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Medical Conditions > Medical Conditions Midterm > Flashcards

Medical Conditions Midterm Flashcards

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USMLE® Step 1 flashcards
1
Q

most common reason a foot ulcer in a patient with diabetes does not heal

A

lack of pressure relief

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2
Q

functions of the skin

A
  • Protection: barrier between internal/external environment
  • Thermoregulation: dilation/constriction of blood vessels in skin. Sweating/evaporation
  • Sensation: containing nerve endings- pain; temperature
  • Metabolism- synthesis of Vit D
  • Aesthetics/communication- provides looks/nonverbal communication
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3
Q

3 layers of skin

A

epidermis, dermis, hypodermis (many times not considered part of “skin”

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4
Q

Structure of epidermis

A
  1. Stratum corneum: dead cells-tough outer layer
  2. Stratum lucidum: may or may not be present (prominent on heels/palms)- AKA horny layer
  3. Stratum granulosum: area where keratinocytes are losing many of organelles from within cell transitional area- metabolically active
  4. Stratum Spinosum: visible spinal processes on cell- form little projections that go into dermis-stability of skin. Desmosomes act as cell-to-cell junction
  5. Stratum Basale: mitotically active where keratinocytes are born. Cells take 203 weeks to migrate from basal layer. Rete ridges protrude to anchor epidermis to dermis
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5
Q

What separates the epidermis from the dermis?

A

basement membrane

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6
Q

What are the 4 cell types in the epidermis?

A
  1. Melanocytes: basal layer- manufacture and secrete pigment
  2. Merkel Cells: basal layer- attached to sensory nerve endings
  3. Keratinocytes: arise from basal layer of epidermis to stratum spinosum: produce keratin, antibodies, and enzymes
  4. Langerhans cells: stratum spinosum- part of immune system
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7
Q

Dermis- three functions

A

Thickest layer

Functions: store supply of water, supply nutrients to epidermis, regulate body temperature

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8
Q

2 layers of dermis

A
  1. papillary layers: regulates body temp and supplies nutrients
  2. reticular layer: provides structure and elasticity
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9
Q

Hypodermis

A

Subcutaneous tissue (often not considered part of skin)

  • attaches skin to underlying bone and muscle- contains 50% of body fat
  • provides shock absorption/insulation
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10
Q

Erosion

A

loss of epidermis only

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11
Q

Partial thickness skin loss

A

loss of epidermis and part of dermis

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12
Q

Full thickness skin loss

A

loss of all of dermis and into subcutaneous tissue

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13
Q

4 steps of wounding and hemostasis

A
  1. vessel injury
  2. vascular spasm: vasoconstriction- reduce blood flow
  3. platelet plug: primary hemostasis
  4. coagulation: secondary hemostasis- form stable thrombus
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14
Q

What cells act during the inflammation process to mediate vasodilation and vasoconstriction?

A

Mast cells

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15
Q

What cells act during inflammation to kill and degrade pathogens?

A

Neutrophils

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16
Q

What cells act during inflammation secrete cells that attract the immune system?

A

Macrophages

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17
Q

5 cardinal signs/symptoms of acute inflammation

A
  1. redness
  2. edema/swelling
  3. heat
  4. pain
  5. loss of function
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18
Q

3 major components of inflammation

A
  1. alterations that lead to increased blood flow
  2. plasma proteins and leukocytes leave the circulation
  3. emigration of leukocytes from the microcirculation to the site of injury combined w/ activation of immense cells
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19
Q

destruction >repair

A

chronic inflammation (may be occurring simultaneously w acute inflammation

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20
Q

The 5 stages of wound healing

A
  1. hemostasis: vasoconstriction/platelets
  2. inflammation: heat/pain/edema
  3. proliferation/migration: granulation tissue- migration of fibroblasts
  4. Remodeling/maturation: around 21 days- changes to type 1 collagen
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21
Q

Mitotic activity for the epidermis occurs in which of the following layers?

A

stratum basale

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22
Q

normal wound healing follows what sequence?

A
  1. hemostasis
  2. inflammation
  3. proliferation
  4. remodeling
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23
Q

Does epidermis have direct blood supply found in the stratum spinosum?

A

no- it is found at the stratum basale

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24
Q

classic signs of inflammation include edema, redness and pain- what are they due to?

A

mast cells release histamine which increases vascular permeability

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25
Q

What would you use to elevate pressure in a patient that requires 2 persons assist to roll in bed?

A

-use a hoyer lift to mobilize the patient out of bed several times per day

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26
Q

what would you do with a patient that weighs 600 lbs. and frequently has to use the bathroom?

A

use expanded capacity sling lift and transfer her to a bedside commode

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27
Q

Do PT’s have the autonomy to apply SPH concepts when most appropriate based on pt presentation?

A

yes

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28
Q

discomfort in the chest or adjacent areas associated with myocardial ischemia leading to myocyte necrosis

A

myocardial infarction

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29
Q

second heart sound associated with

A

aortic valve closure

30
Q

first heart sound associated with

A

mitral and tricuspid valve closure

31
Q

elevation of the S-T segment on an electrocardiogram associated with

A

myocardial ischemia

32
Q

QRS wave of electrocardiogram is produced by

A

depolarization of the ventricles

33
Q

which of the following will normally increase resistance to blood flow the most

A

decreasing the diameter of the blood vessel

34
Q

The AHA states that essential hypertension that requires medical management results from:

A

abnormalities in aretiolar vasomotor tone

35
Q

Bilateral LE edema, dyspnea walking less than 1 block, and an S3 heart sound is consistent with what diagnosis

A

heart failure

36
Q

shortness of breath and GI discomfort are considered angina equivalents in this population

A

patients with diabetes mellitus

37
Q

what is a pressure ulcer the consequence of?

