells proliferate to fill wound bed --> continued cleaning of wound --> Epithelial cell migration --> Wound covered
110
Characteristic of Remodeling & maturation tissue contraction
- Epithelial cell migration causes wound shrinkage
| - Fibroblasts --> myofibroblasts
111
What are the 2 patterns of chronic inflammation?
- Nonspecific chronic inflammation
| - Granulomatous inflammation
112
What are clinical manifestations of chronic inflammation?
- Pain
- Fibrosis
- Decreased joint mobility
- Decreased nutrition
- Retention of metabolites & tissue fluid
113
What is the goal of remodeling and maturation tissue regeneration?
- Goal is to restore normal tissue structure and function by generating new sin cells
- Often involves replacement by scarring as well (occurs when the wound depth is below epidermis)
114
Characteristics of scar tissue development
- 2 step processes
- Angiogenesis
- Fibrinogensis
- As scar matures, vascular degeneration occurs resulting in pale, largely avascular scar
- "closing the gap" trumps function of scar
115
What is angiogensis of scar tissue development?
sprouting new capillaries
116
What is fibrinogenesis of scar tissue development?
activated fibroblasts result in collagen synthesis, forming scar tissue
117
What are characteristics of remodeling of scar tissue?
- Synthesis of collagen by fibroblasts & lysis by collagenase enzymes
- Fibers acquire a more organized pattern; reorients tissue for strength
118
Scar tissue has ______ tensile strength.
reduced (20-30%)
119
Scar tissue and how PT affects it.
- Influenced by PT interventions
- Stress on the scar helps induce reorganization
- What can we do to stress the scar?
120
What is a Keloid scar?
Mass caused by excessive scar production; African-Americans have increased tendency
121
What is wound healing primary intention and when does it occur?
- Healing following a non-infected laceration or surgical incision
- Seen in wounds with minimal tissue loss and have eges closely approximated
- Heals with no infection and little to no scarring
122
What is wound healing secondary intention and when does it occur?
- Seen in deep or large wounds
- Healing proceeds from "the bottom" upward & from the edges of intact tissue
- Scarring is more extensive
- Infected primary may heal by secondary
123
What is wound healing Tertiary intention and when does it occur?
- Intentional delay of closure or re-opening of previously closed wound
- Used for infected wounds to allow cleansing
- Want granulation of deeper tissue before superficial tissue closes
124
What is resolution in outcomes of tissue healing?
recovery of cells-no need for replacement
125
What is regeneration in outcomes of tissue healing?
replacement of dead cells with healthy duplicates
126
What is fibrous tissue repair/scar tissue formation in outcomes of tissue healing?
replacement of dead cells with non-functional scar tissue
127
What is persistent infection in outcomes of tissue healing?
development of an abscess or granuloma
128
What is chronic inflammation in outcomes of tissue healing?
continuous inflammatory response
129
What are factors that affect wound healing?
- Malnutrition
- Blood flow & oxygen delivery
- Impaired inflammatory & immune response
- Wound separation, infection, & foreign bodies
- Age
130
What are the properties of the immune system?
- Protects the body against foreign substances
- Distinguishes self from non-self, attacking the "non-self"
- When working well, prevents infection & disease
- When not working well, localized or systemic infection or disease
131
What are the characteristics of the regulation of the immune response?
- Self-regulation is an essential property of the immune system
- Regulation not well understood
- Exposure to foreign antigens can lead to excessive tolerance & infection
132
What is the term for inadequate immune response?
Immunodeficiency
133
What is terms for excessive immune response?
Allergic reaction or autoimmune disease
134
What does tolerance mean?
The ability of the immune system to be non-reactive to self-antigens (pregnancy, blood transfusion)
135
What are the central organs involved in Immune Response?
- Immune cell production & maturation
- Bone marrow: B-cells
- Thymus: T-cells
136
What is the job of peripheral lymphoid organs involved in Immune Response and what are some examples?
- Trap & process antigens & promote interaction with mature immune cells
- Examples: spleen, tonsils, & appendix
137
What is an antigen?
