Final exam Flashcards
1
Q
secondary factors from marrow infiltration and decreased marrow production
A
anemia, thrombocytopenia, leukopenia/neutropenia, bone or joint pain
2
Q
factors secondary to extramedullary infiltration
A
hepatosplenomegaly, lymphadenopathy, stridor and orthopnea, cranial nerve palsies, retinal exudates, testicular enlargement
3
Q
common laboratory findings at diagnosis
A
low hemoglobin
low platelet count
abnormal WBC- some very high, some lower
4
Q
treatment stages for leukemia
A
induction- puts into remission- 4 weeks
consolidation- treatment to spine 4-8 weeks
interim maintenance- rest phase 6-8 weeks
delayed intensification: reduces hiding cells- 8 weeks
maintenance: 2 yrs females 3 males
5
Q
common side effects w/ chemotherapy
A
bone pain, muscle weakness, avascular necrosis, peripheral neuropathy
6
Q
differential diagnosis for lymphadenopathy
A
infection
cyst
systemic disease- rheumatic
tumor- benign/malgnant
7
Q
when to biopsy lymph node
A
supraclavicular node, increasing size over 2-4 weeks, constitutional symptoms, asymptomatic enlarged node-not decreasing in size over 6 weeks or not normal after 8-12 seeks
8
Q
important factor to remember w/ non-hodgkinds lymphoma
A
can present w/ spinal cord compression and weakness
9
Q
wilms tumor
A
peak age 2-3 years
spreads to contralateral kidney, lungs
asymptomatic abdominal mass
increased risk w/ african americans
10
Q
overgrowth syndromes
A
beckwith-wiedemann syndrome
perlman
simpson-golabibehmel
sporadic hemihypertrophy
11
Q
neuroblastoma
A
tumor of sympathetic nervous tissue majority in adrenal or paraspinal or cervical
median age- 22 months
therapy: chemo, stem cell
12
Q
when to be concerned about bone pain
A
persistent pain
progressive pain
occurs at night
associated w/ swelling/mass/limitation of mvmt
13
Q
osteosarcoma
A
peak incidence in 2nd decade of life
occurs ealier in females- associated w/ growth spurt
occur in metaphyseal portion of long bones
pain, mass
most occur in distal femur, proximal tibia, proximal humerus while in swings, there is even split between extremities dn axial skeleton
14
Q
ewings sarcoma
A
most common in 2nd decade, also young children equally in extremities and central more constitutional symptoms no associations onion peel on xray
15
Q
therapy os and es
A
OS0 chemo, no radiation, surgical resection
ES- chemo and/or radiation, surgical resection if not axial
16
Q
most common pediatric brain tumor
A
supratentorial astrocytoma
17
Q
clinical features brain tumors
A
increased ICP irritability, lethargy early morning HA which improves vomiting- usually in AM unexplained changes in personality/behavior papilledema
18
Q
functions of renal system
A
filters waste regulates ion levels in plasma regulates blood pH conserves valuable nutrients regulates blood volume regulates RBC production
19
Q
functions of nephron
A
filtration
tubular reabsorption
tubular secretion
urinary excretion
20
Q
causes of acute renal failure
A
pre-renal: conditions that decrease renal blood flow (HF, sepsis, shock)
post-renal: conditions that obstruct urine output (kidney stones, prostatic hypertrophy, cancers of the bladder)
intra-renal: injury and/or inflammation within kidneys (interstitial nephritis, acute glomerulonephritis, ischemia)
21
Q
oliguria
A
daily urine output
22
Q
anuria
A
no urine production
23
Q
pyelonephritis
A
when a UTI progresses to involve the upper urinary system
s/s: back pain, flank pain, fever/chills, feeling sick, n/v, confusion, changes in urine
24
Q
urinary tract calculi (stones)
A
increased concentration of salts in good, UTI,
treatment: manage pain, hydration, cytoscope, lithotripsy
25
rhabdomyolysis
breakdown of muscle fibers, specifically of the sarcolemma of skeletal muscle, resulting in release of myoglobin
released myoglobin may cause acute kidney injury
shift of extracellular fluid into injured muscles resulting in undwrperfusion of kidneys and risk for compartment syndrome
26
causes of rhabdomyolysis
traumatic/compression
nontraumatic exertional
nontraumatic nonexertional (alcohol/drugs/infection)
27
triad s/s for rhabdomyolysis
muscle pain, weakness, dark urine
28
laboratory findings in rhabdo
creatine kinase >5x upper limit of normal
| higher the CK, greater the risk of AKI
29
causes of chronic renal failure
```
diabetic nephropathy
hypertension
glomerulonephritis
polycycstic kidney disease
kidney infections, obstructions, renal vascular disease
```
30
normal creatinine levels
.8-1.2 mg/dL
31
normal BUN levels
10-20 mg/dL
32
common laboratory measurements in renal dysfunction
hyperkalemia- muscle weakness, paralysis
hypercalcemia- stones, bones (pain), groans (abdominal pain), thrones (polyuria) and psychiatric overtones
bicarbonate- metablolic acidosis (low bicarb)- lethargy, fatigue, muscle weakness
33
