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Patho Exam 1 > Patho Exam 3 > Flashcards

Patho Exam 3 Flashcards

1
Q

herniated disc

A

rupture of disc causing fluid to leak out and impinge on and irritate nearby nerves.
- decrease in cushioning of vertebral joints
-back pain and limited mobility
- can cause sciatica

risk factors:
- Age 30 to 50 years
- Excess weight
- Regular heavy lifting, bending, and twisting
- previous back problems
- smoking and genetic factors

clinical manifestations:

with abrupt herniation
- nerve root compression
- severe pain
- muscle spasms

with gradual herniation
- slow onset of pain
- weakness or tingling

diagnosis: mobility tests, CT, MRI, or myelography, nerve conduction studies, blood tests

treatment: NSAIDs, Opioids, Antisasmodics, cortisone or corticosterioids, surgery (laminectomy, discectomy, spinal fusion)

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2
Q

herniated disc (tomei)

A

L4, L5. Butt, hamstrings, quads. Pulposus of the disc (where the irritation is)

  • most common age for this is 30-50.
  • most of the time, they will need physical therapy to strengthen core muscles.
    -usually midback, lower region.

disc degeneration: patient will need surgery for this, physical therapy won’t help.

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3
Q

pregnant women

A

women who are pregnant can get back pain. She needs to deliver that baby, get rid of the extra weight.

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4
Q

spinal stenosis

A

narrowing of spinal column
- vertebral bone degeneration with aging.

slow progressive symptoms:
- numbness
- weakness
- cramping
- general pain (may radiate down arm or leg)

diagnosis: medical history and physical examination.
- x ray, MRI, CT scan
- myelography

treatment: NSAIDs, steroid injections (nerve blocks), physical therapy (lumbar brace)

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5
Q

Lordosis (tomei)

A
  • spinal column more concave
  • pregnancy or obesity
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6
Q

scoliosis (tomei)

A
  • Lateral curve of spine
  • C shaped or S shaped
  • Severe scoliosis (rotation of spine, leading to deformities and disability)

risk factors: age 9 to 15 years
- neuromuscular disorder
- family history

types: idiopathic, congenital (incomplete formation or separation of vertebrae), neuromuscular scoliosis

Curve patterns
Dextroscoliosis: right thoracic curve
Kyphoscoliosis: outward and lateral spine curvature
Rotoscoliosis: curvature of vertebral column turned on its axis
Levoconvex
Curvature of spine to the left and thoracolumbar scoliosis
Curvature related to both thoracic and lumbar regions

Sideways curvature
Mild scoliosis: 10 to 20 degrees
Moderate scoliosis: 20 to 40 degrees
Severe scoliosis: over 40 degrees
Structural vs. nonstructural
Structural
Deformities of bones in spinal column
Nonstructural
Poor posture, differences in leg length, tumors, adaptation to pain

Clinical manifestations
Spinal curvature to one side, uneven hips or shoulders
Differences in leg length
Tiredness of spine
Prominent shoulder blade
Rib bump
Complications
Heart and lung problems
Paralysis

Diagnosis
Adam forward bend test
X-ray
MRIs, CT scans, or bone scans
Treatment
Pain management
OTC analgesics, prescription NSAIDs, opioids
Physical therapy (15–25 degrees)
Brace (20–40 degrees)
Spinal fusion surgery (over 40 degrees)

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7
Q

kyphosis

A

spinal column convex

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8
Q

scoliosis (tomei)

A

usually screen kids from school.
what are treatments? when do we put a brace on them?

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9
Q

osteoarthritis

A
  • most common form of arthritis
  • wear and tear on joints break down cartilage (causes bone to rub on bone)

gender differences:
men: OA in hips, knees, spine
women: OA in hips, knees, hands

risk factors:
- jobs requiring hard labor or repetitive motion
- obesity
- certain medical conditions

classications:
1) idiopathic OA: localized OA affects one or two joints. Generalized OA affects three or more joints.

