Other System Diagnosis

Question 1

Ankylosing Spondylitis

Answer 1

• system condition characterized by inflammation of the spine and the larger peripheral joints
• Males are at two to three times greater risk than females with peak onset observed between 20-40 years of age
• clinical presentation initially includes recurrent and insidious onset of back pain, morning stiffness, and impaired spinal extension

Question 2

Arterial Insufficiency Ulcer

Answer 2

• charcaterized by the narrowing of arterial vessels that impedes the delivery of oxygenated blood to tissues
• peripheral artery disease is typically linked to the development of arterial insufficiency ulcers; risk factors include athersclerosis, HTN, obesity, DM, and smoking

Question 3

Breast Cancer

Answer 3

• may spread to the lymphatic system and commonly metastasizes to the brain, lungs, bones, adrenals, and liver
• Breast cancer makes up 30% of all female cancers and is the second leading cause of death for females in the US
• Prognosis and 10 yr survival rates for women are over 85% for stage I; 66 % stage II; 36% stage III; and 7% for Stage IV disease

Question 4

Burn - full thickness

Answer 4

• Burn causes immediate cellular and tissue death and subsequent vascular destruction
• eschar forms from necrotic cells and creates a dry and hard layer that requires debridement
• absent sensation and pain due to destruction of free nerve endings, however, there may be pain from adjacent areas that experience partial thickness burns

Question 5

Burn- partial thickness

Answer 5

• superficial partial-thickness burn involves the epidermis and upper portion of the dermis; deep partial thickness burn involves the epidermis, majority of the dermis and structures within the dermis
• characterized by a red color that will blanch when touched; deep partial thickness burn is characterized by red discoloration, however it will not blanch
• will typically heal w/o residual deficits in the absence of infection or delay healing

Question 6

Complex Regional Pain Syndrome

Answer 6

• increases in sympathetic activity causes a release of norepinephrine in the periphery and subsequent vasocontriction of blood vessels resulting in pain and an increase in sensitivity to peripheral stimulation
• affects all age groups, but s likely found in individuals 35-60 with females being 3x more likely than males
• Pt experience intense burning and chronic pain in the affected extremity that eventually spreads in a proximal direction

Question 7

Diabetes Mellitus Type I

Answer 7

• insulin is functionally absent due to the destruction of the beta cells of the pancreas; where the insulin would normally be produced
• starts in children ages 4 to older, with the peak incidence of onset coinciding with early adolescence and puberty
• common symptoms include polyuria, poludipsia, polyphagia, nausea, weight loss, fatigue, blurred vision, and dehydration

Question 8

Diabetes Mellitus Type II

Answer 8

• characterized by an inappropriate cellular response to insulin, preventing adequate absorption of blood glucose; excess blood glucose results in a persistent hyperglycemic state
• may develop slowly prior to showing initial sympyoms that can include polydipsia, polyuria; blurred vision; delayed healing, frequent infections, and acanthosis nigricans
• medical management is typically focused on lifestyle changes and pharmaceutical intervention through various oral or injectable pharmacological agents

Question 9

Fibromyalgia Syndrome

Answer 9

• nonarticular rheumatic condition with pain caused by tender points within muscles, tone, and ligaments
• greater incidence in females potentially affecting any age
• widespread history of pain that exists in all four quadrants of the body

Question 10

Human Immunodeficciency VIrus

Answer 10

• primary risk factors for contracting HIV include unprotected sexual intercourse, intravenous drug use, or mother to fetus transmission
• w/o tx, HIV advances in three stages 1. acute HIV infection 2. clinical latency and 3. AIDS
• leading cause of death for patients with the virus are AIDS, non-AIDS-defining cancers, liver disease and cardiovascular disease

Question 11

Juvenile Rheumatoid artheritis

Answer 11

• autoimmune disorder found in children less than 16 years of age that occurs when the immune cells mistakenly begin to attack the joints and organs causing local and systematic effects throughout the body
• Girls have a higher incidence of JRA and are most commonly diagnosed as toddlers or in early adolescence
• clinical symptoms include persistent joint swelling,pain, and stiffness

Question 12

lymphadema post-mastectomy

Answer 12

• caused by an excess load of lymph fluid or inadequate transport capacity within the lymphatic system secondary to the loss of homeostasis
• primary contributing factor in the development of lymphedema following a mastectomy is the damage and/or removal of the axillary lymph nodes and vessels
• intervention should focus on manual lymph drainage, short stretch compression bandages, retrograde massage, exercise , compression therapy, and use of a mechanical pump