- Any foreign substance in the body that does not have the characteristic cell surface markers
- Leads to the immune response
138
What is an Epitope?
- Immunologically active site on antigen
- Like a receptor
- Unique shape
- Recognized by antibody
139
What is a major histocompatability complex?
- Consists of unique cell markers that inform the body of what belongs
- Inherited: influence one's predisposition to disease
- Provide cell to cell communication
- Determine how a person responds to antigens
140
What are the WBCs in the innate immunity?
- Granulocytes
- Neutrophils
- Basophils
- Eosinophils
- Monocytes --> macrophages
- Natural killer (NK) cells
141
What are the WBCs in acquired immunity?
- Lymphocytes
- B cells
- T cells
- NK cells
142
What are characteristics of innate (Non-specific) Immunity?
- Lacks memory, non-adaptive
- Defenses in place before infection occurs
- Rapid response (but not variable)
- Includes
- Epithelial barriers that block entry
- Phagocytic cells
- Natural Killer cells
- Doesn't require exposure
143
What are the exterior defense of innate immunity?
skin and body orifices provide defense
144
What is the function of phagocytes in innate immunity?
readily kill and ingest antigens
145
What is the function of soluble (inflammatory mediators) in innate immunity?
complement system (proteins) coat pathogens so they can be more easily phagocytosed
146
What is the function of NK cells in innate immunity?
Kill viruses, tumor cells, others
147
What are characteristics of Acquired (Adaptive) immunity?
- Specific
- Recognizes & reacts to specific pathogens
- Have a "memory"
- Many different antigen receptors involved
- Active & passive forms
- 2 types
- Humoral
- Cell-mediated
148
What are characteristics of passive adaptive immunity?
- Transfer of protective antibodies against an antigen from another person
- Short-term protection (weeks to months)
- Example: mother to baby via breast milk, hepatitis vaccine
149
What are characteristics of Active adaptive immunity?
- Develops after exposure to antigen
- Long-lasting due to memory cells
- Examples: vaccination with inactive virus (mumps, measles, polio), tetnus every 10 years
150
What are characteristics of humoral (antibody-mediated) adaptive immunity?
- Mediated by molecules in blood produced by B lymphocytes
| - Principle defense against extracellular microbes
151
What are characteristics of cell-mediated adaptive immunity?
- Mediated by specific T-lymphocytes
- Defends against intracellular microbes (viruses)
- HIV attacks these
152
What are characteristics of Immunoglobins?
- Produced by B-lymphocyte-plasma interaction
- "Y" shaped
- Forked ends bind with antigen
- Tail determines class
153
What are factors affecting immunity?
- Age
- Nutrition
- Pollution & chemicals
- Surgery & anesthesia
- Trauma & illness
- Medications
- Sleep
- Stress
- Psychosocial situations
154
Developmental aspects of immunity in Infants
Protection of newborn against antigens occurs through transfer of maternal antibodies
155
Developmental aspects of immunity in Elderly
- Decline in immune responsiveness (cell-mediated & humoral responses)
- Difficult time mounting an infection --> more susceptibility
- Risk of reactivation of dominant infection
- Higher prevalence of autoimmune
- Higher incidence of cancer
- Vaccination less effective
- Elders need to have full cycle of meds
156
What is primary immunodeficient disease?
- Defect in T or B cells or lymphoid tissue
- Increase one's risk of infection, autoimmunity, or cancer
- Rare
157
What is secondary immunodeficient disease?
- Due to underlying or previous disease
- Use of medications & medical treatments for other conditions can cause immunosuppression
- Chemo
- Corticord steriods
158
What are hypersensitivity disorders?
exaggerated or inappropriate response to an antigen
159
What is immediate hypersensitivity disorder?
occur within minutes of exposure
160
What is late phase hypersensitivity disorder?
persistent symptoms for hours to days after allergen is removed
161
What is delayed hypersensitivity disorder?
occur after days due to increased sensitization
162
What is immediate, allergic, anaphylactic hypersensitivity disorder?
normally harmless substance causes response in susceptible people
163
What is cytotoxic hypersensitivity disorder?
body tissue recognizes self as foreign or reaction between exogenous pathogen & endogenous tissue
164
What is immune complex hypersensitivity disorder?
accumulation of antigen-antibody complexes in tissue --> inflammation
165
What is cell-mediated immunity hypersensitivity disorder?
a delayed response (transplant)
166
What is auto-immune disease and what is it etiology?