2) secondary OA:
caused by underlying condition

etiology and pathogenesis: cartilage breaks down, allowing bones to rub against each other.
- bone spurs
- mobility issues

clinical manifestations: mild symptoms that worsen over time. pain associated with joint degeneration.

diagnosis: most common: X- ray.
others: MRI, ultrasound, blood tests, and joint fluids analysis

treatment: cortisone injections, surgery, OTC analgesics

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10
Q

osteoarthritis (tomei)

A
  • wear and tear tissue
  • pain that gets worse with activity
  • it’s relieved with rest. with rest you can get stiffness
  • it is unilateral
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11
Q

rheumatoid arthrisis (RA)

A
  • chronic systemic autoimmune disorder
  • most common form of autoimmune arthritis
  • cause unknown: various factors may be involved.

pathogenesis: antibodies in RA bind with other proteins and tissues. create immune complexes that cause inflammation. enzymes cause further joint tissue degeneration.

clinical manifestations: joint swelling, stiffness, warmth, tenderness, pain, joint deformation

systemic manifestations: fatigue, anorexia, weight loss, weakness, low-grade fever.

diagnosis: blood tests, anti-cyclic cirtrullinated peptide (CCP) test, examination of synovial fluids

treatment: NSAIDs, low dose oral corticosteroids, intra-articular steroid injection

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12
Q

rheumatoid arthritis (tomei)

A
  • bilateral
  • most common in women 40-60.
  • mostly in finger, claw like hand.
  • its an autoimmune disorder so they have the antibodies for the cyclic citrullated peptides
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13
Q

psoriatic arthritis (tomei)

A

patients will have a rash

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14
Q

osteopenia

A
  • decrease in bone density
  • can lead to fractures.

common causes: chronic eating disorders or issues with metabolism, chemotherapy or glucocorticoids, radiation exposure, caffenated drinks, alcohol

clinical manifestations: none, spontaneous fracture (limited pain)

diagnosis: DEXA scab

treatment: increased calcium and vitamin D intake. increased weight-bearing exercises

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15
Q

osteopenia (tomei)

A
  • degeneration of the bone.
  • Lack of vitamin D and calcium.
  • patients should decrease their carbonated drink (caffeine, soda) intake.
  • patients should take calcium and vitamin D supplements.
  • squats, dead lifts, weight bearing exercises.
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16
Q

scoliosis (tomei)

A

middle age

in school: Nurse, bend over, check spine, check for lyse (this is called the Adam’s Forward Bend Test)

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17
Q

osteoporosis

A
  • most commonly diagnosed metabolic bone disorder
    -low bone density due to low intake of nutrients for bone growth or increase in bone resorption due to aging.

primary osteoporosis
- type 1: menopause
- type 2: decreased bone formation from aging

diagnosis: DEXA scan
- may not be diagnosed until fracture occurs

treatment focuses on preventing fractures:
nutritional support, calcium and vitamin D
- exercise
- measures to prevent falls
- medications

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18
Q

paget disease

A
  • metabolic disorder
  • causes select bones to overgrow and become week (skull, spine, pelvis, and femur)

etiology and pathogenesis: bone reabsorption faster than bone formation.

pain, enlarged bones, deformed bones.

diagnosis: presence of fracture, X ray, blood tests

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19
Q

fractures

A
  • break in a bone
  • direct force or indirect force

risk factors: age.
younger patients: sports-related injuries
older patients: falls and disease

  • poor nutrition
  • lifestyle habits (dangerous activities)
  • could be presence of bone disease
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20
Q

healing of fractures

A

Indirect healing

Inflammatory stage:
Bleeding causes hematoma
Inflammatory cells degrade debris and bacteria

Reparative stage:
Fibrocartilage formed
Soft callus joins fractured bone
Hard callus develops
Blood vessels form

Remodeling stage:
Lamellar bone replaces woven bone

Union:
Normal healing

Nonunion:
No clinically significant progress toward complete healing for at least 3 months according to x-rays

Delayed union:
Significantly longer than expected healing time

Malunion:
Bone fragments joined in position not anatomically correct

Direct healing
Use of surgical procedure to realign bone
Fractures that benefit from direct healing
Long-term complications
Severely comminuted; threatened vascularity
Surgical procedures
External fixation
Internal fixation
Closed reduction

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21
Q

closed fracture

A

not something that breaks through the skin

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22
Q

open fracture

A

bone breaks through the skin and exposed to environment

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23
Q

how long does it take a fracture to heal?

