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pathophysiology > lecture 1 > Flashcards

lecture 1 Flashcards

1
Q

progression of disease

A

Preclinical phase (disease onset, symptom onset)

Clinical phase (clinical diagnosis, death)
- disease persists along a continum

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2
Q

levels of prevention

A

primordial: maintain health, avoid risk

primary: reduce and eliminate risk, avoid clinical disease events

secondary: minimize severity, reduce likelihood of repeat events

tertiary: minimize impact of chronic clinical disease

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3
Q

syndemic factors

A

when 2 or more concurrent factors exacerbate prognosis or burden of a disease (social, mental, environmental factors that promote and worsen disease)

comprehensive approach to disease understanding and management

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4
Q

symptoms

A

patient complaints, descriptions

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5
Q

signs

A

what you can detect with senses

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6
Q

pathogenesis

A

natural history, how a disease develops

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7
Q

etiology

A

cause of disease

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8
Q

diagnosis

A

determination of nature and cause of illness

(clinical history, physical examination, differential diagnosis)

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9
Q

prognosis

A

eventual outcome of disease

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10
Q

treatment

A

directed at underlying cause

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11
Q

symptomatic treatment

A

alleviates symptoms but doesn’t influence course of disease

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12
Q

clinical history (5 components)

A
  1. history of current illness
  2. medical history
  3. family history
  4. social history (syndemic factors)
  5. review of symptoms (symptoms other than disclosed in history of present illness, suggesting other parts of body affected by disease)
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13
Q

differential diagnosis

A
  • consideration of other diseases or symptoms explaining signs and symptoms of patient
  • diagnostic possibilities narrowed by lab tests/ other diagnostic procedures
  • opinion of medical consultant?
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14
Q

physical exam

A

systematic exam of patient with emphasis on parts of body affected by illness
- ex. vitals, resp exam, cardiac exam, abdominal exam, neuro exam, psych exam, ocular exam, abnormalities noted (see notes for details of each exam)

  • after this, revisit differential diagnosis
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15
Q

general diagnostic test considerations (6 things)

A

-cost
-speed/timing/ availability
- invasive vs noninvasive
- false positive/ false negative ratio (specificity/ sensitivity)
- target/ evidence based (vast and growing number/ types of testing available)
- inform treatment

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16
Q

sensitivity and specificity

A

-highly sensitive = few false neg
-highly specific = few false pos

a perfect test does not exist, most have a crossover of sensitivity and specificity

  • move cutoff left: less false neg, more false pos, more sensitive, less specific
  • move cutoff right: less false pos, more false neg, more specific, less sensitive
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17
Q

sensitivity

A

how well a test picks up disease (truly pos)

measures threshold of detection

%sensitivity = TP/(TP + FN)
- poor sensitivity = more false neg (not picking people up as positive)

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18
Q

specificity

A

how well a test identifies one who doesn’t have disease (truly neg)

ability to not get an incorrect result from cross reaction

%specificity = TN/(TN+FP)
- poor spec = more false pos

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19
Q

screening tests for disease

A
  • detect EARLY ASYMPTOMATIC diseases amenable to treatment to prevent or minimize late-stage organ damage/ cancer
  • routine for pts (physicals, cholesterol, skin, BP)
  • Ontario/ Province wide programs (breast, cervical, lung, colon)
  • specific risks/ occasions (infectious disease, prenatal/ newborn)
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20
Q

screening for genetic diseases/ susceptibility

A
  • screen for CARRIERS of genetic diseases transmitted from parent to child as a dominant or recessive trait
  • ex. recessive gene for sickle cell anemia
  • identifying carriers lets them decide if they want to have kids
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21
Q

requirements for affective screening

A
  • groups suitable for screening (significant number of people at risk in screening group)
  • suitable screening test (appropriate, inexpensive, non-invasive, low # of false neg and false pos, actionable results/ benefit, are weaknesses warrented?)
  • benefits of screening (benefit outweighs risks)
  • invasive vs non-invasive
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22
Q

clinical lab tests

A

determine concentration of substances that are frequently altered by disease by disease in BLOOD or URINE

23
Q

uses of clinical lab tests

A
  • Determine concentration or activity of ENZYMES in the blood
  • Evaluate function of ORGANS
  • Monitor response of certain CANCERS to treatment
  • Detect disease-producing organisms in urine, blood, feces, CSF
  • Determine response to ABX
24
Q

ultrasound

A
  • maps echos produced by high frequency sound waves
  • reflected with change in tissue density
  • reflective waves recorded and image produced
  • low risk/ non-invasive/ fast/ cheap
25
Q

ultrasound - study uterus during pregnancy

A
  • determine position of placenta and fetus within uterus
  • identify fetal abnormalities
  • detect twin pregnancies
26
Q

ultrasound - study structure and function of heart valves

A
  • identify valve abnormalities/ clots
  • determine size/ thickness of ventricular walls/ chambers and septum (echocardiography)

*ultrasounds also identify gall/bladder stones

27
Q

x-ray

A
  • high-energy radiation waves at lower doses to produce images to help diagnose disease
  • can penetrate through tissues at varying degrees depending on tissue density
  • act on a photographic film or plate (roentgenogram) as the rays leave the body
28
Q

x-ray - radiopaque

A
  • high density tissues (bone)
  • appears white on film
  • absorb most of rays
29
Q

x-ray - radiolucent

A
  • low-density tissues
  • appears dark on film
  • allows rays to pass through
30
Q

x-ray - contrast media (BRIAC)