- Body fails to distinguish self from non-self
- Immune system response attacks the body tissue
- Etiology: genetic, hormonal, & environmental combo
167
What is iso-immune disease?
- Organ & tissue transplantation
- Body recognizes the tissue as non-self
- Goal: prevent rejection through matching
168
Skeletal Changes that occur in the lifespan?
- Max bone density achieved by age 30
- Many factors influence skeletal development
- Affects the cartilage, bone surface or bone itself
169
How is nutrition important in bone building?
It is key to building up to peak bone mass (vitamin D & calcium the most important)
170
What effect does exercise have on bone density?
More stress increases bone density
- running>walking
- swimming is bad for bone density
171
What are characteristics of alkaline phosphatase?
- Non-specific marker of metabolic activity in bone tissue
- Adults
172
What is serum calcium used for and what do high levels mean?
- Used to screen for or monitor calcium regulation disorders (parathyroid gland or kidneys) or diseases of the bone
- Higher because calcium is being pulled out of bone
- Cancer can cause high serum calcium
173
What are risk factors for osteoporosis?
- Ethnicity (Caucasian & Asian)
- Genetics
- Climatic/environmental (less change in climate)
- Hormonal factors
- Diet
- Exercise/activity
- Body type
- Prolonged immobilization
- Alcohol, tobacco, & anti-coagulant use (synergistic)
174
What is the pathogenesis of osteoporosis?
- Between 35 & 40 years old bone resorption>bone formation
- Bone matrix deteriorates
- Trabecula thin
- Bone fibrils become more longitudinally arranged
- Bone becomes filled with more fat tissue
175
What are most common spots and causes of primary osteoporosis?
- Hormonal changes
- Women
- Hip, spine, and radius
- Cancellus bone because highly vasculized
176
What are the most common spots and causes of secondary osteoporosis?
- Aging process regardless of hormones
- Cancellous & cortical bone
- More femur fractures
- Pelvis, humerus, tibia (long bone fractures)
177
What are the effects of Osteoporosis?
- Postural abnormalities
- Increased fracture risks
- Pain
- Functional consequences (balance, chest, reaching)
- Shortened stature
- Respiratory compromise
- Increased satiety
178
How is osteoporosis diagnosis?
- Bone mineral density (BMD) testing
- Radiographs
- Laboratory tests
179
What is a bone mineral density test?
- Dual Energy X-ray Absorptiometry (DEXA)
- Measure of mineral content in bone
- Recommended for every woman >65 y.o. & postmenopausal<65 with fracture history
- Hip & spine main bones
180
What is a T-score?
- Standard deviation from peak bone mass
- Can tell bone is weak
- Disadvantage: not age matched
181
What is a Z-score?
-Number of standard deviations as compared to mean value for others at the same age and gender
182
Is a radiographic analysis good for detecting osteoporosis?
Bad way to tell because someone has to lose 30-50% of bone mass for it show up
183
What is the treatment for osteoporosis?
- Begins with prevention
- then
- Medications
- Calcium & vitamin D
- Estrogen replacement
- Lifestyle changes
- Exercise
- Total body vibration
- No smoking
- Limit alcohol intake
184
What is Vertebroplasty?
Insertion of cement into vertebral body
185
What is kyphoplasty?
Insertion of small balloons into vertebral body
186
What is osteomalacia?
- Progressive disease
| - Lack of mineralization of new bone matrix --> softening of bone without loss of matrix
187
What is Paget's disease?
- 2nd most common metabolic
- Leads to abnormal bone remodeling
- Increase bone resorption due to activated osteoclasts
- Excessive, disorganized bone formation
- Soft bone deposition
188
What is clinical presentation of Paget's disease?