Question 13

Neuropathic Ulcer

Answer 13

• occurs most frequently in the diabetic population and are often referred to as diabetic ulcers
• at-risk areas include those that are routinely subjected to pressure during normal WB, atypical stresses due to structural changes or improper fitting footwear
• Will typically heal by secondary intention with appropriate wound healing interventions and the absence of complications

Question 14

Osteoporosis

Answer 14

• metabolic bone disorder where the rate of bone resorption accelerates while the rate of bone formation slows down
• Pt may complain of low thoracic or lumbar pain and experience compression fractures of teh vertebrae
• bone mineral density test accounts for 70% of bone strength and is the easiest way to determine osteoporosis

Question 15

Pressure ulcer

Answer 15

• unrelieved pressure deprives the tissues of oxygen which causes ischemia, subsequent cell death, and tissue necrosis
• high risk areas pressure ulcers include the occiput, heels , greater trochanters, ischial tuberosities, sacrum, and epicondyles of the elbow
• impaired cognition, poor nutrition, altered sensation, incontinence, decr lean body mass, and infection contribute to the development of a pressure ulcer

Question 16

Rheumatoid Arthritis

Answer 16

• systemic autoimmune disorder of the connective tissue that is characterized by chronic inflammation within synovial membranes, tendon sheaths, and articular cartilage
• incidence is three times greater in females than males and is diagnosed most frequently between 30-50 years of age
• blod work assists with the diagnosis of RA though evaluation of the rheumatoid factor, white blood cell count, erythrocyte sedimentation rate, hemoglobin, and hematocrit values

Question 17

Systemic Lupus Erythematosus

Answer 17

• connective tissue disorder caused by an autoimmune reaction in teh body
• females are at greater risk than males with the most common age group ranging from 15-40 years of age
• clinical presentation includes a red butterfly rasj across teh cheeks and nose, a red rash over light exposed areas, arthralgias, alopecia, pleurisy, kidney involvement, seizures, and depression

Question 18

urinary stress incontinence

Answer 18

• occurs during activities where there is an incr in abdominal pressure through straining, sneezing, coughing, or lifting
• risk factors include pregnancy, vaginal delivery, episiotomy, prostate or pelvic surgery, aging, DM, CNS dysfunction, and recurrent urinary infection
• accounts for 50-60% of all incontinence cases and is manifested solely by the involuntary loss of urine with any form of exertion or increased abdominal pressure

Question 19

VEnous insufficiency ulcers

Answer 19

• typically results from venous hypertension which may present idiopathically, secondary to valve incompetence or peripheral impedance
• Pain complaints are typically mild and relieved with elevation or use of compression garments
• tx of a venous insufficiency ulcer and teh underlying pathology should allow for a normal course of recovery w/o residual deficits

Question 20

cellulitis

Answer 20

• Refers to a noncontagious bacterial skin infection occurring in the dermal and subcutaneous layers
• typically presents with visible signs of inflammation including localized redness, warmth, tenderness, and edema that progressively worsens
• early detection and tx are vital in reducing complications and systematic infection; untreated cellulitis can spread, causing potentially fatal septicemia

Question 21

Chronic Fatigue Syndrome

Answer 21

• complex condition with an unknown etiology; potential etiologies include a viral origin, an immune response to inflammation with the NS or a combination of lifestyle factors
• best managed using a multidisciplinary approach including education, medical management, cognitive behavioral therapy, and exercise
• there is no cure; symptom presentation, progression and resolution can be highly variable making outcomes difficult to predict

Question 22

diastasis Recti

Answer 22

• Refers to a separation of the right and left sides of the rectus abdominis
• the condition is not exclusively seen in women who are pregnant, however there is a significantly prevalence among this population
• most patients improve with conservative tx focused on corrective exercise and do not suffer long-term functional deficits associated with teh condition

Question 23

Graves’ Disease

Answer 23

• most common form of hyperactive thyroid disorder and is the result of an autoimmune attack on the thyroid gland causing overproduction of the hormone thyroxine T4
• general complaints may influence heat intolerance, incr appetite, incr sweating, frequent bowel movements, physical fatigue, weakness, tremor, weight loss, and insomnia
• typically responds well to pharmacological intervention that regulates T4 hormone production

Question 24

Addison’s disease

Answer 24

• adrenal insufficiency that occurs due to dysfunction of the adrenal cortex resulting in decreased production of glucocorticoid and mineralocorticoid hormones
• glucocorticoid hormones assist in regulation of cardiovascular function, metabolism, and stress; mineralocorticoid hormones assist in regulation of fluid and electrolyte balances
• lab results of the rapid adrenocorticoid hormone test are considered to be definitive in the diagnosis of Addison’s disease