continuous renal replacement therapy
use of an extracorporeal blood circuit through a small-volume low-resistance filter
34
peritoneal dialysis
uses peritoneum as semipermeable membrane and the diasylate is infused directly into the abdomen
35
important PT takeaways w/ dialysis
no bp measurements on same arm as fistula
protect arm from injury
control obvious hemorrhage
a thrill is normal
36
examination of the renal patient
skin: pallor, yellow-gray
face/extremities: peripheral edema
abdomen: observe abdominal contour for midline mass in lower abdomen
weight: weight gain 2nd to edema, weight loss and muscle wasting in chronic renal failure
37
murphys percussion
costovertebral angle at rib 12
| palm over angle and strike w/ other hand
38
functions of the GI tract
digestion: physical/chemical breakdown
absorption
excretion
host defense
39
4 layers of go tract
mucosea- epithelium
submucosa- regulates secretion
muscularis- regulates motility
serosa- connective tissue
40
achalasia
impaired esophageal persistalsis w/ failure of lower esophageal sphincter to relax
41
diverticulum
out pouching of wall
42
GERD
tussue damage due to reflux of gastric contents
barrett's esophogus- transformation of the normal esophageal squamous epithelium to columnar epithelium- increase risk for cancer
43
esophageal varices
dilated veins- lower 1/3 of esophagus, beneath mucosa, collateral veins develop, increased risk of rupture
44
4 regions of stomach
cardia, fundus, body, antrum (pyloric sphincter)
45
gastritis
inflammation of the inner lining of the stomach
| can be acute (NSAIDS/aspirin) or stress-induced
46
peptic ulcer disease
increased acid secretions and digestive enzymes erodee gastric mucosa
47
role of small intestine
absorb digested foodstuffs
48
large intestine function
re-absorption of water along with ions and some vitamins
49
crohns disease
progressive inflammation primarily of the distal ilium and colon but may include entire GI tract
50
ulcerative colitis
recurrent chronic inflammation of colon and rectum
51
s/s of crowns and UC
abdominal pain, cramping or swelling, GI bleeding, anemia, urgent bowel movements, fever, joint pain malabsorption, weight loss
52
hernia
protrusion of organ through the wall of the cavity that normally contains it
53
hemorrhoids
swelling and stretching of veins around the anal canal; varicose veins of hemorrhoidal venous plexus
54
red flags of GI bleeding
syncope, hypotension, pallor, diaphoresis, tachycardia
drop in Hct and Hgb
vomiting of blood; coffee ground emesis
55
adhesions
fibrous bands that form between tissues and organs- complication following GI surgery
56
side to stand on for abdominal palpation
right
57
difference between acute inflammation and chronic
acute- nonspecific response of living tissue
| chronic- destruction > repair
58
types of leukocytes
```
neutrophils
eusinophils
basophils
lymphocytes
monocytes
```
59
immune system lines of defense
```
*Nonspecific
first line: skin, mucous membranes
second line: phonetic white blood cells, antimicrobial proteins
*Specific
third line: lymphocytes, antibodies
```
60
innate immunity
comprises the cells and mechanisms that defend against other organisms in a non-specific manner
61
acquired/adaptive immunity
derives from the formation of antibodies and sensitized lymphocytes as specific humoral or cellular response
62
4 major types of autoimmune disorders and hypersensitivity reactions
type I hypersensitivity: allergies
type II: reactions to self antigens
type III: immune complex formation
IV: cell-mediated
63
Type I allergic response
occurs within minutes of exposure to antigen- IgE binds to mast cells and basophils, causes release of histamine, prostaglandins, and leukotrienes.
skin: flushing, hives, rash, itching lungs: SOB, wheeze, CV: coronary artery spasm, MI
64
Type II (cytotoxic) reactions
involves antibodies bindin to antigens on the ell surface: antigen may be intrinsic OR extrinsic (self or absorbed)
transfusion reactions, graves disease
65
Type III reaction
reactions against soluble antigens circulating in serum- usually involves IgG and IgM antibodies
result= prolonged inflammation w/ resultant damage
66
Connective tissue disease
Ex: lupus, RA, ankylosing spondylitis, ehlers danlos, marfans
diverse group of diseases in which connective tissues extracellular matrix proteins are damaged
67
systemic lupus erythematosus
multisystem autoimmune disease
| diffuse inflammation involving skin, joints, brain, kidneys, heart, lungs, serous membranes
68
aneurysm vs dissection
aneurysm: ballooning/weakening of vessel wall
dissection: tear in the intimal layer
69
clinical presentation of AAA
abdominal or back pain
hypotension
pulsatile mass
other common: groin/flank pain, hematuria, abdominal bruit
70
what seems to be more beneficial between open and endovascular aneurysm repair?