- Change in bone shape, size, & direction
- Postural abnormalities
- Fatigue, lightheadedness, stiffness
- Can impact nervous system
- Varus
- Rickets
189
What is hematology?
Form & structure of blood & blood-forming tissue
190
What are the 2 main components of blood?
- Plasma
- Formed elements
- RBC
- WBC
- Platelets
191
What are the 3 main characteristics of RBCs?
- Thin (helps with oxygen delivery)
- Flexible (get into small areas)
- Biconcave (increase surface area)
192
What is anemia?
Diminished oxygen-carrying capacity of blood
193
What does anemias generally result from.....
- Decreased erythrocyte production
- Increased erythrocyte destruction
- Blood loss
- Combination of above factors
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What does hypoxia lead to?
- Fatigue
- Weakness
- Dyspnea
- Angina
- Tachycardia --> ventricular hypertrophy
- Pallor
- Headache & fainting
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What is hemoglobin?
Concentration of the oxygen-carrying pigment of the erythrocytes
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What is hematocrit?
percentage of total blood volume occupied by RBCs
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What are the goals of treatment of anemia?
- Alleviate or control the cause
- Reduce symptoms
- Prevent complications
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What are guidelines for PT in the treatment of anemia?
- Seek physician approval before treating patient with anemia
- Expect fatigue & decreased exercise tolerance
- Monitor VS & O2
- Know the cause of the anemia & the patient's co-morbidities
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What does leukocytosis mean?
Increase in WBCs
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What does leukopenia mean?
Decrease in WBCs
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What does Neutropenia mean?
Decrease in neutrophils (most common of leukopenia)
202
What is the pathogenesis of disorders of WBCs?
Suppression of bone marrow, damage to cells, removal of cells from circulation
203
What is leukemia?
- Neoplasm of blood forming
- Replaces normal bone marrow with malignant clone of lymphocyte or myelogenous cells
- Acute or chronic forms
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What are symptoms of leukemias?
- Anemia
- Infection
- Bleeding tendencies
- Bone pain
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What are ways of diagnosis of leukemias?
- Blood counts
- Bone marrow biopsy
- Initially, leukocyte counts elevated but may be low
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What are lymphomas?
- Cancer of lymph system
- 2 groups
- Hodgkin's
- Non-Hodgkin's
- Among most curable
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Prothrombin time, Partial thromboplastin time, & International normalized ratio...... Increased time means ______.
Don't clot well so at risk for bleed
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What is the international normalized ratio (INR)
- Gold Standard
| - PT values used to calculate INR
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Increased INR means......
- The slower your blood will clot
| - Higher risk of bleeding
210
Decreased INR means......
- The quicker your blood will clot
| - Higher risk to develop a blood clot
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What is hypercoagulability?
Exaggerated production and/or occurrence of thromboses
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What are causes of Hypercoagulability?
- Increased platelet function
- Increased clotting activity
- Genetic or acquired
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What are causes of thrombocytopenia?
- Inadequate platelet production
- Platelet destruction
- Splenic sequestration of platelets
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What is thrombocytopenia is associated with....
- Cancer: leukemia metastatic cancer
- Aplastic anemia
- Aggressive chemo
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What are symptoms/signs of throbocytopenia?
- Mucosal bleeding
- Petechaiae and/or purpura
- Hematuria
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What is Von Willebrand disease?
- Autosomal dominant
- Reduced platelet adhesion
- Defective clot formation
- Internal or joint bleeding
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What are signs and symptoms of localized infection?
Swelling
- red
- pain
- heat
- maybe pus
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What are signs and symptoms of systemic infection?
- Fever & chills
- Malaise
- Sweating
- Nausea and vomiting
- Changes in mentation
- Spasticity
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What is symptomatology?
Collection of signs and symptoms expressed (clinical picture or disease presentation)
220
Mechanisms of infection may be specific
Reflect the site of infection
| Examples: diarrhea, rash, pneumonia
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Mechanisms of infection that are non-specific
Fever
Headache
Lethargy
Malaise
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Mechanisms of infection you may see overt signs... What is an example?