Question 25

Appendicitis

Answer 25

• inflammation of the inner lining of the appendix which may spread to other areas
• abdominal pain is most commonly reported with symptoms beginning ad either umbilical or gastric pain that migrates to the right lower quadrant
• examination findings typically include abdominal rebound tenderness, pain with percussion guarding and rigidity

Question 26

Crohn’s disease

Answer 26

• a specific form of inflammatory bowel disease in which the lining of the gastrointestinal tract becomes abnormally inflamed
• typical S/S range form mild to significantly debilitating to life-threatening
• symptoms may develop gradually or rapidly and typically include abdominal pain, cramping, diarrhea, blood in the stool, GI tract ulcers, diminished appetite, and weight loss

Question 27

Cushing’s Syndrome

Answer 27

• results from abnormally high levels of cortisol which may occur due to endogenous overproduction of cortisol or excessive exogenous use of corticosteroids
• typically present with hallmark physical signs including weight gain,purple striae, and a ruddy complexion
• may be diagnosed by lab analysis of cortisol levels in urine, saliva or blood

Question 28

Diverticular disease

Answer 28

• Benign condition characterized by the presence of outpocketings of the colon wall
• risk factors include constipation, a diet low in fiber, obesity, a lack or exercise, connective tissue disorders, and advanced age
• Pt are often asymptomatic, though may experience abdominal pain and tenderness, fever, nausea, vomiting, constipation or diarrhea

Question 29

electrolyte Imbalances

Answer 29

• commonly involve one of the following minerals: Ca, Cl, Magnesium, phosphate,K, and Na
• Symptoms vary depending on the mineral involved and may include a change in mental status or behavior, dehydration, poor skin elasticity, rapid HR, and sunken eyes
• Blood tests and urinalysis can be used to detect abnormalities in electrolyte levels

Question 30

Endometriosis

Answer 30

• condition in which the cells of the uterine lining begin to grow outside of the uterine cavity, resulting in scar tissue and adhesions forming within the pelvic and abdominal cavities
• Primary symptom is pelvic pain, which worsens during menstruation and can spread to the abdomen or lower back
• laparoscopy, a surgical procedure where a camera is inserted into the abdominal cavity to directly visualize the lesions, is used to definitively diagnose this condition

Question 31

Gastroesophageal Reflux Disease

Answer 31

• refers to the abnormal movement of partially digested solids, liquids, and gastric acid from the stomach into the esophagus
• most common complaints include heartburn, acid reflux, nausea after eating and feeling as though food remains trapped in the esophagus
• typically diagnosed reported symptoms and physical examination with additional testing for patients who do not respond to initial TX

Question 32

Gout

Answer 32

• considered a complex form of arthritis resulting from an abnormally high uric acid level in the body
• greater prevalence among males with the great toe, knee,and ankle being the most commonly affected joints; may present as a chronic condition or a series of acute attacks
• identification of uric acid crystals in synovial fluid, collected via synovial biopsy, may be used to confirm the diagnosis

Question 33

Herpes zoster

Answer 33

• varicella-zoster virus is responsible for outbreaks of chickenpox in children and herpes zoster “shingles” in adults
• highly contagious especially to pt with a compromised immune system
• symptoms typically begin with a unilateral painful itching or burning sensation caused by the virus’ initial attack on the nerve fibers

Question 34

Irritable Bowel Syndrome

Answer 34

• characterized by gastrointestinal distress and alterations inbowel habits, such as constipation and diarrhea, which may be triggered by foods, stress or illness
• there are three main types of the condition: diarrhea-predominant, constipation- predominant and alternating diarrhea and constipation symptoms
• diagnosis is based on symptoms and the exclusion of other similar conditions

Question 35

Lung cancer

Answer 35

• smoking, or exposure to smoke is the leading cause of lung cancer
• s/s that may suggest lung cancer include wheezing, coughing, hemoptysis, SOB, chest pain, weight loss, fever, clubbing of the fingernails and fatigue
• x-ray imaging is often used to detect an abnormal mass or nodule within the lungs, though computed tomography may be used to detect smaller lesions that cannot be seen on x-ray

Question 36

malabsorption syndrome

Answer 36

• condition in which the gastrointestinal tract fails to properly absorb nutrients from ingested food, which often results in malnutrition
• S/S differ depending on the nutrients not absorbed, though may include abdominal distention and bloating, flatulence, diarrhea, steatorrhea, soul-smelling stools, weight loss, weakness, fatigue anemia edema muscle cramps and excess bleeding
• there is no diagnostic testing for malabsorption syndrome though the condition should be considered if a pt suffers from chronic diarrhea, nutritional deficiencies, and significant weight loss despite having a normal diet