A

6-8 weeks patient should be able to get movement. Could take a couple of years to get the bone at its full strength. with time, 1-2 years it will regenerate.

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24
Q

internal vs external fixation (tomei)

A

internal fixation: involves the use of devices internally (under the skin) positioned within the patient’s body.

external fixation: the devices are screwed into fractured bones to exit the skin and are attached to a stabilizing structure outside the body

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25
Q

what if someone in a cast has tingling paralysis when it was put on?

A

compartment syndrome. nerve damage, it is a medical emergency.

26
Q

compartment syndrome

A

edema and swelling cause increased pressure in muscle compartment
- decreased blood flow
- possible muscle and nerve damage
- cycle of continually increasing pressure in limb
- ischemia may cause muscles and nerves to die (limb might need to be amputated)

  • most common in lower leg and forearm

prevention: elevation and ice

complications: paralysis, need for amputation, volkmann contracture

27
Q

complications of fractures

A

fat embolism syndrome:
- closed long bone or pelvic fractures
- fat emboli becomes trapped in pulmonary and dermal capillaries
- no symptoms in most patients
- large amount of fat released may cause fat embolism

treatment: oxygen administration, mechanical ventilation, prophylactic treatment with corticosteroids and early immobilization of injury

28
Q

fat embolism (tomei)

A

major trauma due to leg. rapid short breathing dyspnea, clot can develop to the lungs.

29
Q

strain and sprain (tomei)

A

both ice, elevation. Don’t put heat on it for at least 72 hours later.

30
Q

strain

A
  • overstretching injury to muscle or muscle- tendon unit
  • forces muscle to extend beyond capacity, resulting in microscopic tears
  • most common sites: lower back and neck

-immediate pain, reduced range of motion (ROM)
- muscle spasms
- edema
- muscle weakness

31
Q

sprain

A
  • ligaments around joint stretched or torn
  • oppositional forces cause ligament to overstretch and tear
  • most common site: ankle
  • severely hindered ROM
  • pop or rip when injury occurs
  • bruising, pain, immediate swelling
32
Q

strain and sprains treatment

A
  • RICE, NSAIDs
  • casts, splints, immobilizers, or slings
  • surgery for severe injuries
  • physical therapy
33
Q

ACL (tomei)

A

you will usually tear your meniscus as well; knee will pop.

  • don’t need surgery all the time, could heal on its own.
34
Q

ACL (anterior cruciate ligament)

A
  • one of four major ligaments that connects the femur to the tibia
  • injuries occur when stressed, strained, or town

etiology: decelerating while running
- twisting or jumping

pathogenesis:
- tear down middle of ligament
- ligament torn completely from femur

clinical manifestations; intense pain, feeling that knee “popped” and “gave out”, swelling

diagnosis: X- ray and MRI

treatment: ice, elevation, pain medication NSAIDs
- physical therapy
- non-weight bearing until swelling subsides
- surgery if symptoms persist

35
Q

rotator cuff (tomei)

A

patient can’t lift their arm above their head. can’t reach the back of their head. need to rest arm, they may need surgery. first 6 weeks, passive movements they can’t be throwing a baseball.