Endovascular. Open has higher ST mortality, longer IC stay, longer time to activity
71
Type IV delayed reaction
cell mediated
involve reactions by memory cells- subsequent contacts elicit a reaction
reactions are delayed by one or more days
tuberculosis, poison ivy, latex
72
exocrine function of pancrease
releases enzymes as a zymogen- activation occurs at the brush border of the small intestine.
73
Molecules that regulate pancreatic secretion
ACh= released before eating begins and stimulates acinar cells to secrete enzymes
Cholecystokinin- stimulates acinar cells to secrete enzymes
secretin- stimulates aqueous bicarbonate secretion
74
two major causes accounting for ~90% of pancreatitis cases
alcohol abuse and gallstones
75
pancreatic insufficiency
inability to secrete bicarbonate and water which limits the amount of enzymes released into the intestinal lumen
iability to break down nutritional content
76
2 distinct sources that supply blood to liver
oxygenate blood flows in from the hepatic artery
| nutrient rich blood flows in from the portal vein
77
sign that liver is enlarged
>2-3 cm below costal margin may indicate enlargement
78
functions of the liver
synthetic: production of plasma proteins and coagulation factors
excretory: production of bile
metabolism: synthesizes fats and carbs, storage of glycogen, protein catabolism
detoxification- of noxious compounds found in chemicals/drugs
79
3 blood tests for liver function
bilirubin (transaminases)
INR
creatinine
80
transjugular intrahepatic portosystemic shunt
percutaneous formation of tract between hepatic vein and intrahepatic segment of portal vein- blood flows from high pressure portal vein to lower pressure hepatic vein
81
asterixis
liver flap=sign of hepatic encephalopathy
| alternating flexion-extension of hands
82
hepatic encephalopathy
reversible decrease in neurologic function due to shunting of blood away from the portal circulation
associate w/ hepatic failure
extrapyramidal symptoms include: tremor, bradykinesia, cog-wheel rigidity, and shuffling gait
83
most common waste product to accumulate in the systemic circulation secondary
NH3
| hepatocytes incapable of metabolizing waste products
84
what can the accumulation of ammonia (NH3) lead to?
it crosses the blood brain barrier and is absorbed and metabolized by the astrocytes and use it when synthesizing glutamine. Glutamine increases osmotic pressure in the astrocytes which then become swollen and lead to cerebral edema
85
clinical stages of hepatic encephalopathy
0- subclinical, 4 coma/dilated pupils/oculocephalic reflexes, decerebrate posturing
86
hepatic disorders cv complications
```
cirrhotic cardiomyopathy
hyperdynamic syndrome (elevated HR and CO, decreased BP)
chronotropic incompetence
dysthythmias
peripheral edema
```
87
hepatic disorders pulmonary complications
ascites can impair diaphragm
| hepatopulmonary syndrome
88
fibromyalgia
chronic, non-inflammatory, non-autoimmune diffuse central pain processing syndrome
widespread pain and tenderness, depression, fatigue, poor sleep
89
what molecule is found in higher amounts in pts w/ fibro?
substance P
90
treatment for fibro
```
not just meds
start low, go slow
change one med at a time
avoid opioids
NSAIDS don't work
target central neurologic mechanism
```
91
Treatment of fatigue and depression
difficult
| fluoxetine, bupoprion, modafinil, SNRI's(better for pain than fatigue)
92
treatment for pain and sleep
tricyclic antidepressants
| snri's pregabalin, gabapenting, avoid opiods and NSAIDS
93
what unique factor shows increased activation and increased pain?