A

ischemia and anoxia to tissue- commonly due to pressure, or pressure in combination with shear/friction

38
Q

4 stages of wounds

A

1: discoloration of skin/warmth/swelling/hardness
2. partial thickness skin loss
3. full thickness skin loss involving damage to underlying tissue- extends down to but not through fibrous tissue beneath skin
4. extensive tissue/cell seat, damage to muscle, bone or supporting structures

39
Q

What are the key points of pressure ulcers

A
  1. occur over bony landmarks

2. caused by shear, friction, or pressure forces, or moisture

40
Q

what is the most appropriate exercise intensity range for someone who has a HR range of 66-121 bpm?

A

HR= 80-96 bpm

41
Q

Complaints of left shoulder and jaw pain while exercising at the prescribed intensity during cardiac rehab would indicate…

A

contraindication to continuing a scheduled exercise session

42
Q

A probably cause of increased myocardial oxygen demand while rushing to the office resulting iin a heart attack includes…

A

increase in pulse rate

43
Q

Atenolol, a beta blocker is indicated because

A

beta blockers will decrease resting heart rate reducing myocardial oxygen demand

44
Q

6 cardinal symptoms of cardiovascular disease

A
  • chest pain/discomfort
  • dypnea,othopnea, wheezing
  • palpitations, dizziness, passing out
  • cough, hemoptysis
  • fatigue, weakness
  • pain in extremities with exertion
45
Q

Origins of chest pain

A

Cardiac origin: angina/MI/pericarditis/cor pulmonale
Non-cardiac origin: pulmonar-pleurisy, phenmothorax, GI: heartburn/GERD, pancreatitis, MSK: fibromyalgia/rib fx/TOS, Neuropsychiatric: anxiety/panic

46
Q

Definition of angina

A

demand>supply

aggravated by: physical exertion, emotional stress, cold/heat/humidity, heavy meal

47
Q

What relieves angina?

A

rest, NT

48
Q

Angina equivalents

A
  • SOB/DOE
  • n/v
  • weakness/lethargy
49
Q

Angina pectoris

A

-discomfort in the chest and/or adjacent area associated w myocardial ischemia, but without necrosis (angina can LEAD to MI but doesn’t have to)

50
Q

Myocardial infarction

A

local arrest of sudden insufficiency of arterial blood supply that produces an area of necrosis in the heart

51
Q

4 components of oxygen demand in the heart

A

HR, preload, afterload, contractility

52
Q

Examples of demand angina

A

increased: HR, contractility, preload, afterload

53
Q

Examples of supply angina

A

vasospasm, fixed stenosis, thrombus

54
Q

Cardiac markers after acute myocardial infarction

A

Creatine-iinase-MB used to be marker of choice for someone having heart attack- most specific marker now considered Cardiac troponin

55
Q

3 risk factors most closely associated with cardiovascular diseases?

A

smoking, high BP, elevated cholesterol

56
Q

Difference in stable and unstable angina

A

-unstable angina is the change in pre-existing patterns that leads to increased morbidity/mortality- DONT TREAT pts w unstable angina

57
Q

What is the common cause of unstable angina and printzmetal’s variant angina?

A

unstable angina: thrombus
printzmetal’s: vasospasm
(stable angina= fixed stenosis)

58
Q

3 medical treatments for MI

A
  • risk factor reduction
  • cardiac rehabilitation
  • pharmacologic therapy
  • sugery “revascularization” procedures
59
Q

sternal precautions

A
  • weight restriction (5-10 lbs)
  • UE ROM: shoulder elevation <90 degrees, horizontal abduction
  • driving (6-8 weeks)
  • observe for sternal click/infection
  • brace with cough
60
Q

Aortic stenosis

A
  • obstruction to flow from LV into ascending aorta
  • systolic abnormality
  • impairs forward flow
  • leads to ventricular hypertrophy
61
Q

Aortic insufficiency/regurgitation

A
  • retrograde blood flow from the aorta into the LV through an incompetent aortic valve
  • diastolic run off- reduces forward flow
62
Q

Mitral stenosis

A
  • obstruction to flow from LA into LV because of a narrowed mitral orifice
  • “diastolic” abnormality
  • reduces filling, reduces SV/CO
63
Q

Mitral regurgitation

A
  • retrograde flow of blood from LV into LA
  • reduces forward flow
  • increases next diastolic preload
64
Q

pump failure and filling failure

A

systolic (larger chamber size/dilated cardiomyopathy) and diastolic (smaller chamber/hypertrophic cardiomyopathy)

65
Q

At what percent of ejection fraction does one have heart failure

A

50%- as ejection fraction falls, mortality rate increases, but CANNOT judge oxygen consumption or functional abilities by ejection fraction

66
Q

Primary hypertension caused by?

A

TPR/abnormal vasomotor tone
account for 90% of HTN cases
unknown etiology

67
Q

Secondary HTN

A

usually a known cause and is 10% of HTN cases

68
Q

Prehypertension and stage 1

A

120-139/80-89 mmHg

140-159/90-99 mmHg

69
Q

Complications of prolonged/uncontrolled HTN

A
  • changes in vessel wall- trauma/arteriosclerosis

- target organ dysfunction: cardiovascular system, renal system, nervous system, eyes

70
Q

lifestyle modifications that can reduce BP

A

-weight reduction, adopt DASH eating plan, dietary sodium reduction, physical activity, moderation of alcohol consumption

Medical Conditions (3 decks)

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