36
Q

rotator cuff tears

A
  • tendon supporting muscle rips or tears from the bone

causes: fall on shoulder, attempt to break fall with outstretched hand, repeated overhead motions

clinical manifestations: dull ache in joint from microscopic tears, weakness when raising arm, inability to reach behind back

diagnosis: shoulder ROM assessment, X- Ray, Ct scan

treatment: rest, application of cold or heat to area, cortisone injections, surgery

37
Q

hip fractures (tomei)

A

worry about avascular necrosis also called osteonecrosis: bone dying on older patient

  • reduced blood flow to joint
  • bone breakdown occurs faster than replacement
38
Q

osteomyelitis (tomei)

A

inflammation of bone usually due to infection. Bone will be very painful, red, worn, swollen, patient may have fever.

39
Q

osteomyelitis

A

bone infection
- occurs after penetrating wound, from blood infection, skin breakdown.
- joint replacement and internal fixation surgeries

-bacteria, fungi, parasites, viruses

  • bone pain, drainage and ulceration, swelling, redness, warmth, tendernous
  • fever with chills, vomiting, lymph node swelling

diagnosis: X ray, bone scan, MRI

treatment, antibiotics, surgery (for extreme ischemia)

40
Q

know type 1 and type 2 diabetes (tomei)

A

type 1: patient has no insulin, they need to be put on insulin. could be juvenille too.

type 2: patient could have insulin, but their body doesn’t recognize it. these patients do not need to be put on insulin to survive, they just need to watch their diet. usually older onset, mid 20s and up.

41
Q

type 1 diabetes

A
  • almost complete lack of insulin secretion
  • insulin deficiency considered total or absolute
42
Q

type 2 diabetes

A
  • relative insulin deficiency
  • insulin secretion too low in relation to blood glucose levels
43
Q

beta and alpha cells in pancreas. who secretes what? what do they do? (tomei)

A

alpha cells: release glucagon when blood sugar too low

beta cels: release insulin when blood sugar too high

44
Q

more on diabetes (tomei)

A
  • family history or overweight, diabetes risk increases.
  • once you have it, it doesn’t go away, patient has to control it.
  • high risk for diabetes: african americans, heavy weight, hispanics
45
Q

know what normal sugar should be, normal A1C levels too (tomei)

A

A1C ≥ 6.5%

Symptoms of diabetes plus casual plasma glucose concentration ≥ 200 mg/dL

Fasting plasma glucose ≥ 126 mg/dL

2 hour plasma glucose ≥ 200 mg/dL during an oral glucose tolerance test

46
Q

goiters (tomei)

A

little growth on thyroid. can be benign or cancerous.

most common cause: iron deficiency

47
Q

goiters

A
  • abnormal growth of thyroid gland
  • nodular or diffuse
  • normal, decreased, or increased thyroid hormone production.
  • nontoxic diffuse goiters: simple goiters; no overt hyperthyroidism or hypothyroidism

causes:
worldwide: iodine deficiency.

United States: multinodular goiter, hashimoto thyroiditis, graves disease.

uncommon causes: tumors, thyroiditis

clinical manifestations (if present):
- associated with type of thyroidal dysfunction and growth rate of goiter.
- risks of long- standing goiters: obstruction; sudden increase in size.

diagnosis: physical examination through palpation, neck assessed for masses or cervical adenopathy, biochemical testing

48
Q

hyperthyroidism (graves disease)

A

happens when the thyroid gland makes too much thyroid hormone

  • hyperthyroidism speeds up the body’s metabolism.
  • this can cause many symptoms such as weight loss, hand tremors, and rapid or irregular heartbeat
49
Q

hypothyroidism (hashimoto thyroiditis)

A
  • a common condition where the thyroid doesn’t create and release enough thyroid hormone into your bloodstream.
  • this makes your metabolism slow down
  • can make you feel tired, gain weight, and unable to tolerate cold temperatures
50
Q

hyperthyroidism (tome)

A

slow, overweight, constipated, eyes buldge out of head.

exophthalmos in a patient with graves disease: this disease causes edema of the far deposits behind the eyes and inflammation of the extraocular muscles. the accumulating pressure forces the eyes outward from their orbits.