pain catastrophizing
94
PT treatment for fibro
aerobic training, resistance, flexibility (less so, but effective), group exercise, pool based exercises , neurodynamic mobilization, balance program
95
RA definition
chronic, systemic, inflammatory autoimmune disease of unknown etiology
chronic, symmetric, erosive synovitis
96
phases of RA
1: genetic risk- HLA DR, PTPN22
2: preclinical autoimmunity: RA related autoantibodies (RF, anti CCP_
Phase 3: clinical disease- RA related auto antibodies, clinical signs and symptoms, radiographic changes
97
etiology of RA
combination of unknown antigen in genetically susceptible host (HLA-DR1 or DR4)
98
pathophysiology of RA
synovial based
antigen injures synovial endothelial cells
synovial inflammation and release of inflammatory cytokines
stystemic symptoms- cytokines induce fibroblasts and chrondrocytes to produce PGE, collagenase and proteinases
---cartilage and bone destruction
99
factors making it most likely for criteria for RA
>10 joints with at least 1 small joint involved
High positive RF or high positive ACPA
abnormal CRP or abnormal ESR
symptoms >6 weeks
100
screening tool for RA
significant discomfort w/ squeezing the MCP and MTP joints
presence of 3 or more swollen joints
more than 1 hour of morning stiffness
101
most specific antibodies detected for diagnosing RA
RF AND anti-CCP
102
poor prognostic indicators of RA
earlier onset, female sex, polyarticular synovitis, elevated ESR or CRP level, cartilage loss on x-ray, HLA DR4, poor functional status
103
important consideration of cervical spine in RA
AAsubluxation due to laxity/ rupture of transverse ligament or
*thoracic, lumbar and sacral spine usually spared in RA
104
shoulder manifestations of RA
GH and AC joint
subacromial bursitis
rotator cuff
bicipital tendintis/rupture
105
elbow joint manifestations
loss of lateral stability, entrapment of ulnar nerve or radial nerve from synovitis
olecranon bursitis,
106
hand and wrist joint manifestations
```
MCP/PIP/wrist synovitis (DIP's spared)
ulnar drift
palmar subluxation of MCP
swan-neck deformity
boutonniere deformity
tenosynovitis
```
107
swan-neck deformity
rupture of extensor hood mechanism- flexion DIP, hyperextension PIP, flexion MCP
boutounniere- opposite
108
common hip joint manifestations of RA
half w/ evidence of hip disease, protrusion acetabuli, bursitis, avascular necrosis
109
knee joint RA
synovial thickening, quad atrophy, loss of full extension, baker's cyst
110
ankle/foot joints in RA
MTP synovitis, ankle synovitis in severe disease
MTP subluxation w/ deformities
pes planus, post. tib tendon rupture
valgus deformity of ankle
achilles tendon: tendinitis, nodules, rupture
tarsal tunnel syndrome
111
initial treatment of RA
```
NSAIDS- reduce swelling
multidisiplinary care
glucocorticoids- local injection or oral
DMARD's
modalities
joint protection
ROM
```
112
best anchor drug for RA
methotrexate
113
spondyloarthropathies definition
cluster of interrelated chronic inflammatory diseases including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, inflammatory bowel disease
114
enthesis
insertion site
115
gene w/ high correlation in ankylosing spondylitis
HLA B-27
116
classification criteria for axial spondy
sacroiliitis on imaging plus >/=1 spA feature
OR
HLA B27 plus >/=2 other SpA features
117
cardinal s/s AS
age 3 months
morning >60 min and nitetime stiffness
improves w/ activity
no neurologic symptoms
118
AS physical exam items
```
global loss ROM
schobers maneuver 10 cm to 15 cm
occiput to wall
chest expansion 4 cm
patrick test- fabere test
```
119
extraarticular manifestations of AS
```
eyes- acute anterior uveilitis
heart= aortic insufficiency, heart block
glut- IBD, crohns
cauda equina
kidneys-amyloidosis
lungs restrictive lung disease
osteoporosis
```
120
AS treatment
PT exercise (aerobic, strength flexibilit) and smoking cessation
Indocin (NSAID)
sulfasalazine and methotrexate for peripheral arthritis
anti-TNF
121
-mabs
TNF antagonist structures
122
poor prognostic factors AS
hip disease, onset
123
reactive arthritis
starts w/ GI infection, Salmonella, GU infection, chlaymdia
followed by urethritis, conjunctivitis, arthritis
formerly Reiters disease
LE joints- asymmetrical
SI asymmetrical
sausage digits
rash
124
treatment reactive arthritis
PT, intraarticular steroids, NSAIDS, slufasalazine, MTX, anti-TNF
125
key difference between psoriasis arthritis and RA in diff diagnosis?
DIP involvement of psoriatic arthritis
126
asymmetric oligoarthritis
most common presenting pattern of PsA- swelling of one knee
127
psoriatic arthritis mutilans
rare form of PsA- end stage condition of small joints of hands and feet
128
extraarticular manifestations
```
A- synovitis
A- acne
P- pustulosis
H- hyperostos
O- osteitis
```