Chicken pox
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Mechanisms of infection covert signs.... What is an example?
WBC count
224
What is the site of infection?
Depends on type of pathogen, portal of entry, & host's immune defenses
225
What is sepsis & septicemia?
- Infection by microbials in blood
| - Can cause death
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What is an abscess?
Localized pocket of infection; can be surgically removed or drained
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What is an infectious disease?
Consequences of microbial invasions
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What is a host?
Any organism capable of supporting another organism's nutrition & growth
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What is colonization?
Host carries organism, but does not have disease
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What is an infection?
- Presence & multiplication of living organisms on or within the host
- Healthy infection
- Pathogenic infection
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What is an incubation period?
is from pathogen entering host--> appearance of clinical symptoms
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What is a latent infection?
Microorganism has replicated but is dormant or inactive
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What is the period of communicability?
When the infection can be transferred to another person
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What is virulence?
Disease-producing potential (vigorous)
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What are pathogens?
Virulent organisms capable of causing disease
236
What is opportunistic pathogens?
Attack vulnerable hosts (weakened immunity illness, or medical therapy)
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What are nosocomial infections?
- Acquired during hospitalization
- Tend to be related to invasive procedures
- Involve drug resistant organisms
- Increased hospitalization
- Medicare will not pay for
- Increase of risk with increase in doctors
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What are intracellular organisms as infectious agents?
- Grow & multiply only in host cells
- Require host metabolism for survival
- Example: Virus
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What are extracellular organisms as infectious agents?
- Can grow & multiply outside of the cells
- Can be cultured on artificial media
- Example: bacteria
240
What are principal pathogens as infectious agents?
- Cause disease, even in people with intact immune systems
| - Example: flesh eating bacteria
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What are opportunistic pathogens?
Cause disease only in those with immunodeficiency
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What are viruses?
- Smallest known organism
- Protein coat with RNA or DNA
- Penetrate living cell, replicate with cell's DNA. create new viruses or latent virus
- May or may not cause death of host cell
- Must live off the host & need to be within the cell
243
What is bacteria as a pathogen?
- Single-celled with well defined cell walls
| - Can grow independently & reproduce frequently
244
What is Gram (+) Bacteria?
- Easier to treat
| - Stains black or purple
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What is Gram (-) Bacteria?
- Harder to treat because double cell wall
| - Stain pink
246
What is a culture?
- Propagation of microorganism outside of the body (not all pathogens are capable of this type of reproduction)
- Should be done before antibiotic therapy
247
What is serology?
- Study of serum
- Blood tests to detect infectious disease
- Antibody titer; assesses rise of antibody level associated with a specific pathogen
248
What is the general treatment for infectious diseases?
- goal is to rid body of pathogen & restore normal physiologic function to damaged tissue
- Most of the infectious diseases are self-limiting with little or no medical therapy required
249
What is the treatment of viruses?
- Various meds & vaccines
- Effective treatment is difficult, however
- Replication peaks before symptoms
- Drugs require intact immune system
- Able to "hide"
- Develop drug resistance
250
What are vaccines?
- Stimulate immune system to be prepared to fight virus later on
- Use of killed or attenuated vaccine effective without causing disease
- Limitations: vaccines specific to one virus
251
What is the treatment of bacterial infections?
- Depends on the type (Gram + or Gram -)
- Antibodies
- Bactericidal (kill the bacteria)
- Bacteriostatic
- Inhibit bacterial growth, without killing
- Require intact immune system
252
What is innate resistance?
no transport mechanism to move drug across bacterial cell wall
253
What is acquired resistance?
- Various
- Spontaneous genetic mutation & other genetic alterations
- Enzymes that block access to the cell
- Problems with binding sites on the cell membrane
- Transporters that pump the antibiotic away from the cell
254
What is the problem of overuse of antimicrobial agents?
- Given in busy clinics to patients infected with viruses
- Given prophyloctically to surgery patients
- Given to animals in our food chain for growth & fighting infection
- Soaps & lotions are increasing in popularity
255
What are examples of carcinogens?