^^most commonly caused by thyroid disease

51
Q

cushings disease (tomei)

A

striations on belly, swollen face, red face

52
Q

cushing syndrome

A

results from chronic exposure to excess glucocorticoids

  • develops over period of years, leads to adrenal cortical hyperplasia and excessive production of glucocorticoids

clinical manifestations:
- progressive redistribution of fat (abdomen, face, neck)
- dermatologic: skin atrophy; fragile skin

53
Q

anxiety

A

state of apprehension mixed with fear or worry
- real or perceived threat

somatic responses
- palpitations
- sweating
- rapid breathing
- nausea

tyes:
- generalized anxiety disorder (GAD)
- social anxiety disorder (SAD)
- panic disorder

risk factors: genetic, familial, environmental

comorbidities:
- depression
- panic disorder: respiratory disease, vestibular dysfunction, thyroid problems, cardiac disease

54
Q

anxiety disorders (tomei)

A

panic disorder: recurrent, unexpected episodes of panic. Palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, feelings of unreality, dying or “going crazy”
avoidance of any situation seen as inescapable or there is no help if attacked

specific phobia: unreasonable or excessive, persistent fear of specific objects or situations

social anxiety disorder: fear generated by social or performance situations with exposure to unfamiliar or scrutiny

generalized anxiety disorder: excessive worry; difficult to control
worry generates restlessness, fatigue, difficulty concentrating, irritability, tension, and sleep disturbance.

55
Q

pharmacologic and nonpharmacologic treatment of anxiety

A

pharmacologic:
- SSRIs
- selective norepinephrine reuptake inhibitors (SNRIs)
- benzodiazepines
- combination therapy

nonpharmacologic:
- cognitive- behavioral therapy (CBT)
- exposure therapy
- progressice muscle relaxation

56
Q

carpel tunnel syndrome (tomei)

A

tingling in fingers due to median nerve

57
Q

carpal tunnel an cubital tunnel syndromes

A

nerve entrapment: neuropathy causing nerve damage and muscle weakness or atrophy

body areas most prone: where nerves pass over rigid areas or through narrow canals

etiology and pathogenesis: repetitive use injury; median nerve compressed by inflammation and swelling of synovial lining of tendon sheaths

clinical manifestations: numbness and tingling of thumb, index finger and lateral ventral surface of middle finger, hand weakness

diagnosis: tinsel test, phalen maneuver, nerve conduction studies with ultrasound

treatment: splinting and application of ice or heat, surgery to enlarge tunnel

58
Q

carpal tunnel an cubital tunnel syndromes

A

nerve entrapment: neuropathy causing nerve damage and muscle weakness or atrophy

body areas most prone: where nerves pass over rigid areas or through narrow canals

etiology and pathogenesis: repetitive use injury; median nerve compressed by inflammation and swelling of synovial lining of tendon sheaths

clinical manifestations: numbness and tingling of thumb, index finger and lateral ventral surface of middle finger, hand weakness

diagnosis: tinsel test, phalen maneuver, nerve conduction studies with ultrasound

treatment: splinting and application of ice or heat, surgery to enlarge tunnel

59
Q

positive phalen test (tomei)

A

means patient is positive for carpel tunnel syndrome

60
Q

bursitis (tomei)

A

inflammation of bursa (enclosed fluid-filled sacs). they are cushions between muscles, tendons, and bony prominences.

results from:
- overuse of joint
- direct trauma to joint

clinical manifestations:
- tenderness of area around
- pain with extension and flexion of joint
- warm, red, swollen, skin over bursa

treatment: rest, compression, elevation, ice (acute inflammation)

61
Q

thyroid secretes

A

main hormones it secretes are T3 and T4, but it also secretes calcitonin

c cells in thyroid make and secrete calcitonin

62
Q

diabetic ketoacidosis

A

if a patient is in bad shape as a diabetic, they could start to urinate ketones.

Patho Exam 1 (5 decks)

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