A
  • contrast media can be used to outline structures not otherwise seen on standard films
  • barium sulfate (intestinal tract)
  • radiopaque oil (bronchogram)
  • intravenous dye (intravenous pyelogram, urinary tract)
  • arteriogram (blood flow to see narrowing or obstruction)
  • cardiac catheterization (blood flow through heart, detect abnormal communications between chambers)
31
Q

CT (computed tomography) scan

A

radiation detectors record amount of x-rays or ionizing radiation absorbed by body and feed data into computer that reconstructs data into an image

  • radiopaque and radiolucent tissues appear white and dark like a conventional x-ray
  • individual organs appear sharp by planes of fat that appear dark because of low density
  • delivers higher dose of ionizing radiation than x-ray
32
Q

compare different diagnostic tests

A

CT = better pic than x-ray
MRI = better than CT

33
Q

CT scan uses

A
  • screen for cancer in asymptomatic
  • detect abnormalities in internal organs that can’t be identified by standard x-ray
34
Q

MRI (magnetic resonance imaging)

A
  • computer-constructed images of body in response to hydrogen protons in water molecules when placed in a strong magnetic field
  • protons align in direction of magnetic field
  • protons are temporarily dislodged and wobble when radiofrequency waves are directed at them
  • protons emit measurable signal (resonance) that can be used to construct images
  • intensity of resonance depends on water content of tissues, strength, and duration of radiofrequency pulse
35
Q

MRI - T1 and T2

A
  • can further boost sensitivity of MRI with weighted scans (T1 and T2)
  • they show different pics (see notes for more info)
36
Q

MRI advantages over CT (4 things)

A
  • no ionizing radiation (safe for pregnant or children)
  • detect abnormalities in tissues surrounded by bone (spinal cord, orbit, skull)
  • better show cancer, metastases
  • more detailed image

BUT you can’t get an MRI if you have metal (or other implants/ devices) due to powerful magnet in MRI

37
Q

PET (positron emission tomography)

A
  • measures METABOLISM of biochemical compounds labelled with positron-emitting isotopes to measure organ function (eg. glucose - inflammation)
  • assesses biochemical functions in brain
  • evaluate changes in blood flow in heart muscle after heart attack
  • distinguish benign from malignant tumour (increased glucose uptake in malignant vs
  • determine metabolic activities of organ tissue: specific site in organ where compound is metabolized
38
Q

disadvantages of PET

A
  • expensive
  • not widely available
  • requires facilities for incorporating isotopes into biochemical compound
39
Q

combined PET and CT

A
  • PET shows dots, useless on it’s own so it needs CT with it
40
Q

radioisotope (radionuclide) studies

A
  • evaluate organ function by determining rate of uptake and excretion of substances labeled with a radioisotope
41
Q

uses of radioisotope studies (AHPCH)

A
  • anemia (radioisotope-labeled vitamin B12)
  • hyperthyroidism (radioactive iodine)
  • pulmonary blood flow (albumin to detect presence of blood clots)
  • cancer spread (phosphorus to determine presence of tumour in bone or spine)
  • heart muscle damage (evaluate blood flow)
42
Q

cytology

A
  • liquid
  • sputum, CSF, pleural/ pericardial fluid
  • Pap smear: identifies abnormal cells in fluids or secretions (for recognizing early changes associated with cervical cancer) and other cancer screening
  • infectious disease detection
43
Q

histology/ biopsy

A
  • solid
  • tissue samples obtained from histologic examination to determine abnormal structural and cellular patterns accompanying disease
44
Q

tests of electrical activity

A

measure electrical impulses associated with body functions and activities

45
Q

tests of electrical activity - ECG

A
  • changes in electrical activity of HEART (in various phases of cardiac cycle)
  • identify disturbances in heart rate, rhythm, abnormal pulses
  • recognize heart muscle injury from ECG abnormalities
46
Q

tests of electrical activity - EEG

A

electrical activity of BRAIN waves

47
Q

tests of electrical activity - EMG

A

electrical activity of SKELETAL MUSCLE during contraction and at rest

48
Q

endoscopy

A
  • examine interior of body (natural holes) using rigid or flexible tubular instruments with lens and light source
  • perform surgery formerly done through large abdominal incisions (endoscopy allows less invasive)
49
Q

examples of endoscopy

A

bronchoscopy: trachea and major bronchi
cystoscopy: bladder
laparoscopy: abdomen
colposcopy: cervix
colonoscopy: colon
arthroscopy: joints

50
Q

treatment

A
  • disease course and treatment options should allow the development of a PROGNOSIS (determination of probable outcomes and survivability)
  • treatment choice should consider health, stability/ supports for patient, cost to patient
51
Q

preventative treatment

A
  • ex. statins to reduce risk of CVD, vaccinations
  • suppress but don’t eliminate
52
Q

specific treatment

A
  • ex. abx to treat an infection
  • targeted to problem (trying to treat it, not prevent it)
53
Q

symptomatic treatment

A

-treats symptoms, doesn’t get rid of underlying problem
- can be used to manage symptoms as body heals or palliative

  • ex. treatments to manage COGNITIVE and BEHAVIORAL symptoms for dementia patients (disease management and QoL)
  • ex. tylenol for sore throat

pathophysiology (10 decks)

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