- Tobacco use
- Viruses
- Chemical agents
- Physical agents
- Drugs
- Hormones
- Excessive alcohol consumption
256
What are risk factors for cancer?
- Advancing age
- Previous CA
- Lifestyle/behavior
- Exposure to viruses
- Hormones
- Environmental
- Gender
- Stress
257
What are characteristics of neoplasm?
-Abnormal growth (serves no useful purpose)
-Uncoordinated growth
-Benign or malignant
Primary or secondary
258
What is a benign neoplasm?
- More differentiation of cells; resemble cells of tissue origin
- Slow growth
- Non-invasive
- Contained in fibrous capsule
- Can disturb function
- Typically not lethal
- Can be lethal
259
What is an adenoma?
Benign tumor of glandular epithelial cells
260
What is an osteoma?
Benign tumor of bone
261
What is a lipoma?
Benign tumor of fatty tissue
262
What is a polyp?
Projection from mucosal surface
263
What is a cancer in situ?
Localized pre-invasive lesion
264
What is a neoplasm malignant?
- Lacks differentiation
- Grows rapidly
- Can grow into surrounding tissues & distant sites
- Fingerlike projections
- Can cause death
- 2 categories
- Solid tumors
- Hematologic cancer
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What is a carcinoma?
- Malignant neoplasm derived from epithelial tissue
- Tend to metastasize through the lymphatic or hematopoetic systems
- Most common sites:
- skin, cervix, stomach, large intestine, prostate gland, bronchi, breast
266
What is a sarcoma?
- Malignant neoplasms
- Connective tissue origin
- Highly malignant
267
What is osteosarcoma?
- Malignant neoplasms
- Most common & most malignant bone cancer
- Most commonly seen in males between ages 15-30
- Found in the metaphyses of long bones in adolescences
268
What is a lymphoma?
- Malignant neoplasm
| - A lymphoid tissue neoplasm
269
What is leukemia?
- Malignant neoplasm
| - Abnormal cells of hematological origin that metastasize through invasion & inflitration
270
What is an invasion?
Extensive infiltration & invasion of surrounding tissues
271
What is a metastasis?
- Development of (distant) secondary tumor
- Process involves the breaking off of cells
- Spreads to other locations in the body (lymphatic, circulatory, directly to surrounding tissues)
272
What are metastasis most common sites?
- Bone
- Brain
- Lung (because blood returns here 1st)
- Liver
- Lymph nodes
- Because the most vascularized
273
What are local signs & symptoms of cancer?
- Pain
- Fracture
- Shortness of breath
- Coughing
274
What are systemic signs of cancer?
- Pain
- Fatigue
- Cachexia (global wasting of muscle)
- Hormonal imbalance
- Anemia
- Leukopenia
- Bleeding or non-healing wounds
- Infection
275
What are paraneoplastic syndromes?
- Manifestations in sites not directly affected by cancer
- Not explained by local or distant spread of the tumor
- Can show before the actual diagnosis of cancer is made
276
What are diagnostic methods in oncology?
- Biopsy
- Blood test
- MRI
- CT scan
- Isotope scan
- Mammography
- Ultrasonography
- Urinalysis
277
What is a biopsy?
The single most important diagnostic method for the study of tumors
278
How do you perform a sentinel node biopsy?
- Insert radioactive dye in several places around the tumor
- Watch the up-take through the lymph
- sentinel node is the main lymph node that the radioactive dye passes or gathers
279
What are diagnostic imaging for cancer?
- MRI
- CT
- Radiographs
- Nuclear Medicine
280
What is staging & grading diagnostic methods?
- Useful in determining prognosis & selecting treatment
- Grading: histological or cellular characteristics
- Staging: extent & spread of disease
281
What is the TNM system?
T= Size & local spread of primary tumor
N= Involvement of regional lymph nodes
M= Extent of metastasis
This system helps stage
282
What are the goals of intervention for cancer?
- Cure the cancer
- Control the cancer
- Provide palliative care to the cancer patients