Question 37

malignant melanoma

Answer 37

• a form of sin cancer considered to be especially serious due to the high likelihood of metastasis that develops in the melanin-producing cells responsible for giving skin its color
• the first sign is a suspicious change in the appearance of a freckle or mole through asymmetry, irregular borders, uneven coloration or increased diameter
• diagnosis of malignant melanoma is typically confirmed by an analysis of biopsied tissue

Question 38

Metabolic Acidosis

Answer 38

• a state in which the pH of body fluids is abnormally low, which may result frm overproduction ir inadequate excretion of hydrogen ions or excessive excretion of bicarbonate ions
• common S/S include tachypnea, confusion, and lethargy, through other signs and symptoms may present depending on the underlying pathology
• lab analysis of arterial blood gases, serum electrolytes, and urine pH are used to identify abnormal acidity and differentiate between respiratory and metabolic acidosis

Question 39

Metabolic alkalosis

Answer 39

• a state in which the pH of body fluids is abnormally elevated, which may result from inadequate excretion of bicarbonate ions, ingestion of large amounts of bicarbonate or excessive excretion of hydrogen ions
• common S/S include bradypnea and symptoms of hypokalemia, though other S/S may present depending of the underlying pathology
• lab analysis of arterial blood gases, serum electrolytes,and urine pH are used to identify abnormal alkalinity and differentiate between respiratory and metabolic alkalosis

Question 40

multiple organ dysfunction syndrome

Answer 40

• chracterized by the physiologic dysfunction of two or more organs or organ systems that can be caused by infection, injury, hypermetabolism or circulatory shock
• clinical presentation varies depending on the severity of the condition as well as the organs or organ systems affected
• lab and imaging studies are used to identify the source of the condition and may include x-ray, computed tomogrpahy, ultrasonography, blood testing or lumbar puncture

Question 41

Peptic ulcer disease

Answer 41

• form when the balance of protective and erosive factors is disrupted to such an extent that epithelial injury occurs and subsequent erosion extends to the muscularis mucosa
• Primary symptom of a burning epigastric pain that occurs after eating; other symptoms include dyspepsia, chest discomfort, heartburn,fatty food intolerance, and hematemesis
• upper GI endoscopy is typically the diagnostic tool of choice allowing for visualization and tissue biopsy

Question 42

Prostate cancer

Answer 42

• generally slow growing cancer, though it can metastasize to other parts of the body, especially the lymph nodes and bones
• S/S likely to present in the advanced stages of the disease and may include difficulty urinating, nocturia, erectile dysfunction, blood in the urine or semen, pelvic or low back pain, and bone pain, if metastasized
• the prostate-specific antigen PSA test is a blood test used to determine the presence of elevated levels of PSA which can be indicative of prostate cancer

Question 43

Systemic Sclerosis

Answer 43

• connective tissue disease characterized by excess collagen deposition which leads to changes of the skin and internal organs
• S/S vary based on the organs affected but may include itching, skin that appears tight, reddish or scaly, raynaud’s phenomenon, muscle weakness, joint pain, decr lung function, pulmonary hypertension, GERD, decr gatsric or intestinal motility, intestinal malabsorption and renal disease
• Blood tests can be performed to detect elevated levels of certain autoantibodies and a skin biopsy can be performed to determine changes in the skin

Question 44

ulcerative colitis

Answer 44

• inflammatory bowel disease that results in chronic inflammation and the formation of ulcers in the large intestine
• S/S include abdominal pain and cramping, diarrhea, blood in the stools, urgency to defecate, weight loss, fatigue and fever
• the best test for diagnosing ulcerative colitis is endoscopy, which allows for direct visualization of the colon

Question 45

Urinary tract infection

Answer 45

• normally a sterile environment, but under certain conditions infectious organisms from internal or external sources can proliferate and cause infection
• characterized by a strong and persistent urge to urinate as well as burning sensation with urination
• urinalysis and urine culture are most commonly used to diagnose a urinary tract infection however, pt who suffer recurrent UTI may require more invasive diagnostic testing

Question 46

Uterine Cancer

Answer 46

• most common type of uterine cancer affects the endometrium, which is thought to occur when an imbalance of hormones causes the endometrium to grow thicker
• unexpected vaginal bleeding is the most common symptom associated with uterine cancer, especially when it occurs after menopause
• the only method to confirm the diagnosis of uterine cancer is through a tissue biopsy, which is obtains during a procedure known as dilation and curettage